Presentation on theme: "QI Project Team ESTRO-JEN"— Presentation transcript:
1QI Project Team ESTRO-JEN Clinic A&Medication cheat sheetChen, Cowan, Levin, Mostafavi,yang, Ziaee and Quach
2How can Clinic A be improved? More beds, more computers, more attendings, healthier patients. No big dealmore prescription printers, more printers. effectively each room should have a printer, a prescription printer, a resident, 6 assigned patients and every 3 rooms should have an attendingbetter medication organization (when trying to find out what the patient was actually last prescribed), and easier ways of ordering things than yellow forms, etc.The forms are never in the right places. They are always empty. The patients are not showing up ready to be seen at 8am, oftentimes we are waiting for them to clear financial, be vitaled by the nurses, and then 9am rolls around by the time the housestaff start seeing them. We need more staffing. We need more rooms.More rooms--one room per housestaff.Continuity continuity!!!!!! It's an acgme requirement. It improves efficiency bc we already know our patients and how to read our previous notes and it improves provider satisfaction. It's so rewarding to take care of a panel of patients and simply providing continuity will fix a lot of the problems in clinic anot feeling pressured to work through lunch!Less emphasis on how many patients each person saw and more about how much we learned. If we are supposed to see more pts please let us know what to cut out. Should I not use an interpreter (which takes more time)? Not ask a ROS (which inevitably opens a can of worms)? Do a more pointed exam? If we move to a system where we have to account for number of pts seen then I think that should be addressed as well.Don't overbook the clinic!If at all possible, it would be nice to have clearer expectations about how in depth to go. Efficiency always comes at the cost of thoroughness.Survey Says:How can Clinic A be improved?
11Our little contribution… Please list 3 things you would like to discuss at today's appointment: Please list the medications, with name, dose, and how often you take this. Please circle the medications you want:Do you have any allergies to medications?IF you have diabetes, please answer these questions:Fasting blood glucose values:Blood glucose values 2 hours after mealsWhen do you take insulin?What kind of insulin do you takeHow many times a week do you skip your medicinesIn the last month, has your sugar been <90 or >250When was the last time you went to the eye doctorDo you check your feet routinely?If you have high blood pressure, please answer these questions:Home blood pressures (if you have a cuff at home)How much salt do you have in your dietEating Habits:What do your typical meals consist ofCircle thos items which you have regularly:soda, juice, bread, tortillas, fast foodDo you exercise? Yes NoIF yes:How many times a week do you exerciseHow longWhat type of activityOur little contribution…A questionnaire to be given to patients at check-in that will address some of the more common problems we see
12Residents were asked: BRIEF TRIAL PERIOD Did you find the questionnaire helpful for your Clinic A interview?BRIEF TRIAL PERIODQuestionnaire (available in Spanish and English) was tested in Clinic A for ten days recently.Feedback was then requested from 21 residents on Amb rotation during those ten days….Unfortunately only 8 people responded.
13How effective/helpful was the form in stream-lining your Clinic A interview?
15Do you think Clinic A should use the form next year?
16FEEDBACK SUGGESTIONS/CONCERNS Form needs to be shorter and less complicatedIssues with patient completing only limited parts of the form and/or not submitting the form at allIssues with handing out the form – not all patients received the form at time of check-inSome patients did not receive the spanish versionFEEDBACK SUGGESTIONS/CONCERNS
17CLINIC A is a constant work in progress. Thank you Rick and all of our attendings who helped with continuity in Clinic A.BOTTOM LINE…..
18Medication Cheat Sheet For those moments on wards and hospitalist when the 1st, 2nd, and 3rd medications you tried haven’t worked yet….
21As an example… --Constipation-- Colace (stool softener) 100mg PO bid Dulcolax (stimulant) 10mg daily, can be given PO or PRFleet enema (lubricant) 197mL PR daily **caution renal impairment**Metamucil (fiber) 1 packet (3.4gm) PO daily-tidMilk of Magnesia (saline laxative) 30-60mL PO daily **avoid in renal failure**Miralax (osmotic)17gm PO dailySenna (stimulant) 8.6mg tabs, start with 2 tabs PO qhs, max of 8 tabs PO dailyTap water enema, one PR daily prn--Nausea/Vomitting--Ativan 1mg SL q6hr x2 dosesChlorpromazine 10-25mg PO q4-6hrsCompazine 10mg PO q3-4hrsDexamethasone 8mg PO or 12mg IV dailyDramamine (for vertigo/motion sickness) 1-2 tabs PO q4-6hrs, max 8 tabs/24hrsErythromycin (for gastroparesis) 250mg PO tid qac **caution prolonged QTc**Meclizine (for vertigo/motion sickness)25-100mg PO daily divided bid-tidPhenergan mg PO/IM/IV q4-6hrsReglan 10mg PO/IM/IV qac and qhs **renally adjust**Zofran 4-8mg PO/IV q4-12hrs **caution hepatic impairment and prolonged QTc**