osteopathic musculoskeletal exam for hfap lecture
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HFAP and Osteopathic Musculoskeletal Examination
Francis A. Cortez, DO
Introduction to Osteopathic Medicine for Non-DO Faculty:
What Makes an Osteopathic Education Different?
Educational Council of Osteopathic Principles
Photo courtesy of NSU-COM
A.T. Still, MDRural farmer, hunter, inventor,
local politician
Civil War abolitionist
Personal tragedy 1864
Denounces medical treatment
Becomes a medical reformer
Musculoskeletal System (OPP)
American School of Osteopathy in 1892
Osteopathic Medicine30 Accredited Colleges
41 Teaching Locations in 28 states
23,000 future physicians
20% of US medical students
63,000 licensed DO’s
Feb 26, 2014 AOA and ACGME agree to a single GME system
2015-2020 GME Transition
DO and MD will have access to all GME programs
Healthcare Facilities Accreditation Program (HFAP)Accreditation organization with deeming
authority from CMS (Centers for Medicare and Medicaid)
“Our mission is to advance high quality patient care and safety through objective application of recognized standards.”
Several Standards/Elements
Osteopathic Physicians and OME
HFAP Standard 10.01.23
For Osteopathic Physicians (DO)OME is required for every H&P on admitted
patients unless contraindicatedOsteopathic Musculoskeletal Examination
(OME)
The REASON for omitting OME must be documented when contraindicated
HFAP Standard 10.01.23Verify Medical Staff Rules for Osteopathic
Physician
Will pull last 10 inpatient charts discharged by Osteopathic Physician to determine if OME or exemption of OME is documented.
Osteopathic Methods and Concepts CommitteePulled 10 charts50% (Had some mention of OME)
HFAP Osteopathic Musculoskeletal Exam
Appendix B in HFAP
Document OME by either1. Standardized form (Recommended)
2. Narrative report with includes1. Description of exam performed in 2 positions
2. Based on inspection, palpation, motion testing, of spine and pelvis or Major findings of extremities
3. Mention AP and lateral spinal curves, areas of tenderness, spasm, or limited motion
4. If spine not examined, this should be noted along with reason
HFAP Standardized Form
Grandview OME Form
Epic OME Template
EPIC OME TemplateOpen your note
Position Cursor where you want OME
.khnome
Press ENTER
The text with will appear in your note
Putting OME in your H&PEPIC - Smart phrase manager, double click your
H&P template
Position cursor where you want OME to appear@KHNOME@Click acceptWhenever you use your template OME will be
there
You can add OME to any template, note etc.
Osteopathic Musculoskeletal Exam (compliant)
“Patient examined in supine and sitting position, cervical lordosis, thoracic kyphosis were normal, there was decreased lumbar lordosis however there were no gross abnormalities to spine. Muscle Spasm noted to left lumbar region with palpation. Level 1 somatic dysfunction to left lateral lumbar region”
“On seated inspection patient has normal cervical lordosis, thoracic kyphosis and lumbar lordosis. Palpation to these regions reveal no major somatic dysfunction.”
“Exam not performed due to extreme distress”
Unclear“no somatic dysfunction or background levels”
“no kyphosis, no lordosis, no somatic dysfunction”
“Exam deferred”
Using these HFAP standards
GMH3 of 5 OME2 of 3 missing some element of HFAP OMESo only 1 of 5 were compliant
SOIN2 of 5 OME3 “deferred”
Osteopathic Methods & Concepts Committee
Goal is 100% compliance
Pull all charts in next 30 days to evaluate OME
Will provide feedback to physicians
We have room for improvement
Any questions please email me at
Francis.Cortez@khnetwork.org
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