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November 2017

Code Blue Vests Starting December 1, 2017, vests will be provided for the leader to wear during a code at Iowa Methodist Medical Center (IMMC), Iowa Lutheran Hospital (ILH) and Methodist West Hospital (MWH). The vests are located on all crash carts in the Emergency Department and Critical Care areas and will be brought to all codes/MET calls outside of these areas by the MET RN. This decision was made after seeing an increase in incidence reports in which individuals did not know who was the leader of the code. If you have any questions please contact a Chair of the Code Blue Committee, Jillana Valbracht at 241-6065.

Pathology Lab Update: Thyroid Antibodies Thyroid Antibodies - Which one to order?

Antibodies targeting thyroid antigens can be detected in a variety of thyroid diseases. Since multiple assays are available, there can be confusion regarding which is the best one for your patient. Below is a brief summary of each assay along with how these tests can be found in Epic.

Thyroid Peroxidase (TPO) Antibody [Epic: Anti-Microsomal Antibody (aka Thyroid Peroxidase AB)] These antibodies are the most sensitive test for autoimmune thyroiditis (found in 90% of Hashimoto thyroiditis). These antibodies are also seen in 60-80% of patients with Graves’ disease (see TSH Receptor Antibody below). TPO antibodies may also be helpful in identifying patients with subclinical hypothyroidism that are at a higher risk of developing overt hypothyroidism.

Thyroglobulin Antibody [Epic: Anti-Thyroglobulin Antibody] These antibodies are less sensitive than TPO antibodies for detection of autoimmune thyroid disease (30-50% in Hashimoto thyroiditis, 15-25% in Graves’ disease). This test is also useful in identifying antibodies which interference with use of thyroglobulin as a tumor marker in patients with thyroid cancer.

Thyroid Antibody Panel [Epic: Thyroid Antibody Panel]

2 Includes both Thyroid Peroxidase (TPO) Antibody & Thyroglobulin Antibody.

TSH Receptor Antibody [Epic: TSH Receptor AB] First-line test for diagnosis of Graves’ disease. This test identifies antibodies which bind to the TSH receptor. Although, it does not distinguish between antibodies which stimulate the TSH receptor and those that block it, this assay shows excellent performance (>95% sensitivity and specificity) when combined with clinical findings and supporting thyroid studies.

Thyroid Stimulating Immunoglobulin [Epic: Thyroid Stimulating Immunoglobulin (TSI)] Second-line test for diagnosis of Graves’ disease. This is a functional assay which identifies antibodies which simulate the TSH receptor in cultured cells. This assay is not required for the diagnosis of Graves’ disease in most cases (see TSH Receptor Antibody above). Additionally, because of the methodology used, this test has a longer analytic time than the TSH Receptor Antibody assay (2-4 days versus 1 day).

Submitted by: Jacob Sramek MD, Pathology Department Jacob.Sramek@UnityPoint.org

Antibiotic Week Awareness – November 13-19, 2017

Did you know? While rates of antibiotic resistance are rising worldwide, here in Iowa and at UnityPoint Health, our local rates of resistance remain very low. Let’s compare how well we are doing compared to the rest of the country:

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• In fact, in Iowa, only 0.5% of Enterobacteriacea isolates (i.e. E. coli, Klebsiella, Citrobacter, among others) are resistant to carbapenems.

• The only way to prevent the rise of carbapenem-resistant Enterobacteriaceae is by limiting use of carbapenems.

• At UnityPoint Health, cefepime and piperacillin-tazobactam remain excellent choices for when you absolutely need to aim for broad spectrum coverage.

• The threat of multi-drug resistance is close. CDC estimates that in the United States, more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result of these infections. But we can still avoid reaching this situation!

• Limiting use of antibiotics in general also protects patients’ native gut microbiota. Commensal microbiota is affected by short courses of antibiotics and takes at least 2 years to restore, increasing the risk for colonization with multi-drug resistant organisms and C. difficile diarrhea.

• At least 250,000 cases of Clostridium difficile infections per year are reported in the US and 14,000 deaths related to this.

Also CRUCIAL to optimal antibiotic use:

• Asymptomatic bacteriuria is not a disease. • An abnormal urinalysis and urine culture in the absence of symptoms is NOT UTI and DOES NOT

REQUIRE TREATMENT (except in pregnant women and patients undergoing urologic procedures). • Cloudy or foul-smelling urine DOES NOT MEAN UTI.

Article submitted by: Drs. Leyla Best and Rossana Rosa-Espinosa

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Ankeny Medical Park Outpatient Pharmacy NOW OPEN! UnityPoint Health – Des Moines Ankeny Medical Park Pharmacy is a non-profit, full-service retail pharmacy owned by UnityPoint Health – Des Moines. In addition to the pharmacy, the Ankeny Medical Park facility also includes Family Medicine, Urgent Care, Pathology/Laboratory, Outpatient Surgery Center, Physical Therapy, Iowa Radiology and Iowa Digestive Disease Center. This convenient setting allows patients a one stop shop for their health care needs.

The pharmacy is open to the public and can accept prescriptions from UnityPoint Health and non-UnityPoint Health providers. As a preferred pharmacy with most major insurance companies, co-pays are usually the same, and often less, than other retail pharmacies.

Services Offered

• Medication reviews available to help identify adverse effects, adherence issues and cost-saving opportunities.

• MedSync Program assists patients with medication refills and coordinates one pickup time per month whenever possible.

• Immunizations available. No appointment necessary. o Influenza (ages 6 and over) o Zostavax o Tdap o Pneumococcal: Prevnar 13 and Pneumovax 23

• RX Drop Off Box: Free disposal of expired or unused prescriptions, including controlled substances, and OTC medications.

• Discount card available for patients without insurance as well as manufacturer coupons to help with expensive, brand name medications.

• Free medication flavoring upon request. • Many OTC medications stocked and special request ordering available.

Benefits

• The pharmacy uses Epic and MyUnityPoint to promote continuity of care with other UnityPoint Health providers.

• Supports the UnityPoint Health performance strategy to serve more patients and keep care within our organization rather than sending the business to external pharmacies.

Employees enrolled in the UnityPoint Health network insurance plan are eligible for discounted copay with a 90 day supply.

5 Contact Information

• Epic: search CIA N ANKENY OUTPATIENT PHARMACY to select Ankeny Medical Park Pharmacy as a patient’s preferred pharmacy

• Phone: 515-965-4680 • Fax: 515-446-2691 • Address: 3625 N. Ankeny Blvd, Ste. A; Ankeny,

IA 50023 • Hours: 7:30 AM – 8:00 PM Monday through

Friday • Pharmacy Manager: Natasha Ripley, PharmD

(natasha.ripley@unitypoint.org)

Help foster unity by spreading the word by asking your patients who live in the area, “Would you like your prescription sent to our UnityPoint Pharmacy in Ankeny?”

Please contact the pharmacy with any questions – they are here to help as part of our health care team!

UnityPoint Health – Des Moines Excellence in Patient Experience Awards The new UnityPoint Health – Des Moines’ Excellence in Patient Experience Awards debuted in January 2017 as a way to recognize teams for their continued focus on the patient experience and outstanding achievement. The quarterly awards for Quarter 3 were just revealed with recognition of Most Improved (from Q2 2017 to Q3 2017) and Award of Excellence (highest performance) in Q3 2017.

Q3 2017 Excellence in Patient Experience Award Winners:

CAHPS Award of Excellence: UnityPoint Health – Des Moines’ Perinatal Center (100.0% top-box score)

CAHPS Most Improved: Blank Children’s Pediatric Clinic: Gastroenterology (+20.6%age points in top-box score)

Press Ganey Award of Excellence: UnityPoint Health – Des Moines’ Merle Hay Physical Therapy Clinic (97th percentile)

Press Ganey Most Improved: Iowa Lutheran Hospital – Outpatient Laboratory (+72 percentile points)

A big THANK YOU to all of the providers that practice in these areas for providing an EXCELLENT patient experience! Below are the criteria for the UPHDM Excellence in Patient Experience Awards.

CAHPS: awarded to an individual inpatient unit, Ambulatory Surgery department or BCPC Clinic (excluding Psych) based on Rate Hospital 0-10, Rate Facility 0-10 or Rate Provider 0-10 Top-Box Score

1. Award of Excellence – based on highest top box score for HCAHPS “Rate Hospital 0-10”, OAS-CAHPS “Rate Facility 0-10” or CG-CAHPS “Rate Provider 0-10”.

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2. Most Improved – based on most improved top box score for HCAHPS “Rate Hospital 0-10”, OAS-CAHPS “Rate

Facility 0-10” or CG-CAHPS “Rate Provider 0-10”.

Press Ganey: awarded to an individual campus-specific department based on percentile rank (includes Emergency Department, Outpatient Behavioral Health, Inpatient Behavioral Health, Outpatient Services, Blank Children’s Inpatient, Blank Children’s Outpatient Psych, Radiation Oncology, Transitional Care Unit & Rehabilitation)

3. Award of Excellence – based on highest Press Ganey percentile rank for “Standard Overall”.

4. Most Improved Score – based on most improved Press Ganey percentile rank for “Standard Overall”.

Excellence in Patient Experience Awards – Award Criteria

• Awards will be given out on a quarterly basis (January, April, July and October) as well as the annual awards (January). The quarterly awards will be based solely on quarterly performance, not YTD performance.

• In order to be eligible to win an award, the unit or department must have at least 30 returned surveys (n) during the allotted time period.

• The awards will be a poster signed by the UPH-DM Board of Trustees that can be hung in each unit/department. The posters will be modeled after the clinical award posters that are currently in circulation.

• The award will not travel and can be displayed in each area indefinitely. • The same unit/department cannot win the Award of Excellence (highest score/percentile rank) for more than one

quarter each year. However, the unit/department could win the Award of Excellence for a quarterly award and the annual award if it has the highest score/percentile rank for the entire year as well.

• If a unit or department has both the highest score and the most improved for the quarter or year, they are eligible to win both awards.

• Once award winners are chosen, Paige Moore, Director of Patient Experience, will reach out to unit/department leader for patient experience stories in order to encompass the entire care team (inclusion of EVS, Food & Nutrition, ancillary services, nursing, providers, etc.).

Attention Medical Staff: Amino Acid Supply Notice Due to the impact of Hurricane Maria on Puerto Rico, we are unable to obtain our normal volume of amino acids for our total parenteral nutrition (TPN) compounding. Baxter, the company that manufactures our amino acids (Clinisol) is allocating 25% of our normal supply. Baxter is not providing an exact recovery date, although initial projections are for 3-6 months which has prompted immediate conservation plans.

For this reason, we are asking our entire team to be extra judicious of our TPN utilization and prescribing.

Providers can play a key role in our conservation efforts in several ways;

• Adhering to the ASPEN guidelines for appropriate TPN prescribing (see attached ASPEN article).

• Utilizing enteral feedings whenever possible.

• Discontinuation of TPN when the patient is consuming 60% of their caloric needs.

• Early communication with pharmacy regarding plans for continuation or discontinuation of TPNs.

7 The dieticians are also aware of the shortage and will be collaborating with our team to help minimize the impact of this shortage.

This does not impact our TPNS for neonates and infants <12 months of age, which are made with a different amino acid product.

Please contact Laura Elliott at 515.241.8152 if you have any further questions. We will keep you updated as we learn more from Baxter regarding ongoing supply.

Physical Therapy Month UnityPoint Health - Des Moines provides therapy services from newborn through the geriatric population. Physical therapist focus is recovery of function throughout the stages of rehabilitation.

Where can I find a physical therapist at Unity Point Health - Des Moines?

PT Service(s): Location: Address:

Acute Care Therapy

Iowa Methodist Medical Center (IMMC) Inpatient (IP) Younker 3, 1200 Pleasant St, Des Moines

Iowa Lutheran Hospital (ILH) IP 3 Mid, 700 E University Ave, Des Moines Methodist West Hospital (MWH) IP 4th Floor, 1660 60th St, West Des Moines

Inpatient Rehabilitation Younker Rehabilitation Younker 4, 1200 Pleasant St, Des Moines

Skilled Services Transitional Care (TC) 4 East, 700 E University Ave, Des Moines

Outpatient Therapy Clinics

Methodist Younker 3, 1200 Pleasant St, Des Moines Penn 1301 Penn Ave, Suite 308, Des Moines West 2850 Westown Parkway, West Des Moines

Trail Point - DMACC Campus 2006 S Ankeny Blvd, Building 5, Ankeny Ankeny Medical Park 3625 N Ankeny Blvd, Suite C, Ankeny

Waukee 50 E Hickman Rd, Waukee Merle Hay 4020 Merle Hay Rd, Des Moines Southglen 7481 HWY 65/69, Des Moines Altoona 2720 8th Street SW, Suite B, Altoona

Urbandale 2901 86th St, Urbandale

Pediatric Therapy (Inpatient and

Outpatient)

Blank Children’s Hospital Blank 1, 1200 Pleasant St, Des Moines Altoona OP 2720 8th Street SW, Suite B Altoona Ankeny OP 2701 Convenience Blvd, Suite 8, Ankeny

West Des Moines OP 6800 Lake Drive, Suite 140, West Des Moines Home Care Urbandale 11333 Aurora Ave, Urbandale

Lymphedema Clinic John Stoddard Cancer Center 1200 Pleasant St, Des Moines

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EPIC UPDATES: Sensitive Notes Access – See TipSheet for affected clinician types

Non-Behavioral Health clinicians will now be able to view sensitive notes completed within a Behavioral Health encounter without a signed consent from the patient. This change is reflective of Iowa, Illinois and Wisconsin state laws. Clinicians will be able to access the sensitive note in Chart Review associated with an encounter that occurred in a Behavioral Health setting. They will also be able to access a sensitive note directly from the Notes tab of Chart Review.

For a list of affected clinician types and additional information,

Haiku/Canto Access

If Haiku or Canto is uninstalled and reinstalled on an existing device, or if a new device has had Haiku or Canto installed, the user MUST request access again through the Haiku/Canto access website found here.

As a reminder, to locate the device identifier required to request (or re-request) access, please see below.

Apple Devices

Android Devices

Leave of Absence (LOA)

A new functionality will go live 10/17 called Leave of Absence. This new seamless workflow can be used when a patient leaves their current admitted encounter to be bedded at another encounter and then returns to the original encounter. An advantage of this workflow is that it allows for Orders and documentation to be easily reviewed between encounters.

Change to Viewing Scanned Documents

On September 25th, a change was made in Epic that had an unplanned impact on viewing scanned documents. This change caused documents that were scanned in a clinic setting to default to “Fit to Height” instead of “Fit to Width” as they did previously. At this time, there is no resolution or workaround. Please let those who view scanned documents know of this change.

9 Patient Lookup

Remember: More information is better when completing a patient search using Patient Lookup in Epic. Using the first three of the last name and the first three the first name (3, 3) or the first four of the last name, and the first four of the first name (4, 4) method will not provide the best search results possible. The preferred patient search and the one that will provide the best results include the following 4 search elements:

• Patient Full Name: Full Last Name, Full First Name (all in one field) • Sex: Male vs Female • Birthdate: MM/DD/YYYY • When searching by Name – Use of the “Sounds-Like” button may return better results

For the complete guide for Patient Search, Creation and Updates.

Speech Recognition Support and Hotkeys to Apply NoteWriter Macros – Physicians and Advance Practitioners

Providers now have the option to use Hot Keys with up to 9 of their Macros per each SmartBlock. The Macros in NoteWriter will display with a number in front of them. Providers can press Alt + the Macro number to apply the Macro to the SmartBlock. If they would like to reorder the Macros, that can be done in the Macro Manager.

Examples:

To apply Jessica’s Macro below, press Alt + 1. To apply Female 13+ Normal, press Alt + 2.

Providers that use speech recognition can also use a voice command to apply these Macros in their SmartBlocks. Providers will need to create a step-by-step command with the following steps:

1. Press Ctrl + Shift + Insert 2. Enter the name of the Macro 3. Press Alt + Insert

Violent Restraint Options

Per enhancement request, additional options have been added to the violent restraints order. Prior to the change, unlocked options did not differentiate between twice-as-tough and less restrictive soft restraints.

With the change, there will be additional less restrictive options available within the order for: R wrist soft, L wrist soft, R bicep soft, L bicep soft, R ankle soft, L ankle soft.

Des Moines does not use any type of locked restraints. Click on the magnifying glass by Restraint Type to find all the options.

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Updates: UnityPoint Clinic OB/GYN - Penn Avenue to Close

UnityPoint Clinic OB/GYN - Penn Avenue will be closing effective March 2, 2018. Iowa Lutheran Hospital will continue to deliver babies with East Des Moines Family Medicine Residency handling normal vaginal deliveries with the assistance of a local OB/GYN group as back-up. We appreciate the referrals that you have sent over the years. Any questions/concerns can be directed to Anne Riemenschneider at 471-9775.

Bike Rack

We have many physicians who bike to work and recently responded to a request for a bike rack to be placed in the IMMC Parking Ramp. The bike parking is located next to the North A Elevator in the parking ramp. Please use the rack provided when securing your bike in the parking ramp.

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CME Opportunities:

HAWAII43

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To submit articles, please send to Monica Aunan, Physician Liaison at

monica.aunan@unitypoint.org or call 515-241-3480

1 UnityPoint Health - Des Moines Region ACO Members

Abrahamson, Tim, MD (Dermatology)

Allergy and Asthma Associates, PC

Associated Ophthalmologists

Associates in Kidney Care

Blank Health Providers-UPHDM

Boone County Comprehensive Specialty Care

Boone County Family Medicine

Boone County Hospital

Broadlawns Medical Center

Bussey Family Health Center

Cass County Hospital

Central States Medicine (Iowa Pain Clinic)

Clarke County Hospital

Dermatology, PC

Des Moines Anesthesiologists

Des Moines Eye Surgeons

Des Moines Internal Medicine

Des Moines Orthopaedic Surgeons, PC

Des Moines Pastoral Counseling Center

Des Moines Pediatric & Adolescent Clinic

Des Moines University Medical Clinic

Eyerly Ball

Ganske, John Gregory (Greg) MD

Greater Regional Medical Center

Greene County Medical Center

Guthrie County Hospital

Huxley Physical Therapy

Iowa Arthritis & Osteoporosis Center

Iowa Diabetes and Endocrinology Center

Iowa Digestive Disease Center PC

Iowa Endoscopy Center

Iowa Ear Center

Iowa ENT, INC

Iowa Head & Neck, PC

Iowa Kidney Physicians, PC

Iowa Pathology Associates, PC

Iowa Radiology, PC

Iowa Retina Consultants, Inc.

Iowa Surgery Center, PC (Dr. Praveen Prasad)

Koch Facial Surgery

Lakeview Surgery Center

Lifeworks

Lucas County Health Center

Madrid Family Practice- Boone County Hospital

McClairen, Willie C., Jr MD (Surgery) Gen Surg Physician, PC

McFarland Clinic, P.C.

McFarland Clinic - Jefferson

Medical Oncology & Hematology Assoc (MOHA)

Metro Anesthesia and Pain Management

Mid-Iowa Fertility, PC

Midwest Oral and Facial Surgery, PC

New Sharon Medical Clinic

Newton Clinic, PC

2 Orchard Place

Orthopaedic Outpatient Surgery Center (OOSC)

Pediatric and Adult Allergy, PC

Pediatric Cardiology, PC

Pella Medical Clinic

Pella Regional Health Center

Physicians' Eye Clinic

Porto, Dennis P MD (ENT)

River Valley Therapy Clinic, LLC

Story County Medical Center

Surgery Center of Des Moines East and West

The Iowa Clinic

The Iowa Clinic Endoscopy Center

The Iowa Clinic West Lakes

The Iowa Clinic West Lakes-Cardiology

The Iowa Clinic - Family Medicine

The Iowa Clinic - Internal Medicine

UnityPoint Health - Des Moines

West Des Moines Children's Clinic

Wolfe Eye Clinic, PC

Wolfe Surgery Center

Women's Care Clinic, PC

West Lakes Sleep Center

**Skilled Nursing Facilities**

The Bridges at Ankeny

Calvin Community

Edgewater

Fountain West

Hearthstone

Kennybrook Village

Mill Pond

North Ridge Village - Ames

Norwalk Nursing and Rehab Center

On with Life, Inc.

Parkridge Specialty Care

Prairie Vista Village

Spurgeon Manor

Sunnyview Care Center

Urbandale Health Center

Valley View Village

Wesley Retirement Services-UnityPoint Health Des Moines

List updated 5/30/2017