mercy provider website...• pneumonia • sepsis (inflammation caused by infection) • surgical...
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Education CornerYou can check out all of these educational opportunities and more at p.mercycare.org/calendar
Mercy Clinical Grand Rounds (CGR) – OPEN TO ALL CLINICAL STAFFFirst Tuesday of selected months, unless otherwise noted
4:00 to 5:00 p.m.
Hallagan Education Center
Free to attend; No Registration Required
• Thursday,April3–EarlyIdentificationforAutismSpectrumDisorders: Presented by Caroline Moniza, PsyD, LP
• Thursday,May1–Head&SpineInjury:ManagementfortheNon-SurgicalSpecialist:PresentedbyNoraRoyer,MD
Trauma Multidisciplinary Committee – OPEN TO ALL CLINICAL STAFFQuarterly
7:00 to 8:00 a.m.
Mercy Hallagan Education Center, unless otherwise noted
FREE to attend; No Registration Required
• Wednesday,March26atHall-PerrineCancerCenterCommunity Room
• Wednesday,June25
• Wednesday,September24atHall-PerrineCancerCenterCommunity Room
• Monday,November24
Trauma M & M Conference – PROVIDERS ONLYMonthly
7:00 to 8:00 a.m.
Mercy Hallagan Education Center, unless otherwise noted
• Wednesday,April30atHall-PerrineCancerCenter Community Room
• Wednesday,May28
• Wednesday,July30
• Wednesday,August27
• Wednesday,October29
Free CME for Pain Management – Iowa Board of MedicineAvailablenowthruMay1,2014viabook/online
Free
Toorderacopyof “ResponsibleOpioidPrescribing:AClinician’sGuide,”call(515)242-6039oremail [email protected] and postal address.
March 2014
Thank You for taking the 2014 Provider Engagement Survey
# Providers: 391 # Completed: 220 Response Rate: 56.3%Mercyreacheda56.3percentresponserate,comparedtothenationalaverageresponserateof 40-45percent.Thank you for your cooperation as we work to make Mercy physician-led and professionally-managed.
What will we do with the results of the survey? Muchlikewedidwiththelastsurvey,Mercywillconductfocusgroupsessionswithyou,Mercystaff andleaderstodigdeeperintothesurveyresultstouncovercommonthemes.Youwillplayanessentialroleinhelpingusdevelopour2014ActionPlanwhichwillbecommunicatedthrough MEC, Physician Forums and other face-to-face meetings, as well as published on our NEWMercyProviderPortal–p.mercycare.org.Copiesof theactionplanwillalsoreachyouviaemailandwillbepostedinvariouslocationsthroughoutMercy.
New Provider WebsiteThenewproviderwebsiteisLIVEandeasilyaccessiblebyvisitingp.mercycare.org. The new easy-to-read and clean layout is especially designedtoautomaticallyresizetofitanymobiledevice.Someadditional features of the site include the following:
• MercyMedicalStaff Department&CommitteeAgendas &Minutes
• UrgentAnnouncements
• Calendarof EducationalandSpecialEvents
• ResourceCenterincludingVideoTraining
• ProviderAwards&Recognition
Coming Soon! EpicTips&Tricks,VideoResourceLibrary,ProviderBlog,andsomuch more!!
You’llnoticethattherearestillsomesmallglitcheswiththesitewhereitwillaskyoutologin–thatisbecauseweareinthefinalstagesof integratingaspecialfeaturethatwillallowallproviderstologinusingtheir Mercy username and password.
Have a suggestion on what you’d like to see on the new provider website? SimplycontactAndreaAultat(319)558-6405or [email protected].
Look for the new link to the Mercy Provider Website on your Epic menu bar!
If youhaveanyissueswhatsoever,rememberthatyoucanalwayscontactEpicProviderAssistanceatx4610(or319-369-4610).
Mercy Provider Websitep.mercycare.org
Redesigned and easy to access from any mobile device!
Featuring:✓ Urgent Announcements✓ Meeting Agenda/Minutes✓ CME Opportunities✓ Epic Tips & Tricks
✓ Provider Recognition and Awards
✓ Resource Center✓ & More!
C E D A R R A P I D S
PROVIDERW E B S I T E
Congratulations Bonnie Seely, ARNP (Hospice of Mercy) - Winner of the iPad Mini drawing!
Join us in April for the Physician ForumsPlease join Tim Charles, CEO and Dr. Timothy Quinn, Chief of Clinical Operations to learn about:
• ProviderEngagementSurvey–Resultsand ActionPlans
• CurrentClinicalIntegrationEfforts
• Impactof HCAHPSonProvidersandHospitals–Whatcanyoudotohelp?
Forums will take place at the following times: April23,6:30AM–NeuhausBoardroom
April25,12:00PM–NeuhausBoardroom
April29,5:30PM–NeuhausBoardroom
[email protected] or 319.398.6100.Wehopetoseeyouthere!
Diabetic TeamInformationregardingtheDiabeticEducator(RNordietician)atMercyMedical Center:
Hours:Monday–Friday,8:30am–Noon
Phone:398-6663(afterthesehoursthephoneisforwardedtothediabetescenter)
Reports are run each morning to identify the following:• Patientsoninsulintoensuretheyaregettingglucosemonitoring
• Glucose<60or>250
• A1C>8
• Referralsmadebystaff orphysicians
Patientsareseenaccordingtothesereports/referrals.Withareferral,theeducator will also upload insulin pump information. This process was implemented3/1.
Mercy Medical Center | 701 10th Street SE, Cedar Rapids, IA 52403
www.mercycare.org
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Thanks for attending the Winter Warm-Up @ LavaIf youwereunabletomakeit,here’salittleglimpseof whatyoumissed…Specialthankstothe60+whobravedthearcticairtowarmupatLava.Funwashadbyall!
Mercy among Medicare’s 97 Best Hospitals for Joint Replacement (continued)
Mercy Medical Center has once again been named one of the nation’s100TopHospitals® by TruvenHealthAnalytics,aleadingproviderof informationandsolutionstoimprovethecostandquality of healthcare. Mercy is the
onlyhospitalintheCedarRapidsareatobenamedaTop100Hospitalthis year.
TheTruvenTop100Hospitaldesignationisaprestigiousindustryaward,whichcannotbepurchased.Theawardevaluatesnearly3,000hospitalsandrecognizesthetop100thathaveachievedexcellencein patient outcomes, patient safety, treatment standards, patient satisfaction,efficiencyandfinancialstability.
Toconductthe100TopHospitalsstudy,TruvenHealthusespublicinformation—Medicarecostreports,MedicareProviderAnalysisandReview(MedPAR)data,andcoremeasuresandpatientsatisfactiondatafromtheCentersforMedicare&MedicaidServices(CMS)HospitalComparewebsite–todevelopanindependentandobjectiveassessment.
TheTruvenHealth100TopHospitals® study has been conducted annuallysince1993.
FormoreinformationonMercy’sdesignationasaTop100Hospitalandotherqualityandsafetymeasures,visitwww.mercycare.org/quality.
Mercy named one of the nation’s 100 Top Hospitals by Truven
Doctors’ Day is March 30 – Thanks for all you do!Inhonorof NationalDoctors’Day,MercyMedicalCenterwouldliketoextenditsAppreciationfortheexceptionalworkof themedicalprovidersinourcommunity.Thankyou,physicians,physicianassistantsandnursepractitionersforyourdedicationtoimprovingthehealthof ourpatientsandforyourexpertiseinhelpingmakeCedarRapidsoneof thetopcitiesintheU.S.forqualityhealthcare.YourworkisessentialtoprovidingThe Mercy Touch®.
Join us for a Movie on Mercy! April 12, 2014 | Showtimes beginning at 9:30 a.m.Galaxy 16 Wehrenberg Theatre, 5340 Council St. NE, Cedar RapidsAttentiondoctors,nursepractitioners,andphysicianassistants: Bringyourselvesandfamiliesoutforamorningof moviefun–pop andpopcornincluded!PleaseRSVPbyThursday,April10,2013to Deb Roberts at [email protected](319)861-7890.
Now Playing! • Noah(PG-13)•MuppetsMostWanted(PG)
What you need to know about the 2-Midnight Rule (continued)
What you need to know about the 2-Midnight Rule
There are two initial orders for hospital patients…1.“PlacementTo”Order=Outpatient
2.“InpatientAdmission”Order=Inpatient
What “Patient Class” do I need to select if my patient will be staying LESS than 2 Midnights?
• ForSurgicalPatients:Afteraprocedure,if yourpatientwillbestayinglessthan2Midnights,youwillneedtoselect“BeddedOutpatient”forPatientClassand“ExtendedRecovery”forTransferService.
• ForMedicalPatients:Amedicalpatientstayinglessthan2Midnightswouldbeanoutpatientplacedin“Observation”forPatientClassand“GeneralMedicine”forTransferService.
Mercy among Medicare’s 97 Best Hospitals for Joint Replacement
Pictured here from left to right:WesMachnowski,MD(MercyPediatricClinic);NoraRoyer,MD(MercyGeneralSurgeryClinic);SaraNeff,ARNP(MercyPediatrics)andhusbandTom;MadelynPilcher,DNP(MercyInpatientOrthopaedics)andhusbandRyanRader;KeeliIrwin,ARNP(MercyPediatricClinic);ScottNau,MD(MercyPediatricClinic);DebraPiehl,MD(ObGynAssociates);BethBussewitz,MD(ObGynAssociates);andAlvinaDriscoll,MD(ObGynAssociates).
Pictured here:CharlesGrado,MD(CharlesE.Grado,MD,FACS-Plastic/ReconstructiveSurgery);AlanWhitters,MD(MercyPsychiatryOutpatientClinic);andVinceReid,MD(SurgicalOncology–Hall-PerrineCancerCenter).
Pictured here: Nora Royer, MD (MercyGeneralSurgeryClinic)andSajidaAhad,MD(MercyGeneralSurgeryClinic–April2014).
Pictured here:TodWalker,PA-CandwifeAllison
Pictured here:StephanieHoenig,ARNP(HospitalistPhysiciansof LinnCounty,PLC);HollyCopeland,ARNP(PCIENT);MadelynPilcher,ARNP(MercyOrthopaedicCenter);andSarahSchloss,ARNP(HospitalistPhysiciansof LinnCounty,PLC).
MercyMedicalCenterwasnamedasoneof thenation’s97besthospitalsforjointreplacementsurgery,accordingtoinformationrecentlypublishedbytheCentersforMedicare&Medicaid Services(CMS).
AccordingtoCMS,thelistcontainshospitalswherepatientsareleastlikelytosuffersetbacksandbereadmittedafterjointreplacementsurgery.This report compared hospitals using Medicare data that lookedathowoftenpatientswerereadmittedwithin30daysof dischargeand how often they suffered one of the following eight complications:
2014
• Acutemyocardialinfarction(heartattack)
• Pneumonia
• Sepsis(inflammationcausedbyinfection)
• Surgicalsitebleeding
• Pulmonaryembolism(blockageinthelungs)
• Mechanicalcomplication
• Jointinfectionwithin90daysof surgery
• Deathduringadmissionorwithin30days
Approximately600,000Medicarebeneficiariesundergoahiporkneereplacementeachyear.Accordingtothereport,95percentofU.S.hospitalswereconsidered"average."
MercyMedicalCenterwasalsooneofjust97hospitalsinthenationwithreadmissionratesthatwerelowerthanaverageandtheonlyhospitalinIowawith this important distinction.
CMSpublishedthedataonitsHospitalComparewebsite, www.medicare.gov/hospitalcompare.
Manypatientsseekingjointreplacementsurgerywanttoknowahospital’srecordwhenchoosingwheretohavetheirsurgery.ThisreportreaffirmsconclusionsaboutthehighqualityofcareinjointreplacementsurgeryatMercy Medical Center.
NOTE:If itlaterbecomesclearthatthebeneficiarywillrequire2ormore midnights of hospital care due to a complication or other factor, youcanplacethe“InpatientAdmission”Orderatthattime.
It is very IMPORTANT to document the NEED for the “Inpatient Admission” Order in the patient record.TIP: “Service”indicatesthetypeof hospitalbed,while“PatientClass”indicatesthetypeof InpatientorOutpatientyourpatientis.Theprocess of placing the right initial order and subsequently indicating the correctserviceandpatientclassiskindof likethelottery,wherethereareseveralcombinations!Really,therearethreecomponents,butyouare responsible for “picking the right numbers”:
1.First,youneedtoplacetheInitialOrderforthepatient(“PlacementTo”forOutpatient;and“InpatientAdmission”forInpatient).
2.Second,youneedtochoosetheServiceforthepatient(orthetypeof hospitalbed).
3.Lastly,youneedtochoosethePatientClassforthepatient(typeof inpatientoroutpatientstatus).
Example of the options available for “Patient Class” or type of inpatient or outpatient.
Example of the options available for “Service” or type of hospital bed.
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Preparing for ICD-10OnOctober1,2014,theICD-9codesetsusedtoreportmedicaldiagnosesandinpatientprocedureswillbereplacedbyICD-10codesets.ThetransitiontoICD-10isrequiredforeveryonecoveredbytheHealthInsurancePortabilityAccountabilityAct(HIPAA).
MercyandtheCedarRapidsPHOareofferingaseriesof onlinetrainingviaPrecyse™tohelpyoubecomeeducatedandalertwithregardtothese upcoming changes. Contact Connie Cimaglia at Mercy ([email protected](319)369-4771)orJennyMcIntryreattheCRPHO([email protected])formoredetails.
Looking for an App for that? PrecyseUniversityICD-10DocGuideisahelpfulappwhichisdesignedtohelpyouquicklyretrieveinformation on how to document the most common diseases and conditions.
Doc Guide is available for free on the Apple™ App Store for both the iPhone® and iPad®, Google Play™ (Android Store), and the Amazon® App Store.
New administrative offices for Cedar Rapids Family Medicine Residency
TheCedarRapidsFamilyMedicineResidency,longafixtureatbothMercyMedicalCenterandSt.Luke’sHospital,andsincetheFloodof 2008partlyensconcedatSt.Luke’s,partlyattheSt.Luke’sResourceCenter,hasconsolidateditsadministrativeofficeseffectiveMarch3,2014.YoucanfindCRMEFat1260SecondAvenueSE,CedarRapids,52403(formerPCIurologybuilding),andcancallusat319-297-2300,orfaxusat319-297-2280.
Residents and faculty will continue to see Family Medicine clinic patientsatthenearbyEasternIowaHealthCenter(formerLinnCommunityCare),assistwithOBcareatEIHCandatbothSt.Luke’sandMercy,evenaswealsoprovideinpatientcoverageformanycommunity family physicians and pediatricians. For the medical community,letaloneforthecommunityasawhole,themoveisahappyresolutionof theunwelcomeflood.PleaselookforwardtovisitingCRMEF’snewhomeatanopenhousesometimethisspring.
Epic Thrive After Go-Live SessionsINPATIENT Thrive sessions – replaced by WebEx Beonthelook-outforthereleasedateastowhentheseWebExefficiencysessionswillbemadeavailablethroughthenewproviderwebsite–p.mercycare.org.
AMBULATORY Thrive sessions – 1st Monday of the month and available via WebEx Dr.BradBeerwillcontinuetohostin-personEpicAmbulatoryThrivesessions both in person and online. The in person sessions will be held onthefirstMondayof themonthfrom5:30to7:00p.m.locatedonthe2ndFloorof theHall-PerrineCancerCenter.WebExversionsof thesessionswillalsobemadeavailableviap.mercycare.org.
CMS 2-Midnight Rule – Cosigning the “Admit to Inpatient” Order PRIOR TO DISCHARGEReason for this update: NewCMS2-midnightrule.If anurseputsinan‘AdmittoInpatient’ordertheproviderneedstocosignitpriortothepatient’sdischargeforproperreimbursement.Thesystemwillnowpreventa‘dischargepatient’orderuntiltheAdmissionorderhasbeencosigned.
Changes you will see:1.Apop-upwillfireandpreventthesigningof a‘dischargepatient’
order until the admission order has been cosigned.
2.The‘CosignOrders’sectioninOrdersManagementallowsyoutocosignthisorder,savingtimeof signingviatheInBasket.
Epic Update
Scenario/Example Workflow:• ThepatienthasanAdmittoInpatientorderthatstillneedstobe
cosigned but another doctor is ready to discharge this patient
• Whentryingtosignthe‘DischargePatient’order,apop-upfires,anditdoesnotallowtheprovidertosignthedischargeorderuntilthe co-signature of the admit to inpatient order is completed
• ThatprovidergoestoOrdersManagement,ClickCosignOrders,andclicks‘Sign’nexttotheAdmittoInpatientorder
• Thepatientcannowbedischargedproperly
Pop-up:
Epic Update (continued)
How will ICD-10 affect me as a provider?• ICD-9codes(diagnosisandprocedurecodes)willnolongerbe
acceptedbypayersforpaymentafterOct1,2014
• Improvedclinicalcommunicationwithstandardized,complete,accurate diagnoses and procedures
• Improvedcommunicationequalsimprovedpatientcareandoutcomes
• ICD-10codesarecompleteastheyallowforthefulldiagnosticdescription of the disease process
• Improvedmeasurementof quality,safety,andefficacyof healthcare
Discharge Navigator Update:
Discharge to Home or Self Care Order Aremindertosavethisinyour“Favorites.”Theolddischargeordersethasbeenretiredandisnolongeravailable.
Continued on next page
Mercy Medical Center | 701 10th Street SE, Cedar Rapids, IA 52403
www.mercycare.org
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Formulary Additions:• Hespan–restrictedforORuseonly
Formulary Deletions:• Estradiol(AloraorVivelle–Dot)0.025mg/24hourpatch–Nouse
• Rid(LiceKillingShampoo)–Nouse
• Risidronate(Actonel)5mg–Nouse
• Pirbuterol(MaxairAutohaler)–DiscontinuedbyManufacturer
DefaultfrequencieswerereviewedforZofran,ReglanandBenadryl.Defaultwillbechangedfromevery4hourstoevery6hours.ItwasalsoapprovedtochangeReglanfrom10mgIVto5mgIVonallprotocolsandordersets.
The group discussed that with current equipment an intermittent suction can no longer be performed; only continuous suction is permitted.ItwasapprovedtoaddawarningonallNasogastricTubeordersetsforaGIprophylaxisprompt.
Approved Policies:• PainManagementPolicy
• MedicationReconciliationPolicy
• ControlledSubstance,PatientCareDepartmentTracking
“Comments” link removed – “Admin Inst” link will stay Thegroupdiscussedtheongoingissueofordersbeingmodifiedusingthe“comments”link.Itwasnotedpharmacydoesn’tseethe“comments”linkanddoesnotreceivenotificationwhenanorderismodifiedusing“comments.”Itwas also noted nursing does not always refer to the “comments” link. Due to theincreasednumberofissues,the“comments”linkwasremovedfromEPIC.The“Admin.Inst.:”linkwillremainforadditionalcommentsforthepharmacyor nursing staff. This is pictured below:
Medication Management Committee
What is BERT?BERTstandsforBehavioralEmergencyResponseTeam.ItismuchlikeMercy’sexistingMETteam,butforpsychiatricsituations.
Mercy’sBehavioralServices,alongwithotherkeydepartments,iscurrentlyworkingondevelopingandrollingouttheBERTteamasaperformanceimprovementinitiative.Thiswillbeanextrasupportto staff on medical units who are caring for patients with secondary psychiatricillness,areexhibitingdifficultbehaviorssuchasagitationoraggression,orwhenstaff feelstheycouldbenefitfrompsychiatricassistance on an urgent basis.
What is BERT? (continued)There are two ways in which the BERT team can be activated:
• Oneisbypagingtheteam(3908)whenyouareconcernedaboutapatientsbehaviorandyouneedpsychinterventionsoonerratherthanlater,butitisnotacodegreensituation.WhenBERTispagedyouwillgetacallbackbytheBehavioralchargenursewhowillassessthe situation. Much like what happens when you page the MET team. Ateamof fourstaff,includingtheBehavioralchargenurse,accessnurse,behavioralnursemanager,andasecurityofficer,willrespondandassessthesituationforappropriateintervention.TheBehavioralchargenursewillalsobringajumpbagwhichwillcontainmedstypicallynotcarriedinmedicalunit’saccudose.Oneof thegoalsof theBERTteamistodiffusesituationsandprovidesupportandinterventionsinhopesof decreasingtheneedforcodegreens.
• ThesecondwaytheBERTteamwillbeactivatedisbycallingacode green. You will still continue to call a code green, through the operatorat6111,whenit’sanemergencyandyouneedassistanceimmediately. This is for situations where you need a larger presence immediately. This is the current process and will not change. The goal is that when you call a code green you will get a more structured and standardized response by an appropriate team who are trained in handlingcrisissituations.Aresponsethatisconsistent.Theresponsetocodegreenswillbelarger.BERTteammembersdescribedabovewillrespondinadditiontoapsychiatrictechfromthebehavioralunit,thebehavioralsocialworker,astaff personfromtheEDwhowillhaveasecondjumpbagwiththem.Additionalsecuritystaff andthehousesupervisorwillalsorespondwhichiscurrentprocess.
BERTdoesnotreplacetypicalaccessconsultswhicharecurrentlyordered when either the physician or staff wants an access nurse to do an assessment on a patient. You will still continue to order an access consultforbasic,non-urgentconsultstoassess:apatient’spsychiatriccondition,assesssuicidalideationandneedfor1:1,addressmedsetc.This is the current process and this will not change.
What can staff do to help assist the BERT team?Whentheteamarrives,eitherwhenpagedorasaresponsetoanactualcodegreen, it is helpful to the team if someone who is familiar with the patient stays present. This can be the primary nurse caring for the patient or the chargenurse,anyonewhocanprovideinformationtotheteamresponding.
BERT AlgorithmAccess RN consult
• Basicconsultisordered
• Generalassessmentof moodorbehaviornonemergent
• Assessneedforpsychiatristconsult
• Assessmedications
• Assesssuicidality
• Determineneedfor1:1
• Adviceorguidanceonasituation
• Basicquestions
Page BERT when:• Needpsychiatricassistancequickerthanregularaccessconsult
• Concernedaboutacutechangeinpsychiatriccondition
• Acuteincreaseinbehavior(restlessness,agitation,orconfusion)which requires additional assistance
Call code green:• Needimmediateassistance
• Situationrequiresgreaterpresencethanfourstaff
• Activeaggression
• Imminentdangertopatientorothers