cvim. ? web viewlunch and learn – spring, 2018 may 2, 2018. as always, cvim welcomes all of our...

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Lunch and Learn Spring, 2018 MAY 2, 2018

As always, CVIM welcomes all of our amazing volunteers we are so grateful for your contributions, time, and heart!!

A. Team News

1. Sarah Poutasse, CRNP, was promoted to VP of Medical Services

2. Marthe Adler, CRNP, joined the staff (formerly a volunteer) as Clinic Coordinator

3. Lori Trevlyn, RN, joined the staff (formerly a volunteer) as Nurse Navigator

Sarah Poutasse Marthe Adler Lori Trevlyn

4. The Harrison Society recently honored Dr. Pete Hillyer for his dedication and service to CVIM for 20 years. Thank you Pete!

B. Hypertension Guidelines

Key HTN Facts

HTN affects approximately 1 billion adults worldwide

Highly prevalent in adult population > 60 yrs

HTN is the leading cause of death and disability

HTN accounted for more CVD deaths than any other modifiable risk factor except for smoking.

1. Recommended Guidelines for Taking Blood Pressure

Step 1: Properly Prepare the Patient

a. Have the patient relax and sit in a chair (with their feet on the floor and the back supported) for at least 5 min

b. The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement

c. Ensure patient has emptied his/her bladder

d. Neither the patient nor the observer should talk during the rest period or during the measurement

e. Remove all clothing covering the location of cuff placement

f. Measurements made while the patient is sitting or lying on an examining table do not fulfil these criteria

Step 2: Use proper technique for BP measurements

g. Support the patients arm (e.g. let it rest on a desk)

h. Position the middle of the cuff on the patients upper arm at the level of the right atrium (midpoint of the sternum)

i. Use the correct cuff size, such that the bladder encircles 80% of the arm, and note if a larger or smaller-than-normal cuff size is used

j. Either the stethoscope diaphragm or bell may be used for auscultatory readings

k. Separate repeated measurements by 1-2 min

l. Take the average of at least 2 measurements on the first visit

m. If a patient has HTN, diabetes mellitus, or a high BP reading in the office, the medical provider must repeat the BP!

n. Automated BP measurements are now considered acceptable

**FIRST APPT take both arms; use the higher score.

Automatic cuffs are gaining favor, and we are getting a second one. Home monitoring is recommended too; we are trying to get a grant to buy some for our patients.

2. Lifestyle Interventions

Our goal is that every patient with HTN is seen or called by Rachel, our nutritionist, to encourage the lifestyle changes that need to be made. Please consult Rachel when you see a patient with HTN.

Please consider CareMessage for all of your hypertensive patients. There are many different CareMessage programs that could help them, such as nutrition, exercise, managing stress, or managing HTN.

Lifestyle Modification in the Management of Hypertension



Approximate systolic BP reduction, range

Weight reduction

Maintain normal body weight (BMI 18.5 to 24.9 kg/m2)

5 to 20 mmHg per 10 kg weight loss

Adopt DASH eating plan

Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat

8 to 14 mmHg

Dietary sodium reduction

Reduce dietary sodium intake to no more than 100 mEq/day (2.4 g sodium or 6 g sodium chloride)

2 to 8 mmHg

Physical activity

Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day, most days of the week

4 to 9 mmHg

Moderation of alcohol consumption

Limit consumption to no more than 2 drinks per day in most men and no more than one drink per day in women and lighter-weight persons

2 to 4 mmHg

3. What Target BP Should be the Goal?

a. JNC8 Overview

**Consider risk vs reward of medicating. Add Beta Blocker if patient has a history of MI or AFib; consider if diabetic.

b. ACC/AHA Recommendations

** 130-139 Medicate if risk is greater than 10% (use app); otherwise diet and lifestyle changes

** Middle aged diabetics should be treated more aggressively

What Target Blood Pressure is Best?

c. These are just guidelines Individualize Each Patient!

a. CVIM recommends that for patients with low CVD risk and no CKD, to follow the JNC8 guidelines

i. Goal BP > e.g., If the provider wants to see the patient in 3 months, write for 90 days >> 30 x 2 refills = two more visits >> 90 day supply = no extra visits!

D. ZOOM News

a. ZOOM- our free rides program for our patients

How it works: Patients sign a contract, then let us know they will need a ride to/from home, work, school - whatever they need

b. How providers are involved: 1. Ask your patients if they have trouble getting to CVIM 2. Write Zoom on their appointment slip > The Front Desk will sign them up; Samantha Artze will then coordinate them3. Watch for the ZOOM Rider notes on your patient files> Their appts need to run as on-time as possible > If you think theyll run late, notify the front desk! Their volunteer drivers are waiting

E. Tobacco Dependence Update

a. Facesheet

Mark Tobacco Exposure on Facesheet, type of tobacco, quantity, & if they are interested in the program. If they are no longer using tobacco, please write the quit date.

Education Please mark under education when you discuss tobacco use with a patient

Referrals/Interested in TD Program If the patient is interested in meeting with a counselor to discuss their tobacco use, please indicate it on the Facesheet, which in turn will generate a report for the Tobacco Dependence department to follow-up with the patient

b. Have the Conversation

Lets talk about your tobacco use vs. You need to quit smoking

Pros & Cons What do you like about using tobacco? What do you dislike about using tobacco?

Folders in Room This is patient education on tobacco use and our Tobacco Dependence program to give to patients.

While the patient is waiting to see the doctor, if they are a current tobacco user, please see if they would be willing to fill out the Touch Base form in the folders and place the completed form (make sure their name and DOB is on it) on the Tobacco Dependence desk.

c. Connect Patient to a TD Counselor while they are HERE!

TD Counselors here Monday, Tuesday, & Thursdays

Dan is here DAILY & speaks Spanish

d. Medications require TD appt (give appt slip)

Medical providers are welcome to begin a TD medication

Make sure the patient is aware that a TD counselor will be following up with them either In-Person or on the Phone. One of the two is required for the patient to continue receiving medications.

Give the patient an appt slip to make a TD appointment at the front desk

F. Behavioral Health

a. Team


1. Miriam Geiger, BH Coordinator & Bilingual Counselor

2. Sam Artze, Bilingual Social Services Coordinator

Volunteer Counselors

1. Barbara Weber, LCSW (Thurs)

2. Joyce Kleiber, LCSW (Mon)

3. Liz Caggiano, LCSW (Tues)

4. Dr. Nancy Reynolds, Psychologist (Tues)

Volunteer Counselors

1. Barbara Weber, LCSW (Thurs)

2. Joyce Kleiber, LCSW (Mon)

3. Liz Caggiano, LCSW (Tues)

4. Dr. Nancy Reynolds, Psychologist (Tues)

Partnering Counseling Agencies ($10-$30/session for CVIM patients)

1. Anxiety & OCD Center

2. WCU Community Mental Health Center

3. Peacemaker Center (Bilingual)

4. Family Service of Chester County

b. Behavioral Health Referrals

Social Services Sam


2. Complete Referral Form (found outside of Sams office)

3. Write Social Services on appointment slip

4. Front Desk may schedule appointment


Counseling & Psychiatry Miriam


2. Complete orange Internal Referral slip

3. Write Counseling or Psychiatry on appointment slip

4. Front Desk places patient on WAITLIST & Miriam follows up


Facesheet Moments




Domestic Violence

Substance Abuse

Suicidal Thoughts

G. Other Facesheet Updates

a. Order of Diagnoses has been rearranged (grouped related diagnoses)

Including CareMessage referrals

H. Volunteer Recruiting

a. Clinical Volunteer Recruiting remains a top priority - we have lost several clinic volunteers who are no longer able to work at CVIM. We have primary care shift shortages as well as needs for specialists in several areas.

b. The website will be updated with the latest needs, and all staff and volunteers are encouraged to spread the word and distribute some volunteer application packets!

Go out and talk to your friends hand out folders!

Volunteer social events at CVIM

Speak at your local hospital groups, rotary, church

Please consider extra shifts and coming in more!

c. Clinical hours were the only h