THE MEDICAL STAFF

MONTHLYJUNE 2015

Medical Sta� O�ce865-305-9765

John W. Lacey, III, MDSr. Vice President and Chief Medical O�cer

Active Sta�: 483Associate: 51Courtesy: 74Contract: 11

Allied Health: 234Total Sta�: 853

Medical Sta� Communication Purpose:The information contained in this �le and any attached documents are intended only for The University of Tennessee Medical Center Medical Sta� Members in order to alleviate multiple threads of email content and distribu-tion.

It is considered a con�dential internal communication designated for The University of Tennessee Medical Center and Medical Sta�. Any unauthorized distribution or copying of this document(s) is strictly prohibited. Should you have any questions, please contact the Medical Sta� O�ce at 865.305.8872.

James E. Shamiyeh, MDChief of Sta�

Design & Editing by Donna Mowery

Medical Executive Committee (May2015)Presentations & Reports – Mr. David Hall presented a Quarterly Customer Service Update and a Financial Report. Dr. Thomas Gaines presented CALS Protocol and Dr. Inga Himelright shared the CQO Report.

Committee Approvals – Credentials Committee recommendations were o�ered by Dr. Amy Barger-Stevens. Dr. LaPinska presented Performance Improvement; Dr. Ludwig o�ered the P&T Committee items and Dr. LaCharité presented the POSC items; Dr. Keel addressed the Physician Advisory Committee and the CIS Downtime Policy.

Links to the Medical Sta� O�ce Websites:The username and password “utmc” is required to access the internal and the external sites. You can access the MSO website on Insite by going to Quick Links at the top and to “Medical Sta� O�ce and Provider Privileges.”

For Internal Access (INSITE), CLICK HEREFor External Access, CLICK HERE

Core MeasuresHeart Failure Reminders

• Using the Heart Failure pathway will aid in compliance with Core Measures, while also ensuring comprehensive management from admission to discharge. • Use caution with documentation of “volume overload” or “�uid overload” as clari�cation will be needed, for example: non-cardiogenic.

When documenting heart failure, please specify “acute or chronic” or “exacerbation” as it is di�cult to discern when not speci�ed.

Common Heart Failure Documentation:If EF < 39% --ACE/ARB --Evidence-Based BB --Spironolactone or Eplerenone --If pt African American, Hydralazine/Isosorbide Dinitrate Combo

If EF < 35% Consider ICD or contraindication

**ALL OF THE ABOVE (INCLUDING EXCLUSIONS) CAN BE FOUND IN YOUR “2015 QUALITY/CORE MEASURES” POCKET GUIDE

Important for You to Know

• Your “2015 Quality/Core Measures” pocket guide found on Insite is an excellent resource for evidence-based practices and proper documentation for compliance with Core Measures. https://insite.utmck.edu/�les/14128/hp0513026_core-pktcard_02.pdf• Clear & Concise Documentation = Decreased Pages/Calls For Clari�cation. • Clinical Quality Nurses (also known as Core Measure Nurses) are part of the healthcare team and are a resource for you.Contact InformationCLINICAL QUALITY NURSES: Pager 1074 or Phone 5780/5775ACCREDITATION MANAGER: 305-3333 June 1 Credentials Committee, Dr. A. Stevens

June 8 DPOC, J. CecilJune 12 Medical Executive Committee, Dr. J. ShamiyehAugust 18 Quarterly Medical Sta� Meeting, Dr. J. Shamiyeh

Medical Monthly Events

THE MEDICAL STAFF

MONTHLY

What’s NewDynamic Documentation (DynDoc) with Dragon went live May 13, 2015! Response has been very positive. Providers are encouraged to schedule an appointment for customizing their content by calling HELP (x4357). Appointments are available M-F 8am – 4pm. Need other assistance? Call HELP (x4357)

o Message Center has saved notes folder – saved notes are now posted to the Working Items section of message center. Providers may resume their note directly from this folder.

Provider Resources updated with Dynamic Documentation. A link was added to the additional resources page via CPOE shortcut and Provider Resources button thru PowerChart. This will be your one-stop for quick references and “how tos”.The User Guide is a VERY helpful tool for many of your “how to” questions.

Downtime Procedures were updated and reformatted. The Clinical Information System (CIS) Downtime Procedure now features among other updates a new Medical Sta� section.

o What to Know During a downtime/service interruption event, providers will essentially revert to previous methods of documentation such as handwritten notes and/or dictated notes. Any handwritten notes will be scanned into the electronic record when services are restored. The Medical Sta� section of the Downtime policy can be found on pgs. 23-24 of the policy.

PathwaysLive in January:o PRISMS Stroke Study Drug/Placebo for Acute Ischemic Stroke o Post PRISMS Stroke Study Orders o Protocol: Prophylactic Heparin Monitoring

Live in February:o Patient Controlled Analgesia (PCA) Morphine Adjunct Pathwayo Patient Controlled Analgesia (PCA) Hydromorphone Adjunct Pathwayo Patient Controlled Analgesia (PCA) Fentanyl Adjunct Pathwayo SOCRATES Study Orders

One Chart / CPOE

Live in March:o Anesthesia Acute Pain Service Perineural Catheter Adjunct Pathwayo Post Cesarean section Epidural/Spinal Opioid Adjunct Pathwayo Adult Epidural Opioid Adjunct Pathway

Live in April:o New Initiation of Hemodialysis-Nephrology Adjunct Pathwayo Hemodialysis First Session-Nephrologist Only Adjunct Pathwayo Hemodialysis Prescription-Nephrology Only Adjunct Pathway o Plasmapheresis/Apheresis First Session Adjunct Pathwayo Plasmapheresis/Apheresis Prescription Adjunct Pathway o Plasmapheresis/Apheresis DIALYSIS NURSE ONLY Adjunct Pathway o Leukopheresis/White Blood Cell Depletion First Session Adjunct Pathwayo Leukopheresis/White Blood Cell Depletion Prescription Adjunct Pathwayo Continuous Renal Replacement Therapy (CRRT) First Session Adjunct Pathway o Continuous Renal Replacement Therapy (CRRT) Daily Prescription Adjunct Pathway o ED Provider Hyperkalemia Adjunct Pathway o Hyperkalemia Adjunct Pathway

Approved and live May 26:o t-PA (Alteplase) and Dnase (Dornase Alfa) for Chest Tube Adjunct Pathway

Approved and Will go live on July 28:o Ethanol Withdrawal Prophylaxis/Treatment

Always---SIGN / DATE / TIME ALL entries in the medical record