Orientation for the Orientation for the Nix Senior Health Care CenterNix Senior Health Care Center

Welcome to the Welcome to the Community Geriatrics Community Geriatrics

RotationRotation

OverviewOverview MS 3MS 3 students have 2 weeks in the geriatric clinic students have 2 weeks in the geriatric clinic

during your family medicine rotation.during your family medicine rotation. Family Medicine and Gyn Family Medicine and Gyn ResidentsResidents will have 4 will have 4

week rotations. week rotations. We have 5 clinical geriatricians, geriatric nurse We have 5 clinical geriatricians, geriatric nurse

practitioners and geriatrics fellows who will practitioners and geriatrics fellows who will supervise your clinical experience.supervise your clinical experience.

Feel free to ask faculty or staff any questions Feel free to ask faculty or staff any questions regarding clinic operations, grading or any other regarding clinic operations, grading or any other issues of concern.issues of concern.

A A PARKINGPARKING Map is at the end of this presentation Map is at the end of this presentation

Geriatrics FacultyGeriatrics Faculty

M. Rosina Finley, MDRobert Parker, MD David Espino, MD

Kathleen Owings, MD Liliana Oakes, MD

Fellows & Nurse PractitionersFellows & Nurse Practitioners

Geriatrics FellowsGeriatrics Fellows Drs. Adeeba Akhtar, Kathy Owings, Drs. Adeeba Akhtar, Kathy Owings,

Jeanette Ross, Cynthia StoneJeanette Ross, Cynthia Stone Nurse PractitionersNurse Practitioners

Tukumbor Efeovbokhan, Colleen Keller Tukumbor Efeovbokhan, Colleen Keller (at Pavilion)(at Pavilion)

Ms. Rebecca Carreon at the Ms. Rebecca Carreon at the Wednesday PM Clinic at the BradyWednesday PM Clinic at the Brady

Clinic Clinical StaffClinic Clinical Staff

Gloria Valdez RN, Head Nurse

Medical AssistantsMedical Assistants Tina CanoTina Cano Syria RoseSyria Rose

ReceptionistReceptionist Julia PiedraJulia Piedra

Medical RecordsMedical Records Mary Helen PeMary Helen Peñaña

Chris Ramirez, Clinic Administrator

LocationLocation Nix Senior Health Care Nix Senior Health Care

CenterCenter Monday-Thursday, except Monday-Thursday, except

1, 3, 4 Wednesday 1, 3, 4 Wednesday afternoonsafternoons

Nix Hospital 414 Navarro, Nix Hospital 414 Navarro, Suite 1111Suite 1111

PARKPARK in the Nix Valet in the Nix Valet Wednesday AfternoonsWednesday Afternoons

1, 3, 4 Wednesdays at 1, 3, 4 Wednesdays at South ModuleSouth Module

3rd Floor Building C, 3rd Floor Building C, University Health Center-University Health Center-DowntownDowntown

Educational GoalsEducational Goals

Learn the common geriatric syndromesLearn the common geriatric syndromes Learn the geriatric assessment toolsLearn the geriatric assessment tools Evaluate at least one geriatric patient per Evaluate at least one geriatric patient per

session.session. Learn use of summary face sheet for care of Learn use of summary face sheet for care of

elderselders Learn use of electronic medical record in the Learn use of electronic medical record in the

care of elder patientscare of elder patients

Medical Student Evaluation Medical Student Evaluation AreasAreas

Presentation SkillsPresentation Skills Knowledge Base Knowledge Base Problem List CompletenessProblem List Completeness Team Work as reflected by volunteering Team Work as reflected by volunteering

for extra patient work, completion of for extra patient work, completion of prescriptions, etc.prescriptions, etc.

Assessment ToolsAssessment Toolshttp://geriatrics.uthscsa.eduhttp://geriatrics.uthscsa.edu

Review Tutorials and Review Tutorials and Be Be FamiliarFamiliar With The With The InstrumentsInstruments

Mini Mental Status ExamMini Mental Status Exam Activities of Daily LivingActivities of Daily Living Instrumental Activities of Instrumental Activities of

Daily LivingDaily Living Tinetti Gait and Balance Tinetti Gait and Balance

ScaleScale Geriatric Depression Scale Geriatric Depression Scale

(GDS)(GDS) CLOX evaluationCLOX evaluation

Assessment tools are located under Assessment tools are located under TOOLBOXTOOLBOX at at

http://geriatrics.uthscsa.eduhttp://geriatrics.uthscsa.edu..

The White BoardThe White Board

The nurse will put the The nurse will put the patients name on the patients name on the white board after white board after vitals are taken.vitals are taken.

Begin to see patient Begin to see patient as soon as they are as soon as they are on the board and on the board and place your initialsplace your initials by by the patient’s name.the patient’s name.

Seeing your Geriatric PatientSeeing your Geriatric Patient

Review the patient’s chartReview the patient’s chart Take your patients history Take your patients history

and do a physical exam.and do a physical exam. If you need a translator, If you need a translator,

ask the nurses for to ask the nurses for to help.help.

If you need to do a genital If you need to do a genital or breast exam, wait until or breast exam, wait until this can be done with this can be done with your attending.your attending.

Geriatric Patients Geriatric Patients cont’cont’

Present your patient to your attending, including Present your patient to your attending, including your assessment and plan. your assessment and plan.

See your patient with your attending.See your patient with your attending. Next complete the following Next complete the following

Write any prescriptionsWrite any prescriptions Complete any consult or x-ray requestComplete any consult or x-ray request Complete the order sheet including any lab work and Complete the order sheet including any lab work and

indicate the return appointment.indicate the return appointment. Tell the nurse your patient can be checked out.Tell the nurse your patient can be checked out. THEN you may complete your noteTHEN you may complete your note

Value the patient’s timeValue the patient’s time

See your patient See your patient promptlypromptly New visit:New visit: @45 min. @45 min. FollowupsFollowups: @30 min.: @30 min.

Complete all Complete all prescriptions, prescriptions, referrals, and orders referrals, and orders promptly to allow your promptly to allow your patient to leave.patient to leave.

Lastly do your Lastly do your progress note!!!progress note!!!

If you are waiting for the If you are waiting for the attending……attending……

Start your noteStart your note Write the Write the

prescriptions for your prescriptions for your patient.patient.

Fill out referral formsFill out referral forms Look up patient’s Look up patient’s

previous labs and x-previous labs and x-raysrays

Update the Blue Update the Blue Problem ListProblem List

Write ScriptsWrite Scripts

Write prescriptions for patients on the Write prescriptions for patients on the faculties faculties precription padprecription pad

If you are unfamiliar with a particular medication, If you are unfamiliar with a particular medication, look it up before writing the prescriptionlook it up before writing the prescription

Chronic medications - give Chronic medications - give 9090 day supply with day supply with 3 3 (three)(three) refills. refills.

Have your attending sign them.Have your attending sign them.

Notes & Problem ListsNotes & Problem Lists

Write out your notes on Write out your notes on the note sheet providedthe note sheet provided

Fill out the Fill out the BLUEBLUE Problem ListProblem List completely completely (NOTE: there is a front (NOTE: there is a front and back). and back).

Third year students will Third year students will be graded on the be graded on the completeness of their completeness of their Problem Lists. Problem Lists.

The Lists will be randomly The Lists will be randomly auditedaudited

Wednesday AfternoonsWednesday Afternoons1st , 3rd and 4th of Month1st , 3rd and 4th of Month

Show up at the Show up at the Brady-Green Brady-Green 4th4th floor, South Module floor, South Module by 1:00 PMby 1:00 PM

Attendings are usually Attendings are usually Dr. James Kvale and Dr. James Kvale and NP Carreon with a NP Carreon with a geriatric fellowgeriatric fellow

3rd Year WARNING3rd Year WARNING: You Need To Complete : You Need To Complete ALL of Your Patients Cover Sheets Completely ALL of Your Patients Cover Sheets Completely

to Be Eligible to Receive an to Be Eligible to Receive an Honors Honors EvaluationEvaluation

ConclusionConclusion We hope your learning We hope your learning

experience in our clinic is experience in our clinic is valuable.valuable.

Please feel free to give us Please feel free to give us feedback on what we could feedback on what we could improve.improve.

Feel free to ask questions.Feel free to ask questions. If you like geriatrics, we If you like geriatrics, we

have a fourth year elective have a fourth year elective for medical students.for medical students.

ParkingParking, , Subacute and Subacute and Morningside Maps are on the Morningside Maps are on the following slides.following slides.

Maps of Site LocationsMaps of Site Locations

Nix Parking Options:

Park in Valet on your first visit. Tell them you are part of the Nix Senior Healthcare Center Staff.

Note: We do not pay for parking if you do not follow the directions above!

Morningside ManorMorningside ManorTake Fredricksburg Rd. to Babcock Rd.Go west on Babcock Rd. to St. Cloud Rd.Morningside Manor is on the corner.

Texas Specialty HospitalTexas Specialty Hospital

Take Babcock Rd. to Louis Pasteur Dr.Turn on Salk Dr. Follow it around to IHS