Housestaff Orientation

1
Housestaff Orientation

• (quick lock the escape routes)

2
Rehab services How many are there?

• 3

3

• Acute rehab
• Geri rehab
• Subacute rehab

4
Question 1 acute rehab service is for

• Any patient over the age of 65
• Patients requiring 2 weeks of rehab or less
• Patient requiring 4-6 weeks of rehab
• Patients who plan to transition back to home
• A C
• B D

5
Acute rehab is for those patients that meet the
following criteria

• F

• 2 weeks of rehab
• 3 hours a day
• Transition back to home
• Post CVA and post surgical patients

6
Geri Rehab

• Betty Lou Dunlop
• Ext 4020
• Pager 440-562-0924

7
Question 2 Geri rehab is for

• A) Be over the age of 65
• B) be able to transition back to home
• C) Be able to participate in 1-1.5 hours of rehab
  a day
• D) Have been a guest star on the Lawrence Welk
  Show
• E) Have a first name of Jerry
• F) A, B and C

8
Geri rehab is for those patients that meet the
following criteria

• F

• 65 or older
• Transition back to community
• 2-3 weeks total
• 1-1.5 hours of rehab/day

9
Subacute rehab

• Helen Ferrer
• Ext. 839-7550/6550
• 440-562-0948

10
Subacute rehab is

• A) For patients that arent that cute
• B) For patients that you dont know what else to
  do with
• C) For patients that require a SNF
• D) Refers only to Brecksville
• E) A and B
• F) C and D

11
Subacute Rehab is for

• F

• Patients requiring a skilled nursing facility
• BV or Community nursing homes
• 4 week stay or longer
• For patients that dont meet criteria for Acute
  Rehab or Geri Rehab

12
To get a patient to Brecksville, you must do what
five things

• Place and read a PPD
• Place a Brecksville consult
• Have PT evaluate the patient in house
• Arrange for travel
• Call report to the MOD

13
The following meds expire after how much time?

• ABX
• Narcotics
• Warfarin/lovenox
• Vitamin K
• IVFs
• Nebs
• IV heparin
• Sub Q heparin

• 7 days
• 7 days
• 7 days
• 3 days
• 24 hours
• 3 days
• 24 hours
• 7 days

14
True or false

• To prescribe percocet, you must order it in the
  computer and fill out a green narcotics script.

15

• True All scheduled drugs with the exception of
  tylenol 3 must have both computer and hard copy
  written orders

16
Chris Lacey Medicine Man

• Chris Lacey
• Ext. 5455
• 440-562-0988

17
True or false

• When admitting a new patient, if you dont write
  for a diet, the patient is automatically made NPO.

18

• False A diet order MUST be entered on all
  patients

19
To ensure that a fluid restriction is enforced,
you must

• A) Strap your patient to the bed
• B) Order the fluid restriction under the diet
  menu in CPRS
• C) Unbolt the drinking fountains (bubblers) from
  the wall
• D) Place a text order to nursing
• E) AC
• F) BD

20

• F) You must place both a diet and an nursing
  text order

21
Debbie Haarburger Wards 44, 5B
Jen Mahnke Wards 42, PCU
22
Kim Williams Tele Czar
23
True or false

• Every VA patient is eligible for travel

24

• False a patient may or may not be
  eligiblecheck with your friendly social worker.
  Every patient is screened by social work on
  admission

25
Your neighborhood social workers
Marianne Crego Orange and White
Cathy Wardlow-Bullock Blue and Green
26
Discharge Planners, aka your best friends
Tammy Magill Babyok 440-562-0033 Blue and Green
Michelle Stewart 440-562-0042 Orange and White
27
Your neighborhood discharge planner will

• Schedule necessary follow-up appointments
• Facilitate CHH and HBPC referrals
• Procure durable medical equipment
• Facilitate patient education
• Hound you about having discharge prescriptions in
  the night before
• Hound you about portable DNRs

28
The alcohol based foam outside patient rooms

• A) Ensures eradication of c. diff
• B) Should be used before every third patient
• C) Serves the sole purpose of excerbating dry
  skin
• D) Effectively removes cheetos residue from hands
• E) has been proven to be better than handwashing
  against most organisms

29

• E

• Effective against most organisms with the
  exception of c diff
• Will not remove solid particles (ie cheetos)

30
Made you laugh, made you cry, stick a needle in
my eye

• In the event of a needle stick, report
  immediately to
• Employee health during working hours
• Urgent Care during off hours

31
HBPCwhat does it stand for?

• Services provided Monday through Friday
• 800AM 430PM
• VA provided services serving all CBOCs

32
To be eligible for HBPC services, a patient must

• A) Be belligerent and combative
• B) Have a skilled nursing or therapy need
• C) Be homebound
• D) Agree to follow up with his VA primary
• Care Provider
• E) AC
• F) BD

33

• F A patient must have a skilled therapy or
  nursing need and be established with a VA PCP

34
Which of the following is a reason to consult
HBPC?

• A) New or poorly controlled diagnosis
• B) Wound care
• C) Catheter management
• D) Medication non-compliance
• E) On going venipuncture
• F) Safety assessments
• G) Need for PT
• H) The consult is a whole bunch easier than the
  community home health consult
• I) All of the above

35
When should you refer to Community Home Health?

• A) When a patient needs to be seen after hours or
  on weekends
• B) When you have a whole lot of time to fill out
  a REALLY long consult
• C) When you need home IV ABX
• D) When your HBPC consult has been denied
• E) All of the above

36

• E
• Contact Chris Cottingham
• Pager 440-562-1473

37
A Health Buddy is

• The roommate across the way who rats your patient
  out when he violates his NPO
• A way for patients to be monitored from home
• Someone altruistically concerned about your
  overall wellbeing
• A new type of candy bar now available in the
  chiefs office

38

• B) A way for patients to be monitored from home

39
TelehealthContact Jantene Johnson 3507

• Interactive health stations
• Health Buddy
• HTN
• COPD
• CHF
• DM
• Depression
• Video phone

40
When in doubt

• Consult HPBC for home care needs. If unable to
  meet your patients needs, the referral will be
  forwarded to community home health

41
CIWA, DOWA, TEACHWA

• Patients admitted for ETOH withdrawal must be in
  the MICU if
• CIWA gt20
• In restraints because fo withdrawal
• Need for IV BNZs

42
Sign here please

• Written consent must be obtained for all
  procedures with the exception of emergencies
• All procedures must be documented in the chart
  under medicine procedure note template
• IMED package

43
For a patient to be DNR, there must be

• A) A written order by the attending
• B) An Ohio portable DNR sheet completed
• C) A DNR progress note signed by the attending
• D) A phone call placed to the Grim Reaper
• E) AC
• F) BD

44

• E

45
To Die For

• Autopsies must be requested on all deaths
• Request for autopsy must be documented in the
  patient chart

46
Order Renewals

• Remember that orders on patients coming out of
  the unit automatically discontinue

47
Long term IV ABX

• Any patient requiring 1 week or longer of home IV
  ABX must have an ID consult and arrangements for
  follow up in ID clinic

48
Dont stress (or should I say DO stress)

• Patients in house requiring a stress test within
  the next 2-4 weeks should be stressed while they
  are inpatients

49
CT or not CT

• Pulmonary must be consulted on ALL parapneumonic
  effusions
• All patients with CTS must have a pulmonary
  consult, even if CT surgery is managing the tube
• Pulmonary service has the capability of placing
  CTs

50
I Wanna Be Sedated

• Use of IV benzos with the intent to sedate is
  ABSOLUTELY prohibited on the medical wards
• If a patient requires sedation prior to a
  procedure, either anesthesia needs to be called
  or the patient needs to be transferred to the MICU

51
Continuity of Care

• Notify PCPs of admissions and discharges
• Write a note on the day of discharge
• Do your discharge summaries on the day of
  discharge
• Make sure your patients are all scheduled for
  appropriate hospital follow up

52
And finally

• Be mindful of the cut and paste
• Be mindful of the cut and paste
• Be mindful of the cut and paste
• Be mindful of the cut and paste
• Be mindful of the cut and paste
• Be mindful of the cut and paste
• Be mindful of the cut and paste