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All Hands

All Hands. December 13, 2012. Agenda. Recruitment update (Malinda Williams) Employee of the Month ( Malinda Williams ) Recognition (Malinda Williams) 2012 Quality Expo ( Tom Miller) Alcohol Screening (Tom Miller) PCMH update ( Brooke McGuirt and Carrie Palmer)

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All Hands

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  1. All Hands December 13, 2012

  2. Agenda • Recruitment update (Malinda Williams) • Employee of the Month (Malinda Williams) • Recognition (Malinda Williams) • 2012 Quality Expo (Tom Miller) • Alcohol Screening (Tom Miller) • PCMH update (Brooke McGuirt and Carrie Palmer) • Pain Clinic update (Tim Ives)

  3. Recruitment update • Welcome to Maria Romero – Front Desk • Welcome to Michael Sellen, Communication Supervisor • Eva Wamagata, LPN • Nurse Manager starts Orientation 1/7/13 • Interviewing for LPN, PBA, and MOA in OCB, and float PBA • Posting Clinic Manager position- GIM Clinic

  4. Internal Medicine Employee Recognition Program • Criteria for nominations • adherence to the customer service standard • excellence in job performance • teamwork • going the extra mile for patients and colleagues • contribution to quality improvement • Criteria for nominations • Winners will have their photo posted on the Outstanding Performance bulletin board and will receive a $30 gift card. • Winners will be announced at each All Hands meeting.

  5. October Employee of the Month • Tonya Kimrey • Offered to help with a Resident project and was very knowledgeable, thorough, and pleasant • Consistently outstanding in her communication, efficiency, and rapid attention to requests and support for patient care • Has an excellent understanding of how to get things done…and with such a great positive approach

  6. November Employee of the Month • Brooke McGuirt • Involved in numerous clinic processes, QI initiatives all while keeping organized, focused, and keeps her groups on task. • Entirely enthusiastic about her work and always striving to do it better. • Smile and pleasant demeanor are very reassuring and motivating.

  7. Recognition • Dr. Aleman • Dr. Carey • Dr. Chelminski • Dr. Colford • Dr. Dewalt • Dr. Miller • Dr. Pignone • Dr. Shaheen Dr. Cristin Colford promoted to Clinical Associate Professor Eight IMC doctors included in 2013 listing of Best Doctors in America

  8. 2012 Quality Expo Tom Miller

  9. Quality Expo • Annual event hosted by the Performance Improvement and Patient Safety Department • Held October 16-17, 2012 Women’s & Children’s Lobby • Theme: The Faces of Quality • Over 95 posters registered from all areas of the UNC Healthcare system • Two categories of awards: • People’s Choice Award • Judges Pick Award

  10. Streamlining and simplifying referrals to the NC Quitline • Quitline Referrals Poster/ Project Contributors • Brooke McGuirt • Jan Williams • Joshua Hash • Dr. Shana Ratner

  11. Congratulations:1st Place Judges Pick Award • Readmission Poster Authors: • Brooke McGuirt • Jamie Cavanaugh • Robin Roche • Betsy Shilliday • Dr. Darren DeWalt • Dr. Katy Tsai • Dr. Shana Ratner

  12. Alcohol screening Tom Miller

  13. US Preventive Services Task Force The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen adults for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. Grade B recommendation

  14. Ranking of clinical preventive services for the U.S. population: top 5 Maciosek, Annu. Rev. Public Health 2009. 30:341–55

  15. Preventive Services: 6-10 Maciosek, Annu. Rev. Public Health 2009. 30:341–55

  16. Preventive Services: 11-15 Maciosek, Annu. Rev. Public Health 2009. 30:341–55

  17. Preventive Services: 16-20 Maciosek, Annu. Rev. Public Health 2009. 30:341–55

  18. Preventive Services: 21-25 Maciosek, Annu. Rev. Public Health 2009. 30:341–55

  19. Alcohol Misuse • Includes the full spectrum of risky drinking to alcohol abuse and dependence • Risky Drinking: Drinking in excess of recommended limits • Alcohol Abuse: Drinking in excess of recommended limits with evidence of harm • Alcohol Dependence: Drinking above recommended limits with any three of the following criteria: • Unable to cut back on drinking despite attempts to do so • Spending excess time devoted to maintaining drinking habits • Continued heavy drinking despite evidence of harm • Failure to fulfill other obligations due to drinking • Evidence of tolerance • Evidence of withdrawal symptoms

  20. Prevalence • About 30% of the U.S. population misuses alcohol • Most engaging in “risky drinking” • 21.3% of primary care patients reported risky drinking in recent U.S. data • Annual cost to the U.S. is over 220 billion dollars

  21. Drinking Limits • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends the following limits: • MEN up to age 65: • No more than 4 drinks in one day AND • No more then 14 drinks in one week • Women, and men over age 65: • No more than 3 drinks in a day AND • No more than 7 drinks in a week

  22. What does this mean for our practice? • New prompts will appear annually • If patients score positive on the single screening question, the nurse will give the AUDIT form for the patient to complete

  23. AUDIT AUDIT SCREEN

  24. Scoring the AUDIT

  25. Clinic Implementation • Nurse prompt – 2 question screen • Audit for those with positive screen • Doctor prompt to review audit • Referral for patients with dependence • Start counseling - 3-5 min • Arrange following up appt. • Ask patient to complete diary • Follow up visit – 15 min counseling session • Schedule second follow up visit • Preclinic conferences for residents

  26. Resources • Patient handout and diary • Provider guide • Audit • Community resources for alcohol dependent patients • On line under Quick Links • Webcis references: Internal Medicine Clinic Links • Referrals to Robin

  27. Faculty retreat to develop motivational interviewing skills was held on November 15, 2012

  28. PCMH update Brooke McGuirt and Carrie Palmer

  29. PCMH Renewal Update • January-March we will be collecting data for our PCMH Renewal Application • We need EVERYONE’S help!!! • Nurses: Diabetes Self-Management Goals • Providers: Medication Reconciliation

  30. Diabetes Self-Management Goals Nurse Prompt:

  31. Medication Reconciliation Provider Prompt:

  32. Reporting • Weekly Reports on how we are performing • Individual feedback to nurses/ providers on current performance • Let us know if you have any questions or concerns

  33. Pain Clinic update Tim Ives

  34. Changes to the Pain Program • We have successfully worked down the backlog of patients waiting to be seen in the pain clinic. Tim’s schedule, however, continues to be full as he works to see the wave of new patients we have brought in. • We have reached capacity but we are still accepting referrals for patients who established care at the IMC prior to 9/10/12; those that have been referred are being seen in group visits (except in the month of December) • Each group visit has up to 8 patients scheduled. All patients sign the medication contract and watch the “Living Better with Chronic Pain” Decision Aid together. They are then each seen one-on-one by Carol Bledsoe, other care assistants or a pharmacy student to obtain a history • Tim has shortened his appointment slots to 20 minutes and is able to see more patients per half day. All new patients to Tim and select other patients are seen in 40-min slots. • Before opening to new clinic patients we will conduct chart audits to determine if there are more established patients who should be referred to the pain clinic.

  35. Changes to the Pain Program (continued) • Patients that simply need refills are now being seen on Wednesday mornings for a nurse refill visit by Donna Harrell. Others that are stable are also being seen by Brittain Erickson. • We have updated WebCIS Problems lists for all pain patients (past and present) with the following wording: • MEDICATION CONTRACT SIGNED • MEDICATION CONTRACT VIOLATION • NO CONTROLLED RX FROM INTERNAL MEDICINE CLINIC • Reasons for this change: • Inappropriate UTS—cannabinoids, negative for opiates when they are prescribed, positive for medications not prescribed, cocaine (this will lead to dismissal) • Diversion • Drug-related incarceration—selling, trafficking • Alcoholism • Not all of these patients have been dismissed from the clinic; some are still being seen but are just not receiving controlled medications

  36. Time Study Results (October-November 2012) • Average time between Front Desk Check-in and Nurse Check-in for first patient of the afternoon: 21 minutes • Average time between Appointment time and Nurse Check-in Time for first patient of the afternoon: 16 minutes

  37. Patient Guidelines • NO medications will be prescribed at the enrollment visit. • Each patient must bring their current medicine bottles or patches to each clinic visit. If they do not bring their medicine bottles and/or patches, they will NOT receive refills. This includes: • ALL medicine you are currently taking from ANY doctor • Prescription bottles that are empty • ALL used fentanyl patches MUST be returned to the clinic for proper disposal. • When requested, the patient must willingly leave a urine sample at each visit. • If a patient feels he needs to change his pain medicines for any reason, his must call the pain clinic first. He cannot and will not be scheduled for an earlier appointment unless approved by Tim or Carol • Patients must take all medications as prescribed. NO early refills will be given. • If a patient does not contact the clinic and runs out of medicine, they will NOT receive a refill until their next clinic visit. • Walk-in visits are NOT allowed. All visits must be scheduled ahead of time. NO exceptions will be made. • Patients should arrive 20 minutes before their scheduled visit. If they are 30 minutes late, they will have to reschedule to the next available appointment time. • If a patient misses 2 visits in a row without canceling their appointment, they will not be allowed to be seen in the Internal Medicine Pain Clinic.

  38. Staff Expectations • For nurses: • Get patients into an exam room as close to scheduled appointment time as possible. Let Tim know once the patient is ready to be seen. • Determine patient’s pain generators, current pain score and time of last medication dose • If needed, make sure patient leaves a urine sample before leaving clinic. Hold all prescriptions until urine has been collected. Make sure patient goes into the restroom without bags or other people. • For PBA’s: • Schedule patients as directed on the Encounter Form. Do NOT schedule patients earlier per patient request. • If you are unsure, call Carol at ext. 274 and ask. • Send all new patient referrals to Angie. She will get them on the schedule.

  39. Christmas Breakfast Next Thursday, 12/20/12 Carolina Inn 7:30 – 8:30 Please join us for great food and fun

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