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UIM Clinical Services

UIM Clinical Services. What is available to help my patients? 7.2.14. Case .

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UIM Clinical Services

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  1. UIM Clinical Services What is available to help my patients? 7.2.14

  2. Case • 54 year old female patient presents for a follow-up visit and reports chest pain today. Intermittent, substernal and radiating to the jaw. She feels a little short of breath at times. States her pain is 3/10 right now, but has been as high as 8. In addition, she also notes that she has been tired and urinating more than usual. • PMH: hypertension – poorly controlled, low back pain • Smoker, lives alone and was laid off from work 3 weeks ago. Occasional ETOH. Has an insurance plan that does not pay for medications. • BP 170/92, P 68, pulse-ox 98% RA, BMI 29

  3. This is not an ED – what can I do? • 1. Does this patient need to go to the ED? • 2. Assessment tools and testing • 3. Labs and studies • 4. Medications and fluids • 5. Personnel and types of clinical services • 6. Other services in the building

  4. Does this patient need to go to the ED? • Clinical assessment • Attending • Nurse - RN

  5. Assessment Tools • Pulse oximetry • Temperature • Peak Flow meter • Point of care glucose and INR • Diagnostic kits on the walls • Manual BP cuffs • Tuning fork, reflex hammer • Anoscope • Vaginal speculum • Check the drawers – tongue depressors, Gen probes, hemoccult, Q-tips, tape measures

  6. Assessment Tools • EKG • Spirometry

  7. Case • You obtain a 12 lead EKG which does not show any signs of acute or remote ischemia – normal rhythm. Patient states that the pain is now gone with no treatment in clinic. • Repeat manual blood pressure is 168/90. She has been having trouble affording her losartan and HCTZ, so has not taken this in the past few weeks. • Fingerstick glucose: 220

  8. Labs and Studies • Point of care testing: glucose, A1C, INR • Stat labs • 1st Floor lab – Rutledge Tower; ART lab; MT Pleasant lab • Radiology – 1st floor RT – you can send patient down and have them come back to the 8th floor for urgent studies. CT, MRI, Nuclear med also available. • Surgery Vascular lab – DVT studies; ABI, etc. • Cardiology: Stress testing, Holter, Event Monitors

  9. Medications and Fluids • IV’s – can be started • Saline • Full IV pharmacy available – place order in Epic • Some p.o. meds available (UIM Survival) • Some IM available (UIM Survival) • Crash cart for emergencies

  10. Case • The patient has never been told she has diabetes and is taking no medication for this. She likes Coca-cola and drinks 3-4 per day. Eats a lot of fast food. • She does not remember the last time she had an eye exam, and cannot afford to see an eye doctor. • You find a scanned Treadmill/nuclear stress test in the chart from Roper 6 months ago – negative for ischemia.

  11. What other team members can help? • PharmD – CDE: co-management agreement for Diabetes and coumadin. • Smoking cessation • Inhaler teaching • Medication reconciliation and teaching • Dietician – in building/referral • Nurse Case Manager – some are CDE’s, but all can help with self management plans • LPN/CMA – can give some injections; help with self management plans • Vaccines • Cerumen removal • Pap smears • Injections/I&D • Retinal Camera pictures • MSW – Pat Roberts

  12. Medication Issues • RT Pharmacy – 1st floor • Patient Assistance

  13. Charge Capture • EKG, spirometry, I&D, Smoking cessation can all be billed • “Charge Capture” – ask your attending

  14. Epic Tips • “In Clinic” • Change labs to “Stat” • Use the “ + New” for all orders • Patient Education Materials - .UIMEDUALL, .UIMEDUDM, .UIMEDUPLATE

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