Orientation for the Nix Senior Health Care Center

1. Welcome to the Community Geriatrics Rotation Orientation for the Nix Senior Health Care Center

2. Overview • MS 3 students have 2 weeks in the geriatric clinic during your family medicine rotation. • Family Medicine and Gyn Residents will have 4 week rotations. • We have 5 clinical geriatricians, geriatric nurse practitioners and geriatrics fellows who will supervise your clinical experience. • Feel free to ask faculty or staff any questions regarding clinic operations, grading or any other issues of concern. • A PARKING Map is at the end of this presentation

3. Geriatrics Faculty Robert Parker, MD David Espino, MD M. Rosina Finley, MD Kathleen Owings, MD Liliana Oakes, MD

4. Fellows & Nurse Practitioners • Geriatrics Fellows • Drs. Adeeba Akhtar, Kathy Owings, Jeanette Ross, Cynthia Stone • Nurse Practitioners • Tukumbor Efeovbokhan, Colleen Keller (at Pavilion) • Ms. Rebecca Carreon at the Wednesday PM Clinic at the Brady

5. Clinic Clinical Staff • Medical Assistants • Tina Cano • Syria Rose • Receptionist • Julia Piedra • Medical Records • Mary Helen Peña Chris Ramirez, Clinic Administrator Gloria Valdez RN, Head Nurse

6. Location • Nix Senior Health Care Center • Monday-Thursday, except 1, 3, 4 Wednesday afternoons • Nix Hospital 414 Navarro, Suite 1111 • PARK in the Nix Valet • Wednesday Afternoons • 1, 3, 4 Wednesdays at South Module • 3rd Floor Building C, University Health Center-Downtown

7. Educational Goals • Learn the common geriatric syndromes • Learn the geriatric assessment tools • Evaluate at least one geriatric patient per session. • Learn use of summary face sheet for care of elders • Learn use of electronic medical record in the care of elder patients

8. Medical Student Evaluation Areas • Presentation Skills • Knowledge Base • Problem List Completeness • Team Work as reflected by volunteering for extra patient work, completion of prescriptions, etc.

9. Assessment Toolshttp://geriatrics.uthscsa.edu • Review Tutorials and Be Familiar With The Instruments • Mini Mental Status Exam • Activities of Daily Living • Instrumental Activities of Daily Living • Tinetti Gait and Balance Scale • Geriatric Depression Scale (GDS) • CLOX evaluation

10. Assessment tools are located under TOOLBOX at http://geriatrics.uthscsa.edu.

11. The White Board • The nurse will put the patients name on the white board after vitals are taken. • Begin to see patient as soon as they are on the board and place your initials by the patient’s name.

12. Seeing your Geriatric Patient • Review the patient’s chart • Take your patients history and do a physical exam. • If you need a translator, ask the nurses for to help. • If you need to do a genital or breast exam, wait until this can be done with your attending.

13. Geriatric Patients cont’ • Present your patient to your attending, including your assessment and plan. • See your patient with your attending. • Next complete the following • Write any prescriptions • Complete any consult or x-ray request • Complete the order sheet including any lab work and indicate the return appointment. • Tell the nurse your patient can be checked out. • THEN you may complete your note

14. Value the patient’s time • See your patient promptly • New visit: @45 min. • Followups: @30 min. • Complete all prescriptions, referrals, and orders promptly to allow your patient to leave. • Lastly do your progress note!!!

15. If you are waiting for the attending…… • Start your note • Write the prescriptions for your patient. • Fill out referral forms • Look up patient’s previous labs and x-rays • Update the Blue Problem List

16. Write Scripts • Write prescriptions for patients on the faculties precription pad • If you are unfamiliar with a particular medication, look it up before writing the prescription • Chronic medications - give 90 day supply with 3 (three) refills. • Have your attending sign them.

17. Notes & Problem Lists • Write out your notes on the note sheet provided • Fill out the BLUEProblem List completely (NOTE: there is a front and back). • Third year students will be graded on the completeness of their Problem Lists. • The Lists will be randomly audited

18. Wednesday Afternoons1st , 3rd and 4th of Month • Show up at the Brady-Green 4th floor, South Module by 1:00 PM • Attendings are usually Dr. James Kvale and NP Carreon with a geriatric fellow

19. 3rd Year WARNING: You Need To Complete ALL of Your Patients Cover Sheets Completely to Be Eligible to Receive an Honors Evaluation

20. Conclusion • We hope your learning experience in our clinic is valuable. • Please feel free to give us feedback on what we could improve. • Feel free to ask questions. • If you like geriatrics, we have a fourth year elective for medical students. • Parking, Subacute and Morningside Maps are on the following slides.

21. Maps 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!

22. Morningside Manor Take Fredricksburg Rd. to Babcock Rd. Go west on Babcock Rd. to St. Cloud Rd. Morningside Manor is on the corner.

23. Texas Specialty Hospital Take Babcock Rd. to Louis Pasteur Dr. Turn on Salk Dr. Follow it around to IHS