June 2014 Revision Informational Session

1. June 2014 Revision Informational Session Update on Revisions Made to the eCHAM as of June 30th, 2014

3. Resources for Training • www.echam.org > eCHAM Users > Training Materials: • You will find: • On Demand Videos on how to use the eCHAM and iCHAM • PDF’s including: • Scenarios to practice using the eCHAM • Answers to Scenarios • Icon Legends for the eCHAM & iCHAM • Instructions for accessing each of the eCHAM deliverables • Word document of training slides

4. Resources for Training • Live Online Quarterly Trainings: • Beginning on September 15th-16th, 2014 • Contact us at echam@anthc.org to register for a live online training. • Check out calendar at: www.echam.org/echamusers.aspx for future dates.

5. www.echam.org • This is a great website to visit on a regular basis • We post events and trainings on our calendar. • We post updates about the eCHAM on our main page • We provide access to on-Demand training.

6. eCHAM on Facebook • We host a page: Electronic Community Health Aide Manual on Facebook! • www.facebook.com/eCHAMProjectOffice • Be sure to like us to keep track of what is happening with the eCHAM!

7. The eCHAM Website https://access.echam.org • This website allows you to access the eCHAM online! • Log in with the Username and Password assigned to you during training with your THO. • If you don’t have an account, contact us at echam@anthc.org to set one up. • We will need your first and last name, work phone, work email and organization. An account can be set up same day M-F.

8. The iCHAM eCHAM iPad App • Available on the Apple App Store! • Search for the: iCHAM app • Log in with the same Username and Password as the one you use for the website. • Once it is downloaded and the content is updated, you do not need to be online to use this app! • You will need to connect your iPad to WiFi to receive iCHAM updates and to save your notes, highlights, bookmarks to the website. • Notes, bookmarks and highlights made on the website and iPad app are transferrable, they will show up in both places as long as you connect your iPad to WiFi after you’ve made personalizations on either deliverable!!

9. The eCHAM eBook • Available for download to your iPad, Kindle, Kindle for PC program, most any other e-reader. • https://access.echam.org/eCHAM.epub • CASE SENSITIVE WEB ADDRESS!! • Meant as a backup if your iCHAM doesn’t work and/or the website is down. • Your notes, bookmarks and highlights made in the eBook WILL NOT transfer when you upload a new version.

10. eCHAM PDF • Will be available later this year. • Until December 31st, you can use your paper 2006 CHAM as a back up if you have an eCHAM failure.

11. Support for the eCHAM • Contact us at: • 907-729-5618 • echam@anthc.org • AFTER HOURS: • Go to: www.echam.org/helpdesk for a trouble shooting algorithm OR • Call 907-729-2626 for assistance

12. Index Improvements • We have added over 600 new index terms per your suggestions and our findings as we created the eCHAM. You should find the index to have MANY more terms to make it more user-friendly. See your release notes for a full list of new terms! • All Plans from the eCHAM have been added to the index. So you can search Plan Pregnancy 3 and instantly be provided with a link to that plan for example! • Great for RMT providers, chart reviews and recheck visits!

13. Patient Care Visit • Inside Front Cover: • If patient has more than one problem, CHAP is advised to perform complete history. • Added to Drug/ETOH History: • If they answer yes to having consumed drugs or alcohol, ask when they last used. • Emergency: • Added link to eye injuries from Evaluate Patient section of scene size up to ensure chemicals in the eye is treated immediately.

14. Patient Care Visit • Emergency Childbirth: • Added question about what medications the patient is currently taking. • Child and Teen: • Added question about daily servings of fruit, vegetables, grains, protein. • Added question about frequency of brushing teeth and frequency of dental cleanings.

15. Patient Care Visit • Female Reproductive: • Cancer Screening • Added “Schedule Pap smear for recheck, if abnormal results.” • Female Genital Problem • Added question about color of discharge. • HPI • Added question about sex with males, females or both.

16. Patient Care Visit • Mental Health: • Added BHA as a resource to contact. • Mouth • Tooth Knocked Out Assessment • Added “Refer to DHAT if available.”

17. Patient Care Visit • Musculoskeletal • Wrist-Hand Exam • Added hyperlink to Muscle Movement and Strength exam in Reference and Procedure. • Arm or Leg Exam • Added reference to the specific Musculoskeletal Exam Chart.

18. Patient Care Visit • Pregnancy • Exam • Advised to perform pap smear if trained to do so and link to female reproductive cancer screening created. • Return Prenatal • Advised to ask how many pregnancies the patient has had • Return Prenatal • Decreased fetal movement added as a reportable finding.

19. Patient Care Visit • Respiratory • Plan 20 • Added link to How to Collect Sputum Sample. • Respiratory Illness Chart B; Bronchiolitis • H&P findings: added “patient usually has retractions.” • Respiratory Illness; Signs and Symptoms • Added that you can often hear wheezing without stethoscope. • Strep throat • Added “report if you do not have a standing order.”

20. Patient Care Visit • Skin and Soft Tissue: • Patient Education Skin and Soft Tissue #2, 3a, 5: Removed Calamine lotion since it is no longer available on the market.

21. Reference and Procedure • Nervous System Exam • Added Soft/Sharp testing on the face. • History and Physical • Vital Signs: Changed check pulse 30 seconds x 2, to 15 seconds x 4. • Child and Teen; Heart Exam • Changed it from listen to heart in several places to listen in four places and created link to Examining the Heart.

22. Reference and Procedure • History and Exam • Examining the Ear • Summary changed to: • color, position, clarity, mobility then other. • Heart • Changed to listen in four places and link to Examining the Heart added. • Mental Status • Added “ask patient to recall three things I asked you to remember earlier” at conclusion of exam.

23. Reference and Procedure • History And Exam • Step #2 • Removed statement about percussion in small children. • Anus and Rectum • Suggested having chaperone in the room even for same sex patients. • Changed name of Child Screening Exam to Well Child Screening Exam

24. Reference and Procedure • History and Physical • Information about testing rebound tenderness made to match information provided in Patient Care Visit. • Emergency Equipment • Added trash bags, zip ties, small sharps container to the list. • Oxygen tank use • Improved explanation for opening and closing valve .

25. Reference and Procedure • Labs • Urine Dipstick Values Chart • Added information about Specific Gravity • Added a link to normal hemoglobin ranges chart in the Well Child Exam. • Splinting • Fixed image demonstrating adding padding to match text regarding how many layers of padding should be added.

26. Medicine • Anti-infectives • Amoxicillin • Added to warning box: Do not give to patient if allergic to Augmentin. • Changed suspension strength from 250mg/5ml to 400mg/5ml.

27. Medicine • Anti-infectives • Azithromycin • Changed from (1) 1 gram powder packets to (4) 250 mg tablets. • Affects • Female Reproductive Plan 2, 3, 5, 6 • Sexual Assault Plan 1, 2 • Male Reproductive Plan 1, 2, 3

28. Medicine • Anti-Infectives: • Nitrofurantoin • Changed brand name drug from Macrodantin to Macrobid, which means the patient will take the medicine twice daily instead of four times a day, ideally improving patient compliance • Affects: • Urinary Plan 1

29. Medicine • Anti-Infectives • Tetracycline • Removed from the eCHAM • No longer available on the market • Replaced Tetracycline with Doxycycline • Acne Plan-Skin and Soft Tissue 12.

30. Medicine • Contraceptives • Emergency Contraceptive Pill • Changed from brand name drug Plan B to Next Choice due to market availability. • Affects: • Birth Control 6 • Sexual Assault 1, 2

31. Medicine • Emergency Medicines • Ipecac • Removed from the eCHAM • No longer available on the market • Affects: • Emergency Plan 31

32. Medicine • Medicine Skills • Charting: Added strength to list of information to chart when dispensing medication • Giving ImmunizationsTechnique • Updated, including: • Aspiration • Charting vaccines • Choosing where to give vaccine • Getting set up • Giving Subcutaneous injections • Giving Intradermal injections • Injecting and adult or child > 40 lbs • Giving powder vaccines • Needle and syringe size

33. Medicine • Pain and Fever • Aspirin • Added to warning box: Do not give to patient under 18 years of age.

34. Medicine • Pain and Fever • Ibuprofen • Simplified dosing for this drug • Only one chart • Based on a 10mg/kg dose, regardless of the patient’s temperature

35. Medicine • Pain and Fever • Children’s Tylenol • 80mg/0.8ml is no longer available on the market • Changed dose to 160mg/5ml only, to be compatible with market availability

36. Medicine • Respiratory • Pseudoephedrine • Removed this drug from the eCHAM • Due to the Combat Meth Act of 2005. • Affects • Respiratory Plan 2, 3, 4, 5, 6

37. Medicine • Skin • Permetherin • Added do not take shower prior to applying, to make consistent throughout eCHAM.

38. Medicine • Skin • Calamine Lotion • Removed from eCHAM due to market availability. • Affects: • Skin and Soft Tissue Plan 2, 3a, 5

39. Thank You! • Thank you for joining us and taking the time to learn about your new eCHAM! • Please do not hesitate to contact us with questions or with suggestions for the December 2014 Revision Release. • echam@anthc.org • Have fun and enjoy your new eCHAM!!