ACCEPTING TRANSFERRING NEW PATIENTS ACCEPTING …
Transcript of ACCEPTING TRANSFERRING NEW PATIENTS ACCEPTING …
mercycare.org/pediatriccardiologyclinic
Mark Zittergruen, MD
MERCY’S NEW PEDIATRIC CARDIOLOGY CLINIC
Welcomes Mark Zittergruen, MD
PEDIATRICCARDIOLOGY CLINIC
Serving the heart-care needs of infants, children and adolescents
ACCEPTING TRANSFERRING & NEW PATIENTS (319) 398-6650
mercycare.org/pediatriccardiologyclinic
Mark Zittergruen, MD
MERCY’S NEW PEDIATRIC CARDIOLOGY CLINIC
Welcomes Mark Zittergruen, MD
PEDIATRICCARDIOLOGY CLINIC
Serving the heart-care needs of infants, children and adolescents
ACCEPTING TRANSFERRING & NEW PATIENTS (319) 398-6650
Cedar Rapids Medical Education Foundation Counting Medical Education Courses
January 2016
Page 1 of 1 1/8/2016
DATE TOPIC PRESENTOR(S)
Wed. 1/6 1315 – CRMEF – End-of-Life /Chronic Pain Speaker: Dr. James Bell
Tues. 1/26 1200 – CRMEF – Visiting Professor Program Topic: Geriatric Sleep Problems
Speaker: Mark Dyken, MD University of Iowa
ACCREDITATION * The Cedar Rapids Medical Education Foundation is accredited by the Iowa Medical Society (IMS) to provide continuing medical education for physicians. + The Cedar Rapids Medical Education Foundation designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with their participation in the activity.
CONFLICT OF INTEREST As a sponsor accredited by the Iowa Medical Society, the Cedar Rapids Medical Education Program must assure balance, independence, objectivity and scientific rigor in all its individually sponsored or jointly sponsored educational activities. All faculty participating in a sponsored activity are expected to disclose to the activity audience any significant financial interest or other relationship (1) with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity (significant financial interest or other relationship can include such things as grants, or research support, employee, consultant, major stock holder, member of speakers bureau, etc.) The intent of this disclosure is not to prevent a speaker with a significant financial or other relationship from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remains for the audience to determine whether the speaker’s interests or relationship may influence the presentation with regard to exposition or conclusion. Disclosure forms for each presenter are on file in the CME office. Participants interested in viewing copies may write the CME Office, including a self-addressed, stamped envelope. Please write to: Continuing Medical Education Office, Cedar Rapids Medical Education Foundation, 1260 2nd Avenue, SE, Cedar Rapids, IA 52403. DURING PRESENTATIONS THERE ARE OCCASIONALLY DISCUSSIONS OF UNAPPROVED USE OF FDA APPROVED DRUGS, DEVICES OR TREATMENTS. THIS MUST BE DISCLOSED TO THE AUDIENCE DURING THE LECTURE.
Orthomyxoviruses cause
Influenza A, B and C.
Paramyxoviruses cause
Croup, bronchitis, bronchio-
litis, RSV, measles and
mumps.
What are important differ-
ences between paramyxo-
viruses and orthomyxovi-
ruses?
Orthomyxoviruses
have segmented RNA
which allows for
“antigenic shift”, this is
the genetic change that
enables a flu strain to
jump from one animal
species to another. This
only happens with In-
fluenza A.
Another change that can
occur with Orthomy-
coviruses is called
“antigenic drift”.
Each year, the flu vac-
cine contains protec-
tion against 3-4 flu
strains. Influenza
virus genes are prone
to mutations and can
change shape. Anti-
bodies that normally
would match up to
provide protection, no
longer can. This al-
lows the newly mutat-
ed virus to infect the
body. Because of
antigenic drift, new
versions of the influ-
enza vaccine are need-
ed each year.
Paramyxoviruses, on
the other hand, have
non-segmented ge-
nomes and only one
serotype, this can al-
low for long term im-
munity. For example,
once the vaccination
series is completed or
the person has had the
mumps, their bodies
will have established
long term immunity
and yearly vaccines
are not needed. Boost-
er vaccinations may be
periodically advised
by the Health Depart-
ment and CDC, when
outbreaks occur. We
have seen this recom-
mendation this fall due
to the increase in
mumps cases at local
universities.
Remember, the new, the
old and immunocompro-
mised are at highest risk for
acquiring serious complica-
tions from influenza. The
very best way to protect
yourself and others is to
vaccinate.
Differences between orthomyxo and paramyxoviruses.
Epidemic vs Pandemic
Epidemic and pandemic are
similar terms that refer to
the spread of infectious
diseases amongst a popula-
tion.
An EPIDEMIC is a classi-
fication of a disease that
appears as new cases in a
given human population
during a given period, at a
rate that exceeds what is
expected. It may be local-
ized to a small region , but
the number of people af-
fected my be very large.
An epidemic that is NOT
localized to a city or small
region, but spans a larger
geographical area, or ex-
ceeds a far higher number
of people in that region, is
called a PANDEMIC.
Simply put, when an epi-
demic gets out of hand, it’s
called a pandemic. This
may spread across a large
region or even world-wide.
Scarves, gloves and mittens…….OH MY!!!!
Ok, let’s all admit it. Who hasn’t used a scarf, glove or mitten to wipe a runny
nose or cover a hacky cough? Remember, good laundering can alleviate those
pesky germs that linger on such items. Also, although it’s recommended to
replace your toothbrush every 3-4 months, washing on a regular schedule and
more often when sick is super easy. Just pop it in the dishwasher or simply
hand wash with soap and water. Don’t forget, NO ONE likes a dirty mouth! Re
sp
ira
tor
y V
iru
se
s
ME
RC
Y
ME
DI
CA
L
CE
NT
ER
Bugs n Drugs
December 2015
P a g e | 1
|
Medication Management Committee
Mercy Medical Center
Cedar Rapids, Iowa
Volume 21 December 2015
Formulary Additions
Tucks (Witch Hazel)
Approved indications include: after-stool
wipe to remove most causes of local
irritation; temporary management of
vulvitis, pruritus ani and vulva, help relieve
the discomfort of simple hemorrhoids,
anorectal surgical wounds, and
episiotomies.
Orbactiv (Oritavancin)
Approved for adult patients with acute
bacterial skin and skin structure infections
only suspected to be caused by MRSA.
Patients should have local and systemic
signs of infection that necessitate IV
therapy over oral therapy but are stable
enough to go home after the infusion.
Medication Alert Suppressions
Aluminum Hydroxide Warning
Therapeutic Interchanges
Medication Ordered Interchanged To
Verelan PM and
Verelan
VERApamil SR
Citrucel Powder Citrucel Tablets
Cepastat Lozenges Chloraseptic Spray
Policies/Protocols
-Disposal of Controlled Substance
-Pediatric and Neonatal Dosing Policy
-Labeling Standards Policy
-Herbals Policy
-Medication Reconciliation Policy
-Discharge Prescription Policy
-Prescriber Signature and DEA Authorization
Policy
-Anticoagulation Management Policy
-Aminoglycoside Monitoring Protocol
-Metformin Initiation Guidelines
-IV to PO Protocol
-High Alert Medications
-Safe Management of Medications and Security
-Automatic Renal Dosing Protocol
Membership
Fadi Yacoub, Chair Vincent Reid, MD
Susan Schima, MD Chris Walsh, MD
Asma Al-Zougbi, MD Usha Renganathan, MD
Martin Cearras, MD Mary Brobst
Lauren Cumings Sarah Schloss, ARNP
Stephanie Hoenig, ARNP Jamie Sinclair
Becky Prier Ariel Loring
Lisa Ridge Jen Goings
Linda Klein Megan Standish
Kathy Swift Andrea Bennett
Katy Rolfes
I N S I D E T H I S I S S U E
Formulary Additions
Therapeutic Interchange
Medication Alert Suppressions
Policy Approvals
PPI for FT Administration
P a g e | 2
|
PPI for FT Administration:
Situation:
We would like to assess our current formulary proton pump inhibitor (PPI) for administration via feeding tube (FT).
Background:
We currently utilize Protonix powder for administration of a PPI via a FT. The problem is that the powder can only be mixed with apple juice and this is not always readily available on the patient care floors.
Assessment:
There are other PPIs that can be mixed into a suspension to be administered via a FT.
Recommendations:
Switch to Omprazole 2 mg/mL suspension compounded by pharmacy as our PPI of choice
for FT administration. This would result in nursing satisfaction improvement and annual cost
savings of approximately $530.
Mercy Specialty Clinics – Updates on New Services Provided
General Surgery Clinici. The surgeons are willing to place peritoneal dialysis catheters on a case by
case basis; Bulent Cetindag, MD will primarily perform these proceduresii. Screening Colonoscopies – Nora Royer, MD adding this service to her practice
Surgical Oncologyi. Vince Reid, MD addressing skin cancers including: melanoma, basal cell
cancer, squamous cell carcinomaCardiology Clinic
i. Dave Glassman, MD is adding subcutaneous ICD as an option for patients with an ICD indication who do not also require pacing
Pulmonology Clinici. Eduardo Celis, MD named interventional pulmonology medical director and
within this role is reviewing quality and costs of all cases performed at MercyPediatric Clinic
i. Sara Neff, ARNP offering pediatric diabetic care and education for our inpatient and outpatient pediatric patients
BUG’S-N-DRUG’S
DECEMBER 2015
MUMPS Prevention
What steps can I take to prevent be-
coming infected with mumps?
Personal action, such as hand wash-
ing, covering your coughs and sneezes,
not sharing cups, utensils or food, and
staying home when sick, can help re-
duce your chances of getting and
spreading mumps.
All health care workers, and especially
those who work in acute care or with
people at high risk for mumps compli-
cations (such as OB-GYN), should re-
ceive two doses of Measles, Mumps,
Rubella (MMR) or have serologic evi-
dence of immunity.
Droplet Isolation for patients suspect-
ed of Mumps until ruled ou t.
College Students, staff and faculty
should make sure they are immune to
mumps. Immunity to mumps includes:
o 2 doses of MMR vaccine given at
least 4 weeks apart
o Laboratory confirmation of mumps
disease
o Laboratory confirmation of mumps
immunity
If mumps is occurring among your
family, friends or community, insure
everyone has received two doses of
MMR (or had mumps already).
MUMPS
Updated December 12, 2015, there have been 241 lab
confirmed cases of Mumps in Iowa for 2015, . Of the 241
cases 196 are from John son County. Mumps is a viral illness
It is spread by contact with saliva (e.g., sharing eating utensils, drinking glasses or
straws, kissing) and airborne respiratory droplets – similar to influenza.
Symptoms include: low-grade fever, headache, muscle ache, decreased appetite
and swollen glands under the jaw. As many as 15-27% of people infected with
mumps may have no symptoms at all.
Mumps is generally a mild to moderate illness, with complete recovery and no
long-term health problems in most cases. Hospitalizations are uncommon. Com-
plications, such as male testicular inflammation and deafness can occur.
What should I do if I have these symptoms?
People with these symptoms should stay home from work, school or childcare,
and contact their personal health care provider.
Contact your health provider by telephone. Those providers will make arrange-
ments to minimize chances you will spread the illness in waiting rooms (perhaps
by wearing a mask).
Isolate yourself at home until 5 days after onset of symptoms or until symptoms
go away – whichever time period is longer.
There is a vaccine to prevent Mumps disease
Virtually all Iowa school children have received two doses of the MMR vaccine.
Two doses of MMR vaccine is approximately 88% effective in protecting against
mumps disease. This means out of every 100 people who received 2 doses of
MMR vaccine 12 did not develop protective antibodies against mumps disease.
The mumps vaccine is effective in preventing disease. Without mumps vaccina-
tion there would be considerably more cases than we are currently seeing.
Those who are not yet immune to mumps should receive age appropriate MMR.
The first dose of MMR vaccine should be given on or after 12 months of age and
the second dose is usually given when the child is 4–6 years of age.
.
Eastern Iowa Sleep Center Release: Monday, December 28, 2015 Contact: Lisa Gleason, (319) 362-4433 ext. 302, [email protected] Cedar Rapids, IA – Eastern Iowa Sleep Center (EISC) plans its new additional sleep study location in Belle Plaine, IA. In a recent agreement with the City of Belle Plaine, EISC will provide sleep studies to Belle Plaine, Benton County and surrounding areas. The facility is located at 1010 8th Ave and was the former location of Belle Plaine Family Medicine. EISC looks to officially open its doors there March 7th and host an Open House event on March 10, 2016 from 4pm-7pm. “The City of Belle Plaine has been great to work with. We are excited to bring this unique service to such a welcoming community. Patients can reduce time and mileage to receive EISC top of the line service that would normally require travel into Cedar Rapids”, says Mrs. Gleason, EISC Administrative Director. EISC plans to remodel interior areas to provide state-of-the-art sleep study technology while providing a comfortable hotel like experience. A gracious private room, cable TV and WI-FI will be available for each patient. Infrared light and camera in each room allows the sleep technologist to monitor the study without interruption to the patient. Eastern Iowa Sleep Center (EISC) is a partnership between UnityPoint St. Luke’s Hospital, Mercy Medical Center and Physician’s Clinic of Iowa. EISC is accredited by the American Academy of Sleep Medicine. EISC is an Independent Diagnostic Testing Facility that provides comprehensive care for sleep-related disorders such as: Obstructive Sleep Apnea, Restless Leg Syndrome, Narcolepsy, Insomnia and more. Medical Director Andrew Peterson, M.D., Scott Geisler, M.D., Robert Struthers, M.D. and Warangkhana Wongba, M.D. are board certified in Sleep Medicine and serve at the Eastern Iowa Sleep Center in Cedar Rapids, IA.