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July 2016

Mammography and Ultrasound Have now moved back to the Iowa Lutheran Campus; mammography with tomosynthesis can be performed at this location. For more information on these services, please call the UnityPoint Clinic OB/GYN | Imaging Services – Penn Avenue at (515) 263-2602.

The Doctor’s Lounge at Iowa Methodist Medical Center remodel is underway The Doctor’s Lounge is set to start on July 18. The temporary lounge will be on South 5, the large conference room B. There are restrooms, a kitchenette and a small private room for privacy. There will computers available as well as a few other amenities during this time. This project is due to be completed on Sept. 18th.

Hostile Threat/Active Shooter Procedures

As we reflect on the recent tragic events in Orlando and evaluate our own level of preparedness, we wanted to provide you with some ways in which you can be better prepared should such an event impact our facilities.

1. Please review the UnityPoint Health – Des Moines Hostile Threat/Active Shooter procedures (attached). Know the four A’s (Accept, Assess, Act, and Alert). This information is also on your employee badge for quick reference.

2. If you have not already done so, sign up for our mass communication system, Send Word Now. It is important that we have your correct information so you can be contacted quickly in an emergency. To register, go to https://uphdm.sendwordnow.com/homepage.aspx

3. Review your department safe areas. If a person with a weapon were to enter your area, where would you go? This information should be outlined in your department safety management plan. Consult with your supervisor or manager if you have questions regarding these plans.

4. We have provided three videos on the Intranet (Emergency Response Procedures area) for your benefit. The videos address general workplace violence, active shooter response, and intimate partner violence. The video links are:

a. Flash Point for Healthcare – general healthcare workplace violence information - https://vimeo.com/169737101

b. Shots Fired for Healthcare – healthcare active shooter response - https://player.vimeo.com/video/127159546

c. Silent Storm – intimate partner violence awareness - https://vimeo.com/169737102 5. If you have not already done so, please complete the “Bleeding Control Bag” Net Learning

module. This module provides education on how to use one of the 28 Quik Clot bleeding control kits placed throughout the hospital campuses. You’ll find the module in your “My Courses/Classes” queue.

2 Lastly, remain alert to your surroundings. If you see something unusual, report it immediately to your

supervisor or Public Safety Dispatch (16476). If the threat is imminent, dial 777 (241-7777 from cell phone).

Questions? Please Contact: Scott Draper, Risk Manager & Safety Officer (241-8377) or Mike Wilwol, Public

Safety Manager (241-4218)

Infection Prevention News: “Dress for the Occasion: Precautions” Case 1: 4 month old presents with a 3 day history of an upper respiratory infection. Wheezing and coughing are noted along with congestion, fussiness and poor oral intake. In the Emergency Department (ED) the patient is noted to have respiratory distress and retractions. Sibling recently diagnosed with Respiratory syncytial virus (RSV). Physician orders a Respiratory Filmarray. Question: What PRECAUTIONS are needed for this patient? Answer: CONTACT and DROPLET Why: Even though the sibling has had a recent RSV infection which requires only CONTACT PRECAUTIONS there are other organisms that could be present requiring DROPLET PRECAUTIONS also. The most common organisms requiring DROPLET PRECAUTIONS in infants and young children are influenza, pertussis and mycoplasma pneumonia. Other common organisms requiring both DROPLET and CONTACT PRECAUTIONS in infants and young children are; adenovirus, and Human rhino/entero virus. Case 1 continues: The filmarray polymerase chain reaction (PCR) comes back negative. Pt continues to have a harsh productive cough and you need to suction their secretions. Question: What PRECAUTIONS are now needed? Answer: No pathogen has been identified so transmission based precautions (contact, droplet) can be discontinued but STANDARD precautions remain in effect. Remember, STANDARD precautions means avoidance of contact with blood or body fluids so when suctioning this patient appropriate PPE should be used (gown, gloves, mask). Routine cares are conducted without PPE but with good hand hygiene (always!). Remember always dress for the occasion! Even if there is not a known organism to help identify isolation needs, STANDARD PRECAUTIONS are in place for ALL patients.

Case 2: A 78 year old man presents to the ED with fever, respiratory distress, constant productive cough, SOB, and hypoxia. He is somewhat incapacitated and is unable to cover his cough. The physician orders a respiratory filmarray and you are going to obtain this sample. This is not during the known influenza season. Question: What PPE (personal protective equipment) is needed for this situation? Answer: To obtain the specimen (and while performing other tasks with possible respiratory secretion exposure) utilize a mask (with eye protection) and gloves at a minimum. Consider gown if likely to contaminate clothes (i.e. copious secretions). Why: Even though this is not flu season, adults can have organisms that require specific PRECAUTIONS. Utilizing the appropriate PPE when the causative organism is unknown is dependent on the patient’s clinical presentation. If organism/pathogen is known, refer to isolation table on the infection prevention tab. If unknown, utilize STANDARD PRECAUTIONS and PPE appropriate for the task being performed. Case 3: Your patient is incontinent of diarrhea. The stool filmarray is pending. Question: What PRECAUTIONS are needed? Answer: CONTACT, until filmarray results are back. If negative and/or non-infectious etiology is suspected, change to STANDARDPRECAUTIONS. If positive see isolation table for organism specific PRECAUTIONS. Why: As per the “EMPIRIC PRECAUTIONS for clinical syndromes” on the isolation link of the infection prevention webpage, individuals who are diapered or incontinent should be placed in CONTACT PRECAUTIONS until the diarrhea subsides or determined to be non-infectious. This is because the

3 environment could be heavily contaminated if the patient is incontinent. This helps to minimize spread and keep healthcare workers clothing clean and hands free from contamination. Please refer to the clinical tab on the intranet then go to infection prevention tab to help answer questions or contact the infection prevention department at 241-6826.

UnityPoint at Home Specialty Pharmacy Launching in Central Iowa

UnityPoint at Home is expanding its pharmacy operations to provide full-service specialty pharmacy services. UnityPoint at Home has provided infusion pharmacy services for more than 20 years. The additional services will enable UnityPoint Health to provide medications with unique handling, storage, dispensing, and clinical management requirements to patients with complex conditions such as cancer, multiple sclerosis, HIV, hepatitis C and rheumatoid arthritis. This strategic initiative aligns directly with our goal of delivering superior care coordination. Specialty pharmacies provide a higher degree of patient “touch”, coordination, and reporting than traditional pharmacies. At the same time, providers are offered increased access to information regarding the status of their patients and the medications prescribed. UnityPoint at Home already has begun providing specialty pharmacy services to UnityPoint Health self-insured health plan members. On July 1, UnityPoint Health employed and aligned providers in Central Iowa will be able to access the specialty pharmacy’s additional services for any of their patients. Rollout to the remaining participating regions will take place though 2016 and early 2017. The specialty pharmacy is located at the UnityPoint at Home office in Urbandale, IA. To schedule a tour or to learn more contact Chad Mentele, Specialty Pharmacy Manager, at 515-557-3267 office or Chad.Mentele@unitypoint.org. More information is also available at unitypoint.org/specialtypharmacy.

What Questions Do You Have For Me? Submitted by Paige Moore, Director of Patient Experience

Review of the “E” in AIDET

In the February edition of Provider Focus, we reviewed the AIDET + the Promise communication framework.

You may recall that using the AIDET framework can help us communicate more clearly with patients, take the

guesswork out of care being provided and help reduce anxiety for patients and family members.

A • ACKNOWLEDGE

I • INTRODUCE

D • DURATION

E • EXPLANATION

T • THANK YOU

+ • THE PROMISE

4 In the July edition, we will be focusing on the final step of “E” which is asking “What questions do you have for

me?”

As a reminder, the “E” in AIDET includes an explanation of why you are doing what you are doing and what

the patient should expect. The explanation should be closed by asking “What questions do you have for me?”

Why ask “What questions do you have for me?” instead of “Do you have any questions?”

There are several benefits to using “What questions do you have for me?” as opposed to “Do you have any

questions?” from both the patient and family perspective as well as from the provider perspective. This is one

of the easiest changes to verbiage that can make the most significant impact during a patient encounter.

From the patient and family perspective:

Patients or family members can be hesitant to ask additional questions or share additional concerns because

they know providers are very busy and they do not want to be perceived as a nuisance. Asking, “What

questions do you have for me?” uses more open-ended, inviting language and you are likely to elicit more than

a yes/no answer from the patient or family. Using this specific verbiage also signals to the patient and family

that you have time and are interested in answering their questions or concerns.

From the provider perspective:

Dr. Ryan McCracken is the Medical Director of the Emergency Departments at UnityPoint Health – Des

Moines. The following reflects Dr. McCracken’s experience with using “What questions do you have for me?” in

the EDs.

“I noticed a dramatic change in patient response when I changed my wording. I changed my wording

from, "Do you have any questions?" to, "What questions do you have for me?" and have noticed

improved dialogue with the patients. Patients are more receptive to this phrasing and have asked

important questions or expressed worries they have. This slight change in wording changed from a

head shake "no" to a more engaging conversations with the patients. It was definitely a noticeable

change.”

Dr. Nick Fustino is a Pediatric Hematologist/Oncologist with Blank Children’s Hospital. He also serves as the

Patient Experience Physician Champion for UnityPoint Health – Des Moines. The following is Dr. Fustino’s

experience with the transition from, “Do you have any questions?” to, “What questions do you have for me?”

and the benefits he has experienced.

“I used to have difficulty eliciting questions and wrapping up patient visits. Often times I would use the

phrase “Do you have any questions?” It was polite and not incorrect, but I never realized how it actually

paradoxically discouraged questions. It was like pulling teeth to get at the patient or family’s

concerns. The phrase almost sounds paternalistic and can make patients reluctant to ask questions. Our

entire physician group now uses the phrase “What questions do you have for me?” which has been much

more effective at eliciting questions from patients during the visit. It is a much more patient-centered

phrase, does not take any longer to say and probably doesn’t cost me any more time. Use of this verbiage

probably even saves me and our nurses some phone calls after the patient leaves because we are able to

address any questions or concerns during the visit. Some of us have adopted other versions of this

depending on the situation. For example, we may say “I have been doing a lot of the talking (especially

after explaining the pathophysiology of a disease process). Let me pause for a moment and ask what

questions do you have?” or “What else can I do to help today? I have time.” These phrases can help keep

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the dialogue open and elicit important concerns. Below are a few examples of what I’ve heard after asking

“What questions do you have for me?”

“I have started taking [name the herbal supplement]. Is that going to interact with this

chemotherapy?”

“So wait, I don’t have cancer, right?”

Sometimes the patient will bring up a critical issue that I might have missed or finally bring up their chief

concern.”

Challenge!

Try incorporating “What questions do you have for me?” into your patient interactions. See if you get more

questions or information from your patients.

If you have any patient experience questions or suggestions, please contact Paige Moore, Director of Patient

Experience, at 515-241-3473 or paige.moore@unitypoint.org.

EPIC Provider Updates Placing Imaging Orders: Timed vs. Stat

Important to Remember: when placing imaging orders, please be sure to indicate “Frequency” as appropriate Timed Imaging Orders – to be performed on a specific DATE and/or TIME should not be placed as STAT if study is to be performed on “X” date and/or at “X” time STAT Imaging Orders – to be performed IMMEDIATELY

--- See screenshots below ---

Timed Orders

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STAT Orders

Discharge Summary – Providers

The Inpatient Physician Advisory Committee approved to change the Discharge Diagnosis section within the Gen IP DC Summary from a *** (wildcard) to @hprobovrvedetailed@. This will make it easier for the provider to see all hospital problems that have been resolved as well as other problems that haven’t been resolved. This will also help explain the severity of illness of the patient within the discharge summary.

Missing Problem BPA - Providers

The Missing Problem BestPractice Advisory (BPA) has been updated to fire after 12 hours instead of every hour. This change will allow providers to complete orders before being required to address the Problem List.

Additional Workspaces – Providers

All providers will now be able to have one home workspace and four charts open at the same time. This is consistent between both ambulatory and inpatient providers. As always please be cautious that you are in right patients chart at the right time.

Cosign Notes, My Incomplete Notes and Transcription Folders in In Basket - Providers

Currently the Cosign Notes, My Incomplete Notes and Transcription folders are not visible within the In Basket to a number of providers. These folders were hidden because they are ambulatory-specific folders and they were not made available as each site went live on Epic Ambulatory. On June 21, these folders will become available to those providers that previously did not have access to them.

If you are a provider that works primarily from your ambulatory context, you should work your Cosign Notes, Incomplete Notes, and Transcription folders before working your Hospital Chart Completion folder.

If you are primarily working as an inpatient provider, you should work your Hospital Chart Completion folder first.

If you complete the same message from any one of the three folders, it will complete out of all three.

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Welcome to the UnityPoint Health Family: Welcome to the UnityPoint Health – Des Moines – East Des Moines Family Medicine Residents:

Daniel Hanson, M.D. graduated from Ross University School of Medicine. He

received his B.S. in Microbiology and Spanish from University of Wisconsin-Eau

Claire. His hometown is Mendota Heights, Minnesota. One of his hobbies

includes traveling. He was able to explore this when he studied abroad in Spain

for 5 months in college and received the opportunity to expand his Spanish

language skills.

Sarah Jones Ketter, D.O. graduated from Rocky Vista University College of

Osteopathic Medicine. She received her B. S. in Cellular and Molecular Biology

from Fort Lewis College. Her hometown is Loveland, Colorado. She enjoys

gardening, hiking, and cooking.

Samantha Keady, D.O. graduated from Des Moines University College of

Osteopathic Medicine. She received her B.S. in Biology from Northwestern

College with a minor in Psychology. Her hometown is Conrad, Iowa. Her

interests include fitness, weight-lifting, and nutrition. She and her husband are

expecting their first child in October.

Eryn McClutchey, D.O. graduated from Des Moines University College of

Osteopathic Medicine. She received her B.A. in Communications Disorders,

Spanish and her M.S. in Speech-Language Pathology from University of

Wisconsin-Eau Claire. Her hometown is Oconomowoc, Wisconsin. She spends

her personal time with her daughters being outside and doing extra-curricular

activities.

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Kavita Powaria, M.B.B.S. graduated from Lady Harding Medical College in

2000. She completed a preliminary year in Internal medicine at the University of

Massachusetts Berkshire Medical Center. Her hometown is Faridabad, India

which is a suburb of New Delhi. Her native language is Hindi.

Meredith Swenson, D.O. graduated from Des Moines University College of

Osteopathic Medicine. She received her B.S. in Biology from Calvin College.

Her hometown is Johnston, Iowa. She likes any water activity, crafting/do-it-

yourself projects, and being involved with church.

Welcome to new members of the Medical Staff Services Department:

Please welcome Carly Hansen to her new position as Administrative Secretary. Carly is a recent graduate of Faith Baptist College and Seminary in Ankeny, and holds a degree in Office Administration. Please stop by her office at Iowa Methodist Medical Center and welcome Carly!

Please welcome Amy Witte, Credentialing Specialist, to her new position at UnityPoint Health-Des Moines. Amy has been with UnityPoint Health for 14 years, starting at the clinic in Altoona, then working in provider enrollment for UnityPoint Clinic. Amy is processing initial applications and is located at Iowa Lutheran Hospital. Please stop by and welcome her to her new position.

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Welcome to UnityPoint Clinic®:

Please join in welcoming Lisa Carlson, M.D. to UnityPoint Clinic Lakeview - Pediatrics (Float).

Lisa completed her medical education at University of Texas Southwestern and her

undergraduate education at University of Texas at Austin with Bachelor of Science in Chemical

Engineering.

Lisa's specialties are within patient education, adolescent health, pediatric care, pediatric

oncology/hematology and pediatric health maintenance.

Dr. Carlson is motivated in providing quality pediatric health care, creating a working relationship

with patients and families and watching patients grow from infants/young children to young

adults.

Say hello to Dr. Carlson as you see her around the clinics!

We are proud to welcome Jenny Butler, M.D. to UnityPoint Point Clinic Family Medicine –

Clarke County. Jenny completed her medical education at the University of Iowa. She also

completed her

residency at Iowa Lutheran Family Medicine in Des Moines, Iowa. She is board certified by the

American Board of Family Medicine. Butler specializes in family medicine, occupational

medicine, and is certified to perform Department of Transportation (DOT) physicals.

Dr. Butler comes to the clinic from Unity Point Health – St. Luke’s Cedar Rapids, Jones Regional

Medical Center where she practiced from 2008-2016 acting as the Urgent Care, Inpatient, and

Occupational Medicine and Employee Health Medical Director. She was honored as the Jones

County Iowa Top 20 Leaders under 40 in 2015 in addition to receiving St. Luke’s Hospital

Quality Award.

Say hello to Dr. Butler as you see her at UnityPoint Clinic and Clarke County Hospital!

Please help us in welcoming Michelle “Rhea” Hutchcroft, A.R.N.P. to our UnityPoint Health Family, Rhea is joining us as a family medicine provider at UnityPoint Clinic Family Medicine – Parks Area. Rhea completed her medical education at Graceland University. She also completed her undergraduate at Simpson College. She is board certified by American Association of Nurse Practitioners. Rhea’s clinical interests include family medicine, immunizations, women’s health, chronic medical conditions and psychology.

Say hello to Rhea when you see her at the clinic!

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Please join in welcoming Kimberly Joliet, D.O. to UnityPoint Clinic Pediatrics – Lakeview.

Kimberly completed her medical education at Des Moines University and she received her undergraduate degree from Creighton University. Dr. Joliet completed a residency at University of Nebraska Medical Center/Creighton University Joint Pediatric Resident Program and served as chief resident in her final year. She is board certified by the American Board of Pediatrics. Dr. Joliet’s clinical interests include allergies, asthma, weight management and adolescent and sports medicine. Say hello to Kimberly at UnityPoint Clinic Pediatrics – Lakeview!

UnityPoint Clinic Family Medicine – Clarke County welcomes Amy Lortz, P.A. - C. Amy completed her medical education at Des Moines University. She also completed her undergraduate degree at Iowa State University. Amy is board certified by the National Commission on Certification of Physician Assistants. Amy’s clinical interests are family medicine, acute care and women’s health. When she isn’t at the clinic, you can find Amy traveling or spending quality time with her friends and family. Say hello to Amy when you’re in Clarke County!

We are proud to welcome Jennifer Jenkins, D.O. to UnityPoint Clinic family! Dr. Jenkins will be a family medicine provider at UnityPoint Clinic Family Medicine – Southglen.

Dr. Jenkins completed her medical education at Philadelphia College of Osteopathic Medicine

and her residency at Heritage Valley Family Medicine Residency. She is board certified by the

American Board of Family Physicians and the American Osteopathic Board of Family

Physicians.

Jennifer became a family medicine provider because she loves the continuity, variety and

personal interaction she has with her patients. When Jennifer isn’t at the clinic you can find her

spending time with her family and friends, walking her dog and traveling!

Say hello to Dr. Jenkins when you’re out at Southglen!

Welcome to Blank Children’s Hospital:

Please join in welcoming Shelley Hancock, M.D., pediatric critical care, to Blank Children’s!Dr. Hancock joins us from University of Texas Health Science Center at San Antonio,

where she was an attending physician in the Pediatric Intensive Care Unit and

Pediatric Cardiac Care Unit. She completed her residency in pediatrics and fellowship

in pediatric critical care medicine at University of Texas Health Science Center at San

Antonio. She also attended medical school there.

Dr. Hancock will be working in pediatric critical care medicine with Drs. Tracy Ekhardt

and Judy Walker. To reach Dr. Hancock, please call 210-392-4178.

As you see Dr. Hancock around, please welcome her to the Blank Children’s family!

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June 2016 CME Calendar:

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Hawaii42

Start making plans to attend. Details can be found at: unitypoint.org/Hawaii

To submit articles, please send to Monica Aunan, Physician Liaison at

monica.aunan@unitypoint.org or call 515-241-3480