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Lipid Panel Changes

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Updated Direct LDL Order Education: 7.2.18

As per education provided in June 2018, the UMC lab and financial departments identified that they were receiving no reimbursement for Direct LDLs with Triglycerides less than 400. Based on this, subject matter experts were consulted and a new set of Lipid Panel orders were developed.

You will now find Lipid Panel and Lipid with Cardiac Risk panel for your use.

Contents:

Lipid Panel:

Non-HDL Cholesterol

Triglycerides

VLDL

LDL Calculated

HDL

Cholesterol

 

Lipid with Cardiac Risk:

Non-HDL Cholesterol

Chol/HDL

Triglycerides

VLDL

LDL Calc/HDL

HDL

Cholesterol

 

BOTH panels will have a calculated LDL and reflex Direct LDL when Triglycerides are over 400.

If the triglycerides are over 400, LDL Direct will reflex

If the LDL cannot be calculated you will see this comment.


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Admission PowerPlan: Oncology Patient

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When admitting a patient for Oncology (typically 4E) we must use the ONC General Inpatient Plan. You can find this plan by searching the word General just like you would the General Medicine Plan.

Once in the plan you will notice several differences that is important to oncology patient care. In Patient Care you have the Access Implanted Port, and Perform Neurological Checks.

In the ONC General Inpatient Plan there is also a medication section. This section includes biotene mouthwash, lidocain-prilocains topical (lidocaine-prilocain 25%), and heparin flush.

The final difference in the plan is under Consult MD. You will see in this field a required order, Consult MD. This allows you to choose to choose what service to notify. You can notify either Oncology or Hematology.


Lung Cancer Screening Workflow

Lung Cancer Screening

Based on the results of the 2011 study from the New England Journal of Medicine on low dose CT screenings, UMC now offers lung cancer screening through the Southwest Cancer Center. 

This service is covered by Medicare as health maintenance if the following guidelines are met:

  1. The patient must have a documented shared decision making visit at a Screening Center
  2. The patient must meet the USPSTF requirements for screening
    1. Ages 55 to 80
    2. Smoking history of 30 years or more (an average of one pack a day for 30 years)
    3. Currently smoking or have quit within the last 15 years
    4. No current cancer symptoms requiring a diagnostic workup
    5. Counseling must be provided on the importance of maintaining cigarette smoking abstinence if the patient is a former smoker; or the importance of smoking cessation if the patient is a current smoker and they must be furnished with information about tobacco cessation interventions, if appropriate.
    6. The patient must be entered into the National Lung Cancer Screening Registry through the American College of Radiology

Patients referred to the Lung Cancer Screening program will have a shared decision meeting scheduled with either Dr. Yepes or Dr. Islam.  Our pulmonologists will order the screening CT and provide follow-up on the results of the scan; e.g. regular visits for observation of a nodule, biopsy of a nodule, yearly follow-up for surveillance of a negative CT. 

To order your patient’s lung cancer screening, please select the Consult/Referral SWCC Lung Screening order in PowerChart.  Please educate your patients, they will be receiving a phone call from the SWCC Lung Cancer Screening Program Patient Navigator for scheduling of the initial screening appointment, which will take place at the SWCC, and scheduling of the Low Dose Screening CT of the chest. 

Outpatient Surgery Plans

It has been brought to our attention that the Adult Outpatient Surgery Plan is not being utilized as designed.  When this plan is not used correctly, it affects patient care.  This causes a delay in care and results in a waste of resources.  To ensure your requested orders are done efficiently and correctly, please perform the following workflow:

 

Place the Adult Outpatient Surgery Plan on adult patients only.  The Pediatric Outpatient Surgery plan is for pediatrics only.

The Plan is divided into phases.  Each phase is very specific for the area.  PACU needs ALL orders placed in its phase. 

 

To avoid confusion and delay of patient care, place PACU orders in the PACU phase.  When “one off” orders occur, the nurse cannot see the order.  To add an order to the PACU phase, click the “Add to Phase” button.  This will keep all PACU orders together.

 

By keeping all the area specific orders within its designated phase, phone calls of clarification can be avoided.   When we work as a team and follow this workflow, we become more efficient and provide a better level of care to our patients.

~UMC Clinical IT

Automation of Bedside Sedation Process

Starting 4/3/2018, the bedside sedation process will become electronic

The following plans will be available for your use and should be placed prior to using sedation for a procedure at the bedside.

You will notice the plans have four phases.  The Provider will ONLY complete the FIRST THREE phases. (Pre, Intra, Post-Procedure).  Nursing will complete the Fourth phase.

The first order is the Sedation History and Physical Update Order and this order has a form attached to it that the physician will complete after signing the powerplans.

Once the plan is signed by you, the following form will appear.  This form must be completed by the physician. 

There will also be two new PowerNote Templates available for use with this process.

  1. UMC Pediatric Sedation Brief H&P (This note is specifically used for sedations done in PICU)
  2. UMC Procedural Sedation Note (this will also be available to Insert as a Sentence in any existing note that has a Procedure Paragraph (Ex: Central line Procedure Note)

 

Laryngectomee Speech Consult Order

A new order is available for use on patient’s that have had a laryngectomy.  The order is called “Laryngectomee Speech Consult”.  When placed, this order will consult Speech/Language for evaluation and treatment and also for care of the patient.  If a speech therapist is not available, it references the policy and procedure for nurses to follow on how to care for a patient with a laryngectomy.  This order should be considered for use on a patient that is status post laryngectomy, has a permanent tracheostomy, or history of laryngeal cancer. 

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Diagnosis Requirement on All Outpatient lab orders

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Announcement per UMC Clinical IT:

As of 8:00 AM Monday, February 19th, 2018 all Outpatient Lab Orders (orders placed from a clinic encounter in a future state) will require a diagnoses associated with it.  As shown below, the diagnosis tab will show the blue ball/white “X” indicating the need for a diagnosis code to be added. This workflow is the same as the current radiology order process.  

This change will require all ordering clinicians to associate the appropriate diagnosis at the time the outpatient order is placed. 

NOTE: All EXISTING Future Lab Orders that are still active will require the diagnosis to be added to the order when activated in the lab. This means any orders placed from the clinics prior to Monday, awaiting your patient to get their labs drawn, will require the UMC laboratory registration staff to try and identify a patient’s diagnosis for that visit from the chart. If there is no diagnosis associated, then additional steps will be required to perform the order; including possibly calling the ordering provider/clinic, and ultimately canceling the order if no diagnosis can be found or ordering provider approval cannot be reached (UMC Laboratory is solidifying this workflow).

This change is being implemented to improve the amount of rejected lab charges declined due to the lack of diagnoses.

 

 

 

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Tamiflu Dosing Reminder

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Per manufacturer and pharmacy recommendations, Tamiflu should be adjusted for renal impairment.

Flu Season is upon us and with so many providers prescribing Tamiflu, it is important to remember that this drug needs to be renally dosed.

(there has been a large influx of Dose Range Checking Alerts on patients with poor renal function)

See screenshot below:


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Fecal Occult Blood (FOB) Outside Source Powerform

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Fecal Occult Blood (FOB) Outside Source section has been added to the Basic Labs Outside Source Ad Hoc form to document FOB results a patient may have received from a provider other than UMC, UMCP, or TTP. This section can be accessed from the Basic Labs Outside Source form or from the Health Maintenance tab under Colorectal Cancer Screening. Results will satisfy HM for 365 days.

The Performed on date should reflect the date the test was resulted, not the day it is being charted in Powerchart.