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That’s Bad Form!. Michael Ben- Aderet , Tim Cushing, Derek Huang, Alvin Liu, John Sy, and Summer Williams. Why?. Too many forms Forms need to be updated Incomplete forms Too many medical errors Nurses paging housestaff about orders Housestaff unsure about available options. Goals.

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that s bad form

That’s Bad Form!

Michael Ben-Aderet, Tim Cushing, Derek Huang, Alvin Liu, John Sy, and Summer Williams

slide2
Why?
  • Too many forms
  • Forms need to be updated
  • Incomplete forms
  • Too many medical errors
  • Nurses paging housestaff about orders
  • Housestaff unsure about available options
goals
Goals
  • Simplify Forms
  • Improve Patient Safety and Care
  • Improve Housestaff Satisfaction
  • Meet Government Requirements
slide4
Plan
  • Review all forms that housestaff use
  • Highlight necessary ones that need to be updated
  • Tackle those that are used the most
old cardiology form ov1399 from 2007
Old Cardiology Form (OV1399)From 2007

CLINICAL INFORMATION???

MEDICATIONS???

I‘M AN INTERN…HOW THE HECK SHOULD I KNOW WHAT TEST TO ORDER???

process
Process
  • Reviewed form with Cardiology Dept
  • Came up with form specifications:
    • Patient information
      • Name
      • Medications
      • HISTORY
    • Test information
  • Cardiology WILL change test depending upon clinical history and reason for exam
to be smart
To be smart?
  • What is a smart form?
    • A form that can be filled out online and/or printed
  • Improve legibility
  • Improve accuracy of information
review of cardiology form
Review of Cardiology Form
  • Improved transfer of information to cardiology department
  • Enabled optimal testing to occur
  • Reduce exposure to unnecessary testing
  • No longer need old EKG form – especially as outpatient, just ask clerk to enter into system and patient should present OV card to cardiology department
medicine admission form ov2428
Medicine Admission Form (OV2428)
  • Top 3 forms used by housestaff
  • Consistently being reviewed and updated
  • …but missing a lot
  • A comparison of forms:
    • OVMC – 3 pages
    • Harbor – 6 pages
specifications
Specifications
  • Each section of the form with different specifications depending upon the department involved… for example:

Clerks, Phlebotomy, Laboratory

Medical Administration, Patient Safety, JCHAO

things we cannot change
Things we cannot change…
  • Handwriting – PLEASE WRITE LEGIBLY
  • Dosing errors – PLEASE CHECK YOUR RXs
  • That the RNs will STILL page you about your patient…
basic information section 1
Basic Information – Section 1
  • ICU Added – no longer a separate form
  • Holdover box added – nurses know who to page (especially for hospitalist holdovers)
  • Admission location clear
  • Level of care change indication
diagnosis and assessment section 2
Diagnosis and Assessment - Section 2
  • Specified Isolation
  • What old chart???
  • Don’t forget our neutropenic patients!
physician notification section 3
Physician Notification – Section 3
  • What the heck is a SUPO Form? – JC requirement
  • STANDARD VITALS!!! 
  • Don’t forget to change them if needed!
activity and diet section 4
Activity and Diet – Section 4
  • Fluid restriction box
consult and treatment section 5
Consult and Treatment – Section 5
  • Occupational Therapy
  • IV therapy: continuous vs fixed amount
  • Respiratory therapy
  • Chlorhexidine baths for patients on chemotherapy or with central venous catheters (CVCs) – for nursing
labs test section 6
Labs/Test – Section 6
  • More tests, especially for ICU
  • No more STAT labs – abuse of STAT power
  • Phlebotomy Information
vte prophylaxis section 7
VTE Prophylaxis – Section 7
  • Meets all government requirements
  • Don’t forget to select a contraindication!
medication reconciliation section 8
Medication Reconciliation – Section 8
  • Start, continue, stop?
  • Don’t forget hold parameters and PRNs
  • Home medications MUST be listed in H&P
common medications section 9
Common Medications – Section 9
  • All those and more!... Night float will thank you for that Miralax!
  • GI prophylaxis
  • Prevent therapeutic duplication
  • Those pesky nebs!
insulin section 10
Insulin – Section 10
  • Can’t help you there…
  • But at least you don’t have to write “units”!
pain medications section 11
Pain medications – Section 11
  • The pen is mighty…but checkboxes are easier!
  • I didn’t know we had (insert pain med here)!
  • What is that dose of IV dilaudid again? 2 mg?!
  • Avoid therapeutic duplication problem
code status section 12
Code Status – Section 12
  • Only Attendings can sign DNR/DNI orders anyway…
achievement highlights
Achievement Highlights
  • Eliminated ICU order form
  • Consistent vital signs for patient safety
  • Reduce use of STAT labs
  • Reduce therapeutic duplication
  • Encourage proper use of DVT and GI ppx
  • Eliminate confusion with med rec section
  • Brought in further commonly used medications
assessment of new form
Assessment of New Form
  • Asked housestaff to fill out the old and new forms from a mock case
  • Timed themselves filling out both forms
  • Answered 5 questions based on old and new forms
committees
Committees
  • Both forms approved by MRRC (Medical Records Review Committee)
  • Admission Form must go to P&T committee to be approved (for medications) in early July
  • Will uploaded to the intranet for housestaff to use after P&T committee review
ongoing activities
Ongoing activities…
  • Radiology form update
  • Nuclear Medicine form elimination
  • Insulin Form update
acknowledgments
Acknowledgments
  • Dr. Mark Richman
  • Dr. Mike Rotblatt
  • Dr. Leland Powell
  • Dr. Susan Stein
  • Dr. Katherine Yu
  • Dr. Dennis Yick
  • Dr. Nick Kamangar
  • Dr. Robin Waschner
  • Anna Ziouzina
  • Laura Sarff
  • Karla Nungaray
  • Joy Mata
  • Lori Smith
  • Alma Alvarez
  • Jan Love
  • Carlos Carranza
  • Clerks
  • Nurses
  • Respiratory Therapy
  • Housestaff
ad