Cancer Screening for our patients

At JS Free Clinic we are able to provide affordable recommended  screening to our patients for some but not all of the preventive measures recommended by the USPSTF (United States Preventive Services Task Force).
http://www.ahrq.gov/clinic/pocketgd1011/

In this post I will review cancer screening we are able to provide to our patients and how we order them. In  future posts I will focus on other types of screening and preventive measures. For all tests I am discussing recommendations for patients with no special or increased risks. 

Colon cancer--We cannot obtain free colonoscopy for our patients. Colonoscopy is expensive, however annual  Fecal Occult Blood Test (FOBT) immunoassay done annually is inexpensive and is another recommended way to screen patients.

 For patients 50 years and older , order FOBT by checking the box on the exit sheet and asking a rooming assistant to instruct the patient in how to use the kit. The age at which to stop screening is less clearly defined but consider discontinuation when the life expectancy is less than 10 yrs or after 75 years of age.

Cervical Cancer--We send specimen for Thin Prep Pap with reflex HPV to Reston Hospital at no cost to our patients. The current recommendations are to start pap tests at age 21, and repeat every 3 yrs; Pap testing can be discontinued after age 65 years. For patients who have never had pap testing and who are older than 65 but in good health, and able to be examined, it is reasonable to do a pap test.

Breast Cancer--Mammography is recommended for women 50 years and older every 1 to 2 years. The current recommendation is to discuss  with the whether to obtain mammograms during between age 40 and age 50 as it is less clear if screening with mammography is beneficial is this age range. Discontinue offering screening after age 75. Order mammography by completing a Washington Radiology Associates form for "screening mammography", and asking the patient to make an appointment. This service is provider free to our patients.

Routine screening for prostate, ovarian, lung and other forms of cancer are not recommended by the Task Force.

Evaluating Outstanding Referrals

Tuesday, July 3, 2012

Evaluation of All outstanding Referrals

Lilian and I are going through all the outstanding referrals for whom appointments have not been obtained. You may see a message (JELLYBEAN to the right of T in the message section of the EMR) asking you to evaluate the need, and the urgency of a specific referral that has been made in the past --for a patient that you will be seeing at a scheduled visit. After you see the patient, you can TIME STAMP, and reply and send the message back to Lilian to answer the question about the patient after you have made the determination of need.

The T Jellybean is red if you have an urgent message. You have a message if there is a number inside the jellybean.  

So Please check all your messages before you see your patients the next time you are in the clinic.

Carrying on

We all have a lot on our minds about big changes looming for clinic, but we still have to carry on;
Here are just 3 things this time:

1) Please look at your message buttons--both the one for internal messages, and the important clinical tasks in the telephone encounter button.  These are often important tasks, messages about clinical care from staff or other providers.

2) It is critical that we all update the medication list before we lock that note.  It's not enough to order the medication order from NS on the exit sheet, you also need to put the medication into the EMR. You do not need to type out the order in the plan if you order it. If you don't understand how to use this function --please ask staff to help you. Help is available.

3)And something you might not have thought about:
If you use an interpreter during a clinical visit it's important to document WHO did the interpreting. You can make this note as another line in the Chief complaint.

Signing up for Insulin samples

Clinic staff discovered this week  that nurse practicioners could not sign up for samples at the Sanofi site. And a resident found out that samples could only be sent to her main practice site. So thanks to those who have tried. If you can sign up--please do, or ask Lilian to do it for you at the clinic. If you can sign up and receive samples to donate to the clinic, they will be appreciated. And Thanks again for trying.

Insulin Again

Acquiring insulin at an affordable price for our pateints continues to be a struggle for JS Free Clinic

We have, with the persistent effort of our staff, especially Victor, applied for insulin to PAP programs for all our patients that are eligible, and are trying to make sure we have samples for patients who are not eligible. 

To this  end, I would like to ask  all of our providers  to go to this website and register, then request that samples be sent to JS Free Clinic. 

https://www.sanofiservices.us/

Registration will require that you have your NPI number or your state license, and the JS Free Clinic address handy. I was able to request 4 samples of Lantus.  It took me about 5 minutes  to do this.

Referrals --All through the EMR!

Even for our in house consultants--Dr. Ray Hoare for Cardiology, and Dr. Deborah  Leiderman for Neurology, please do a referral through the EMR.

You can  type--that you would like the patient to see one of them in preference to an out of house consultant, and why you are referring the patient.

 Lilian will keep a waiting list, and the consultants will be able to easily find the reason for the referral by clicking on  "outgoing referrals".

When you see a patient be sure to check to see if there are any referrals pending so you can evaluate if it's still needed, and the urgency.

Another Blog for JS Free Clinic Providers

At last night's clinical services meeting Winston Liaw, our medical director,  suggested that we keep track of provider updates on a Blog. So today's updates are in this post in addition to the  email.

The thing about a blog is that it is not just a one way  memo. It can be a forum for questions and answers, corrections, and additions. So consider using it that way, and let's see  how it goes.

All of this is in an effort to keep all our providers updated on the information we all need to take care of the patients.

Pharmacists at JS Free Clinic

NOVAScripts pharmacists Sarah Long and Huyen Nguyen are now on site  for patient counselling and provider consultation  Monday through Friday 9 AM to 1 PM. Seek them out, introduce yourself, see how they can help our patients. 

 

Insulin Availability --PAP ONLY 

For the approximately 10 patients that we have who do not have a Social Security number and are using Insulin, we have applied to Lilly for Humulin (NPH, R, 70/30), as we cannot obtain Sanofi or NovoNordisk products for them. Most of us are more familiar with treating patients with Lantus, Apidra, Levimir and Humalog or Novalog--so it's time to refamiliarize ourselves with how the older insulins work. 

We have been placing  an encounter note in these patients' charts documenting the insulin ordered  and an a starting dose, so that when supplies of their current insulin are exhausted, they can be switched to the new regimen.

 

All other patients using insulin need to apply to a PAP program if they have not already done so to continue to receive their insulin. Victor has been trying to sign up all patients as they come in. Check with Victor or your patient at the time of a visit to make sure the application has been signed. 

 

Men's Support Group

Doug is starting a   Men's Support Group. Please mention it to any male patients who seem like they might benefit or be receptive.  Sign-up sheets have been placed  on a clipboard in the medical provider area and at the front desk with Marlena.   Please contact  Social Workers Grace or Doug with any questions. 

 

Diabetes Education

1) Individual Appointments with a trained nurses for diabetes education with an established curriculum are now available. Please make a  general note about your concern--such as "review diabetic diet", "instruct in testing Blood glucose fasting and 2 hrs post largest meal 3x weekly", or "diabetic patient has never had any education --needs to start with general information and diet instruction".

2) GMU Nursing Graduate Students are holding Spanish and English Group Diabetes Education classes  through April 2012. Patients can still enroll.

3) Kim Gauthier, Volunteer Dietician from Sanofi-Aventis, holds Spanish and English group diabetes classes that focus on diet for patients using Insulin; Classes are held on Wednesdays one time a month.

 

Order all diabetic education on the exit sheet.

If you are unsure  about what might work best for your patient contact Diane Henzey NP, Adult Clinic Coordinator. 

 

GYN clinic provided by GMU Path program

On two Wednesdays per month  GYN clinics led  by Renee Milligan, GMU faculty NP with expertise in GYN will be offered in the afternoons started at 2 PM.  If you would like your patient to be seen in this clinic for a GYN problem or for a Pelvic and Pap, write the request on the Exit sheet. Contact Renee or Kathy Dickman NP, director of the GMU faculty practice with questions. 

Flu Vaccine

We still have vouchers for flu vaccine for our patients. Continue to ask your patients if they've received flu vaccine and give out vouchers.