GSAA | HBS

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Advanced Care At Home Intro

By

On June 8, 2024

In Announcements

Advanced Care At Home (ACAH) is coming to the GSAA and that date is July 9th. 

Here is a quick refresher on what ACAH is and how it affects us.

  • What is ACAH? A program that takes care of patients who meet inpatient criteria but are stable enough to be managed at home. Think your failed CDA patients, cellulitis patients who failed oral therapy, CHF patients who need IV diuresis with stable oxygen requirements, neutropenic fever patients, etc. It is NOT the same as a discharged patient on home health. These patients are seen at least daily by nurses and virtual ACAH physicians. Labs (within 4 hours) and imaging are available. Patients are set up with technology to allow them to stay connected to the medical hub and communicate their needs. 
  • How it affects us: Patients that normally need admission who are candidates for ACAH may be transferred directly from ER to ACAH (without HBS involvement). Patients on your panel may be discharged sooner to ACAH. 
  • HBS roles and responsibilities: Screen through your list daily to see if there are any candidates for this program. Inform your PCC and ACAH Hospitalist to review case for ACAH admission. If approved, complete POLST, discharge summary, and order for DC to ACAH (DCI and AVS not needed). 

There will be a formal presentation during our next department meeting. For now feel free to review the following powerpoints.

ACAH HBS Role Card
ACAH Introduction Powerpoint

Medications in the Management of Delirium

By

On May 24, 2024

In Education, How To, Protocols

MedicationUsual DosageSpecial Considerations
Haloperidol0.5 to 1mg q4h PO/IM/ IV prnBest evidence in treating delirium, can cause akathisia as high potency, Needs telemetry if using IV
Olanzapine2.5mg QHS or BID and 1.25 mg q6hrs PRNCan be deliriogenic. Good for sedation
Quetiapine12.5mg to 25 mg QHS PO plus 12.5mg q6h PRNSedating, anticholinergic. Worse for QTc. Best for Parkinson’s. LBD
Risperidone0.5 mg BID and 0.25mg q8hrs prnHigh potency, can cause akathisia
Valproic Acid250mg BID, can increase to 500mg BID if well toleratedCheck VPA level 5th day (trough), Check LFTs, NH3
Gabapentin100-300mg TID, scheduled or PRNCheck renal function before starting. Good for anxiety as well
Trazodone12.5mg BID, titrating up to 25mg BID to TID, standing or PRN for sedationUse only for sedation. Can be deliriogenic

Cardiology Workflow for Transfers for Inpatient Cath

By

On May 1, 2024

In How To, Protocols

1. Write a discharge summary (but use transfer summary template (see picture below); this is still in question per Eric Au’s email but Parv Kaur (HIM liaison) will clarify with medical records.  For now, we should write a DC summary note

2. Ensure there is an order for NPO after midnight

3.Sign ambulance form (only done at Fremont)

4. Use “INTERFACILITY CARDIAC TRANSPORT ORDERS” order-set (see attachment 2).  This order set includes the LOA order and cardiologist will click on the 4th option “Transport to another facility on a Leave of Absence-Returning”  this will hold the bed for 4 hours (see attachment 3).  Also click “yes” on medication reconciliation.  We should not be writing a separate discharge order. 

Nurse supervisor at SCL/SF will contact FRE/SLN supervisor if patient is staying or being discharged from receiving facility so our bed can be released. 

Transfer between SLN / FRE

By

On April 23, 2024

In Announcements, How To, Protocols

Admitting Provider

  • Patient evaluated and requires hospitalization
  • If Unstable
    • Perform H&P and Admit orders
  • Is Stable
    • Complete H&P, place admit orders, complete transfer summary using .GSAATransfersummary in hospital course of DC summ portion. Place transfer orders

Transferring Provider

Evaluate patient prior to transfer and ensure stable for transfer. Update transfer summary at time of discharge (if patient no transferred until the next day must be updated at time of transfer)

Receiving Provider

  1. Go to Direct Admission Navigator
  2. Choose option under “Patient is in a Hospital floor or ICU Bed”
  3. Select “Restart from Previous Admission”
  4. Review orders and complete admit order
  5. File H&P note and use .GSAAINTERVALHANDP. Reference the name of the admitting physician who completed the full H and P and transferring physician from prior encounter. Copy the prior H and P into your note.

Interval H&P Requirements

Patient must be examined at time of arrival to the receiving facility.  Labs/imaging from the last time patient seen must be reviewed and any changes in physical exam or assessment/plan should be documented. 

Guidance

• Please do not copy orders for transfers between SLN and FRE

• Please be mindful of duplicate orders if copying orders for other facilities (ensure no repeat imaging-ct head etc order, transfer orders continued)

KPHC Spring Update

By

On April 22, 2024

In Announcements

The Spring Update is this Saturday, April 27, 2024. Visit What’s New How To for details about the Site Freeze and Environment Pause happening on April 24 – 25, 2024, and the System Interruption happening the day of the Update.

Important change in this update:
The Work/Activity Status activity tab is now Activity RX (ARX). Each section or form has been modified. For details, including known issues and instructions for completing/managing ARX, see the job aids on WNHT.

Stroke Alert – HBS Role

By

On March 4, 2024

In Protocols

Stroke Alert

  • Respond to bedside
  • Briefly assess patient with BEFAST – Stroke or no stroke?
  • If possible acute stroke, FaceTime TeleStroke (7am-12midnight),
  • give KP phone to Charge/relief RN/ ANM for exam
  • Obtain history and review chart for Hx: ever head bleed, surgery in 3 weeks, GI bleed, platelets, sq heparin, anticoagulants (Warfarin, Pradaxa), other thrombolytic contraindications, POLST form
  • Enter Initial CVA/TIA Orderset for thrombolytic eligible patient
  • Evaluate most recent BP, GFR, RBS, is patient on SQ HEPARIN?
  • Examine patient for medical issues
  • Discuss with TeleStroke if potential thrombolytic/EST

If “Go” for Stroke Alert: *Note: Creatinine waived for Stroke Alerts*

  • Discuss w/ TeleStroke if any labs are needed – If YES, alert lab/RN.
  • No labs are needed for thrombolytic unless suspected abnormal (if on sq heparin need PTT)
  • If on Coumadin – need INR today
  • GFR in last 6 months
  • If BP >185/110, assure patient gets labetalol per order (labetalol up to 20mg, then nicardipine ggt are prechecked)
  • Update family
  • Accompany patient to CT
  • TeleStroke Physician obtain consent for CTA and order Thrombolytics for Ischemic Stroke

After CT/ CTA

  • Discuss w/ TeleStroke on patient destination
  • if NO thrombolytic and NO EST, back to floor if appropriate
  • if only thrombolytic, to ICU
  • if EST (+/- thrombolytic), inform House Sup of imminent transfer

ICU

  • Initiate post thrombolytic Orderset
  • Complete NIHSS and note if not already done
  • Update family
  • Call local on call neurologist if needed (i.e., post thrombolytic patient staying, non-thrombolytic patient with other neuro issue)

Medication Ordering for Non-KP Pharmacy

By

On February 16, 2024

In How To

For medications that need to be sent to non-KP pharmacy and have already been released by RN, see below for how to reorder and change pharmacy.
1) Click on Ancillary Order Encounter

2) Click on reorder button for any medications that need to be ordered

3) Associate diagnosis to medications then choose the appropriate pharmacy. Sign orders.

Viral Respiratory Illness Isolation Duration Guideline

By

On January 16, 2024

In Guidelines

Influenza
Isolation:  Droplet 
Duration:  7 days after illness onset or until 24 hours after resolution of fever and respiratory symptoms, whichever is longer. Immunocompromised pt remain on for duration of hospital stay.

COVID-19
Isolation:  Enhanced Respiratory (contact, droplet, eye protection)

Asymptomatic or Mild Illness
10 davs after symptom onset or date of positive result, with
improvement of symptoms and resolution of fever for > 24 hours without the use of fever- reducing medications. No
repeat test required

Severe or Critical Illness
At least 10 and up to 20 days from symptom onset or date of positive result, after resolution of fever for at least 24 hours without the use of fever- reducing medications) and improvement of other symptoms and repeat negative test results. No repeat test
required after 20 days

Subset of Severely Immunocompromised
At least 20 days from symptom onset or date of positive result. Test- based strategy with negative test results prior to removal of isolation precautions. Consult ID/IP team to
review in acute care setting

RSV
Isolation:  Contact
Duration:  during hospitalization for pediatrics and immunocompromised individuals.

Regional Transfer Center

By

On January 4, 2024

In How To, Protocols

For any patient that needs transfer for higher level or specific care…please call 855-327-0509 to initiate the process. This service team operates 24/7, and will coordinate all aspects of care to streamline the transfer. This replaces the prior method of PCC/House Supervisor initiated transfers. If you forget the number, it can be found on ClinConnect under “All KP Patient Transfer Center”. Cortext can be subsequently used for follow-up communication or to confirm ETAs, after the initial request via phone.

HBS Holiday Party 2023

By

On December 19, 2023

In Photos

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