1. UIM Clinical Services What is available to help my patients? 7.2.14

2. Case 54 year old female patient presents for a follow-up visit and reports chest pain today. Intermittent, substernal and radiating to the jaw. She feels a little short of breath at times. States her pain is 3/10 right now, but has been as high as 8. In addition, she also notes that she has been tired and urinating more than usual. PMH: hypertension – poorly controlled, low back pain Smoker, lives alone and was laid off from work 3 weeks ago. Occasional ETOH. Has an insurance plan that does not pay for medications. BP 170/92, P 68, pulse-ox 98% RA, BMI 29

3. This is not an ED – what can I do? 1. Does this patient need to go to the ED? 2. Assessment tools and testing 3. Labs and studies 4. Medications and fluids 5. Personnel and types of clinical services 6. Other services in the building

4. Does this patient need to go to the ED? Clinical assessment Attending Nurse - RN

5. Assessment Tools Pulse oximetry Temperature Peak Flow meter Point of care glucose and INR Diagnostic kits on the walls Manual BP cuffs Tuning fork, reflex hammer Anoscope Vaginal speculum Check the drawers – tongue depressors, Gen probes, hemoccult, Q-tips, tape measures

6. Assessment Tools EKG Spirometry

7. Case You obtain a 12 lead EKG which does not show any signs of acute or remote ischemia – normal rhythm. Patient states that the pain is now gone with no treatment in clinic. Repeat manual blood pressure is 168/90. She has been having trouble affording her losartan and HCTZ, so has not taken this in the past few weeks. Fingerstick glucose: 220

8. Labs and Studies Point of care testing: glucose, A1C, INR Stat labs 1 st Floor lab – Rutledge Tower; ART lab; MT Pleasant lab Radiology – 1 st floor RT – you can send patient down and have them come back to the 8 th floor for urgent studies. CT, MRI, Nuclear med also available. Surgery Vascular lab – DVT studies; ABI, etc. Cardiology: Stress testing, Holter, Event Monitors

9. Medications and Fluids IV’s – can be started Saline Full IV pharmacy available – place order in Epic Some p.o. meds available (UIM Survival) Some IM available (UIM Survival) Crash cart for emergencies

10. Case The patient has never been told she has diabetes and is taking no medication for this. She likes Coca-cola and drinks 3-4 per day. Eats a lot of fast food. She does not remember the last time she had an eye exam, and cannot afford to see an eye doctor. You find a scanned Treadmill/nuclear stress test in the chart from Roper 6 months ago – negative for ischemia.

11. What other team members can help? PharmD – CDE: co-management agreement for Diabetes and coumadin. Smoking cessation Inhaler teaching Medication reconciliation and teaching Dietician – in building/referral Nurse Case Manager – some are CDE’s, but all can help with self management plans LPN/CMA – can give some injections; help with self management plans Vaccines Cerumen removal Pap smears Injections/I&D Retinal Camera pictures MSW – Pat Roberts

12. Medication Issues RT Pharmacy – 1 st floor Patient Assistance

13. Charge Capture EKG, spirometry, I&D, Smoking cessation can all be billed “Charge Capture” – ask your attending

14. Epic Tips “In Clinic” Change labs to “Stat” Use the “ + New” for all orders Patient Education Materials -.UIMEDUALL,.UIMEDUDM,.UIMEDUPLATE