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TRANSCRIPT
Graduate Medical Education at the
Brody School of Medicine and Pitt County Memorial Hospital
Resident and Fellow Manual
2011
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Table of Contents Page Topic4 Overview4 GME at Pitt County Memorial Hospital & Brody School of
Medicine4 GME Office5 GME Website and GME Policies5 Program Leadership5 Resident Council
6 Learning 6 Educational Goals6 Research8 Competencies9 Duty Hours9 Teaching14 Health Sciences Library16 Academic Assistance16 Tuition Aid Plan and Duke Endowment MPH Support
17 Practicing17 Working as Part of a Team17 Tips for Working at the Bedside17 Case Management Services24 The Medical Record24 Privacy and HIPAA32 Infection Control36 Pharmacy49 Code Teams and Urgent Clinical Resources50 Palliative Care51 Talking with a patient about End-of-Life53 Writing a DNAR Order
54 Working54 E-mail Account54 Parking54 Information for Employees (Insurance, Flexible Benefits,
Savings, Partnership Savings Plan, Employee Discounts)
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55 Information for Employees (Smoking, Occupational Health, Police Force)
56 Dress Code and ID Badges57 Occupational Health Issues for Residents & Blood
Exposure59 Compliance67 Joint Commission Readiness71 Liability & Malpractice
74 Living74 Resident Assistance and Support74 Resident/Fellow Liaison75 Family Support Group76 Self-Assessment Quiz (Must be completed, signed and return to GME
Office prior to beginning work)77 Education Record (Must be signed after reviewing this
Handbook and prior to beginning work)
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Overview of Graduate Medical Education
Graduate Medical Education at our institution is a collaborative endeavor of Pitt County Memorial Hospital and the East Carolina University’s Brody School of Medicine. The hospital is the sponsoring institution of our Graduate Medical Education Programs, employs all residents and fellows, and runs the GME Office. The medical school is the academic home for the residencies and fellowships, and supplies the faculty, supervision, and program administration. In several places in this handbook you will find information from each of the institutions to assist you with policies and processes as they differ from one institution to the other.
A Graduate Medical Education Committee (GMEC) is responsible for providing oversight of the GME endeavor of the two institutions. Voting membership in the GMEC includes all Program Directors, elected resident representatives, the Designated Institutional Official, and representatives of the Resident and Program Coordinator’s Councils. The GMEC meets monthly in an open meeting—any resident or fellow is invited to attend.
Pitt County Memorial Hospital and the Brody School of Medicine are committed to: 1) providing an organized educational program with guidance and supervision of residents in ACGME accredited specialty and sub-specialty programs; 2) facilitating residents’ professional and personal development and 3) ensuring safe and appropriate care for patients.
The GME OfficeThe GME Office is located in the PCMH Support Building in Suite 1SB221. Our phone number is 252.847.4268. The GME Staff includes:
Dr. Lorrie Basnight—Associate Dean, Graduate Medical EducationDr. Darla Liles – Director, GME AccreditationAlyson Riddick—GME ManagerShirley Rutledge—Program AssistantMelissa Whitmer—Credentialing SpecialistKaren Gliarmis—Resident/Fellow Liaison
The GME Office will assist you with your employment issues, your training contract, annual employment requirements, NC Licensing,
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Immigration, and any absences other than vacation or sick leave of less than 3 days if needed. Any time away from training must be approved by your program, however the GME Office MUST be notified if you are away from work due to illness or injury for more than 3 days. Occupational Health must approve your return to work if you have been absent for 3 days or more. The GME Office will assist you in these situations.
We are interested in getting to know you while you are training at our institution, so please stop by. Certainly call or come by our office if you have questions or need assistance.
GME Website and GME PoliciesBe sure to spend some time looking through the resources on the GME website at www.ecu.edu/gme. You will find a number of GME policies as well as other pertinent information on the website. You will be responsible for understanding and complying with the policies on our site.
Program LeadershipWhile the GME Office will be your home base for employment issues, your program leadership including your Program Director, Chief Resident(s), and Program Coordinator will support your education. Programs are responsible for providing you with a rotation schedule to meet your educational needs (to prepare you for Board certification) including rotation goals and objectives, your duty schedules, and your faculty supervision. In addition to the institutional GME Policies, your program will have program-specific policies with which you must comply. You will be informed of these policies, but be sure to ask your program leadership if you have questions.
Resident CouncilResidents and Fellows provide essential leadership to the GME enterprise and the two institutions through the Resident’s Council. The Council meets monthly. Each program has a representative, and we would love for you to be involved. The Council advocates for the residents on issues such as benefits and work environment issues. They also provide critical input to the hospital for improving quality of patient care. The Chair of the Resident’s Council attends the Medical Staff Executive Committee as a representative of the residents and fellows.
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Learning
Educational GoalsSuccessful training as a physician requires a balance between education and clinical service. You must be given the opportunity to build an appropriate knowledge base, but you must also have the opportunity to apply that knowledge and develop the skills to take care of patients effectively and efficiently.
The Accreditation Council for Graduate Medical Education (ACGME) is the primary body that accredits residencies and fellowships. The ACGME has program requirements that stipulate what must be included in any accredited training program. You can find the requirements for your program on the ACGME website at www.ACGME.org. Look for your program requirements under “Review Committees” on the menu at the left. Your program here at PCMH/BSOM will meet, at a minimum, the requirements of the ACGME. All of our programs are accredited and are reviewed regularly to assure that they are maintaining accreditation standards.
Specialty Boards (such as the American Board of Internal Medicine) stipulate the requirements of physicians who want to be Board certified in that specialty. Our training programs are designed to provide you with the opportunity to meet the specialty Board requirements. However, we can only provide you with the opportunity—you must take that opportunity and turn it into success. If you consider residency and fellowship training as graduate school, and develop a study plan and study habits when you start your training, you will be off to a good start. All specialties are academically challenging, and you will not be able to master the required knowledge base, skills, and attitudes without study and preparation outside your time on duty. We want all of our learners to become Board certified physicians in their specialty of choice. Check with your program leadership, or look for your specialty Board on-line, to learn more about the specific requirements to become Board certified.
Research
Research and the University & Medical Center Institutional Review Board (UMCIRB)
Residents and fellows will often conduct or participate in research during their training. Any project that involves the use of humans or private, identifiable information about a human will require the
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investigator to receive approval from the Institutional Review Board (IRB) prior to initiating the study. Federal regulations require that studies are approved by the UMCIRB, and this assures the safety of research participants and patients, and protects the interests of the medical center. The following information is a brief overview of the IRB process. Please discuss this process with your faculty research mentor, or contact the UMCIRB if you have additional questions.
Does the project constitute research?Research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. Activities which meet this definition constitute research for purposes of this policy, whether or not they are conducted or supported under a program which is considered research for other purposes. For example, some demonstration and service programs may include research activities. 45CFR46.102(d)
Does the UMCIRB have jurisdiction over the project?Any ECU faculty, staff, or student conducting human research activities or any project constituting human research conducted at PCMH must have UMCIRB approval
Does the project involve human subjects? Human subject means a living individual about whom an investigator whether professional or student) conducting research obtains data through intervention or interaction with the individual, or identifiable private information. 45CFR46.102(f)
What is the level of risk?Minimal risk means that the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests. 45 CFR 46.102(i) Definition for prisoners differs and is located at 45 CFR 46.303(d).
The review process starts with the determination of the level of risk
No more than minimal risk More than minimal risk
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Deadline & meeting information on the UMCIRB website
EXEMPT EXPEDITED FULL IRB REVIEW
6 specific criteria 9 specific criteria Exempt form ` Full / expedited form Full/expedited form + protocol Request Addt’l Information Request Modifications/Information
Investigator Responds Investigator Responds
IRB Chair certifies exempt IRB Chair approves Full committee approval
Certification letter Approval letter Approval letter
No expiration date Approval <365 days Approval <365 days
No action unless change Continuing review Continuing review
IRB Education Modules: http://www.ecu.edu/irb/education.html Mandatory education must be completed every 3 years. This education is required for any individual involved in the direct conduct of the research study; for example, principal investigators, subinvestigators, and study coordinators. Those subinvestigators performing outside services that are standard of care and do not require research intervention do not have to complete these modules. Certification of completion can be printed from the Miami site after all modules have been completed.Contact Information: L. Wiley Nifong, MD, Chair
Biomedical CommitteeUniversity and Medical Center Institutional Review Board
(UMCIRB)1L-09 Brody Medical Sciences Bldg.Office 252-744-2914/Fax 252-744-2284 Email: [email protected] or [email protected]: www.ecu.edu/irb
Competency-based Training: The Outcome ProjectWhen we learn new skills we move through levels of competence that can be described as: Novice, Beginner, Competent, Proficient, and
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Expert. We may be Proficient at some skills and a Novice or even Expert at others. Residency training is meant to make you, at a minimum, a Competent physician on completion of your program. As you gain experience as a practicing physician, you will move towards a higher level of competence, towards being expert. The following information is taken from www.ACGME.org, and provides an overview of the general competencies you will be required to demonstrate before completion of your program. As you read through the description of the competencies below, you will notice that they are quite general—your program will further define the competencies in specialty-specific language for you.
ACGME General Competencies The residency program must require its residents to obtain competence in the six areas listed below to the level expected of a new practitioner. Programs must define the specific knowledge, skills, behaviors, and attitudes required, and provide educational experiences as needed in order for their residents to demonstrate the following:
Patient care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health;
Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patience care;
Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care;
Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals;
Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds;
Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
For more information about the Competencies, see the ACGME website www.ACGME.org and look on the toolbar at the left for “Outcome Project”.
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Duty HoursPitt County Memorial Hospital and the Brody School of Medicine take physician fatigue and patient safety very seriously. Programs and learners are expected to comply with Duty Hour guidelines as required by the institution, each program and the ACGME. The ACGME minimum requirements for duty hours may be found at www.acgme.org/acWebsite/dutyHours/dh_Lang703.pdf and additional information at www.acgme.org/acWebsite/dutyHours/dh_faqs.pdf. Our institution’s Duty Hour policies may be found in the policy section of our website. Several programs have more restrictive guidelines. Please check with your program leadership for your program’s policy.
Your program will be monitoring duty hour compliance as well as resident fatigue, and will present their findings to the GME Committee on a regular basis. In addition, the GME Office will intermittently monitor the hours of all residents and fellows. If you have a concern about the hours you or a co-resident work, please contact your program director or you may contact the GME Office by e-mail at [email protected] or phone at 847-4268.
Teaching
As a PCMH resident, you have a responsibility to teach other learners within the institution, including medical students and fellow residents. This responsibility helps you and your training program in several ways, with particular reference to the “practice-based learning and improvement” competency wherein you are expected to learn by doing. So, not only will such teaching benefit learners with whom you have contact, but it will serve to reinforce and enhance your training experience as well. Therefore, it is expected that you will demonstrate an understanding of adult education principles, effective instructional methods, and reflective practice when interacting with other learners.
Preparation
Appropriate preparation for teaching begins with a consideration of what it means to be an “Educator”, both the characteristics of effective instructors and your role as one. Common attributes of effective instructors include the following:
Establishes a rapport with learners and is viewed as approachable
Excited to share the content and educational experience with learners
Provides clear direction through defined objectives, goals, and instructions
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Offers feedback that is timely, meaningful, and appropriate with a focus on learning and growth
Creates a positive learning environment Motivates learners to be actively engaged in the educational
process Knowledgeable regarding content, learners, and the context
Take a moment to think of an excellent teacher you had in the past, then write three of his/her educational attributes below.
___________________________________ ___________________________________ ___________________________________
Now consider yourself as an educator. Do you exhibit the characteristics listed above? What are your strength/weaknesses as an educator? What resources may be available to assist you in further developing your teaching skills?
Preparation also includes a consideration of the unique nature of adult learners, including the role of prior knowledge and importance of relevance within the learning process. In general, adults benefit the most from educational experiences that:
Highlight Relevance – It is critical for adults to understand how the content is applicable to their daily lives, work role, or personal goals. If the content isn’t perceived to be relevant, then it usually isn’t deemed important.
Lead to Timely, Meaningful Feedback – Adults expect an instructor to provide information regarding educational progress in a way that fosters personal and academic growth.
Capitalize Upon Prior Knowledge – Adults come to the educational setting with a wealth of knowledge, therefore, it is important for learners to connect new content with what they already know or have experienced.
Allow for Problem-Solving – Adults may come to the learning environment with differing motivations, however, a commonality among adult learners is a desire to address problems or challenges. Learning not only occurs when a viable solution is found, but also through the process of determining such a result.
Allow for Active Engagement – Adults learn best when they are actively involved in the learning process, interacting with content, experimenting with ideas, and applying knowledge in a meaningful way.
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Lastly, preparation involves a consideration of educational objectives. Whether you are creating objectives or simply reviewing those already established, it is critical that expectations for learning are clearly defined. Therefore, objectives should outline what learners are expected to learn at each level of their training, how they will learn it, how learning will be evaluated, and the timeframe in which learning should be demonstrated. In addition, these objectives should be discussed with learners so they understand the content to be mastered, why it is important, and the criteria used for assessment.
From: The Institute for Medical Education – Mount Sinai School of Medicine, Teaching Skills for Residents, pp. 4-10
Annual Meeting of the Society of General Internal Medicine, Improving Resident Teaching Skills: Teaching Residents to Teach, pp. 4-5
Instruction/Clinical Teaching
Effective instruction involves both the selection and implementation of instructional methods within the learning environment. When choosing methods, educators are often tempted to select techniques based on ease of use or comfort level, however, this approach may ultimately impede learning. To maximize effectiveness, instructional methods should be chosen with learner needs, educational objectives, context, and time available in mind.
The successful implementation of teaching methods involves a foundational knowledge of various techniques, however, repeated practice is key. Keep in mind that the learning process involves growth for both the educator and learners, therefore, your continued refinement of instructional methods is an aspect of effective teaching. Common instructional methods include:
The Five Microskills for Clinical Teachingo Get a commitment from the learner – What do you think
is going on?o Probe the learner for supporting evidence – What led
you to that conclusion?o Teach general rules – When this happens, do this…o Reinforce what was right – Specifically, you did an
excellent job of…o Correct mistakes – Next time this happens, try…
Group Discussion
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o Approach discussion with a plan in mind and ensure learners understand your expectations for the activity
o Ask open-ended questions to promote discussion and critical thinking
o Encourage reflection by posing guided questionso Allow learners to teach one another by sharing
knowledge, questions, and thoughtso Redirect learners when necessary
Simulations/Demonstrationso Show the learners how you would approach and carry
out the tasko Share your thought processes with learners as you are
completing the task so they not only understand what you are doing, but why you are doing it
o When possible, allow learners to actively participate in the simulated/demonstrated task
From: The Institute for Medical Education – Mount Sinai School of Medicine, Teaching Skills for Residents, pp. 23-26
Annual Meeting of the Society of General Internal Medicine, Improving Resident Teaching Skills: Teaching Residents to Teach, pp. 6-8
Take a few minutes to think about instructional techniques you have seen successfully implemented in medical education and record them below. What made them effective? How could you incorporate these into your teaching?
___________________________________ ___________________________________ ___________________________________
Feedback
Feedback is an essential component of the educational process leading to learner, educator, and program growth. Without timely, meaningful, and appropriate feedback, educators and learners alike miss valuable opportunities for improvement. It is important to note that feedback should not be equated with evaluation. Although often used interchangeably, the focus of feedback is improving learner outcomes
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while evaluation is focused on measuring a learner’s performance against expectations. Feedback is:
Expected – Telling learners that you will be providing feedback on a daily basis and at predetermined intervals will prepare the learner for your constructive comments. If not prewarned, many learners will assume that feedback equates to poor performance on their part.
Well-timed – Ongoing feedback should be given as soon after the observed behavior as is practical. Cumulative feedback should be given in a private, comfortable setting, at a time when both the resident and learner can speak without distraction.
Based on Firsthand Data – This is exactly why residents are best equipped to provide feedback! Secondhand data will often lack specificity, or worse, authenticity. In either case, you are more likely to produce resentment than learning.
Regulated in Quantity – Too much feedback, regardless of form, will be seen as berating. The more frequent error, however, is to provide too little feedback.
Eliciting the Learner’s Perspective – This is especially important if you are giving feedback concerning a conflict. If you have heard both sides of a confrontation, you will be better able to address the true issues.
Descriptive and Nonjudgmental – The more specific you can be about what needs to be changed, the more likely the learner is to understand the problem and be able to address it. Always remember that you are correcting the behavior, not the person.
Concerned with Decisions and Actions, rather than Assumed Intentions and Interpretations – In other words, concentrate on WHAT was done or said, rather they WHY you think it was done or said. If the “why” is important, ask.
Providing Guidance to Resolve the Problem – Without suggestions for a means to improve, your “feedback” will be little more than criticism. If you cannot provide guidance, reconsider the feedback. In the case of positive feedback, you can use your comments to reinforce a desired behavior.
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Limited to Remediable Behavior – If the behavior is not remediable, it is likely to be personality based. Stay focused on the behavior, even if you feel it originates from a less-than-ideal personality.
Remembering the Positive – It is fine to compliment the person, but do not confuse this with positive feedback, which is based on the criteria above. Feedback does not have to be negative.
From: AAP, Residents as Teachers Handbook, pp.32-33.
Annual Meeting of the Society of General Internal Medicine, Improving Resident Teaching Skills: Teaching Residents to Teach, pp. 20-27
Take a few minutes to think about your experiences receiving feedback. Think beyond feedback during your medical education. Consider the feedback of a coach or music teacher. Which experiences were meaningful to you or contributed to your learning? What attributes of the feedback made it valuable to you?
Educational ResourcesThere are many resources available to support your education while you are at our institution. A number of these can be accessed electronically, including Micromedex, Up To Date, and MD Consult, as well as a Cultural Reference Guide, from the PMCH intranet homepage. The university has a robust health sciences library that is in an adjacent building on the Health Sciences Campus. Many additional electronic sources can be accessed through the library website. See the section on the Library in this manual for more information.
William E. Laupus Health Sciences Library East Carolina UniversityHomepage: http://www.ecu.edu/laupuslibrary/Reference Desk: (252)744.2230Circulation Desk: (252)744.2219
Librarian Services for Brody School of Medicine: Katherine Rickett [email protected] (252)744.2217Kathy Cable [email protected] (252)744.2222
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Librarians can meet with you at the medical school or at PCMH if needed. Librarians can assist with literature searches, including Evidence-Based Medicine resources and help with other research concerns.
Hours of OperationCurrent Hours and Upcoming Holidays: http://www.ecu.edu/cs-dhs/laupuslibrary/hours.cfmFall and Spring: Monday – Thursday: 7:30am – 12:00am
Friday: 7:30am – 8:00pmSaturday: 9:00am – 5:00pmSunday: 12:00pm – 10:0pm
Summer: Monday – Thursday: 7:30am – 12:00amFriday: 7:30am – 5:00pmSaturday: 9:00am – 5:00pmSunday: 12:00pm – 10:00pm
How to get to Laupus Library Directions: http://www.ecu.edu/cs-dhs/laupuslibrary/directgville.cfmParking: http://www.ecu.edu/laupuslibrary/images/parkingmap2_1.gifWalking: http://www.ecu.edu/cs-dhs/laupuslibrary/WalkBrodyLaupus.cfm
After 5pm on weekdays and on weekends those with a PCMH parking permit can park in the A Lot in front of Laupus Library. If you have an ECU parking permit please use designated parking lots at the Health Sciences Building. Others without an ECU permit can use metered parking in the B Lot that faces the library entrance.
Map:West Campus http://www.ecu.edu/cs-dhs/laupuslibrary/ecu-westcampus.cfm
ServicesAsk-a-Librarian:
http://www.ecu.edu/cs-dhs/laupuslibrary/asklibrarian.cfmChat with a Librarian:http://www.ecu.edu/laupuslibrary/chatlibrarian.cfmInstruction: Librarians are available to provide one-on-one or
class library skills instruction or resources: Library Skills Classes available: http://www.ecu.edu/cs-dhs/laupuslibrary/classes/
Contact: (252)744.2230 or visit the 2nd floor Service Desk to schedule
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Mobile Resources: http://www.ecu.edu/cs-dhs/laupuslibrary/MobileResources.cfm
Laupus Library provides access to resources that are either optimized for viewing on mobile devices or include downloadable software.
Poster Printing:
http://www.ecu.edu/cs-dhs/laupuslibrary/posterprinting.cfmPrint posters up to 42" wide for ECU Division of Health Sciences faculty, staff, and students. Contact the library’s Computer Lab (252)744.3081
Reserves:Reserve materials for classes can be arranged. Call (252)744.2219
Video Services: http://www.ecu.edu/cs-dhs/mts/index.cfmThe Laupus Library Multimedia Development Center offers video editing and streaming services to create supplemental course material for Division of Health Sciences faculty. Contact (252)744.3614 Laupus Library ResourcesHow Do I? FAQ’s: http://www.ecu.edu/cs-dhs/laupuslibrary/howdoi.cfmCatalog : http://abbott.lib.ecu.edu/uhtbin/cgisirsi/S8MP70OnUd/HSL/240690023/60/1182/X
Databases: http://www.ecu.edu/cs-dhs/laupuslibrary/ElectronicResources.cfm
Available databases include:Cochrane ReviewsDynaMEd – a point of care resourceMD ConsultMedLine
via Ovidvia Pubmed
MicroMedex (on ECU campus or access from PCMH’s Website)PsychInfoPubMedSTATRef
Accessing databases via Laupus Library’s Website will link users to more full text journal articles.
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Academic AssistanceThe Academic Support and Enrichment Center at The Brody School of Medicine is an additional resource for our learners. Assistance with academic issues such as study skills, test anxiety, and stress management are available to all learners, including residents and fellows. While the ASEC provides counseling services primarily to medical students and allied health students, they can also provide assessment and academic development sessions especially related to preparation for standardized testing, interview skills, anxiety, etc. You can contact the Academic Support and Enrichment Center at 744-2500. See http://www.ecu.edu/ascc for more information.
Tuition Aid Plan and Duke Endowment MPH SupportPCMH has a Tuition Aid Plan intended to help employees wishing to continue their education through voluntary off the job instruction and study. Details are available in the Office of Human Relations.
Duke Endowment Scholarship Program If you are interested in pursuing a Masters in Public Health while you are a resident or fellow, we have a program sponsored by Duke Endowment and Eastern Area Health Education Center and supported by ECU and PCMH to provide all of your tuition and fees. Evening and late afternoon classes are offered with individual scheduling so as not to interfere with clinical your responsibilities. The program is an in-depth practice oriented program with opportunities for distance learning to accommodate individuals who relocate before graduation. For more information contact: Lloyd F. Novick, MD, MPH—MPH Program Director at 252-744-4065 or [email protected].
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Practicing
Working as Part of a TeamOne of the most rewarding aspects of being a physician is working as part of a team to deliver the best medical care for your patients. Nurses, pharmacists, social workers, and physical and respiratory therapists are only some of the professionals you’ll be working with. Unit secretaries and the environmental staff will also be helping you provide excellent care. We encourage you to take a leadership role on the team by introducing yourself when you work in new clinical settings, and by getting to know the others you’re working with. Modeling collaborative communication styles is another way to provide team leadership. Ask the nurses for their input into the patient’s treatment plan. Often they will want to accompany you on rounds.
Tips for Working at the Bedsideo Always clean your hands before and after touching a patient (use
hand sanitizer, or wash for 20 seconds with warm water and soap). We encourage our patients to assure that your hands are clean, so don’t take offense if they question whether or not you’ve washed up!
o Be aware of maintaining the patient’s privacy by keeping the patient appropriately covered and drawing the curtain when needed.
o Work with the nursing staff to conduct and document time outs when performing invasive procedures.
o After examining the patient, be sure the side rails are up and secure.
o Only bring supplies/items to the bedside that you need for that visit, and do not leave items on the bedside stands or the patient’s bed. Be careful to NEVER leave syringes or needles at the bedside.
Case Management ServicesCase Management Services provides discharge planning, social work, utilization review and clinical efficiency oversight to all inpatient areas including the Emergency Department (excluding Rehab or Behavioral Health). Inpatient Nurses and Social Work Case Managers work together on each unit; they each have an individualized area of expertise, but you can contact either one for assistance. Case managers follow Milliman care guidelines, make home care arrangements, nursing/rest home placement, transfers to other facilities, provide community resources, family conferences, abuse/neglect assessments, transportation, indigent medications, etc.
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What can case managers do for you? Help you complete post-acute care arrangements (home health,
nursing home, transportation, transfers, etc.) Help you confirm with the patient/family their needs and plans
for discharge. Help the patient/family adjust to hospitalization. Crisis Intervention and Support Plan of care continuity and coordination with team members and
the patient/family Help you get your patient home sooner with a positive outcome.
How do you contact/find us?A member of the case management team is generally on the individual units from 8:30 am to 5:00 pm at a minimum, but feel free to page for assistance at your convenience. The contact numbers for specific units are below, and you will be provided this information on a resource card as well. The central office number is 847-4490 and the after hours pager number is 561-9189.
Inpatient Case Management
UnitDischarge Planning Nurse Case Manager
Discharge Planning Social Work Case Manager
1 South tube #61S 113-140Ph 7-1505 / 7-1434 Surgery: Oncology / Urology / ENT
Pam SuggPh 7-1462 Bpr 3690Fax 7-1401
Kim Sessoms (Friday-Monday)Ph 7-3954 Fax 7-1401
2 South tube #62Side A: S 201-222 Ph 7-8240Side B: S 223-244 Ph 7-4891Internal Medical
Laura Boyd S 201-222 Ph 7-9167 Bpr 1235 Fax 7-9247
Mike MilliganS 223-244 Ph 7-9500 Bpr 4739Fax 7-9247
3 South tube #63SideA: S 301-322 Ph 7-4372SideB: S 323-344Ph 7-4805Nephrology
Melissa LanierS 301-322 Ph 7-6221 Bpr 4601 Fax 7-6021
Kim Chambers S 323-344 Ph 7-6261 Bpr 1308 Fax 7-6021
1 East tube #68Ph 7-7017 / 7-7007Fax 7-0993Observation
Jacqueline BennettPh 7-3580 Bpr 3608Fax 7-0485
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2 East tube #69Side A: E201-222 Ph 7-4574 Fax 7-9601Side B: E223-244 Ph 7-4163 Fax 7-9618Family Medicine
Michelle JonesPh 7-5424 Bpr 4740Fax 7-9831
Edith StilleyPh 7-4069 Bpr 4983Fax 7-9831
3 East tube #70Side A: E301-322 Ph 7-4576 Fax 7-8129Side B: E323-344 Ph 7-4277 Fax 7-8129Hospitalist
Angie Lloyd E 323-344Ph 7-5387 Bpr 2405Fax 7-6567
Tracey Correa E 301-322Ph 7-7524 Bpr 1640 Fax 7-6567
Palliative Care tube #90(Rehab Hallway)F477-494Ph 7-5565/7-4273
Sheryl SuttonPh 7-4334 Bpr 1122Fax 7-7330
3 West tube #49 / 52Side A: W301-315Ph 7-4110 Side B: W325-346Ph 7-4111Oncology Medicine
Suzanne Gielen W 325-346Ph 7-4757 Bpr 0340Fax 7-7595
Peggy Hartsfield W 301-324Ph 7-7680 Bpr 0986 Fax 7-7595
UnitDischarge Planning Nurse Case Manager
Discharge Planning Social Work Case Manager
1 North (ASU) tube #26N101-130Ph 7-4544 / 7-5842Ambulatory Surgery
Jacqueline BennettPh 7-3580 Bpr 3608Fax 7-0485
2 North (MIU) tube #32 Side A: N225-248 Ph 7-7125Side B: N249-256, Ph 7-7127(RIU) tube #31 Side B: N257-270Ph 7-3136 Respiratory Intermediate
Wendy Crumpler N 225-270Ph 7-5753 Bpr 1361 Fax 7-0286
Deanna Snead N 225-248 Ph 7-1015 Bpr 4669Fax 7-0286
Sally McAdamN 249-270Ph 7-7522 Bpr 4824 Fax 7-0286
2 North (MICU) Side A: C201-208Ph 7-4890 tube #29Side B: C209-216Ph 7-4895 tube #27Side C: C217-224Ph 7-4893 tube #28Medical Intensive Care& Vent Weaning ICU
Victoria Mitchell N 201-224Ph 7-5665 Bpr 3822 Fax 7-8140
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3 North (NSIC / NSICU)
Side A: C301-308Ph 7-9805 tube #35Side B: C309-316Ph 7-9858 tube #33Side C: C317-324Ph 7-0576 tube #34Neuro / BariatricGeneral Surgery ICU
Kimberly EnnisC 309-324 Ph 7-2214 Bpr 1120Fax 7-7492
3 North (BGSU / NSU )Tube #38 Side A: N325-356Ph 7-9393 Neuro / BariatricGeneral Surgery Intermediate
Angela BullinsN 343-360Ph 7-9356 Bpr 4742 Fax 7-7492
Leah Boyd N 325-342Ph 7-7615 Bpr 1098 Fax 7-7492
4 North NSICU C401-408Ph 7-4290 tube # 41 TICU C409-416Ph 7-4856 tube# 39 SICU C417-424Ph 7-4159 tube# 40 Trauma, General Surgery Intensive Care
Jackie Willard Ph 7-0722 Bpr 0513Fax 7-2810
4 North (SIU) tube #42N425-464Ph 7-7379 Trauma, general surgery Intermediate
Donna Hodges N 425-444Ph 7-7616 Bpr 1887Fax 7-7614
Rose Barber N 445-446 Ph 7-6082 Bpr 3688 Fax 7-7614
PACU tube# 60Ph 7-0314Post Anesthesia Care
UnitDischarge Planning Nurse Case Manager
Discharge Planning Social Work Case Manager
1 ECHIWelcome Desk 7-1366CV Resource Ctr 7-1368Cath Lab 7-5144 EP Lab 7-8482 / 7-5855 Echo 7-7385 ECG 7-5151 1 ECHI (COU)CV 001-050 Ph 7-4689Cardiovascular Outpt.
Jacqueline BennettPh 7-3580 Bpr 3608Fax 7-0485
1 ECHI (HDU)CV 146-148 Ph 7-4464 Dialysis for Cardiology
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2 ECHI (CVICU)CV 201-224Ph 7-4204Tube #625 / 658 (CV OR)Ph 7-1856Cardiovascular Services
Kim HallPh 7-7328 Bpr 0384 Fax 7-9097
Susan Taylor Ph 7-8967 Bpr 1891 Fax 7-9097
4 ECHI (CVIU)CV 401-424 Ph 7-4145Tube #629 / 659PT / OT Gym Ph 7-3610 / 7-1620Cardiovascular Surgery Services Intermediate
Kim HallPh 7-7328 Bpr 0384 Fax 7-9097
Susan Taylor Ph 7-8967 Bpr 1891 Fax 7-9097
4 ECHI (CICU)CV 425-448Ph 7-4157 / 7-4158 Tube # 649 / 669Cardiovascular Services Intensive Care
Melanie Kee CV 425-448Ph 7-1953 Bpr 4358Fax 7-4973
5 ECHI (CIU) CV 501-548Ph 7-7150 / 7-7152 Tube #680 / 690Cardiovascular Services Intermediate
Art Schneider N 513-536Ph 7-4301 Bpr 1321Fax 7-0910
Mary Beth WynnN 537-548Ph 7-7617 Bpr 1686Fax 7-0910
6 ECHI (Ortho)
tube #631CV 601-624 Ph 7-4965 Orthopedic Surgery
Susan LanePh 7-1149 Bpr 3691Fax 7-6486
Laura Hamill Ph 7-2804 Bpr 0979 Fax 7-6486
CEU tube #81Ph 7-5072 / 7-5073
Jacqueline BennettPh 7-3580 Bpr 3608 Fax 7-0485
UnitDischarge Planning Nurse Case Manager
Discharge Planning Social Work Case Manager
NICU / NBN tube #55Ph 7-4378 / 7-4106
Neonatal Intensive Care / Newborn Nursery
Amy SandersPh 7-6153 Bpr 1085Fax 7-8171
Cathy Leary Ph 7-5324 Bpr 0831Fax 7-8171
Heather Davenport Ph 7-4123 Bpr 1974 Fax 7-5867
Angela Puuri Ph 7-4885 Bpr 1975 Fax 7-5867
1 West tube #47W101-134Ph 7-4161 / 4162 / 4168
L&D tube #88
Amy SandersPh 7-6153 Bpr 1085Fax 7-8171
Cathy Leary
Myrna Lewis Ph 7-4447 Bpr 0661 Fax none
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Side A: Ph 7-5800 / 7-5891Side B: Ph 7-4553 / 7-4550
Women’s Services/Labor and Delivery
Ph 7-5324 Bpr 0831Fax 7-8171
2 West tube #48CH 214-246Ph 7-4979 / 7-4135
PICU tube #45CH 201-212Ph 7-4984 / 7-6030
Children’s Hospital / Pediatric Intensive Care
Amanda HargrovePh 7-4993 Bpr 3067Fax 7-2976
Debra Leggett Ph 7-6097 Bpr 1385Fax 7-6229
Janet Valliere Ph 7-5963 Bpr 3101 Fax 7-0042
Nikki James Ph 7-5963 Bpr 3102 Fax 7-2976
ED tube #16 / 17AdmissionsPh 7-5773 / 7-5224GoldPh 7-4461 / 7-4561PurplePh 7-4293 / 7-4295TriagePh 7-0191
ED staff beeper 561-9189ED fax 7-1611
Gail BrewerPh 7-4921
Beth BroderickPh 7-4921
Maria BrunerPh 7-4921
Hospitalist Team MD’s pgr # 561-3881
Julie AbeyounisIP 7-3953Bpr 0508
Weekend Team *Primary Bpr 3829
After 5pm page 561-9189
Kim Wheat-RobinsonIP 7-3222
Kim Mury IP 7-3224
Kim Sessoms IP 7-3954
Beth Rabil IP 7-3225
Julie Crocker IP 7-3223
Case Management Services Leadership Team
Ryan Raisig Dr. Eshelman Darren Anderson Carrie BainInterim Administrator Medical Director UM/UR Manager DCP ManagerCase Mgmt. Services Office: 7-9847 Office: 7-2402 Office:7-7265
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Office: 7-5834 Fax: 7-5778 Fax: 7-8236 Fax: 7-8236Cell: 561-9038 Bpr: 707-8131 Bpr: 561-9060 Bpr: 707-8605Fax: 7-8236Bpr: 561-9038
Bob Williams Chris Smith Cathy Smith Marsha HarperCM Supervisor CM Supervisor CM Specialist UR SupervisorOffice: 7-4115 Office: 7-7326 Office: 7-4331 Office: 7-4861Fax: 7-8236 Fax: 7-8236 Fax: 7-8236 Fax: 7-8236Bpr: 1629 Bpr: 4334 Bpr: 1823 Bpr: 0348
Janet Lewis Sarah BrownAdmin. Secretary Sr. SecretaryOffice: 7-5837 Office: 7-4490Fax: 7-8236 Fax: 7-8236
Bpr: 4683
PCMH Utilization Review Phone Line/Voice Mail: 252-847-4959
PCMH Operator: 847-4100 Paging System: 847-4999 VM:847-5100
The Medical RecordDocumenting clinical encounters is a crucial part of patient care—describing your thoughts and plans, and communicating with others about your patients. Your care of the patient is not complete until the
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medical record is complete. Residents and Fellows must follow the Medical Staff Bylaws regarding medical records. Detailed information from the Bylaws can be found on the PCMH intranet page, beginning on page 73 of the Bylaws Handbook. A copy may also be obtained from the GME Office. In brief:
Handwritten notes should be legible. Documentation of a patient encounter should be timely, and all
encounters should be dated and timed. Admission H&Ps should be documented within 24 hours of
admission. At a minimum, there must be a brief written admission note on admission.
Progress notes should be made daily on all inpatients. Discharge summaries should be completed on discharge or
within 24 hours.
Both PCMH and BSOM have electronic medical records.
HealthSpan The inpatient electronic record at PCMH is HealthSpan. Physicians use HealthSpan for writing orders, progress and procedure notes, accessing results (lab and imaging), and reading vital signs and nursing notes. We went live with HealthSpan at Pitt County Memorial Hospital in 2007 and continue to optimize the system. Other regional hospitals also use the system, and the medical school will go live with HealthSpan in 2010.
Centricity (formerly Logician—you will often hear people call it this) is the electronic medical record used by the medical school. Imaging and lab results as well as appointments and clinical encounters are all documented in this system. This system will be phased out as HealthSpan goes live at the university.
You will learn how to use the electronic medical record systems during orientation.
Privacy/HIPAA HIPAA is the Health Insurance Portability and Accountability Act. It is a federal law that took effect April 14, 2003 and which legislates standards regarding patient privacy, electronic data information and the physical security of health care information. While this is a complex piece of legislation, privacy is the element that will affect all of you the most. As those of you with experience in health care already know, protecting patient confidentiality is not something new, most of us have been doing it all along. The difference is that under HIPAA, how we can access, use and disclose patient information is mandated by
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the federal government. In addition, a federal rule implemented in 2009 presents additional obligations under HIPAA on how we maintain confidentiality of our patients’ information.
Under the Health Information Technology for Economic and Clinical Health Act (HITECH), both the compliance and enforcement provisions of HIPAA are significantly broadened. Among the most challenging aspects is that hospitals and other health care providers will soon be required to tell patients--and in some cases the news media--when patients’ personal information has been inappropriately accessed or disclosed, even if the disclosure was accidental.
Under North Carolina law, providers are also obligated to notify the state Attorney General’s Office when notifying patients of a privacy breach. The laws reflect a significant shift toward transparency in health care, and will help patients fight against identity theft in the event their information is compromised.
As a member of University Health Systems, we take precautions to protect the confidentiality of protected health information (“PHI”) and other personal or sensitive information. However, if a patient’s information gets into the wrong hands despite our best efforts, we must do what’s necessary to make it right and do our best to prevent it from happening again.
In an effort to standardize our response to an impermissible privacy breach, UHS formed a multi-disciplinary Breach Notification Response Team with representatives from all UHS entities. The Team has developed a policy to address this new issue, as well as steps to guide us through the process. These are discussed in the section below titled “Breach Notification Obligations”.Protected Health Information (PHI) pertains to any individually identifiable information involving the health status of a patient, regardless of whether it is oral, written, or in some other form.PHI may be used for treatment, payment and hospital operations. Use of PHI for other purposes requires the patient’s authorization.
It is a requirement to audit our HIS (hospital information system) usage
As a caregiver, you need to know that patient information should be made available only to people directly involved in the care of that patient.
It is our duty to protect the patient’s information.
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Only the minimum information necessary should be shared (Note: this refers to information that is being shared for purposes of payment or hospital operations; it is permissible to share any information necessary for the treatment of the patient).
There is never a reason to look at or discuss patient records unless it is directly related to your job responsibilities. The same goes for providing patient information to someone else – they must be directly involved with the patient’s care in order to receive information by any means – including verbal, written or electronic.
Both PCMH and the Brody School of Medicine are required to conduct audit trails on each of our electronic medical records to monitor compliance.
Public Conversations Always subject to being overheard in public areas (keep this in
mind when you are in an elevator, on (in) line in the cafeteria, in the restroom)
Be aware of the patient’s privacy when you are in a semi-private room.
Protecting Hardcopies: Confidential information needs to be removed from fax, copy
machines and printers You should only fax information if it is necessary for immediate
patient care purposes; if you don’t’ know where the receiving fax is located (e.g., if the fax machine could be located in a public area), telephone ahead to be sure a person authorized to receive the information is waiting by the fax machine before you send it.
Double check the fax number before sending. Never leave confidential information in public places (i.e.
restrooms, conference rooms) or in patient rooms.
Protecting Electronic Information Information regarding patients should be sent by e-mail only
within the medical center’s secure network. If you need to send PHI via email, contact the IS Customer Support Help Desk at 847-5111 to receive directions on encrypting the email.
It is best to send de-identified information whenever possible (e.g. “34 year old female exhibiting symptoms. . .” instead of patient’s name if that is not necessary).
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Also remember to always check the TO, CC and BCC fields for the correct names before hitting the send button on e-mails.
Disposal of Information Dispose of patient information in a way that others will not see it
(i.e. shredding) Either use a shredder, place in a container marked for shredding (gray shred bins throughout PCMH ) or rip into small pieces.
Delete from the computer electronic messages and files with patient information.
HIPAA and Research You must have University Medical Center and Institutional Review Board (UMCIRB) approval regardless of the type of research to be conducted if it involves the access or use of patient health information. For questions regarding research and HIPAA privacy, contact either the ECU Privacy Officer at 744-5200 or contact the UHSEC (PCMH) Privacy Officer at 847-6545.
Secure Passwords Secure passwords are equivalent to your personal signature You are responsible for work done under your password. Remember to log off when you are done using your computer or
a program on a departmental computer. It is good practice to use a screen saver on your computer – this
way when you leave your desk temporarily, information is not easily seen.
Never share computer passwords.
Breach Notification Obligations
What is a reportable breach of privacy?
A reportable breach of privacy is an incident in which someone inappropriately acquires, accesses, uses or discloses personal health information under either state law or the HIPAA Privacy Rule, where there is a “significant risk of harm” to the affected individual(s). In the following questions, we will go over a list of some of the items that are considered personal health information, as well as what is considered significant harm.
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What is personal health information?
The term “personal health information”(PHI) includes protected health information (“PHI”) under the federal HIPAA Privacy Rule, as well as any of the following information:
A person’s first name or first initial and last name, in combination with: Social Security number Driver’s license number Financial account number (including a credit or debit card
number) Employer taxpayer identification numbers Driver’s license, state identification card, or passport numbers Checking account numbers Savings account numbers Personal identification number (PIN) code Electronic identification numbers, electronic mail names or
addresses, Internet account numbers, or Internet identification names
Digital signatures Any other numbers or information that can be used to access a
person’s financial resources Biometric data Fingerprints Passwords Parent’s legal surname prior to marriage
These items would also be considered personal health information if they would permit access to the person’s financial account or resources.
What triggers the notification?
The notice obligation would be triggered if an employee or physician viewed a patient’s medical information without a legitimate need for diagnosis, treatment, payment or other lawful use of the information. However, we would not have to notify anyone for certain “good faith” breaches, such as if the wrong patient’s record was accessed because of a mistake in entering the patient identifier. The law requires that we ask the
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following questions when determining if a breach requires notice: 1. Was there an impermissible use or disclosure of unsecured PHI? 2. Was the use or disclosure a violation of the HIPAA Privacy or Security rules? 3. Was there significant risk of financial, reputational or other harm to the individual? 4. Does an exception to the breach rules apply?
If the answer to any of the first three questions is “yes” and no exception exists, then notice likely will be required under the HITECH provisions.
What determines if a “significant risk” of harm to the involved individual(s) exists?
There are three levels of harm: low, moderate and high. Depending on the level of harm, UHS must take action to notify the people involved, and if the risk of harm is great enough, even to notify the general public through the news media. Factors that will be considered in determining the level of harm include:
Who impermissibly used or obtained the information. The type of information involved. What steps were taken that immediately eliminated or reduced
the risk of harm (if any). Whether the information was returned prior to being used for an
improper purpose.
For example, it would be a reportable breach if a radiology report was inadvertently faxed to a person outside of UHS, or to an unauthorized, non-clinical UHS employee. However, if the report was faxed to a clinician within UHS, and the clinician returned or destroyed the fax, there would be no reportable breach. Important Note: This is a narrow exception under the law. If the recipient is not authorized to view PHI, the disclosure itself is considered a reportable breach, regardless of whether the recipient was internal (within UHS) or external (outside of UHS).
Another example of a reportable breach would be if a laptop, flash drive or other portable device containing patient information was stolen - even if the device was password protected.
Who is notified of a breach?
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With some exceptions, if the Team determines that even one patient’s privacy is a reportable breach under the law, we must notify both the affected patient and the N.C. Attorney General’s Office. If more than 500 people are affected in a single state by any one breach, we must also notify the media, as well as the Department of Health and Human Services, which will then post the breach on its website. In certain circumstances we will also need to post a notice on our website. If the patient resides in another state, that state’s law may mandate further notices. But the most important thing to know here is that we must do all we can to alert these people about the fact that their protected health information has been breached.
How do we help the people affected by the breach?
In the notice itself, we will provide information on how the affected individual can help protect against identity theft by placing a fraud alert on personal accounts, contacting credit reporting agencies, etc. Depending on the number of people affected, UHS may notify the big three consumer-reporting agencies directly. We may also choose to provide credit monitoring and identity theft services to those affected.
What is my role in this new plan?
Any employee or agent of a UHS entity must report a breach to UHS Risk Management as soon as the breach is known or suspected. The appropriate privacy officer(s) will then conduct a preliminary assessment and, if warranted, will convene the UHS Breach Notification Team to determine if the breach is reportable. Through this process, we will assess risk and determine next steps.
Whenever someone finds out about or suspects a breach of privacy, we must treat it as being “discovered” and immediately report it to UHS Risk Management at
252-413-4473
Be prepared to answer the following questions, if possible:1. What types of identifying information were involved (i.e.,
Social Security numbers, driver’s license, etc.)?2. Was medical or health information involved?3. Was the individual’s first name (or first initial) and last name
included?4. Was the identifying information in electronic or paper form?5. Was the identifying information stolen, lost, misplaced or
other?
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6. Was the information disclosed to someone outside of UHS?
Important Note: Do not delay contacting Risk Management if you suspect or know about a breach just because you don’t have definite answers to these questions. Contact Risk Management immediately if you suspect a breach of privacy.
Lost or stolen information resources having PHI or other sensitive/confidential information must be reported immediately. Some of these resources are laptops, PDAs, portable hard-drives, thumb/USB drives, floppy disks, CD-ROMs, DVDs, etc.
What are the Consequences of Non-Compliance with HIPAA? LEGALLY – for You and either ECU or PCMH
Lack of compliance could lead to criminal, civil and financial penalties to you, the hospital or ECU
Disciplinary action up to and including termination Enforce regulations to the full extent of the law Possible basis for civil lawsuit for privacy violations
ORGANIZATION Loss of patient/community trust Lack of professional atmosphere
What Are the Benefits of HIPAA Compliance? We create an even safer environment for our patients We manage the balance between the disclosure of patient
information and their right to privacy We bring our standards to life in one more way
Please read the following Policy on Privacy, Information Security and Confidentiality of Medical Information. If you have any questions you may contact the Hospital’s privacy officer, at 847-6545 or ECU HIPAA Privacy officer at 744-5200. The HIPAA privacy policies for ECU can be located at http://www.ecu.edu/hipaa/. More information about UHS corporate HIPAA policies can be found by following the links from the PCMH intranet page: click on policies in colored tool bar, then to the left click on University Health Systems, then click on HIPAA tab to view all HIPAA privacy policies. The IS tab contains all HIPAA security policies.
POLICY STATEMENT ON PRIVACY, INFORMATION SECURITY, AND CONFIDENTIALITY
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-University Health Systems and East Carolina University, which includes both Brody School of Medicine and UHS, places a high priority on maintaining the confidentiality of its records, documents, agreements, and all other sensitive information.
In the course of your duties, you may be given access to confidential information about patients (including people who choose to participate in our research), employees, students, other individuals, or the institution itself. The institution's confidential information includes policies, business practices, financial information, and technology such as ideas and inventions (whether this information belongs to the Hospital or the Brody School of Medicine or was shared with us in confidence by a third party).
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Infection Control GuidelinesHAND HYGIENE Hand hygiene is the single most effective means of preventing the spread of organisms and diseases in the healthcare setting. Hand hygiene is defined as cleansing hands with either soap and water, or alcohol-based hand rubs.
Hand Hygiene is indicated at the following times: IMMEDIATELY BEFORE patient contact When moving from a contaminated site to a clean site on the
same patient (eg. After moving soiled linens, before proceeding to take examine the patient)
After contact with blood or potentially infectious body fluids, regardless of whether gloves were worn
After touching objects in the patient’s environment (these are likely contaminated, and hands should be cleansed even if you did not contact the patient)
AFTER patient care or after removing gloves AFTER using the toilet BEFORE eating, drinking or applying cosmetics
ALCOHOL-BASED HAND RUBS are effective, less drying to skin than soap and water, easy to locate throughout the healthcare setting, and convenient to use. Rubs are recommended by the Centers for Disease Control and Prevention for most routine hand cleansing. There are two exceptions to this general rule:
Hands must be washed with soap and water when visibly soiled, and
Hands must be washed with soap and water when caring for a patient with C. difficile diarrhea (alcohol does not kill bacterial spores).
To properly apply hand rub: Squirt an adequate amount of hand-rub to cover all surfaces of
hands into the palm of one hand. Rub hands together for at least 15 seconds, spreading the
alcohol rub on all surfaces of hands Don’t forget around fingernails and between fingers Alcohol-based hand rubs are FLAMMABLE when wet. Be sure
hands are completely dry before touching powered equipment or objects.
DO NOT use Alcohol hand rub if hands are visibly soiled DO NOT use Alcohol hand rub when caring for patients with C.
difficile diarrhea
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HAND WASHING is defined as using either anti-microbial or plain soap and water to clean hands and remove pathogens using surfactant and friction.
Turn on WARM water (hot or cold water is irritating to skin) Wet hands and apply soap Rub hands together vigorously for at least 15 seconds (sing
Happy Birthday twice) Be sure to wash all surfaces of hands including nail beds and
areas between fingers WASH hands (as opposed to using alcohol products) whenever
hands are visibly soiled, when they feel sticky from lotions, or when caring for patients with C. difficile diarrhea.
For your safety, perform hand hygiene often and sanitize equipment such as pagers and stethoscopes that are easily contaminated by frequent touching. Hand lotion available in clinical areas is compatible with the soaps that we use in patient care areas. Use this lotion rather than your own personal lotion to protect skin while at work. We encourage patients and families to ask all healthcare providers whether they have washed/sanitized their hands before they begin providing care. Don’t be surprised if patients ask you about hand hygiene. The correct answer is either, “Thanks for reminding me.” Or “Thanks, I just used the alcohol gel before coming in.” If there’s any doubt, play it safe and do it again! This contributes to safe care and improved patient satisfaction. The best approach: Use the alcohol rub or wash your hands as you enter the patient’s room. Patients really DO notice this.
Alcohol Hand Gels vs. Soap and Water: Why not Mix? If hands are wet when you apply alcohol based products, the
alcohol will penetrate deeper into the dermal layers and may cause irritation. Avoid using alcohol gels when hands are still wet/damp from soap and water washing.
If you apply alcohol gels, let hands dry completely. When you wash alcohol gel away with water, you also lose the oils that protect your skin from drying out. Once the alcohol dries, the oils from your skin remain in place to protect your skin.
If hands feel sticky after several applications of alcohol gel, wash with soap and water. Continue to use alcohol until they feel sticky, and then wash with soap and water again.
Tips for Success with Hand Hygiene in Winter: Use alcohol gels when possible. Studies show that alcohol
products are less drying to hand skin.
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Friction from paper towels, used with soap and water, can be very drying and damaging to skin, so use alcohol unless hands are soiled or sticky, or the patient is assumed to have C. difficile infection.
Use lotion to protect skin. Lotion should be available on your unit, and use lotion at home as well.
When washing hands with soap and water, make sure the water is warm, not too hot or cold. Extreme temperatures can be damaging to skin.
INFECTION CONTROL PRECAUTIONS Standard Precautions are the protective measures we routinely use to prevent spread of pathogens. Standard precautions are used with all patients and require anticipation of the type of contact and the potential for exposure to pathogens. All secretions and excretions are considered to contain infectious agents, except sweat.
Standard precautions protect both the staff member and patient, because the barriers prevent transmission of pathogens in both directions.
Standard precautions must be used for EVERY PATIENT, and EVERY ENCOUNTER to be effective.
Standard precautions require hand hygiene at all times, and the appropriate use of gloves, fluid-resistant gowns and face and eye protection, depending on the nature of the interaction with the patient. Gloves gowns and masks are known as personal protective equipment (PPE).
o GLOVES: Wear gloves when contact with secretions (other than sweat), excretions, mucous membranes and non intact skin is anticipated
o GOWN: Wear fluid-resistant gown when splashes or contact with body fluids that could contaminate uniforms is anticipated. Examples are performing surgery, bathing a patient, dressing an extensive wound
o FACE and EYE PROTECTION: Use face masks and eye protection when splashes to the eyes or mucous membranes of nose and mouth are anticipated. Examples are surgical operations, extensive wound dressings
Transmission Based Precautions are used in addition to Standard Precautions for diseases of epidemiologic importance, or diseases with known modes of transmission. Patients on transmission based precautions have signs on their doors and/or charts that indicate the type of protection needed. Follow the directions on the signs and be sure to comply. Transmission based precautions include
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AFB Isolation (for tuberculosis, SARS and other emerging pathogens). Patients are housed in specially ventilated rooms which have high air flow and negative air pressure relative to the corridor. Wear a respirator mask whenever you are in an AFB isolation room. YOU MUST BE FIT-TESTED for the RESPIRATOR mask—this will be done during orientation. Dedicate equipment for use with this patient only. Disinfect reusable items (stethoscope).
Airborne Precautions (for varicella, measles, disseminated zoster, or zoster in an immunocompromised patient). Same type room as above, surgical type mask must be worn by all who enter room. Dedicate equipment for use with this patient only. Disinfect reusable items (stethoscope). Remove and discard mask immediately before leaving room.
Droplet Precautions (for influenza, pertussis, bacterial meningitis and pediatric viral respiratory illnesses). A private room is used but the room need not have negative pressure. Dedicate equipment for use with this patient only. Disinfect reusable items (stethoscope). Remove and discard mask immediately before leaving room.
Contact Precautions (for C. difficile, Multi- drug- resistant organisms [MDRO], and pediatric respiratory or diarrheal diseases of unknown origin) this is the most common of the transmission-based precautions. Wear GOWN and GLOVES for all contact with the patient and/or patient’s environment. Dedicate equipment for use with this patient only. Patient will be in a private room. Disinfect reusable items (stethoscope). Discard gown and gloves immediately prior to leaving patient’s room.
INFECTION CONTROL SIGNAGE A listing of each type of transmission based precautions used at PCMH including a picture of the signage with a description of the precautions needed and typical diseases for which each is used is available in the facility infection control manual.
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Pharmacy Services at Pitt County Memorial HospitalThe Department of Pharmacy Services is open 24 hours a day as a professional service department. Pharmaceutical services are available from our Main Pharmacy (across the main hallway from the cafeteria) and our Pediatric satellite (2West) 24 hours a day. Our Critical Care Satellite (3North) and our OR Satellite are open from early morning to late evening. Our Rehab/Psych (Rehab area) and Medicine satellite (3South/3East) are open first shift hours. Pharmacy offers unit dose dispensing, IV additive, total parenteral nutrition and chemotherapy preparation, provision of drug information and various clinical services. Pharmacists round with a number of ECU teaching services including Medicine, Family Medicine, Pediatric Intensive Care, Neonatal Critical Care, Rehabilitation, Cardiology, Psychiatry, Oncology, Pulmonary Critical Care, Cardiac Surgery, and Trauma.Commonly called Pharmacy telephone numbers are listed in Appendix I.
The following are key points of interest concerning our department summarized for your information. If further information is needed, contact the Pharmacy at 7-4586 or 7-4481.
Assigned DEA numbers: The Department of Pharmacy Services will assign a temporary DEA number to hospital residents who do not have an individual registration number. This number is valid for prescribing controlled substances in the hospital and for discharge prescriptions for patients; however, this number is not valid outside the hospital. The resident will be issued a card with the temporary DEA number during Resident Orientation. Residents must obtain prescription pads through their departmental office, since the hospital does not provide pads.
Hospital Formulary:The Formulary is an approved listing of drugs available for use by physicians at PCMH. The Formulary is regularly reviewed and updated by the Pharmacy and Therapeutics Committee. The Medical Staff Committee is responsible for promulgating the safe and effective use of medications at PCMH. Use of the Formulary is strongly encouraged by the Pharmacy and Therapeutics Committee. If a physician is uncertain as to the availability of an item, contact Pharmacy for needed information.
It should be noted that non-formulary orders take more time to deliver to a patient than formulary items. This is necessary because non-formulary items are not stocked and must be obtained from another
source, which is obviously much more time consuming and expensive to the patient. Therefore, it is advisable that the physician insure that a therapeutic equivalent of the non-formulary drug is not already available.
On orders for non-formulary drugs, pharmacists will contact the prescriber and notify him/her of a delay in obtaining the drug and will make recommendations for formulary alternatives, if appropriate. Orders for non-formulary antibiotics will need to be approved by Infectious Disease Service before they can be ordered by Pharmacy.
Physician Order Priority: There are four designations of orders at Pitt County Memorial Hospital: Stat, Now, ASAP, and Routine. This terminology was established for use in this hospital and is followed in the hospital pharmacy. Appendix II lists the definitions for each of these terms.
Emergency Cart/Code Team:This hospital is serviced by a Code Blue Team with a Code Blue Cart in every area. PCMH provides a Rapid Response Team that responds to “pre-code’’ patient situations. The Team can be accessed by dialing 7-4333.
Stop/Hold Order Policy: Hospital policy dictates that orders for certain drugs are discontinued automatically according to time limits set by the Medical Staff. These medications must be reordered for continuation of therapy. HealthSpan notifies prescribers when a medication is soon to expire or if a med has recently expired, allowing for order renewal.
Antimicrobials – 7 days Meperidine – 2 days Ketorolac (Toradol) – 5 days Becaplermin (Regranex) - 7 days Filgrastim (Neupogen) - 7 days
Nebulized Bronchodilators – 3 days
Physicians may write orders which designate a specific number of doses or specific stop date to override the automatic stop order limits. The duration of an order will be 14 days unless otherwise specified by the prescriber.
Investigational Drugs: Only the principle investigators and co-investigators (designated on the protocol) are authorized to prescribe investigational drugs. Verbal
or telephone orders of the authorized investigators are acceptable if co-signed within 24 hours.
Protocols must be reviewed and approved by the University Medical Center Institutional Review Board before a drug can be administered.
Patients that are enrolled in clinical trials through other medical centers will be allowed to continue to take their investigational medications while at PCMH. However, a copy of the research protocol and signed informed consent should be obtained from the enrolling institution.
Patient’s Home Medications: Medications brought to the hospital by patients will not be administered in the hospital under normal circumstances. These medications will be sent home with a patient’s family member whenever possible. If no family is available to take the patients’ medications, they will be stored in the Department of Pharmacy until the patient is discharged. These meds are to be placed in patient “Home Med envelope” by nursing and sent to Pharmacy. Medications will be destroyed by Pharmacy if not claimed by the patient or family at discharge.
Patient Home Medications may be used in the hospital if the medication is not stocked as part of the hospital Formulary, no acceptable therapeutically equivalent medication is available, and the medication cannot be readily obtained from another local source. The medication must be identified by Pharmacy prior to use of patients own medications.
Complete physician orders should be entered by the prescriber for each medication to be given.
Medications Sent Home with Patients at Discharge: PCMH does not have an outpatient pharmacy service. The only items that are allowed to be sent home at discharge are the remaining inpatient units of single-patient items such as ointments, liquids, ENT preparations and insulins. These items, once opened, are not creditable and can be sent home with patients.
There must be an order for these medications to be sent home in the chart with complete directions on their use. The medication should be sent to the Pharmacy for labeling and to assure all laws are met concerning labeling and packaging.
A physician may authorize a 24 supply of medications be dispensed to a patient at discharge if needed until the patient can reach an outpatient pharmacy. (48 hours on weekends, 72 hours on holiday weekends.)
TPN (Total Parenteral Nutrition) Orders: TPN orders need to be entered by 1:00pm every day. Orders received after 3:00pm will not be processed. Changes in TPNs are very expensive. A 24-hour supply of TPN is mixed after an order is received. Whenever possible, changes should be written so that they can be in effect after the present supply is utilized.
If questions arise concerning TPN orders, contact an IV pharmacist at 847-4559 or Nutrition Support Team Pharmacist on beeper 0765. The Nutrition Support Team of PCMH is available for consultation on TPN or tube feeding patients upon request of the attending physician/House Staff. The Nutritional Support Team may be consulted by placing a request in HealthSpan. The initial consultation will include a nutritional assessment, a list of nutritional requirements, and recommendations for nutritional support and monitoring. The team will then follow the patient regularly and monitor for complications and achievement of the nutritional goals. Follow-up recommendations will be entered by the team in the progress notes. Orders are entered if specifically requested.
Therapeutic Interchanges: A therapeutic interchange or alternative is defined as the authorized dispensing of medications with different chemical structures that are expected to have similar therapeutic outcomes and adverse effects when administered in therapeutically equivalent doses. This practice contributes to more appropriate, safer and cost effective care by encouraging the use of selected products that the institution's medical staff believes to be the most useful for patient care.
Orders for non-formulary medications in designated classes will be interchanged with the indicated formulary class representative using pre-approved dosing guidelines, unless otherwise indicated on the order by the physician. If a patient is allergic to, has experienced an adverse reaction to or had a treatment failure to the interchange medication, an attending physician or fellow may override the interchange by entering Continue with Original Order when the Therapeutic Alternative screen displays.
Examples of medication classes that have therapeutic interchanges include proton pump inhibitors (PPI), H-2 receptor antagonists,
vitamins, ACE inhibitors, ARBs, statins, topical products, and certain antimicrobials
Transfer Orders: Transfer orders are required for a patient moving from one level of care to another and also upon transfer from Labor & Delivery and the Critical Care Units. Transfer orders are also required following all surgical procedures with the exception of minor procedures.
Prescriptions for Residents and their Families: Prescription medications may be purchased by residents for their immediate families (living in same household) at a discount at the Employee Pharmacy, phone 7-4311.
Adverse Reaction Reporting Form: JCAHO Standards and PCMH policy require that all significant adverse drug reactions (ADR) be reported to the Pharmacy and Therapeutics Committee for evaluation. An ADR is defined as: Any undesired effect of a drug that requires some action be taken (such as stopping drug therapy or treatment with another drug). This reporting process is non-punitive, and data is used for quality improvement.
Adverse Drug Reactions should be reported to Pharmacy for entering into the Patient Safety Net (PSN) system. The Pharmacy and Therapeutics Committee will review these reports monthly and forward significant reports to the FDA.
Drug Information: The Department of Pharmacy Services has established the Eastern Carolina Drug Information Center. The Center contains extensive reference texts, drug literature files, abstracting sources, and microfilmed articles related to drugs and drug therapy. The Center offers information on topics such as drug identification, adverse reactions, interactions, pharmacokinetics, toxicity, dosing, I.V. compatibilities, pharmacology, therapeutic use, etc. This information is available to all allied health professionals. The Center, staffed by a Drug Information Specialist, is open Monday through Friday, 8:00am to 5:00pm and can be reached by dialing extension 7-4257.
The Pharmacy publishes a monthly Newsletter covering therapeutic topics and new drugs; suggestions for topics are welcomed.
Patient Medication Counseling: Pharmacy provides discharge medication counseling to patients who have been prescribed warfarin (Coumadin). Physicians may request
this service by calling the Main Pharmacy or appropriate satellite unit. Pharmacists will instruct patients as to indication for use, administration directions, potential side effects and interactions, and monitoring of therapy. In addition, reinforcing written information will be left with each counseled patient. This patient interaction will be documented in the patient’s medical record. While more limited in scope, similar counseling can be performed with other medications, as requested. Pharmacists also counsel patients on dofetilide (Tikosyn).
Antimicrobial Streamlining ProgramThe Pharmacy and Therapeutics Committee, in concert with the Antibiotic Utilization Stewardship Subcommittee has implemented an Antimicrobial Streamlining Program. The goals of this program are to reduce microbial resistance to antibiotics and to reduce expenditures for these medications.
The Antimicrobial Use Coordinator, a pharmacist daily reviews charts of patients receiving high use, costly and misused (Controlled) antimicrobials and makes recommendations to improve use of these medications within guidelines established by Infectious Disease physicians. Results of this Service are shared with the Antimicrobial Utilization Stewardship Subcommittee (AUSS).
This pharmacist may leave notification in the patient’s chart of the need to alter antimicrobial therapy based on culture and sensitivity data and other pertinent information that may be available at that time.
This recommendation will remain on the chart for 24 hours at which time the new therapy will be implemented - unless the primary physician for that patient indicates otherwise on the form. The reviewer will always be available to the primary physician by beeper for open discussion and for educational purposes.
IV to PO Switch ProgramThe Pharmacy and Therapeutics Committee has approved an IV to PO Medication Switch Program to reduce the use of parenteral therapy when not needed for patient care. This allows for increased patient comfort and reduces cost of care. Pharmacists will switch the parenteral forms of select medications to their oral equivalents if the patient is tolerated oral diet and is receiving other oral medications. Examples of medications in the IV to PO program include aziththromycin, ciprofloxacin, fluconazole, moxifloxacin, famotidine and linezolid, among others.
Deep Sedation Physicians must be credentialed to administer deep sedation medications. In addition, a sufficient number of qualified personnel must be present during use of these medications to monitor the patient. Contact Department/Section Chief, Medical Staff Support or Residency Director for additional information.
Dose Optimization Program Dose Optimization is a program approved by the Pharmacy and Therapeutics Committee to standardize the dosing of commonly used antibiotics for adults and adolescent patients. The ordered dosage and/or schedule will be changed per approved protocols by Pharmacy unless an approved exception to this change exists. A physician may override this process by obtaining approval through the Antimicrobial Use Stewardship (AUSS) pager at 383-0387.
Beta-lactam antibiotic use in allergic patients.The Department of Pharmacy Services will follow specified guidelines for dispensing beta-lactam antibiotics to patients with penicillin allergies. Pharmacists will make the dispensing determination based on the nature of the penicillin allergy and input from the patient's prescriber.
The admitting physician is responsible for taking a detailed allergy history from the patient or the patient's family when circumstances permit. This information should be documented in the physician notes (progress notes) section of the patient's chart.
The physician who prescribes a ß-lactam antibiotic for a patient with a documented penicillin allergy is responsible for noting the severity of the reaction with the order, i.e. rash, anaphylaxis, angioedema, etc. If there is inadequate allergy information in the chart, then it is the responsibility of the prescribing physician to obtain this information.
For patients who report a rash or other non-type I reaction to penicillin, the pharmacy will dispense any cephalosporin, carbapenem or monobactam. The dispensing pharmacist will document the type of reaction and the source of the information in the pharmacy notes on the patient's profile.
For patients who report a type I reaction to penicillin, the pharmacy will not dispense a cephalosporin or carbapenem unless the patient has a documented negative skin test to penicillin or has been appropriately desensitized to the prescribed antibiotic.
If a patient has a documented allergy to pencillin and the severity of the reaction cannot be characterized, the pharmacy will notify the prescribing physician to determine if he/she wishes to proceed with administering the ß-lactam antibiotic in question. If the physician still wants to give the ß-lactam antibiotic, the pharmacy will dispense the prescribed ß-lactam antibiotic and the dispensing pharmacist will document the details of the physician contact in the pharmacy notes on the patient's profile. As approved by the Pharmacy and Therapeutics Committee, a sticker will be placed on the IV bag which states, "WARNING: In general, cephalosporins can be safely use in a pencillin-allergic patient. However, if a patient has had an immediate/ anaphylactic reaction to penicillin, cephalosporin use should be avoided if possible. "This sticker serves to alert the nurse to check the circumstances of the patient's reaction to penicillin and to monitor the patient for any reaction that may be related to the currently prescribed ß-lactam antibiotic. Medication ReconciliationMedication Reconciliation is the process of communicating a complete list of medications to the next provider of care. It is an interdisciplinary process between patient, physician, pharmacy and nursing designed to prevent potential medication events. Patient medications are to be reconciled on patient admission, transfer (including post-op), and discharge.
Pharmacy technicians interview patients on admission and place a home medication list into HealthSpan for the physician to reconcile. This list is also used at transfer and discharge to insure that the patient is receiving appropriate pharmacotherapy. This list must be kept accurate by all healthcare providers to reduce the chance of medication events.
All high risk medications will be reconciled within 4 hours of admission or a nurse will contact the patient’s physician to reconcile these medications.
Pharmacy to Dose Physicians may request Pharmacy to dose and monitor gentamicin, tobramycin, amikacin and vancomycin for their patients. This order can be placed in HealthSpan by typing Pharmacy in the Order Entry field.
Meds Requiring ApprovalMedications may be restricted by indication or by approval from certain physicians. Documentation of these requirements must be made in HealthSpan before the medication can be released by Pharmacy. Examples of medications restricted to approval by physicians include certain antibiotics (i.e. amikacin, voriconazole, non-formulary antibiotics, etc), drotrecogin, and argatroban. Meperidine and liposomal amphotericin are medications which are restricted to specific indications for use
HealthSpan TipsPreference lists – use of service medication preference lists will speed entry of medication ordering in HealthSpan. Most clinical departments have medication preference lists, which can be altered to accommodate changing prescribing trends.
Order Sets – Many order sets have been built in HealthSpan to mirror previous available written order sets. Utilization of these electronic order sets will expedite medication order entry.
Chemotherapy orders – For safety reasons, all orders for chemotherapy must be handwritten and scanned to Pharmacy. Residents must have chemotherapy orders co-signed by an oncologist.
Navigators - Many of the basic functions need by physicians to manage medication therapy can be accessed within the Admission, Transfer, Rounding or Discharge Navigators.
APPENDIX I DEPARTMENT OF PHARMACY SERVICES
TELEPHONE NUMBERS Administrative Office 0800-1630 (M-F) 7- 4481Drug Information 0800-1700 (M-F) 7- 4257Antimicrobial Use Coordinator 0700-1530 (M-F) 7-5619/7-0280Medicine Clinical Pharmacist 0800-1630 (M-F) 7- 7030
Bpr. 561-9468 Neonatal Clinical Pharmacist 0800-1630 (M-F) 7-7397
Bpr. 3562Oncology/SCT Clinical Pharmacist 0800-1630 (M-F) 7-6845
Bpr. 3184Pediatric Clinical Pharmacist 0800-1630 (M-F) 7-7858
Bpr. 1904
In- Patient Pharmacy(Main Pharmacy) 24 hours (7 days) 7-5866/7-4256/7-4919I.V. Admixture Services 24 hours (7 days) 7-4559 or 7-4259Nutrition Support Pharmacist 7-6266
Bpr. 0765Chemotherapy (IV Additives) 0700-1900 (7 days) 7-4258Rehab Satellite Pharmacy 0800-1630 (5 days) 7-4567 Bpr. 3106Pediatric Satellite Pharmacy 24 hours (7 days) 7-
4517/7-5226 Bpr. 3012Medicine Satellite Pharmacy 0700-1530 (M-F) 7-4901
Bpr. 1468Critical Care Satellite 0700-2330 (7 days) 7-7311Surgery CCare Decentralized Pharm 0700- 1530
Bpr. 3483Medicine/Cardiac Surgery Decentralized Pharmacist 0700-1530 Bpr. 3279Cardiology Decentralized Pharmacist 0700-1530 Bpr. 1966OR Satellite Pharmacy 0600-2330 (M-F) 7-6198 0600-2300 (S-S)
7-6198 Bpr. 3104Pharmacy Accounting 0800-1630 (M-F) 7-4906Pharmacy Business Coord. 0800-1630 (M-F) 7-1016Pharmacy Storeroom 0800-1630 (M-F) 7-0360 Employee Pharmacy 0630-1830 (M-F) 7-4311
0800-1200 (Sat)
Appendix II
Priority for Handling Physicians’ OrdersThe following definitions have been developed to provide a more efficient distribution of patients’ medications in order of their clinical priority.
STAT Orders: This is the top priority order. This order implies an emergency or pre-emergency situation and must be carried out immediately. These orders take priority over all other orders or activities. STAT orders must always be hand-delivered or transported via the pneumatic tube.
Examples: 1. Epinephrine: 1:10,000 10 cc IV STAT2. Protamine Sulfate 50 mg IV STAT3. Any medication needed in a potentially life- threatening clinical situation.4. NOTE: Laxatives, suppositories, vitamins, and extended action preparations are never STAT medications.
NOW Orders: This order is second only to stat orders in terms of priority. It does not indicate the emergency or life-threatening
status which the stat order implies. These orders should always be hand-delivered or transported via the pneumatic tube and are handled immediately after stat orders.
Examples: 1. Cefazolin 2 gm IV now and 1 gm every 8 hours2. Kayexalate enema (standard) Now and repeat in 2 hrs.3. Any medications requiring immediate administration in non-emergency clinical situations.4. NOTE: Laxatives, vitamins and refill orders are never Now orders.
ASAP Orders: This order follows both the STAT and Now orders in priority, but it would take precedence over all routine and refill orders. ASAP (or as-soon-as-possible) orders should be faxed or sent via the pneumatic tube.
Examples:
1. Clonidine 0.2mg po every 6 hours ASAP.2. Any medication order which must be administered within the next two hours.3. NOTE: Refill orders should never be ASAP as they should be obtained far before the next dose is due.
Routine Orders: All orders not classified above have routine status. These orders will be handled after STAT, NOW and ASAP orders are filled. Routine orders should be sent via fax. All refill orders and most new orders which can be delayed for transport should be classified as routine.
IMPORTANT: The abuse of the high priority stat and now order status will render the entire system ineffective.
Pharmacy Services at the Brody School of MedicineJanuary 2010
Contact Information:Ruth S. Parish, Director of Pharmacy 252-744-1846
[email protected] Walston, Administrative Assistant 252-744-1830
[email protected]#: 252-744-2709
Pharmacy Locations:ECU Physicians Department of Pharmacy Services operates four pharmacies for the use of patients of ECU Physicians, employees of East Carolina University, students at Brody School of Medicine, and residents at PCMH. All pharmacies can receive prescriptions in person at their individual locations, by phone, fax, e-prescribing, and through Centricity and Healthspan, the electronic medical records of ECU Physicians and University Health Systems. All ECU Pharmacies take all major insurance cards and accept cash, credit cards, and checks. Patients and providers can email any pharmacy from our web refill request page: http://www.ecu.edu/cs-dhs/ecuphysicians/patient-care/pharmacy.cfm
Family Practice Center Pharmacy 744-4680 (phone) 744-3804 (fax)Monday – Friday: 8:30 am - 5:00 pm
Jill Hardee, Pharmacy ManagerKennedy Blount, Pharmacist EMR: Refill, FPC Pharmacy
Brody Outpatient Pharmacy 744-2721 (phone) 744-1800 (fax)Monday – Friday: 8:30 am – 5:30 pmJohn Dombach, Pharmacy ManagerHannah Allison, Pharmacist EMR: Refill, Brody Pharmacy
LJCC Cancer Center Pharmacy 744-2426 (phone) 744-7554 (fax)Monday – Friday: 8:00 am – 4:30 pmPaul Gibbs, Pharmacy ManagerGeoff Stroud, Pharmacist EMR: Stepps, Jean
Bernstein Center Pharmacy 413-0063 (phone) 413-0646 (fax)Monday – Friday: 8:30 am – 5:30 pmChristy Whitley, Pharmacy ManagerMarian Cascio, Pharmacist EMR: Refill, Bernstein Pharmacy
Formulary:There is no specific formulary for insured patients at the ECU Pharmacies. All pharmacies will order any medication prescribed by any ECU Provider. In addition, the FPC Pharmacy supplies patient medications administered in the clinical areas of ECU Physicians.
Pharmacy Indigent Care Program:The Pharmacy Services Department has been very concerned about the current trend in prescription pricing. Many of the large retail pharmacies are offering discounted generic prescriptions in an effort to generate sales on non prescription items. Patients are being lured into believing that this is an effective way to purchase medications. In practice, this has many disadvantages. Consumers and providers may not read the fine print regarding number of tablets and dosage forms offered at the discounted level. Many times the actual price of the patient’s prescription is above the advertised price they are expecting. Patients often spend more money on unneeded items while waiting for their discounted prescriptions. Patients go from store to store “shopping” for the lowest price for their prescriptions. This can lead to drug/drug interactions and therapeutic duplications because a single
location does not have a complete profile of all the medications the patient is taking.
Having a prescription filled should be about more than just the price at the register. Our pharmacy staff at ECU works diligently to assure patients receive meds for appropriate indications at appropriate doses, as well as screen patient profiles for interactions and duplications. The clinical pharmacy staff takes great pride in providing excellent pharmaceutical care. Our employees realize the importance of developing personal relationships with patients in order to develop a sense of trust so that patients will confide in our staff with medication questions. In an effort to encourage compliance, our pharmacists also always provide counseling at the point of sale for all new prescriptions and are readily available to assist patients with any questions.
To encourage the use of our professional pharmacies and experienced clinical pharmacists, Pharmacy Services provides discounted pricing for our indigent patients. Any patient who is identified by patient access services, financial counselors, social workers, or clinical staff as having NO pharmacy insurance, is eligible to receive our Pharmacy Community Assistance Program (P-CAP). These patients can receive maintenance medications from our formulary at $3.75 per prescription per month. Patients may also get a two or three month supply at a single visit to assist with patients living some distance from our facilities. A second tier of medications is also available to uninsured patients for a co-pay of $12.00 per month. Pharmacy Services will continue to order brand name medications through the manufacturers’ patient assistance programs for the administrative fee of $5.00 for a one month supply. Formularies for all of these programs can be accessed at
http://www.ecu.edu/cs-dhs/ecuphysicians/upload/PCAPFormulary.pdfThe assistance of ECU providers and staff in educating patients about these programs is greatly appreciated. Best Prescribing Guidelines:Providers and Clinical Staff are reminded and cautioned that:
NO provider may write prescriptions for a patient that has not been medically evaluated.
All prescribing activity must be documented in the electronic medical record.
NO provider should write prescriptions for themselves or family members, except in the case of acute, minor illness or medical emergency.
NO clinical staff should phone in or authorize prescriptions without the express authority of the provider, and such authorization must be documented in the EMR. Failure to follow
this rule of law may result in dismissal from the university and/or criminal prosecution.
Providers may designate representatives to phone in or authorize prescriptions but are encouraged to limit this to skilled clinical staff, preferably RNs and LPNs.
Pharmacists both at ECU and at private pharmacies have the right and the responsibility to refuse to fill prescriptions that they feel are in violation of any of these standards.
North Carolina law limits prescription refills to one year from the date written and six months on any controlled substances. The number of prescription refills is limited on controlled substances with no refills allowed for CII meds and a limit of 5 refills on III, IV, and V drugs.
Please note that these reminders are intended to assist our clinicians in providing our patients with the highest quality of patient care and are based, in part, on the established policies of the North Carolina Medical Board and the Professional Practice Guidelines and Expectations of the Brody School of Medicine.Any questions regarding these guidelines should be directed to Dr. Nicholas Benson, Acting Medical Director.
Pharmacy and Therapeutics Committee:Dr. Nathan Brinn, ChairIt is the goal of this committee to establish guidelines and monitor all pharmaceutical use at ECU Physicians. The goals for the committee include:
Adopt a uniform best practices prescribing policy Educate providers, residents, and staff about legal issues
involving medication prescribing Investigate sample usage and alternatives to existing policy Develop program for uniform prescription pads that are in
compliance with new federal law for tamper resistant prescriptions
Continue to provide indigent care discounted pricing for non-insured patients
Work with clinical staff on vaccine procedures Monitor Investigational Drug Studies at BSOM Improve clinical supply, ordering, and billing
Code Teams and Urgent Clinical ResourcesThere are several ways to access additional resources for your patients who are decompensating clinically.
The Code Blue Team can be called and will be able to assist with cardiac or respiratory arrest. If you’re not sure whether or not to call
the Code Team—call them. They can always go back to what they were doing, and it’s the safest thing for your patient.
The Rapid Response Team can provide medical consults for patients who are doing poorly. The Team is in place to prevent codes. Discuss with your senior resident whether or not to consult the Rapid Response Team.
The Code Stroke Team should be called whenever you suspect your patient is having a stroke. The Code Stroke Team is comprised of experts on stroke, and will help you access the best resources for your patient with the goal of the best possible outcome.
Other critical announcements and resources:
Code PinkCode Pink means a suspected or actual infant/child abduction is taking place at PCMH. If you believe this is happening, try to detain the individual with the child or infant and contact the Police at their emergency number (7-4376). There are special lock down procedures to follow if you are in the pediatric units of the hospital during a code pink. Please ask about these in the pediatric departments.
Station RedStation Red means that a fire or potential fire is occurring. The overhead page will announce that there is a Station Red and the location. Once the Station Red is resolved, an overhead page will announce that Station Red Is All Clear.
If you spot a fire, dial 7-4333 for an Emergency. State that there is a fire, the exact location, extent of the fire and your name.
Dr. SearchDr. Search means that there has been a bomb threat received by the hospital. In the case of a Dr. Search, search the room you are currently in starting with the floor and moving towards the ceiling looking for any suspicious items. Once you have searched the room, please exit the room and close the door and mark it with a piece of visible tape to let others know the room has been searched. If you find any suspicious items, dial 7-4333 giving them your exact location and item you have found. Once the Dr. Search has been resolved an overhead page will announce that Dr. Search Is All Clear.
What Is Palliative Care?Palliative care, sometimes called comfort care, is designed to give relief to patients through symptom management and by addressing the spiritual, emotional and psychosocial burdens of disease. The goal is not to cure, but to provide comfort and maintain the highest possible quality of life. The focus is on compassionate, specialized care, which may be delivered in all care settings including hospice, nursing home and home care as well as in hospitals.
Please contact Susan Redding, MSN, FNP-C for assistance or more information about Palliative Care. Phone 847-0868 or 847-4999, pager #3821.
What Palliative Care Services Are Available At PCMH? The services of the palliative care team are available to patients, families and staff at PCMH. The team includes a physician, nurse practitioners, a social worker, a chaplain and several trained volunteers. A palliative care unit is now available at PCMH to meet the short-term needs of patients and families who are in need of this type of care. These beds are available to patients who are actively dying or whose families are preparing to take them home or to a nursing facility with hospice case management or to an inpatient hospice facility. Patients with advanced disease who have a need for symptom control may also be appropriate for placement on the palliative care unit. If you have questions regarding placement on this unit, please call 847-4273 and ask to speak to the nurse manager. Specially trained volunteers provide visitation and/or respite services for the patients/families referred to palliative care. With the generous support of the Service League at PCMH, the loved ones of patients who are actively dying receive “comfort kits”. These kits provide supplies that can facilitate appropriate care of the dying. Several of the affiliate hospitals in the UHS system are beginning to develop palliative care services for their institutions.
How Does One Access The Services Of The Palliative Care Team At PCMH? Although the majority of referrals are initiated by the patient’s primary hospital medical team, the palliative care team accepts a referral from anyone who has a concern for the comfort needs of patients with advanced disease. If the referral has not been initiated by the primary team of physicians caring for the patient, the nurse practitioner on the team reviews the chart and contacts the appropriate physician on the primary team to verify that the referral is appropriate for a palliative care consult. Anyone may call a referral to 252-847-0868. Please leave patient/consult information on line #1 at this number as all team
members access this line. Physicians write an order for consultation per hospital policy.
What Kind Of Circumstances Might Prompt A Referral To The Palliative Care Team?
1.) Advance Care Planning while hospitalized 2.) Resources for symptom management in advanced
disease.3.) Education regarding advanced disease and/or
bereavement issues.4.) Information about hospice services.5.) Resources/assistance at the time of dying.6.) Support with bereavement.7.) Education/support with family conflict regarding end of
life issues.
Is There A Program In Place To Meet The Bereavement Needs Of Families Referred To The Palliative Care Team?In addition to a sympathy card sent from the hospital, the families of all adults who die at PCMH receive from the palliative care service a letter of condolence and resources to help them deal with grief. These resources include information on the signs and symptoms of normal grief and suggestions to help deal with this difficult time. Information about the grief groups for adults and children, held at the Leo Jenkins Cancer Center and open to everyone, are also provided. Additionally the loved ones of those who are referred for a palliative care consult prior to death receive a telephone call from a trained volunteer professional to provide additional support and resources for those left behind.
How Do I Place A Consult For Palliative Care?There are 2 ways to place a consult. 1) Electronically via HealthSpan:
Go to Orders Management and then to Order Entry and type in Palliative Care or pall or end of life
If it is appropriate for your patient to utilize the Palliative Care for Advanced Disease Order Set (PCAD), go to Rounding and click on Order Sets. Type in palliative or pall.
All patients placed on the PCAD will automatically appear on the consult list in HealthSpan for the palliative care team.
2) By Telephone- Dial 252-847-0868 and select option 1 for the palliative care
consult line.
Please let us know if you have any difficulty with placing a consult. Susan Redding, FNP-C pager # 3821Roger Nelson, FNP-C pager # 3086Brenda Poole, FNP-C pager # 3374
How Do I Talk With A Patient Or Family About End-Of-Life Issues?Talking with a patient or family about End-of Life issues can be difficult, and is an important skill to acquire. Your attending should be able to help you with this, or please feel free to contact Susan Redding at 847-0868 or 847-4999, pager #3821 for assistance. Some useful tips are below:
Language to guide End of Life Conversations:
“Are there any treatments that you might not want to receive? “Are you a person, who when the time comes, would like to be allowed to die
naturally?”
“If you ever became so ill that you were unable to speak for yourself, who would you want to make decisions regarding your medical care?” 1
"Please understand that we are not asking you to decide whether your mother will live or die, but to communicate to us what she would want."
"Our goal is to make sure that all treatments we offer will be beneficial to your father."
Effective communication at end of life can help allay fears the patient or family members often experience as they struggle to accept the reality of their situation...”
Dr. Richard B. Balaban
1 Balaban RB. A Physician's Guide to Talking about End-of-Life Care. JGIM. 2000;15:195-200
Questions to contemplate when considering interventions for the patient at end of life.
1. Consider the patient’s wishes regarding life-sustaining therapies.
2. Consider potential benefits versus possible burdens of treatment.
3. Is it probable that the patient will die regardless of this intervention?
4. Will the patient accept the quality of life if he/she survives the intervention?
5. Would it surprise you to hear that this patient died in the next 1-2 years? If not, we owe it to the patient and family to initiate advanced care planning discussions.
To help someone die in comfort, in peace, and with dignity is to give one final gift of life.”
Dr. Richard B. Balaban
How Can I Learn More About Palliative Care?Please reference the End of Life and Palliative Care links on UHS and PCMH web pages and the following list of Internet sites.
http://www.nhpco.org/ The National Hospice and Palliative care Organization
http://www.endoflifecarecoalition.org/ Local community coalition working to improve end of life care in Eastern Carolina
http://www.lastacts.org/ Organizations banding together to improve care at the end of life
http://abcd-caring.org/ Americans for better care of the dying
http://dyingwell.org/ Website consisting of resources and referrals to organizations
http://growthhouse.org/ award winning international gateway to resources for life-threatening illness and end of life care
http://stoppain.org/ Website for Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York.
http://agingwithdignity.org/ Information on living wills and other legal issues
http://hospiceinfo.org/ National Hospice Foundation
http://www.uslivingwillregistry.com/ Information and national registration for Living Wills.
http://www.secretary.state.nc.us/ahcdr/ State registration for Advanced Directives.
Please contact Susan Redding, MSN, FNP-C for assistance or more information about Palliative Care 847-0868 (phone) 847-4999, pager #3821
Writing a DNAR (Do Not Attempt to Resuscitate) OrderOrders for DNAR must be written on a Patient Care Status Orders form. This form can be found in HealthSpan (the electronic medical record), or can be provided to you by the unit secretary. This form should be completed anytime a patient’s status is anything other than full code and routine care. It is an excellent tool for providers to communicate patient’s or their surrogate’s desire for acceleration of care. The Patient Care Status Orders form is particularly helpful to providers when they are covering patients with whom they are not familiar. An electronic form should have a paper backup completed as well.
Any order written by a resident or fellow for a level of care other than full code and routine care (DNAR) must be co-signed by an attending within 24 hours.
Working
E-mail AccountYou will be provided an e-mail account through the Brody School of Medicine. Even if you have your own personal e-mail account, work-related information will be sent to you through this Outlook account. You will be expected to check your e-mail regularly for communication from your training program as well as from the GME Office.
ParkingAll vehicles owned or driven to work by PCMH employees must be registered with Parking Enforcement and have a parking permit affixed to the rear of the vehicle. Parking is free on the hospital campus to employees. Residents are permitted to park in any the Resident Lot or any Employee Parking Lot. Please refer to the PCMH Parking Policy given to you when you receive your parking permit for more information.
Be aware that no parking is allowed on ECU property without an ECU parking permit. Your PCMH parking sticker is NOT valid for parking at the medical school. The one exception is for parking at the Health Sciences Library after 5pm and on weekends.
Changes in Name, Address, Telephone Number, Marital Status, or Number of DependentsIt is necessary that residents and fellows notify the GME Office and their Program promptly of any changes in their name, address, and telephone number. When marital status or the number of dependents changes, you must contact the Compensation and Benefits Department to update the necessary benefit and insurance information within 45 days of the change. Tax form changes are made in the Personnel Records Center or the Payroll Department. If you have any questions, please contact the GME Office and we will assist you.
InsurancePCMH offers employees medical and dental coverage, life/dismemberment, and disability insurance. The medical plan is self-insured and the costs are shared by PCMH and employees, based on claims cost from year to year. The dental plan and disability insurances are paid by employees. Life insurance for full-time employees equal to base pay rounded up to the next $1000 is paid by the Organization. Additional life insurance may be purchased by full-time employees. Part-time employees with benefits may purchase medical, dental, and are not eligible for additional life insurance or disability. Details of
insurance coverage are available in the Human Resources Office and your benefit booklet.
Flexible BenefitsEligible employees have an opportunity to make their own benefit decisions to meet their particular situation and needs. Annually, during the open enrollment period, employees may elect changes to these benefits as offered by the Organization. Changes may be made at other times only with a change in family/certain employment statuses. The following benefits are pre-tax deductions:
• Medical Plan• Dental Plan• Health and Dependent Care Reimbursement Accounts (Flexible Spending Accounts-FSA).
Details about Flexible Benefit programs are provided in the Individual Benefit Booklet and are available in the Compensation and Benefits Department.
Partnership Savings PlanPCMH offers a 401(k) plan to help employees build additional retirement income. There is a current match of $.50 for each $1.00 the employee contributes, with a maximum match of 5% of annual salary, i.e. employee contributes 5% before state and federal taxes, and the Organization matches 2.5%. Details of this plan are available in the Compensation and Benefits Department and Benefit Booklet.
Employee DiscountsA. PHARMACY. Prescribed drugs may be purchased from the
employee pharmacy (located in the BB&T building) at a reduced rate for use by the employee or his/her immediate family including spouse, children, and stepchildren living in the same household.
B. HOSPITAL BILLS/SURGICENTER. Employees of the Organization, spouses of employees, and dependents of employees with the Organization's Medical Plan coverage or another insurance comparable to the Organization's Medical Plan will be eligible for a discount of 50% towards the deductible and/or 50% towards the co-insurance. Discounts MUST be requested in person at the Business Office within 60 days of the insurance payment or denial. Balance remaining after the eligible discount portion must be paid in full or set up on payroll deduction at that time in order to receive the discount. Claims not paid by the Organization’s Medical Plan or comparable insurance coverage will not be eligible for discount. Also, accounts in bad debt are not eligible
for discounts. If the patient has more than one insurance, a discount will be given only after all insurers have responded.
Smoking/Tobacco ProductsThe use of tobacco products is prohibited on the hospital campus and in all hospital owned or leased vehicles and aircraft. Disciplinary action will be taken if a violation occurs.
PCMH Police ForcePCMH has a trained police force on duty 24 hours a day. If you have an emergency on our campus call 7-4376 or press the button at any emergency call box. Emergency call boxes are located in parking lots and outlying areas of the PCMH campus. They are white cylinders with blue lights at the top of them. If you just need to contact the dispatcher about a non-emergency (ex. car won’t start) call 7-8568.
The Police also offer help if you are in a domestic violence situation. You can contact our police department and they can help protect you on campus with escorts and special parking. They will also help you with the legal aspects of domestic violence situations.
Also, if you are leaving campus going to your car in a remote lot and do not feel safe walking to your car, please contact the non-emergency number at 7-8568 for an escort to your car.
Dress Code and ID BadgesDress Code: Minimum Standards of Professional Dress and AppearanceThe following standards are minimum standards for professional dress and appearance, your program may have standards that are stricter, and you will need to comply with those standards as well. The Organization reserves the right to determine at its discretion what is and is not appropriate workplace attire and to address issues as they arise.
1. Identification Badgesa. The Hospital Police Department will issue ID badges to all
employees. If you do not wear your ID badge, you may be challenged by Hospital Police personnel. The badge must be worn so that the information it contains is readily visible to those who come in contact with you. Employees are required to wear their ID badges at all times while on duty. Residents and Fellows will also be issued ID badges from ECU (ECU One Card) which will give you access to the GME Center and other appropriate areas within the medical school.
b. Employee identification badges are essential to dress as they identify staff members to patients, patient family members, visitors, and other staff. The PCMH identification badge is the property of University Health Systems and is multifunctional. In addition to providing identification, the badge is necessary for access control.
c. Badges must be worn above the waist and displayed front-side-out (not covered or reversed) so that the name and photo are always visible.
d. Badges are not to be covered with pins, ornaments, stickers, or any other objects. The front face of the badge is to be clean and clearly visible at all times.
e. Any lost, misplaced, stolen, or worn out badges must be replaced at the earliest possible date that the Hospital Police department can provide a replacement. Replacement fee for badges is ten dollars ($10).
f. Managers and supervisors may prohibit those employees reporting to work without their ID Badge from working until their badge is present.
2. Appropriate grooming and hygiene a. Personal hygiene is critical to your professional appearance
and perception. Particular attention should be given to skin, fingernails, hair, bathing, proper oral hygiene, and use of deodorant as needed. Employees must keep their hair clean, well groomed, and away from the face in an orderly fashion that does not present a safety hazard. Beards, mustaches, and sideburns are to be neatly trimmed and groomed.
b. The use of excessive makeup should be avoided and strong fragrances are prohibited.
c. Offensive or inappropriate tattoos must be covered. For the purposes of this policy, inappropriate means any tattoo deemed by management to be inconsistent with the standards of a professional, quality health care workplace.
3. Appropriate personal behaviors a. Gum chewing is prohibited in direct patient care areas and
other specified areas.b. Employees are not permitted to wear sunglasses indoors
unless for medical reasons. 4. Appropriate attire
All clothing should be clean, fit properly, be in good repair, and pressed or ironed as needed. Employees must wear appropriate undergarments to avoid an unprofessional appearance. Leather (other than shoes and dress coats) and sheer garments should be avoided.
Occupational Health ServicesOccupational Health Services is provided to all hospital employees. Their focus is on employees’ health and safety. Main services they provide are initial and annual health screens, employee illness, return to work clearances, exposure to communicable diseases and accidental injury.
Annual screenings are required on your birth month. The GME office will remind you to make an appointment.
If you are absent from work for more than 3 days for health reasons or with an infectious illness, you will be required to have clearance from Occupational Health prior to returning to work.
Occupational Health Issues for Residents:‘We are here to serve you, so you may serve others’
I. Blood Exposures: If you should have a blood exposure:1. Stop what you are doing and,
If a skin puncture has occurred, wash the area with soap and water.
If a splash to skin or mucous membranes has occurred, rinse the area thoroughly.
2. Report the exposure immediately. If occurs Monday – Friday 7:00 – 4:00 contact
Occupational Health about the exposure at 847-4386 or 847-7609
If occurs any other time, contact the Patient Care Coordinator at 847-4470 or have them paged by calling the switchboard at 847-4100
Complete the blue Employee Event Report to include the source patient information / location.
3. Occupational Health or the Patient Care Coordinator will make arrangements to have the source patient tested. A rapid HIV test will be done. You should have the results within an hour.
4. If the source patient is HIV positive: Monday – Friday 7:00 – 4:00: The Occupational Health
Nurse will collaborate with the Infectious Disease Medical Director to provide preventive care.
After hours and weekends: Report to the Emergency Department immediately.
5. If the source patient is HIV negative;It is important that you follow up with Occupational Health to have further assessment and counseling.
II. Work Related Injuries:1. If medical emergency – go to the Emergency Department.2. For all other injuries other than blood exposure, notify your
supervisor and complete a blue Employee Event report and follow up with Occupational Health. If injury occurs when Occupational Health is closed, please put completed event report in the Occupational Health drop box outside of the cafeteria in the main hallway.
III. Annual Health Screens:1. It is required that all PCMH employees have an annual health
screen. Immunity status, tuberculosis surveillance and protections in addition to wellness screening and voluntary MRSA screening opportunities are provided at that time.
IV. Absences from Work Due to IllnessIf you are absent from work due to illness for more than 3 days or with an infectious illness, you must report to Occupational Health for a screening prior to returning to work.
CompliancePCMH Corporate Compliance Program A System of Employee Empowerment and AccountabilityThe Board of Directors for University Health Systems of Eastern Carolina (UHSEC) is committed to effective and efficient operations, reliable financial reporting and compliance with all applicable laws and regulations. To that end, the compliance program was created as a system of employee empowerment and accountability.
Program Purpose:The purpose of the program is to prevent, detect and correct potential violations of the law, rules and policies by all employees of the health system. The intent of the program is twofold. First, the program is designed to aid all health system employees in complying with the increasingly complex rules and regulations governing the health care industry by providing uniform policies and procedures. Second, it is the health system's desire for this program to aid in the identification and
correction of any violations of any applicable rules and regulations and the health system's Code of Conduct. In order to attain this goal, the Code of Conduct imposes a duty upon all employees to report any actual or perceived violation of the Code of Conduct, the Corporate Compliance Program or any other health system policy or procedure to designated individuals.
Mission:The mission of the Office of Audit and Compliance is to assist and advise management and employees to help ensure the health system is compliant with applicable Federal, State and Local laws. The Office of Audit and Compliance shall perform independent appraisal functions to examine and evaluate the adequacy and effectiveness of the health system’s internal control system, overall quality of performance and compliance with applicable laws, rules, policies and regulations.
Key Elements:Compliance is more than a defensive mechanism for the health system. It is a key component for managing risk, improving operational efficiency and increasing the quality of patient care. This program complies with Application Note 3 (k) of Section 8A1.2 of the Federal Sentencing Guidelines and the Office of the Inspector General (OIG) Guidelines for Compliance Programs. The Compliance Program contains the following seven key elements:
1. Compliance standards and procedures2. Oversight responsibility3. Effective education and training4. Monitoring and auditing system5. Effective lines of communication6. Enforcement and discipline7. Response and direction
Program Goals:The following are the program goals for the compliance program:1. Maintain zero tolerance of fraud.2. Prevent, detect and respond to unacceptable legal risk and its financial implications.3. Route non-compliance issues to appropriate areas.
Code of Conduct:As an Organizational employee, you are expected to abide by a high standard of ethical behavior at all times. You must obey the laws and rules that apply to health system operations and to your particular duties. We urge you to make sure you know and understand all the rules and policies that apply to your work. If you are not familiar with
them, you might make mistakes that could be costly to the health system and to you. If you do not know what rules apply to you, talk to your supervisor or call the Chief Audit/Compliance Officer at (252) 847-0125. You must also be careful to understand and obey applicable laws including antitrust laws as well as the conflict of interest policy and the ethical behavior policy in the Administrative Policy Manual. You should be particularly careful not to inadvertently do anything that amounts to fixing prices, limiting competition or dividing up customers or markets. You should also be careful not to engage in any of the following illegal activities:1. Kickbacks- you may not ask for, give or receive any kind of direct or indirect payment or reward for Medicare or Medicaid referrals.2. False Claims- you may not make false or misleading claims for services given or received or about people who gave or received services.3. Mail and Wire Fraud- you must not send false claims or statements through the US Postal Service or electronically.
It is your duty to report any transaction or conduct that you think may be a violation of federal, state or local law. You can do that by:1. Notifying your immediate supervisor (Alyson Riddick in the GME Office, 847-4268)2. Contacting the Chief Audit/Compliance Officer by telephone or email.3. Making a toll-free, anonymous call to the compliance hotline at 1-888-777-2617.4. Should employees or agents feel that the health system has not taken appropriate action to address a potential violation, they can also lodge a complaint concerning waste, fraud and abuse directly to the federal government to the Health and Human Service’s Office ofInspector General hotline at 1-800-447-8477.
You must also report anything you see or hear that may be a violation of rules or policies dealing with the following:1. Financial records2. Living wills3. Patient care4. Personal conduct5. Personnel issues such as: equal employment, sexual harassment, personal conduct, the Fair Labor Standards Act and time and attendance.
Compliance PoliciesThe health system’s Board of Directors has adopted the following policies:
Policy 1—University Health Systems of Eastern Carolina will not take any adverse action or retribution against any employee due to the good faith reporting of a suspected violation or irregularity.Policy 2—Employees are expected to obey and report any suspected violations of the following:1. Federal, state, and local laws and government regulations2. Health system policies and procedures3. Organizational rules and regulations4. Corporate Compliance Program5. Code of ConductPolicy 3—All clinical professional services will be documented in the medical record, and such documentation will comply with applicable payer regulations.Policy 4—All clinical professional services will be coded to accurately reflect the documentation in the medical record.Policy 5—All claims shall be submitted in compliance with applicable payer regulations or requirements.Policy 6—Employees will not knowingly and willfully solicit, receive, offer or pay any remuneration directly or indirectly, in cash or in kind, in exchange for Medicare and/or Medicaid referrals.Policy 7—Employees will not knowingly and willfully (1) falsify, conceal or cover up a material fact, (2) make any false, fictitious or fraudulent statement or representation, or (3) make or use false writing or document known to contain false, fictitious or fraudulent statement in information submitted to the government.Policy 8—Employees will not conceal or fail to disclose knowledge of an event affecting an initial or continued right to any benefit or payment with intent to secure such benefit or payment fraudulently.Policy 9—Employees/agents will not knowingly present or cause to be presented false or fraudulent claims, including situations where (1) the service was not provided as claimed, (2) the service was provided during a period in which the provider was excluded from the program and 3) the service was provided due to false or misleading information on coverage in order to influence a decision regarding when to discharge a person from inpatient hospital services.Policy 10—Employees will not knowingly make or present a false, fictitious or fraudulent claim to a Federal agency.Policy 11—Employees will not use the US Postal Service or electronic submission processes as part of a scheme to defraud the government or obtain money by false or fraudulent pretenses.Policy 12—Employees will not embezzle, steal or otherwise convert to the benefit of another person or intentionally misapply money, funds, securities, premiums, credits, property or other assets of a health care benefit program.Policy 13—Employees will not willfully prevent, obstruct, mislead, delay or attempt to prevent, obstruct, mislead or delay the
communication of information or records relating to a violation of Federal health care offense to a criminal investigator. Note: Legal Counsel should be contacted immediately upon learning of such investigations.Policy 14—Employees will not conspire to defraud any government agency or health care benefit program in any manner for any purpose.
False Claims/Whistleblower Suits:The False Claims Act allows a private person, known as a “relator,” to bring a lawsuit on behalf of the United States, where the private person has information that the named defendant has knowingly submitted or caused the submission of false or fraudulent claims to the United States. The relator need not have been personally harmed by the defendant’s conduct. The False Claims Act has a very detailed process for the filing and pursuit of these claims. For more information on the Whistleblower process, including State and Federal protections in these situations, please see the footnote at the end of this section or the UHS Employee Handbook. A copy of the Employee Handbook can be obtained from the GME Office.
Whistleblower ProtectionIt is the policy that University Health Systems of Eastern Carolina will not take any adverse action or retribution against any employee due to the good faith reporting of a suspected violation or irregularity. We encourage our employees to report any suspected violations of law and to ask questions if they are unsure of a regulation.
COMPLIANCE AT THE BRODY SCHOOL OF MEDICINEThe Brody School of Medicine (BSOM) is committed to providing the highest quality patient care, education and research in an ethical and law abiding manner. The BSOM Office of Compliance is committed to building and maintaining a culture of compliance that encourages faculty, staff, students, and agents to conduct all BSOM operations with honesty and integrity. The BSOM Compliance Program provides a framework for BSOM compliance with applicable healthcare federal and state laws and regulations, and the BSOM Code of Conduct. The Director of Compliance at BSOM is Joan A. Kavuru, J.D., R.N.
Everyone working for or on behalf of BSOM has an obligation to be aware of the rules and regulations that govern their work and an obligation to seek answers and guidance when unsure about a course of action or situation. You are encouraged to work with your supervisor, administrator or contact person in addressing or reporting potential concerns or violations. However, BSOM guarantees your right to discuss or inquire about compliance issues or report suspected violations directly to the Director of Compliance or via the Compliance
Hotline. You may remain anonymous. You may also contact BSOM Chief Legal Counsel or the ECU Office of Internal Audit with questions or concerns.
Please note that you must adhere to the ECU Physicians Standards for Documentation and Billing of Professional Services as it relates to all professional services billed by BSOM. You can access this document at the following link: http://www.ecu.edu/cs-dhs/bsomcompliance/customcf/policies/Billingstandards.pdf
In addition, you can access a pocket billing guide that describes documentation requirements for inpatient and outpatient Evaluation and Management Services at the following link http://www.ecu.edu/cs-dhs/bsomcompliance/customcf/Compliance%20brochure%20005980.pdf
Please do not hesitate to contact your supervisor or the BSOM Office of Compliance with any questions related to billing and documentation of professional services.
See the BSOM Office of Compliance website for additional information. You can access this website at http://www.ecu.edu/bsomcompliance/
Important Contact Information for BSOM
Interim Director of Compliance: Kenneth DeVille, PhD, JD: 744-5200 [email protected] Office of Internal Audit Hotline: 328-9025BSOM Compliance Hotline (toll free): (866) 515-4587 (no caller ID)
False Claims/Whistleblower Suits (Footnote)The following is a brief overview of the False Claims Act and Government Intervention in such cases as detailed in the Department of Justice (DOJ) memorandum below:“False Claims Act Cases: Government Intervention in Qui Tam (Whistleblower) Suits”This DOJ memorandum provides a brief, general overview of qui tam litigation under theFalse Claims Act. It does not constitute legal advice and does not represent the official policy of the United States Department of Justice.
The False Claims Act, 31 U.S.C. § 3729 et seq., provides for liability for triple damages and a penalty from $5,500 to $11,000 per claim for anyone who knowingly submits or causes the submission of a false or fraudulent claim to the United States. The statute, first passed in 1863, includes an ancient legal device called a “qui tam” provision (from a Latin phrase meaning “he who brings a case on behalf of our lord the King, as well as for himself”). This provision allows a private person, known as a “relator,” to bring a lawsuit on behalf of the United States, where the private person has information that the named defendant has knowingly submitted or caused the submission of false or fraudulent claims to the United States. The relator need not have been personally harmed by the defendant’s conduct.
The False Claims Act has a very detailed process for the filing and pursuit of these claims. The qui tam complaint must, by law, be filed under seal, which means that all records relating to the case must be kept on a secret docket by the Clerk of the Court. Copies of the complaint are given only to the United States Department of Justice, including the local United States Attorney, and to the assigned judge of the District Court. The Court may, usually upon motion by the United States Attorney, make the complaint available to other persons.
The complaint, and all other filings in the case, remain under seal for a period of at least sixty days. At the conclusion of the sixty days, the Department of Justice must, if it wants the case to remain under seal, file a motion with the District judge showing “good cause” why the case should remain under seal. In the usual course, these motions request an extension of the seal for six months at a time.
In addition to the complaint filed with the District Court, the relator must serve upon theDepartment of Justice a “disclosure statement” containing substantially all the evidence in the possession of the relator about the allegations set forth in the complaint. This disclosure statement is not filed in any court, and is not available to the named defendant.Under the False Claims Act, the Attorney General (or a Department of Justice attorney) must “diligently” investigate the allegations of violations of the False Claims Act. The investigation usually involves one or more law enforcement agencies (such as the Office of Inspector General of the victim agency, the Postal Inspection Service, or the FBI.) In some investigations where state agencies are victims, state attorneys general with expertise and interest will participate in the investigation and work closely with the federal agencies.
The investigation will often involve specific investigative techniques, including subpoenas for documents or electronic records, witness
interviews, compelled oral testimony from one or more individuals or organizations, and consultations with experts. If there is a parallel criminal investigation, search warrants and other criminal investigation tools may be used to obtain evidence as well.
At the conclusion of the investigation, or earlier if so directed by the Court, the Department of Justice must choose one of three options named in the False Claims Act:1. Intervene in one or more counts of the pending qui tam action. This intervention expresses the Government’s intention to participate as a plaintiff in prosecuting that count of the complaint. Fewer than 25% of filed qui tam actions result in an intervention on any count by the Department of Justice.2. Decline to intervene in one or all counts of the pending qui tam action. If the United States declines to intervene, the relator may prosecute the action on behalf of the United States, but the United States is not a party to the proceedings apart from its right to any recovery. This option is frequently used by relators and their attorneys.3. Move to dismiss the relator’s complaint, either because there is no case, or the caseconflicts with significant statutory or policy interests of the United States.In practice, there are two other options for the Department of Justice:1. Settle the pending qui tam action with the defendant prior to the intervention decision. This usually, but not always, results in a simultaneous intervention and settlement with the Department of Justice (and is included in the 25% intervention rate).2. Advise the relator that the Department of Justice intends to decline intervention. Thisusually, but not always, results in dismissal of the qui tam action.There are no statistics reported on the length of time the average qui tam case remains under seal. In this District, most intervened or settled cases are under seal for at least two years (with, of course, periodic reports to the supervising judge concerning the progress of the case, and the justification of the need for additional time).Intervention by the Department of Justice in a qui tam case is not undertaken lightly. Intervention usually requires approval by the Department in Washington. As part of the decision process, the views of the investigative agency are solicited and considered, and a detailed memorandum discussing the relevant facts and law is prepared. This memorandum usually includes a discussion of efforts to advise the named defendant of the nature of the potential claims against it; any response provided by the defendant, and settlement efforts undertaken prior to intervention. This memorandum is considered to be attorney work product exempt from disclosure.Upon intervention approval, the Department of Justice files:
1. A notice of intervention, setting forth the specific claims as to which the United States is intervening;2. A motion to unseal the qui tam complaint filed by the relator (including any amendedcomplaint) and the notice of intervention. All other documents filed by the Department of Justice up to that point remain under seal.The decision by the Department of Justice to intervene in a case does not necessarily mean that it will endorse, adopt or agree with every factual allegation or legal conclusion in the relator’s complaint. It has been the usual practice of the Department to file its own complaint about 60 days after the intervention, setting forth its own statement of the facts that show the knowing submission of false claims, and the specific relief it seeks. In addition, the Department of Justice has the ability to, and often will, assert claims arising under other statutes (such as the Truth in Negotiation Act or the Public Contracts Anti-Kickback Act) or the common law, which the relators do not have the legal right to assert in their complaint, since only the False Claims Act has a qui tam provision.After the relator’s complaint is unsealed, the relator has the obligation under the Federal Rules of Civil Procedure to serve its complaint upon each named defendant within 120 days. Each named defendant has the duty to file an answer to the complaint or a motion within 20 days after service of the government’s complaints. Discovery under the Federal Rules of Civil Procedure begins shortly thereafter.”The State of North Carolina also has a General Statute concerning false claims. The following information on the statute is provided below:
North Carolina General Statute § 108A-70.12. Liability for certain acts; damages; effect of repayment.(a) Liability for Certain Acts – It shall be unlawful for any provider of medical assistance under the Medical Assistance Program to:(1) Knowingly present, or cause to be presented to the Medical Assistance Program afalse or fraudulent claim for payment or approval; or(2) Knowingly make, use, or cause to be made or used a false record or statement to get afalse or fraudulent claim paid or approved by the Medical Assistance Program.Each claim presented or caused to be presented in violation of this section is a separate violation.(b) Damages –(1) Except as provided in subdivision (2) of this subsection, a court shall assess againstany provider of medical assistance under the Medical Assistance Program who violates
this section a civil penalty of not less than five thousand dollars ($5,000) and not morethan ten thousand dollars ($10,000) plus three times the amount of damages which theMedicaid Assistance Program sustained because of the act of the provider.(2) A court may assess a penalty of not less than two times the amount of damages, which the Medical Assistance Program sustains because of the act of the provider if a court finds that:a. The provider committing a violation of this section furnished officials of theState responsible for investigating false claims violations with all information known to the provider about the violation within 30 days after the date the provider first obtained the information;b. The provider fully cooperated with any State investigation of the violation; andc. At the time the provider furnished the State with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced with respect to the violation, and the provider did not have actual knowledge of the existence of an investigation into the violation.(3) In addition to the damages and penalty assessed by the court pursuant to subdivision(1) or (2) of this subsection, a provider violating this section shall also be liable for the costs of a civil action brought to recover any penalty or damages, interest on the damages at the maximum legal rate in effect on the date the payment was made to the provider for the period from the date upon which payment was made to the provider to the date upon which repayment is made by the provider to the Medical Assistance Program, and the costs of the investigation.(4) As applied to providers that are subject to certification review by the Division ofFacility Services, a violation of Medicaid provider certification standards in providing a service, good, or accommodation shall not be considered an independent basis for liability under this Act. However, liability may be imposed if a false or fraudulent claim is presented as set forth in subsection (a) of this section in connection with that service, good, or accommodation.(c) Effect of Repayment – Intent to repay or repayment of any amounts obtained by a provider as a result of any acts described in subsection (a) of this section shall not be a defense to or grounds for dismissal of an action brought pursuant to this section. However, a court may consider any repayment in mitigation of the amount of any penalties assessed. (1997-338, s. 1.)
Joint Commission Survey Readiness: What House Staff Need to Know
Background on Joint Commission The Joint Commission is a private organization that develops
quality and safety standards for health care organizations. Most hospitals in the country seek accreditation by Joint Commission. The Joint Commission establishes standards that all accredited institutions must comply with. These standards involve all aspects of hospital operations and health care delivery including but not limited to patient care, patient rights, documentation, the physical environment, infection control, and credentialing of medical staff and patient safety. The Joint Commission surveys hospitals every 3 years. Pitt County Memorial Hospital was last surveyed in February 2006.
Unannounced Survey Process As of January 1, 2006, the Joint Commission triennial surveys are unannounced. We are scheduled to have a survey within the next 12 months. The Joint Commission continues to randomly survey a small percentage of hospitals each year. Our focus at PCMH is on continuous survey readiness.
Following is a summary of some key hospital policies that are critical to compliance with the Joint Commission standards.
Documentation - Do not use abbreviations - see unsafe abbreviations in the grid below in the section on 2008 National Patient Safety Goals. These abbreviations are not to be used in our hospitals.
- Telephone orders - All telephone orders must be countersigned within 48 hours. The physician must wait for the person taking the order to write it down and read it back (no other verbal orders except in an emergency). Please collaborate with the individual taking the telephone order in this process so the patient gets the safest care possible.
- History and Physicals -- A complete history and physical must be documented and signed within 24 hours of admission. When the H&P has been completed by a resident, the attending physician must countersign within 24 hours of admission. An update must be written on any H&P written prior to the patient’s admission. The signed H&P must be on the chart prior to operative and invasive procedures.
- Authentication - All entries in the medical record must be signed, dated and timed.
- Legibility - All documentation in the medical record must be legible.
- Coordination of care - Daily progress notes by attending physicians should reflect knowledge of clinical observations and treatment plan previously documented by residents, physician assistants, and nurse practitioners. Residents should link their notes with the attending’s note (“Case discussed with the attending, Dr. _____.”)
- Supervision - Resident supervision must be clearly documented by the attending or the resident in the progress notes.
- Post op notes - A post op note must be entered in the chart immediately after surgery and the operative report must be dictated within 24 hours.
Patient Rights - All employees and medical staff must be cognizant of patient privacy issues. Bed curtains should be used in patient rooms and patient information should not be discussed in public places.
- Informed consent must be obtained and must include risks, benefits, and alternatives. Consents must be signed and witnessed.
Restraints and Seclusion - Physicians must write orders for every episode of restraints. Non violent restraint orders must be renewed every 24 hours. Violent or self destructive orders must be renewed every 4 hours for adults, ever 2 hours for children age 9 to 17 and every 1 hour on children under the age of 9. A physician must conduct a “face to face” assessment of the patient no longer than 1 hour after the application of restraints. This assessment must be documented in the medical record.
- Physicians must document the rationale for the use of restraints, type of restraint and the specific time period for their use.
Patient Safety - Know the Joint Commission National Patient Safety Goals (please note that you should be particularly comfortable speaking about those related to your area of practice)
2009 JCAHO National Patient Safety Goals
Each year the Joint Commission issues a set of National Patient Safety Goals. All accredited hospitals are required to comply with these goals. The goals are selected based on sentinel events that have been submitted to the Joint Commission and reviewed by the Sentinel Event Advisory Group. These goals address safety issues that have resulted in a significant patient harm.
Goal 1 Improve the accuracy of patient identification A. Use at least two patient identifiers (ex., patient’s name and date
of birth) whenever administering medications or blood products; taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures. In addition, containers used for blood and other specimens should be labeled in the presence of the patient.
Goal 2 Improve the effectiveness of communication among caregivers A. For verbal or telephone orders or for telephonic reporting of
critical test results, verify the complete order or test result by having the person receiving the order or test result "read-back" the complete order or test result.
B. Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization.
The following table displays the unsafe abbreviations that should not be used as well as the preferred term.
Abbreviations and Dose Expressions No Longer Valid
Valid
Abbreviation Safe Term IU write "International Unit" QD write "Daily" Q.O.D. or QOD write "Every Other Day" U write "Unit" Trailing zero after decimal point (e.g. 1.0mg)
Do not use zeros for dose, express as whole number (e.g. 1mg)
No zero for dose before decimal point (e.g. .5mg)
Leading zero begins at decimal dose (e.g. 0.5mg)
Drug Name Abbreviations Valid MgS04 write "Magnesium sulfate" MS, MS04 write "Morphine sulfate
C. Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.
D. Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.
Goal 3 Improve the safety of using medications A. Standardize and limit the number of drug concentrations
available in the organization. B. Identify and, at a minimum, annually review a list of
look-alike/sound-alike drugs used in the organization, and take action to prevent errors involving the interchange of these drugs.
C. Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings.
D. Reduce the likelihood of patient harm associated with the use of anticoagulation therapy
Goal 7 Reduce the risk of health care-associated infections A. Comply with current Centers for Disease Control and Prevention (CDC) hand
hygiene guidelines. B. Manage as sentinel events all identified cases of unanticipated death or major
permanent loss of function associated with a health care-associated infection.
Goal 8 Accurately and completely reconcile medications across the continuum of care
A. There is a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list.
B. A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient upon discharge from the facility.
Goal 9 Reduce the risk of patient harm resulting from falls A. Implement a fall reduction program and evaluate the
effectiveness of the program.
Goal 13 Encourage patient’s active involvement in their own care as patient safety strategy
A. Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
Goal 15 The organization identifies safety risks inherent in its population (applies to patients who are being treated for emotional or behavioral problems)
A. The organization identifies patients at risk for suicide. Goal 16 Improve recognition and response to changes in a patient’s condition
A. The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening.
Universal ProtocolsThe organization fulfills the expectations set forth in the Universal Protocol
A. Conduct a preoperative verification process at describe in the Universal Protocol
B. Mark the operative site as described in the Universal protocolC. Conduct a “time out” immediately before starting the procedure
as describe in the Universal Protocol.
Liability & MalpracticePitt County Memorial Hospital and the Brody School of Medicine Hospital Insurance and Risk Management
PCMH provides malpractice coverage for your medical activities that are part of your training program. The PCMH Risk Management Office is available to you for liability support and will be contacting you when issues of potential risk arise. If you are contacted by Risk and have concerns about that, please contact the GME Office and/or your program director.
► Contact Information
Name Responsibility Telephone
Vicki Haddock
Administrator Risk Management, UHSPitt County Memorial Hospital
847-5591
Annette Mayo
For information regarding resident professional liability coverage and all other UHS lines of insurance
847-5592
Jody Cook Director, Risk ManagementThe Brody School of Medicine
744-2380
Risk Management On-call Pager 847-4473
► Malpractice Statistics Medical errors kill between 44,000 and 98,000 people a year. More than the number of people who die on the road (43,450), from breast cancer (42,300), or from AIDS (16,500).
► Legal Definition Medical malpractice is the handling of a case by a physician, surgeon, or other professional in a manner that fails to meet the standards of conduct for duties relating to the medical profession and results in an injury to the patient. These standards are based on what a reasonable person with requisite knowledge and skills would or would not do. Keep in mind that a bad result from a treatment or procedure does not automatically mean bad medicine. Example: a heart surgeon may do everything right during surgery and still lose the patient during surgery.
In a medical malpractice action, in order for the plaintiff to prevail, the plaintiff’s attorney must prove the following:
1. there is a standard of care in the community which applied to the physician’s conduct
2. the physician departed from this standard of care 3. the departure directly injured the patient
Once a doctor enters into a physician-patient relationship, he or she has a duty to provide care at a level that compares to what other competent doctors would have provided in the same situation.
► Steps Leading to a Malpractice Action 1. The patient meets with a plaintiff’s attorney to discuss the care in
question. A determination is then made as to whether the filing of an action at this time would be within the statute of limitations which is the time the law allows from the act or omission complained of or from the end of a continuous treatment during which this act or omission took place. This varies state by state. In North Carolina:
a. Medical Malpractice is three (3) years
b. Within one (1) year from the date upon which the foreign object was discovered or should reasonably have been discovered.
c. Infants/Children: One (1) year after the child reaches the age of majority
d. Wrongful Death: Two (2) years from the date of death 2. The patient signs an authorization for the release of their medical
records to the attorney. 3. The attorney has the records reviewed by a physician who gives
an opinion as to whether or not malpractice has occurred. If the physician reviewer believes that it has, the attorney will sign a certificate of merit, which will accompany the Summons & Complaint when it is served.
4. The attorney prepares the Summons, which is then served on the physician or someone authorized to accept service for that physician. This starts a civil action and gives jurisdiction over a party. It can be either a Summons & Complaint or a Summons with Notice.
a. Summons with Notice: gives formal notification to the party that has been sued in civil case of the fact that the lawsuit has been filed. The Summons also tells you the type of court in which the case will be heard, usually Superior Court, and it will tell you the venue (location) which is one of the Counties, usually the one in which the care took place. or the county in the patient resides.
b. Summons and Complaint: This Summons tells you the above information and the Complaint tells the court what the plaintiff wants and vaguely describes the allegations of malpractice.
► Defendant’s Response The individual who is sued is known as the Defendant and he/she can be served with legal papers in a number of ways: Personal Service: The papers are given directly to the physician. With this type of service, the defendant has 20 days (exclusive of the day of service) in which to have his/her attorney put in an Answer. The Answer is the document in which the attorney denies all allegations and demands a Bill of Particulars, which lists the allegations in very specific detail.
Substitute Service: The papers are given to some other person of standing, i.e. office manager, secretary in Dean’s Office. With this type of service, the defendant has thirty (30) days in which to have his/her attorney put in an Answer.
Mail: This can be sent to the physician’s address along with two (2) copies of “Statement of Service by Mail and Acknowledgement of Receipt.” With this type of service, the defendant has thirty (30) days to return the receipt and twenty (20) days from the return of the receipt to have his/her attorney put in an Answer for him/her.
A failure to Answer or serve a Notice of Appearance results in a Default Judgment against the physician for the relief demanded in the Complaint. Legal papers must be dealt with properly and promptly. Notify your Risk Management immediately after being served.
► Other Legal PapersThe other legal papers that you may see are called Subpoenas. These documents can be either a request for an Examination Before Trial (EBT), trial testimony, or for the production of records in your possession (Subpoena Duces Tecum).
►What To Do If You Receive Legal PapersIf a process server attempts to serve you with papers, accept them. Do not try to deny who you are or try to “get away”. More often than not, service will be accepted for you in our Risk Management Department, who will send you a copy of the papers. Whenever you receive legal papers, no matter how you receive them, you must call both the Insurance Department and the Risk Management Department. Instructions and reassurance will be provided. Do not attempt to review the medical records. That will be done at a later date with your attorney. You will be guided closely and skillfully through the legal process.
LivingResident Assistance & SupportFrom time-to-time, we all encounter personal or substance abuse problems that can affect our relationships, our work performance, and our physical and emotional well-being. A residency can be especially stressful on the resident, the spouse and children with little time and a lot of work hours. Marriages are especially challenged. There are several resources available for residents and fellows who need assistance with well-being, stress, or substance abuse issues.
InSight is the employee assistance program of University Health Systems including Pitt County Memorial Hospital. InSight provides short-term, confidential counseling and referral services to help resolve concerns that may affect personal well-being or job performance. Participation is voluntary and completely confidential.
The staff is comprised of licensed mental health professionals. The services of InSight are offered free of charge to PCMH/BSOM resident and fellow physicians, their spouses and their children (18 years of age and younger). There is no limit on the number of sessions to the resident or their family members. The main office of InSight is near Pitt County Memorial Hospital, at 626 Medical Drive, Greenville, N.C. InSight can be reached at: (252) 847-4357 or [email protected] for more information or to make an appointment.
North Carolina Physicians Health Program (NCPHP) is a not-for-profit independent corporation initially established by the NC Medical Society to assist physicians who have been impaired by alcohol, chemical dependency, or behavior issues. “The North Carolina program is designed to identify and assist trouble physicians before they endanger their patients or themselves…. Nearly 90 percent of North Carolina physicians participating in our program are in recovery and have actively retuned to the safe practice of medicine.”For more information, check out http://www.ncphp.org/. For assistance, please call NC Physicians Health Program at 800-783-6792.
Resident/Fellow LiaisonThe Institution provides a staff member to assist you in preparing for life after training. The Resident/Fellow Liaison is available to help you prepare your CV, find job opportunities, and even help you get ready for a job interview. The Resident/Fellow Liaison provides regular education programs for all residents and fellows (and their spouses) on financial planning, insurance, legal issues, and debt management. You can contact the Resident/Fellow Liaison at 847-3708.
Family SupportResidency training is not only hard on those in training, but also the people supporting them. We will arrange for spouses and children to have an opportunity to meet each other during orientation, and encourage the development of a strong support network.
Self-Assessment Questions: Utilize the manual contents to determine if the statements below are true or false. Mark with a T or F.
_____1. The GME Office should only be notified if you are away from work due to illness or injury for more than 3 days.
_____2. The PCMH Medical Staff Executive Committee membership includes a resident/fellow representative.
_____3. Institutional Review Board (IRB) approval is necessary prior to any research involving human subjects.
_____4. Admission H&Ps should be documented within 48 hours of admission.
_____5. Do not contact Risk Management unless you can definitively prove a breach of privacy.
_____6. Hand hygiene includes cleansing hands with either soap and water, or alcohol-based hand rubs.
_____7. Station Red indicates a suspected or actual infant/child abduction is taking place at PCMH.
_____8. If a blood exposure occurs, you should contact Occupational Health/Patient Care Coordinator and complete the Employee Event Report.
_____9. University Health Systems of Eastern Carolina will not take any adverse action or
retribution against any employee due to the good faith reporting of a suspected violation or irregularity.
_____10. The use of at least two patient identifiers whenever administering medications or blood products is a PCMH requirement, but is not endorsed by the Joint Commission.
Return completed quiz to the GME Office with the Educational Record on page 77.
_________________________ ___________________Resident Signature Date
_______________________________Resident Printed Name
Graduate Medical Education at the Brody School of Medicine andPitt County Memorial Hospital
Resident and Fellow Manual Educational Record
I have read the Graduate Medical Education at the Brody School of Medicine and Pitt County Memorial Hospital Resident and Fellow Manual.
If I have questions on any of the topics located within the manual, I know that I can
Contact the GME office for clarification or
The GME office will put me in contact with individuals who can provide further education on the topics.
_________________________ ___________________Resident Signature Date
_______________________________Resident Printed Name
