mercy medical center cedar rapids, iowa anesthesia...
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MERCY MEDICAL CENTER Cedar Rapids, Iowa
Anesthesia Department of the Medical Staff
Wednesday, January 8, 2014 0700 – Mercy Neuhaus Board Room
I. Call to Order
II. Approval of November 6, 2013 Minutes (pg. 2-4)
III. Committee Reports a. MEC Excerpts (Dec. 2013 & Jan. 2014) – Dr. Morri ssey (pg. 5-8) b. Administrative Report and Introduction – Mary Br obst (pg. 9) c. Medication Mgmt. Newsletter (Oct/Nov 2013) – Dr. Morrissey (pg. 10-11)
IV. Old Business
V. New Business
a. Anesthesia Block Order Set – Dr. Morrissey / Leo n Arens (pg. 12-13)
VI. Next Meeting Wednesday, March 5, 2014, 0700 in St. Luke’s Formal Lounge
VII. Adjournment
Date: November 6, 2013
Discussion/
Leader
Expected
ResultContent/ Agenda Item
Meeting Notes/Decisions/Actions or
Assignments
Dr. Leff Action Call to Order Dr. Leff called this regularly scheduled meeting of the Anesthesia Department of Mercy Medical Center, a peer review committee, to order at 0705.
Dr. Leff Action Approval of September 4, 2013 minutes. The minutes were reviewed and approved as distributed.
Dr. Leff Information Medical Executive Committee Excerpts (October & November 2013)
Dr. Leff reminded physicians to get influenza vaccination. The OB/Gyn was approved to remove the NRP certification, if feel advanced level practitioners needed let Dr. Leff know. Dr. Matsuda is the new Pediatric Hospitalist for Mercy, and Mercy added Dexmedetomidine to formulary.
Mercy Medical Center
Cedar Rapids, IA
Meeting Minutes for: Anesthesia Department MeetingChair: Dr. Leff / Recorder: Kathy Holmes
Committee Reports Committee Reports Committee Reports Committee Reports
Present: Drs. Aerts, Ahmed, Almasi, Anderson, Botkin, Buffo, Carter, Cogdill, Crumley, Hallman, Harman, Herring, Kemen, Kidwell, Maze, Morrissey, Murtha, Nemickas, Schmidt, Sedlacek, Shires, Stein, Steine and Walsh. Also present: Emily Andrews, Leon Arens, Barb Armstrong and Lauren Cumings.
Call To OrderCall To OrderCall To OrderCall To Order
Approval of MinutesApproval of MinutesApproval of MinutesApproval of Minutes
Start Time: 0700
Date: November 6, 2013
Mercy Medical Center
Cedar Rapids, IA
Meeting Minutes for: Anesthesia Department MeetingChair: Dr. Leff / Recorder: Kathy Holmes
Present: Drs. Aerts, Ahmed, Almasi, Anderson, Botkin, Buffo, Carter, Cogdill, Crumley, Hallman, Harman, Herring, Kemen, Kidwell, Maze, Morrissey,
Start Time: 0700
Dr. Valliere Information Administrative Report (November 2013) Dr. Valliere shared the Physician Forum dates/times. UpToDate access is available on Epic and also available on mobile devices. Mary Brobst, CNO started last week and will be introduced at next meeting. Area wide Active Shooter Emergency Drill taking place in HPCC this evening. If interested in participating, contact Medical Staff office. Results of 2nd floor physician lounge petition showed concerns including too crowded/busy to get through in a timely fashion and infection control concerns. Will be reconfiguring 1st floor lounge to provide noon meal as well. A badge reader will be added to the back door entrance so if you don't have or misplaced your badge, stop by Human Resources. Will be working with infection control risk.
No old business was discussed.
Dr. Leff Action Chair/Vice Chair Elections (January 2014 - December 2015) Kyle Morrissey, MD was nominated and elected as Chair. Michelle Lutz, MD was nominated and elected as Vice Chair.
New BusinessNew BusinessNew BusinessNew Business
Old BusinessOld BusinessOld BusinessOld Business
Date: November 6, 2013
Mercy Medical Center
Cedar Rapids, IA
Meeting Minutes for: Anesthesia Department MeetingChair: Dr. Leff / Recorder: Kathy Holmes
Present: Drs. Aerts, Ahmed, Almasi, Anderson, Botkin, Buffo, Carter, Cogdill, Crumley, Hallman, Harman, Herring, Kemen, Kidwell, Maze, Morrissey,
Start Time: 0700
Dr. Walsh Discussion
Perioperative Aspirin Administration
Pre-operative Testing Guidelines
Dr. Walsh shared memo regarding Perioperative Aspirin Administration. If patient on aspirin for cardiac reason there needs to be conversation between PCP, Cardiologist and Surgeon before stopping.
There was discussion on the importance of the C Spine on Rheumatoid or even degenerative spine disease. These guidelines are an on-going process and there is room for clinical judgment.
Dr. Leff Information Physician Annual Meeting December 3, 2013 at 1800 in St. Luke's Heart Center
Dr. Leff InformationThe next meeting will be held on Wednesday, January 8, 2014 @ 0700 in Mercy Neuhaus Board Room.
With there being no further business, the meeting adjourned at 0735.
Respectfully submitted,Kirsten Leff, MD
Adjournment & Next Meeting:Adjournment & Next Meeting:Adjournment & Next Meeting:Adjournment & Next Meeting:
ANNOUNCEMENTSANNOUNCEMENTSANNOUNCEMENTSANNOUNCEMENTS
MERCY MEDICAL CENTER Cedar Rapids, Iowa
Medical Executive Committee Excerpts
December 3, 2013 Cedar Rapids Medical Education Foundation Executive Director Dr. Beck introduced Dr. Jennifer Holmes Latterell to the committee. Dr. Holmes Latterell is the newly hired Executive Director of CRMEF. Credentials Committee The Credentials Committee meeting report of November 19, 2013 was given. The following physicians were recommended for membership and privileges: • Jennifer Holmes Latterell, DO – Family Medicine joining Cedar Rapids Medical Education
Foundation. • Arnold Honick, MD – Radiology rejoining Radiology Consultants of Iowa. Carrie Campbell, ARNP was recommended for Category I ARNP status and privileges in the Surgery department. The below practitioners were recommended for employed surgical assistant activities. • Shayla Baird, RN – Birthplace • Kristyn Francksen, RN – Birthplace • Lisa Jaschen, RN – Birthplace • Amy Steger, RN – Birthplace • Courtney Upah, RN – Birthplace • Julie Wittman, RN – Birthplace • Michelle Erickson, Surgical Technologist – WEO/PRN The committee reviewed the list of reappointments for the 4th quarter 2013. The following physicians were recommended for Advancements: • Jessica Kelley, MD – Anesthesiology • Jody Harmsen, MD – Family Medicine • Joseph Kennedy, DO – Family Medicine • Thomas Serbousek, MD – Family Medicine • Amanda Sommerfeldt, MD – Family Medicine • Muhammad Anwer, MD – Internal Medicine • Jason Cogdill, MD – Internal Medicine • Karim Nahra, MD – Internal Medicine • Alice Fagin, MD – Surgery • Nora Royer, MD – Surgery
Medical Executive Committee Excerpts December 3, 2013 Page 2 The committee accepted the following resignations: • David A. Brickey, DO – Internal Medicine/Pulmonology • Stephen Sladek, MD – Family Medicine • Mary Eyanson, MD – Pediatrics • Richard Kahn, MD – Internal Medicine – did not apply for reappointment The committee recommended the revisions to Therapeutic Flexible Fiberoptic Bronchoscopy privilege criteria as submitted. Eduardo Celis, MD was recommended for Bronchial thermoplasty privileges. The committee accepted the department’s review of the current delineation of privileges for Orthopedics and Emergency Medicine and recommendation of no changes to these requirements. The Credentials Committee reviewed the summary report of the FPPE conducted in 4th quarter 2013 and their respective department chair recommendations. No quality issues were identified. James Howe, MD – Surgery was recommended for a full two year reappointment. Dr. Valliere updated the Credentials Committee on the outcome of the conflict resolution vote. The vote was 152 to 56 in favor of discontinuing NRP requirement for obstetricians. The Credentials Committee recommended removal of the requirement from the OB privileging criteria. The Allied Health Practitioner Committee meeting report of October 23, 2013 was given. Applicants recommended for approval: • Sarah Cole, ARNP – UnityPoint Multi-Specialty Clinic (Dr. Paynter) Practitioners recommended for advancement: • Rhonda Bridgewater, ARNP – Mercy Cardiology Clinic (Dr. Campbell) • Mackenzie Groteluschen, ARNP – Linn County Emergency Medicine (Dr. P. Peraud) • Sarah Kluesner, ARNP – PCI Orthopaedic/Podiatry (Dr. Hart) • Nicole Miller, ARNP – Oncology Associates at Mercy (Dr. Wilbur) • Anne Nugent, ARNP – Mercy Cardiology Clinic (Dr. Campbell) • Patricia O’Donnell, ARNP – Internist Associates of Iowa (Dr. Yacoub) Practitioners recommended for re-registration: • Carolyn Hosch, RN – Cedar Valley Hand Surgery (Dr. Johns) • Kevin Huddleston, CA – Biotronic for Intraoperative Monitoring Services (Dr. Maggio) • Katie Kavanaugh, ARNP – Respiratory and Critical Care Associates (Dr. Cowden) • Mindy Martin, ARNP – The Ghosh Center for Oncology and Hematology (Dr. Ghosh) • Kristina Nystrom, RA – Radiology Consultants of Iowa (Dr. Hammer) • Matthew Pilsner, CA – Biotronic for Intraoperative Monitoring Services (Dr. Maggio)
Medical Executive Committee Excerpts December 3, 2013 Page 3 Practitioner resignations: • Holly Copeland, ARNP – PCI ENT (Dr. Krivit) • Jody Kolb, ARNP – Mercy Psychiatry (Dr. Munagala) • Evan Lawrence, CA – Biotronic for Intraoperative Monitoring Services (Dr. Davis) • Lesley Vancura, ARNP – PCI Hematology & Oncology (Dr. Warren) Change in Supervising Physician: • Kristina Nystrom, RA – Radiology (Dr. Hammer) • Sarah Kluesner, ARNP – Orthopedics (Dr. Hart) The Allied Health Practitioner Committee reviewed and recommended approval of the revisions to the Scope of Practice section of the Radiologist Assistant Policy along with the accompanying criteria for the new activities with the additional clarification that the hysterosalpingogram interpretation will be preliminary and that all final interpretations will be performed by the supervising radiologist. Kristina Nystrom, RA and Shellie Pike, RA were recommended for the activities of joint injection/aspiration under fluoroscopy of the hip and of the wrist. The Credentials Committee discussed the expanded Radiologist Assistant activities recommended by the Allied Health Practitioner Committee. Discussion included: • Education, training and experience of the practitioners • Complications risk and the practice model for follow up care of complications • Communication with the referring physician The Credentials Committee tabled recommendation of the additional Radiologist Assistant activities, requesting feedback from the orthopedics department be presented at the next regularly scheduled meeting of the committee. The Medical Executive Committee discussed the expanded activities and the Orthopedic Department Chair will seek feedback from his department members and report at the next meeting. It was also noted that Allied Health Practitioner activities are granted by the Allied Health Committee, a subcommittee of the Board of Trustees and do not require Medical Staff approval. Bylaws Committee The Bylaws Committee meeting report of November 13, 2013 was given. The committee has identified 16 free standing Medical Staff policies where a significant part of the policy now resides in the recently revised Medical Staff Bylaws. The Committee recommended these policies be archived due to their redundancy. This will be presented to the Medical Staff for a vote at the same time as the Medical Staff Rules and Regulations revisions.
Medical Executive Committee Excerpts December 3, 2013 Page 4 Treasurer’s Report Dr. Anderson presented the Treasurer’s Report. Current savings account balance is $0 and checking account balance is $54,635.58. $43,925.00 was received in revenue from membership dues assessments. This revenue was dispersed to pay $10,000.00 for Medical Staff Officer Compensation, $21,850.00 for Medical Staff gifts, $8,149.25 in legal fees and $607.38 in miscellaneous expenses. The Treasurer’s Report was accepted as submitted. Medical Staff Leadership Compensation Dr. Wilbur then turned the chair over to Gordon Baustian, MD, Vice President. Dr. Wilbur reviewed with the committee the various increases to the time obligations of the Medical Staff Officer positions. It was approved to compensate the Medical Staff Leadership as follows: • Medical Staff President $12,500 annually • Medical Staff Vice President $7,500 annually • Medical Staff Secretary/Treasurer $2,500 annually • Medical Staff Bylaws Committee Chairperson $1,250 annually • Medical Staff Credentials Committee Chairperson $1,250 annually Charitable Giving The following gifts were approved: • Sisters of Mercy 3,000.00 • Willis Dady House 1,500.00 • Tanager Place 1,500.00 • Catholic Worker House 1,500.00 • Madge Phillips Center 1,500.00 • St. Vincent DePaul 1,500.00 • His Hands Free Medical Clinic 1,500.00 • Community Health Free Medical Clinic 1,500.00 • Community Health Free Dental Clinic 1,500.00 • Mission of Hope 1,500.00 • H.D. Youth Center 1,500.00 • Catherine McAuley Center 1,500.00 • St. Luke’s Dental Health Center 1,000.00 Orientation of Medical Staff Department Chairs Orientation for new department chairs will be held Tuesday, January 7, 2013 at 5:00 p.m. Mercy Neuhaus Board Room followed by the regularly scheduled Medical Executive Committee meeting. Returning chairs are strongly encouraged to attend as well, to reacquaint themselves with the expectations and duties and assist in the orientation process.
ADMINISTRATIVE REPORT December 2013
PROVIDER ENGAGEMENT SURVEY COMING IN JANUARY!
Mercy Medical Center will be administering a provider engagement survey with The Advisory Board Company beginning
on January 20, 2014. As a leader at Mercy Medical Center, you play an instrumental role in ensuring your peers
understand the value and logistics of the survey so we can generate a robust dataset.
We are committed to making our organization a best-in-class place to practice medicine for physicians and mid-level
providers like you. We want to understand how we can help improve your work environment and enhance the quality of
care provided to your patients. This survey will help us assess where to target our efforts to accomplish this goal. The
information we gather will help define our strategic priorities for the coming year.
What’s different about this year’s survey? While our previous surveys measured physician satisfaction with
Mercy Medical Center, this year’s survey is designed to measure physician engagement with the hospital.
Engagement goes beyond simple satisfaction to include commitment to and connection with Mercy Medical
Center. We think this is an important change to make as we look to partner more closely with physicians and
mid-level providers.
How long will the survey take? The survey should take no more than 5 minutes to complete. We have
intentionally chosen a short, concise survey as we know how valuable your time is.
***How do I take the survey?*** You will be emailed a link to the survey on January 20th
when the survey is
opened. Clicking on the link will take you to the survey page. Of course, we will also post the link and
instructions on our new provider website, p.mercycare.org, just in case you misplace the email.
If you don’t receive an email on January 20th
that means we don’t have your email address on file. To change
that, contact Andrea Ault at [email protected] or (319) 558-6405 to have your name added to the “All
Providers” email distribution list. You’ll also see plenty of signage on physician workstations, in the physician
lounges, among other places.
Where should I take the survey? You can complete the survey from any computer, smartphone or tablet with
Internet access.
Will anyone ever see my responses? Your responses to the survey are completely confidential. The aggregate data will
be analyzed and developed into action plans to work toward continuous improvement.
What happened since the last survey?
• Launch of Mercy’s one-patient, one-record Epic Initiative
• UpToDate purchased and implemented for all Providers
• Expansion of Clinical Grand Rounds to enhance clinical education opportunities
• Attend, Admit and Consulting Policy Established
• Better Nursing Communication through SBAR Practices
• Establishment of Physician Leadership Council
• Participation by physicians in the Capital Budgeting Scoring Process
• Epic Physician Advisory Council
• Physician Forums continued to enhance communication with administration
• Additional Updates & Information via NEW Provider Website, p.mercycare.org
MMC Annual Report now available online:
Go to: https://www.mercycare.org/app/files/public/5428/Mercy-Annual-Report-2013.pdf
The Medication Management Committee of Mercy Medical Center
Cedar Rapids, Iowa (Formally P&T)
October & November 2013
Prothrombin Complex Concentrate (Kcentra) ADDED TO FORMULARY Kcentra is a hemostatic agent that provides an increase in the levels of the vitamin K-dependent coagulation factors (II, VII, IX, and X) with the addition of protein C and S. It’s used for urgent reversal of acquired coagulation factor deficiency induced by Wafarin in patients with acute major bleeding. Prothrombin Complex Concentrate (Kcentra) added to formulary.
Dexmedetomidine (Precedex) ADDED TO FORMULARY Precedex is a selective alpha2-adreonceptor agonist with anesthetic and sedative properties thought to be due to activation of G-proteins by alpha2-adreonceptors in the brainstem resulting in inhibition of norepinephrine release. It’s approved uses include:
• Sedation of initially-intubated and mechanically-ventilated patients during treatment in an intensive care setting
• Procedural sedation prior to and/or during awake fiberoptic intubation • Sedation prior to and/or during surgical or other procedures of non-intubated patients
Dexmedetomidine (Precedex) added to formulary.
LATEST DELETIONS
DELETED REASON
Hetastarch (Hespan) The FDA has included a boxed warning on increased mortality and severe renal injury, and an additional warning on risk of
bleeding for use of hydroxyethyl starch solution in some settings.
Pilocarpine (Pilopine) HS Gel Discontinued by manufacturer. Thrombin 20,000 unit topical spray No use. Thrombin 5,000 unit topical spray No use. Ticlopidine (Ticlid) 250 mg tablet No use.
Ethosuximide (Zarontin) 250 mg capsule No use.
Formulary Addition Request Form
A form has been approved to assist providers who want to propose a medication addition to formulary. This form can be found on the pharmacy website and may be send to the Medication Management Committee for review.
IV to PO Therapeutic Conversion Protocol
A protocol was approved to allow pharmacy to automatically convert patient from IV medication to PO for the listed medications when the guidelines are met.
Guidelines:
1. The patient is taking other oral medications or is tolerating an oral diet (this includes a liquid diet). 2. The patient does not have severe diarrhea or a malabsorptive syndrome. 3. There is no active nausea and/or vomiting—defined as not receiving an anti-emetic in the last 24 hours or no
active vomiting in the last 24 hours. 4. If the medication in question is an antibiotic:
a. WBC is within normal limits or decreasing towards normal. b. The patient is afebrile (< 38⁰C or < 100.4⁰F) for at least 24 hours. c. Patients with meningitis, endocarditis/endovascular infections, osteomyelitis, brain abscess, or other
central nervous system infection are excluded from the program. 5. If the medication in question is pantoprazole:
a. There is no documented gastrointestinal bleed on this admission.
If all applicable guidelines above are met, convert the IV medication to PO based on the table below: Drug IV:PO Conversion Bioavailability of PO Pantoprazole 1:1 80% Famotidine 1:1 45% Azithromycin 1:1 37% ̂Levofloxacin* 1:1 99% Metronidazole 1:1 100% Fluconazole 1:1 90% Sulfamethoxazole/trimethoprim 1:1 based on trimethoprim
component 90-100%
Clindamycin 2:1 with same frequency (example: 600 mg IV q 6 hours converts to 300 mg
PO/NG q 6 hours)
90%
Linezolid 1:1 100% ^Although azithromycin has a low bioavailability, it is well-distributed into tissues. *Separate oral administration by at least 2 hours from products that contain magnesium, calcium, aluminum, or iron (antacids, sucralfate, supplements).
Members of the Medication Management Committee
Dr. Fadi Yacoub, Chair Dr. Schweta Diwaker Dr. Susan Schima Dr. Vincent Reid Dr. Martin Cearras
Dr. Mark Valliere Sarah Schloss Stephanie Hoenig Taylor Felker Lauren Cuming
Kathy Smelser LeAnn Tatman Becky Prier Brianna Stueck