Patients who have used this particular K2 product may present to our clinics, urgent cares and EDs with the following:

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Clinton Parker
5 years ago
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1 MAY 2018 Attention medical staff members and allied health providers: Please see the following message from Dr. Dan Allen to our clinics and urgent care sites concerning a new threat to the health of our patients that has been identified. Attached also are the communications from the Iowa Department of Public Health and the Illinois Department of Public Health. These patients could present to your sites of care. If you are not already aware, in Illinois and Wisconsin we are seeing patients with severe life threatening coagulopathies who have used a K2, a synthetic cannabinoid (currently we have not seen any of these patients in Iowa). K2 is also known as spice, synthetic (fake) marijuana and several other names. Synthetic cannabinoids are not one drug. Hundreds of different synthetic cannabinoid chemicals are manufactured and sprayed on dried plant material or sold as liquids to be inhaled in addictive tobacco products like e-cigarettes or other vaping devices. New ones with unknown health risks are available each year. The product K2 being used in these cases contains an illicit substance, Brodifacoum, a more potent and longer acting vitamin K antagonist (a superwarfarin ). INRs are significantly elevated on testing. Patients who have used this particular K2 product may present to our clinics, urgent cares and EDs with the following: 1. HEENT: Epistaxis, bleeding gums 2. Skin: ecchymosis, petechiae, hematoma 3. GU: Hematuria, vaginal bleeding 4. GI: Bloody stool, hematemesis, non-traumatic intraperitoneal bleed 5. Pulmonary: Hemoptysis, alveolar hemorrhage with respiratory failure, hemothorax 6. Hematologic: Hemorrhagic anemia, elevated INR 7. Musculoskeletal: Some patients with complaints of abdominal pain and back pain 8. Neuro: Mental status changes, seizures from intracranial bleed 9. Reproductive: spontaneous abortion 10. Bleeding out of portion to the injury Should a patient with severe bleeding present to you in your clinic or urgent care they should be sent to the emergency room for immediate workup and treatment. Attached is the Iowa DPH alert from this morning. The Illinois DPH alert is also attached. The Department of Wisconsin Health Services has also issued a warning on synthetic cannabinoids on their web site. Note that the diagnosis of K2 induced coagulopathy is a reportable condition to these state Health Departments. Please continue to be alert for these patients and please advise patients or others they may know who may use synthetic cannabinoids of this potential severe bleeding risk. We will continue to keep you informed of this situation.

TO DO: Order Optimization PLANNING FOR JUNE EPIC CHANGES AND UPDATES Schedule your optimization session now! On June 26 th, ALL Ordersets will be refreshed to the unchecked versions.

2 TO DO: Order Optimization PLANNING FOR JUNE EPIC CHANGES AND UPDATES Schedule your optimization session now! On June 26 th, ALL Ordersets will be refreshed to the unchecked versions. You will be required to save your old pre-checks prior to that date. You will want to spend min between now and June 26 th to get your frequently used prechecked Ordersets ready prior to JUNE 26 th. Optimization Sessions are scheduled for you to attend: May 29, Tuesday ERC Computer Classroom 4:00pm - 5:30pm May 30, Wednesday ERC Library Media Center 7:00am - 8:30am May 31, Thursday ERC Computer Classroom 1 11:30am - 1:00pm June 4, Monday ERC Computer Classroom 1 12:00pm - 1:30pm June 5, Tuesday ERC Computer Classroom 1 3:30pm - 5:00pm June 6, Wednesday ERC Computer Classroom 1 7:00am - 8:30am June 7, Thursday MWH Computer Classroom 3:00pm - 4:30pm June 8, Friday ILH Computer Classroom 7:00am - 8:30am Call to schedule your clinic/provider(s) for group order-set work. PRESCRIPTION MONITORING PROGRAM (PMP) Please make sure your registration is up to date. New website at (Refer to specific or last month s Provider Focus) Going live on May 8 th, NEW SCHEDULED DRUG BEST PRACTICE ALERT (BPA) Goals: 1. Offers the opportunity to check the PMP for this patient at the time of ordering scripts a. The buttons to attest to looking at PMP or give reason for not using PMP are required in some states and soon to be required here. 2. Make you aware of pain contracts filled with UnityPoint providers. 3. Order or cancel order, based on information presented 4. Offers to put controlled substance agreement on the Problem list if a new agreement is signed as part of this order.

Load Net I&O since Admission with a Click Inpatient Clinicians: A new check box in the Intake/Output Activity loads the net Intake/Output starting from the patient's admission until now, which is how

Because having it enabled slows down the Intake/Output activity, tell users to clear it if they don't need it for their next patients.

3 Load Net I&O since Admission with a Click Inpatient Clinicians: A new check box in the Intake/Output Activity loads the net Intake/Output starting from the patient's admission until now, which is how net Intake/Output was calculated before we limited it to 14 days for performance reasons. The check box doesn't appear for patients who've been admitted less than 14 days. Because having it enabled slows down the Intake/Output activity, tell users to clear it if they don't need it for their next patients. We also recommend telling only users who need to be able to load net I/O since admission without being limited to the past 14 days. NEW: To Order a PICC Line: CONSULT PICC Line -or- CONSULT Midline - Other orders will NOT be acknowledged (they are used by IR staff so they cannot be taken out) - Search on Consult PICC - Not on PICC Sepsis Screening Tool This new tool being used by ER and Floor Nurses may discover parameters consistent with sepsis. Nurse is prompted to notify physician one time of possible sepsis. The new Sepsis order-set will help with correct antibiotics to order and serial Lactate orders if appropriate. YOUNKER REHABILITATION CARF ACCREDITATION Younker Rehabilitation recently received a Three-Year Accreditation as a Comprehensive Integrated Inpatient Rehabilitation Program in February An organization receiving a Three-Year Accreditation has put itself through a rigorous peer review process. Younker Rehabilitation demonstrated to a team of surveyors during an on-site visit their commitment to offering program and services that are measurable, accountable and of the highest quality. This accreditation decision represents the highest level of accreditation that can be given to an organization and demonstrates Younker Rehabilitation s substantial conformance to the CARF standards and ability to meet standards for a higher success rates for patients. Congratulations to our team members who helped UnityPoint Health Des Moines receive this high honor.

ISOLATION SIGNS AND CATEGORIES Isolation signs on the door tell you what personal protective equipment (PPE) is needed. If isolation cart is present, it should contain all appropriate PPE.

Poles are not to be used for dirty gowns or masks. Used gowns go in a linen bag found inside the rooms, bathroom cabinets or behind bathroom door.

until ruled out. Types of Isolation: CONTACT PRECAUTIONS Use of barriers (gloves & gowns) protect your patient from organisms spread by contact.

4 ISOLATION SIGNS AND CATEGORIES Isolation signs on the door tell you what personal protective equipment (PPE) is needed. If isolation cart is present, it should contain all appropriate PPE. Units not using carts provide supply cabinets inside (TCU) or outside (P-3 and BCH) rooms. Carts may have a pole for hanging coats and waste bin for used gloves or disinfectant wipes. Poles are not to be used for dirty gowns or masks. Used gowns go in a linen bag found inside the rooms, bathroom cabinets or behind bathroom door. Use Empiric Isolation Precautions for Clinical Syndromes or for Specific Infections Patients presenting with symptoms consistent with an infectious disease requiring isolation should be isolated until ruled out. Types of Isolation: CONTACT PRECAUTIONS Use of barriers (gloves & gowns) protect your patient from organisms spread by contact. Example: C- Difficile DROPLET PRECAUTIONS Use a mask/shield when within 3 feet of patient to protect against organisms spread by Droplet Route. Example: Influenza AIRBORNE PRECAUTIONS Use a fitted N-95 respirator or a Positive Air Pressure Respirator (PAPR) for protection. A Negative Airflow Room is required. Example: Disseminated Varicella Zoster Combined signs, indicate 2 categories of isolation are needed. Example: Acute respiratory infection in a child Specific signs are used for Cystic Fibrosis (CF) patients to prevent sharing of active or colonized organism. An Isolation Table that lists of the type of isolation needed for diseases and conditions is on the HUB, for questions; contact Infection Prevention at

THE CARE INN The Care Inn provides over-night accommodations for Iowa Methodist Medical Center and Blank Children s Hospital patients and their families and friends.

The Care Inn is not a hotel and cannot accept reservations for over-night accommodations without these relationships.

5 THE CARE INN The Care Inn provides over-night accommodations for Iowa Methodist Medical Center and Blank Children s Hospital patients and their families and friends. Located one block south of IMMC, guests must be an outpatient of IMMC/Blank (having surgery or a procedure) or must have a family member or friend that is a patient at IMMC/Blank. The Care Inn is not a hotel and cannot accept reservations for over-night accommodations without these relationships. The Care Inn provides hotel-type rooms equipped with bed(s), pull-out sofa, cable television, alarm clock, kitchen with refrigerator and microwave. Also included is housekeeping and free parking. The Care Inn is a secure building, and only those with a key have access. The UnityPoint Health Des Moines Department of Public Safety staff is available 24 hours a day to escort guests to and from our hospital, free of charge. The following types of rooms are available: Double $55 per night, 2 Double $65 per night, 2 Twin $60 per night. Discounts are given for those who stay for 7 consecutive days. The Care Inn accepts cash, check, Master Card and Visa. We do not charge tax on our rooms. The Care Inn hours of operation are: Monday Friday, 7:00 a.m. 4:00 p.m. Saturday-Sunday, 8:00 a.m. 12:00 Noon For reservations or inquiries, please contact the Care Inn directly at CME OPPORTUNITIES

LUNG FORCE EXPO IN 2018 The Lung Force Expo offers information on lung cancer and lung disease to both healthcare professionals and patients/caregivers.

6 LUNG FORCE EXPO IN 2018 The Lung Force Expo offers information on lung cancer and lung disease to both healthcare professionals and patients/caregivers. The agenda has been posted with an exciting program planned. Please visit to obtain more information, view the agenda or register. The event takes place: Wednesday, May 9th, :00 AM-4:00 PM: NEW location this year: Hilton Garden Inn - West Des Moines, 205 South 64th Street West Des Moines, IA Hope you are able to attend!

7 2018 UnityPoint Health Des Moines Provider Directories are now available. Please contact Monica Aunan to obtain a copy. To submit information to the Provider Focus, please send to Monica Aunan, Physician Liaison at: monica.aunan@unitypoint.org or call

10 UNITYPOINT HEALTH - DES MOINES REGION ACO MEMBERS Abrahamson, Tim, MD (Dermatology) Allergy and Asthma Associates, PC Associated Ophthalmologists Associates in Kidney Care Blank Health Providers-UPHDM Boone County Comprehensive Specialty Care Boone County Family Medicine Boone County Hospital Broadlawns Medical Center Bussey Family Health Center Cass County Hospital Central States Medicine (Iowa Pain Clinic) Clarke County Hospital Dermatology, PC Des Moines Anesthesiologists Des Moines Eye Surgeons Des Moines Internal Medicine Des Moines Orthopaedic Surgeons, PC Des Moines Pastoral Counseling Center Des Moines Pediatric & Adolescent Clinic Des Moines University Medical Clinic Eyerly Ball Ganske, John Gregory (Greg) MD Greater Regional Medical Center Greene County Medical Center Guthrie County Hospital Huxley Physical Therapy Iowa Arthritis & Osteoporosis Center Iowa Diabetes and Endocrinology Center Iowa Digestive Disease Center PC Iowa Endoscopy Center Iowa Ear Center Iowa ENT, INC Iowa Head & Neck, PC Iowa Kidney Physicians, PC Iowa Pathology Associates, PC Iowa Radiology, PC Iowa Retina Consultants, Inc. Iowa Surgery Center, PC (Dr. Praveen Prasad) Koch Facial Surgery Lakeview Surgery Center Lifeworks Lucas County Health Center Madrid Family Practice- Boone County Hospital McClairen, Willie C., Jr MD (Surgery) Gen Surg Physician, McFarland Clinic, P.C. McFarland Clinic - Jefferson Medical Oncology & Hematology Assoc (MOHA) Metro Anesthesia and Pain Management Mid-Iowa Fertility, PC Midwest Oral and Facial Surgery, PC New Sharon Medical Clinic Newton Clinic, PC Orchard Place

11 Orthopaedic Outpatient Surgery Center (OOSC) Pediatric and Adult Allergy, PC Pediatric Cardiology, PC Pella Medical Clinic Pella Regional Health Center Physicians' Eye Clinic Pine Rest Counseling Services Porto, Dennis P MD (ENT) River Valley Therapy Clinic, LLC Story County Medical Center Norwalk Nursing and Rehab Center On with Life, Inc. Parkridge Specialty Care Prairie Vista Village Spurgeon Manor Sunnyview Care Center Urbandale Health Center Valley View Village Wesley Retirement Services-UnityPoint Health DM List updated 2/8/2018 Surgery Center of Des Moines East and West The Iowa Clinic Primary Care and Specialties UnityPoint Clinic Primary Care and Specialties UnityPoint Health - Des Moines West Des Moines Children's Clinic Wolfe Eye Clinic, PC Wolfe Surgery Center Women's Care Clinic, PC West Lakes Sleep Center **Skilled Nursing Facilities** The Bridges at Ankeny Calvin Community Edgewater Fountain West Hearthstone Kennybrook Village Mill Pond North Ridge Village - Ames

Patient Flow: Assuring Right Care, Right Setting, Right Time

Patient Flow: Assuring Right Care, Right Setting, Right Time July 2017 Patient flow is a complex problem - and we need everyone s participation to tackle it! While current volumes have normalized somewhat