POMA (Preoperative Medical Assessment ) F.A.Q.

Transcription

1 POMA (Preoperative Medical Assessment ) F.A.Q. 1. What is POMA? POMA or Preoperative Medical Assessment is a hospital wide initiative that aims to promote and ensure and improve surgical safety and outcomes. POMA is a comprehensive tool that assesses patient s clinical risk factors prior to surgery. The goal is to ensure that patients with major medical problems are assessed in a standardized, evidence- based way by a medical clinician to ensure that they are medically optimized for surgery. 2. Who needs a POMA? POMA is required for All adult inpatients scheduled for non- emergent surgery who are American Society of Anesthesiologists (ASA) Physical Status 3 or 4. Obese patients with BMI more than or equal to 40 DAS (Day of Admission Surgery) patients in GP2 who are: Obese patients with BMI more than or equal to 40 ASA 3 is defined as a patient with severe systemic disease. ASA 4 is a patient with severe systemic disease that is a constant threat to life. 3. Who is responsible for patients ASA score? The surgeon is responsible for the ASA score. It is required before they can book their cases. Anesthesiology should be paged for help if they have difficulty with the ASA score. 4. When should POMA be completed? Ideally it should be completed as soon as the schedule for surgery has been determined. Surgery will be delayed if the POMA has not been completed at least 90 minutes prior to the non- emergent surgery. 5. How long is POMA valid? It is valid up to 30 days. However, a new POMA is indicated if there has been a change in patient s clinical status OR the new procedure has much higher risk compared to what the POMA was originally intended for.

2 POMA done at the IMA Pre- op clinic OR any ambulatory visit POMA are valid if within 30 days. 6. How do you COPY/PASTE a valid POMA? When you copy/paste a previous valid POMA (from IMA preop clinic or previous inpatient POMA) we should use the following attestation statement and can use the smart phrase.pomavalid A valid POMA was completed by <insert POMA provider> on <insert date> and is pasted below. I have reviewed the most recent labs/data and vitals and these do not indicate any change in the patient s status since that evaluation. Procedure, date and Surgeon must be updated Most recent vitals and labs should be reviewed by attending The POMA needs to be revalidated for each surgical procedure If a Valid POMA at the IMA pre- op clinic or In Patient or previous admission already exists à then this is how you do it: DO NOT create a new PROGRESS NOTE or CONSULT note to copy and paste the valid POMA. 1. Go to IMA pre- op clinic visit /encounter and copy the POMA note or copy the previous Inpatient POMA note. 2. Go to rounding navigator and Pre- op Assessment tab 3. Click create med note 4. Paste the IMA pre- op or Inpatient POMA note 5. Write an attestation statement use smart phrase.validpoma 6. Sign (and or route to POMA Attending) 7. Who can do the POMA? Any credentialed Mount Sinai Internist and medical subspecialty can complete POMA. Medicine residents, fellows, NPs and PAs can also complete POMA and case must be discussed and co- signed by a Medical Attending physician. Patients will not be not be transported to the OR holding area until the POMA is completed and cosigned by the medical attending.

3 The COMA (Co- management) Hospitalist- Vascular surgery Attending is responsible for completing the POMA for the patients of the following surgeons: Malik, Vouyouka, Teodorescu, Ellozy, Ting, Lajos, Tadros, or Kim Harrington Vascular patients almost always are seen by Cards (Nguyen or Lee) please confirm with whoever calls consult that they will not be calling cardiology as well Patients on a Medicine or Cardiology team OR on a surgical service with a Gen Med consultant should have POMA completed by the medicine/cardiology attending on that service unless they do not feel comfortable doing this and specifically request that a hospitalist complete the POMA (commonly occurs with oncology service) Night hospitalists are available to staff urgent overnight POMAs with the MCR for cases going to OR before 10am 8. How do I complete the POMA in EPIC? POMA is found in the rounding navigator and follow and complete all the tabs 9. Do Cardio Thoracic Surgeries need POMA? Yes. However, cardiovascular risk assessment and recommendation is not required on the form. POLICY FOR CARDIO THORACIC Service There have been a few Cardiac Surgery cases that were cancelled or delayed over the past few weeks based on our evaluation while doing the POMA. The delay was primarily caused by lack of available outpatient information. For essentially all Cardiac surgery cases, these patients have been extensively evaluated, seen by a cardiologist, and optimized prior to admission, so it should be rare for any patient to need a delay for medical reasons. In most cases, the CTS team will have access to the necessary information. In efforts to improve workflow for our Consult and Night Attendings and the Cardiothoracic surgeons, we are setting up processes to improve communication and avoid delays. Most importantly, there is a new requirement to immediately inform Divisional leadership when you feel a CTS patient is not optimized (Briones, Dunn, Markoff, Rule, or Chang), including overnight and weekend hours, prior to completing the POMA. The goal will be to work together with CTS to obtain the necessary information and allow the patient to be optimized and prevent any delays. Please send us any additional comments or suggestions as we work to improve the workflow for CTS patients.

4 10. Who can help me with POMA? Help can be obtained by paging POMA (dial x41300 and enter "POMA" or "7662") or contact me Alan Briones, MD at 41739, pager #9041 or 11. What procedures are included / excluded from POMA? (as of March 2013) INCLUDED: MAIN OR MRI under MAC IR EXCLUDED: Cardiac Cath lab EPS/ablations Cystoscopy (even if done in main OR) Endoscopy: (even if done in the main OR) Category 1 (emergency) Category 2 (surgery within 6 hours) 12. What are the MCR roles and CAPS for the POMA? POMA can be assigned with the following caps for MCRs MCR Day MONDAY to Friday is 3 MCR day Saturday is 3 MCR day Sunday is 5 POMAs completed by MCRs should be staffed by CONSULT Attending.

5 13. WHAT is the POMA Attending expected work hours? Monday to Sunday 8 AM- 5 PM. In the window of that there is NO Hospitalist on duty (typically 5 PM- PM or 7 PM) the MCR will carry the virtual POMA pager 7662.