DIRECTOR S CORNER. CMS, JC, QA, OSMB, OAPA, AAPA, NCCPA, BOG, the list goes on.

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1 Volume 3, Issue 2 April 2010 DIRECTOR S CORNER CMS, JC, QA, OSMB, OAPA, AAPA, NCCPA, BOG, the list goes on. We have more credentialing/monitoring bodies than fingers and toes combined! It is apparent from past conversations that these bodies are the source of additional stress levels in some of our colleagues. So, what can we do? First, take a breath. If you look at the big picture with all of these agencies, the common themes are: Documentation: If it s not documented, it wasn t done Legibility: If you can t read it, it will be considered not done Transparency: the truth will set you free! Do the right thing, and there s nothing to hide Policy: Rules are in place for a purpose. They are truly easier to follow than to break! Procedures: Like a blue print, consistency for equal outcomes Safety: The rhyme and reason for all of above. Put yourself in patients shoes, what would you want? Take in the big picture for all of this. If you do your daily work with the expertise that you know you have within each of you, then, there will be no question that the above themes will be second nature. They will not take away from patient care (our number one objective). They will not hinder your productivity, and they should not increase your stress levels. As PA s, we are monitored carefully and meticulously. This has been the way since our professional beginnings. And we rise to this occasion to show just how professional, and competent we are as PA s providing quality health care. So, embrace the scrutiny. Do what you do best taking care of patients, safely and efficiently. Thanks for reading, Carpe Diem Josanne Inside this issue: PA Highlight: Patricia Hirkala PA-C 2 PA Night Out: Distinguished PA Award 3 NEED TO KNOW 4-5 MT. UNION ORIENTATION DAY 6 NEW HIRES EVENTS CALENDAR 8-9 Medical Education Program Invites 10 JOB POSTINGS 11 WORDS FOR THE DAY: INFLUENCE: By: Joseph Norris Drop a pebble in the water, And its ripples reach out far; And the sunbeams dancing on them, May reflect them to a star. Give a smile to someone passing, Thereby making his morning glad; It may greet you in the evening When your own heart may be sad.. Do a deed of simple kindness; Though it s end you may not see, It may reach, like widening ripples, Down a long eternity.

2 P AGE 2 IN THE SPOTLIGHT PATRICIA HIRKALA PA-C This issue, we are highlighting Trish Hirkala dedicated, hard working, caring and a genuine good spirit come to mind when thinking of her. I was a Surgical Tech before I became a PA, I loved the OR, but I was always curious about the didactic portion of medicine How did they come to that particular diagnosis? Being solely in the OR, you only get a brief snapshot in the continuity of patient care I wanted to know more. In the early years of the profession, You knew other PA s by word of mouth, a PA would be assisting in the OR, or rounding on the floors and I thought, Hey, I would like to know more about that. Trish has worked at the Lorain ASC Pre Admission Testing (PAT) department for all of the 12 years she has been with the Clinic. In her words, It has treated me well and I have enjoyed watching it grow. Her role in PAT is to ensure that it is safe for patients to proceed with their surgery from both an anesthesia perspective and medicine perspective. She also performs as a Midlevel Manager overseeing the PA s who work at the Lorain ASC PAT and the Chestnut Commons office in Elyria. Recently, she has expanded her role to practice as a PA assisting with hospital patients at the Chestnut Commons office. When asked about special projects, she says, I have been very fortunate to work with some very talented and hardworking PA s. We have initiated an Employee Wellness Clinic in our institute to serve chief complaints for employees only. This has served us quite well, especially through this past cold and flu season. Currently, she is working on her Master s Degree and has recently joined the OAPA and AAPA because she has realized all that these organizations can and do for the PA profession. She says, These organizations are at work defending, procuring and advancing our careers we need to own it and at the very least be a member. The majority of her mentoring has been by word of mouth for friend s children. They hear about what I do and want to come and see what our profession is all about. It pleases me to say that some are in the PA training as we speak. In her spare time, she enjoys spending time with her husband and two dogs, running and backpacking. There are only a handful of National Parks that she has not hiked. She is also a certified yoga instructor. When asked about her overall experience at the Clinic, Trish says, There is a certain pride that comes with being part of a large institution, especially, one as well known as the Cleveland Clinic. Overall, my experience has been rewarding and yet challenging. What always seems to impress me is that with the size of this institution there is still some intimacy, especially when it comes to exchanging ideas and moving forward. To me, that is a balance I suspect one won t find just anywhere.

3 P AGE 3 SPRING IS HERE! A time for renewal, growth, and sunshine. So as the crocus s and daffodils break out of their bulbs and burst forth, with beauty, we are asking all of you to shed your shells, and come out of your work areas, offices and from behind your desks and mingle with your fellow PA s at our annual PA Night Out!

4 P AGE 4 NEED TO KNOW Documentation Guidelines for Respiratory Orders 1.Outpatient Option Order placed, order associated, click on MD/Provider icon, place check mark in co sign required box, then enter the covering provider in the procedure field. After the order is filed, all procedures ordered during that encounter will go to the covering providers inbox for a co sign in their co sign orders folder. The orders that are resulted (pulse ox, if completed in enter/edit) will also go to the covering providers InBasket in the result folder. 2. Inpatient Orders Place orders for respiratory services as a verbal order in a manner similar to the Schedule II meds. The APN/PA put in most of the order, close the order then opens up another order for the Respiratory orders as a verbal order. These should be forwarded to the physician who is collaborating with you on that specific day. These will need to be co signed within the 48 hour time frame. See attached screen shots for CPOE APN instructions begin on slide 18. Another option might be for the physician to place the order for the respiratory services. Some services have discussed this and are opting to do that as long as it doesn't impede pt care. Please discuss with your collaborating physician to determine what works best for your service. ABG draw Heliox therapy PEP therapy Aerosol treatment Incentive spirometer RT patient education Apnea test Intubation RT consultation Arterial line insertion IPPB therapy Sputum induction Bedside spirometry MDI therapy Suctioning, respiratory Bronchopulmonary hygiene Mechanical ventilation orders Tracheostomy care Bronchoscopy assistance NO therapy VEST therapy Capnography Smoking cessation counseling Weaning from ventilator support CPAP Oxygen therapy Decannulation, tracheal Oximetry Desaturation study Passy Muir valve Extubation Peak flow measurement Informed Consent All APNs /PA's need to review the Informed Consent training and complete the attestation form. See below: Complete informed consent training and attestation (by April 30) Read a list of FAQs on informed consent Review informed consent policies and procedures, including standard operating models All informed consent information can be found on the Do the Right Thing Now website. rightthing/default.aspx Remember, APNs / PA's can obtain the informed consent for procedures which they perform. For a list of procedures requiring informed consent within your department, contact your quality review officer (QRO).

5 P AGE 5 NEED TO KNOW Standardized Order Set to Be Used Enterprise-Wide for Do Not Resuscitate Orders Effective May 4, 2010, all Cleveland Clinic facilities will share a common Do Not Resuscitate (DNR) order set (electronic or paper). The DNR order indicates that a person usually with a terminal illness or other serious medical condition has decided not to have cardiopulmonary resuscitation (CPR) performed. The physician or licensed independent provider writes the DNR order after discussing CPR with the patient. What s impacted by this change? DNR ordering, documentation and communication in both the hospital and ambulatory setting What does this include? DNR orders placed through computerized provider order entry (CPOE) at active sites DNR orders placed on new paper forms and then entered by Health Unit Coordinators via COE Modification of DNR orders at the time of invasive procedures How will I be aware a DNR order has occurred? DNR status is displayed in the patient header and communicated through the nursing SBAR Current and past DNR orders are recorded in the patient s DNR history

6 P AGE MOUNT UNION ORIENTATION CLASS Group Photo with Pat Ginley PA-C, Facilitator for Orientation Day Students filling out paperwork to obtain badges and parking assignments Students touring the Cadaver Lab

7 P AGE 7 NEW HIRES Please join us in welcoming the following PA s to Cleveland Clinic: Lindsay Motz PA C Independence Orthopaedics Emergency Medicine Tiffany Washkewicz PA C Chestnut Commons Dermatology Janice Todd PA C Lutheran Orthopaedics David Harrison PA C Center for Spine Health Sowmya Rao PA C Neurology Tracy Norris PA C Gastroenterology Erin Anderson PA C Center for Spine Health Robin Phillips PA C Hematology/Oncology Paul Bragg PA C Willoughby Neurosurgery John Sternen PA C Willoughby Neurosurgery Mark Holtcamp PA C Willoughby Neurosurgery Amanda Kurtz PA C Pulmonary MICU

8 2010 EVENTS CALENDAR * Friday, May 7: Distinguish PA Awards; PA Night Out: 4:00pm 7:30pm Cleveland Playhouse, Stages Restaurant Thursday, May 20: PA meeting with Dr. Merlino, CEO by his request to discuss PA s role in patience experience, NA5 08, 7:30 8:30am May 29 June 3: AAPA National Conference; Atlanta Ga. ( Tuesday, June 15: PA Knowledge Sharing Mtg: Bioethics, Amy Greene, When bad things happen to family of caregivers ; 7am coffee & breakfast breads, 7:30 8:30am, Bunts Auditorium Thursday, Aug. 26: PA Knowledge Sharing Meeting: Merck, 7am coffee & breakfast breads, 7:30 8:30am, NA5 08 (See Invite) August: OAPA Capitol Hill, Columbus, OH, Meet the representatives for PA legislation, date TBA Oct. 6 12: PA Week; Skyway TV presentations, Outstanding PA awards Thursday, Oct. 7: PA Reception, Foundation House, 4:00 7:30pm Thursday, Oct. 28: PA Knowledge Sharing Mtg: Merck, 7am coffee & breakfast breads, 7:30 8:30am, NA5 08 (See Invite) Nov 5 7: OAPA CME (20 category I), Doubletree Hotel, Dublin, OH (Columbus), see OAPA website for info Thursday, Dec. 2: PA Holiday Greet & Meet, place TBA, 4:00 7:30pm

9 You are invited to a medical education program for health care professionals and health care business professionals only that will focus on: The Patient Centered Medical Home Date Thursday, August 26, 2010 Time 07:30 AM Location THE CLEVELAND CLINIC 9500 EUCLID AVE CLEVELAND OH, RSVP by Aug 24, Ext Maureen Hall Merck & Co., Inc. Speaker Frederick J BloomJr, M.D. Dr. Bloom is Assistant Chief Quality Officer in the Geisinger Health System, responsible for quality in 40 community practice sites and 2 medical centers in Pennsylvania. He attended Hahnemann University School of Medicine and received a Master of Medical Management at the Tulane University School of Public Health and Tropical Medicine. He completed the Family Practice Residency program at Saint Vincent Health Center and received a B.S. in Health Sciences from Gannon University, Erie, Pennsylvania. Dr. Bloom has published articles in various scientific journals, including Journal of General Internal Medicine and Journal of Medical Education. Dr. Bloom is a recipient of the American Medical Group Association Preeminence Award presented to Geisinger Community Practice for service line redesign, including systems of care for chronic disease. Learning Objectives Provide an opportunity to learn about and discuss this important health care trend in the United States Provide information on the rationale and supporting evidence on the impact to patients and practice Provide information on implementation challenges, measurements, and related initiatives Merck & Co., Inc., is pleased to sponsor this program to provide information consistent with FDA guidelines. This program is not an accredited CME program and is not designed to meet any training and/or educational requirements. The speaker for this program is speaking on behalf of Merck & Co., Inc.

10 You are invited to a medical education program for health care professionals and health care business professionals only that will focus on: Delivering Quality Care to Diverse Populations Date Thursday, October 28, 2010 Time 07:30 AM Location THE CLEVELAND CLINIC 9500 EUCLID AVE CLEVELAND OH, RSVP by Oct 26, Ext Maureen Hall Merck & Co., Inc. Speaker Joseph R Betancourt, M.D. Dr. Joseph R. Betancourt M.D., M.P.H., is Director of The Disparities Solutions Center and Senior Scientist at the Institute for Health Policy at Massachusetts General Hospital. He is also an Assistant Professor of Medicine at Harvard Medical School. Dr. Betancourt's primary interests include cross cultural medicine, minority recruitment into the health professions, and minority health/health policy research. Dr. Betancourt has served on several Institute of Medicine (IOM) Committees, including one that produced "Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care." Dr. Betancourt received his medical degree from the UMDNJ New Jersey Medical School. Following residency, he completed The Commonwealth Fund Harvard University Fellowship in Minority Health Policy, and received his Masters in Public Health from the Harvard School of Public Health. Learning Objectives Present evidence of racial/ethnic disparities in health care Discuss the impact of disparities, cultural competence, and patient centered focus on health care quality Provide organizational strategies to achieve cultural competence and patient centered focus and address disparities Merck & Co., Inc., is pleased to sponsor this program to provide information consistent with FDA guidelines. This program is not an accredited CME program and is not designed to meet any training and/or educational requirements. The speaker for this program is speaking on behalf of Merck & Co., Inc.

11 Josanne Pagel, MPAS, PA-C, RMT PA Services Director, Cleveland Clinic 9500 Euclid Avenue, EB116h Cleveland, OH Phone: Fax: Tammela Jeffries, PA Coordinator Cleveland Clinic 9500 Euclid Avenue, EB116d Cleveland, OH Phone: Fax: Our VISION is to offer the most professional and educational opportunities to Physician Assistants. throughout the world! MISSION To work with physicians to provide quality and accessible health care to our patients. To continue our professional and personal development as Physician Assistants. To increase awareness of the Physician Assistant profession at Cleveland Clinic. PURPOSE By disseminating information, increasing communication, and promoting educational activities for continual medical and professional opportunities, the Physician Assistants of Cleveland Clinic are committed to providing affordable and accessible quality health care to all patients. physicianassistants/ (under construction) Job postings For info contact Margaret Vandervort, PA Recruiter, ; or MAIN CAMPUS Bone Marrow Transplant (1) Brochoscopy Service (1) Cardiovascular Medicine (1) Cardiothoracic ICU (1) Dermatology Outpatient (1) Digestive Disease (1) Emergency Dept (1) Emergency PRN (1) Fast Track Cardiac ICU (1) Gastroenterology Inpatient (1) General Anesthesia Acute Pain Mgmt (1) General Surgery Outpatient (1) Heart Failure (1) Hospital Throughput/Neurology (1) Hospital Throughput/Urology (1) Neurology (1) Neuro ICU (1) Neuro/Oncology (1) Occupational Health (1) Orthopaedics (1) Pain Management Outpatient (1) Psychiatry (1) Spine Center (1) Urology (1) REGIONAL HOSPITALS Euclid Hospital: MICU (1) Hillcrest: Cardiothoracic Surgery (1) House Coverage (1) Hospital Medicine (1) Huron Road: Critical Care MICU/SICU (1) Lakewood: General Surgery (1) General Surgery PRN (1) Orthopaedics (1) Lutheran: Surgery (1) South Pointe: Surgical Services (1) FAMILY HEALTH CENTERS & AMBULATORY SURGERY CENTERS Lakewest: CT Surgery (1) Lorain: Pre-Admission Testing (1) Independence: Express Clinic (1) KINDRED HOSPITAL Sub-Acute (1) WILLOUGHBY HILLS Neurosurgry (1) ASHTABULA COUNTY MEDICAL CENTER Pain Management (1)