2022/04/25 Updates
NW FED Spring Social: Please make an effort to join us! Click HERE to RSVP!
Patient Surges at Town Square
Town Square Teledoc Surge Support: Any time you have a volume-surge at Town Square, don’t forget that we have the Teledoc Surge Support process in place! If you are the on-shift physician, make sure you take over the note done during the televisit and do not start a new note. This is triage-independent and the sole goal is to decrease door-doc time and prevent LWOTs. If you would like to be included in the process, let me know. Click HERE to view the process in the “FED Provider Manual”.
Ortho
OTS: Ortho Trauma Surgery: NW is fortunate to now have two ortho traumatologists - Dr. Reddix and Dr. Potter.
for ALL ortho cases (except hand), we just need to the regular ortho on-call and then they will guide us if they can manage or if we should call the Ortho Traumatologist.
Pediatric Ortho Trauma: can call Dr. Potter (NW Ortho Traumatologist) Monday-Friday at 06:00 - 18:00. Otherwise, call the Pediatric Intensivist on the Call Roster and they will guide us if they can accept the patient.
Sepsis
Sepsis: We need to do better with out sepsis compliance. NW has fallen from #1 in all UHS to the bottom ⅓ in rankings on sepsis outcomes. I am working on a dedicated Sepsis section on tips and flow charts.
Lab
Culture Reports & Send-Out Labs: we are all responsible for following up on the culture reports and send-out labs. This is now available within Cerner. The labs will not be printing out reports. The day-shift physician and midlevels should review these at the beginning of each shift and make calls as indicated throughout the day as time permits. Click HERE to view the process.
Add-On Lab Orders: Effective immediately, when ordering additional labs, change the order status to “Add On STAT” instead of STAT.
NOTE: if a patient requests a test that is a send-out such as flu/rsv/covid pcr/respiratory panel, do NOT tell them to go to the main ED so they can get it faster. Simply inform them that we can do the test, but will have to either wait the several hours for the result or we can call them over the next 48 hours. I almost never order any of these tests as it will not change my management.
Medications
Lidocaine/Bupivicaine: We are no longer using the multi dose vials, but are moving to 10-cc single-dose vials. Please do not ‘save’ any vials after using them.
SGLT2 Inhibitors: NW has added two Sodium-Glucose Cotransporter Type 2 Inhibitors - Empagliflozin (Jardiance) & Dapagliflozin (Farxiga) - to the formulary. Click HERE to view the P&T Committees Executive Summary regarding these medications.
IMPORTANT WARNING: EUGLYCEMIC DKA: one of the subtle adverse events that can occur with SGLT2-i drugs is EUGLYCEMIC DKA. This requires a high degree of suspicion to catch, so pay attention to the CMP, anion gap, and bicarbonate levels - DESPITE a normal glucose level.
Policy Updates
NWTHS Provider Orientation Manual: the orientation manual that Delynn gives to every physician during on-boarding and training is now uploaded to the “Policies | Procedures | Processes” section of the newsletter. Click HERE to view
NWTHS Bylaws and General Rules & Regulations: these have been updated and are now available to review in the “Policies | Procedures | Processes” section of the newsletter.
