Mercy Provider Website...• Pneumonia • Sepsis (inflammation caused by infection) • Surgical site bleeding • Pulmonary embolism (blockage in the lungs) • Mechanical complication

Education CornerYou can check out all of these educational opportunities and more at p.mercycare.org/calendar

Mercy Clinical Grand Rounds (CGR) – OPEN TO ALL CLINICAL STAFFFirst Tuesday of selected months, unless otherwise noted

4:00 to 5:00 p.m.

Hallagan Education Center

Free to attend; No Registration Required

• Thursday,April3–EarlyIdentificationforAutismSpectrumDisorders: Presented by Caroline Moniza, PsyD, LP

• Thursday,May1–Head&SpineInjury:ManagementfortheNon-SurgicalSpecialist:PresentedbyNoraRoyer,MD

Trauma Multidisciplinary Committee – OPEN TO ALL CLINICAL STAFFQuarterly

7:00 to 8:00 a.m.

Mercy Hallagan Education Center, unless otherwise noted

FREE to attend; No Registration Required

• Wednesday,March26atHall-PerrineCancerCenterCommunity Room

• Wednesday,June25

• Wednesday,September24atHall-PerrineCancerCenterCommunity Room

• Monday,November24

Trauma M & M Conference – PROVIDERS ONLYMonthly

7:00 to 8:00 a.m.

Mercy Hallagan Education Center, unless otherwise noted

• Wednesday,April30atHall-PerrineCancerCenter Community Room

• Wednesday,May28

• Wednesday,July30

• Wednesday,August27

• Wednesday,October29

Free CME for Pain Management – Iowa Board of MedicineAvailablenowthruMay1,2014viabook/online

Free

Toorderacopyof “ResponsibleOpioidPrescribing:AClinician’sGuide,”call(515)242-6039oremail [email protected] and postal address.

March 2014

Thank You for taking the 2014 Provider Engagement Survey

# Providers: 391 # Completed: 220 Response Rate: 56.3%Mercyreacheda56.3percentresponserate,comparedtothenationalaverageresponserateof 40-45percent.Thank you for your cooperation as we work to make Mercy physician-led and professionally-managed.

What will we do with the results of the survey? Muchlikewedidwiththelastsurvey,Mercywillconductfocusgroupsessionswithyou,Mercystaff andleaderstodigdeeperintothesurveyresultstouncovercommonthemes.Youwillplayanessentialroleinhelpingusdevelopour2014ActionPlanwhichwillbecommunicatedthrough MEC, Physician Forums and other face-to-face meetings, as well as published on our NEWMercyProviderPortal–p.mercycare.org.Copiesof theactionplanwillalsoreachyouviaemailandwillbepostedinvariouslocationsthroughoutMercy.

New Provider WebsiteThenewproviderwebsiteisLIVEandeasilyaccessiblebyvisitingp.mercycare.org. The new easy-to-read and clean layout is especially designedtoautomaticallyresizetofitanymobiledevice.Someadditional features of the site include the following:

• MercyMedicalStaff Department&CommitteeAgendas &Minutes

• UrgentAnnouncements

• Calendarof EducationalandSpecialEvents

• ResourceCenterincludingVideoTraining

• ProviderAwards&Recognition

Coming Soon! EpicTips&Tricks,VideoResourceLibrary,ProviderBlog,andsomuch more!!

You’llnoticethattherearestillsomesmallglitcheswiththesitewhereitwillaskyoutologin–thatisbecauseweareinthefinalstagesof integratingaspecialfeaturethatwillallowallproviderstologinusingtheir Mercy username and password.

Have a suggestion on what you’d like to see on the new provider website? SimplycontactAndreaAultat(319)558-6405or [email protected].

Look for the new link to the Mercy Provider Website on your Epic menu bar!

If youhaveanyissueswhatsoever,rememberthatyoucanalwayscontactEpicProviderAssistanceatx4610(or319-369-4610).

Mercy Provider Websitep.mercycare.org

Redesigned and easy to access from any mobile device!

Featuring:✓ Urgent Announcements✓ Meeting Agenda/Minutes✓ CME Opportunities✓ Epic Tips & Tricks

✓ Provider Recognition and Awards

✓ Resource Center✓ & More!

C E D A R R A P I D S

PROVIDERW E B S I T E

Congratulations Bonnie Seely, ARNP (Hospice of Mercy) - Winner of the iPad Mini drawing!

Join us in April for the Physician ForumsPlease join Tim Charles, CEO and Dr. Timothy Quinn, Chief of Clinical Operations to learn about:

• ProviderEngagementSurvey–Resultsand ActionPlans

• CurrentClinicalIntegrationEfforts

• Impactof HCAHPSonProvidersandHospitals–Whatcanyoudotohelp?

Forums will take place at the following times: April23,6:30AM–NeuhausBoardroom

April25,12:00PM–NeuhausBoardroom

April29,5:30PM–NeuhausBoardroom

[email protected] or 319.398.6100.Wehopetoseeyouthere!

Diabetic TeamInformationregardingtheDiabeticEducator(RNordietician)atMercyMedical Center:

Hours:Monday–Friday,8:30am–Noon

Phone:398-6663(afterthesehoursthephoneisforwardedtothediabetescenter)

Reports are run each morning to identify the following:• Patientsoninsulintoensuretheyaregettingglucosemonitoring

• Glucose<60or>250

• A1C>8

• Referralsmadebystaff orphysicians

Patientsareseenaccordingtothesereports/referrals.Withareferral,theeducator will also upload insulin pump information. This process was implemented3/1.

Mercy Medical Center | 701 10th Street SE, Cedar Rapids, IA 52403

www.mercycare.org

Thanks for attending the Winter Warm-Up @ LavaIf youwereunabletomakeit,here’salittleglimpseof whatyoumissed…Specialthankstothe60+whobravedthearcticairtowarmupatLava.Funwashadbyall!

Mercy among Medicare’s 97 Best Hospitals for Joint Replacement (continued)

Mercy Medical Center has once again been named one of the nation’s100TopHospitals® by TruvenHealthAnalytics,aleadingproviderof informationandsolutionstoimprovethecostandquality of healthcare. Mercy is the

onlyhospitalintheCedarRapidsareatobenamedaTop100Hospitalthis year.

TheTruvenTop100Hospitaldesignationisaprestigiousindustryaward,whichcannotbepurchased.Theawardevaluatesnearly3,000hospitalsandrecognizesthetop100thathaveachievedexcellencein patient outcomes, patient safety, treatment standards, patient satisfaction,efficiencyandfinancialstability.

Toconductthe100TopHospitalsstudy,TruvenHealthusespublicinformation—Medicarecostreports,MedicareProviderAnalysisandReview(MedPAR)data,andcoremeasuresandpatientsatisfactiondatafromtheCentersforMedicare&MedicaidServices(CMS)HospitalComparewebsite–todevelopanindependentandobjectiveassessment.

TheTruvenHealth100TopHospitals® study has been conducted annuallysince1993.

FormoreinformationonMercy’sdesignationasaTop100Hospitalandotherqualityandsafetymeasures,visitwww.mercycare.org/quality.

Mercy named one of the nation’s 100 Top Hospitals by Truven

Doctors’ Day is March 30 – Thanks for all you do!Inhonorof NationalDoctors’Day,MercyMedicalCenterwouldliketoextenditsAppreciationfortheexceptionalworkof themedicalprovidersinourcommunity.Thankyou,physicians,physicianassistantsandnursepractitionersforyourdedicationtoimprovingthehealthof ourpatientsandforyourexpertiseinhelpingmakeCedarRapidsoneof thetopcitiesintheU.S.forqualityhealthcare.YourworkisessentialtoprovidingThe Mercy Touch®.

Join us for a Movie on Mercy! April 12, 2014 | Showtimes beginning at 9:30 a.m.Galaxy 16 Wehrenberg Theatre, 5340 Council St. NE, Cedar RapidsAttentiondoctors,nursepractitioners,andphysicianassistants: Bringyourselvesandfamiliesoutforamorningof moviefun–pop andpopcornincluded!PleaseRSVPbyThursday,April10,2013to Deb Roberts at [email protected](319)861-7890.

Now Playing! • Noah(PG-13)•MuppetsMostWanted(PG)

What you need to know about the 2-Midnight Rule (continued)

What you need to know about the 2-Midnight Rule

There are two initial orders for hospital patients…1.“PlacementTo”Order=Outpatient

2.“InpatientAdmission”Order=Inpatient

What “Patient Class” do I need to select if my patient will be staying LESS than 2 Midnights?

• ForSurgicalPatients:Afteraprocedure,if yourpatientwillbestayinglessthan2Midnights,youwillneedtoselect“BeddedOutpatient”forPatientClassand“ExtendedRecovery”forTransferService.

• ForMedicalPatients:Amedicalpatientstayinglessthan2Midnightswouldbeanoutpatientplacedin“Observation”forPatientClassand“GeneralMedicine”forTransferService.

Mercy among Medicare’s 97 Best Hospitals for Joint Replacement

Pictured here from left to right:WesMachnowski,MD(MercyPediatricClinic);NoraRoyer,MD(MercyGeneralSurgeryClinic);SaraNeff,ARNP(MercyPediatrics)andhusbandTom;MadelynPilcher,DNP(MercyInpatientOrthopaedics)andhusbandRyanRader;KeeliIrwin,ARNP(MercyPediatricClinic);ScottNau,MD(MercyPediatricClinic);DebraPiehl,MD(ObGynAssociates);BethBussewitz,MD(ObGynAssociates);andAlvinaDriscoll,MD(ObGynAssociates).

Pictured here:CharlesGrado,MD(CharlesE.Grado,MD,FACS-Plastic/ReconstructiveSurgery);AlanWhitters,MD(MercyPsychiatryOutpatientClinic);andVinceReid,MD(SurgicalOncology–Hall-PerrineCancerCenter).

Pictured here: Nora Royer, MD (MercyGeneralSurgeryClinic)andSajidaAhad,MD(MercyGeneralSurgeryClinic–April2014).

Pictured here:TodWalker,PA-CandwifeAllison

Pictured here:StephanieHoenig,ARNP(HospitalistPhysiciansof LinnCounty,PLC);HollyCopeland,ARNP(PCIENT);MadelynPilcher,ARNP(MercyOrthopaedicCenter);andSarahSchloss,ARNP(HospitalistPhysiciansof LinnCounty,PLC).

MercyMedicalCenterwasnamedasoneof thenation’s97besthospitalsforjointreplacementsurgery,accordingtoinformationrecentlypublishedbytheCentersforMedicare&Medicaid Services(CMS).

AccordingtoCMS,thelistcontainshospitalswherepatientsareleastlikelytosuffersetbacksandbereadmittedafterjointreplacementsurgery.This report compared hospitals using Medicare data that lookedathowoftenpatientswerereadmittedwithin30daysof dischargeand how often they suffered one of the following eight complications:

2014

• Acutemyocardialinfarction(heartattack)

• Pneumonia

• Sepsis(inflammationcausedbyinfection)

• Surgicalsitebleeding

• Pulmonaryembolism(blockageinthelungs)

• Mechanicalcomplication

• Jointinfectionwithin90daysof surgery

• Deathduringadmissionorwithin30days

Approximately600,000Medicarebeneficiariesundergoahiporkneereplacementeachyear.Accordingtothereport,95percentofU.S.hospitalswereconsidered"average."

MercyMedicalCenterwasalsooneofjust97hospitalsinthenationwithreadmissionratesthatwerelowerthanaverageandtheonlyhospitalinIowawith this important distinction.

CMSpublishedthedataonitsHospitalComparewebsite, www.medicare.gov/hospitalcompare.

Manypatientsseekingjointreplacementsurgerywanttoknowahospital’srecordwhenchoosingwheretohavetheirsurgery.ThisreportreaffirmsconclusionsaboutthehighqualityofcareinjointreplacementsurgeryatMercy Medical Center.

NOTE:If itlaterbecomesclearthatthebeneficiarywillrequire2ormore midnights of hospital care due to a complication or other factor, youcanplacethe“InpatientAdmission”Orderatthattime.

It is very IMPORTANT to document the NEED for the “Inpatient Admission” Order in the patient record.TIP: “Service”indicatesthetypeof hospitalbed,while“PatientClass”indicatesthetypeof InpatientorOutpatientyourpatientis.Theprocess of placing the right initial order and subsequently indicating the correctserviceandpatientclassiskindof likethelottery,wherethereareseveralcombinations!Really,therearethreecomponents,butyouare responsible for “picking the right numbers”:

1.First,youneedtoplacetheInitialOrderforthepatient(“PlacementTo”forOutpatient;and“InpatientAdmission”forInpatient).

2.Second,youneedtochoosetheServiceforthepatient(orthetypeof hospitalbed).

3.Lastly,youneedtochoosethePatientClassforthepatient(typeof inpatientoroutpatientstatus).

Example of the options available for “Patient Class” or type of inpatient or outpatient.

Example of the options available for “Service” or type of hospital bed.

Preparing for ICD-10OnOctober1,2014,theICD-9codesetsusedtoreportmedicaldiagnosesandinpatientprocedureswillbereplacedbyICD-10codesets.ThetransitiontoICD-10isrequiredforeveryonecoveredbytheHealthInsurancePortabilityAccountabilityAct(HIPAA).

MercyandtheCedarRapidsPHOareofferingaseriesof onlinetrainingviaPrecyse™tohelpyoubecomeeducatedandalertwithregardtothese upcoming changes. Contact Connie Cimaglia at Mercy ([email protected](319)369-4771)orJennyMcIntryreattheCRPHO([email protected])formoredetails.

Looking for an App for that? PrecyseUniversityICD-10DocGuideisahelpfulappwhichisdesignedtohelpyouquicklyretrieveinformation on how to document the most common diseases and conditions.

Doc Guide is available for free on the Apple™ App Store for both the iPhone® and iPad®, Google Play™ (Android Store), and the Amazon® App Store.

New administrative offices for Cedar Rapids Family Medicine Residency

TheCedarRapidsFamilyMedicineResidency,longafixtureatbothMercyMedicalCenterandSt.Luke’sHospital,andsincetheFloodof 2008partlyensconcedatSt.Luke’s,partlyattheSt.Luke’sResourceCenter,hasconsolidateditsadministrativeofficeseffectiveMarch3,2014.YoucanfindCRMEFat1260SecondAvenueSE,CedarRapids,52403(formerPCIurologybuilding),andcancallusat319-297-2300,orfaxusat319-297-2280.

Residents and faculty will continue to see Family Medicine clinic patientsatthenearbyEasternIowaHealthCenter(formerLinnCommunityCare),assistwithOBcareatEIHCandatbothSt.Luke’sandMercy,evenaswealsoprovideinpatientcoverageformanycommunity family physicians and pediatricians. For the medical community,letaloneforthecommunityasawhole,themoveisahappyresolutionof theunwelcomeflood.PleaselookforwardtovisitingCRMEF’snewhomeatanopenhousesometimethisspring.

Epic Thrive After Go-Live SessionsINPATIENT Thrive sessions – replaced by WebEx Beonthelook-outforthereleasedateastowhentheseWebExefficiencysessionswillbemadeavailablethroughthenewproviderwebsite–p.mercycare.org.

AMBULATORY Thrive sessions – 1st Monday of the month and available via WebEx Dr.BradBeerwillcontinuetohostin-personEpicAmbulatoryThrivesessions both in person and online. The in person sessions will be held onthefirstMondayof themonthfrom5:30to7:00p.m.locatedonthe2ndFloorof theHall-PerrineCancerCenter.WebExversionsof thesessionswillalsobemadeavailableviap.mercycare.org.

CMS 2-Midnight Rule – Cosigning the “Admit to Inpatient” Order PRIOR TO DISCHARGEReason for this update: NewCMS2-midnightrule.If anurseputsinan‘AdmittoInpatient’ordertheproviderneedstocosignitpriortothepatient’sdischargeforproperreimbursement.Thesystemwillnowpreventa‘dischargepatient’orderuntiltheAdmissionorderhasbeencosigned.

Changes you will see:1.Apop-upwillfireandpreventthesigningof a‘dischargepatient’

order until the admission order has been cosigned.

2.The‘CosignOrders’sectioninOrdersManagementallowsyoutocosignthisorder,savingtimeof signingviatheInBasket.

Epic Update

Scenario/Example Workflow:• ThepatienthasanAdmittoInpatientorderthatstillneedstobe

cosigned but another doctor is ready to discharge this patient

• Whentryingtosignthe‘DischargePatient’order,apop-upfires,anditdoesnotallowtheprovidertosignthedischargeorderuntilthe co-signature of the admit to inpatient order is completed

• ThatprovidergoestoOrdersManagement,ClickCosignOrders,andclicks‘Sign’nexttotheAdmittoInpatientorder

• Thepatientcannowbedischargedproperly

Pop-up:

Epic Update (continued)

How will ICD-10 affect me as a provider?• ICD-9codes(diagnosisandprocedurecodes)willnolongerbe

acceptedbypayersforpaymentafterOct1,2014

• Improvedclinicalcommunicationwithstandardized,complete,accurate diagnoses and procedures

• Improvedcommunicationequalsimprovedpatientcareandoutcomes

• ICD-10codesarecompleteastheyallowforthefulldiagnosticdescription of the disease process

• Improvedmeasurementof quality,safety,andefficacyof healthcare

Discharge Navigator Update:

Discharge to Home or Self Care Order Aremindertosavethisinyour“Favorites.”Theolddischargeordersethasbeenretiredandisnolongeravailable.

Continued on next page

Mercy Medical Center | 701 10th Street SE, Cedar Rapids, IA 52403

www.mercycare.org

Formulary Additions:• Hespan–restrictedforORuseonly

Formulary Deletions:• Estradiol(AloraorVivelle–Dot)0.025mg/24hourpatch–Nouse

• Rid(LiceKillingShampoo)–Nouse

• Risidronate(Actonel)5mg–Nouse

• Pirbuterol(MaxairAutohaler)–DiscontinuedbyManufacturer

DefaultfrequencieswerereviewedforZofran,ReglanandBenadryl.Defaultwillbechangedfromevery4hourstoevery6hours.ItwasalsoapprovedtochangeReglanfrom10mgIVto5mgIVonallprotocolsandordersets.

The group discussed that with current equipment an intermittent suction can no longer be performed; only continuous suction is permitted.ItwasapprovedtoaddawarningonallNasogastricTubeordersetsforaGIprophylaxisprompt.

Approved Policies:• PainManagementPolicy

• MedicationReconciliationPolicy

• ControlledSubstance,PatientCareDepartmentTracking

“Comments” link removed – “Admin Inst” link will stay Thegroupdiscussedtheongoingissueofordersbeingmodifiedusingthe“comments”link.Itwasnotedpharmacydoesn’tseethe“comments”linkanddoesnotreceivenotificationwhenanorderismodifiedusing“comments.”Itwas also noted nursing does not always refer to the “comments” link. Due to theincreasednumberofissues,the“comments”linkwasremovedfromEPIC.The“Admin.Inst.:”linkwillremainforadditionalcommentsforthepharmacyor nursing staff. This is pictured below:

Medication Management Committee

What is BERT?BERTstandsforBehavioralEmergencyResponseTeam.ItismuchlikeMercy’sexistingMETteam,butforpsychiatricsituations.

Mercy’sBehavioralServices,alongwithotherkeydepartments,iscurrentlyworkingondevelopingandrollingouttheBERTteamasaperformanceimprovementinitiative.Thiswillbeanextrasupportto staff on medical units who are caring for patients with secondary psychiatricillness,areexhibitingdifficultbehaviorssuchasagitationoraggression,orwhenstaff feelstheycouldbenefitfrompsychiatricassistance on an urgent basis.

What is BERT? (continued)There are two ways in which the BERT team can be activated:

• Oneisbypagingtheteam(3908)whenyouareconcernedaboutapatientsbehaviorandyouneedpsychinterventionsoonerratherthanlater,butitisnotacodegreensituation.WhenBERTispagedyouwillgetacallbackbytheBehavioralchargenursewhowillassessthe situation. Much like what happens when you page the MET team. Ateamof fourstaff,includingtheBehavioralchargenurse,accessnurse,behavioralnursemanager,andasecurityofficer,willrespondandassessthesituationforappropriateintervention.TheBehavioralchargenursewillalsobringajumpbagwhichwillcontainmedstypicallynotcarriedinmedicalunit’saccudose.Oneof thegoalsof theBERTteamistodiffusesituationsandprovidesupportandinterventionsinhopesof decreasingtheneedforcodegreens.

• ThesecondwaytheBERTteamwillbeactivatedisbycallingacode green. You will still continue to call a code green, through the operatorat6111,whenit’sanemergencyandyouneedassistanceimmediately. This is for situations where you need a larger presence immediately. This is the current process and will not change. The goal is that when you call a code green you will get a more structured and standardized response by an appropriate team who are trained in handlingcrisissituations.Aresponsethatisconsistent.Theresponsetocodegreenswillbelarger.BERTteammembersdescribedabovewillrespondinadditiontoapsychiatrictechfromthebehavioralunit,thebehavioralsocialworker,astaff personfromtheEDwhowillhaveasecondjumpbagwiththem.Additionalsecuritystaff andthehousesupervisorwillalsorespondwhichiscurrentprocess.

BERTdoesnotreplacetypicalaccessconsultswhicharecurrentlyordered when either the physician or staff wants an access nurse to do an assessment on a patient. You will still continue to order an access consultforbasic,non-urgentconsultstoassess:apatient’spsychiatriccondition,assesssuicidalideationandneedfor1:1,addressmedsetc.This is the current process and this will not change.

What can staff do to help assist the BERT team?Whentheteamarrives,eitherwhenpagedorasaresponsetoanactualcodegreen, it is helpful to the team if someone who is familiar with the patient stays present. This can be the primary nurse caring for the patient or the chargenurse,anyonewhocanprovideinformationtotheteamresponding.

BERT AlgorithmAccess RN consult

• Basicconsultisordered

• Generalassessmentof moodorbehaviornonemergent

• Assessneedforpsychiatristconsult

• Assessmedications

• Assesssuicidality

• Determineneedfor1:1

• Adviceorguidanceonasituation

• Basicquestions

Page BERT when:• Needpsychiatricassistancequickerthanregularaccessconsult

• Concernedaboutacutechangeinpsychiatriccondition

• Acuteincreaseinbehavior(restlessness,agitation,orconfusion)which requires additional assistance

Call code green:• Needimmediateassistance

• Situationrequiresgreaterpresencethanfourstaff

• Activeaggression

• Imminentdangertopatientorothers