Transcript Virtual Tour of SVC

St. Vincent’s Clinic
Volunteer Orientation
Outreach and Services of
St. Vincent’s House
• St. Vincent’s House is a comprehensive community
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outreach organization begun in 1954
Focuses on the needs of a forgotten people: the working
poor and those persons moving from welfare to work”
Situated in a neighborhood where the average income is
well below $10,000, our services at St. Vincent's House
are targeted to help the growing number of families and
individuals who are working at minimum wage, seasonal
or part-time low paying jobs and do not have any
benefits.
Clinic History and Mission
• Clinic began in early 1990s
• SVC is a cooperative effort between UTMB
and St. Vincent’s House, committed to
providing competent healthcare to the
underserved population of Galveston while
facilitating the education of UTMB Medical
and Physician Assistant students
Overview of Volunteer
Responsibilities at Clinic
• “Underclassmen” (aka MS-I, MS-II, PA-I students):
– Expected to participate in the evaluation and
management of patients – includes H&Ps, writing notes,
formulating treatment plans, and presenting to faculty
– Be eager to learn by “seeing” and “doing”
– Can do as much or as little as you want – depends on
your comfort level
• General rule of thumb: “watch one, do one, teach one” applies!
– The hope is for you to gain experience with “real”
patients early in your career, which will be invaluable
when you hit the wards
Overview of Volunteer
Responsibilities at Clinic
• “Upperclassmen” (aka MS-III, IV, and PA-II students):
– Expected to assume a leadership role as “junior
faculty”
– Two main jobs: Mentor junior students + See
patients
– First priority is to help junior students with their
patients, management plans, and presentations
– Also be there to evaluate and manage SVC patients
– Your presence is vital for smooth clinic operations!
Virtual Tour of St. Vincent’s Clinic
• Step 1 – The Patient Arrives:
– The patient arrives and checks in at the front
with Debbie, aka the woman whom SVC could
not function without
Pictures of the clinic from the outside
We love Debbie!!!
Waiting room full of patients to be seen
Virtual Tour of SVC
• Step 2 – Review the Chart:
– Take a patient’s chart on the door of the front
office to review
– Focus on the CC, PMHx, current meds,
pending lab results, and what happened at
their most recent clinic visit
Virtual Tour of SVC
• Step 3 – Play Doctor:
– Call patient when ready and bring them to exam
rooms
– Interview and examine patients with your arsenal of
POM skillz that would make Dr. Beach proud!
– All instruments and tools you may need for exams
are either in the rooms or the lab area
– Students are expected to do everything for the
patient– this means taking vitals, doing labs, etc
yourselves!
– **Don’t be afraid to ask if ever uncertain about your
history and exam – we’re all here to learn!**
A typical patient-student interaction
(note: when the clinic is busy, we
overflow into the outside/common areas)
A typical exam room – fully loaded
with BP cuffs, a sink, and plenty of
stool guaiac cards!
Virtual Tour of SVC
• Step 4 – Present to Senior Student:
– “Present” your case to an upper level student
(MS-III, IV, or PA-II) and establish a plan after
examining your patient
– Upper level student volunteers will make the
mentoring of junior students a top priority
Sameet (MSIV) helping out Viet (MSII) with
questions about his patient
Virtual Tour of SVC
• Step 5 – Organize Medications:
– Organize meds and draw pertinent labs BEFORE
presenting to faculty
– 3 sources of meds for SVC patients:
1. Samples
2. PATIENT ASSISTANCE
3. Prescriptions
– Basic labs that can be checked before presenting
include blood draws, UA, and BG fingersticks
Overview of SVC Medications
• Samples:
– Local physicians donate tons of samples and
keep our pharmacy stocked
– When dispensing samples, remember to
document in the chart:
• LOT# (on the bottle)
• EXPIRATION DATE (on the bottle)
• Number of pills dispensed
Closets full of samples in our pharmacy
Overview of SVC Medications
• Patient Assistance:
– Program started at SVC in 2003 to get meds
for patients direct from pharmaceutical
companies
– Provides meds to our patients, who would
otherwise not be able to afford them
– A true “win-win” situation: free meds for
patients at no additional cost to the clinic
Overview of SVC Medications
• Patient Assistance:
– Patients that are good candidates for this
program are those with chronic diseases
requiring regular continued medications
– Use your judgment to differentiate “chronic”
from acute – e.g., 5 days of ABx for a UTI vs
a 10 year h/o diabetes controlled by 2
different hypoglycemic agents
– When in doubt, just ask!
Overview of SVC Medications
• 7 Easy Steps to Patient Assistance:
1. Have patient sign consent form – this allows us to
sign their names for them when filling out their med
applications
2. Add patient’s name, meds needed, and date to the
clipboard on the door to the pharmacy
3. If the patient is out of meds now, dispense a Rx for
4-6 weeks – this will “hold them over” until we receive
the meds at the clinic
4. Tell patient that they will get a phone call from Debbie
when the meds arrive (usually 4-6 wks) and then can
come pick them up
Overview of SVC Medications
• 7 Easy Steps to Patient Assistance:
5. Remind patient that when they have 1 month of
meds left, call Debbie or come to clinic to
reorder - this insures an uninterrupted flow of
medication
6. Document!! – In the chart AND in the Patient
Assistance Excel spreadsheet on the computer
7. Patient receives 3-4 months of meds with each
order
Overview of SVC Medications
• Prescriptions:
– Fill out Rx using regular format – if you’re unsure of
how to do this, just ask
• All pads to be kept in the front office at all times!
– Stamp all Rx with “St. Vincent’s Clinic” stamp
• Tell patient to fill Rx at UTMB Outpatient or Inpatient
pharmacy
– All Rx need faculty signature
– Patients do not pay anything to fill an SVC stamped
Rx at UTMB
Virtual Tour of SVC
• Step 6 - Labs 101 the Basics:
1.
Blood Draws –
a. Gather materials – tubes, tourniquet, needles, bandaid,
etc
b. Fill out appropriate forms – example forms are found
taped to the wall in the lab area
i. (Note: key for figuring out what type of tube to use is found on
this form as well)
c. Place finished bloodwork in clear bag and drop in red bin
on the counter
d. ALL bloodwork needs to be double documented in the
lab area and the chart! – including CBC, chem panel,
STD labs, TB tests, etc
i. After drawing/performing these tests, be sure to document on
the form taped to the counter in the lab area!!!
Bottle of strips for UAs
Proper lab documentation
on the forms
Finished blood work in the
clear bag with a form
More pictures of the lab complete with a
microscope for wet preps, etc
Box for finished bloodwork
Box of needles for fingersticks
Virtual Tour of SVC
• Step 6 - Labs 101 the Basics (cont’d):
2. Urinalysis:
i. All necessary materials are in the lab area
ii. PLEASE pour out specimens when finished!
3. Blood Glucose Fingersticks:
i. Glucometers are to be kept in the front office when
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not in use – please remember to bring them out of
the rooms so they can be tracked
Spring-loaded, single-use needles and strips are kept
with the glucometers in the cases
Virtual Tour of SVC
• Step 6 -Labs 101 the Basics (cont’d):
4. Vaccines:
i. Vaccines are kept in the fridge in the lab area
ii. ONLY DIRECTORS may access vaccines!!
iii. If you need to give a vaccine, please notify a director!
iv. Be sure to double document vaccine administration in
the chart AND the form in the lab area
Tal (MS-IV) demonstrates proper
documentation of labs. He double
documented in the chart shortly after
this picture was taken.
Refrigerator “lock-box” full of vaccines
Please be careful when handling anything in the lab!!!
Virtual Tour of SVC
• Step 7 - Time to Present to Faculty:
• Have as much as possible done PRIOR to presenting
• Have medication refill Rx filled out and ready for signing so
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all the faculty has to do is sit back, listen, and pimp
Goal is for us the students to act as providers and the faculty
to be there for support
Don’t be afraid to be wrong in front of faculty – we’re all
here to learn and they’re here to teach!
Senior students are your best resource for organizing your
plan and for tips about how to present properly – please ask
if you feel lost!
Virtual Tour of SVC
• Step 8 - Consults and Radiology:
• Radiology
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Starting this year, UTMB radiology dept has graciously
allowed for us to send pts to get imaging studies free of
charge
Patients must first complete a financial screen (DAMP
office) at UTMB to verify eligibility and need
We fill out the paperwork and patients are called to
schedule an appointment
• If any of your patients need imaging studies, please
find a director to help you out
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This is a brand new arrangement b/t SVC and Rads that
will be huge for our patients but can be confusing at first
Virtual Tour of SVC
• Step 8 - Consults and Radiology: (cont’d)
• Consults
– Consults process is similar to radiology
– Patients undergo financial screen at UTMB first
and are then contacted by that UTMB dept for an
appt
– Fill out the appropriate consult form and drop it
in the box for consults in the office
– Again, if your patient needs a consult, please
find a director to help you out
Virtual Tour of SVC
• Step 9 - DOCUMENT!!!
a. Document in the chart – e.g.,
i. Fill out the visit note thoroughly,
ii. Document sample meds distributed (lot #s and exp dates)
iii. Document Rx given
iv. Document labs drawn
v. When does the pt need to follow-up?
b. Document EVERY patient encounter in the SVC MS Access
database on the computer
c. Document ALL patient assistance orders in the appropriate
place on the clipboard AND the computer spreadsheet
d. Document ALL immunizations given (if applicable)
e. Return finished chart to the box next to computer
Common Myths about
Volunteering at SVC
• Myth #1:
“I’m only a first year and I don’t think I know
enough yet to be of use at the clinic.”
– Junior level students are the foundation of SVC and
without you, the clinic would NOT be able to run,
PERIOD.
– SVC is meant to be a low pressure learning environment
• We’re all volunteers, we’re all here to learn, and you’re NOT being
graded
– Student at all levels come to clinic to learn the practice of
medicine in a real world setting with real patients and real
problems (no POM actors here!)
Common Myths about
Volunteering at SVC
• Myth #2:
“There are always too many students and not
enough patients at clinic or vice versa and I was
overwhelmed.”
• Usually happens at very predictable times of the year:
– Beginning of each semester are notoriously crowded –
e.g., eager new students ready to see real patients in the
fall and those with New Year’s resolutions to volunteer
– First clinic following a round of exams as people now
have time to volunteer
– “Down” times @ SVC usually around Oct-Dec and midlate spring – same # of patients in need with not nearly
enough students to help out!!
Common Myths about
Volunteering at SVC
• Myth #2: (cont’d)
“There are always too many students and not
enough patients at clinic or vice versa and I was
overwhelmed.”
• Preferable for students to sign up in advance
• If you show up, you can always stay and help but, when
overcrowded, scheduled students have priority
• Thinking ahead and coming at times (Sat AM) when
classmates may be studying or nursing hangovers
(Yaga’s) often translates into great learning
opportunities with one-on-one faculty interactions
Common Myths about
Volunteering at SVC
• Myth #3:
“Faculty are scary”
• Faculty can be intimidating at first, but they all
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volunteer their free time b/c they enjoy working with
students and with our patient population
Don’t let jitters about presenting or the fear of not
knowing an answer when “pimped” dissuade you
Medical school’s challenging but if you don’t put
yourself out there at places like SVC, you’ll be
missing out on invaluable learning opportunities
Common Myths about
Volunteering at SVC
• Myth #4:
“I’m a third or fourth year and I’ll probably be too
busy to make it to clinic during rotations”
• You actually have quite a bit of free time during third year –
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see psychiatry, family medicine, and medicine consult
Let’s be honest: fourth year is a cakewalk
We want to build on this past year and continue to see good
support from MS III and IV students
In the past, third years would disappear for a year and then
maybe came back to clinic early in first semester of fourth year
By doing so, you’re missing out on one of the most rewarding
opportunities at SVC…TEACHING!
Common Myths about
Volunteering at SVC
• Myth #4:
“I’m a third or fourth year and I’ll probably
be too busy to make it to clinic during rotations”
• Clinic is dependent on upperclassmen students to be there
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to help underclassmen with their A/P, presentations, and to
answer questions
You may not think you’re ready to “teach” others but believe
it or not, you’ve all learned a lot of stuff that you take for
granted – e.g., after taking renal with Dr. Beach, we’re all
aware of the use of ACEIs in diabetics but most first years
don’t even know what an ACEI is, let alone how and why
they work specifically in diabetics..…get the idea?
Common Myths about
Volunteering at SVC
• Myth #5:
“I get hungry and need to eat regularly, so
there’s no way that I could miss a meal to
volunteer. It just doesn’t jive with my
metabolism and physiology.”
• Free food for volunteers is always provided as a
thank you from the clinic
Shameless attempt to buy volunteers with pizza
(shameless plug: Mario’s pizza really is the best on the island!)
St. Vincent’s House
Contact Info
St. Vincent's Episcopal House
2817 Postoffice Street
Galvestion, Texas 77550
Office (409) 763-8521
Fax (409) 763-0572
Directions to SVC
• From John Sealy, go
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down Harborside
towards the causeway
Turn Left on 28th St.
Clinic is located on
right hand side at
corner of 28th and
Postoffice St.