VTH Board Minutes 9/27/2019

Updates: Info Only

Personnel

• Dr. PJ Hamel passed ACVR boards
• B. Korus is working with StringSoft work group
• We have an extra-help pharmacist
• Asst Dean Admin Services – search is underway for this individual to oversee the VMBSC, HR, Grants & Contracts, and CVM Finance
• IT has undergone reorganization so that Julie Steinman will now lead the Information Systems Processes (VetStar or StringSoft/VADDS) and will report to the VTH/VDL Directors, not under IT
• Mark Anderson has been hired as an extra-help consultant to provide expertise for the next 6 months on HIS transition
• A meeting with Campus Procurement has been set to discuss the StringSoft contract

Facilities

• Pharmacy clean room – Facilities, pharmacy, and F&S contractors have met to launch pharmacy clean room project completion.  Early quotes are higher than expected.
• Lin Acc - caseload is better than expected.
• CT – construction is being completed and delivery of new unit is scheduled for early November
• WMC Ambassador Animal Residence – serial challenges have placed this project well behind schedule.

Programs

• We will be closed Dec. 24, 25, 26 and Jan. 1
• Closing of services for Fall Conference – thoughts? – members concluded that services should remain open for emergencies and consults but that routine receiving and student teaching could be replaced with conference attendance.
• ISVMA – Meetings with ISVMA and College reps have reinvigorated the desire for VM4 students to attend the annual meeting (typically a weekend in November).  The ASA office proposes that VM3 students in VM610 be assigned to rotations for clinic coverage as a mandatory laboratory.  This would take effect in 2020.  VM4 students attending ISVMA would need to request leave but would not be using personal days, nor would they have to make up the days missed. 
• Culture swabs – The VDL will no longer be providing the VTH with sample collection material for cultures.  These items will be stocked in the storeroom and can be purchased as ward stock.
  
  

3:00 Communications: Update and Issues 

The VTH has received RDVM feedback in survey form which indicates significant dissatisfaction in communication regarding referred patients.  Primarily, the complaints stem from our failure to notify that their client has brought the animal to the VTH, to provide patient status updates while the patient is hospitalized, to provide notification of discharge or death, and to provide discharge information in a timely manner. The VTH also receives many complaints from clients, as well as RDVM, who have not received post visit communications regarding pending test results and instructions.  Michelle Jaeger has been leading a task force to review processes and to make suggested solutions to address these communication shortcomings.  Working group summary provided by Michelle (see summary document):

The working group is comprised of faculty and technicians from several services including those that don’t have communication issues (Equine).

2 current policies address communication and records, haven’t been updated since 2010

Review of current processes: Client Services faxes RDVM upon patient’s arrival and when the patient dies.  This requires that the correct RDVM information is in the patient’s record when admitted. When a discharge report is finalized, there is a prompt to SEND the report to owner or RDVM.  This should be done by the person finalizing the report.  Every work day Medical Records runs a list of reports that have been finalized but not sent, and sends those to the RDVM by fax.  Medical Records sends faculty a report detailing the records assigned to them that have not been finalized.  Many faculty either miss this email or find that the report is inaccurate (records on the list have actually already been finalized).  Some faculty report that they wait on students/house officers to complete the discharge for days, then struggle to finalize everything.

A question was posed by board members regarding when RDVM want phone calls.  M. Jaeger stated that most want an admission update and a post discharge update.  Some want daily updates but she feels that most would be placated with basic communication regarding their case.

Ideas being considered by the working group:

• Abbreviated form to go home with owner.
• Remodeling the discharge template to streamline.
• Separating the discharge from the patient’s medical record document.
• Creation of ‘template’ verbiage for disease information to cut down on free-form rhetoric (Avoid 37 page discharge reports)

Further Discussion:

What is the point of the Discharge Report – owner info, ref vet info, student instruction.  First 2 are critical. Idea is that student should still be involved so that they learn complete and concise communication including content and vocabulary; what and how you say it. Concern raised that if students only write the client portion, they don’t learn the doctor conversation.

Discussion was had regarding sending an unverified record to RDVM – concern that sending a draft may contain misinformation.

The working group will continue to meet as they address these concerns.

OTHER HIS UPDATES – Lessons learned from a recent equine case:

Medical information regarding patient care/status, including images and emoji), sent between staff via text, email, or otherwise in written format (ie. Posts, tweets, snaps, etc.) is technically part of the medical record and should be recorded in the patient’s communication log. Because of the Client-Patient-Vet relationship, the medical record is not subject to Freedom of Information Act.  However, the information contained in the medical record is ‘owned’ by the client and they may request a copy at any time.  When a client is provided the complete medical record, they typically do not get the communication log as this legally represents clinician consultation and notes (opinion).  However, the communication log may be requested, and is certainly open for subpoena. Therefore, the medical record and communication logs must be complete and professional.

Informal ‘hallway’ comments shared by the above mentioned means between individuals not directly involved in a patient’s care are not part of the medical record, and are not subject to the Freedom of Information Act. 

It is imperative that phone conversations be recorded in the communication log. 

No clinician or staff should promise an owner financial restitution without Director involvement.  When warranted, these arrangements will occur but University Legal Counsel must be consulted.

Controlled Drugs: OmniCell, policies, compliance, responsiveness 

Dr. Lauren Forsythe (pharmacy) has been working to account for the Controlled Substances sold by the pharmacy and distributed to other services.  The list is extensive and includes product that has long been expired and is unaccounted for.  She has contacted the responsible parties to ascertain drug status but in some cases is having difficulty in getting timely responses.  Additionally, the process of AACUP maintaining the supply for FARMS ambulatory to use is non-sustainable.  Proposal: remove controlled drugs used by FARMS from AACUP.  Place necessary drugs in LA Omnicell.  Create controlled substance ambulatory inventory process.  AACUP may maintain their own supply under their veterinarian’s DEA license.  Provide FARMS with a controlled substance lock box to maintain controlled substances (BAM kits) not purchased from pharmacy.  Any responsible party in possession of controlled substance ward stock MUST respond to inventory inquiries from the pharmacist in a timely manner or they will lose prescribing privileges for these drugs.  ACTION: Board members accepted recommendations.  Board members approved Omnicell Countback process be implemented.