WLAVA:Enhanced Screening Tent LIP Orientation

Provider Start Guide

EST Provider Orientation Video

EST Provider Orientation #1

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EST Provider Orientation #2

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EST Provider Orientation #3

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EST Provider Orientation #4 (Q&A)

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EST Phone Extensions

• 310-478-3711
  • EST provider x53333 (310-268-3333)
  • RN Tent screener 1 x41034
  • RN Tent screener 2 x41035

Computer Setup

Windows Desktop Configuration

• Search (click on magnifying glass) for and load the following programs and 'pin' to your taskbar (right click over icon and select "pin to taskbar"):
  • Skype (to communicate with RNs in EST and other providers in VA)
  • CPRS
  • Outlook
  • Internet Explorer
  • Chrome
  • Impax

Search & Taskbar Set up

Printer Setup

• Search for "Printer" and select "Printer & scanners"

Print Search

• Select "Add a printer or scanner"

Add a Printer

• Select "The printer that I want isn't listed

Printer Not Listed

• Select "Stop" then type in GLA-PT186586 in "Name:" search bar and hit enter.
• Under "Search results:" select the Tent printer listed and click "OK"

Add Tent Printer GLA-186586

ED Sharepoint

• Contains VA extensions and UCLA/VA on-call pager numbers
• GLA VA ED Sharepoint
• Can copy and paste the URL if above link does not work
  • https://dvagov.sharepoint.com/sites/VHAGLAMed/ed/default.aspx GLA VA ED Sharepoint
  • Also found in CPRS -> Tools -> GLA/VA Links -> Other Links -> ED Sharepoint
  • Add to favorites

CPRS Setup

CPRS Configuration

• To configure an automated list of patients checked into EST:
  • Select "Clinics" in upper left hand, type in and select:
    • "WLA-Screening Tent"
  • Under "List Appointments for" select: "Today"
  • Click "Save Patient List Settings" & set it up for "All Days of Week" if you are working multiple days OR "Current Day Only" if working one day.

Appointment List Example

CPRS Notes Set Up

• To add notes to your home screen for easy access:
  • Toolbar click Tools -> Options -> Notes -> Document Titles.
  • Type in then ADD:
    • “Enhanced Screening Tent (EST) Provider Note”
    • “Employee Health Note”
• You can move this group of notes to TOP of your list using shift and “^” arrow

Note Favorites

EST Provider Template

• Mostly for use when starting an Employee Health Note since it does not provide a template.
  • File:EH Provider Note.pdf

CPRS Visit & Encounter

WLA Screening Tent Visit

• Please make sure you link your EST note to the correct encounter
  • The visit is "WLA-Screening Tent" or "STENT"

Selecting Correct Visit

EST Encounter

• When signing your note please complete the encounter information
• Click on Encounter bar on the bottom left of CPRS.

Encounter Tab

• • Make sure you are added as primary provider
  • Type of Visit "Emergency Dept Visit"
  • Section Name "Expanded Problem Focus Low"

Encounter Main Screen

• Must add a diagnosis
  • Can select from "Diagnosis Section" OR select "Other Diagnosis..."
  • If select "Other Diagnosis" open this link as the CPRS search engine for ICD10 codes is horrendous.
    • Best ICD10 Search Engine
  • Please make sure that the diagnosis you selected is the primary diagnosis

• Suggested ICD10 codes include (but not limited to):
  • Acute Upper Respiratory Infection, J06.9
  • Cough, R05
  • Viral Infection unspecified, B34.9
  • Fever unspecified, R50.9
• Coding COVID19 Encounters
  • For exposure to COVID19, or suspected COVID19 cases: Z20.828
    • If asymptomatic no other diagnosis code needed
    • If symptomatic, use appropriate diagnosis code above
  • For confirmed COVID19 cases: B97.29

Insert Encounter Diagnosis

Workflow

• Overview of Enhanced Screening Tent Operations:

WLA VA EST Overview

• General RN & provider workflow for Enhanced Screening Tent:

WLA COVID19 EST Workflow

Orders

• The order menu is located in the "WLA Outpatient Clinics" section of "Orders" tab

Order Menu

EST Order Menu

EST Orders

Discharge Medications

• Medications for discharged must be processed by EST Provider (not RN or LVN).
• See SOP for details (File:ER Triage Tent Outpatient Med Ordering and Dispensing SOP_v4 3.20.20.pdf)
• Please call Pharmacy at the end of the day to refill EST medication supply.
  • Please call Pharmacy to troubleshoot pharmacy-related issues:
    • Outpatient Pharmacy – ext. 48294
      • Monday through Friday: 8am – 7pm
      • Saturday: 8am – 4:30pm
    • Inpatient Pharmacy – ext. 53244
      • May be reached at any time outside of those listed for Outpatient Pharmacy
• Step-by-Step Process:
  • Order medication in CPRS from EST discharge medication menu
    

    EST DC Medication Menu
  • Find correct medication in cart and check that medication label AND overlay label match
    

    Pre-label Example
    

    Overlay Label Example
  • Fill out overlay label with patient name, your name, and date
  • Apply overlay label to medication bottle (do not cover product Lot and Expiration Number)
  • Use Prison-style tally marks to record dispensed medications in Ward Stock Request form inside of white binder located on top of discharge medication cart
  • Provide patient with medication information handout included in manila folder

Urgent Primary Care Follow-Up For Enhanced Screening Tent (EST)

• We are temporarily borrowing the ED PACT Tool in order to ensure urgent primary care f/u
• The ED-PACT Tool is an order that directly alerts PACT RN Care Managers to address urgent or specific needs of patients who are sent home from the ED.
  • It assures that patients post-ED follow-up care needs are addressed by bringing the PACT RN Care Manager into the communication loop.
  • The PACT RN Care Manager will work with the PACT Team to let (Primary Care Provider, LVN, Clerk) to address the Veteran’s care need(s).

How Does ED PACT Tool Work?

• The flow depends on if patient is assigned or unassigned

Assigned Patients

• Identify Patient’s PACT Team by looking at top banner in CPRS

PACT Team

• Providers enter a CPRS order indicating urgent or specific needs for post-EST follow-up care using link on EST order menu

ED-Pact Tool Order

• Choose PACT Clinic AND

PACT Clinic

• Then the Team

PACT Team Example

• Fill in and Sign Templated Order
  • Under reason for request:
    • Check “Seen in COVID- 19 Enhanced Screening Tent (EST)”
    • If you have clinical concern for potential COVID-19 (regardless of whether you sent test), check “Clinical concern for potential COVID-19”
    • Check other boxes to indicate follow-up care need

Order Template

Unassigned Patients

• For patients without a GLA PACT assignment, with urgent or specific needs, use link “No PACT assigned at any VA location/no local PACT at bottom of ED-PACT Tool Menu.
• This link will direct you to the Primary Care Consult Menu.
  • Select the clinic location closest to the Veteran’s residence.
  • Place the primary care consult AND add the points of contacts for each clinic (listed on the primary care consult menu) as additional signers on your EST note.

Unassigned Patients

Management Algorithms

Suggested Management Algorithm for Patients Presenting to EST

• Is patient ambulatory?
  • YES -> Go to next step
  • NO -> Go to ED
• Is patient obviously sick appearing (i.e., in severe pain, visibly tachypneic, somnolent, diaphoretic, etc.)?
  • YES -> Go to ED
  • NO -> Go to next step
• Check focused vital signs:
  • HR >110, SBP < 100, RR> 25 SaO2 < 94%
    • YES -> Send to ED with warm handoff
    • NO -> Go to next step
• Does patient have a fever AND...?
  • Fever alone is not a reason for ED evaluation if the patient is well appearing, is able to care for self and has no obvious finding suggestive of serious bacterial illness or SIRS criteria.
  • Does patient has a fever AND:
    • meets SIRS criteria or has acute/new significant dyspnea or has chest pain or is unable to care for self or has obvious signs of serious bacterial illness (abdominal pain, pyelo, cellulitis, etc).
      • YES -> Send to ED with warm handoff or consider ED consult
      • No --> go to next step
• Does patient meet "Wild Card" criteria?
  • Wild Card = Patient with a high-risk co-morbidity (Immunocompromised, Age > 75 years, significant lung or heart disease history, active malignancy)
    • YES -> consider ED consult
    • NO -> Go to Step 6
• Significant acute/new shortness of breath that affects activities of daily living?
  • No -> Treat empirically and discharge home with urgent f/u
  • Yes -> consider ED consult

Employee Health Algorithm

• We are testing symptomatic employees (and a select few asymptomatic) with a history of exposure to COVID19 for COVID19 if they are involved in direct patient care as it will guide our return to work instructions.
• Please provide all employees with EH handout at discharge.
  • If employee was tested for COVID-19 in EST they must be instructed to not go back to work until they are cleared by EH.
  • If employee was not tested for COVID-19, they must speak to EH and their supervisor to discuss sick leave and return to work timeline.
• Employee Health (x53522).

Employee COVID-19 Triage Algorithm

Last Updated: 4/16/20

Employee COVID-19 Triage

Employee Exposure Risk Determination Algorithm

Last Updated: 4/16/20

• Reviewing the exposure risk algorithm shows that this simple intervention keeps exposure risk low to medium.
  • Second layer of defense is ensuring that you wear a face mask (NOT N95).

Interim Guidance at GLA during regular staffing mode for ASYMPTOMATIC employees WITH PROLONGED CLOSE CONTACT with a COVID-19 patient

Supplementary Appendix

Employee Return to Work Guidance

Last Updated: 4/16/20

Return to Work Guidance for Staff with Direct Patient Contact

Educational Materials

• Medical Screening Exam (Sick vs Non-sick)
• File:Back Pain EST.pdf

Other WLA VA Pages

• WLAVA: COVID19 ED Operational Updates
• WLA VA PPE Main Information Page
• WLAVA: COVID-19 ED Airway Main
• WLAVA: Enhanced Screening Tent
• WLAVA:Enhanced Screening Tent Telehealth