APC+Update-+Includes+Resource+Nurse+protocol+for+labs,+UTIs,+etc.+July+2013

Hi, A few updates and good things to know from APC:

•**__Resource Nurses__**: This policy (4200) delineates how resource nurses respond to abnormal labs and how they treat 7 common infections when they receive positive test results. We are pleased to report that __resource nurses at all sites will soon be able to treat UTIs, including pregnant women and individuals over aged 55,__ who had been excluded in the previous version. __They will also be able to treat partners of individuals with Chlamydia and Trichomonas__.

•**__Linguistic Services__**: The current version of this policy requires providers to score a "low advanced" on an oral exam to be allowed to use a language with patients. It also does not allow patients the option of declining a professional interpreter. After much negotiation, __changes are in the works that would not restrict providers from using a language to the degree they are able__, using their judgement and patient preference to determine when they seek interpreter assistance. __There will also be a mechanism for patients to decline interpreters.__ These changes are consistent with what other organizations are doing, and with initiatives to respect and accommodate patient preference. The test? It will still determine your eligibility for the bilingual stipend.

•**__Health History Form__**: Remember the red line form that was given by registration annually to patients to record their current meds, issues and past med history? By popular demand, it will be brought back for new patients, and patients for their first post ccLink visit. Nurses are to enter meds, allergies and history from the form into ccLink, problem list editing is for the provider to do. Nurses will give the form to the provider who can review and then discard it. The forms will need to be printed, so it may be a while until you see them. There also is a Kaizen on rooming patients that is working on the best way to get this information, and hoping to go paperless with it eventually.

•**__Policy Look-up__**: Who knew you could look up ambulatory policy on iSite? Yes, you can. Best if you know the policy number or key words used. If not, (most of the time, perhaps) there is an "[|Ambulatory Care Policy Table of Contents]" that can be easily found on "advanced search" with the title keywords. This is a list of ambulatory policies by number, with direct links. 4000 ( nursing) and 6000 series (medical staff) are of the most interest.

•This is the last APC update from me as chair. I plan devote most of my reduced hours as a "retiree" to clinical work. We welcome Danya Parish who will take over as chair July 1. We look forward to her bridging this work with her existing work in Pediatric Quality Improvement and on the Health Home Improvement Team.

•Please direct your Ambulatory Policy issues (clinical issues spanning departments and services) to Dayna, or to any of the other committee members representing DFM regions and ambulatory departments:

Dayna Parish, Pediatrics and Chair Kalyani McCullough, Ambulatory Internal Medicine Judy Bliss, Ob-Gyn Ken Katzman, DFM Central David Hearst, DFM Far East Tai Roe, DFM Chair, and Near East Krista Farey, DFM West Howard Shaw, Midlevel Practice

Best, Krista Farey, MD, MS Ambulatory Policy Committee, Outgoing Chair

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