Dr Newsletter Q3 2019 - TI (Edited)

Physician Newsletter

September 2019

Message from YOUR CEO

Cris Rivera
CEO

“Above All Else, We Are Committed to the care and improvement of human life”

Review medical necessity for central lines, PICC lines, hemodialysis catheters and Foley catheters daily. Consider use of
midline catheter instead of a central or PICC line if the medication being infused is not an irritant to the vessel. Avoid
allowing a blood culture to be drawn from a central line or PICC. These longer dwelling lines develop an intra-luminal
biofilm, which is a primary source of CLABSI within the first week of catheterization.
We have a Nurse Driven Foley Removal Protocol which states an RN may remove a Foley catheter without a physician
order. C.Diff specimens: We have adopted evidence-based standards on types of stools that are appropriate for C.Diff
cultures. If the specimen does not meet the standard, it will be rejected. The purpose is to eliminate over culturing that
may result in reporting C.Diff colonization and not infection.
We have adopted evidence-based standards on types of stools that are appropriate for C.Diff cultures. If the specimen
does not meet the standard, it will be rejected. The purpose is to eliminate over culturing that
may result in reporting C.Diff colonization and not infection.

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Message from YOUR Chief of Staff

Ed Requenez, MD
Chief of Staff

“Above All Else, We Are Committed to the care and improvement of human life”

Review medical necessity for central lines, PICC lines, hemodialysis catheters and Foley catheters daily. Consider use of
midline catheter instead of a central or PICC line if the medication being infused is not an irritant to the vessel. Avoid
allowing a blood culture to be drawn from a central line or PICC. These longer dwelling lines develop an intra-luminal
biofilm, which is a primary source of CLABSI within the first week of catheterization.
We have a Nurse Driven Foley Removal Protocol which states an RN may remove a Foley catheter without a physician
order. C.Diff specimens: We have adopted evidence-based standards on types of stools that are appropriate for C.Diff
cultures. If the specimen does not meet the standard, it will be rejected. The purpose is to eliminate over culturing that
may result in reporting C.Diff colonization and not infection.
We have adopted evidence-based standards on types of stools that are appropriate for C.Diff cultures. If the specimen
does not meet the standard, it will be rejected. The purpose is to eliminate over culturing that
may result in reporting C.Diff colonization and not infection.

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Message from YOUR Medical Staff Office

Yolanda Cavazos, MBA

Medical Staff Office

Numbers to Know ext. *16172
Yolanda Cavazos, Director ext. *16169
Nelda Pena,

Welcome to New Physicians

Kevin McMahon, MD Frank Velez, MD David Alonzo, MD Cruz Bernal, MD Megan Lyle, MD Rolando Rios, MD Rolando Diaz, MD

Neurology General Surgery Urology Family Medicine Pedi Hema/Oncology Emergency Medicine Emergency Medicine

Physicians No Longer on Staff

Alvaro Giraldo, MD (IM)

Edgar Cruz, MD (Surgery)

Mahdi Rostamizadeh, MD (Ophthalmology)

Viraf Cooper, MD (Neurosurgery)

Milagros Martinez, MD (IM)

Bao Quang Christopher Sankaman Timothy J. Seipel, MD Elizabeth
Praisoody, MD
Pham, MD Litchfield, MD Radiology Radiology Birkenfeld, MD

Emergency Medicine Emergency Medicine Radiology

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Message from YOUR Quality Department

Nancy Reeder

Quality Department

Numbers to Know

Nancy Reeder, Vice President Quality ext. *16464

Pama Ellis, Quality Manager ext. *16129

Alfred Mascorro, Quality Compliance ext. *13137

Anna De La Cruz, Infection Prevention ext. *16195

Gladis Amaya, Infection Control ext. *13098

Good Practice REMINDERS & REQUESTS

Dept. of Surgery & Proceduralists:
• All invasive procedures must start with a formal Time-Out
• Correct count(s) are a must prior to final skin closure.
• Never use items such as blue towels in a body cavity – all soft goods must have a radiopaque strip/thread or RFID marking
• Post-procedure note is required prior to leaving the surgical area.
• Operative reports must be completed within 24 hrs. of the procedure

PREVENTION OF Hospital-Acquired Infections (HAI’s)
• Review medical necessity for central lines, PICC lines, hemodialysis catheters and Foley catheters daily.
• Consider use of midline catheter instead of a central or PICC line if the medication being infused is not an irritant to the vessel.
• Avoid allowing a blood culture to be drawn from a central line or PICC. These longer dwelling lines develop an intra-luminal

biofilm,
which is a primary source of CLABSI within the first week of catheterization.
• We have a Nurse Driven Foley Removal Protocol which states an RN may remove a Foley catheter without a physician order.
• C.Diff specimens: We have adopted evidence-based standards on types of stools that are appropriate for C.Diff cultures. If the
specimen does not meet the standard, it will be rejected. The purpose is to eliminate over culturing that may result in
reporting C.Diff colonization and not infection.

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Message from YOUR Pharmacy Department

Isidro Ramirez, Pharm. D.

Pharmacy Department

Numbers to Know ext. *16172
Isidro Ramirez, Director ext. *16169
Pharmacy Department ext. *16151
Yvette Garcia, Clinical Manager

Pharmacy Department intranet page: (Accessable from any hospital based computer)
https://divisions.hca.corpad.net/gcd/rgrh/Pharmacy/_layouts/15/start.aspx#/SitePages/Home.aspx

Here you can find valuable information from the Pharmacy Department including:

• Hospital Antibiogram • Periodic information on Drug Shortages

• Empiric Therapy Guidelines • Duration of Therapy Guidelines

• Duration of Therapy Guidelines • List and rationale for Restricted Anti-Infectives

• Opioid Allergy Management Guidelines

• Antimicrobial Management Program folder with access to Quarterly Antimicrobial Management Newsletter

The Pharmacy & Therapeutics (P&T) Committee and the Antimicrobial Management Program (AMP) Committee which is

currently chaired by Dr. Ricardo Garcia (Infectious Disease) representing the Department of Medicine.
• You are encouraged to attend and participate in either committee.
• The role of P&T is to optimize the medication utilization process to provide safe and effective therapeutic outcomes

from the medications used here at Rio Grande Regional Hospital.
• AMP is charged with the specific task of monitoring and managing the safe and appropriate use of antimicrobial agents

at Rio Grande Regional Hospital.

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Message from YOUR Advanced Clinicals Department

Theresa Escobar, MSN

Advanced Clinicals

Numbers to Know

Theresa Escobar, ext. *16464

Pama Ellis, Quality Manager ext. *16129

Alfred Mascorro, Quality Compliance ext. *13137

Anna De La Cruz, Infection Prevention ext. *16195

Gladis Amaya, Infection Control ext. *13098

Good Practice REMINDERS & REQUESTS

LIVE date for 2019.1 EHR Maintenance Release for provider documentation and provider ordering for Inpatient and ED:

INPATIENT PDoc
• General Updates for: Interventional Radiology, Neurology, OBGYN, Pharmacy, Well Baby/Neonatology

• This release added review of shock index documentation to the sepsis reassessment

ED PDoc
• Updates to Cardiology documentation and TPA administration.
• Added Cardiopulmonary Resuscitation procedure and new Fecal Impaction procedure.

INPATIENT Order Entry
• Orderables included in this release are:

ED Trauma Hip Alert
Indwelling Catheter/Foley
Opioids/ Multi-Model Pain Management

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Message from YOUR IT&S Department

Carlos Leal

IT&S

Numbers to Know

Carlos Leal, Director ext. *16464

Pama Ellis, Quality Manager ext. *16129

Alfred Mascorro, Quality Compliance ext. *13137

Anna De La Cruz, Infection Prevention ext. *16195

Gladis Amaya, Infection Control ext. *13098

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