Health Services Advisory Group

Posted on Dec 5, 2017 in Uncategorized | 0 comments

In-Patient Acute Stroke Guidelines: Physician Reference

Posted on Dec 5, 2017 in Uncategorized | 0 comments


Posted on Dec 5, 2017 in Uncategorized | 0 comments

Malnutrition is common in hospitalized patients but under recognized and undertreated.  Since patients with malnutrition are at increased risk for poor outcomes, including a 4-5-fold higher mortality rate, it’s worth learning how to recognize this condition.

Most physicians aren’t familiar with the diagnostic guidelines published by the American Academy of Nutrition and Dietetics (the Academy) and the American Society for

Parenteral and Enteral Nutrition (ASPEN).  Fortunately, the hospital registered dieticians (RDs) are a great resource for evaluating, verifying clinical indicators and assigning appropriate nutritional diagnoses and treatment plans for these patients.

If you suspect malnutrition (eg patients with weight loss, pressure ulcers, cancer or SNF residents), order a dietician consult.  And before saying that your patient is “well-nourished, well-developed”, pause to consider whether this description is accurate.  Proper nutritional assessment is actually quite complicated AND even obese patients can be malnourished.  For these reasons, it might be better if we use the description “well-developed” when appropriate but leave the nutritional assessment to the RDs.

In order for the diagnosis of malnutrition to be properly coded, the diagnosis and the degree of malnutrition (mild, moderate or severe) must be documented by the physician.

Make it a habit to read the RD notes (located under the “Care Team” tab in Notes section of EPIC) and if you agree with the diagnosis and treatment plan, document this in your note and discharge summary and monitor the condition during the hospitalization.

To avoid getting a query about malnutrition, read the RD notes and if you agree with the diagnosis and treatment plan, including degree of severity of malnutrition, document this in your note and discharge summary.   The diagnosis of malnutrition can impact both severity of illness (SOI) and risk of mortality (ROM) so remember to check the RD notes for help with recognizing malnutrition.

Beth Gong, MD–  CDI Physician Champion

Dr. Junaid Khan Provides Expert Commentary on New Hypertension Guidelines

Posted on Nov 15, 2017 in Uncategorized | 0 comments

Junaid Khan, M.D., Director of Cardiovascular Services at Alta Bates Summit Medical Center, provided expert commentary for a KTVU-2 story on new hypertension treatment guidelines released by the American Heart Association (AHA). High blood pressure, which for decades has been a top reading of at least 140 or a bottom one of 90, now drops to 130 over 80. This means 46 percent of U.S. adults or about 103 million people could now be diagnosed with hypertension. That’s up from 32 percent, or 72 million, under older guidelines.

The story aired on the KTVU News on Monday, Nov. 13. You can watch the clip here:


Pharmacy Update

Posted on Nov 6, 2017 in Uncategorized | 0 comments

Supplies and Maria

Status as of 10-31-17***

IV Fluids

Puerto Rico has a large concentration of U.S. Biotech, Pharmaceutical, & Medical Device manufacturers due to long standing tax incentives.

Hurricane Maria did significant damage to many of these manufacturing plants, including the company that supplies a large portion of the smaller volume IV fluid bags that we use at ABSMC for inpatients.

This has affected ABSMC’s ability to use our point-of-care medication delivery system – Baxter Mini-Bag Plus.  The Baxter Mini-Bag Plus system allows the vials of medication to be stored on the hospital unit in a Pyxis automatic dispensing machine.  Once there is an order, a nurse is able to retrieve the vial of medication from the Pyxis, attach the vial of drug to a 50 ml or 100 ml IV bag, mix them aseptically on the unit, and immediately administer to the patient.  This streamlines the distribution system and minimizes waste of medications prepared but not administered.

This shortage affects smaller volume IV Mini bag plus and regular bags, 250 ml bags, and 500 ml IV bags.

The medications themselves – primarily antibiotics – are not in shortage.

The shortage is estimated to last for some months.  The FDA is working with the various manufacturers on strategies such as importation of non-U.S. products.  This has not yet reached the U.S. market.

In response, the Pharmacy Department has implemented a number of strategies including using alternative dosing forms (e.g. premixes), if available.

Physicians may assist by using oral formulations of antibiotics and other medications as often as clinically appropriate.

Hydromorphone and Morphine Injection

These medications are in a serious shortage situation currently.  This is due to the recent merger of two large pharmaceutical companies, with subsequent interruptions in the supply.

In response, the Pharmacy Department is aggressively purchasing both morphine and hydromorphone.  Nurses and physicians may see alternative forms such as ampules and/or higher dose presentations such as morphine 10 mg/ml in order to keep our patients supplied with these agents.

These shortages are expected to last into mid – 2018.

Physicians may assist by using oral formulations of pain relievers (tablet/capsule or solution) as often as clinically appropriate.

***These situations do change daily.  A regular shortage report is presented at the Pharmacy & Therapeutics Committee Meeting each month.  Physicians and ABSMC staff are notified of urgent shortages between P&T Meetings as appropriate.

 Antimicrobial Stewardship

Antimicrobial Stewardship (AMS) has been around for a very long time.  More recently, the State of California enacted a statutory requirement for acute care hospitals to have an AMS program in place.  The Joint Commission (TJC) also has established a standard for AMS.

ABSMC has an established AMS Program with a multi-disciplinary AMS committee that reports to Medical Staff through both the Pharmacy & Therapeutics and the Infection Committees.

Recently ABSMC has hired an AMS Specialist Pharmacist, James Truong, who will be expanding the breadth and depth of the current program.  He will be working with physicians, nurses, and other health care professionals in order to optimize the antimicrobial use at ABSMC and help prevent adverse unintended effects of antimicrobial use such as C.difficile disease.

The first project that the AMS Team is working on is the development of a hospital IV to PO Program.  More information to follow!

Krista Bramble Pharm.D.
Alta Bates Summit Medical Center
Summit Pharmacy Manager
350 Hawthorne Ave
Oakland, CA  94609

510-869-8822 (ph)

What’s New at ABSMC –Risk Management and Patient Safety Introduces an Electronic Reporting of Unusual Occurrences

Posted on Sep 12, 2017 in Uncategorized | 0 comments

The Midas RDE (Remote Data Entry) Electronic Incident Reporting System has come to our ABSMC.  The Unusual Occurrence Forms (pink sheets) have gone away.

ABSMC has undergoing a system-wide implementation of MIDAS RDE. The Summit Campus is up and running as of March 1, 2017.  The Alta Bates Campus on April 3, 2017 and Herrick in May 2017.

Employees and physicians can access the system via the Intranet and enter and submit an incident in the Hospital Patient Safety Report portal.  The Risk Management Team and the EHR–liaisons are available to train physicians.  Look for us at your upcoming “Grand Rounds” and Specialty Department meetings.

For more information and assistance, please contact the Risk Department at (510) 204-6455.

Thank you for your support of this very exciting system implementation to promote patient safety and process improvement, and the overall patient’s experience at ABSMC.

The Risk Department,

Lois Wong, ABSMC Risk Officer, Cathy Werner, Risk Specialist; Fran Ohashi, Risk Specialist