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Duke Outpatient Clinic Newsletter - March 2021
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The latest news from the Duke Outpatient Clinic
NEW AT THE DOC
COMMEMORATING THE COVID ANNIVERSARY & THANKING EVERYONE
"Thank You" - for a year like no other
by Frances Rogers

​​​​​Throughout a year that we could have never predicted, our world has been turned upside down. Everything in our lives has changed, and that has been especially true for healthcare.

Duke Health leaders are proud of the incredible work our team members have done to shape our response to the COVID-19 pandemic over the past year. Despite the challenges in your work and personal lives, you have continued to ensure quality care for our patients, and you've supported each other like never before.

Your resilience, your kindness, your bravery and your amazing teamwork have made such a difference in the lives of so many. Once again, "Thank You" for all that you do!
45-PORTRAIT COVID ART EXHIBIT  
Lynn Bowlby and Julia Gamble were both nominated to be painted for this unique art installation!  READ FULL STORY
CONGRATS LAURIE FOR ACHIEVING CCM

HomeBASE Plus Ambulatory Case Manager Laurie Germino passed her Case Management Certification exam, and is now Laurie Germino, RN, BSN, CCM!

CELEBRATING CERTIFIED NURSES DAY
March 19 shines a well-deserved spotlight on nurses who have chosen to enhance their professional knowledge through formal certification. There are over 3.8 million nurses in America today.

Congratulations to Amber Walters, RN CMSRN, who has maintained her certification for over 10 years as a Certified Medical Surgical Registered Nurse!

NEED SOCIAL WORK (a.k.a. JAN AND ELISSA)?

How to Refer: It's now as easy as 1-2

1) Your first choice (and never the wrong answer) is to find Jan Dillard, LCSW or Elissa Nickolopolous, MSW in the back hallway on the Lavender side. Or use Secure Chat in Epic (speech balloon in upper left corner) to ping them.

2) If a patient has been coming to the DOC for a while, and especially if  dealing w/ a chronic issue, type "LCSW" in the Search box in the patient's chart and it should pull up prior Social Work notes, so you can double-check if the issue has been addressed previously (maybe even last visit).

Note: The EComm DOC Social Work that was in use earlier in the pandemic is now being discontinued.
WOUND CARE PERFORMANCE IMPROVEMENT AT DOC
Thanks to DOC Wound Care champion Susie Walker, RN for compiling these helpful resources, including what materials would be recommended for different types of wounds. Remember nursing orders can be entered for wound care in the clinic and nursing visits scheduled for leg wraps and dressing changes. Thanks, Susie!
DOC CHAPLAINCY WORK RECOGNIZED 
Congrats to DOC Resident Alyssa Stavig for her first-author publication in JGIM -- and to DOC co-authors Lynn Bowlby, Katherine Henderson, Jan Dillard, Elissa Nickolopoulos, and Patrick Hemming. View full article here. Their work was also presented at this year's national Conference on Medicine and Religion! 
OPTIONS FOR FINDING (AND GETTING) A COVID VACCINE

Thanks to Holly Canupp et al. for creating and adding to dot-phrase summarizing all these options, below (.DOCCOVIDVACCINEINFO):

Free shared rides to and from COVID-19 vaccination sites are available for people with appointments. Please call at least 24 hours in advance to schedule the ride.
•    GoTriangle: 919-485-7582
•    GoDurham: 919-560-1551
•    Go Wake: 919-212-7005

1. Call the Duke Covid Hotline: 919-385-0429
- Si habla español, indíquelo eligiendo la opción 2
- Then listen through the prompts and select option 2 to schedule vaccine
- If there is an opening, you can be scheduled; if not, ask to be added to the waitlist
- Or you can go here to be added to the wait list here 

2. Go to vaccinefinder.org:
- Select "Find Covid-19 Vaccines"
- Enter zipcode  (a list of locations will appear along with if the vaccine is "in stock")
- Select a location
- Then select "check appointment availability"

3. You can also schedule with the Durham County Public Health Department:
-To schedule an appointment, sign up for our scheduling list in English and in Spanish, and they will call to set up an appointment as soon as possible. Durham County Public Health Website (accessed 3/12/2021) 

4. OptumSERV (the state of NC has partnered with them to give vaccines, do testing):
- Call 877-505-6723
- Make sure you say you want to schedule a COVID vaccine
- Note: Their registration process is probably the most involved

5. Local Walgreen's pharmacies:
- Either call around, or click here to register online (Note: Patients going online will have to create a walgreens.com account)

6. Southpoint Pharmacy:
- 6216 Fayetteville Rd, Suite 105, Durham NC 27713; 919-908-0200
- A great local independent pharmacy that has held community vaccination events; signing up for vaccine appointment is EZ on their website
MORE QUALIFY FOR NC MEDASSIST
NC MedAssist, the program providing free prescription drugs to uninsured North Carolinians, has increased the income threshold to at or below 300% of the Federal Poverty Limit! See Jan Dillard or Elissa Nickolopolous to refer patients/for info.
 
As a reminder, eligible patients must:
  • Live in North Carolina
  • Have no health insurance
  • Demonstrate income at/below 300% FPL
DOC MARCH EQUITY EXERCISE
View this month's DOC Equity Exercise by clicking here.  Thanks to Dani Zipkin and Gloria Manley for organizing!
DOC DREAMS 3 SURVEY LIVE; CLOSES APR 5
Have your say! In advance of Apr 9 kick-off retreat w/ representatives from across the clinic, a survey has been sent out to get your ideas for the priority areas highlighted in this cycle:
  • Clinic Operations: Paperwork, Diabetes Care
  • Population Health: Understand Cmty Resources, Improve ACP
  • Education: Standardize SAR/Intern Transitions
Click here for link to survey, which closes Mon, Apr 5 at 5p.
ONE CALL DOES IT ALL!  919-660-6965
There is now a single, centralized phone number to reach the DOC Front Desk: 919-660-6965.  It rings to all 3 Front Desk phones, both Financial Care phones, and Service Access Team Lead's Heather Beau.  The idea is to give you only 1 direct number to remember, to get an urgent scheduling issue addressed.  Thanks again, Heather!
Quick Jump to a Section: 
SOCIAL NEEDS

INSURANCE EXCHANGE OPEN THRU 5/15
The Health Insurance Marketplace® for free or subsidized ACA plans is now open for a Special Enrollment Period in NC and the other 35 states that use the HealthCare.gov platform, through Sat, May 15. LEARN MORE HERE

At schools, neighborhood sites, even available for home delivery! Link to flyer here.  
HELP HAS MOVED!  ♿
HELP (Health Equipment Loan Program) is now our neighbor!  That means we (and our patients) are so much closer to rolling walkers, canes, bedside commodes, and so much more!  HELP was founded by retired Duke RN Anne Drennan and Duke complex case manager Gaye Weaver and now calls Project Access of Durham County home.
Click here to view their flyer for more information
DUKE LAW LEGAL RESOURCE FOR PATIENTS
Seeing a needy patient facing a challenging legal situation (unsafe housing, denied Social Security disability, or other denied/terminated benefits s/he should be eligible for)? A Duke Law School clinic may be able to provide assistance or identify community resources that can help. DOC Resident Yolanda Guzman was able to help a primary care patient win an appeal of a Social Security disability denial for a rare derm condition.  For referrals, just send an email to both Allison Rice and Hannah Demeritt: rice@law.duke.edudemeritt@law.duke.edu
SPECIALTY CARE
NEED DOC PSYCH?  Just a friendly reminder to first put in an 'ECommunication DOC Behavioral Health' for scheduling. (Just type in "ecomm," and a list should pop up; if not there, click Facility tab). Does not take the place of real-time assessment needed for active SI/HI/psychosis, by DOC Team Social Work (Jan Dillard, Elissa Nickolopolous) or Greg Brown.
COVID-19 and SCREENING MAMMOGRAMS
IMPROVING CRC SCREENING RATES
Thanks to Resident Melanie Cabezas for leading effort to improve colorectal cancer (CRC) screening rates at the DOC! Click here to view algorithm, and this link for educational deck. One barrier can be Duke instructions that ask patients to pay out-of-pocket for mail-order prep, which we can prescribe instead! See links to Miralax and Golytely preps. 
Pro tip: Cologuard can now be ordered in Maestro.
COVID
VACCINE HOW-TO'S + MYTHBUSTING
Thanks to DOC Resident Lonnie Sullivan for coming up with bulleted facts about COVID vaccination; use .DOCCOVIDVACCFACTS to place in AVS. And again, thanks to Holly et al. for dot-phrase summarizing diy options for how to find vaccine; use .DOCCOVIDVACCINEINFO.   
DUKE COVID TESTING SITE CHANGES
Due to a decrease in volume, the Duke GC lot and Arringdon COVID test locations have closed. Testing will still be done at the Willard Street location (near Durham Bulls Stadium) and at Duke Raleigh. Willard Street will be operating on revised hours: Mon-Fri 7a-3:45p and Sat/Sun 8a-4:45p. If patients need testing, a future order should be placed, and they should call the COVID Hotline at 919-385-0429.
FREE CMTY COVID TESTING SITES
Walk-up drive-thru testing continues to also be available at multiple sites around Durham (click HERE for info).  Testing at Holton Resource Center ended Feb 25.
SUPPORT FOR NEEDS FROM INCOME LOSS DUE TO COVID 
Including food/shelter/$ for bills/transport/supplies from loss of income. Do not have to have had COVID. For Durham, Granville, Vance counties. Link to flyer here.
DUKE COVID REFERRALS FOR PATIENTS
  • Covid Testing - Place FUTURE order for Coronavirus Outpatient PCR (Symptomatic) or (Asymptomatic); patient calls 919-385-0429 to schedule
  • Antibody Infusion - Ambulatory Referral to COVID Infusion (criteria in order)
  • Financial/Food support - Ambulatory Referral to COVID Social Support
  • Scheduling Vaccinations for eligible patients - Send names of definitely interested 65+ patients to Heather Beau via In Basket, and be on lookout for messages about same-day/weekend availability.
LATEST COVID-19 GUIDANCE
click the hyperlinks below for updates
TELEHEALTH
NEED VIDEO INTERPRETER
The DOC has ordered an iPad in case a patient arrives without an interpreter, and needs video interpretation (e.g., American Sign Language). A laminated copy has been placed at each pin station. Click image to view bigger
EZ DOC VIDEO VISIT GUIDANCE
Scheduled for a Video Visit?  Now easier!
 
  1. BEST PRACTICE: If behind, call patient to let them know approx. when to expect you
  2. Open Video Visit encounter in your schedule
  3. Push Zoom button; if patient is in the Waiting Room, Admit them and conduct Video Visit
  4. If patient is not there, go to Doximity (on device of choice, e.g., own smartphone)
  5. Type in patient's mobile number from chart
  6. Check that clinic # (919) 471-8344 will display
  7. Click Video Call, which will send patient video link; you will be notified when patient joins
  8. Use Call Nudge feature to call patient to tell them you just sent them link to do the visit.(Remind them to "Allow" both camera and microphone so you can see and hear them.)
  9. Conduct Video Visit
  10. Only if patient can't do this (can't find messages, doesn't know how to operate phone), then can do phone visit instead. (Also be sure to let Front Desk know at (919) 660-6965 to change the visit to Telephone.)
Also click link for quick guide on doing Video Visits in clinic, courtesy of Dani Zipkin.
DOC BEST PRACTICE TIPS
Need help expediting a specialty clinic referral for a DOC patient outside of clinic?  Message Gloria Manley for last names A-L; Diane Bullock for M-Z.
NEW SLEEP TESTING ORDER PANEL 
New sleep study order makes it easier to order testing for OSA.  Pro tip: Don't forget to order BOTH diagnostic AND CPAP titration so both can be done in the same session.
NEXT-DAY OUTPATIENT TRANSFUSIONS
  • Tywana Donaldson, NP: 919-681-2933
  • Infusion Center Number: 919-681-0645
Check out this PowerPoint presentation for tips on how to place orders for referrals to Duke Specialty Infusion Center/2A.
ORDERED A TEST FOR A PATIENT AND IT DIDN'T GET SCHEDULED?

Many (and even some referrals) do NOT have scheduling hubs that will contact patients.  They may have to be scheduled by the Front Desk, or patients may have to call themselves.  Be sure to tell ALL patients to stop by the Front Desk on check-out to get accurate instructions on how to schedule (and get their next appointment, too). 
ORDER LIKE A BOSS
When entering orders, take special care to specify in what timeframe it is needed (always FUTURE for labs outside of a regular clinic appointment, but also same-day, routine, etc. for radiology).  Also, when ordering imaging, leave the location blank (unless there is clear preference/need) so that it can be scheduled at any location.
WALK-IN LABS
Please also remind patients that when they walk in to get labs drawn, to still check in at the Front Desk!
SMART MEDICAID PRESCRIBING
A few tips from Larry Greenblatt:
  • The NC Medicaid Preferred Drug List changes.  Always google “NC Medicaid PDL” to get the latest.
  • Medicaid patients can be prescribed 90 days for same copay as 30 days ($3 brand or generic)!  Save money, time, gas, COVID exposures and go for 90!  Now available for all meds except opioids and benzos from the very 1st prescription (during COVID; after COVID, 30 days to start, then next can be 90 days.)
  • Medicaid will pay for vehicle or mail delivery.  Some pharmacies are now doing this, mainly independents (e.g., Gurley's, Josef's); they can also do pre-packaged med boxes/pill packs.
  • Medicaid is still also paying for automatic BP cuffs, scales, and pulse oximeters.  Ask your attending for details.
DOC TOOLBOX
Want more great tips? Thanks to Holly Canupp for reoganizing the DOC Toolbox! Check out the resources in there with the QR code or this link.
MAESTRO TIPS
CLOSING THE LOOP ON CALLS

Get a Patient Calls/Internal Comm message in your In Basket? Use "Encounter" activity to open it directly (instead of creating a new Orders Only): 

Also, be sure to route these back to sender once action is taken, to close the loop. Copy "P Duke Outpatient Clinic Front Desk" for scheduling.
COLOGUARD ORDER IN MAESTRO

Cologuard tests can now be ordered and resulted in Maestro. Results will automatically be pulled into Health Maintenance, too!
LIKE SEEING YOUR OWN PATIENTS?
Use the "For:" field exclusively for scheduling return to PCP (hopefully yourself), and SKIP that useless "Return in:" box. Write in: "<reason for return> in <x> to <y> months with PCP Dr. ____ (or Julia/Val)."  Pro tip: Build in speed buttons; see Dani Zipkin to show you how!  Remember, only YOU can prevent medical homelessness.
WANT AN EZ BUTTON? ADD DOC FLOORSTOCK TO YOUR PREFS
Want an easy way to order meds in clinic? From Epic menu, go to Tools/Patient Care Tools/ Pref List Composer; then at bottom click 'Copy User,' type in Holly Canupp and find 'Clinic-Administered Medication.' Here is a link. Then when ordering, click circles ("tadpoles") by order box and your pref lists will open, including this one. Thanks, Holly!
Pro tip: Add 'Immunizations' while you are at it.
Click here to view list of previous practice tips
MORE MAESTRO TIPS
Coding right dx for labs for Medicare

Making EZ patient insulin instructions

Reprinting DME orders
Have a Maestro question?  Contact donna.myers@ duke.edu &/or (919) 660.0962
GOT NEWS? 
Have an item for next month?
SHARE NEWS HERE
HOW TO UDS
Not sure what to order?
See tips from Holly
VIEW DOCUMENT

Interpreting UDS?
More tips! 
VIEW DOCUMENT
Newsletter Archive
DOC RESOURCE DOCUMENT LIBRARY
COMMONLY USED SMART LINKS
DOC PHONE LIST
PRACTICE PARTNERSHIPS
STAFF PHOTO LIST
RESIDENT PCP TRANSITIONS
DOC HEP C WORKUP FORM
DOC DIABETES ALGORITHM
HOW TO AMION
Geriatric Patient: Cognitive Impairment
DOC SERVICES
IMAGING DECISION SUPPORT
DUKE IMAGE VIEWER
DOC PRACTICE TIPS
THRIVE GUIDE
SUBSCRIBE
INTERNS, PRELIMS + MED PSYCH 2020-21
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