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August 2017

John Stoddard Cancer Center has been re-accredited for Breast

Cancer Care in Central Iowa

UnityPoint Health – John Stoddard Cancer Center has received re-accreditation by the National Accreditation Program

for Breast Centers (NAPBC), a program administered by the American College of Surgeons.

This accreditation ensures that patients with breast cancer have access to:

The most comprehensive care and state-of-the-art services available

Individualized treatment plans coordinated across multiple specialties

Information about ongoing clinical trials and new treatment options

Top-quality breast care close to home.

John Stoddard Cancer Center and The Iowa Clinic Women’s Center collected and measured data of the care they are

providing for their patients. With that information the Breast Program Leadership team was able to quantify the

number of breast cancer patients who received each type of therapy, the efficiency with which treatments were

administered, patient outcomes, and more. This was followed by a rigorous on-site review by the NAPBC of center

leadership, clinical management, research, community outreach, professional education, and quality improvement.

Each year Stoddard Cancer Center treats 1600 patients, 300 of them are breast cancer patients. For more information

visit: www.johnstoddardcancer.org .

Update on Restraints: Physical hold orders, Conducting a one-hour

face-to-face evaluation and PRN orders

In late June and early July, DNV completed our annual hospital surveys. Subsequently, we had findings regarding the

use of restraints. There is now an order available in EPIC for physical holds. A physical hold is holding a patient in a

manner that restricts their movement against the patient’s will. This is considered a violent restraint and includes;

Medication Hold- holding a patient for a medication administration against their will. Therapeutic escort - moving a patient from one location to another against their will.

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A licensed independent practitioner will conduct a face-to-face evaluation of the patient within one hours of initiation

of restraint incident. The purpose of the face-to-face evaluation is to

Observe and review with staff the immediate medical and behavioral condition of the patient Evaluate the patient’s reaction to the intervention Determine whether restraint or seclusion should be continued Work with the patient and staff to identify ways to help the patient regain control Make any necessary revision to the treatment plan Supply an additional order if necessary.

The one-hour face-to-face evaluation includes both a physical and behavioral assessment of the patient that must be

conducted by a qualified practitioner within the scope of their practice.

An evaluation of the patient’s medical condition would include a complete review of systems assessment, behavioral assessment, review and assessment of the patient’s history, drugs and medications, most recent lab results, etc.

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The purpose is to complete a comprehensive review of the patient’s condition to determine if other factors, such as drug or medication interactions, electrolyte imbalances, hypoxia, sepsis, etc., are contributing to the patient’s violent or self-destructive behavior.

If a patient’s violent or self-destructive behavior resolves and the restraint or seclusion intervention is discontinued

before the practitioner conducts the one hour, face-to-face evaluation, the practitioner is still required to see the

patient face-to-face and conduct the evaluation within one hour after the initiation of this intervention.

How to Document a One Hour Face To Face Evaluation

Select a new note

Search smart text for Restraint

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Additionally, we had findings related to PRN orders. Reminder we CANNOT have PRN orders for restraints. We have

submitted an enhancement request to EPIC to remove the ability to order restraints directly from the Mechanical

Ventilation order set. The two findings were related to this order sets and ordering restraints when the patient did not

have a need.

HCAHPS and Providers – Courtesy and Respect

Review from July’s issue of Provider Focus: In order to measure inpatient patient satisfaction, UnityPoint Health – Des Moines utilizes a survey tool called HCAHPS. The HCAHPS rating scale is a 4-point scale including “Never”, “Sometimes”, “Usually” or “Always” and the only response that counts towards the score (top-box score) is “Always”. There are 32 questions on the HCAHPS survey that fall into the following domains:

Communication with Nurses Discharge Information

Communcation with Doctors Hospital Environment

Staff Responsiveness Care Transitions

Pain Management Overall Rating of Hospital

Communication about Medicines Discharge Information

Select IHS RESTRAINT NOTE

5 The following three questions roll up into the Communication with Doctors domain:

1. During this hospital stay, how often did doctors listen carefully to you? 2. During this hospital stay, how often did doctors treat you with courtesy and respect? 3. During this hospital stay, how often did doctors explain things in a way you could understand?

In July’s issue, we review the definition and suggested improvement solutions for “During this hospital stay, how often did doctors listen carefully to you?” For August, we will focus on the next question regarding courtesy and respect.

2. During this hospital stay, how often did doctors treat you with courtesy and respect?

Question definition: Respect and courtesy are similar and both tied to explicit behaviors. The degree to which a physician’s interaction with a patient is considered courteous indicates respect towards the patient. Friendliness is judged according to the physician’s verbal and nonverbal behavior. Patients tend to respond negatively to physicians who do not make eye contact, who do not respect their privacy or who use a familiar name without permission. It is also important to convey a sense of caring for each patient. By treating each person as a fellow human, rather than simply a patient or diagnosis, doctors can make patients feel respected. Improvement Solutions: The following improvement solutions are based on evidence-based research and best practices. If used consistently and effectively, these solutions will help ensure patients “always” perceive that providers are treat them with courtesy and respect.

Knock before entering the patient’s room. While the patient is in the hospital, this is his/her “home”. Just as you would if you were visiting someone’s house, it’s important to knock before entering the room. This shows your respect for the patient’s space and announces your presence.

Use AIDET. As a review, AIDET stands for o Acknowledge (i.e. knock before entering, make eye contact with everyone in the room, greet the

patient and anyone else in the room warmly) o Introduce (i.e. name, role on the care team, shake hands with patient and visitors) o Duration (explain how when the patient can expect next steps to happen, prepare them for realistic

discharge time and expectations) o Explain (using plain language that the patient and visitor can understand, explain what the patient can

expect, why we’re doing what we’re doing and when certain steps will be done. Always end with “what questions or concerns do you have for me?”)

o Thank you (i.e. show appreciation to your patient and visitor)

Sit at the bedside. This shows patients and visitors that you have time to talk to them and they are your sole focus in that moment. Patients can quickly feel disrespected if they perceive that their physician does not have time for them.

Allow patients to speak without interrupting them. As natural problem solvers, providers tend to interrupt with a solution before patients have had time to finish expressing their thoughts or concerns. Rather than jumping in while the patient is still talking, allow the patient to express his/her concerns and anxiety. Then respond with empathy to demonstrate that you care for the patient as a whole and not solely a diagnosis.

Manage up other care team members, the organization and the patient themselves. This shows teamwork and your respect for the care team.

Ask patients and visitors/family members “Is there anything else I can do for you?” before leaving the room. Again, this demonstrates caring for the patient as a whole person.

If you are interested in reviewing your individual or group/specialty inpatient patient experience results, please contact Paige Moore, UPH-DM Director of Patient Experience, at paige.moore@unitypoint.org or 515-241-3473.

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Pediatric Respiratory Isolation Algorithm

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Iowa Lutheran Hospital: Mammography Update

Effective 1-August-17, the ILH Mammography Department will follow the Standard of Care, regarding the use of 3D

technology. We will no longer be offering choice of 2D imaging, to our patients. The evidence supports the use of 3D

tomography exams.

All screening and diagnostic imaging will include 3D tomographic imaging. In many cases this change will require the

ordering Providers to change their order sets to match the new imaging standard.

Insurance companies have been paying for the 3D tomographic imaging, since the first of the year. We’ll not be asking

the patient to sign an ABN.

Below is the updated listing for the new imaging process:

Description (NEW CHARGES)

IMG4151 MM 3D MAMM BILAT DIAG W CAD

IMG4153 MM 3D MAMM BILAT DIAG WO CAD

IMG4149 MM 3D MAMM BILAT SCREENING W CAD

IMG4152 MM 3D MAMM UNILAT DIAG W CAD

IMG4154 MM 3D MAMM UNILAT DIAG WO CAD

IMG4150 MM 3D MAMM UNILAT SCREENING W CAD

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Des Moines Orthopaedic Surgeons (DMOS)

DMOS Orthopeadic Centers is proud to announce their new location at 350 N. 36th Street, Ankeny. The comprehensive orthopaedic center houses four dedicated orthopeadic surgeons focused on caring for Ankeny and the surrounding community. Their surgeons will see newborns to geriatrics and they cover sports medicine, general orthopedics, hip, knee, foot, ankle, hand and upper extremity specialties.

Their four orthopaedic physicians include two names familiar to Ankeny, as they move from the UnityPoint Health Prairie Trail location, along with two physicians who’ve made the move from our DMOS East location in Des Moines.

Paul D. Butler, M.D. Foot & Ankle Surgeon Provider profile: https://dmos.com/profile/paul-d-butler-md/

Iowa native, Dr. Paul D. Butler completed an orthopaedic foot and ankle surgery fellowship with the Orthopaedic Associates of Michigan, in Grand Rapids, MI. His interest and specialty training in complex foot and ankle reconstruction includes sports injuries, ankle instability, traumatic fracture, arthritic degeneration, tendon problems, bunion and bunionette correction, Achilles inflammation/rupture, hammer/claw toes, and congenital malformation.Foot and ankle pain/injuries are commonly associated with other orthopaedic lower extremity dysfunction, thus as a lower extremity specialist, Dr. Butler also provides arthroscopy, joint replacement, and fracture fixation options for other lower extremity problems. Dr. Butler has been the recipient of many awards and accolades. His research has been published in several professional publications and he also serves as a manuscript reviewer for American Journal of Sports Medicine and Foot and Ankle Clinics of North America.

Andrew J. Taiber, M.D. Hand & Upper Extremity Provider profile: https://dmos.com/profile/andrew-j-taiber-md/ The world of orthopaedic medicine is ever-changing and it’s important for Dr. Andrew J. Taiber to always be prepared and keep up-to-date with new findings and innovative research. And that’s exactly what he’s been doing since receiving his doctor of medicine from the University of Iowa and throughout his residency at University of Nebraska Medical Center and continued Fellowship Training at Vanderbilt Medical Center. His specialties include post-traumatic reconstruction of the upper extremity, treatment of arthritic conditions of the hand, wrist and elbow, compressive neuropathies of the upper extremity (including carpal tunnel and cubital tunnel syndromes), wrist arthroscopy and sports-related injuries.

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Joseph Brunkhorst, D.O. Sports Medicine and Knee, Hip & Shoulder Surgeon Provider profile: https://dmos.com/profile/joseph-brunkhorst-do/ Iowa native Joseph Brunkhorst, D.O. completed fellowship training in sports medicine and arthroscopy at the University of Kentucky in Lexington, Kentucky.. Prior to joining DMOS Orthopaedic Surgeons in 2015, he also served as a Captain in the U.S. Army. Dr. Brunkhorst specializes in shoulder and knee arthroscopy, knee ligament reconstruction, shoulder arthroplasty – including reverse total shoulder arthroplasty, cartilage restoration procedures – to include the new MACI and joint injections. Dr. Brunkhorst also has an interest in hip arthroscopy and enjoys helping patients with new, advanced hip procedures. Dr. Brunkhorst also manages the care of sports-related injuries and conditions, as well as workers’ compensation cases. He is committed to continuing education and research, so he is able to offer the most advanced and state-of-the-art treatments to his patients.

Mark Isaacson, D.O. Joint Replacement and General Orthopaedics Provider profile: https://dmos.com/profile/mark-isaacson-do/ An Iowa native, Mark Isaacson, D.O., joined Des Moines Orthopaedic Surgeons in 2015. Dr. Isaacson completed fellowship training in adult reconstruction at Houston Methodist Hospital at Texas Medical Center in Houston, Texas. He specializes in total knee and hip arthroplasty, complex revision knee and hip arthroplasty, minimally invasive direct anterior hip replacement, knee and shoulder arthroscopy, adult and pediatric fracture care, partial knee arthroplasty, sports-related injury management, as well as workers compensation injuries and some conditions of the hand and wrist.

UnityPoint Health - KUDOS!

Each spring/summer the 32 Internal Medicine Residents vote on both General Internal Medicine Physician and Sub-Specialty Teacher of the Year Award. This year we are pleased to announce that Dr. Jon Van Der Veer was chosen as the General Internal Medicine Physician and Dr. Leyla Best was chosen as the Sub-Specialty Teacher of the Year! Congrats to Dr. Van Der Veer and Dr. Best!

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Welcome New Providers to UnityPoint Clinic!

Thomas Fagg, DO UnityPoint Clinic Family Medicine – Greene County UnityPoint Clinic® is proud to welcome Thomas Fagg, DO to our team of experienced and dedicated family medicine providers. Dr. Thomas Fagg completed his medical education at University of Osteopathic Medicine in Des Moines and he received his undergraduate from Iowa State University. Dr. Fagg has a passion for serving his community and solving patient’s problems with a caring and compassionate approach. His medical interests are in family medicine, internal medicine, geriatric medicine, urgent and walk-in care, disease prevention, general pediatrics and emergency medicine. When Dr. Fagg isn’t in the clinic, you can find him spending time with his family, spending time outside biking and hiking, enjoying carpentry, traveling on a medical missionary and engaging in history.

Saurabh Aggarwal, MD UnityPoint Clinic Cardiology – Penn Avenue UnityPoint Clinic® is proud to welcome Saurabh Aggarwal, MD to our team of experienced and dedicated cardiologists. Dr. Saurabh Aggarwal received his medical training at the Government Medical College in Patiala, India. He completed his internal medicine residency at Chicago Medical School and his cardiovascular disease fellowship at Creighton University School of Medicine. He served as the Medical Officer at Fortis Hospital in Noida, India in 2009 and Aruna Asaf Ali Government Hospital in Delhi, India from 2009 to 2011. Dr. Aggarwal is board-certified by the American Board of Internal Medicine in Echocardiography and Nuclear Cardiology. Dr. Aggarwal’s clinical interests include cardiac care, echocardiography, non-invasive imaging and cardiology. When he isn’t in the clinic, you can find him spending time with his daughter, reading magazines and playing the guitar!

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Jill Louise “J. Louise” Nesset, PA – C UnityPoint Clinic Mental Health – Penn Avenue UnityPoint Clinic® is excited to welcome Jill Louise to our team of dedicated and experienced mental health providers. J. Louise completed her medical education at A.T. Still University and received her undergraduate degree from Grand View University. She is board-certified by the National Commission on Certification of Physician Assistants. Her clinical interests are post-partum depression, patient education and adult general psychiatry. When J. Louise isn’t at the clinic you can find her spending time with her two sons, reading, exploring nature and vegan cooking!

Stasia Skrobish, PA – C UnityPoint Clinic Family Medicine | Urgent Care – Urbandale UnityPoint Clinic® is happy to welcome Stasia Skrobish to our team of committed and experienced urgent care providers. Stasia completed her medical education at Des Moines University and received her undergraduate degree from University of Wisconsin Stevens Point. She is board-certified by the National Commission on Certification of Physician Assistants. Stasia’s clinical interests are trauma, sports medicine, health and wellness, acute care, cardiology, urgent care/walk-in, laceration repair and emergency medicine. When she isn’t in the clinic you can find her cooking, hiking, exercising, painting, attending a musical festival, traveling, being active in our community, spending time with her animals or indulging in her passion for photography!

Alex Hubbell, MD UnityPoint Clinic Family Medicine – Northwest UnityPoint Clinic® is proud to welcome Alex Hubbell, MD to our team of experienced and dedicated family medicine providers. Dr. Alex Hubbell completed his medical education at University of Iowa and he received his undergraduate from Harvard College. He completed his residency and internship at the University of Minnesota – North Memorial and is board-certified by the American Board of Family Medicine. Dr. Alex is interested in helping people help themselves and empowering patients to use medical advice in order to do the most with their own lives and situations. His medical interests are in health promotion, chemical dependency, family medicine, wilderness medicine, joint injections and chronic medical conditions. When Dr. Alex isn’t in the clinic, you can find him with his family and friends, or camping, snowboarding, climbing, woodworking and cooking!

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Megan Lukes, ARNP UnityPoint Clinic Internal Medicine – West Des Moines UnityPoint Clinic® is proud to welcome Megan Lukes, A.R.N.P. to our team of experienced and dedicated internists. Megan received her MSN as a Family Practice Nurse Practitioner from Allen College and she received her B.S. in nursing from Allen College. Megan completed her clinical hours within the UnityPoint Health family at various UnityPoint Clinics throughout the Des Moines metro. She is board-certified by the American Association of Nurse Practitioners (AANP). Megan’s clinical interests include Primary Care, Adult Medicine, Women’s Health, Disease Management and Preventive Health. When she isn’t in the clinic you can likely find spending time with family and friends, reading books and playing golf and other sports!

Leann Nelson, ARNP UnityPoint Clinic Family Medicine – Pleasant Hill UnityPoint Clinic® is pleased to welcome Leann Nelson, ARNP to our team of dedicated and compassionate family medicine providers. Leann completed her medical education at Creighton University and received her undergraduate degree from the University of Iowa. She is board-certified by the American Nurses Credentialing Center. Leann’s medical philosophy is to build a relationship with each patient to promote healthy lifestyles and disease prevention that is high-quality care for the patient and their family in all states of health through open communication and evidence-based practice. When Leann isn’t in the clinic you can find her spending time with family and friends, running, practicing yoga and reading!

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HAWAII43

$100 hotel credit for those that register and reserve their room by October 1

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2017 Hospital Provider Directories are available – please call or email Monica Aunan to receive a copy.

To submit articles, please send to Monica Aunan, Physician Liaison at

monica.aunan@unitypoint.org or call 515-241-3480

UnityPoint Health - Des Moines Region ACO Members

Abrahamson, Tim, MD (Dermatology)

Allergy and Asthma Associates, PC

Associated Ophthalmologists

Associates in Kidney Care

Blank Health Providers-UPHDM

Boone County Comprehensive Specialty Care

Boone County Family Medicine

Boone County Hospital

Broadlawns Medical Center

Bussey Family Health Center

Cass County Hospital

Central States Medicine (Iowa Pain Clinic)

Clarke County Hospital

Dermatology, PC

Des Moines Anesthesiologists

Des Moines Eye Surgeons

Des Moines Internal Medicine

Des Moines Orthopaedic Surgeons, PC

Des Moines Pastoral Counseling Center

Des Moines Pediatric & Adolescent Clinic

Des Moines University Medical Clinic

Eyerly Ball

Ganske, John Gregory (Greg) MD

Greater Regional Medical Center

Greene County Medical Center

Guthrie County Hospital

Huxley Physical Therapy

Iowa Arthritis & Osteoporosis Center

Iowa Diabetes and Endocrinology Center

Iowa Digestive Disease Center PC

Iowa Endoscopy Center

Iowa Ear Center

Iowa ENT, INC

Iowa Head & Neck, PC

Iowa Kidney Physicians, PC

Iowa Pathology Associates, PC

Iowa Radiology, PC

Iowa Retina Consultants, Inc.

Iowa Surgery Center, PC (Dr. Praveen Prasad)

Koch Facial Surgery

Lakeview Surgery Center

Lifeworks

Lucas County Health Center

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Madrid Family Practice- Boone County Hospital

McClairen, Willie C., Jr MD (Surgery) Gen Surg Physician, PC

McFarland Clinic, P.C.

McFarland Clinic - Jefferson

Medical Oncology & Hematology Assoc (MOHA)

Metro Anesthesia and Pain Management

Mid-Iowa Fertility, PC

Midwest Oral and Facial Surgery, PC

New Sharon Medical Clinic

Newton Clinic, PC

Orchard Place

Orthopaedic Outpatient Surgery Center (OOSC)

Pediatric and Adult Allergy, PC

Pediatric Cardiology, PC

Pella Medical Clinic

Pella Regional Health Center

Physicians' Eye Clinic

Porto, Dennis P MD (ENT)

River Valley Therapy Clinic, LLC

Story County Medical Center

Surgery Center of Des Moines East and West

The Iowa Clinic

The Iowa Clinic Endoscopy Center

The Iowa Clinic West Lakes

The Iowa Clinic West Lakes-Cardiology

The Iowa Clinic - Family Medicine

The Iowa Clinic - Internal Medicine

UnityPoint Health - Des Moines

West Des Moines Children's Clinic

Wolfe Eye Clinic, PC

Wolfe Surgery Center

Women's Care Clinic, PC

West Lakes Sleep Center

**Skilled Nursing Facilities**

The Bridges at Ankeny

Calvin Community

Edgewater

Fountain West

Hearthstone

Kennybrook Village

Mill Pond

North Ridge Village - Ames

Norwalk Nursing and Rehab Center

On with Life, Inc.

Parkridge Specialty Care

Prairie Vista Village

Spurgeon Manor

Sunnyview Care Center

Urbandale Health Center

Valley View Village

Wesley Retirement Services-UnityPoint Health Des Moines

List updated 5/30/2017