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Manual for an Orthopedic Nurse Created by: Lauren Perryman

Table of Contents iii

Introduction ................................................................................................................... v

Chapter 1 – Setting up the Office on Clinical Days .......................................... 1

1.1 Turning on the computers ........................................................................................... 3

1.1.1 Logging into the computers ............................................................................... 3

1.1.2 Logging into AOA’s imaging program.............................................................. 4

1.1.3 Logging into BOSHA’s imaging database ........................................................ 4

1.1.4 Pulling up informational websites ..................................................................... 4

1.2 Access and pull up daily schedule .............................................................................. 5

1.3 Gathering important forms .......................................................................................... 5

1.4 Gathering Vials for Injections ..................................................................................... 6

1.5 Patient rooms .............................................................................................................. 6

1.5.1 Stocking patient rooms ...................................................................................... 6

1.5.2 Cleaning the patient rooms ................................................................................ 7

Chapter 2 – Procedures on Clinical Days ............................................................. 9

2.1 Types of Patients ....................................................................................................... 11

2.1.1 New Patients .................................................................................................... 11

2.1.2 Follow-up Patients ........................................................................................... 11

2.1.3 Pre-op Patients ................................................................................................. 12

2.1.4 Post-op Patients ................................................................................................ 12

2.1.5 Test Result Patients .......................................................................................... 12

2.2 Rooming Patients ...................................................................................................... 12

2.2.1 Retrieving the Patient ....................................................................................... 13

2.2.2 Recording the Blood Pressure .......................................................................... 13

2.2.3 Recording the Pulse Rate ................................................................................. 14

2.2.4 Taking the Respiration Rate ............................................................................. 14

2.2.5 Gathering Other Relevant Information from the Patient ................................. 15

2.2.6 Proper Attire for Patient ................................................................................... 15

2.2.7 The Light System ............................................................................................. 15

2.3 Injections ................................................................................................................... 16

2.3.1 How to Draw the Injection ............................................................................... 16

2.3.2 Shoulder – Subacromial Space ........................................................................ 16

2.3.3 Shoulder – Glenohumeral Space ...................................................................... 17

2.3.4 Shoulder – Acromioclavicular Joint ................................................................ 17

2.3.5 Elbow – Olecranon Bursitis ............................................................................ 17

2.3.6 Elbow – Lateral Epicondylitis ......................................................................... 17

2.3.7 Elbow – Medial Epicondylitis ......................................................................... 18

2.3.8 Elbow – Cubital Tunnel ................................................................................... 18

2.3.9 Wrist – Carpal Tunnel ...................................................................................... 18

2.3.10 Wrist – Joint ................................................................................................... 18

2.3.11 Wrist – De Qeurvain’s Tenosynovitis ............................................................ 19

2.3.12 Hand – First Metacarpal Space ..................................................................... 19

2.3.13 Hand – Metacarpal – Phalangeal Joint........................................................... 19

2.3.14 Hand – Trigger Finger ................................................................................... 19

iv Manual for an Orthopedic Nurse

2.3.15 Hip – Trochanteric Bursitis ............................................................................ 20

2.3.16 Knee-Joint ...................................................................................................... 20

2.3.17 Ankle – Joint ................................................................................................. 20

2.3.18 Foot – Peroneal Tendonitis ........................................................................... 20

2.3.19 Ganglion Cyst ................................................................................................ 21

2.4 Forms for roomed patients ....................................................................................... 21

2.4.1 Prescription medications forms ........................................................................ 21

2.4.2 Physical therapy forms ..................................................................................... 21

2.4.3 Surgery forms................................................................................................... 21

2.4.4 Imaging forms .................................................................................................. 22

2.5 Durable Medical Equipment ..................................................................................... 22

2.5.1 Wrist Brace ...................................................................................................... 22

2.5.2 Arm Sling ......................................................................................................... 22

2.5.3 Foot Brace ........................................................................................................ 23

Chapter 3 – Procedures on Non-Clinical Days ................................................. 25

3.1 Fielding Calls from Patients...................................................................................... 27

3.2 Fielding Calls from Home Health ............................................................................. 27

3.3 Fielding Calls from Surgery Implant Reps .............................................................. 28

3.4 Fielding Calls from Hospitals ................................................................................... 28

3.4.1 Surgery Department ......................................................................................... 28

3.4.2 Pre-Assessment Department ............................................................................ 28

3.4.3 Hospital Administration Department ............................................................... 29

3.5 Surgical Assists ......................................................................................................... 29

3.6 Scheduling Surgeries ................................................................................................ 29

Index .............................................................................................................................. 31

References ................................................................................................................... 33

Introduction v

Introduction

Dr. Danny Nicholls, D.O. is an orthopedic surgeon at Arlington Orthopedic Associates (AOA).

He requires a least one nurse to assist with managing patients and their needs. In order for the

orthopedic office to run efficiently the nurse must be fully aware of his or her duties and capable

of doing them. This manual will outline all of the duties of an orthopedic nurse working for Dr.

Nicholls.

Preparing the office is the first thing that should be done at the beginning of each day in order to

prepare for the arrival of patients. Chapter one will outline everything that should be done prior

to the arrival of the first patient.

Clinical days are fast-paced and require the nurse to stay alert and be ready for any situation that

might happen. Chapter two of this manual will go into detail about the duties and requirements

that Dr. Nicholls will expect of his nurse. Because clinical days involve a lot of interaction with

patients and their needs will be various, chapter t two has a lot more material in it than the other

two chapters.

The days that Dr. Nicholls does surgery are non-clinical days and chapter three of this manual

will outline the requirements of his orthopedic nurse for these days. Non-clinical days involve

fielding calls from many sources and being able to represent Dr. Nicholls in an appropriate

manner.

Refer to the manual often and read the chapters carefully.

Chapter one – Setting up the Office on

Clinical Days

Setting up the Office on Clinical Days 3

Setting up the office is the first thing that should be done

in the morning. Arrive at the office thirty minutes before

the first patient is scheduled to arrive so that you have

plenty of time to set everything up. Because the nurse’s

station is the hub of activity in the office, everything

needs to be in its proper place before the first patient

arrives. Refer to Figure 1.1 for the layout of the nurse’s

station.

Setting up the office includes:

Turning on the computers and opening programs

Accessing the schedule

Setting out all the script pads and important forms

Setting out vials of injectable solutions

Setting up patient rooms

1.1 Turning on the Computers

The first thing you should do in the morning is turn on both of the computers at the nurse’s

station. You will have a personal computer and there will be a diagnostic computer. Your

personal computer has access to the schedule and will do other basic functions. The diagnostic

computer has programs installed on it that will access AOA’s imaging database along with

Baylor Orthopedic and Spine Hospital at Arlington’s (BOSHA) imaging database. The

diagnostic computer will also be able to access the schedule as well. You must log into both

AOA’s imaging database and BOSHA’s imaging database in the morning so that it will be

accessible for Dr. Nicholls throughout the day.

1.1.1 Logging into the Computers

Follow these instructions for logging into AOA’s computers:

1. Turn on the computer.

2. A dialog box will appear, asking for your username and password. Type in the personal

username and password assigned to you and press enter.

3. If the system displays “Access denied” you may have typed your username or password

incorrectly. Try again.

4. If you are repeatedly denied access even though you are typing your password correctly,

call the Help Desk at ext. 5308.

Figure 1.1: Diagram of nurse’s

station. A = Diagnostic Computer.

B = Personal Computer.

4 Manual for an Orthopedic Nurse

1.1.2 Logging into AOA’s Imaging Program

Follow these instructions for logging into AOA’s imaging program:

1. On the diagnostic computer’s desktop, find the icon labeled “E-film.”

2. Click on the icon.

3. A dialog box will appear, prompting you for your username and password. Type in the

general username and password assigned to you and press enter.

4. If the system displays “Access denied” you may have typed your username or password

incorrectly. Try again.

5. If you are repeatedly denied access even though you are typing your password correctly,

call the Help Desk at ext. 5308.

1.1.3 Logging into BOSHA’s Imaging Database

Follow these instructions for logging into BOSHA’s imaging database:

1. On the diagnostic computer, open your web browser (Internet Explorer or Mozilla).

2. Find the icon on the desktop labeled “VPN Portal.”

3. A dialog box will appear, prompting you for your username and password. Type in the

username and password you assigned to you and press enter.

4. After logging in, the default work list is displayed.

1.1.4 Pulling up Informational Websites

External medical websites will be used throughout the day for various purposes. Post-operative

patients will need packets that explain how to take care of their surgery-site. Dr. Nicholls might

also want to print off packets for patients that have questions about their alternative options. Pull

up the following websites on the diagnostic computer so that they are easily accessible

throughout the day:

Http://www.aaos.org

Http://www.webmd.com

Http://www. methodisthealthsystem.org

Http://baylorhealth.com

1. After going to http://baylorhealth.com find the tab at the top of the page titled

“Physicians and Locations” and click on it.

2. Click on “Find a Location.”

3. Click on “See All Facilities.”

4. Under the heading “Baylor Affiliates, Leases & Joint Ventures” find “Baylor

Orthopedic and Spine Hospital at Arlington” and click on it.


1.2 Access and Pull up Daily Schedule

Maintaining and monitoring the schedule is important. Because the day revolves around what

patient is going to be seen and when, you must make sure that a patient that will require at least a

thirty minute appointment isn’t in a fifteen-minute timeslot, or vice versa. Section 2.1 in this

manual will describe the types of patients that can be seen and how long an appointment for each

should be.

Once you have looked over the schedule and made any necessary changes to it you need to print

it off and tape it to the counter of the nurse’s station so that it is easily accessible. Follow these

instructions to access and print off the daily schedule:

1. On the personal computer, find the icon labeled “ANITA” on the desktop and click on it.

2. A menu will appear. Find and click on “schedule.”

3. The schedule for the current day should appear. If it does not appear, use the interactive

tools to navigate to the current day.

4. At the top left of the screen, find and click on “file.”

5. Click on “print.” The schedule will be printed off at the printer next to your personal

computer.

6. Tape the schedule to the counter of the nurse’s station where it is easily seen.

1.3 Gathering Important Forms

There are many different forms that Dr. Nicholls or a patient will need to fill out. Have these

forms ready and organized at the beginning of the day is important. Gather the following forms

and organize them on the counter of the nursing station so that they are easily accessible:

AOA’s physical therapy script pad

All external facilities’ physical therapy script pads

Prescription medication script pad

Patients’ work status forms

Image ordering forms

Patient questionnaire

School excuse notes

Surgery order form


1.4 Gathering Vials for Injections

A patient might need an injection during their appointment. It will be your job to prepare the

injections for Dr. Nicholls to administer. The injections consist of differing amounts of these

three substances:

Marcaine 0.25%

Xylocaine 1.0%

Kenalog 40 mg

Set out these vials on the counter of the nurse’s station so that you have easy access to them

whenever you need them.

1.5 Patient Rooms

Maintaining the patient rooms is your job. You must make sure that they are kept clean and fully

stocked for the convenience of both Dr. Nicholls and the patients. This section will explain

exactly what you need to stock the rooms with and how to clean the rooms once a patient leaves.

1.5.1 Stocking Patient Rooms

Each patient room is to be kept fully stocked. Before the first patient arrives, make sure that all

of the following items are in either the drawers or cabinets of each room:

Freeze spray

Gloves (small, medium, large)

Sterile applicators

Suture removal kits (for stitches and

staples)

Bottled rubbing alcohol

Saline solution

Hydrogen peroxide

Tape (various sizes)

Xeroform

Betadine swabsticks

Neosporin and Bacitracin ointments

Alcohol swabs

Steristrips (all sizes)

Steristrip adhesive

Dressing scissors

All-purpose scissors

Gauze (various sizes)

Sterile gauze

Adaptic dressing

Adhesive Telfa dressings (various

sizes)

Non-adhesive Telfa dressings

(various sizes)

Ace wraps (various sizes)

Cotton padding

Conforming roll gauze

Band-Aids (various sizes)

Soft-cling roll gauze

Coban wrap

Paper shorts (various sizes)

Paper tube tops (various sizes)

Gowns

Towels

Wash cloths

Table paper


Paper pillow cases

Chucks

Germicidal wipes

Sharps container

1.5.2. Cleaning the Patient Rooms

Before the first patient arrives, every room should be prepared. Each room should also be

cleaned after each patient leaves. The following should be done to maintain cleanliness in the

patient rooms:

1. Tear off the paper cover on top of the bed.

2. Replace the bed cover with new, clean, paper.

3. Throw the old bed cover away.

4. If the pillow was used, take off the paper pillowcase.

5. Replaced the paper pillowcase with a new, clean, one.

6. Throw the old pillowcase away.

7. Throw any other trash into the trash can.

8. Throw any used syringes, disposable scalpels, stitch/staple removers in the sharps

container.

9. Throw anything with the patient’s bodily fluids on it in the biohazard container.

10. If any bodily fluids were excreted:

a. Put on gloves.

b. Wipe them up with a paper towel.

c. Throw paper towel in the biohazard container or flush down the toilet.

d. Clean surfaces with antibiotic wipes.

Chapter Two – Procedure on Clinical Days

Procedure on Clinical Days 11

Clinical days are fast-paced and require focus. You must be able to interact with the patients in

an appropriate manner while also managing any last-minute schedule changes or fielding calls.

This section will explain the following:

What types of patients Dr. Nicholls sees and how long each of their appointments should

be

The procedure you need to follow when rooming patients

The light system that is used to communicate with the front desk and Dr. Nicholls

The list of forms that some patients should receive after they are roomed

The ingredients of each injection

The different types of durable medical equipment and the specific application of each

2.1 Types of Patients

Dr. Nicholls sees a variety of different ailments but, for scheduling purposes, there are five types

of patients:

New patients

Recheck patients

Pre-op

Post-op

Test results

2.1.1 New Patients

There should be at least five new patients scheduled for every half day of clinic. A half day is

considered the time from the morning until lunch or the time from lunch until the end of the day.

New patients should be allowed a thirty minute appointment. New patients must also fill out

information regarding their current health insurance, billing address, etc. All this information is

on the “New Patient” form that patients need to fill out.

2.1.2 Follow-up Patients

Follow-up patients are patients that have already seen Dr. Nicholls once, and are seeing him

again about the initial complaint. Follow-up patients should already have all of their personal

information on file. Follow-up patients should be in a fifteen minute time slot for an

appointment. Dr. Nicholls will want to know how they are doing since their last appointment.

He will also want to know if the regimen he prescribed them is working.


2.1.3 Pre-op Patients

Pre-op patients are patients that already have surgery scheduled for the next day or within the

next few days. Dr. Nicholls likes to make sure that the patient knows what to expect and to go

over any last-minute concerns with the patient. If a brace is to be used following the operation

Dr. Nicholls will go over the guidelines of using it with them and it will be your job to make sure

that they know how to remove and reapply it. Pre-op patients should be scheduled to have a

thirty minute appointment.

2.1.4 Post-op Patients

Post-op patients are patients that just recently had surgery within the last day or two. Dr.

Nicholls will want to know how they are doing and if they are having any adverse reactions to

the pain medications he prescribed them. He will then have them practice their set of exercises

in the room to make sure that they know exactly what to do. Post-op patients should be

scheduled to have a thirty minute appointment.

2.1.5 Test Result Patients

Test result patients are patients that have had imaging done at other facilities and are there to

hear the results of their imaging. Dr. Nicholls will want to know how they have been since they

had their imaging done. If the patient had the imaging done at a facility that is not a part of

AOA, the patient should already have had their imaging results sent to the office. If the patient

did not have this done you need to call the facility immediately and request for the results to be

sent to Dr. Nicholls’s office so that he can discuss them with the patient.

2.2 Rooming Patients

It is your duty to room the patients. To room a patient you will go to the front of the office,

retrieve the patient, and put him or her in the next available room. There are four patient rooms

in the office, each labeled with their corresponding number. In order to maintain efficiency,

using the rooms in a linear fashion will reduce any confusion between you and Dr. Nicholls. In

other words, the first patient goes in room one, the second in room two, and so on.

This section will describe the proper procedures to room patients, how to take their vitals,

information that you should gather, how to make sure the patient is in proper attire, and how to

communicate with the light system.


2.2.1 Retrieving the Patient

When the next patient to be seen has arrived, the front desk will alert you via the light system.

When you see this signal you are to follow these instructions:

1. Get the patient’s chart.

2. Skim the chart to make sure all the information is complete.

3. Double check to make sure that the patient’s complaint is something that Dr. Nicholls

sees.

4. Go into the waiting room and call the patient’s name.

5. If the patient’s complaint is not one that Dr. Nicholls sees:

a. Alert the patient of the situation.

b. Advise the patient that if they insist on being seen they will still have to pay for

the appointment.

6. Put the patient in the next available room.

If patients do not have all the information filled out when you go to retrieve them, inform them

that they must fill out the required information before they can be seen.

2.2.2 Recording the Blood Pressure

Once you have put the patient in the appropriate room, the patient’s blood pressure must be

taken. The office has two types of blood pressure machines that you can use. One machine is

digitally read, and the other is manually run and requires the use of a stethoscope.

To operate the digital blood pressure pump:

1. Wrap the sleeve around the patient’s arm with the air tube on the inside bend of the

elbow.

2. Fasten the sleeve with the Velcro straps, keeping careful to leave a small amount of

space.

3. Turn on the digital screen.

4. Pump air into the sleeve.

5. Stop pumping air into the sleeve when you hear the machine beep.

6. Wait for the machine to finish calculating the blood pressure.

7. Read off the results.

The digital blood pressure pump will also give you the pulse rate of the patient. Section 2.2.3

will address taking the pulse.

To operate the manual blood pressure pump:

1. Wrap the sleeve around the patient’s arm with the air tube on the inside bend of the

elbow.


Do NOT use your thumb to take the patient’s pulse. The pulse in your

own thumb will give an inaccurate result.

2. Fasten the sleeve with the Velcro straps, keeping careful to leave a small amount of

space.

3. Place the ear buds of the stethoscope in your ears.

4. Using the stethoscope, find the pulse on the inside bend of the elbow.

5. Pump air into the sleeve.

6. Stop pumping air when you no longer hear the pulse.

7. At this point, look at the gauge and read the number. This is the systolic.

8. Slightly open the valve to slowly release air from the sleeve.

9. When you hear the heartbeat again look at the gauge and read the number. This is the

diastolic.

Once you have successfully taken the blood pressure, record the systolic over diastolic in the

patient’s chart.

2.2.3 Recording the Pulse Rate

After you have taken the patient’s blood pressure you must take the patient’s pulse. If you used

the digital machine to take the blood pressure it will have given you the pulse. If you used the

manual pump, you must manually take the pulse.

The pulse is a measure of heart beats per minute. You can choose to count the number of heart

beats for a full minute, or you can take it for thirty seconds and multiply by two, or you take it

for fifteen seconds and multiply by four. Each method will give an accurate pulse.

Follow these instructions to take the pulse:

1. Place your index finger and middle finger on the radial side of the wrist.

2. Using your two fingers, find the heartbeat.

3. Using a clock or watch with second-hands, count the number of heartbeats.

As stated above, if you counted the number of heartbeats over an interval less than a minute,

multiply appropriately to find the number of heart beats per minute. Record the pulse rate in the

patient’s chart.

2.2.4 Taking the Respiration Rate

Once the blood pressure and pulse have been taken you must record the respiration rate of the

patient. Just as with the pulse, respiration is recorded as the amount of breaths per minute. You

can count the number or breaths for a full minute, or you can count for thirty seconds and

multiply by two, or count for fifteen seconds and multiply by four. Each of these methods will

give an accurate respiration rate. Follow these instructions to take the respiration rate:


Figure 2.1 – The

light system.

1. Have the patient sit up with his or her back straight.

2. Watch the patient’s chest and record every intake of breath.

As with the blood pressure and pulse, multiply if necessary to reach the number of breaths per

minute. Record the respiration rate in the patient’s chart.

2.2.5 Gathering Other Relevant Information from the Patient

Once you have recorded the blood pressure, pulse, and respiration rate of the patient in the chart,

ask pertinent questions to gather exactly why the patient is there. If the patient is a new patient

inquire as to why they are there to see Dr. Nicholls. Record everything that the patient says

regarding his or her symptoms on the patient’s chart. Section 2.1 describes the different types of

patients and what kind of information Dr. Nicholls will want to know.

2.2.6 Proper Attire for Patient

Patients that require an X-ray will need the appropriate attire for the X-ray room. The office has

paper shorts and tube tops available for patients’ needs. If you see that a patient is wearing

clothing over the affected area, inform the patient that he or she will have to change prior to

getting an X-ray. If the X-ray is to be done anywhere on the waist down, provide them with a

pair of paper shorts to change into. If the X-ray is to be done on the torso, men can take their

shirt off and women can wear a paper tube top that you provide them with. Section 2.2.7 will

explain how patients are to use the light system to communicate that they are done with imaging.

2.2.7 The Light System

The light system is a square block of four different buttons. Each

button is a different color and signifies a different thing. Pressing a

button will cause it to light up with its color and pressing it again

causes the light to turn off. Figure 2.1 shows a picture of the light

system.

When a patient is told to go to the X-ray room you will press the red

button. Inform patients that when they are done and have returned to

their room they need to press the red button again to turn it off. This

tells Dr. Nicholls that they are back in the room and ready to be seen.

The yellow button on the light system tells Dr. Nicholls which room has the next patient to be

seen in it.

The green button tells Dr. Nicholls which room has the second patient in line to be seen.


The white button is not used.

2.3 Injections

If Dr. Nicholls wants to give a patient an injection he will tell you the body part and you will

need to mix the ingredients of the injection for him. Each injection site requires its own

ingredients with different size needles. This section will tell you how to draw the syringe and

what to put in each syringe per body part.

Once you have made the injection, place it in the patient’s room so that Dr. Nicholls can use it

when he returns to the room. Sometimes Dr. Nicholls will want different ingredients in the

injection for a specific site. When this happens he will tell you exactly what to put in it.

2.3.1 How to Draw the Injection

Before drawing the injection collect the vials needed, the appropriate size syringe, an alcohol

swab, a 16-gauge needle, and the appropriate size needle for injecting. Follow these instructions

to draw in injection:

1. Swab the top of all vials with an alcohol swab.

2. Attach a 16-gauge needle to the appropriate size syringe.

3. To avoid a vacuum, push the same amount of air that you will be drawing out into each

vial.

4. Draw the correct amount into the syringe from the vial.

5. Detach the 16-gauge needle from the syringe.

6. Attach the appropriate size needle to the syringe.

To set up for the injection in the patient’s room the physician will need:

Topical vacocoolant spray

Betadine swab stick

Alcohol swab

4x4-gauze

Band-Aid

It is sometimes necessary to use a 3 ½-inch needle on an obese patient in order to penetrate the

fatty tissue. If needed, have the 3 ½-inch needle available for Dr. Nicholls at the time of setup.

2.3.2 Shoulder – Subacromial Space

The subacromial shoulder space injection requires the following ingredients in the syringe:


3cc Marcaine 0.25 %

3cc Xylocaine 1.0 %

1cc Kenalog 40 mg

Attach a 22-gauge 1 ½-inch needle to the syringe.

2.3.3 Shoulder – Glenohumeral Space

The glenohumeral shoulder space injection requires the following ingredients in the syringe:

1cc Xylocaine 1.0 %

1cc Kenalog 40 mg

Attach a 25-gauge, 1 ½-inch needle, to the syringe.

2.3.4 Shoulder – Acromioclavicular Joint

The acromioclavicular shoulder space injection requires the following ingredients in the syringe:

0.5cc Xylocaine 1.0 %

0.5cc Kenalog 40 mg


2.3.5 Elbow – Olecranon Bursitis

The injection for olecranon bursitis of the elbow requires the following ingredients in the

syringe:

1cc Xylocain 1.0 %

1cc Kenalog 40 mg


2.3.6 Elbow – Lateral Epicondylitis

The injection for lateral epicondylitis of the elbow requires the following ingredients in the

syringe:

1cc Xylocaine 1.0 %


1cc Kenalog 40 mg


2.3.7 Elbow – Medial Epicondylitis

The injection for medial epicondylitis of the elbow requires the following ingredients in the

syringe:

1cc Xylocaine 1.0 %

1cc Kenalog 40 mg


2.3.8 Elbow - Cubital Tunnel

The injection for cubital tunnel of the elbow requires the following ingredients in the syringe:

1cc Xylocaine 1.0 %

1cc Kenalog 40 mg


2.3.9 Wrist – Carpal Tunnel

The injection for carpal tunnel of the wrist requires the following ingredients in the syringe:

1cc Xylocaine 1.0 %

1cc Kenalog 40 mg


2.3.10 Wrist – Joint

The injection for the wrist joint requires the following ingredients in the syringe:


1cc Kenalog 40 mg



2.3.11 Wrist – De Qeurvain’s Tenosynovitis

The injection for De Quervain’s Tenosynovitis requires the following ingredients in the syringe:

0.5cc Xylocain 1.0 %

0.5cc Kenalog 40 mg


2.3.12 Hand – First Metacarpal Space

The injection for the first metacarpal space of the hand requires the following ingredients in the

syringe:


0.5cc Kenalog 40 mg


2.3.13 Hand – Metacarpal – Phalangeal Joint

The injection for the metacarpal – phalangeal joint of the hand requires the following ingredients

in the syringe:


0.5cc Kenalog 40 mg


2.3.14 Hand – Trigger Finger

The injection for a trigger finger in the hand requires the following ingredients in the syringe:


0.5cc Kenalog 40 mg



2.3.15 Hip – Trochanteric Bursitis

The injection for trochanteric bursitis of the hip requires the following ingredients in the syringe:

1cc Xylocaine 1.0 %

1cc Kenalog 40 mg


2.3.16 Knee-Joint

The injection for a knee joint requires the following ingredients in the syringe:

2cc Marcaine 0.25 %

2cc Xylocaine 1.0 %

1cc Kenalog 40 mg


2.3.17 Ankle – Joint

The injection for an ankle joint requires the following ingredients in the syringe:


0.5cc Kenalog 40 mg


2.3.18 Foot – Peroneal Tendonitis

The injection for peroneal tendonitis of the foot requires the following ingredients in the syringe:


0.5cc Kenalog 40 mg



2.3.19 Ganglion Cyst

The injection for a ganglion cyst on various parts of the body, post-aspiration, requires the

following ingredients in the syringe:


0.5cc Kenalog 40 mg


2.4 Forms for roomed patients

After Dr. Nicholls has seen a patient he may want to order one or many of the following:

Prescription medication

Physical therapy

Surgery

Imaging

He will tell you what he wants to order and you need to collect the proper forms.

2.4.1 Prescription medications forms

When Dr. Nicholls wants to order a prescription medication for a patient he will tell you what he

wants to order. You need to write it on the script pad and give it to him to look over. He will

sign it and give it to the patient to fill.

2.4.2 Physical therapy forms

Dr. Nicholls will sometimes want to order physical therapy for a patient. Physical therapy is

usually prescribed for patients who are about to have surgery or as preventative treatment to keep

them from having surgery. If he wants a patient to have surgery he will tell you what regimen he

wants them to follow and you need to fill out the proper forms for the patient and give it to Dr.

Nicholls. He will then discuss it with the patient.

2.4.3 Surgery forms

If the patient and Dr. Nicholls have decided that the patient needs surgery Dr. Nicholls will tell

you to fill out the surgery form for the patient’s chart. You will also need to put together the


Figure 2.2 – The

wrist brace

surgery packet. This will be made on non-clinical days though, and is addressed in Chapter

Three.

2.4.4 Imaging forms

If the patient needs imaging done Dr. Nicholls will tell you what kind of imaging he wants done

and you will find the appropriate form for that specific type of imaging (MRI, EMG nerve

conduction study, CT, etc). You will then fill it out and give it to the patient. Dr. Nicholls will

discuss with the patient where he or she can have the imaging done.

2.5 Durable Medical Equipment

Any kind of brace, sling, cast, etc. is considered to be durable medical equipment (DME). If Dr.

Nicholls sees a patient and says that they need to start wearing durable medical equipment he

will tell you. It will be your job to get the equipment and show the patient how to apply it. This

section will explain the basic kinds of DME and how to apply them. The more heavy-duty

equipment will have instructions in their box that you will need to follow.

2.5.1 Wrist Brace

Retrieve a wrist brace from the supply closet and follow these instructions to

apply the wrist brace:

1. With the straps loosened, insert the hand into the brace. The thumb

should be placed through the thumb hole and the straps should be on

the back of the hand.

2. Starting with the strap farthest away from the hand, pull the straps

through the plastic loop to tighten.

3. Pull the straps over the back of the plastic loop and attach to the

Velcro.

4. Refer to Figure 2.2 for the final product.

Inform the patient that the brace will not prevent or eliminate risk of injury. Also tell the patients

that if they experience any discomfort while using the brace that they should immediately inform

Dr. Nicholls. Give the patients instructions on caring for their brace.

2.5.2 Arm Sling

Retrieve an arm sling from the supply closet and follow these instructions to apply the arm sling:

1. Place the arm in the sling pouch.


Figure 2.3 – The arm sling.

2. Pull the strap over the opposite shoulder.

3. Pull the strap through the double rings and secure.

4. Adjust the shoulder strap as necessary to ensure a

comfortable fit.

5. Refer to Figure 2.3 for the final product.

Inform the patient that the sling will not prevent or

eliminate the risk of injury. Also tell the patients that if

they experience any discomfort while using the sling that

they should immediately inform Dr. Nicholls. Give the patients instructions for caring for their

brace.

2.5.3 Foot Brace

Retrieve a foot brace from the supply closet and follow these instructions to apply the foot brace:

1. Loosen the straps and remove the liner and ankle cuff from the boot.

2. Place foot in liner.

3. Fasten the foot flaps on the liner first, making sure they are snug.

4. Wrap and fasten the leg portion of the liner, again making sure that it is snug from bottom

to top.

5. Trim the liner if necessary to get the best fit.

6. Spread the uprights using both hands and have the patient step into boot.

7. Align the uprights with the midline of the ankle.

8. Secure the boot straps, starting at the foot and working up the leg.

9. To inflate the air liner, turn in inflate/deflate knob clockwise.

10. Press and release the air bulb several times until liner is providing comfortable cushion

and support.

Chapter Three – Procedures on Non-

Clinical Days

Procedure on Non-Clinical Days 27

The days that Dr. Nicholls does surgery are non-clinical days. No patients will be seen in the

office on these days and you will be required to work at your desk. Non-clinical days are slower

and less varied than clinical days. You might find yourself doing the same thing multiple times

throughout the day for different patients. Your duties will include:

Fielding calls from patients

Fielding calls from home health

Fielding calls from surgery implant reps

Fielding calls from hospitals

Fielding calls from drug reps

Scheduling surgeries

Putting together surgery packets

This section will explain all these duties and provide you with the necessary information to

perform them.

3.1 Fielding Calls from Patients

Patients will call for many reasons. It will be your job to field these calls and advise patients.

Usually, you can use your best judgment to advise them. If you believe it is something that they

should see Dr. Nicholls for you can tell them to call the scheduling desk at 817-375-5200. It is

not your job to schedule patients. There is a central scheduling desk that is in charge of

scheduling. On occasion you can try to squeeze somebody in if it is an emergency, but you will

not do the majority of scheduling.

If patients that Dr. Nicholls has already seen call with any complaints, you need to record this in

their chart along with the date they called.

3.2 Fielding Calls from Home Health

Home health companies will call for multiple reasons. They will call about a patient of Dr.

Nicholls’s that they are taking care of or they will call asking for business. If they are calling

about a patient, record whatever they say in the patient’s chart. If they are asking for Dr.

Nicholls to see the patient, tell them to have the patient call the scheduling desk at 817-375-5200.

If a home health business calls asking for business, it is illegal to give them any patients’

information. Tell them that they can come to the office and leave some business cards. If Dr.

Nicholls sees a patient that he feels could use their business he will give the patient their card.


3.3 Fielding Calls from Surgery Implant Reps

Dr. Nicholls will sometimes use surgical implants in surgery as anchors or clamps. In order for

him to use the implant at least one representative from the company must be present at surgery.

It is their job to bring the implant for Dr. Nicholls to use. They must also observe and make sure

he uses it correctly.

Surgery implant reps will call asking to verify when and where they are supposed to be for

surgery. You must give them accurate information as to when and where they are supposed to

be. They might also need to verify what it is they are supposed to bring.

If a surgery implant rep calls asking for business tell them that they can call the scheduling desk

at 817-375-5200 and make an appointment to talk to Dr. Nicholls about it. Inform Dr. Nicholls

also of anything that you think he might want to hear.

3.4 Fielding Calls from Hospitals

Different departments of hospitals will call for various reasons. This section will inform you of

the different departments you can expect to hear from and what information to give them.

3.4.1 Surgery Department

Sometimes the surgery department will call wanting to move a surgery either earlier or later,

depending on how the day is going. Sometimes if they have scheduled an emergency surgery for

the next day they will call saying that they need to move a surgery that they have scheduled with

Dr. Nicholls because they have run out of operating room space.

They will also have questions pertaining to a case. They will call asking about the implantation

that they will be using wanting to know how necessary it is. Do your best to answer all their

questions in an appropriate and efficient manner.

3.4.2 Pre-Assessment Department

Patients will go to the hospital a few days before surgery to have testing done. If the hospital

finds anything abnormal they will call and report it. For example, if the EKG testing was

abnormal the anesthesiologist will not put them to sleep until the patient has seen a cardiologist.

It is your duty to call the patients and inform them of any abnormalities in their lab results and

tell them what to do next. They must get clearance from a secondary source before they can

have surgery.

Procedure on Non-Clinical Days 29

3.4.3 Hospital Administration Department

The hospital administration will call if a patient owes more money towards their surgery than

they have the ability to pay. The administration will want to know if the surgery is absolutely

necessary or not. If it is absolutely necessary you need to tell that that it is and why. If it is not

absolutely necessary you need to tell them. The hospital will then deal with the patient

themselves. Typically, they will call back to cancel the surgery until the time when the patient

has the money and can reschedule.

3.5 Surgical Assists

Dr. Nicholls will want a surgical assist to help him out with some surgeries. It is your duty to

call and find ones to help him. He will always need a surgical assist for the following

procedures:

Total joint replacements

ACL reconstruction

Larger patients

If he wants a surgical assist for any surgeries outside of this list he will inform you of this and

you will need to find him a surgical assist.

3.6 Scheduling Surgeries

After Dr. Nicholls and a patient have decided that the patient will have surgery Dr. Nicholls will

fill out the pink sheet to order surgery. The next thing you should do is fill out the pre-cert form

on the personal computer. After you fill it all out, print out three copies and follow these

instructions:

1. Take one copy of the pre-cert form to AOA’s pre-cert department.

2. Print out the patient’s insurance and demographic information.

3. Fax a copy of the pre-cert form, the insurance and demographic information to the pre-

cert department of the facility where the surgery will be performed.

4. File the copy that was faxed in the patient’s chart.

5. Save the third copy for the surgery packet.

Dr. Nicholls needs a surgery packet to take with him to every surgery. It is your job to put

together the surgery packet. It includes the following from top to bottom:

Follow-up post-op appointment card.

The surgery pre-cert form

The Patient’s Medical History

The dictation from the initial office visit


The last dictation prior to surgery

The MRI report

A copy of the X-ray

A copy of MRI images

The hospital agency consent form

The hospital’s history and physical form

It is your job to put together the surgery packet forms for him to take to surgery. Put the third

pre-cert form in his surgery packet. Retrieve the patients’ medical history, Dr. Nicholls’s initial

and last dictations, and the MRI report from the patients chart and make copies. Place the copies

in the surgery packet. Print out a copy of the X-ray and relevant MRI images from the

diagnostic computer and put them in the surgery packet. Have the hospital fax their consent

form and their history and physical form to the office and put them in the surgery pack also.

Once this is all together, staple the patients’ follow-up post-op appointment card to the front of

the surgery packet.

Index 31

Index

A acromioclavicular, 17

ANITA, 5

ankle joint, 20

arm sling, 22

attire, 12, 15

B blood pressure, 13, 14, 15

BOSHA, iii, 3, 4

C carpal tunnel, 18

cubital tunnel, 18

D De Quervain’s, 19

diagnostic computer, 3, 4, 30

drug reps, 27

durable medical equipment, 11, 22

F first metacarpal space, 19

Follow-up patients, 11

foot brace, 23

G ganglion cyst, 21

glenohumeral, 17

H home health, 27

hospital administration, 29

hospitals, 27, 28

I imaging, iii, 3, 4, 12, 15, 22

injection, 6, 11, 16, 17, 18, 19, 20, 21

K knee joint, 20

L lateral epicondylitis, 17

light system, 11, 12, 13, 15

M medial epicondylitis, 18

metacarpal – phalangeal, 19

N new patients, 11

O olecranon bursitis, 17

P peroneal tendonitis, 20

personal computer, 3, 5, 29

physical therapy, 5, 21

Post-op patients, 12

Pre-op patients, 12

prescription medication, 21

pulse, 13, 14, 15

R respiration, 14, 15

S schedule, iii, 3, 5, 11, 27

subacromial, 16

surgery department, 28

surgery form, 21

surgery packet, 22, 29, 30

surgical assist, 29


surgical implants, 28

T Test result patients, 12

trigger finger, 19

trochanteric bursitis, 20

V vials, 3, 6, 16

W websites, iii, 4

wrist brace, 22

wrist joint, 18

References 33

References

Mark. (2008, December 19). Cough medicine ingredient could treat prostate cancer. Retrieved

April 2011, from MedicineWorld.Org: http://medicineworld.org/news/ent-news.html

Nisarg. (2011, April 5). Why Be a Doctor? Retrieved April 2011, from UConn Welcome Mat:

http://uconnwelcomemat.wordpress.com/2011/04/05/why-be-a-doctor/

Ontario Schools of Medicine. (n.d.). Retrieved April 2011, from Regional Education: School of

Medicine at Queen's University, Kingston, Ontario:

http://meds.queensu.ca/regionaled/links/ontario_schools_of_medicine

Personal Injury at Work. (n.d.). Retrieved April 2011, from Personal Injury Work:

http://personalinjurywork.com/

ProLite Wrist Brace 8" Deluxe. (n.d.). Retrieved April 2011, from Doc Ortho:

http://www.docortho.com/fla-professional-wrist-brace-8-deluxe.html

Rubenstein, A. H., & Dunlop, R. G. (n.d.). PENN Medicine. Retrieved April 2011, from Making

History: The Campaign for PENN: http://www.makinghistory.upenn.edu/penn_medicine

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