2015 PROVIDER SURVEY ACTION PLAN UPDATE

WE HEARD YOU AND WE TOOK ACTION! In the Fall of 2015, Mercy conducted a Provider Engagement Survey. Since that time, survey results were communicated, an

action plan was created and initiatives have been implemented based on your feedback. See all we’ve accomplished below.

Have Questions? Please contact Jessica Coppess at 319-861-7684 or jjcoppess@mercycare.org

In the 2015 provider survey YOU shared…. MMC heard you and responded by: You are interested in physician leadership opportunities at this organization.

Mercy believes physician leadership is crucial to shepherding healthcare into the future and creating a delivery system rooted in quality care at lower costs. Below is what we are doing to help cultivate that:

• Establishment of 5 key medical director roles: o Physician Communication o System Quality& Population Management o Medicare/Medicaid Population Health o Nursing Home Development o Medical Affairs

• Reinforcing the importance of becoming involved and taking a more active role in the Physician Leadership Council.

• Encouraging physicians to reach out to Leslie Schwarting or Monica Fergus if they wish to be involved in physician recruitment candidate interviews.

• Enhancing the dyad model that pairs physician clinical leaders with non-physician operational leaders.

• Increasing awareness of how to become involved in Medical Staff and hospital committees.

• Continuing the recognition of physician leaders through the Annual Provider Awards and the “This is Leadership” article in the physician newsletter.

• Promoting involvement in the Capital Prioritization meeting in the spring. At this meeting, capital requests are presented and scored by physicians based on standard criteria. This scoring is instrumental in final funding decisions.

• Inviting partners/physician leaders to introduce new providers to the rest of the medical community at the Mercy New Provider Welcome event in the fall.

• Engaging and introducing key physician leaders to new providers within Mercy.

You want better working relationships with clinicians in the organization inside and outside of your practice area.

Relationships are personal and each individual is responsible for their own good working relationships. Ways in which we have and will help facilitate relationships include:

• Encouraging direct communication between providers. • Continuation of events such as the New Provider Event

and the Mercy Honors. • Organization of a Mercy provider volleyball team that

participated in the spring YMCA league.

In the 2015 provider survey YOU shared…. MMC heard you and responded by: You want better working relationships with clinicians in the organization inside and outside of your practice area. Continued…

• Maintaining the Advanced Practice Professionals business meetings and educational presentations.

• Facilitating periodic networking events. • Encouraging physicians to attend staff/department

meetings. • Coordinating biannual MercyCare CME events and

inviting the entire medical community to attend. • Introducing new providers to key clinicians throughout

the organization during orientation. • Facilitating meet and greets for new providers in the

medical community with primary referral sources.

You want a strategic partner in navigating the changing healthcare landscape.

Mercy continues to adjust, actively create opportunities and integrate Medical Staff into strategic planning. ( i.e. department summits, capital planning, strategic planning pillar meetings)

You wish to be informed of strategic plans and direction. • Maintaining current channels of communication such as the Physician Newsletter, Top 5, p.mercycare.org and reports at medical staff committee and section meetings.

• Posting the strategic plan on p.mercycare.org. • Providing administrative reports at Medical Executive

Committee and section meetings. • Exploring a communication app for mobile devices. • Attending individual provider meetings to review the

strategic plan and provide updates as needed and when requested.

You want the organization to provide excellent clinical care to patients.

• Continuing to create and publish Mercy’s annual Quality Report so that providers and consumers are aware of Mercy’s quality achievements.

• Ongoing monitoring and improvement of patient satisfaction and HCAHPS scores.

• Continuing to maintain an educational skills library with over 50 topics. These topics are consistently designed for the simulation lab to ensure hands-on practice.

• Hiring educators for specialty areas to include ICC, CSC, ED, Med Surg, and Birthplace.

• Focusing on onboarding new staff and conducting ongoing education for existing staff (using the skills library materials).

• Enhancing orientation to include a Post-Epic skills session where new hires go to the simulation lab after each day of Epic training to practice, hands-on, what they have learned that day.

In the 2015 provider survey YOU shared…. MMC heard you and responded by: You want the organization to provide excellent clinical care to patients. Continued…

• Redesigning the New Nurse Graduate Residency Program to emphasize skills practice and soft skill education.

• Rolling out the Self-Care for HealthCare program to all staff. Over 800 participated in the launch sessions.

• Revision and posting of Mercy’s Performance Improvement Plan.

• Ongoing education from the Clinical Improvement team that is evidence-based and enhances the safety and quality of patient experiences.

• Providing education at department meetings when new services are established. (i.e. caring for the bariatric patient)

• Requiring staff to complete annual courses, competencies and web in-services.

• Facilitating periodic grand rounds and CME events for staff and providers.

You wish to have more clinical support staff assistance and development.

• Hosting and participating in multiple job fairs. • Establishing and offering a referral bonus. • Creating flyers, screen savers, lunch and learns, etc. to

create interest around Mercy and jobs we have available.

• Continuing growth (Med/Surg and Post-Acute) and formation of additional float pools (Critical Care and Women's and Children's).

• Implementing incentive pay policy. • Focusing on onboarding new staff and conducting

ongoing education for existing staff (using the skills library materials).

• Hiring educators for specialty areas. Educators are currently in place on ICC, CSC, ED, Med Surg and Birthplace.

You would like to see improvement in nursing staff recruitment and retention.

• Eliminating mandating and required extra shifts above the employee's FTE.

• Rolling out the Self-Care for HealthCare program to all staff. This program has provided us with a mechanism to better care for our staff which in turn decreases burnout and increases satisfaction.

• Continuing market reviews of compensation in an effort to retain staff.

• Creating an intern RN II program that allows graduated RNs to start their training before passing their boards. It is a temporary part-time position that allows the individuals to go through training while they are studying for boards. They go through training as a cohort.

• Increasing targeted advertising for specific specialties.

In the 2015 provider survey YOU shared…. MMC heard you and responded by: You would like to see improvement in nursing staff recruitment and retention. Continued…

• Pipeline building: partnering with KPACE (Kirkwood) on Health Professional Certification; partnering with Mt. Mercy on the BSN program, internship program and goodwill training.

• Hosting and participating in multiple job fairs. • Establishing and offering a referral bonus.

You wish to have additional support to address Epic and IT issues in a timelier manner.

• Hiring a new CMIO, Nicholas Hodgman. • Restructuring IT teams. • Continuing to look at ways of improving Epic training for

physicians. • Reviewing and revising Epic templates one department

at a time. • Beginning discussions on Epic access and reconsidering

authority to act within Epic.

NEWS RELEASE

For release: Immediate

Mercy introduces new, advanced technology for breast biopsies Mercy is first in Iowa to offer the 2D/3D prone biopsy system

CEDAR RAPIDS, IA (Oct. 24, 2016) – Mercy Medical Center has added a new 2D/3D system

for breast biopsies, making it the first hospital in Iowa to use the Affirm™ prone biopsy system

by Hologic™. This technology, the first dedicated stereotactic prone biopsy system offering 2D

and 3D imaging-guided breast biopsies, is now available at Mercy’s Women’s Center.

The system, which allows patients to lie face-down, or prone, on the specially designed exam

table, gives doctors better access to the breast and allows them to more precisely target lesions or

calcifications found during 3D mammography exams, as well as other screening procedures.

The system is designed to increase patient satisfaction through comfortable prone positioning

that eliminates a direct view of the biopsy needle, reduced need for surgery in many cases, and

faster procedure times. Improved efficiency means less time under compression for patients.

For physicians, using the system’s cutting-edge targeting and guidance technology offers

superior image quality, improved workflow, and 360-degree access to the breast with both

standard and lateral needle approaches, using a built-in lateral arm. Angles can be varied with

minimal movement on the patient's part, as the patient is supported stably throughout the

procedure.

This new system further expands Mercy’s comprehensive breast cancer care program, which

consists of top technologies and services from detection to diagnosis and treatment. Mercy’s

701 10th

St. SE

Cedar Rapids, IA

52403

319-398-6011

Contact: Karen Vander Sanden,

319-398-6083, 319-558-8424

From the office of Steve Drake,

V.P., Marketing Communications

arsenal of cancer-fighting tools and technologies include: 3D mammography, Molecular Breast

Imaging (MBI), Savi Scout®, Hidden Scar® surgery, MammoSite®, MarginProbe®, walk-in

mammograms, a fellowship-trained oncologic surgeon, nurse navigators, medical and radiation

technology, and other cancer care experts and technology.

Infection Prevention Bugs n’ Drugs 2016

“To prevent

germs from

infecting more

people, we must

break the chain

of infection. No

matter the germ,

there are six

points at which

the chain can be

broken and a

germ can be

stopped from

infecting

another person.”

The six links in the chain of infection are:

Infectious agent: the pathogen (germ) that causes diseases

Reservoir includes places in the environment where the pathogen lives

(includes people, animals and insects, medical equipment and soil and

water).

Portal of exit is the way the infectious agent leaves the reservoir

(through open wounds, aerosols, and splatter of body fluids including

coughing, sneezing and saliva).

Mode of transmission is the way the infectious agent can be passed on

(through direct or indirect contact, ingestion, or inhalation)

Portal of entry is the way the infectious agent can enter a new host

(through broken skin, respiratory tract, mucous membranes, and

catheters and tubes).

Susceptible host can be ANY person (the most vulnerable of whom are

receiving healthcare, are immune compromised, or have invasive

medical devices including lines, devices, and airways).

Break the chain by:

Cleaning your hands frequently

Staying up to date on your vaccines

Covering coughs and sneezes and staying home when sick

Following the rules for standard and contact isolation

Using personal protective equipment the right way

Cleaning and disinfecting the environment

Sterilizing medical instruments and equipment

Following safe injection practices

Using antibiotics wisely to prevent antibiotic resistance

Infection Prevention Bugs n’ Drugs 2016

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Insulin Subcutaneous CORRECTIONAL Order Sets (Adult):

Situation: • COMING SOON (Tentatively November 7th): Adult Insulin Subcutaneous Correctional order sets.

Background: • Certain patients have steroid induced hyperglycemia or other reasons blood sugars are elevated, but the patient is not diabetic and does

not need carbohydrate correction. • A patient may be NPO, be receiving Tube Feedings or TPN and need correctional insulin.

Assessment: • No adult order set existed in EPIC for correctional only insulin for patients who are eating and not needing to count carbs. • The current subcutaneous insulin order sets for NPO, Tube Feeding or TPN needed revising. • The Diabetes Committee reviewed current best practice and developed the attached order sets. • Order sets were discussed with the following committees/groups:

o Diabetes Committee – June 2016 o Clinical Readiness Committee – June 2016 o Medication Management Committee- June 2016 o Medical Director Council – July 2016 o Diabetes Champion Committee – September 2016 o Family Med/Internal Med Section – September 2016 o Medical Executive Committee – September 2016 (to approve expected ICF and ICR ranges) o Hospitalists – October 2016 o ICC Medical Directors – Scheduled for November 1st o EPIC Champion meetings – Scheduled for November 1st, 2nd and 3rd

Recommendation: • See attached NEW order set and screen shots for correctional insulin for patients who are eating but do not need carb correction. This

order set is titled “Insulin Subcutaneous, Correctional” • See attached REVISED order set and screen shots for patients who are NPO, receiving TPN or Tube Feeding. This order set is titled “Insulin

Subcutaneous, NPO/TPN/Tube Feeding” • If the patient is diabetic and consuming carbohydrates, continue to utilize the existing “Insulin Subcutaneous, Carb Count Meal” order set • Contact Jaclyn Smith with questions at 319-398-6725

[Type text]

Insulin Subcutaneous, Correctional Screen Shots The NovoLOG order has an informational chart at the time of ordering for the provider to reference regarding how to perform the calculations for TDD, ICF and ICR. These instructions are in color on the left of the order composer. We have also added information for expected ranges for ICF and ICR:

In the NovoLOG order, we have defaulted the ICR (Insulin to Carb Ratio) to “0” since for correctional purposes, no ICR if necessary. For the calculator to work properly for nursing, we must include an ICR of “0” in the order. There is no way for the provider to change this to any other number. If they un-check it, they receive a hard stop requiring them to check it.

[Type text]

E-MAR view when nursing goes to administer the NovoLOG bolus dose: The calculator looks to the ICR of “0”. When this is “0”, the calculator ignores the “Food insulin” field and does not factor in any insulin for carb correction in the total dose of insulin to be administered:

Insulin Subcutaneous, NPO/TPN/Tube Feeding: Screen shots are identical, except insulin has a frequency of “every 4 hours” instead of “3 times daily with meals”:

Print Order Set

Report ID Report Name Print304774602 PRL SmartSet Preview Print

Insulin Subcutaneous, Correctional [4080000038]meal blood sugar correction for steroid induced hyperglycemia, etc. -Intended Use: Pre

For carbohydrate meal correction, refer to the "Insulin Subcutaneous Carbohydrate Counting Meal" order set. patient is NPO, TPN or Tube Feeding, refer to the "Insulin Subcutaneous, If

NPO/TPN/Tube Feeding" order set

GeneralPOCT Glucose (Single Response)

POCT Glucose Routine, 4 times daily before meals and at bedtime

POCT Glucose Routine, 3 times daily before meals

and at bedtime

POCT Glucose Routine, 3 times daily before meals

Nursing Interventions

Hemoglobin A1C Once, Starting today For 1 Occurrences, Lab Collect

For blood glucose less than 70 mg/dl, treat per

hypoglycemia protocol

Routine, Until discontinued, Starting today

Notify provider - Blood Glucose Parameters Routine, Until discontinued, Starting today For Until

specified

-Blood glucose greater than 400 mg/dL

-Blood glucose is above goal and no change in insulin

orders have occurred in 24 hours

Give patient Diabetes Education Booklet Routine, Once For 1 Occurrences

MedicationsCorrective Insulin

Consider the patient's home regimen unless otherwise indicated. insulin aspart (NovoLOG) injection (For meal

coverage)

0-60, Subcutaneous, 3 Times Daily After Meals

TOTAL insulin to administer will be calculated using

the insulin dosing calculator in the administration

screen. Nurse to fill in the provided ICF, goal glucose,

ICR and carbs consumed in the first 4 rows of the

calculator. The ICR will be 0 since this insulin order is

for correction only. The calculator uses the following

equation = (premeal glucose - goal glucose) ÷ ICF

For blood glucose less than 70 mg/dL, follow the

hypoglycemic protocol.

Is this insulin for carb counting correction? No

Insulin Correction Factor (ICF)-Expected values

between 15 to 75:

Goal Glucose: 180

Insulin to carb ratio (ICR): 0

Basal Insulin

the patient's home regimen unless otherwise indicated. For steroid induced Consider mg of hyperglycemia, consider adding 0.1 units/kg of basal insulin for each 10

units/kg.prednisone or other steroid for a max of 0.4

insulin detemir (LEVEMIR) injection Subcutaneous, Bedtime

Page 1 of 2

Printed by KEARNEY, SARAH [4527] at 9/14/2016 12:13:29 PM

DRAFT

Print Order Set

Report ID Report Name Print304774602 PRL SmartSet Preview Print

Insulin Subcutaneous, NPO/TPN/Tube Feeding [4080000019]while NPO.should have a dextrose source equivalent to dextrose 5% at 75 mL/hour Patient eating meals.to "Subcutaneous Insulin, Carb Counting Meals" order set when patient Switch

GeneralNursing Assessments

POCT Glucose Routine, Every 4 hours, Starting today with First

Occurrence As Scheduled

Nursing Interventions

Hemoglobin A1C Once, Starting today For 1 Occurrences, Lab Collect

For blood glucose less than 70 mg/dl, treat per

hypoglycemia protocol

Routine, Until discontinued, Starting today

Notify provider - Blood Glucose Parameters Routine, Until discontinued, Starting today For Until

specified

-Blood glucose greater than 400 mg/dL

-Blood glucose is above goal and no change in insulin

orders have occurred in 24 hours

Give patient Diabetes Education Booklet Routine, Once For 1 Occurrences

If bolus insulin given in PACU at time different

than ordered on MAR, communicate in handoff

report

Routine, Until discontinued, Starting today For Until

specified

Receiving nurse to check blood glucose at next

scheduled administration time. If blood glucose is

greater than 300 mg/dL, contact physician for further

instructions, otherwise no insulin to be given and

resume scheduled protocol.

MedicationsCorrective Insulin

Consider the patient's home regimen unless otherwise indicated. insulin aspart (NovoLOG) injection (For meal

coverage)

0-60, Subcutaneous, Every 4 Hours - Insulin

TOTAL insulin to administer will be calculated using

the insulin dosing calculator in the administration

screen. Nurse to fill in the provided ICF, goal glucose,

ICR and carbs consumed in the first 4 rows of the

calculator. The ICR will be 0 since this insulin order is

for correction only. The calculator uses the following

equation = (premeal glucose - goal glucose) ÷ ICF

For blood glucose less than 70 mg/dL, follow the

hypoglycemic protocol.

Is this insulin for carb counting correction? No

Insulin Correction Factor (ICF)-Expected values

between 15 to 75:

Goal Glucose: 180

Insulin to carb ratio (ICR): 0

Basal Insulin

the patient's home regimen unless otherwise indicated. For steroid induced Consider mg of hyperglycemia, consider adding 0.1 units/kg of basal insulin for each 10

units/kg.prednisone or other steroid for a max of 0.4

insulin detemir (LEVEMIR) injection Subcutaneous, Bedtime

Page 1 of 2

Printed by KEARNEY, SARAH [4527] at 9/14/2016 12:11:18 PM

DRAFT

Mercy Medical Center

Welcomes Intensivist Linda Hodges, DO

Providing care for patients in Mercy Intensive Care Center during nighttime hours starting in November.

Dr. Hodges holds a bachelor’s degree from Truman State University and attained her Doctor of Osteopathic Medicine from Kirksville College of Osteopathic Medicine, both in Kirksville,

Mo.

She comes to us from Comp Health with sites in Georgia and South Dakota where she provided coverage for facilities in need of intensivist services.

In her downtime, she enjoys running marathons and activities that promote fitness,

nutrition, improve overall health and prevent chronic disease.

Pharmacy Update: The order for Dexmedetomidine (Precedex) will be changing to help guide use based on medication use restrictions approved by the Medical Executive Committee (MEC). Please see the example below as there will be some additional fields that need to be filled out before ordering. This order will be live 11/09/2016.

A PARTNERSHIP UNITYPOINT-ST. LUKE’S HOSPITAL • MERCY MEDICAL CENTER • PHYSICIANS’ CLINIC OF IOWA

600 7th Street SE • Cedar Rapids, IA 52401phone.319.362.4433 • tollfree.877.361.4433 fax.319.362.4466

EISC Use Only – Thank you!

Scheduled Date/Time:

EISC Dr. signature:

EISC Approval/Date: CO2: Y N

EISC No:

EISC LOCATION PREFERRED: o EISC Cedar Rapids (default) o EISC Belle Plaine

Patient first name: ______________________________________ Patient last name: _______________________________________________

Address: ________________________________________________City: _______________________State: _______ Zip: ______________

Cell phone: ___________________________ Home phone: ___________________________Work phone: ___________________________

DOB: _______________________ Gender: M F Weight __________Height _______________ Neck circumference __________ inches

Sleep hours: o Night o Day o Shift work o Other hours ________________________________________

Special needs:oOxygen o Wheelchair o Walker o Other _______________________________________

INSURANCE INFORMATION: Please provide front and back for card(s)Primary Secondary Pre- AuthInsurance: _____________________________Insurance: _________________________________Form/ #: ____________________________

ATTACH ORDERING PROVIDER NOTES – Per insurance requirements medical necessity must be established by a face-to-face visit by the ordering provider prior to the study and documented in the patient medical record. Medical necessity includes, but not limited to two sleep symptoms: snoring, witnessed apnea, choking or gasping during sleep, excessive daytime sleepiness, disturbed/restless sleep. Additional comorbidities and symptoms may be sent as appropriate.

PROVIDER ORDERS:DX: OSA (unless otherwise indicated) DX: ____________________________ DX: _________________________

o Diagnostic PSG 95810 & 95811 (polysomnogram) w/ split night if indicatedo Diagnostic PSG 95810 (polysomnogram) ONLY, no additional testingo Home Sleep Apnea Test 95806 (HSAT) High pre-test OSA ONLYo PAP (re)titrations with CPAP or BiPAPo Consider CO2 monitoring

Failed CPAP & BiPAP – a Sleep Medicine consult is required for next steps, including potentially BIPAP-ASV, BIPAP-ST or other treatment options.

For MWT, MSLT, Actigraphy please discuss with a Sleep Medicine Provider first.

Previous study done at:

Sleep Aid: None: ____ Zaleplon(Sonata) _____ mg Zolpidem(Ambien) _____ mg Eszopiclone(Lunesta) ______mg Other: ______________

IF YOU HAVE PROVIDED YOUR PATIENT WITH A SLEEP AID, PLEASE INSTRUCT THEM TO BRING THE FILLED PRESCRIPTION WITH THEM TO THE SLEEP STUDY. THE SLEEP TECHNICIAN WILL INFORM YOUR PATIENT WHEN THE SLEEP AID SHOULD BE TAKEN.

Referring Provider _____________________________________ Phone:_________________________ Fax: ___________________________

Referring Provider Signature: _________________________________________________________ Date: _____________________________

PCP (if different): ___________________________________________________________________ Phone: ___________________________

(Print)

Select one of the following should the patient have a sleep disorder:o Send the patient for follow up and treatment to a PCI Sleep Medicine Provider. o I will follow up with the patient regarding the test results.

INSURANCE REQUIRING PRE-AUTHORIZATION (PA)

UHC – United Health Care & UHC – River Valley

AETNA (Med Solutions 888-693-3211)

Midlands Choice

Humana (Health Help 877-883-5690)

BCBS ANTHEM (AIM Specialty Health 866-745-5995) (Anthem policies thru Alliant and Rockwell do not need PA)

AARP Medicare Complete (insured thru UHC)

CIGNA (Care Centrix 877-877-9899)

Coventry PPO (800- 470-6352)

Amerigroup (800-600-4441)

UHC Community Plan (Medicaid plan) is the only UHC policy that does not require pre-authorization.

Secondary coverage

UHC- River Valley and Amerigroup as a secondary insurance,

require pre authorization.

10/7/2016