St. Vincent

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St. Vincents Clinic Volunteer Orientation

• 2005 2006

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Outreach and Services ofSt. Vincents House

• St. Vincents House is a comprehensive community
  outreach organization begun in 1954
• Focuses on the needs of a forgotten people the
  working poor and those persons moving from
  welfare to work
• Situated in a neighborhood where the average
  income is well below 10,000, our services at St.
  Vincent's House are targeted to help the growing
  number of families and individuals who are
  working at minimum wage, seasonal or part-time
  low paying jobs and do not have any benefits.

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Clinic History and Mission

• Clinic began in early 1990s
• SVC is a cooperative effort between UTMB and St.
  Vincents House, committed to providing competent
  healthcare to the underserved population of
  Galveston while facilitating the education of
  UTMB Medical and Physician Assistant students

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Overview of Volunteer Responsibilities at Clinic

• Underclassmen (aka MS-I, MS-II, PA-I students)
• Expected to participate in the evaluation and
  management of patients includes HPs, writing
  notes, formulating treatment plans, and
  presenting to faculty
• Be eager to learn by seeing and doing
• Can do as much or as little as you want depends
  on your comfort level
• General rule of thumb watch one, do one, teach
  one applies!
• The hope is for you to gain experience with
  real patients early in your career, which will
  be invaluable when you hit the wards

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Overview of Volunteer Responsibilities at Clinic

• Upperclassmen (aka MS-III, IV, and PA-II
  students)
• Expected to assume a leadership role as junior
  faculty
• Two main jobs Mentor junior students See
  patients
• First priority is to help junior students with
  their patients, management plans, and
  presentations
• Also be there to evaluate and manage SVC patients
• Your presence is vital for smooth clinic
  operations!

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Virtual Tour of St. Vincents Clinic

• Step 1 The Patient Arrives
• The patient arrives and checks in at the front
  with Debbie, aka the woman whom SVC could not
  function without

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Pictures of the clinic from the outside
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We love Debbie!!!
Waiting room full of patients to be seen
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Virtual Tour of SVC

• Step 2 Review the Chart
• Take a patients chart on the door of the front
  office to review
• Focus on the CC, PMHx, current meds, pending lab
  results, and what happened at their most recent
  clinic visit

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Virtual Tour of SVC

• Step 3 Play Doctor
• Call patient when ready and bring them to exam
  rooms
• Interview and examine patients with your arsenal
  of POM skillz that would make Dr. Beach proud!
• All instruments and tools you may need for exams
  are either in the rooms or the lab area
• Students are expected to do everything for the
  patient this means taking vitals, doing labs,
  etc yourselves!
• Dont be afraid to ask if ever uncertain about
  your history and exam were all here to learn!

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A typical patient-student interaction (note when
the clinic is busy, we overflow into the
outside/common areas)
A typical exam room fully loaded with BP cuffs,
a sink, and plenty of stool guaiac cards!
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Virtual Tour of SVC

• Step 4 Present to Senior Student
• Present your case to an upper level student
  (MS-III, IV, or PA-II) and establish a plan after
  examining your patient
• Upper level student volunteers will make the
  mentoring of junior students a top priority

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Sameet (MSIV) helping out Viet (MSII) with
questions about his patient
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Virtual Tour of SVC

• Step 5 Organize Medications
• Organize meds and draw pertinent labs BEFORE
  presenting to faculty
• 3 sources of meds for SVC patients
• Samples
• PATIENT ASSISTANCE
• Prescriptions
• Basic labs that can be checked before presenting
  include blood draws, UA, and BG fingersticks

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Overview of SVC Medications

• Samples
• Local physicians donate tons of samples and keep
  our pharmacy stocked
• When dispensing samples, remember to document in
  the chart
• LOT (on the bottle)
• EXPIRATION DATE (on the bottle)
• Number of pills dispensed

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Closets full of samples in our pharmacy
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Overview of SVC Medications

• Patient Assistance
• Program started at SVC in 2003 to get meds for
  patients direct from pharmaceutical companies
• Provides meds to our patients, who would
  otherwise not be able to afford them
• A true win-win situation free meds for
  patients at no additional cost to the clinic

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Overview of SVC Medications

• Patient Assistance
• Patients that are good candidates for this
  program are those with chronic diseases requiring
  regular continued medications
• Use your judgment to differentiate chronic from
  acute e.g., 5 days of ABx for a UTI vs a 10
  year h/o diabetes controlled by 2 different
  hypoglycemic agents
• When in doubt, just ask!

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Overview of SVC Medications

• 7 Easy Steps to Patient Assistance
• Have patient sign consent form this allows us
  to sign their names for them when filling out
  their med applications
• Add patients name, meds needed, and date to the
  clipboard on the door to the pharmacy
• If the patient is out of meds now, dispense a Rx
  for 4-6 weeks this will hold them over until
  we receive the meds at the clinic
• Tell patient that they will get a phone call from
  Debbie when the meds arrive (usually 4-6 wks) and
  then can come pick them up

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Overview of SVC Medications

• 7 Easy Steps to Patient Assistance
• Remind patient that when they have 1 month of
  meds left, call Debbie or come to clinic to
  reorder - this insures an uninterrupted flow of
  medication
• Document!! In the chart AND in the Patient
  Assistance Excel spreadsheet on the computer
• Patient receives 3-4 months of meds with each
  order

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Overview of SVC Medications

• Prescriptions
• Fill out Rx using regular format if youre
  unsure of how to do this, just ask
• All pads to be kept in the front office at all
  times!
• Stamp all Rx with St. Vincents Clinic stamp
• Tell patient to fill Rx at UTMB Outpatient or
  Inpatient pharmacy
• All Rx need faculty signature
• Patients do not pay anything to fill an SVC
  stamped Rx at UTMB

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Virtual Tour of SVC

• Step 6 - Labs 101 the Basics
• Blood Draws
• Gather materials tubes, tourniquet, needles,
  bandaid, etc
• Fill out appropriate forms example forms are
  found taped to the wall in the lab area
• (Note key for figuring out what type of tube to
  use is found on this form as well)
• Place finished bloodwork in clear bag and drop in
  red bin on the counter
• ALL bloodwork needs to be double documented in
  the lab area and the chart! including CBC, chem
  panel, STD labs, TB tests, etc
• After drawing/performing these tests, be sure to
  document on the form taped to the counter in the
  lab area!!!

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Bottle of strips for UAs
Proper lab documentation on the forms
Finished blood work in the clear bag with a form
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More pictures of the lab complete with a
microscope for wet preps, etc
Box for finished bloodwork
Box of needles for fingersticks
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Virtual Tour of SVC

• Step 6 - Labs 101 the Basics (contd)
• Urinalysis
• All necessary materials are in the lab area
• PLEASE pour out specimens when finished!
• Blood Glucose Fingersticks
• Glucometers are to be kept in the front office
  when not in use please remember to bring them
  out of the rooms so they can be tracked
• Spring-loaded, single-use needles and strips are
  kept with the glucometers in the cases

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Virtual Tour of SVC

• Step 6 -Labs 101 the Basics (contd)
• Vaccines
• Vaccines are kept in the fridge in the lab area
• ONLY DIRECTORS may access vaccines!!
• If you need to give a vaccine, please notify a
  director!
• Be sure to double document vaccine administration
  in the chart AND the form in the lab area

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Tal (MS-IV) demonstrates proper
documentation of labs. He double documented in
the chart shortly after this picture was taken.
Refrigerator lock-box full of vaccines
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Please be careful when handling anything in the
lab!!!
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Virtual Tour of SVC

• Step 7 - Time to Present to Faculty
• Have as much as possible done PRIOR to presenting
  
• Have medication refill Rx filled out and ready
  for signing so all the faculty has to do is sit
  back, listen, and pimp
• Goal is for us the students to act as providers
  and the faculty to be there for support
• Dont be afraid to be wrong in front of faculty
  were all here to learn and theyre here to
  teach!
• Senior students are your best resource for
  organizing your plan and for tips about how to
  present properly please ask if you feel lost!

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Virtual Tour of SVC

• Step 8 - Consults and Radiology
• Radiology
• Starting this year, UTMB radiology dept has
  graciously allowed for us to send pts to get
  imaging studies free of charge
• Patients must first complete a financial screen
  (DAMP office) at UTMB to verify eligibility and
  need
• We fill out the paperwork and patients are called
  to schedule an appointment
• If any of your patients need imaging studies,
  please find a director to help you out
• This is a brand new arrangement b/t SVC and Rads
  that will be huge for our patients but can be
  confusing at first

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Virtual Tour of SVC

• Step 8 - Consults and Radiology (contd)
• Consults
• Consults process is similar to radiology
• Patients undergo financial screen at UTMB first
  and are then contacted by that UTMB dept for an
  appt
• Fill out the appropriate consult form and drop it
  in the box for consults in the office
• Again, if your patient needs a consult, please
  find a director to help you out

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Virtual Tour of SVC

• Step 9 - DOCUMENT!!!
• Document in the chart e.g.,
• Fill out the visit note thoroughly,
• Document sample meds distributed (lot s and exp
  dates)
• Document Rx given
• Document labs drawn
• When does the pt need to follow-up?
• Document EVERY patient encounter in the SVC MS
  Access database on the computer
• Document ALL patient assistance orders in the
  appropriate place on the clipboard AND the
  computer spreadsheet
• Document ALL immunizations given (if applicable)
• Return finished chart to the box next to computer

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Common Myths about Volunteering at SVC

• Myth 1
• Im only a first year and I dont think I know
  enough yet to be of use at the clinic.
• Junior level students are the foundation of SVC
  and without you, the clinic would NOT be able to
  run, PERIOD.
• SVC is meant to be a low pressure learning
  environment
• Were all volunteers, were all here to learn,
  and youre NOT being graded
• Student at all levels come to clinic to learn the
  practice of medicine in a real world setting with
  real patients and real problems (no POM actors
  here!)

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Common Myths about Volunteering at SVC

• Myth 2
• There are always too many students and not
  enough patients at clinic or vice versa and I was
  overwhelmed.
• Usually happens at very predictable times of the
  year
• Beginning of each semester are notoriously
  crowded e.g., eager new students ready to see
  real patients in the fall and those with New
  Years resolutions to volunteer
• First clinic following a round of exams as people
  now have time to volunteer
• Down times _at_ SVC usually around Oct-Dec and
  mid-late spring same of patients in need with
  not nearly enough students to help out!!

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Common Myths about Volunteering at SVC

• Myth 2 (contd)
• There are always too many students and not
  enough patients at clinic or vice versa and I was
  overwhelmed.
• Preferable for students to sign up in advance
• If you show up, you can always stay and help but,
  when overcrowded, scheduled students have
  priority
• Thinking ahead and coming at times (Sat AM) when
  classmates may be studying or nursing hangovers
  (Yagas) often translates into great learning
  opportunities with one-on-one faculty
  interactions

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Common Myths about Volunteering at SVC

• Myth 3
• Faculty are scary
• Faculty can be intimidating at first, but they
  all volunteer their free time b/c they enjoy
  working with students and with our patient
  population
• Dont let jitters about presenting or the fear of
  not knowing an answer when pimped dissuade you
• Medical schools challenging but if you dont put
  yourself out there at places like SVC, youll be
  missing out on invaluable learning opportunities

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Common Myths about Volunteering at SVC

• Myth 4
• Im a third or fourth year and Ill probably
  be too busy to make it to clinic during
  rotations
• You actually have quite a bit of free time during
  third year see psychiatry, family medicine, and
  medicine consult
• Lets be honest fourth year is a cakewalk
• We want to build on this past year and continue
  to see good support from MS III and IV students
• In the past, third years would disappear for a
  year and then maybe came back to clinic early in
  first semester of fourth year
• By doing so, youre missing out on one of the
  most rewarding opportunities at SVCTEACHING!

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Common Myths about Volunteering at SVC

• Myth 4
• Im a third or fourth year and Ill probably
  be too busy to make it to clinic during
  rotations
• Clinic is dependent on upperclassmen students to
  be there to help underclassmen with their A/P,
  presentations, and to answer questions
• You may not think youre ready to teach others
  but believe it or not, youve all learned a lot
  of stuff that you take for granted e.g., after
  taking renal with Dr. Beach, were all aware of
  the use of ACEIs in diabetics but most first
  years dont even know what an ACEI is, let alone
  how and why they work specifically in
  diabetics..get the idea?

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Common Myths about Volunteering at SVC

• Myth 5
• I get hungry and need to eat regularly, so
  theres no way that I could miss a meal to
  volunteer. It just doesnt jive with my
  metabolism and physiology.
• Free food for volunteers is always provided as a
  thank you from the clinic

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Shameless attempt to buy volunteers with
pizza (shameless plug Marios pizza really is
the best on the island!)
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St. Vincents House Contact Info

• St. Vincent's Episcopal House2817 Postoffice
  StreetGalvestion, Texas 77550Office (409)
  763-8521 Fax [phone]

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Directions to SVC

• From John Sealy, go down Harborside towards the
  causeway
• Turn Left on 28th St.
• Clinic is located on right hand side at corner of
  28th and Postoffice St.

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Contact Information

• Faculty Advisor
• Dr. Robert Beach rebeach_at_utmb.edu
• Student Co-Directors
• PA-II
• Kristin Pogue kepogue_at_utmb.edu
• Ashley Ready akready_at_utmb.edu
• MS-IV
• Bryan Bruner bcbruner_at_utmb.edu
• David Rider dmrider_at_utmb.edu
• Janet Tcheung wytcheun_at_utmb.edu
• David Ming dyming_at_utmb.edu

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Any Questions?