Clinic Procedures

Agape Clinic & Community Care Procedures

General Principles (the below applies to students, volunteers, and paid staff)

Treat each patient with respect.
Be sure that the patient stays in the loop of care (follow-ups, referrals, financial classification, outcomes).
Be sure that the patient understands the problem and the plan.
Use the Old East Dallas Community Resource Guide to determine how to solve problems.
Remember that you are responsible for ensuring that your patient receives quality care. There is nobody else to do this - if you fail, the patient does not receive the care. If you wait, the patient does not receive care until you take care of the problem.
Our patients and families - and the community we serve - experience terrible difficulty accessing health care and other services. Connection to services is always a priority. All families with children should be given a CHIP application and, time permitting, given assistance filling it out. Encourage people to return to the clinic for social work assistance with any letters or questions in response to the CHIP application.
Adult patients should be assisted in understanding the Parkland/EDHC registration process. Details are found in the Community Resources Guide. Pre-registration is important. Patients who show up for treatment at EDHC without proper documentation will be charged full-fee. The registration process is arduous for most of our patients, but it is worth the trouble. People who work for cash have great difficulty registering and receiving services. Income tax returns may suffice as income documentation. Check with our social worker.
Always look for and document outcomes: Decreased BP, blood glucose, early prenatal care, positive change in behavior, and so on are what we are trying to achieve. Top

Staffing

Front Coordinator: The front coordinator works with the social worker to coordinate set up, sign in patients, pull charts, know who is waiting and why (requires frequent checks of the waiting room), patient flow, ensure support for the back manager, and whatever else is needed to keep the clinic running smoothly. Stays aware of noise level and keeps waiting room from becoming too chaotic. Depending on circumstances may take vital signs and obtain histories (stays aware of need for confidentiality).

All staff should stay aware of who is waiting to be sure that nobody is lost in the shuffle.

Back Manager: Responsible for orderly flow of patients, information, medications, and staff in the exam area and pharmacy. Insures that charts are complete (VS, wt, allergies, etc.). Assigns and delegates as needed for efficient operations. May pull people from other areas. Keeps exam rooms filled. Coordinates with front coordinator.

Primary Nurse(s): Take histories, perform initial assessments, and complete charts. Accompany patients when seen by nurse practitioner (NP) or physician. Assist NP or physician, ensure that patients obtain correct medications, assess need for assistance obtaining medications with Rx, teach medications and related material. Perform teaching and related after patient is seen by physician.

Pharmacy: The "pharmacist" pulls, counts, and labels the medications. The NP, physician, or health educator (promotora) confirms all meds correctly filled, teaches patient about medications, and gives the medications to the patient. Also, see "After the patient sees the doctor or nurse practitioner below."

Missionaries (Currently Lupe Springer): provide spiritual care to patients/families identified by other staff as needing spiritual care. Talk with patients/ families in the waiting room. Make home visits.

Social Workers (Leslie Kemp or promotora): Screen each patient. Assist patients obtain other types of services, make and follows-up on referrals, make home visits.

Lay Health Promoters or Promotoras: Teach patients and families, assist patients obtain other types of services, make home visits, accompany patients to appointments, assist with screening, provide translations, and other responsibilities according to patient/family needs.

Volunteers: Check-in. Read to children and otherwise assist parents and patients in the waiting area, help patients obtain prescriptions, transport patients to other sites of care, make HVs with nurses. Top

Partners

Among the partners actively providing care are the Agape Clinic, Louise Herrington School of Nursing Baylor University (BUSN), Concilio Dallas, Common Grace Ministries, East Dallas Cooperative Parish, Dallas County Health Department, Emanuel Lutheran Church, and, of course, Grace United Methodist Church. Top

Records and supplies

Records are kept locked in the cabinets by the check-in desk. It is very important that the cabinets are always locked when we are all out of the room.

Some charts are kept by family head-of-household name (previous format - some older charts still like this) and some (newer charts) by individual names. Shot records are kept in separate files. If a chart is not found under the patient's name, look under the family name. It sometimes happens that charts are filed under the patient's first name rather than last; and of course charts are sometimes misfiled. So you may have to look in several places to find a patient's chart.

Most paper and related supplies are kept in the bottom drawers of the files. Please tell CK (write it down) if any form is in short supply.

Medical supplies and medications are a challenge to keep in stock. Write down any supplies or medications that are in short supply. Give to CK.

Setting up (and closing)

(Everyone helps - The Manager is responsible for ensuring that setup and closing are correct. Oto-opthalmoscopes (Dx sets), glucometers, and other equipment is in the pharmacy and handles kept plugged in in the workroom.

Unlock church door, alarm off, and setup sign to clinic.
Sign-in sheets on clipboard on desk + pens, paper clips, permit to treat, donations can setup.
Arrange waiting room chairs.
If sewer smell present, set up fan atop gray files.
Check for patients with appointments (note should be attached to clipboard).
Have 20 blank charts ready to go (folder; permission to treat and demographic sheet on left; and blank Progress Notes sheet or last SOAP on right).
Set up exam rooms, including exam tables & paper, chairs, oto-opthalmoscopes, canulas, tongue blades, gloves.
Post signs about family planning, etc.

Closing (the goal is for the people working the next day to walk in to a clinic that looks better than when they left the previous week)

All charts filed.
Sign-in sheet completed (diagnosis, disposition, etc.) and given to CK.
Plans set about referrals, other related actions.
All equipment ready-to-go except oto-opthalmoscope handles plugged back in.
Be sure pharmacy is in better shape than it was at the beginning of the day.
If any supplies or medications are noted to be running low, give info to CK and leave note for Agape on the counter in the exam area.
Exam rooms cleaned (except for sweeping and trash) and table paper fixed.
Exam area cleaned and straightened, including counter tops. The janitor will take care of the floor and trash.
UA machine and pulse oximeter turned off.
Lock (1) pharmacy, (2) door to exam area, (3) files, (4) door into clinic.
Alarm set if nobody else in church. CK knows details.Top

As patients enter the clinic

Identify any patients who are ill-appearing, febrile, toxic, confused, short of breath, having chest pain or other significant S/S. Discuss immediately with physician or NP.
Check in staff/volunteers handle check-in paperwork. If volunteers not present, job is assigned by the Manager. Intake staff provide triage and open charts (job description above). Primary nurses complete initial assessments - usually in an exam room, but sometimes in waiting room (job description above). Patients who come in after the limit on number of patients is reached should be assessed and appointed to the next session or referred to an appropriate provider. Please check with Baylor faculty before providing referral service only. Never send a patient away without providing concrete assistance.
Greet each patient as you would expect to be greeted at a church or expensive restaurant.
People who are very ill may need to be moved to an exam room. Children with fever should be medicated (talk with instructor).
Some people walk in and sit down without signing in - stay aware of who is sitting in waiting area and ensure that nobody is overlooked.
In most cases, this done by Leslie: Sign in each patient, including full address, CC (being sensitive to privacy issues, etc.). Staff should fill in the sign-in sheet for the patient or should verify that the information is accurate and legible. If a new patient, write "New Patient" beside the patient's name. The sign-in log and corresponding chart numbering (below) determines the order in which patients are seen (unless the patient is in distress or otherwise requires immediate care). The Manager decides whether patients need to see the physician or Baylor faculty. See below for new patient procedures. Charts should be opened on all patients, including immunizations (see below discussion of immunizations), social work, CHIP applications, etc..
Pull chart if the patient has previously been to the clinic and confirm address from sign-in sheet. If the chart is not where you expect to find it, look also under the first and middle names or spouse or parent name. Keep looking!
Open a new chart for new patients (see new patients below).
All charts should have number put in upper right hand outside corner of the chart (corresponding to sign-in order).
Patients should be given the permission to treat form during the sign-in process. Be sure the form is signed and that parents list all their children on the form.
Charts for children should have an age-appropriate (1) developmental chart clipped on to the left side of the chart and (2) Babies First! "What Your Baby Can Do" sheet loose in the chart so that the doctor or nurse practitioner can discuss and give to the parent.
Patients referred to Parkland or EDHC will have to provide complete documentation at EDHC or be charged full fee. Quite a bit of work is required to accomplish this for many of our patients - but the work is well-worth the payoff for the patients. See current requirements for EDHC in the Community Resources Guide. Often we need to make a home visit to gather all necessary papers. Make a copy of all papers and place in chart. Although this process is somewhat burdensome for the patient (and us), completing the process means that low-cost quality care will be available six days/week at EDHC. Top

Established patient procedures (also see GYN)

Patients who have an established chart need to have current problem SOAPed, including a brief recap of history of previous visits and care given and identification of outcome(s) of previous care. Note any +/- patterns in response to treatment, e.g., downward trend in BP, lack of pattern in blood glucose, improved compliance, etc. Complete history and necessary testing, e.g., UAs for women with lower abdominal pain and related, UTI Sx, etc.; DFS - note if fasting - for patients with diabetes; peak flow on patients with asthma or other respiratory difficulties). Use the assessment guide form to improve history-taking.

Check with families who have children whether they have begun the CHIP application process. If not, they should be given a CHIP application and, time permitting, given assistance filling it out. Encourage people to return to the clinic for social work assistance with any letters or questions in response to the CHIP application. Top

New patient procedures (also see GYN)

Charts are to opened for all persons requesting health or other services from us.

Include health promo (if adult), growth chart (if pediatric), medications, demographic data, and permission to treat form signed.
Immunizations: See the next section below.
Check-in: Talk with Baylor faculty if VS remarkable, patient is toxic or extremely ill, or has fever. Permission to treat form must be signed and dated and demographic data obtained.
History and Assessment (Primary Nurses): Be sure all work is complete, including LNMP, Hx violence, etc. Use the one page assessment guide to help focus the assessment.
Histories and initial assessments should be completed in an exam room. Always be sensitive to privacy issues.
Start CHIP process for all pediatric patients: All families with children should be given a CHIP application and, time permitting, given assistance filling it out. Encourage people to return to the clinic for social work assistance with any letters or questions in response to the CHIP application.
Patients who have the potential to infect other patients should wait in the long hall by the Fellowship Hall.
Patients needing to see the NP or doctor should have charts numbered in upper right corner. These charts should have all necessary demographic data included.
Make contact with everyone in the waiting room. At a minimum, ask adults who are not waiting to see the doctor if they have any health problem(s) or question(s). If time allows, take all adult blood pressures, whether they are patients or not.
Assist with referrals for family planning and other requests. Top

Women's Health/Gynecological Care

For the gynecological visit to run smoothly the room should be set up and supplies gathered before the nurse midwife (CNM) and first patient arrive. I suggest that you print this page and keep it handy throughout your work with the CNM

Preparing the room

The last room on the right (#3) is used and a privacy screen is put in front of the door for additional privacy.

Position the exam table diagonally from the corner with the feet end closest to the counter space.
Place the rolling stool (that can usually be found in the room) at the end of the exam table for the examiner.
Check that the lamp is in the room and is working.

Gathering supplies

Supplies need to be set up before each new patient excluding the paper towel with jelly that can be reused unless contaminated.

Organize the counter space to have extra room so that you can set up your supplies, and check to be sure there is a box of small gloves available.
Place 2 paper towels down on counter and in the drawer under the exam table in front you will find a tube of lubricant jelly. A squirt a little larger than a quarter is usually enough for four patients, place this in the lower left hand corner closes to where the Midwife will be sitting.
You will also need 1 Cervix brush, 1 Prepstain specimen container (for the Pap), and 1 package containing 2 cotton swab sticks and a specimen tube (for Chlamydia/Gonorrhea testing) which is in the 2nd drawer in front of the exam table. Open the package and lay out the specimen tube and open the end of the cotton swabs on the paper towel so the Midwife can just grab the end of them when it is time. Also lay the Cervix brush, Prepstain specimen container, and 3 small gloves on the same paper towel that has the lubricant jelly. ***(Check to see if Midwife wants normal saline in medicine cups for exams - if so barely fill the bottom of the cup).
There is a pinkish lab sheet out on the Pharmacy counter behind the microscope or you can sometimes find them by door in exam room that you will also need for each patient.
To fill it out put patient’s full name in space, patient I.D. which is her date of birth, also put her date of birth, address is Agape Clinic with phone number, check and circle indigent in upper left hand corner. On lower right side of paper check endocervical and in Other put PAP w/HPV if abnormal and check Chlamydia w/o differential. On the top of lab sheet there will be stickers: put one on each of the 2 specimen containers. Write the patient’s name, I.D. number (date of birth), and the date on each specimen container.
On the side of the exam table you will find paper gowns and smaller paper covers in the drawer that you can place on the table for each patient.

Patient preparation

Note GYN at top of progress note.

Patient Vitals: Call the patient from the waiting room and obtain her weight and height. In the room take the patient’s blood pressure, pulse, respirations, and temperature.

Patient History: A history should be obtained including questions from top of SOAP note (draw line through negatives; circle positives), reason or any problems leading to visit (details if not just for Pap smear, but do not put on sheet, discuss w/midwife first), gravida (how many times pregnant past 20 weeks), parity (living children), any abortions, date of last menstrual period (LMP), method of birth control, (if any), and whether she is sexually active. Note dates LMP on lab sheet.

Patients who are within child-bearing age/years and cannot recall period or has not had period in over a month need UA and HCG

Preparation: When you are finished obtaining the history, explain the exam and ask if she has any questions. Give her a written explanation of the exam (Spanish/English) and explain to patient to take off ALL of her clothes, put gown on with opening in front, and that the Midwife will be in shortly. Arrange for translator if needed.

Assisting with the exam

The midwife will complete her history, breast exam, and then will begin the pelvic exam. During the exam /Pap smear you will be responsible for setting up lamp in appropriate position (she will help you), handing her the supplies she needs as follows:

2 gloves,
then Cervix brush,
hand her the 3rd glove,
hold the open Pap specimen container (Prepstain) for her, then
she will need the cotton swab sticks, and
you will need to hold the open lab specimen container for her.
Patients over 50 years will need stool guiac set-up.

After the exam you will both leave the room and allow the patient time to get dressed.

After educating the patient on her needs/treatment and explaining that she will only hear something from the clinic if there is anything abnormal she will be dismissed and you will need to clean up (throw away any trash) and prepare for next visit (see Preparing the room and Gathering supplies).

You will also need to place patient’s 2 lab specimens in plastic Ziploc bag with original copy of laboratory sheet after the CNM has signed it. Put this in a brown paper bag that all patients’ labs will go in for the day. Put note on front of chart to fill in lab pending. Author: Ciri Snyder (Fall, 2004) Top

Immunizations (not currently done except Td when indicated)

On days when the Dallas County Health Department has few or no refugees to screen, they will take care of most or all immunizations at the refugee agency next door to the church. Until we know how many screens they have (we find out about 0900 when the County arrives @ the refugee agency) we will (1) maintain a list of people needing immunizations and (2) start immunizing them. It is imperative that the list for immunizations be updated at the refugee agency every 15 minutes to ensure that clinic patients do not lose their place to others who come into the refugee agency. Clinic patients coming for immunizations should be escorted to the refugee agency by a clinic staff person or volunteer. If there are large numbers of refugees to be screened at the refugee agency we will take care of clinic immunizations to the best of our ability. Paperwork and services for immunizations should be completed as follows:

Permission to treat form filled out and signed.
Demographic page filled out.
CHIP application given (and assistance filling out as time permits).
SOAP sheet with name, vitals, allergies, pregnancy, breastfeeding, and other spaces filled in (discuss any positives with C Kemp or physician). Determine if (1) past complications (convulsions within 3 days after past immunizations, fever >105 within 48 hours, collapse or shock, inconsolable crying for 3 hours); (2) acutely ill with high fever (URIs, OM, mild diarrhea are not reasons to delay immunization); (3) altered immune response such as oral/parenteral steroids past 30 days (child or adult in close contact). Check with Mr. Kemp or physician if any + responses. Note what immunizations are given and the number in series (e.g., MMR #1, Hep B #3, etc.).
Agape assessment sheet, including name and address, signature of parent if patient is a minor, all immunizations given, site, number in series (e.g., MMR #1, Hep B #3, etc.). I understand that there is some duplication of effort here, but it cannot be avoided.
Colored TDH sheets for each immunization, again with the number in series (e.g., MMR #1, Hep B #3, etc.) noted.
These last two Agape documents should be kept in a separate stack from the chart and given to C Kemp at the end of the day. The chart goes back to the front desk to be filed at the end of the day.
School forms should be filled out and signed by C Kemp.

Also see Vaccination Procedures.

The waiting area (front manager responsible; all staff participate)

Stay aware of who is in the waiting area. Be sure nobody is deteriorating or sitting forgotten and waiting for something to happen. Walk through and make contact with people.

People who are very ill may need to be moved to an exam room. Children with fever should be medicated (talk with instructor).

Intake staff (usually one student) helps check patients in, obtains VS, CC, and other health data as appropriate; and, when the first press of patients is done, begins health screening.

Children who have to wait a long time may become fussy or difficult to manage. Volunteers or others should read to the children. We have crackers for those who become hungry.

Volunteers and nurses (time permitting) should interact with parents and children. Talk to parents about reading to their children as a way of maintaining closeness to the children and improving the children's reading ability.

We have books in the waiting and the back storage rooms. There should always be children's books in the waiting room. Children can take 1-2 books home. Books for older children are also available. Top

Seeing the doctor or NP (manager & primary nurses)

There should be patients (completed histories and necessary testing done, e.g., UAs for women with lower abdominal pain and related, UTI Sx, etc.; DFS - note if fasting - for patients with diabetes; peak flow on patients with asthma or other respiratory difficulties) waiting in the exam rooms.
If a translator is needed, have her or him ready to go when the doctor is ready to see the patient.
The Primary Nurses change the paper on the table, have the chart ready (check to see if complete), and otherwise helps make the doctor's job easier.
When the patient is being seen, the Primary Nurse should be present to assist and to learn.
If a prescription is written, the doctor should note how many refills are okayed on the SOAP note so that medications can be refilled when the doctor is not present. Top

After the patient sees the doctor or NP (& filling prescriptions)

Introduction, Supplies and Tools

At the start of a morning or during a quiet time familiarize yourself with where supplies are.
Review the medications and how they are grouped on the shelves
Note the backup drug boxes and extension of the heart drugs on the West wall
Medications are also stored in the refrigerator
Review all the different prescription labels for creams, pills, inhalation, and suspensions. All are available in both Spanish and English and are on the table in labeled folders.
Don’t take the last sheet without notifying someone that additional sheets are needed.
Familiarize yourself with the English to Spanish tools for filling out the labels that are taped to the table.
Medication labels are in English and Spanish; a Spanish “cheat sheet” is taped to the table for ease when writing the label.
Tools for pill counting are on the table in a bin.
Patient handouts and information are in the file cabinet next to the refrigerator.
Don’t take the last item of any folder, make sure a copy is made and the item is marked original with a post-it note.

Filling & Assisting

Prescriptions are filled by the nurse or volunteer assigned to the pharmacy and are checked and given to the patient by the NP, physician or health educator. The student role in the pharmacy is to assist the nurse or volunteer in filling Rxs. An essential part of filling prescriptions is to double-check (and teach when appropriate) for (1) allergies, (2) contraindications, (3) precautions, (4) drug interactions, (5) adverse reactions, and (6) dosing. Points will be added to the final grade of any student who identifies a significant problem or mistake.
All medication orders should have the number of capsules, etc. written in, e.g., amoxicillin 500 mg tid x 10 days (#30). If there is any question about the number of capsules, MDIs, etc., check with the provider.
If there any questions, verify before proceeding.
When you are filling medicine, make sure the bottles are clean – remove foil around the opening so we can reuse the bottle. Use at least one “orange” bottle.
Fill out the appropriate label (we have separate labels for capsules/tablets, MDIs, topicals, and liquids) completely, except that in general, medications taken for a chronic illness (e.g., HTN, DM, asthma), are usually given for an indefinite period of time. For example, even though we may give 30 10 mg. lisinopril tablets, do not fill in the blank for number of days: just cross out that section. Medications given for an acute condition such as AOM are given for a specific time period and this will be noted in orders, e.g., amoxicillin 250/5 5 ml bid x 10 days. If it is unclear whether medications are given for a specific time period, consider the patient's condition and the medication - and then ask.
If the patient is to take 1/2 tablet of a medication, e.g., the Rx is for HCTZ 12.5 mg and all we have is 25 mg tablets, do not break the tablets in half. Instead label as follows: HCTZ 25 mg: take 1/2 tablet every day.
For all suspension orders that have to be reconstituted check the math of the original order for correct dose based on patient’s age, weight, etc. If you are not able to do this, verify that it has been done.
Be sure that the chart states when the patient is to return to clinic (RTC) and that there are sufficient medications to last until then.
After counting and writing the medication label, you must check your work. Labels should be placed evenly on the bottle. For chronic illness meds do not fill in the # of days to be taken (leave blank). Then, always have an FNP or doctor check the medicine.
Have an RN or FNP verify all filled prescrptions.
List all medications with dose and frequency and date filled for the patient on the Medication list - Left side of the patient folder.
If the patient is on medicine for a chronic illness (DM, HTN, etc), fill out the “What are you on?” sheet and give to patient with their medication so they can keep it in their wallet.
The health educator takes the medications to the patient and (1) verifies the patient's identity, (2) verifies meds are correct, (3) teaches about the medications, (4) teaches about any other measures noted in the plan, (5) answers questions, and (6) insures referrals are made or are in process. When giving the medications to the patient, put the generic vs. brand name medications handout in the bag.
After the patient is seen by the doctor or NP, medications dispensed, teaching done, referrals made, follow-up plans made, and any other actions taken, the chart is put on the back right (wall) corner of the front desk for information transfer (to sign-in sheet) and filing.
Important: Be sure that the patient leaves: (a) understanding the problem and the plan; (b) with medication or prescription - some patients cannot afford to purchase medications; (c) with necessary teaching and printed material on problem(s) and any other relevant issues. Talk with Charles Kemp about each patient's ability to purchase medications.
The primary nurse decides whether the patient is likely to need a follow-up home visit (HV) and if so, make out a Progress Note with name, address, phone, and briefly stated reason for F/U. Give the F/U Progress Note to the appropriate home care team on the same or next clinical day or to Charles Kemp. Be sure to F/U on the F/U to be sure that the patient was not lost.
Patients referred to other providers are likely to need help understanding what happens next. In most cases, the patient will have to be notified of appointments to other providers. Therefore, those who are referred should have a Progress Note form filled out and given to the appropriate team as above. If the patient is to go immediately to another provider, be sure the necessary paperwork is filled out and a copy given to the patient (referral form and note from doctor to the other provider). Be sure the patient is able to get to the next stop, e.g., emergency room.
Note the disposition of the patient on the sign-in sheet. Diagnosis. Were medications provided? Refills? Referrals? When should F/U occur? Who will F/U? Anything else we need to know to keep the patient in the loop of care? The sign-in sheets are the primary means of determining need for F/U, hence information not noted may mean services not provided. This is the responsibility of the Manager.

Finally

It is easier to make mistakes when the desk and pharmacy is cluttered. Keep personal belongings off the table and out of the way of the shelves. Throw away all drink cans, food, etc. when you are finished.

Keep the work area cleaned, organized, and free of clutter.
Put medications back on the shelves after each use.
Mark all bottles with an “O” on the top when opened.
Use all bottles marked with an “O” before opening another bottle of the same med.
Use the stools for reaching upper shelves.
Follow proper lifting guidelines for carrying boxes of medications.
Note the Outcome of this and all other services. This is vitally important!
When you have free time, re-stock medicine you have used back on shelves in the right place. If you don’t know where something goes, ask someone.
Keep medication labels organized in their right folders. Notify RN if supply of labels is low.
If there is down time and there are boxes of medication on the floor, ask Charles or Mary Horn if you should check the medicine for expiration date and stock on shelf. Top

Referrals

The patient is your responsibility, so you must be sure that the referral is made and the patient understands where and when she or he is supposed to go and is able to get to the appointment.

Most patients with complex chronic illnesses such as hypertension or diabetes should have an appointment made to EDHC (see CHM below). There is an approximate two month wait for non-urgent care adult appointments for new patients. We will manage the patient until he/she can go to EDHC. Patients referred to EDHC or Parkland should be given an EDHC/Parkland appointment slip which is obtained by going to EDHC to pick up the slip - or if an appointment is confirmed, we can make out an appointment slip and give to the patient (we have appointment slips in the brown file cabinet in the pharmacy). Patients without these slips have been turned away at EDHC.
CHM (Church Health Ministries or Central Dallas Ministries ) is another important referral site for complex patients. Lupe or Leslie handle these referrals.
OBGyn patients, are referred to the Women's Clinic which is co-housed in the EDHC building @ 3320 Live Oak - 214.823.6199.
Other patients such as those with + pregnancy tests will need your help making referrals. When you make a referral or help the patient make an appointment, you are responsible for ensuring that the patient understands where and when she or he is supposed to go, what he/she needs to take, and is able to get to the appointment.
Patients waiting on a referral or appointment should usually receive weekly F/U visits. Top

After the clinic closes

Students and volunteers review patients seen in the clinic and on home visits (HVs) and outreach. This occurs every day to be sure that patients receive quality/timely services. Top

Home visits

Safety is always a concern on home visits and outreach. Pay attention to your surroundings and never put yourself at risk. See the Baylor Safety Memo for specific guidelines.

Home visits (HVs) are the primary means by which we keep patients in a loop of care as problems are resolved and we move toward health promotion. All patients with problems related to preventable admissions, i.e., asthma, hypertension, diabetes, congestive heart failure, and other teaching-intensive chronic illnesses. All these patients will receive F/U and implementation of a structured teaching plan.

HVs are based on your evaluation of the patient/family need for F/U assessment and teaching. What happens on the HV is determined by patient/family need, problems, your intuition, and other factors.

Each HV should include a focused assessment of the primary patient, BP and possibly other checks of other adults, review of immunization records of children, and any other assessments indicated by circumstances or history.

All HV patients should have a chart in the file. HV documentation/charts includes: (a) permission to treat form, medication list, demographic form; (b) SOAP on Progress Note form (Important: note the Outcome of this and all other services); (c) Include all teaching and teaching plans. The mark of good documentation is if another person can pick up your work and quickly understand the patients problem, what you have done to address the problem, and what needs to be done next to address the problem. Top

Outreach

Outreach is the means by which we identify new patients, families, and community problems. Students are assigned to specific areas of East Dallas and should work to meet new people in those areas by (1) asking existing patients to introduce them to new families, (2) knocking on doors and offering to check blood pressures, immunization cards, and other services, and (3) meeting people in the course of seeing patients/families. Photo: Outreach at community garden with Cambodians

Health fairs and other screening activities are discussed in other documents. The essential feature of a worthwhile screening is ensuring that positive findings/problems are (1) significant health problems and (2) addressed - in our case, usually through follow-up and referral combined.

We are discussing possibilities for increased capacity in outreach and other community health services. All thoughtful ideas are welcomed and considered. Top

Finally

Remember, if you do not handle the problem, it will not be handled. Always remember, we are about solutions to problems and about dignified and respectful interactions with individuals and the community. Top

(Last update 10/2006)