SAINT ANTHONY EMERGENCY DEPARTMENT PHYSICIANS ORIENTATION
CHECKLIST
The following checklist is to be used in the orientation of any new TeamHealth NorthWest
physicians or mid-level providers working in the Emergency Department at Saint Anthony
Hospital. The Medical Director/designee and the orienting physician should initial each item.
All arriving physicians should receive the basic orientation package from TeamHealth prior to
arrival. During the initial orientation the Medical Director will ask for and answer any questions
generated by this package.
Prior to Orientation Day:
□ Log in to TeamHealth Institute Online https://thi.th-ext.com/portal/server.pt
o Call 1-800-424-3672 x 2849 for access information
 M – F 9am – 5pm ET
o View the Discharge Vital Signs Project
o View the Patient Safety Fables
o Complete the Mine Field Navigator for Emergency Medicine
□ View the Franciscan Health System New Physician Orientation
o https://www.fhshealth.org/physicians/newPhysOrientation.asp
o Password: newdoc
□ Obtain ID from Human Resources at St. Anthony’s and parking sticker from Security
out by the ED Entrance.
□ Arrange for Epic and Dragon dictation training: Contact AbigailPritchard@fhshealth.org
□ Ask about having one of our physicians spend some time with you to set up your Epic
smartphrases and Dragon orders before starting work.
□ Give your phone number(s) to the ED Desks and Admin. Office
o Please call the HUC station 253-530-2100 to give them your current cell phone
and home numbers.
o Email Tom Minter with the same info.
tjminter@comcast.net
Tour of the Emergency Department including:
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Patient entrances 119# / ambulance entrance (119*)
Location and use of fire alarms, fire extinguishers and oxygen shut-off valves
ED break room and physician’s office
 Mailboxes
 Lockers
Treatment Areas: Intake rooms, Acute care rooms
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Location and use of emergency patient care equipment including:
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Defibrillators and Code Carts
Intubation equipment
Emergency drugs
Difficult Airway Bag
Ultrasound machine
Cardiac monitors
Oxygen supplies
Suction equipment
Central line equipment
Cardiac pacing equipment
Glidescope
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Nursing stations
 Introduction to nursing personnel, unit secretaries and ED techs
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Medications, location and prescribing in the ED
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Pyxis - No to go meds
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Charity Care
Use the red ‘CHARITY CARE’ stamper as you see
appropriate or ask pharmacist to facilitate.
Pharmacies:
 The SAH Outpatient Pharmacy is now open in the Milgard Building from 9-5 M-F.
 In addition to filling employee prescriptions for the newly announced FHS Mail Order
system the pharmacy can fill all discharge prescriptions during their hours of operation,
including for patients requiring Prescription Assistance. The outpatient pharmacy can be
reached at 130.2066 from inside the hospital.
Walgreens – only 24 hour pharmacy in the area is in Tacoma. 15-20 minutes away.
4315 6th Ave, Tacoma, WA 98406
(253) 756-5159
Walgreens in Gig Hargbor open M-F 9-9p, Sat & Sunday 10-6p
Target Pharmacy in Gig Harbor open M-Sat. 8-10, Sunday 8-9p
EMS expectations
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Location and use of radio –
o We are the Base Station for West Pierce County EMS. We handle
calls from Gig Harbor and Key Peninsula EMS departments.
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Still receive calls from South Kitsap EMS, not as a Base
Station, but as a receiving facility
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Prehospital Protocols, see Patient Care Protocol booklet and
note Signal 1,2,3 and AMA info (page 7)
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Security Issues
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Suicidal or agitated patient; ask for a security 1 to 1; search
and stand-by (Referred to as a Code 1)
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Code Gray– agitated person
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Code Red – Fire
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Code Yellow –Hospital-Only Trauma
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Code Blue- Cardiac/Respiratory Arrest
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Amber Alert – Infant/Child Abduction
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Rapid Response Team- Activate Rapid Response Team
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Code Silver- Weapon/Hostage
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Code 5 Shelter in Place
o Code Triage – Disaster Response (Phase 1: Alert or Planning
Phase 2: Activate)
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Registration staff/process
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Physician work stations (Max of 2 providers to the East or West stations to give
nurses a place to work)
Document time that patient was initially seen, this is used to calculate
the Door to Doc time. This is performed by clicking the “Initial Provider
Exam” button in Epic.
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Medical Decision Making – your best defense
o Critical care time – unstable patient, lifesaving intervention
see TeamHealth guidelines
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 Admission/Order sets: Transition, Rapid Rule out (Outpatient
observation for Chest pain), Pneumonia, Sepsis, Procedural sedation,
Transfusion and procedure consent forms, Code Neuro, tPA, Alcohol
Withdrawal, Heparin, DKA, PCA, and Transfusion,
Remember to document “Time outs” for procedures!
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Location and use of referral and on-call lists for local physicians
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Admission process
 After speaking with the admitting physician (usually Franciscan
Inpatient Team) place an order for “ED to Hospital Bed request”. Place
transition orders as soon as you have time or immediately if Charge Nurse
asks you to write them.
 Med/Surg, Med-Tele, PCU, ICU,
 All new onset afib go to PCU
 All beds in hospital are Tele-capable
 Currently patients on NTG drips go to PCU
 Franciscan Inpatient Team (FIT) – unattached patients
Group Health – (Marked as “G” on track board or personally
informed by registration staff).
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Ask HUC to contact EPRO, (Emergency Patient Resources and
Options). Present the case to the Group Health Triage physician for location
of admission. Usually a transfer to St. Joseph Medical Center in Tacoma
which is the Group Health base facility.
 Private MD’s who admit their own patients: Dr. Bill Roes and Dr.
Mark Craddock. Call them first, they may request that FIT admit their
patients but want to decide themselves.
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Mental Health – seek ED Social Worker assistance in
disposition.
Involuntary or Voluntary or any need of auxiliary Mental
Health care – Call single point of Care: Optum Health Pierce RSN at
1-800-576-7764
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Transfer of Care in Department to following provider
 Complete Transfer of Care form in Epic
 Do not hand off incomplete patients
 At end of shift,
 THIN SLICE: start work-up on new patients for oncoming
provider, and document “Initial Provider Exam” time.
 Explain to patient concern for efficient evaluation/hand-off
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Transfer process to other facility
With the exception of Trauma Transfers, Code Neuro Transfers, Pediatric &
OB transfers you ask the HUC to contact the FPPC (Franciscan Patient
Placement Center) where a trained nurse will discuss the case with you and
then find an appropriate bed and contact an accepting physician and
consultants.
 Complete transfer forms in Epic completely
 Send x-ray/CT copies if outside Franciscan System. (Trauma Team at
Multicare does have same Diagnostic Imaging equipment so you don’t need
to send copies for them.
 Transfer Risk includes worsening of specific disease process
written on COBRA Form
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Discharge Vital Signs:
Vital signs are taken within 30 minutes of discharge. If they are abnormal, the nurse will confront
you with them. If you still wish to discharge a patient with abnormal vital signs (high risk!), you
should add to your note why you are doing so.
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Discharge instructions
Identify follow-up time and doctor
Discuss reasons to return to ER
 Instruct what to do/not to do
 Medication counseling
o (FMG clinic. You can arrange for a 1-2 day follow up even for no doc
patients.)
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Franciscan Health Systems and TeamHealth Northwest have adopted the OXYFREE Emergency
Department policy.
Please read the Regional Emergency Services Policy on Controlled Substances which is
added to the end of this document.
It is a requirement for all providers to register for the Washington State Prescription
Monitoring Program. This is a tool to improve patient care and work to assure patient safety by
the review of a patient’s controlled substance dispensing records.
https://wapmp-provreg.hidinc.com
At the end of this Orientation document is a letter from the Department of Health detailing how
to register.
The Franciscan EDs are partners in the Statewide Emergency Department Information Exchange
(EDIE). Which faxes an orange document that indicates that a patient has had more than 5 visits
in a year and may include a care plan.
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Restraint process
 Do not write ‘restrain as necessary’
 Chart reason and pre-restraint evaluation, date and time order
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Dictation now happens extremely rarely, but in the situation that Epic is
nonfunctional, you could actually dictate.
Dictation process
 1-888-322-6104 or pick up dedicated dictation phone
 enter site code 7 + then hit pound key
 enter your MD dictation code (WA license #) + pound
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enter SAH facility code 5 + pound sign
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enter work type 340 (ER Report)
enter 9-digit MRN number + pound
dictate pt name + your name + MRN + date
at the end of the dictation, hit "9" and write down the number that
verifies your dictation on the chart
4 = pause
2 = resume
3 = rewind & listen
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81 = rewind to beginning
7 = fast forward
63 = go to end and resume dictating
5 = begin new report
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Code 4 – In-House Code Materials
 Location and use of Code Blue Red Binder
 Complete reimbursement sheet
 Include patient face sheet or sticker
 Document a note in Epic.
 Tom Minter checks the Red Binder weekly and sends them in
for coding.
Radiology
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Location of x-rays and instructions for initial readings of x-rays by the ED
physician
X-ray discrepancy – radiology tech will present discrepancy notice
 dictate resolution cc: Tom Minter
Radiology Reading Room at SAH 530-2162 (or in house 130- 2162)
After 9 pm (Ford Building)
Room 1
253-680-3586
Room 2
253-680-3584
Room 3
253-680-3585
NEP / FHS Expectations
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Professional Conduct
Professional Attire
Quality Medical Practice
State and Federal Law Compliance
MD/PA Resource Book
Risk-adverse Medical Practice
o Hand-off: and sign out.
o MLP Supervision
o Cardiac Equivalents
o Missed FB
o Poor Documentation
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Patient Satisfaction
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the 5 S’s of Satisfaction.
o Smile: be nice. People appreciate this more than anything.
o Say: your name, the members of your team, the patient’s name, that you are
concerned, that you have time, that we are all one team with the pts best interest at
heart. Sit is also important but many of us interact in the ED while standing, and
moving around, so I did not include it.
o Solicit: ask for input from pt and family. Ask their expectations. It’s hard to meet
expectations if you don’t know them. And if you meet them they will be satisfied.
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Summarize: make sure they know what you think, what’s going on, and what’s the
plan.
o Satisfy: ask if there is anything else you can do to make their visit
satisfactory and meet their expectations. Knowing this is a priority with you
is deeply satisfying.
Patient Interactions
o Introduction: greet, introduce, sit, listen, establish expectations.
o Initial Scripting
 Any more information we haven’t covered
 What I think is going on
 What I think we need to do to evaluate/treat you
o How long I think it will take
 Can I get you something for pain right now (or anything else)
 Do you have any questions
o “Do the Show”
o Updates on Progress
o Final Scripting
 What’s wrong with you
 What we’re doing about it
 Who to follow-up with and when.
 What to do if I get worse
o Discharge Instructions
o Referrals
 General
 Specific
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Introduction to ED Quality Assurance program
 Complaint Resolution/Chart reviews/Peer Reviews
 Patient Advocate
 Resolution process
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Dr.Tom Minter tjminter@comcast.net
Office: 253-530-2133
cell phone: 253-948-2048
ThomasMinter@fhshealth.org
Vocera system: To call from outside the hospital on a cell or landline to person at hospital currently
using Vocera: 253-426-6991
Before beginning your first shift, you will need to:
1.Be signed up for Vocera
2.Have Epic and PACS access.
3.Completed AIDET training (watch a video and complete simple test obtain from Tom M)
4.Completed NIHSS training and certification ( the following is the free web site)
http://nihss-english.trainingcampus.net/uas/modules/trees/windex.aspx
5.Be a registered Practitioner of the Washington State Prescription Monitoring Program
SJMC EMERGENCY DEPARTMENT PHYSICIANS ORIENTATION CHECKLIST
PHYSICIAN/MLP BEING ORIENTED
(signature) Date___________
MEDICAL DIRECTOR/DESIGNEE
(signature) Date___________
When complete, please sign and return to:
505 South 336th Street, Suite 600
Federal Way, WA 98003
Regional Emergency Services Policy on Controlled Substances
PURPOSE:
To provide safe prescribing practices for patients with chronic,
recurring and minor pain-related complaints in the absence of an
Emergency Medical Condition
SUPPORTIVE DATA: ● CDC – Injury – Poisoning in the United States – Issue Brief:
http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/breif.htm
● Agency Medical Director Group, Interagency Guideline on Opioid Dosing
for Chronic Non-cancer Pain:
http://www.agencymeddirectors.wa.gov/Files/Opioid/Gdline.pdf
National Center for Health Statistics. Medication therapy in ambulatory
Medical care: United States, 2003-04. Vital Health Statistics. Series 13,
number 163, December, 2006.
● Emergency Department Acute Pain Protocol (#816)
●
CONTENT
PROCEDURE
1.
2.
3.
The emergency department (ED) must
provide a medical screening
examination to all patients presenting
for emergency care.
Some patients presents for exacerbations of
their chronic, recurring pain from a known
condition or illness, or with visits for minor painrelated complaints.
Patients with any painful condition may request
treatment with narcotic medications, but
treatment with narcotic medication is not always
the best medical care.
KEY POINTS
▪Regardless of frequency of visits, all
patients must receive a medical
screening examination.
▪Not all patients in the ED will have an
emergency medical condition
▪Treatment of chronic pain outside of a
Primary Care Provider (PCP), or
treatment of minor complaints with
narcotic pain medications, puts patients
at risk for accidental overdose,
diversion, morbidity and mortality
▪The lowest potency medication should
generally be prescribed to reduce the
side effects and morbidity associated
with these medications
▪For the above reasons
4.
The treatment of pain will be guided by the provider’s
judgment.
5.
Narcotic medications should not be used for the treatment of
minor pain-related complaints.
6.
If chronic pain is to be treated in the ED, the use of oral
analgesic is preferred over IV/IM administration.
▪Oral analgesics provide a more level,
less dangerous treatment option
7.
If the ED provider deems treatment of a chronic or minor
condition necessary with controlled substances, no more than 5
pills will be given and not more often than every 30 days.
▪This is an exception to the rule and
should ideally be coordinated with the
patient’s PCP or pain specialist
8.
The following medications will generally not be prescribed
from the ED:
Oxycontin, MS Contin, Dilaudid, Methadone,
Fentanyl, Soma, Oxymorphone, or other long acting
Opioids, except for compelling circumstances to be specifically
documented by the provider on why they are necessary beyond
the standard choices.
9. Oxycodone (Percocet, Roxicet, etc.) will be provided
only in the presence of an objective source of new pain,
documented on examination or by diagnostic testing.
10. If a provider feels that IV analgesic is indicated for
treatment, generally no more than three weight based doses will
be provided.
▪If the patient does not have a PCP the
ED will provide a list of community
primary care providers to the patient
▪These medications are for use in long
term pain management and not
appropriate out of the ED
▪They have a high rate of abuse
▪Oxycodone is associated with
significant abuse and risk of morbidity
and mortality
▪Use of higher doses of IV analgesia in
the acute setting may result in patient
harm in opiate naïve patients. In those
with chronic pain, IV medications
should be used only if PO medication is
felt to be inadequate or contra-indicated
▪Refer to Emergency Department Acute
Pain Protocol (#816)
Franciscan Health Systems Emergency Department Chronic, Recurring and Minor Pain Control Policy
The Franciscan Health System, in coordination with our Emergency Medicine Physicians, has developed an
Emergency Department policy to govern the utilization of pain medications for the treatment of chronic, recurring
and minor pain conditions. The State of Washington has seen a 400% increase in the death rate associated with
prescription pain medications. Accidental overdoses are due to prescription drugs in 90% of cases. Emergency
departments provide 39% of the prescriptions for controlled substances. As a result, this has become a public health
issue and one we are working to address through this policy. Thank you for your assistance with this important
issue and thank you for choosing Franciscan Health Systems.
The goal of treatment of chronic, recurring and minor pain will be the use of oral medications. Oral medications
have a longer course of action and provide a longer lasting relief of pain. In addition to oral medications, your
emergency department provider may recommend ice/heat, relaxation, positioning or other measures which may
provide relief.
Treatment Guidelines
While we strive to treat pain in an aggressive manner, it is important to remember that the decision on what
medications to use is complicated and within each provider’s individual judgment. We generally encourage the use
of oral pain medications given their longer duration of action, better safety, and safety in administration. In the rare
instances where intravenous (IV) pain medication is needed, these will be limited to a few weight based doses with
the plan for the conversion to oral medications as soon as possible.
The following medicatons will not be prescribed in the emergency department:
Oxycodone (Percocet, Roxicet)
Oxycontin
Fentanyl
Dilaudid
MS Contin
Oxymorphone
Methadone
Soma
Long acting opioids
Chronic Pain
It is important for your safety and good care that chronic pain issues be managed by a single care provider. This
care provider should be your primary care provider or a pain management specialist. The emergency department
cannot provide the appropriate level of monitoring and safety checks to manage chronic pain. As a result, we do not
provide medication refills, replacement or supplementation of narcotic pain medications. Your providers will
discuss medication options with you that will focus on non-controlled substances to help you get to your provider.
Thank you again for choosing Franciscan Health Systems, we look forward to serving you now and in the future
with all of your healthcare needs.