St. Vincent’s Clinic Volunteer Orientation

1. St. Vincent’s Clinic Volunteer Orientation

2. Outreach and Services ofSt. Vincent’s House • St. Vincent’s 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.

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

4. 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 H&Ps, 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

5. 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!

6. Virtual Tour of St. Vincent’s 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

7. Pictures of the clinic from the outside

8. We love Debbie!!! Waiting room full of patients to be seen

9. Virtual Tour of SVC • Step 2 – Review the Chart: • Take a patient’s 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

10. 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! • **Don’t be afraid to ask if ever uncertain about your history and exam – we’re all here to learn!**

11. 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!

12. Virtual Tour of SVC • Step4 – 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

13. Sameet (MSIV) helping out Viet (MSII) with questions about his patient

14. 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

15. 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

16. Closets full of samples in our pharmacy

17. 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

18. 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!

19. 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 patient’s 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

20. 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

21. Overview of SVC Medications • Prescriptions: • Fill out Rx using regular format – if you’re 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. Vincent’s 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

22. 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 • ALLbloodwork 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!!!

23. Bottle of strips for UAs Proper lab documentation on the forms Finished blood work in the clear bag with a form

24. More pictures of the lab complete with a microscope for wet preps, etc Box for finished bloodwork Box of needles for fingersticks

25. Virtual Tour of SVC • Step 6 - Labs 101 the Basics (cont’d): • 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

26. Virtual Tour of SVC • Step 6 -Labs 101 the Basics(cont’d): • 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

27. 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

28. Please be careful when handling anything in the lab!!!

29. 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 • Don’t be afraid to be wrong in front of faculty – we’re all here to learn and they’re 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!

30. 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

31. Virtual Tour of SVC • Step 8 - Consults and Radiology: (cont’d) • 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

32. 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

33. Common Myths about Volunteering at SVC • Myth #1: “I’m only a first year and I don’t 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 • We’re all volunteers, we’re all here to learn, and you’re 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!)

34. 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 Year’s resolutions to volunteer • First clinic following a round of exams as people now have time to volunteer • “Down” times @ SVC usually around Oct-Dec and mid-late spring – same # of patients in need with not nearly enough students to help out!!

35. Common Myths about Volunteering at SVC • Myth #2: (cont’d) “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 (Yaga’s) often translates into great learning opportunities with one-on-one faculty interactions

36. 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 • Don’t let jitters about presenting or the fear of not knowing an answer when “pimped” dissuade you • Medical school’s challenging but if you don’t put yourself out there at places like SVC, you’ll be missing out on invaluable learning opportunities

37. Common Myths about Volunteering at SVC • Myth #4: “I’m a third or fourth year and I’ll 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 • Let’s 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, you’re missing out on one of the most rewarding opportunities at SVC…TEACHING!

38. Common Myths about Volunteering at SVC • Myth #4: “I’m a third or fourth year and I’ll 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 you’re ready to “teach” others but believe it or not, you’ve all learned a lot of stuff that you take for granted – e.g., after taking renal with Dr. Beach, we’re all aware of the use of ACEIs in diabetics but most first years don’t even know what an ACEI is, let alone how and why they work specifically in diabetics..…get the idea?

39. Common Myths about Volunteering at SVC • Myth #5: “I get hungry and need to eat regularly, so there’s no way that I could miss a meal to volunteer. It just doesn’t jive with my metabolism and physiology.” • Free food for volunteers is always provided as a thank you from the clinic

40. Shameless attempt to buy volunteers with pizza (shameless plug: Mario’s pizza really is the best on the island!)

41. St. Vincent’s House Contact Info St. Vincent's Episcopal House2817 Postoffice StreetGalvestion, Texas 77550Office (409) 763-8521 Fax (409) 763-0572

42. 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. Directions to SVC