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how to get things done

The VA system can be quite different compared to your home institution and the best way to get things done is to embrace that. Any order you place or thing you need done for a patient needs follow up with a phone call or an in-person discussion. If you place an order for stat antibiotics, you should follow it up with a call to the pharmacy and a call to the nurse. For other tips of getting things done, see below!

ordering labs

Routine labs. These are collected by phlebotomy at scheduled collection times between 5am and 10pm. If you want labs drawn off a PICC or a new PIV, place the order as "lab collect: and call the IV team via vocera to "IV Nurse."

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Stat labs. Place the order and change to "Ward Collect" and the timing as "Stat." Accept the order and then highlight it, go to File >> Print. Change the requisition to the printer "BB94." This will print to the printer right next to the phlebotomist. Then, notify the phlebotomist by vocera "Phlebotomy."

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Add-on labs. Click "Add New Orders (Clinician)" on the Orders tab. Under Labs, click "Lab add order." Click "Add-On Order Set." Fill out ordering provider's number i.e. "Team 2 Vocera." Accept the nursing order that informs the lab. Then select the desired labs to be added on. "Collected by" should say "Send patient to lab." Sign both the labs and nursing order. The Lab will call you if they do not have enough blood to add on the lab. 

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Blood Gas labs. For VBGs, call "IV nurse" on Vocera. For ABGs, resident teams must first attempt to draw themselves, after which teams can call Respiratory Therapy for assistance.

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Specialty Labs. Go to VA home page >> Click "Departments" on the left side menu. Click "Pathology-Laboratory Medicine Service." Find the necessary lab under "Sections with Test Information" including:

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If needed, log in using your VA email. 

 

For questions regarding specialty labs, contact the Ancillary Testing Coordinator (x55102) or Core Lab (x57492)

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ordering imaging

Ordering stat CXR. Vocera "X-ray tech" to expedite the imaging study.

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Ordering X-rays routine. Let nursing know because they can take the patient down to radiology any time; they do not need a scheduled time slot.

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Ordering CT with contrast. Requires a contrast screening form. These can be acquired from the nursing stations on all of the floors. Yes, they need a physician to fill them out. Please call the CT/MRI technician when placing the order for help to get the study done!

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MRI screening form. Also can be acquired at the nursing station and also yes, need a physician to fill them out.

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FYI on Radiology

X-ray: 24/7 in house

CT: 24/7 in house

MRI: M-F 8am-10pm, Sat 8am-4pm in house (nights, weekends, and holidays are on call*)

U/S: M-F 8am-8pm in house (nights, weekends and holidays are on call*)

What to Order When

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calling consults

Where do I find the pager? You can either look at the phone book or go to the DC VA intranet home page and click on the On-Call schedules, also linked here. Remember, you need to call the consult AND place the consult in CPRS.

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Neurosurgery consults (Walter Reed is currently not accepting consults):

-Refer to instructions on the Neurosurgery on-call schedule to page Baltimore neurosurgery. 

-Call Baltimore VA. 410-605-7000 x55673. 

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WR Contact:

  • Please refer to the Walter Reed Patient Transfer website: WR Transfers

  • WR Neurosurgery pager: 202-668-0973

  • WR 24/7 phone: 301-295-2136

  • Providers Only Number (for transfer center): (866) 666-2362

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Brief outline of steps for transfer to OSH after acceptance from outside physician:

  1. Call VA transfer coordinator 57887

  2. You will need several notes completed for transfer, including:

    1. Interfacility transfer note​

    2. Community Care Consult* - Inpatient (*If not a DOD / VA Facility) 

    3. Consent for transfer (discuss this with AOD at 54160)

    4. Beneficiary travel note

    5. Discharge summary

    6. Discharge notes Parts A and B

Consents for procedures

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For procedures such as paracentesis, thoracentesis, or PICC/mid-lines, you will need consent; this is done electronically through CPRS.

Here are instructions (new as of February, 2021):

  1. Please note that you will need a PIV card to obtain electronic consent.

  2. You will need to first link your PIV cards to your VistA account prior to using this new platform (click document for instructions).

  3. On CPRS, click Tools >> iMedConsent Web

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TOP TIP: If the system is down or you are only able to get a paper consent, IT MUST BE SCANNED INTO THE SYSTEM >> Call Admissions or AOD in order to scan 

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Opioid Prescriptions

If you plan on discharging your patient on opioids, you will need a paper script. These can be obtained by asking your chief residents. Along with writing the actual prescription, you will need to include both the VA specific DEA number and the MR number of the doctor writing the prescriptions. Both of these numbers can be obtained by calling inpatient pharmacy.

complex orders
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The pharmacists put together this information on their website on how to put in complex orders (let's say if you want a morning med to be given at exactly 7am and not the 9am default). It also gives how-tos on getting those pesky non-formulary medications ordered. Check out the website here. 

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PLEURX Information

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See attached information here for the PleurX insertion criteria and supplies. This applies for peritoneal drains as well.  

 

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