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Important message from Dr Richard Lichtenstein - Chief of Staff

#1 - New Albumin Order Set is Live
Attached please find the new albumin order set which was created to help streamline ordering of albumin and address the most common medication issues.

#2 - Electronic Prescribing Requirements
House Bill 831 (2019), Electronic Prescribing, was signed into law by Governor DeSantis. The effective date is January 1, 2020. The bill provides important new requirements for prescribers to generate and transmit all prescriptions electronically upon licensure renewal or by July 1, 2021, whichever is earlier.

At SMHCS, effective July 1, 2021, paper prescription pads will be available on a very limited basis. For more information, please see the attached. These paper prescription pads may only be utilized if a specific exemption is met. The full list of exemptions, contained within this bill, can be found here.

Lastly, for your protection, any provider specific prescription pads currently stored on the SMHCS campus will be returned to the provider. SMHCS will not be storing provider specific prescription pads moving forward.

#3 - 2020 BLS/ACLS Guidelines Update
American Heart Association released the 2020 BLS/ACLS Guidelines Update in 10/2020. AHA guidelines are updated every 5 years.  They have been approved by the SMH Code Blue Committee and are attached.

#4 - Creating a ‘Difficult Intubation’ flag in the SCM Patient Header
Please see the attached for step-by-step instructions

#5 - We are pleased to announce the opening of Sarasota Memorial’s new Apheresis Center, which will be staffed by our Hemodialysis team
Sarasota Memorial will offer apheresis and several related services beginning June 7, 2021.  The treatment will be provided by our specially trained dialysis team.  It will be offered to our inpatients at the bedside or in the Hemodialysis Department, and to outpatients at the Sarasota Memorial Infusion Center. 

Nishant Bhensdadia, MD will be medical director of the center.  Dr. Bhensdadia will oversee all orders and policies directly related to hemodialysis and apheresis.  Ordering of the apheresis procedure will currently be limited to nephrologists, neurologists, hematologists, oncologists and rheumatologists.  

For more information, please see the attached.

#6 - 3D Mammography is now the Standard of Care at SMHCS
•    Sarasota Memorial Health Care System is pleased to announce our screening mammography exams will now routinely include 3D imaging as the standard of care.
•    Breast cancer screening with 3D imaging, when combined with conventional 2D mammography, has a higher cancer detection rate than conventional 2D alone.  
•    The majority of insurance providers, including Medicare and Medicaid, are now covering the cost of the 3D screening mammogram.
•    While 3D digital mammography provides the best imaging quality, 2D will still be available for patients who request it.

For more information, please see the attached.

#7 - Appropriate Use Criteria for Advanced Diagnostic Imaging (AUC)
•    Beginning in 2021, if you order Medicare Part B advanced diagnostic imaging services, you must consult appropriate use criteria (AUC) through a qualified Clinical Decision Support Mechanism (CDSM). You must also provide the information to furnishing professionals and facilities, because they    must report AUC consultation information on their Medicare claims. 
•    The purpose of the AUC program is to enable you to order the most appropriate test for your patient. The Centers for Medicare & Medicaid Services (CMS) will use data collected from the program to identify outlier ordering professionals who will become subject to prior authorization.

For more information, please see the attached.

#8 - Updated Medical Staff Rules and Regulations - What’s New Regarding Medical Records
On September 21, 2020 the Medical Staff Rules and Regulations were updated.  Our Health Information Management Department has provided highlights of the changes that were made regarding Medical Records.  Please see the attached.

#9 - Covid Update as of June 4, 2021
In March 2020, SMH created a Covid treatment team as part of Covid-19 emergency response. Since then, the "treatment team" has been taking care of all covid-19 patients admitted at SMH. Fortunately, our Covid-19 census has been declining and have been stable for quite some time. As a result, starting June 6th 2021, Covid 19 patients will be admitted as per the usual SMH admission privileges of providers.

The SMH COVID Taskforce and Stewardship team has put together this education for managing patients with COVID-19. Information is up-to-date as of 6/1/2021 and subject to change.

*Severe cases of COVID-19 may be associated with hypoxemic respiratory failure, acute respiratory distress syndrome (ARDS), septic shock, cardiac dysfunction, elevation in multiple inflammatory cytokines, thromboembolic disease, and/or exacerbation of underlying comorbidities
*Certain attributes and comorbidities (e.g., older age, CV disease, diabetes, COPD, cancer, renal disease, obesity, sickle cell disease, receipt of a solid organ transplant) are associated with an increased risk of severe illness from COVID-19

Summary of Treatment Options for COVID-19
A treatment algorithm and summary of current COVID-19 therapeutics are available on the SMH COVID-19 Treatment Website here (only accessible via SMH Intranet/Computer or via SCM-Tools-Antibiotic Resources-COVID-19 Resources)
*SMH currently has several medications available for the treatment of patients admitted with COVID-19
*These include Dexamethasone, Remdesivir, Baricitinib, and Tocilizumab
*These medications should not be used universally in all patients and have a particular role and timing for clinical benefit based on available studies
*Given their targeted role and risk of severe adverse effects, most of these medications (except dexamethasone) are restricted to Infectious Diseases or Pulmonary/Critical Care approval
*Note: Dexamethasone should only be given to patients who have significant hypoxia, requiring oxygen supplementation, non-invasive ventilation or mechanical ventilation
*Patients being admitted to the ICU should have critical care consult. Patients being admitted to non-ICU units should have an ID consult.
*For those on room air, the best initial treatment is close monitoring and supportive care
*For patients on supplemental oxygen, non-invasive ventilation, or mechanical ventilation, timely and appropriate treatment with medications listed above have the potential to improve morbidity and mortality. They can be ordered and managed by the ID or critical care consultant.
*SMH has also been integrally involved in clinical trials and is a site for investigational therapies. For more information please consult with a pulmonologist or ID provider.
*SMH Order Sets: Common labs, VTE prophylaxis, and Consult orders are available in the following order sets
*COVID-NON ICU Patient Treatment and Monitoring Order Set
*COVID-ICU Patient Treatment and Monitoring Order Set

Role of VTE Prophylaxis/Treatment in COVID-19
*COVID-19 has been associated with inflammation and a pro-thrombotic state, with increases in fibrin, fibrin degradation products, fibrinogen, and D-dimers as well as a higher incidence of VTE
*For hospitalized patients with COVID-19, prophylactic dose anticoagulation (e.g., enoxaparin) should be prescribed unless contraindicated (e.g., a patient has active hemorrhage or severe thrombocytopenia)
*Patients who are receiving chronic anticoagulant (e.g., apixiban) or antiplatelet therapies for underlying conditions should continue these medications if they receive a diagnosis of COVID-19
*Patients admitted with COVID-19 who have signs/symptoms consistent with a thromboembolic event should have appropriate diagnostic testing and anticoagulation therapy as per the standard of care for patients without COVID-19
*VTE prophylaxis can be ordered using the "COVID-19 VTE prophylaxis orders", located in the "COVID-NON ICU Patient Treatment and Monitoring Order Set" and "COVID-ICU Patient Treatment and Monitoring Order Set"

Medications currently NOT recommended for the treatment of patients admitted with COVID-19 based on available evidence:
*Hydroxychloroquine/Chloroquine
*Ivermectin
*Colchicine
*Azithromycin

Additional Resources

*SMH COVID-19 Treatment Website  (only accessible via SMH Intranet/Computer)
*COVID-19 National Treatment Guidelines:
*Infectious Diseases Society of America: Last updated April 5, 2021
*National Institutes of Health: Last Updated May 27, 2021
 

Thank you,
Richard Lichtenstein, MD
Chief of Staff