Clinic Assistant Training: Level 1

Clinic Assistant Training: Level 1 Role Overview and Expectations Work up Walk thru Scenarios and Mock Work ups Safety Tips and Tricks Frequently Asked Questions VFC History and Facility Tour

Introductions: VFC Volunteer Services Department VFCvolunteer@mednet.ucla.edu (Accessible to all Vol. Services Staff) Cassie Roque Volunteer Services Manager croque@mednet.ucla.edu Carlos Gomez Medical Volunteer Coordinator rcgomez@mednet.ucla.edu Waverly Paradox, Medical & Events Volunteer Coordinator wparadox@mednet.ucla.edu Zahra Ismail AmeriCorps Volunteer Coordinator *Joining us soon!

Role Overview and Expectations VFC s Mission (and thus every CA s Mission): Provide quality health care to people in need Clinic Assistant s Role Provide quality customer service to each patient Provide constant support to the clinic staff Check vitals on patients Expectations Consistent Attendance Three Strikes Rule Consistent Communication

Role Overview and Expectations What to Do Before Your First Shift Submit your up to date immunization records Review your Clinic Assistant Handbook Get scheduled by the Vol Services Department Get assigned an experienced CA buddy What to Do During Your First Shift Introduce yourself to staff and other CAs Shadow your experienced CA buddy Get Familiar with the flow of the clinic

What You ll Need for Your First Shift: Clinic Assistant Nametag Scrubs or Business Casual Attire Stethoscope Pen and Pocket Notebook Watch Copy of this Presentation

Clinic Assistant Skills Checklist Name Tags & CA Skills Checklist: Our Clinic Assistant name tags are color coded to identify each CA s skills and experience level. GREEN : Clinic Assistant Level 1 YELLOW: Clinic Assistant Level 2 RED: LEAD Clinic Assistant Clinic Assistant Level 1: Basic Skills Goal: Master Basic Skills tasks Height & Weight, Temperature, Pulse, and Blood Pressure Congratulations! You completed your Skills Checklist: What s Next? Alert the Volunteer Department by emailing us at VFCvolunteer@mednet.ucla.edu We will print a new yellow (level 2) name tag for you, which will include the Special Skills Checklist for you to complete

(see I care) Guidelines for what is expected of every team member at UCLA Health: Video Connect with the patient or family member using Mr./Ms. or their preferred name. Introduce yourself and your role. Communicate what you are going to do, how it will affect the patient, and other needed information. Ask for and anticipate patient and/or family needs, questions, or concerns. Respond to patient and/or family questions and requests with immediacy. Exit courteously explaining what will come next or when you will return.

Vitals by Patient Type First Visit Height Women Visit Last menstrual period (LMP) Specific OGYN Info Homeless Visit Homeless Screening Vitals for All Visits Pulse Weight Blood pressure Chief complaint Allergies Smoking History (ages 13+) Prenatal Visit Popra (a prenatal progress form that goes on top of chart) Peds/Teens Visit Height Head circumference (if less than two years old) Blood Pressure (if three years of age and annually) Special Needs Visit Diabetic: Blood sugar Asthmatic: Peak flow (measures person's ability to breathe out air) and Pulse Ox (measures O2 saturation)

Work up Walk thru Step by Step Instructions for Each Work up 1. Pick up a chart Review name, patient ID, DOB, and check for Staff Only indicators 2. Call patient from the waiting room & escort patient to work up room Introduce yourself; C I CARE! Confirm patient s name and DOB Note: Each work up room is set up the same 3. Take vitals and document on the back of the sticker sheets Obvious Vitals Height Weight Pulse Blood pressure Chief complaint 4. Escort patient to exam room Add patient to list in doctor s charting area Note patient s name, exam room number, and any other special details 5. Input info into NextGen* Only available for Level 2 Clinic Assistants Less Obvious Vitals Allergies Smoking History Last Menstrual Period Glucose (Diabetes) Peak Flow

Work up Walk thru: Next Gen Next Gen Training: This Friday, September 5 th! Reminders: DO NOT share your account information with anyone DO NOT forget or lose your account information DO NOT enter any information if you are unsure the staff is always happy to help! REFERENCE the Next Gen training information and presentation that we have available online on the Volunteer Resources page *Please refrain from utilizing Next Gen until you have attended a Next Gen Training and have completed your Level 1 Clinic Assistant Skills checklist, or are otherwise instructed by a VFC Staff member!

When should you flag a patient for staff? Anyone with a Staff Only Indicator Noted under the Details section of each patient s Encounter Form Anyone exhibiting violent behavior or is very agitated Anyone exhibiting any of the following concerns (Staff may then ask you to ) Eye problems and/or complaints (Perform visual acuity exam Staff Only) Urinary complaints (Perform UA Staff Only) Complaints of cough (Give mask for client to wear) Fever (Check O2 saturation (pulse ox)) When you are unsure about anything! Any acutely ill adults

Acutely Ill Adults Definition: Conditions that require immediate care to relieve suffering & minimize mortality risk Indicators Include: 1. Complains of shortness of breath, wheezing or choking 2. Pulse Oximetry less than 92% on room air **Ask nearest staff member to notify RN on the floor while checking pulse ox 3. Chest pain or pressure 4. Recent drug overdose, ingested poison or recent skin exposure with dangerous chemicals 5. Complains of severe headache starting in last 24 hours or new paralysis of any part of the body 6. Actively bleeding, vomiting blood or recently passing bright red blood in stool, check hemoglobin and report to provider 7. Has an abnormal blood pressure and or pulse: Systolic BP greater than 200mm Hg or less than 80 mm Hg Diastolic BP greater than 110mm Hg Pulse greater than 120/min or less than 50/min 8. Blood glucose: Less than 70; MUST TREAT with juice and notify provider and/or RN/LVN staff >350; MUST obtain UA (urine analysis) to check for ketones 9. Hemoglobin < 8 10.Temperature > 102 F

Summit Consent Form Research program at VFC; Partnership with the National Institute of Drug Abuse Data will help society and improve public policy regarding substance abuse Optional survey for patients at Venice Family Clinic Step by Step STEP 1: Complete patient survey on alcohol and drugs. Place the original in the chart. STEP 2: Review patient's answer. If any of the patients answers corresponds to a shaded box (i.e. "3 4 times"), then the patient qualifies for the summit research program. STEP 3: Ask the patient if they would like to participate; Each participant will be given $5 i.) If the patient declines, write "C2C" or "patient declined" (either works) on the Summit form ii.) If the patient accepts, there is a green SUMMIT folder in every work up room Take one Summit consent form and have the patient fill out (signature, date, full name). Then you tear the form at its perforation and put the page with the patient signature, date, and full name in the chart [along with the original copy of the survey]. Then you give the patient the remaining portion of the consent form (it reads "I have agreed to speak with someone about SUMMIT"). Before handing the patient the remaining part of the consent form, YOU MUST PUT 4 PATIENT STICKERS ON IT. STEP 4: When you are done working up the patient, sign them up in charting and place him/her in one of the doctor's exam rooms. If there are no rooms, send them into the waiting room. STEP 5: Locate the Walkie Talkie behind one of the coordinator's desk. Push the button and say "Hi, my name is and I have a patient in Room (or the waiting room) who qualifies for the summit research program in order to contact a Summit Staff member.

Homeless Patient Scenario 1 Patient Name: Irene Price Age: 57 You ve been smoking since you were 16 years old. You went to college for a year before deciding to run off with your guitarist boyfriend. He became very abusive, so you left him and moved to Venice. You are homeless, and always stay for the night at Marine Park. You have no regular contact with anyone. Your favorite color is purple; it allows you to forget about the abuse. Your abusive boyfriend caused your left leg to break. From the break, you gained arthritis in your leg. You are hoping to get surgery within the next year, but you need also to insure that your health is right. This includes your teeth. You have gum disease, chipped teeth, and pain when you eat sweets. Discussion Points: Where is the best place for you to go? How are you going to get there? Where are you going to find a purple shirt to wear to help you cope with the emotional pain from the abuse? Is it possible to get a toothbrush from somewhere? What else might you need to do today or think about?

Homeless Patient Scenario 2 Patient Name: Luis Gomez Age: 42 You worked construction for 15 years but lost your job in the building slowdown in the recession. You have lost a lot of friends over the last couple of years, many moving away or getting caught up in alcohol. You have never used drugs and never binge drink. You have to smoke a half pack of cigarettes a day to help keep yourself de stressed. You have been applying for jobs recently but you don t have many contacts in business anymore and competition is stiff. You lost all your blood pressure medication last week when your car, where you live, was impounded while you were showering. You have been a patient at VFC for two years. Recently you have been going to the bathroom a lot, getting really bad headaches and feeling weak, particularly in the morning and before dinner (if you can get one that day). Today you have an interview with at 1pm at Hansen Construction in Santa Monica ( 1328 18th St # 1 Santa Monica, CA 90404). You think the interview will take about a half hour to an hour. VFC called you last night to confirm your 3:00pm appointment. Discussion Points: How are you going to get to the interview and appointment on time? If you get the job (which will pay about $400 a week) where can you live? How will you afford the diabetes medication your doctor will probably prescribe to you? What else might you need to do today or think about?

Homeless Patient Screening It is important to practice positive and conscientious interviewing skills for sensitive topics drug & alcohol use, gender based violence, sexual behavior, sexuality, and housing situation Be honest and ethical Treat all patients with respect Seek advise and support from the Nursing Staff on how to ask difficult or sensitive questions Do not allow personal judgments or cultural values to influence the patient interaction

How to take a temperature: By Mouth: Appropriate for everyone two years of age and older 1. Place thermometer in plastic sheath 2. Place end of oral thermometer under tongue 3. Tell patient to close mouth, but not to bite thermometer 4. Leave in place until device signals, remove thermometer 5. Carefully dispose of plastic sheath 6. Note temperature for records

How to Test Blood Pressure Choosing the Correct Cuff Size: 1. Cuff should cover 2/3 of the upper arm 2. There are four kinds of cuffs: 1. Children s cuffs 2. Regular adult cuffs 3. Large cuffs for obese patients 4. Thigh cuffs for extremely obese patients 3. Palpate brachial artery 4. Clothing should be out of the way of the cuff 5. Apply cuff snug and evenly, one inch above the elbow Stethoscope Placement and Inflation: 1. Place diaphragm of stethoscope on bare skin over brachial artery but NOT touching cuff or tubing 2. Apply slight pressure of diaphragm with one hand 3. With the other hand, inflate cuff rapidly, using a smooth, continuous rate, to around 160mmHg initially, or higher if necessary 4. Deflate slowly, 2 4 mmhg mercury per heart beat 5. Read the manometer at eye level

How to Test Blood Pressure Readings: Systolic Blood Pressure: The first audible beat (the number on top) Diastolic Blood Pressure: The last audible beat or the last beat before a change in volume (this is the bottom number) Normal Range (Adult) : Systolic 100 140, Diastolic 60 86 Normal range (Child) : Systolic 90 126, Diastolic 50 80 Reminders: Note which cuff size is used Always use EVEN numbers when recording blood pressure If you are unable to hear, try again after waiting about 1 2 minutes. Also you may try the other arm. If you are still unable to hear, ask a staff member to help.

Scenarios and Mock Work ups How to work with a language barrier Review of basic Spanish phrases in each CA handbook Free Online Resources with audio! Basic Conversational Spanish Medical Spanish Terminology Medical Spanish Dialog per Symptom

Spanish Translators We have Spanish Translator volunteers that are available to assist you! Keep an eye out for any volunteers that have a blue Spanish tag on their name tag. If you are bi lingual in Spanish, and you are interested in translating, please sign up for a Spanish Assessment in Volgistics to get your Spanish tag. Reminder: When working with Spanish Translators the conversation and relationship should be with the patient, rather than with the Translator. Be sure to face and maintain eye contact with the patient, and not the Translator.

Safety Tips and Tricks Judy De La Torre, Nursing Director Gloves Sharps and Sharps Containers Blue Charts Hepatitis B Vaccination Injuries Overall Safety & Security

How to Test Blood Glucose Gather All Supplies BEFORE Starting Test: 1. Gloves put on BEFORE starting 2. Alcohol pad 3. Cotton balls 4. Small band aid 5. Blood glucose monitors found in the Lab. You have to sign out for the machine 6. Blood monitor strips also found in the Lab. Make sure the strip code matches the monitor code Placement and Inflation: 1. Clean end of finger (patient s preference) with an alcohol pad and dry with cotton ball 2. Activate NEW lancet 3. Turn machine on and the instructions will read: a. Insert strip (you should insert the test strip), b. Wait c. Apply sample. 4. To remove lancet end cover, twist and pull 5. Apply slight pressure to the finger until some blood appears; wipe away the first drop of blood. Apply slight pressure again, until enough blood for a sample appears 6. Wait until the glucometer beeps, for total blood sugar results and record results 7. Remove used lancet and discard in Sharps container 8. Dispose of other materials (alcohol pad, cotton, etc.) in regular trash 8. Return monitor to its place in the work up room 9. Remove gloves and wash hands

How do I get added to the schedule? Within the next week, a member of the Volunteer Department Staff will send a follow up email to each new Clinic Assistant that has signed in for today s Clinic Assistant Training session. In this email, we will request any remaining documents that we will need to get you scheduled. Once you are cleared to volunteer directly with patients, we will add you to the Clinic Assistant schedule at any of our four clinical sites, based on your availability and clinic needs. What if I need to miss a shift or two? If you know that you will need to miss a shift, please alert the Volunteer Department Staff by emailing VFCvolunteer@mednet.ucla.edu. Notify us at least 48 hours in advance of your absence. May I buddy with a doctor instead of a CA or MA? No, you will need to buddy with an experienced Clinic Assistant or MA. We do not have opportunities available for our volunteers to shadow physicians.

When can I get proof of my hours? The Volunteer Department will provide an official Verification of Hours document to any volunteers that have completed our minimum time commitment requirement (at least 8 hours per month for a minimum duration of 6 months). When can I get a letter of recommendation? We are more than happy to commend our exceptional volunteers! However, in order to request a Letter of Recommendation from the Venice Family Clinic, you must complete over 100 volunteer hours at VFC. What do I do when there is nothing to do? Be proactive and get the most out of your volunteer experience! If it is slow, please ask the Nursing Staff if they need help with anything. There is always something to do, even if you are not working up a patient!

VFC History and Site Tour Todd Lechtick, Medical Assistant Founded in 1970 by Phillip Rossman, MD, and co founder Mayer B. Davidson, MD Volunteers role in Venice Family Clinic Facility Tour of Rose

Next Steps Volunteer Services will follow up via email within 1 week to confirm whether or not you are cleared to start! In order to be cleared, you will need to submit: HIPAA Certification Updated TB test results: Negative results, within 1 year MMR Immunization Record or Positive MMR Blood Titer After all documents are submitted, we will ask for your current availability and match you with available shifts Clinic Assistant Shifts: Simms/Mann Health Center Monday to Friday 8:30 AM 12 PM (Morning) 1 PM 5 PM (Afternoon) 604 Rose Ave Clinic Monday to Friday 8 AM 12 PM (Morning) 12 PM 5 PM (Afternoon) 5 PM 8 PM (Evening) Irma Colen Health Center Monday to Friday 9 AM 12 PM (Morning) 1 PM 5 PM (Afternoon) Robert Levine Family Health Center Monday to Friday 9 AM 12 PM (Morning) 1 PM 5 PM (Afternoon)

Congrats on Completing Your Clinic Assistant Training: Level 1 Thank you for coming!