Internal Medicine

Onboarding

  1. New employees will receive an employee handbook upon starting employment at ASCM. Be aware that modifications to the employee handbook will be made on occasion and employees will be informed of the changes. Our Safety Manual is at the back of the handbook. This guides you through security and accident reporting.
  2. Fill out tax forms provided by Dr. Lisa. You need 2 forms of ID such as a drivers license, passport, social security card, etc.
  3. Set up direct deposits of paychecks. Dr. Lisa will need an account number and routing number.
  4. A key fob for entry into the building will be provided. Dr. Lisa to review entry into building when hospital is closed.
  5. A login will be provided for Swipeclock.com for punching in and out of work. You will also punch out for lunch/break periods. Discuss PTO time.
  6. Staff Introduction: Doctors- Dr. Dan/Lisa Degner – owners of the practice
  7. Surgeons- Dr. Noah Bander, Dr. Charlie DeCamp, Dr. Jennifer Godfrey, Dr. Brayden Stanley, Dr. Erik Zellner
  8. Internal Medicine- Dr. Jennifer Pearson
  9. Interns- Dr. Tim Lin, Dr. Jordan Pieczynski
  10. Managers- Susan Holland, Sarah Haggerty
  11. Your department: Aaron, Kathleen, Kaylie and Sarah
  12. A job description for your position will be provided. A signature will be required once you have read through it,
  13. A review of your schedule will be discussed. If you need to call in please notify Dr. Lisa AND Susan. Their numbers will be provided to you.
  14. Dress Code is navy blue scrubs. Please see the employee handbook for more detail.
  15. Parking for employees is behind the building. The front parking lot if for clients.
  16. OSHA/Safety classes are on-line. You will receive an e-mail with a link through AVMA-PLIT. Please complete these on your first day.
  17. Emergency contact information given to Susan Holland.
  18. Hills food professional discount program- hillsprofeeding.com. Account # 830493
  • SpecVet –our medical records system
    • Login – please see Dr. Dan for login profile
    • Dash board and how to navigate to various patients
    • Enter a diagnosis, referral letter, surgery report and discharge instructions; applying a template to the referral letter, discharge instruction sheet, surgery report
    • Create a treatment plan (estimate); how to apply an estimate to an invoice
      • Understand that not all items are automatically transferred from an estimate to invoice
      • Basic charges per day – day hosp, night hosp, fluid therapy, analgesia per day, any injections
      • Checking invoices to make sure that they are complete – compare to services rendered on the flow sheet in Smartflow program on ipads.
    • Creating an order – primary for labs
      • Always fill out history sheet in detail for pathologist
      • Always click button to make sure it indicates that it has been submitted so that it will appear on the invoice
    • Make a new client/patient profile
    • Schedule an appointment
    • Resources – educational videos
  • Smartflow
    • Login – please see Sarah Haggerty for login profile
    • Onboarding videos and educational material – provided by Sarah H
    • How to make a treatment flow sheet
      • Using templates
    • How to make an anesthesia sheet
  • Radiographs
    • Use of the Heska Cuattro x-ray machine
    • Proper positioned radiographs
    • Using appropriate settings
    • Radiation monitoring badge – obtain from Susan Holland
      • You must turn your badge in when requested for processing and you will receive a new one 
      • If there is an alert to high radiation exposure, you will be notified
    • Radiation safety
      • Always wear a lead apron with thyroid shield
      • Always wear lead gloves
  • CT scans
    • Set up for CT by choosing the correct rebreathing hoses/bag, changing t-port on contrast, check fill level of contrast, warm up CT
    • Refill contrast injector
    • Enter patient information
    • Selecting settings for scan and run
    • Program IV contrast injector
    • Position patient on the table and center with lights
    • Transfer scan to server
    • Radiation safety
      • CT has much greater radiation, always stay in the operator booth during CT acquisition
      • Never stand in the gantry room during acquisition of scan
    • Wear your radiation badge at all times whenever performing, radiographs or CT scan; you must hand the badge into Susan Holland

Chemotherapy Safety

How to don and doff PPE for chemotherapy administration

https://www.youtube.com/watch?v=dYX-CXdd4cU

Chemoclave needle-free closed system

https://www.youtube.com/watch?v=phSwYepEQUE

How to handle hazardous drug spills

https://www.youtube.com/watch?v=VI5m2QR4V_M

https://www.youtube.com/watch?v=WJchkc1xRNo

  • Warming patients safely with Hover Heat

https://vetorsolutions.com/pages/hoverheat-warming-pad-instructions

OUTPATIENT TASKS

  • Take a history
  • Order labwork
  • Spin sample and separate to send to Idexx
  • Prepare urine sample to send to Idexx
    • Handle correctly and place in correct tube
  • Prepare an invoice
  • Invoice visit
  • Fill medications
  • Discharge patient including review of instructions with owner
  • Fill in referral letter information (ex. TPR)
  • MEDICATIONS
  • Be familiar with commonly prescribed medications and side effects
  • Correctly draw up injectable medications
  • Cubex login and usage
  • IN HOUSE LABAWORK
  • CBC
  • Chemistry
  • EPOC
  • Coag/Blood type
  • PCV/TS
  • Urine dipstick
  • Urine specific gravity
  • PROCEDURE SETUP
  • Endoscopy-GI
  • Endoscopy-Rhinoscopy
  • Bone Marrow
  • Liver biopsy-U/S guided
  • Abdominocentesis/Thoracocentesis
  • Feeding tube
  • CSF tap
  • Central Line
  • Urinary catheter-male and female
  • SCOPE CARE
  • Hook up gastroscope
  • Hook up bronchoscope
  • Clean scopes between patients
  • Clean scope at end of day and proper storage
  • Clean biopsy instruments
  • PROCEDURES
  • Doppler blood pressure
  • Pulse oximetry
  • ECG
  • SQ injections
  • IM injections
  • IV injections
  • Draw blood from peripheral veins
  • Draw blood from jugular veins
  • IV catheter placement
    • Select appropriate size catheter
    • Select and prep vessel
    • Aseptic placement
    • Tape and secure
  • ANESTHESIA
  • Create an anesthesia sheet
  • Draw up correct dosage of drugs
  • Calculate fluid rate
  • Induction and intubation
  • Basic anesthesia monitoring
    • Planes of anesthesia
    • Normal parameters/when to notify doctor
  • HOSPITALIZED PATIENTS
  • Create and update flowsheet in SmartFlow
  • Rounding with doctor and patient care staff
  • Updating charges
  • CLIENT EDUCATION
  • Diabetics
    • FreeStyle Libre
  • Feeding tubes
  • Aerokat
  • BLOOD TRANSFUSION
    • Collection for transfusion
    • Monitoring the transfusion