East Cluster Meeting Minutes, January 7, 2009

A very well-attended meeting today!

Flow

• We reviewed our immunization discussion from last week, which concluded that only children under 4 years old must go to CORE for shots. However, we have no reliable system for delivering immunizations in the clusters, as MAs are prohibited from doing so. Sheila reports today that CORE does not expect clusters will do their own shots if clusters are busy. If clusters are flowing efficiently, cluster flow staff should do their own injections. (Note: this last bit was clarified further by Sheila on Jan 9).
  
• Regarding our original flow document. This is several pages long and quite complex. It sits in a notebook, and no one could be expected to review it regularly to recall what the nursing flow job is. So, is there a disconnect between that "formal" document and the day-to-day work our nurses are doing? Cheryl responded that there are still quite a few variables in the day, floating staff and provider preference differences make our standardization work more challenging.
• Blood pressure. Could we eliminate some re-work by deferring blood pressure measurement until the patient has been seated for a few minutes (end of nursing assessment)? We agreed to do this and discuss it next week.
• An FYI: our new Occupational Medicine provider starts soon (February?), and will see both Occ Med cases and commercial driver's license certification visits.

Quality

• New PCER reports are out. They feel lighter.
• As a clinic, we are up 1%, which is a big move for a big population! We're at 70%, goal is 75%. We're on our way.
• We agreed to have Becky deliver PCER reports next month with just the priority items we have identified (see last week's notes).
• Levine has asked to be held accountable to deliver a sample HEDIS letter in seven days. The clock is running. Tick tock.
• Dr. Butler's flowstaff, working in Katie's absence, should absolutely be doing HEDIS outreach. Katie comes back Feb 2!
• Sherrie's DM classes start soon! Every second Friday of the month, she'll spend 90 minutes (from 3-4:30p) with a group of up to ten patients with diabetes. She'll review their clinical data with them and use this as a way to do facilitated, group teaching around issues of self-managment. Jason Wong has created a dot phrase we can use in our AVS notes, and Wellesley will see if it is BRN-wide, or can be made so.