THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: October 20, 2006 02:30 PM Friday;
Millie at Kaiser 13th cycle Xeloda Taxotere IBC relapse.
2...Treatment Regular 3 Week Schedule Steady Level Chemotherapy Agent
3...Breathing Difficulty Heavy Chest Pulmonary Emboli Side Effects
4...Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
5...Schedule Next Treatment Continue Fridays
6...Blood Counts Good Dose Chemotherapy Taxol Normal
....Anticoagulattion Therapy INR High 3.4 PT Patient High 34.2
7...ACN 3869 Well Above 1500 Criteria for Blood Counts Approve Treatment
8...CA 15-3 56 Rise from 51 Cancer Marker Current Blood Test
9...Preparation for Treatment Required One (1) Attempt to Connect Port
10...Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment
11...Taxotere Full Dose Blood Counts on Targets
12...Vitals Show Patient Stable
13...Communication Oncology Coagulation Balance Treatments
14...Xeloda Coumadin Balance Treatments Collaboration Required
15...Pharmacist Orders Capecitabine Decadron; Coordinate with Coumadin
16...Pulmonary Emboli Pharmacist Not Aware Communication Medication Fails
17...Energy Normal Stable After Treatment Taxotere Support Drugs
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13th Cycle Treatment Taxotere Xeloda Capacitibine Chemotherapy 5th C
0503 - ..
0504 - Summary/Objective
050501 - Follow up ref SDS 97 0000. ref SDS 95 0000.
050503 - Blood counts very good again today, though ANC continues to drop over
050504 - the past 2 - 3 months. ref SDS 0 P560 Treatment was accomplished
050505 - without incident. Side effects seem less severe, except Millie was
050506 - diagnosed with pulmonary emboli. Treatment of this side effect has
050507 - reduced severity of fatigue and shortness of breath. ref SDS 0 QU8K
050508 - Rising CA 15-3 from 51 to 56 reflects slow progress with current
050509 - treatment recovering from IBC relapse. ref SDS 0 2N5J Ross said the
050510 - Oncology Pharmacy was not aware that the doctor in Oncology prescribed
050511 - Coumadin (warfarin) to treat Millie for pulmonary emboli. He noted
050512 - that Kaiser's computer system posts prescriptions which is available
050513 - to the Coagulation Treatment Clinic. However, since he was not aware
050514 - of Millie's treatment for pulmonary emboli, he asked Millie to notify
050515 - the Coagulation Treatment Clinic to adjust her Coumadin prescription
050516 - for concurrent treatment with capecitabine (Xeloda). ref SDS 0 T650
050517 - Ross later called the Coagulation Treatment Clinic and was told that
050518 - the Clinic was not aware Millie is being treated with capecitabine
050519 - (Xeloda) prescribed by Oncology. The staff entered this in their
050520 - computer and will make the adjustments to Millie's prescription for
050521 - Coumadin. ref SDS 0 VE4K
050529 - ..
0508 - Progress
050901 - Treatment Regular 3 Week Schedule Steady Level Chemotherapy Agent
050903 - Follow up ref SDS 97 407N, ref SDS 95 407N.
050905 - Received treatment to begin 13th cycle overall of chemotherapy with
050906 - Taxotere and capecitabine (Xeloda), and the 5th treatment for 3rd
050907 - relapse of IBC. Scheduling and treatment were reviewed by the primary
050908 - care physician on 060825. ref SDS 94 025H There was another review on
050909 - 060929. Treatments were initially irregular, and there has been slow
050910 - response, reported on 060922. ref SDS 96 0D4T Treatment was on
050911 - schedule for 060929, and again today. This keeps a steady level of
050912 - chemotherapy agent treating cancer.
050917 - ..
050918 - Debbie had fun with us today. Her last name was hard to discern sown
050919 - onto her hospital gown. When asked, she said "Reynolds." Writing up
050920 - the record and noting coincidence with the actress and entertainer;
050921 - Debbie laughed and said, "Hey, you didn't write that down, I hope!"
050923 - ..
050924 - Millie had a blood draw yesterday afternoon, Thursday, 061019.
Side Effects Consultation Pharmacist Tired Fatigue Heavy Chest Short
160401 - ..
160402 - Breathing Difficulty Heavy Chest Pulmonary Emboli Side Effects
160403 - Side Effects Consultation Pharmacist Heavy Chest Difficult Breathing
160405 - Follow up ref SDS 97 QU8K, ref SDS 95 QU8K.
160407 - On 060724 diary showing history of side effects for 2nd phase taking
160408 - Taxotere and capecitabine (Xeloda). ref SDS 86 QX8K
160410 - ..
160411 - Millie met with the pharmacist, Ross, briefly in the examination room,
160412 - per below, and notified of reduced side effects. ref SDS 0 819O
160414 - ..
160415 - Tired, fatigued - pulmonary emoblims...
160417 - Millie's energy seems improved after Kaiser diagnosed
160418 - pulmonary emboli and started treatment with Coumadin on
160419 - 061002. ref SDS 99 MI5I The 3rd week of treatment this
160420 - cycle was better than last month, reported on 060929,
160421 - ref SDS 97 FG3N; however, energy remains lower than
160422 - normal, even for chemotherapy treatments; chronic
160423 - fatigue prevents routine exercise at the gym.
160425 - ..
160426 - Heavy chest - difficult breathing
160428 - This has improved slightly with respect to climbing
160429 - stairs, walking several blocks, but not sure.
160431 - ..
160432 - Dry hands.
160434 - Hands, fingers, cuticals bleeding slightly; patient
160435 - using commercially available moisturizing lotion.
160437 - ..
160438 - Nausea
160440 - Uneasy, queazy feeling in stomache relieved by eating
160441 - small amounts of food thorughout the day.
160443 - ..
160444 - sores in mouth
160446 - None yet, cleaning mouth carefully to avoid problem.
Schedule Treatment Regular 3-week Cycle on Friday 061020 1430 Blood
200401 - ..
200402 - Schedule Next Treatment Continue Fridays
200404 - Follow up ref SDS 97 QK6L, ref SDS 95 QK6L.
200406 - ..
200407 - Today, Millie's next treatment is scheduled for 061110 1430.
200409 - ..
200410 - Blood draw is schedued forthe day before on 061109 1600.
200412 - ..
200413 - Meeting with the doctor also scheduled for 061110. Not sure about
200414 - the time, because we can do it before or during treatment.
Blood Tests Chemotherapy WBC White Cell Count Good 13th Cycle Taxote
230401 - ..
230402 - Blood Counts Good Dose Chemotherapy Taxol Normal
230404 - Follow up ref SDS 97 Q659, ref SDS 95 Q659.
230406 - ..
230407 - Debbie submitted the report showing...
230409 - Patient Provider Category View FR Date To Date
230415 - ..
230416 - Procedure Results Reference Range
230425 - ** Marina Way South **
230427 - ..
230428 - Test Name Value Unit <-------- RANGE-------->
230429 - @CBC
230430 - WBC x 10-3 5.3 K/uL 3.5 - 12.5
230431 - RBC x 10-6 3.79 M/uL 3.60 - 5.70
230432 - Hemoglobin 12.4 g/dL 11.5 - 15.0
230433 - Hematocrit 37.3 % 34.0 - 46.0
230434 - MCV 98 fL 80.0 - 100.0
230435 - RDW H 16.1 % 11.9 - 14.3
230436 - Plt x10-3 306 K/uL 140 - 400
230437 - ..
230438 - Neutrophils 73 % 50 - 70
230439 - Lymphocytes 24 % 20 - 50
230440 - Monocyte 2 % 0 - 11
230441 - Eosinophils 0 % 1 - 5
230442 - Basophil 1 % 0 - 2
230443 - Bands No Report % 0 - 5
230445 - ..
230446 - CA 15-3 H 56 U/mL -< - 39
230448 - ..
230449 - Alkaline Phos No Report U/L 38 - 126
230450 - Bili, Tot Adult 0.5 mg/dL 0.2 - 1.3
230451 - Creatinine 0.7 mg/dL 0.6 - 1.2
230452 - ALT (SGPT) H 37 U/L 14 - 36
230453 - AST (SGOT) No Report U/L 11 - 66
230455 - ..
230456 - RBC Morphology No Report
230457 - Poikilocytosis * No Report
230458 - Anisocytosis * No Report
230459 - Schistocytes * No Report
230460 - PLT Estimate No Report
230461 - PLT Morphology No Report
Anticoagulation Therapy Pulmonary Emboli INR High 3.4 PT Patient Hig
260401 - ..
260402 - Anticoagulattion Therapy INR High 3.4 PT Patient High 34.2
260405 - PT, patient H 34.2 sec 8.9 - 11.1
260406 - PT INR 3.4 sec 2 - 3
Absolute Neutrophils Count ANC 3869 Well Above 1500 Required for Tre
290401 - ..
290402 - ACN 3869 Well Above 1500 Criteria for Blood Counts Approve Treatment
290404 - Follow up ref SDS 97 P560, ref SDS 95 P560.
290406 - Millie was surprised that blood counts reported today are very strong,
290407 - per above. ref SDS 97 0N7Q Experience since 2002 has shown a strong
290408 - correlation between feeling tired, reported today, ref SDS 97 FG3N, and
290409 - having low blood counts.
290411 - ..
290412 - Formula for ANC, from record on 050128. ref SDS 49 TZ3N
290414 - ..
290415 - Calculation from 060908 yielded 6390. ref SDS 95 P560
290417 - ..
290418 - Note that bands are added to neutrophils, but both neutrophils and
290419 - bands have no report today.
290421 - WBC = 5.3
290423 - Neutrophils = .73
290424 - Bands = no report
290426 - ..
290427 - ANC = 5.2 x 1000 x .73 = 3869
290429 - ..
290430 - ANC calculation was submitted by the nurse today.
CA 15-3 56 Rise from 51 Cancer Marker Current Blood Test Reversing P
310401 - ..
310402 - CA 15-3 56 Rise from 51 Cancer Marker Current Blood Test
310404 - Follow up ref SDS 97 2N5J, ref SDS 95 2N5J.
310406 - ..
310407 - Test today showing CA 15-3 56, ref SDS 0 5K6K, reversed course for the
310408 - first time in several months and increased, compared to the report for
310409 - the test on 060928, received on 060929. ref SDS 97 2N5J
310411 - ..
310412 - Reflects very slow progress of IBC rash subsiding on the left breast.
Port Connection Prepare for Treatment 1 Try Required Debbie Excellen
3404 - 1446
340501 - ..
340502 - Preparation for Treatment Required One (1) Attempt to Connect Port
340504 - Follow up ref SDS 97 EB7J, ref SDS 95 EB7J.
340506 - ..
340507 - Julie did the administration with Debbie to verify Millie gets the
340508 - correct treatment.
340510 - ..
340511 - Millie explained having taken Decadron tablets according to the
340512 - prescription to take two tablets twice a day, per instructions on
340513 - 050415. ref SDS 56 8U4O
340515 - ..
340516 - Decadron was not given by Debbie again before treatment today, because
340517 - Millie took the pills this morning with her meal, as prescribed; and
340518 - Millie will take another treatment of Decadron tomorrow as part of
340519 - chemotherapy treatment with Taxotere today.
340521 - Generic name: dexamethasone
340523 - http://www.tirgan.com/decadron.htm
340525 - ..
340526 - Description and purpose of Decadron is reported in the record
340527 - on 060721. ref SDS 84 4I4Q
340529 - ..
340530 - Compazine - Debbie gave Millie a pill prior to treatment. Millie took
340531 - this with a cup of water; this was after Julie and Debbie did the
340532 - protocol verfication, per above, ref SDS 0 6O5G, which corrected the
340533 - mistake that occurred on 060929. ref SDS 97 NG55
340535 - ..
340536 - Ativan - was not part of treatment today, previously given on 060721.
340537 - ref SDS 84 FZ5M
340539 - Generic name: benzodiazepines
340541 - Purpose of Atiman reported on 060721. ref SDS 84 NF6K
340543 - ..
340544 - Anzemet - was not part of treatment today, previously given on 060908.
340545 - ref SDS 95 O64I This was reported ineffective on 060929. ref SDS 97
340546 - NR5F
340548 - Generic name: dolasetron mesylate
340550 - http://www.anzemet.com
340556 - ..
3408 - 1448
340901 - Debbie connected the IV tubes to the port....
340903 - ..
340904 - Interlink System Vented Paclitaxel set
340906 - ..
340907 - This was done without incident, very professional and competent.
Benadryl Drip Treatment Prepares Patient for Taxotere Chemotherapy A
3704 - 1455
370501 - ..
370502 - Benedryl Reduce Side Effects Taxotere Chemotherapy Treatment
370504 - Follow up ref SDS 97 DC7J, ref SDS 95 DC7J.
370506 - Benadryl started.
370508 - ..
370509 - Purpose reported on 060721. ref SDS 84 DC7J
370513 - ..
3708 - 1502
370901 - Benedryl completed.
Taxotere 102 MG Drip Treatment 12th Cycle Taxotere Capecitiabine (Xe
4004 - 1503
400501 - ..
400502 - Taxotere Full Dose Blood Counts on Targets
400504 - Follow up ref SDS 97 4N5M, ref SDS 95 4N5M.
400506 - ..
400507 - Taxotere started - 102 MG.
400509 - ..
400510 - There was no patient evaulation process today, which fits the
400511 - procedure the first time Millie was treated with Taxotere on 020610,
400512 - ref SDS 6 MR5I; later, on 050415 Kaiser performed patient evaluation
400513 - of side effects for Taxotere treatment. ref SDS 56 4333
400519 - ..
4008 - 1605
400901 - Equipment beeped indicating treatment is over.
400903 - ..
400904 - Debbie disconnected the IV tubes.
400906 - ..
400907 - She inserted Herceptin to flush the port.
400909 - ..
400910 - She then removed the needle from the port, and swabbed the needle
400911 - wound, and placed a temporary bandage.
Vitals Blood Pressure Pulse Temperature Taxotere 102 MG Drip Treatme
4304 - 1534
430501 - ..
430502 - Vitals Show Patient Stable
430504 - Follow up ref SDS 97 AW4L, ref SDS 95 AW4L.
430506 - Debbie took vitals after starting Taxotere drip treatment...
430508 - Blood
430509 - Date Time Pressure Pulse Temprtr Weight So2
430511 - ..
430512 - 061020 1534..... 140 79 67 99.8 151 97
430513 - 060929 1452..... 141 78 66 98.3
430514 - 060908 1335..... 139 79 73 98.1
430515 - 060814 1610..... 139 80 59 98.2
430516 - 060722 1440..... 142 74 67 98.1
430517 - 060711.......... 172 87 54 97.5 147
430518 - 060623.......... 141 87 71 98.0 147
430519 - 060428.......... 129 73 80 99.4 149
430520 - 060217.......... 153 81 61 98.6 150
430521 - 050916.......... 120 80 80 98.5
Pharmacist Orders Capecitabine (Xeloda) 13th Cycle Decadron Review S
AI04 - 1447
AI0501 - ..
AI0502 - Communication Oncology Coagulation Balance Treatments
AI0503 - Xeloda Coumadin Balance Treatments Collaboration Required
AI0504 - Pharmacist Orders Capecitabine Decadron; Coordinate with Coumadin
AI0505 - Pulmonary Emboli Pharmacist Not Aware Communication Medication Fails
AI0507 - Follow up ref SDS 97 TZ4I, ref SDS 95 TZ4I.
AI0509 - Ross visited briefly. He verified that Millie is taking 1.5 pills of
AI0510 - capecitabine (Xeloda) twice a day. He will have a prescription ready
AI0511 - for Millie to purchase at the 2nd floor Pharmacy after treatment
AI0512 - today.
AI0514 - ..
AI0515 - This procedure is slightly different from cycle 12 on 060929. At that
AI0516 - time, the pharmacist asked Millie to explain the protocol for
AI0517 - capecitabine, and advised that asking the patient to state the dose
AI0518 - for treatment satisfies Kaiser's quality control to verify that the
AI0519 - patient is taking the prescribed amount of treatment. ref SDS 97 WK95
AI0521 - ..
AI0522 - There was discussion of side effects, per above. ref SDS 0 QU8K
AI0524 - ..
AI0525 - The pharmacist was unaware that Millie had been diagnosed with
AI0526 - pulmonary emboli on 061002 and is being treated again with Coumadin.
AI0527 - ref SDS 99 MI5I
AI0529 - ..
AI0530 - Ross said that Millie should notify the Coagulation Treatment Clinic
AI0531 - that she is being treated with capecitabine (Xeloda), because the
AI0532 - amount of Coumadin has to be adjusted. This requirement was
AI0533 - previously discussed on 060711 with Ross' colleague, Zan; however, at
AI0534 - that time Millie had been removed from treatment with Coumadin.
AI0535 - ref SDS 83 S33L
AI0537 - [On 061024 Gloria explained that capecitabine impacts effects
AI0538 - of treatment with Coumadin, which requires frequent blood
AI0539 - testing. ref SDS A2 TZ4I
AI0541 - ..
AI0542 - [On 061024 case study medical practice computer access limited
AI0543 - even with everything on the computer, people can't find details
AI0544 - stored in parts of the computer (software modules) that are not
AI0545 - frequently used. ref SDS A2 JD9L
AI0547 - ..
AI0548 - There was discussion that requirements for treatment medication should
AI0549 - be coordinated dirctly by the Pharmacy in Oncology under the doctor's
AI0550 - supervision, with the Coagulation Treatment Clinic, rather than depend
AI0551 - on frailties of patient personal memory to convey details critical for
AI0552 - effective care.
AI0554 - ..
AI0555 - [On 061214 treatment mistake pulmonary embolism warfarin
AI0556 - (Coumadin) conflicts with prescription for Diflucan; blood test
AI0557 - INR rises 6.4 danger zone for hemoraging; blood clot
AI0558 - coagulation treatment paused for 3 days; INR update test
AI0559 - advanced. ref SDS A6 HF4O
AI0561 - ..
AI0562 - [On 070201 Millie's INR drops to 1.6 after ending treatments
AI0563 - with capecitabine on 061201, requires adjusting level of
AI0564 - Coumadin again. ref SDS A8 6U5J
AI0566 - ..
AI0567 - Ross said that the Coagulation Treatment Clinic has access to patient
AI0568 - treatment prescriptions on Kaiser's computer system, and so will
AI0569 - likely make the correct adjustments in Coumadin to fit Millie's
AI0570 - prescription for capecitabine.
AI0572 - ..
AI0573 - There was further discussion, that if Kaiser's computers automatically
AI0574 - notify the Coagulation Treatment Clinic about medications prescribed
AI0575 - by the doctor in Oncology, then why was the patient asked to notify
AI0576 - the Coagulation Treatment Clinic about the doctor prescribing
AI0577 - capecitabine, and why didn't Ross know that Millie is being treated
AI0578 - with Coumadin, since the Oncology Clinic Pharmacy here in Walunt
AI0579 - Creek, has access to the same list of treatments as the Coagulation
AI0580 - Treatment Clinic in Martinez, and further the Oncology Pharmacy staff
AI0581 - is working directly with doctors who prescribe treatments?
AI0583 - [...in another record today primary care physician developed
AI0584 - Kaiser computer system for automatic notification of patient
AI0585 - medications, ref SDS A1 YQ8J; frustrated because Oncology
AI0586 - pharmacy and Coagulation Treatment Clinic not aware Millie
AI0587 - being treated with capecitabine and coumadin. ref SDS A1 M69H
AI0589 - ..
AI0590 - [On 061024 Coagulation Treatment Clinic uses software that
AI0591 - requires accessing another part of Kaiser's computer system to
AI0592 - coordinate patient treatments; such access requires training,
AI0593 - and time for performance; therefore direct notice from the
AI0594 - doctor and support staff in Oncology Pharmacy, as occurred
AI0595 - today, per below, ref SDS 0 VE57, and also by the patient, as
AI0596 - encouraged by the pharmacist, per above, ref SDS 0 S69H,
AI0597 - assists the Coagulation Treatment Clinic in making an accurate
AI0598 - and effective balance of treatments for pulmonary embolism with
AI0599 - chemotherapy treatments for cancer using capecitabine (Xeloda)
AI0600 - in this case. ref SDS A2 TZ4I
AI0602 - ..
AI0603 - Ross was not comfortable relying on Kaiser's computer for notifying
AI0604 - the Coaguluation Treatment staff to prescribe Coumadin for pulmonary
AI0605 - embolism, and in amounts compatible with concurrent capecitabine
AI0606 - treatments ordered by the Oncology department to treat Millie's
AI0607 - cancer.
AI0609 - [On 061020 primary care physician cannot access Kaiser's
AI0610 - computer for details in the medical chart. ref SDS A1 ET5J
AI0612 - ..
AI0613 - [On 061110 doctor's list of current medications incorrect not
AI0614 - listing Coumadin, and also does not list antibiotics for
AI0615 - cellulitus, Lovenox, also, for PE, Procrit is not listed for
AI0616 - anemia (low energy) to redress low blood counts for hemoglobin,
AI0617 - Tums is not listed for GERD. ref SDS A4 SE86
AI0619 - ..
AI0620 - [On 061112 Doctor Seier found patient history on 061027
AI0621 - prepared by lead ER physician, and this assisted diagnosis and
AI0622 - treatment for cellulitus relapse on 061112 ref SDS A5 XS5J;
AI0623 - patient history of other doctors treating Millie for cellulitus
AI0624 - beginning on 061027 under Kaiser's team care practice was not
AI0625 - available. ref SDS A5 5L6H
AI0627 - ..
AI0628 - Ross indicated that complexity of constantly expanding medications
AI0629 - prescribed in varying multi-agent combinations increase mistakes
AI0630 - entering details in the computer system. Tired, busy people with a
AI0631 - hectic schedule hurry to catch up enter data incorrectly or get
AI0632 - distracted and forget to enter critical details. Sometimes people
AI0633 - don't have time to check the computer. These human factors that cause
AI0634 - errors and omissions require checks and balances with feedback for an
AI0635 - audit trail to verify accuracy in treatment prescriptions. (see
AI0636 - below, Ross corrected errors ordering Milli's Coumadin treatment for
AI0637 - pulmonary embolism. ref SDS 0 VE57) An example are continuing
AI0638 - failures of analysts to compare imaging tests with prior related work
AI0639 - to demonstrate accurate understanding of trends on emerging problems,
AI0640 - reported on 061012. ref SDS A0 2935 Sometimes small, innocuous
AI0641 - details compound into major problems, reported on 921127. ref SDS 1
AI0642 - 0674 He therefore asked Millie to get feedback from the Coagulation
AI0643 - Treatment Clinic, since balancing Coumadin treatment with capecitabine
AI0644 - (Xeloda) is important for treating cancer and pulmonary, since both
AI0645 - are life threatening.
AI0647 - [On 070106 similar problem treating heart attack patient.
AI0648 - ref SDS A7 RS62
AI0650 - ..
AI0651 - Ordinarily, treatment prescriptions to relieve life threatening
AI0652 - maladies, reported on 060722, ref SDS 85 BI5J, should be conveyed with
AI0653 - urgency, and feedback loops for the attending physician to verify that
AI0654 - treatments are properly balanced. Ross explained Kaiser policy that
AI0655 - accuracy balancing medications to prevent harm to the patient is a
AI0656 - responsiblity of the prescribing doctor and pharmacy.
AI0658 - ..
AI0659 - Challenges applying requirements for feedback and traceability to
AI0660 - original sources for strengthening accuracy are studied in records
AI0661 - on...
AI0663 - Pulmonary emboli risks........... 060722, ref SDS 85 6G6O
AI0664 - Medical practice................. 040416, ref SDS 13 GN7J
AI0665 - Management standards............. 020504, ref SDS 5 NS6F
AI0667 - ..
AI0668 - [On 061024 background on difficulties accessing computers that
AI0669 - reduce productivity. ref SDS A2 TF45
AI0671 - ..
AI0672 - Earlier today, Debbie commented that even though nurses now have fewer
AI0673 - patients to treat in the Oncology Infusion Clinic, the work is more
AI0674 - confusing, because nurses spend more time with the computer. Kaiser
AI0675 - has three (3) different software programs that are overlapping in some
AI0676 - respects. Nurses have to learn and use all three, including continual
AI0677 - revisions. Full or optimal use of software program functions to care
AI0678 - for patients is therefore hard to achieve. Previously, on 020110
AI0679 - statistics presented show that difficulty learning to keep up with
AI0680 - changes to software is a common problem. For example, most people
AI0681 - only use about 5% of Microsoft features. ref SDS 4 CK4K An example
AI0682 - occurred on 060711 when the primary care physician explained that a
AI0683 - key part of patient history on status change took over 2 years to find
AI0684 - in Kaiser's software , because Kaiser had failed to provide training
AI0685 - and support. ref SDS 83 RK4L
AI0687 - [On 061020 primary care physician cannot access Kaiser's
AI0688 - computer for details in the medical chart. ref SDS A1 ET5J
AI0690 - ..
AI0691 - As related above in discussion with Ross, ref SDS 0 TR47, a recent
AI0692 - example of computer access problems is the study on 061012 showing
AI0693 - continuing failure of anlaysts to make correct comparisons with prior
AI0694 - tests for trend analysis to discover emerging problems in time for
AI0695 - effective treatment. ref SDS A0 2935
AI0697 - ..
AI0698 - Debbie gave an example of delays and fatigue from extra time and
AI0699 - effort because staff are required to cut and paste to transfer data
AI0700 - from one program to another. It takes a lot of concentration to avoid
AI0701 - mistakes when a nurse must attend to a patient, answer a telephone, or
AI0702 - talk to a nurse or a doctor, then remember the context to resume a
AI0703 - specific sequence of steps to perform after being interruped, 2
AI0704 - minutes, 5 minutes, 20 minutes earlier. Debbie said this means that
AI0705 - work never settles into a professional practice that allows increasing
AI0706 - skill through experience, because experience is in constant flux. The
AI0707 - technology people continually make improvements and add new programs,
AI0708 - so nurses spend more time learning to use new computer steps that
AI0709 - reduce time for treating patients. She feels that is why nurses are
AI0710 - now treating fewer patients than a few years ago. She prefers working
AI0711 - with the old paper system, and treating more patients.
AI0713 - ..
AI0714 - [On 061024 case study medical practice computer access limited
AI0715 - even with everything on the computer, people can't find details
AI0716 - stored in parts of the computer (software modules) that are not
AI0717 - frequently used. ref SDS A2 JD9L
AI0719 - ..
AI0720 - [On 061214 treatment mistake pulmonary embolism warfarin
AI0721 - (Coumadin) conflicts with prescription for Diflucan; blood test
AI0722 - INR rises 6.4 danger zone for hemoraging; blood clot
AI0723 - coagulation treatment paused for 3 days; INR update test
AI0724 - advanced. ref SDS A6 HF4O
AI0726 - ..
AI0727 - The problem of stable technology for people to learn and also learn to
AI0728 - deploy productively into a highly skilled professional practice was
AI0729 - discussed with Doug Engelbart at SRI on 000327. ref SDS 3 4420
AI0731 - ..
AI0732 - Debbie also said that Kaiser is getting 200 new Oncology patients a
AI0733 - month in the Walnut Creek hospital.
AI0735 - [On 061110 Contra Costa county has the highest cancer rate in the
AI0736 - country. ref SDS A3 KE93
AI0743 - ..
AI10 - 1543
AI1101 - Stopped and visited with Ross breifly in his office near the entrance
AI1102 - to the Infusion Clinic.
AI1104 - ..
AI1105 - Mentioned that Millie appreciates Ross's work, and that questions do
AI1106 - not reflect lack of confidence, but support the work with feedback, as
AI1107 - called out in Kaiser's Healthwise Handbook, reviewed on 990625.
AI1108 - ref SDS 2 3960
AI1110 - ..
AI1111 - Ross said that collaboration with the patient was helpful feedback,
AI1112 - called out in Kaiser's Healthwise handbook.
AI1114 - ..
AI1115 - After talking to Millie in the Infusion Clinic, per above, ref SDS 0
AI1116 - T650, he called the Coagulation Treatment Clinic in Martinez, and
AI1117 - reported that Millie is being treated with capecitabine (Xeloda). He
AI1118 - was told that capecitabine (Xeloda) would be added to Kaiser's
AI1119 - computer program for the Coagulation Treatment Clinic, and that
AI1120 - Millie's Coumadin treatments would be adjusted accordingly.
AI1122 - [On 061020 meeting with primary care physician discussed roles and
AI1123 - responsibilities to verify that treatment prescribed by the
AI1124 - primary care physician is implemented; doctor frustrated that
AI1125 - computer system implemented 10 years ago to automtically notify
AI1126 - everyone in a common data base of patient medications requires
AI1127 - oversight and feedback loops for verification. ref SDS A1 M69H
AI1129 - ..
AI1130 - [On 061024 called Coagulation Treatment Clinic, and Gloria
AI1131 - confirmed that Millie's chart has been posted to show she is being
AI1132 - treated with capecitabine (Xeloda). ref SDS A2 TE60
AI1134 - ..
AI1135 - [On 061024 case study medical practice computer access limited
AI1136 - even with everything on the computer, people can't find details
AI1137 - stored in parts of the computer (software modules) that are not
AI1138 - frequently used. ref SDS A2 JD9L
AI1140 - ..
AI1141 - Previously, on 050415 Zan, who also works in the pharmacy, avoided a
AI1142 - treatment mistake by collaboration with the patient and the doctor to
AI1143 - change the prescription and order the correct treatment. ref SDS 56
AI1144 - KX49
Energy Normal Stable Alert Drive Home After Treatment IBC 3rd Relaps
AM04 - 1733
AM0501 - ..
AM0502 - Energy Normal Stable After Treatment Taxotere Support Drugs
AM0504 - Follow up ref SDS 97 F54N, ref SDS 95 F54N.
AM0506 - Millie was alert after treatment today, and not wobbly nor
AM0507 - disoriented.
AM0509 - ..
AM0510 - On 060724 diary side effects for 2nd phase taking Taxotere and
AM0511 - capecitabine (Xeloda). ref SDS 86 QX8K