CONTACTS 

SUBJECTS
Power Port Notify Medical Team Surgery Successful Follow Up Tasks Re

2503 -
2503 -    ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS 31 0000. ref SDS 30 0000.
250502 -
250503 - Millie got treatment with Neupogen to increase blood counts so she can
250504 - get chemotherapy treatment for cancer next week on Thursday.
250505 - ref SDS 0 IT77  The schedule for continuing Neupogen treatments was
250506 - extended through August to correlate with Millie's weekly treatments
250507 - in the clinical study at UCSF. ref SDS 0 RW3F  The Infusion Clinic
250508 - reported today that Millie's correspondence coordinating arrangements
250509 - for the CT test scheduled next Friday have not been forwarded by the
250510 - Oncology Department nor discussed with the CT Department, ref SDS 0
250511 - OC9G, and there have been no assignments nor coordination to support
250512 - the test. ref SDS 0 PP5J  The Director of the Infusion Clinic
250513 - suggested Millie visit the CT Department to verify arrangements are
250514 - set so that the test will not be delayed. ref SDS 0 RN5O  Millie went
250515 - to the CT Department. ref SDS 0 7K8I  As with the Infusion Clinic,
250516 - correspondence over the past month sent to Oncology planning the CT
250517 - test on 080718 was not forwarded to the CT Department.  They have no
250518 - record that the test requires using Millie's Power Port. ref SDS 0
250519 - PP6O  The fact that the CT Department called Millie a month ago on
250520 - 080617 to schedule the test, and notified her to make arrangement with
250521 - the Infusion Clinic to access the Power Port at 1030 in time for
250522 - injection of contrast medium half an hour later in the CT Department
250523 - at 1100, was evidently lost or otherwise forgotten until today.
250524 - ref SDS 0 PP7O  The Department has started to think about developing
250525 - training and a protocol for using Power Ports on CT tests, but this
250526 - will not be ready in time for Millie's test next Friday. ref SDS 0
250527 - JQ55  The Department feels that plans by the Oncology doctor to
250528 - support the CT test cannot be implemented because the doctor does not
250529 - have a state certificate to operate the test equipment. ref SDS 0 JQ87
250530 - Kaiser has 3 doctors with the certificate, however, notifying any of
250531 - these doctors to perform 20 minutes of work for the CT test next week
250532 - on 080718 would inconvenience their schedules.  The Department
250533 - recommended delaying the test to allow time for training and staff
250534 - certification, and to line up support activities.  UCSF feels the test
250535 - is already a month later than needed for patient care under the
250536 - clinical study protocol. ref SDS 0 JR30  Upon discussion, the CT
250537 - Department will work the issues and notify Millie by next Wednesday,
250538 - if the test can be done on Friday, 080718, as currently scheduled.
250539 - ref SDS 0 JR7Y  Review shows 10 alternative work plans that enable
250540 - doing the test on time. ref SDS 0 JR88
250542 -             ..
250543 -            [On 080712 Millie notified the doctor that proactive
250544 -            support required to accomplish objectives for CT test using
250545 -            Power Port on 080718. ref SDS 33 K13Q
250547 -             ..
250548 -            [On 080715 Arlette called and said the doctor solved
250549 -            coordination problems; CT test is good to go on 080718.
250550 -            ref SDS 34 RB4N
250552 -             ..
250553 -            [On 080716 Ike called and confirmed that Kaiser has made
250554 -            arrangements for Millie to get a CT test using her Power
250555 -            Port. ref SDS 35 PZ4L
250557 -             ..
250558 -            [On 080718 Nora with Kaiser Interventionary Radiology
250559 -            assigned to access the Power Port for Millie's CT test,
250560 -            ref SDS 36 2U8V; during procedure, Nora requests
250561 -            manufacturer's Instructions for Use on Power Injection
250562 -            procedures, ref SDS 36 NM5V, which was submitted to Kaiser
250563 -            on 080709, ref SDS 31 TR9X, review was requested on 080712,
250564 -            ref SDS 33 K13Q, and again on 080715, ref SDS 34 RB3T;
250565 -            complications occurred on power injection when contrast
250566 -            medium overflowed; CT test with Power Port failed.
250567 -            ref SDS 36 LK3R
250569 -             ..
250570 -            [On 080801 Bard asks about Huber needle used for the CT
250571 -            test today - could be defective, ref SDS 40 OV5I; Kaiser
250572 -            was trained a year earlier, but adopted policy not to use
250573 -            Power Ports for CT tests, so nobody has experience,
250574 -            ref SDS 40 OV9H, Julie offes to consult during Millie's
250575 -            next CT test. ref SDS 40 OW41
250576 -
250577 -
250578 -
250579 -
250581 -  ..
2506 -
2507 -
2508 - Progress
2509 -
250901 - Neupogen 1st Treatment at Kaiser for 3rd Chemotherapy 5th Cycle UCSF
250902 -
250903 - Follow up ref SDS 31 IT77, ref SDS 30 IT77.
250904 -
250905 - Millie went to the Infusion Clinic at Kaiser in Walnut Creek to
250906 - implement the UCSF prescription on 080626 for 2 Neupogen treatments
250907 - this cycle for each of the 3 weekly treatments with Carboplatin
250908 - chemotherapy. ref SDS 24 QJ4H  Millie followed guidance at UCSF
250909 - yesterday to get treatment today, despite very high blood counts for
250910 - the labs yesterday on 080710 that may justify cost containment by
250911 - skipping treatment today and/or tomorrow. ref SDS 32 PU6K
250913 -  ..
250914 - Florida was the nurse today providing Neupogen treatment.
250916 -  ..
250917 - Millie made arrangements with Florida to change the meeting tomorrow
250918 - scheduled for treatment at 1100, to come in at 0900, following up
250919 - Florida's discussion of flexibility on 080620, ref SDS 22 IE7L, and
250920 - subsequent scheduling adjustments on 080627. ref SDS 26 PPVW
250921 -
250922 -
250923 -
250924 -
250925 -
250926 -
2510 -

SUBJECTS
Default Null Subject Account for Blank Record

2603 -
260401 -  ..
260402 - Schedule Neupogen Treatments Extended through August
260403 -
260404 - Follow up ref SDS 22 YY88.
260405 -
260406 - After getting treatment, Millie met with Zan in the Oncology
260407 - Pharmacy.
260409 -  ..
260410 - Zan extended Kaiser's schedule of 2 Neupogen treatments per week for
260411 - Millie through August.  The current schedule received on 080620 covers
260412 - only 2 more weeks. ref SDS 22 YY88  Zan asked for dates of Millie's
260413 - chemotherapy treatments in the clinical study at UCSF, listed in the
260414 - record on 080626. ref SDS 25 IK7H  He scheduled Neupogen treatments at
260415 - Kaiser on day 2 and 3 after chemotherapy at UCSF.
260416 -
260417 -            [On 080725 Neupogen treatments have not been listed in
260418 -            Millie's schedule received from Kaiser; discussion with Zan
260419 -            indicated he does not actually schedule treatment; he
260420 -            submits a note to the Infusion Clinic to enter the schedule
260421 -            in Kaiser's computer. ref SDS 38 TS7G  Paula planned to
260422 -            schedule Millie's treatment for August, but was very busy.
260423 -            ref SDS 38 XO8J
260425 -             ..
260426 -            [On 080726 Kaiser's schedule does not show Millie's
260427 -            treatments for August; Bonnie entered in Kaiser's computer
260428 -            system Millie's schedule for Neupogen treatments for
260429 -            August. ref SDS 39 9839
260431 -  ..
260432 - Zan's schedule implements UCSF Chemotherapy Orders on 080529,
260433 - presented to Zan on 080609. ref SDS 19 L16I
260434 -
260435 -                                                        UCSF Chemo
260436 -        Date    Time   Provider         Services      Cycle Treatmnt
260437 -        080711  1630   Infusion Nurse   Neupogen        5     3
260438 -        080712  1200   Infusion Nurse   Neupogen        5     3
260439 -         ..
260440 -        080718  1030   Infusion Nurse   Port access     5     4
260441 -        080718  1100   Imaging Dep      CT scan test    5     4
260442 -         ..
260443 -        080718  1300   Infusion Nurse   Neupogen        5     4
260444 -        080719  1100   Infusion Nurse   Neupogen        5     4
260445 -        080725  1300   Infusion Nurse   Neupogen        6     1
260446 -        080726  1100   Infusion Nurse   Neupogen        6     1
260447 -         ..
260448 -        080731  0900   Infusion Nurse   Neupogen        6     2
260449 -        080801  0900   Infusion Nurse   Neupogen        6     2
260450 -        080808  0900   Infusion Nurse   Neupogen        6     3
260451 -        080809  0900   Infusion Nurse   Neupogen        6     3
260452 -         ..
260453 -        080815  0900   Infusion Nurse   Neupogen        6     4
260454 -        080816  0900   Infusion Nurse   Neupogen        6     4
260455 -        080822  0900   Infusion Nurse   Neupogen        7     1
260456 -        080823  0900   Infusion Nurse   Neupogen        7     1
260457 -        080829  0900   Infusion Nurse   Neupogen        7     2
260458 -        080830  0900   Infusion Nurse   Neupogen        7     2
260459 -
260460 -           [On 080725 Kaiser planned to enter Millie's schedule for
260461 -           treatment in the computer. ref SDS 38 TS7G
260463 -            ..
260464 -           [On 080726 Bonnie entered in Kaiser's computer system
260465 -           Millie's schedule for Neupogen treatments for August.
260466 -           ref SDS 39 BS5H
260468 -            ..
260469 -           [On 080809 Donna extended Millie's schedule of Neupogen
260470 -           treatments through September. ref SDS 41 NQ4O
260471 -
260472 -
260473 -
260474 -
2605 -

SUBJECTS
Default Null Subject Account for Blank Record

2703 -
270401 -  ..
270402 - Infusion Clinic No Planning Millie's CT Test With Power Port on 080718
270403 -
270404 - Millie visited with Cesi, the Charge Nurse, her assistant, Bella, and
270405 - with Paula Vannicola, Service Director in the Infusion Oncology
270406 - Clinic.
270408 -  ..
270409 - Bella had not received Millie's letter to Kaiser on Wednesday, 080709,
270410 - coordinating work to be prepared for Millie's CT test on 080718,
270411 - ref SDS 31 TR9X, and for which Bella scheduled support by the Infusion
270412 - Clinic, in the call on 080617. ref SDS 20 OQ61  At that time, 3 weeks
270413 - ago, Bella recommended coordination to line up Kaiser's protocol for
270414 - doing CT tests with the Power Port. ref SDS 20 OQ67  This issue was
270415 - presented to the primary care physician a week later during a meeting
270416 - at Kaiser on 080627.
270418 -  ..
270419 - Bella recalled today that the primary care physician visited with her
270420 - in the Infusion Clinic on 080627 to plan for Millie's CT test next
270421 - week on 080718, as noted in Millie's recent letter to Kaiser on
270422 - 080709. ref SDS 31 TR5P  After meeting with Bella, the doctor expected
270423 - a certified clinician would be assigned to assist the CT test
270424 - department, as Bella had previously said was required in the call on
270425 - 080617. ref SDS 20 OQ61
270427 -  ..
270428 - Millie asked today about progress addressing issues Bella presented on
270429 - 080617, ref SDS 20 OQ67, and discussed with the doctor on 080627?
270431 -  ..
270432 - Paula said Millie is still scheduled to have the Power Port accessed
270433 - in the Infusion Clinic on 080718 1030, as Bella set out in the call on
270434 - 080617. ref SDS 20 OQ61
270435 -
270436 -            [...below, CT Test Department has not received
270437 -            correspondence over the past 3 months coordinating Millie's
270438 -            CT test on 080718. ref SDS 0 7K8I
270440 -             ..
270441 -            [On 080712 Infusion Clinic reported not receiving
270442 -            correspondence coordinating Millie's CT test on 080718.
270443 -            ref SDS 33 RK5N
270445 -             ..
270446 -            [On 080715 Arlette called and said the doctor solved
270447 -            problems; CT test is good to go on 080718. ref SDS 34 RB4N
270449 -             ..
270450 -            [On 080716 Ike called an cancelled planning for Infusion
270451 -            Clinic to access the Power Port collaborating with the CT
270452 -            Department for Millie's CT test, and ordered that all work
270453 -            would be performed in the CT Department, despite lack of
270454 -            experience. ref SDS 35 AN5I
270456 -             ..
270457 -            [On 080718 Nora with Kaiser Interventionary Radiology
270458 -            assigned to access the Power Port for Millie's CT test,
270459 -            ref SDS 36 2U8V; during procedure, Nora requests
270460 -            manufacturer's Instructions for Use on Power Injection
270461 -            procedures, ref SDS 36 NM5V, which was submitted to Kaiser
270462 -            on 080709, ref SDS 31 TR9X, review was requested on 080712,
270463 -            ref SDS 33 K13Q, and again on 080715, ref SDS 34 RB3T;
270464 -            complications occurred on power injection when contrast
270465 -            medium overflowed; CT test with Power Port failed.
270466 -            ref SDS 36 LK3R
270468 -             ..
270469 -            [On 080801 Bard asks about Huber needle used for the CT
270470 -            test that failed on 080718 - it could be defective,
270471 -            ref SDS 40 OV5I; Kaiser was trained a year earlier, but
270472 -            adopted policy not to use Power Ports for CT tests, so
270473 -            nobody has experience, ref SDS 40 OV9H, Julie offes to
270474 -            consult during Millie's next CT test. ref SDS 40 OW41
270476 -  ..
270477 - Paula is worried that Kaiser's arrangements so far may not be
270478 - sufficient for Millie to get the CT test on 080718 using the Power
270479 - Port.
270481 -  ..
270482 - Paula noted that nobody has contacted the Infusion Clinic about
270483 - coordinating with the CT test department planning assignments and
270484 - responsbilities for Millie's CT test using the Power Port, as
270485 - requested by Bella also on 080617. ref SDS 20 OQ67
270486 -
270487 -            [...below, Ike proposes that an Infusion Clinic nurse come
270488 -            to the CT Test Department and remain during the test, to
270489 -            then remove the Huber needle from the Power Port.
270490 -            ref SDS 0 JQ98
270492 -             ..
270493 -            [...below Ike took Paula's name and number along with
270494 -            Millie's primary care physician to coordinate Millie's CT
270495 -            test next Friday, 080718. ref SDS 0 JR7Y
270497 -  ..
270498 - Paula suggested Millie check with the CT Test Department today to
270499 - verify all arrangements have been made, or that someone is working the
270500 - issue, so that work goes smoothly next Friday on 080718.  Cisi said
270501 - that Millie should have a "chit chat" with CT to make sure everything
270502 - is lined up.
270503 -
270504 -
270505 -
270506 -
2706 -

SUBJECTS
Default Null Subject Account for Blank Record

2803 -
280401 -  ..
280402 - CT Test Department Coordinate Millie's Test on 080718
280403 - Correspondence CT Test with Power Port Not Received CT Test Department
280404 - CT Test Department Correspondence CT Test with Power Port Not Received
280405 - Coordinating CT Test with Power Port No Communication Past 3 Months
280406 -
280407 - Millie talked to Ike Wardle, CT Technologist.
280408 -
280409 -                      925 295 6878
280411 -  ..
280412 - Millie related discussions a few minutes ago with the Infusion Clinic,
280413 - and the suggestion to coordinate today in order to get the CT test
280414 - next Friday using the Power Port. ref SDS 0 PP5J
280416 -  ..
280417 - Ike does CT tests.  He checked Kaiser's files and found Millie is
280418 - scheduled for a CT test next week on 080718.  Ike asked about the
280419 - scope of the test, and whether Millie has scheduled a blood test for
280420 - Creatinine?
280422 -  ..
280423 - Millie explained the test will cover from her neck to the pelvis, like
280424 - all of her previous tests every 8 weeks over the past 4 years.  Kaiser
280425 - did labs on 080708 for Power Port surgery. ref SDS 30 MF4K  Creatinine
280426 - 0.39 was reported, ref SDS 30 8U4N; there is a comment that...
280427 -
280428 -        Specimen grossly hemolyzed.  Results may be affected
280430 -  ..
280431 - UCSF will do another blood test for Millie's chemotherapy treatment on
280432 - 080717, the day before the CT test on 080718.  Millie asked if she
280433 - should bring a copy of the labs at UCSF on Thursday to Kaiser for the
280434 - CT test on Friday?
280436 -  ..
280437 - Ike indicated that the Department will check the lab on file at Kaiser
280438 - for 080708, and notify Millie on whether to bring results of the UCSF
280439 - blood test to Kaiser for the CT test on 080718.
280441 -  ..
280442 - Millie asked if Ike received correspondence sent to Oncology over the
280443 - past 3 months coordinating work for the CT test using the Power Port?
280445 -  ..
280446 - Ike asked what has been sent to Kaiser on this matter?
280448 -  ..
280449 - Millie has submitted following letters notifying Kaiser on plans to
280450 - use Power Port with Huber needle for next CT test...
280451 -
280452 -    1.  Kaiser primary care physician investigating
280453 -        using Huber needle for next CT test
280454 -        presented in agenda for meeting at
280455 -        UCSF.................................. 080430, ref SDS 8 W64T
280456 -                                               YYMMDD = April 30, 2008
280458 -         ..
280459 -    2.  CT test in mid-July planned to use
280460 -        Power Port, citing 2 - 3 months
280461 -        for people to be
280462 -        prepared.............................. 080502, ref SDS 11 GN8P
280463 -                                               YYMMDD = May 2, 2008
280464 -         ..
280465 -    3.  Requests meeting with Image Department
280466 -        on planning required to be prepared
280467 -        for doing the next CT test with a
280468 -        Power Port............................ 080520, ref SDS 12 TV4S
280470 -         ..
280471 -    4.  Millie's letter to the medical team cites
280472 -        8 weeks for CT Test Department to prepare
280473 -        for using the Power Port on Millie's
280474 -        next CT test.......................... 080528, ref SDS 13 IK4Q
280476 -         ..
280477 -    5.  Millie's letter to the surgeon coordinated
280478 -        accessing the Power Port with a Huber
280479 -        needle to enable CT
280480 -        testing............................... 080608, ref SDS 17 XS4S
280482 -         ..
280483 -    6.  Kaiser Surgery Department notified that
280484 -        requirements for coordination of Power
280485 -        Port surgery in time for the next CT
280486 -        test were presented to the Schedule
280487 -        Department............................ 080609, ref SDS 18 MG5I
280489 -         ..
280490 -    7.  CT test scheduled at Kaiser on 080718 1100
280491 -        using Power Port and Infusion Clinic
280492 -        will access the Power Port with
280493 -        Huber needle.......................... 080619, ref SDS 21 YU6X
280494 -        Kaiser notified to address protocol
280495 -        certification issue................... 080619, ref SDS 21 YV4R
280497 -         ..
280498 -    8.  Millie's letter to medical team confirms
280499 -        planning for CT test to use the Power
280500 -        Port for saving time and money that
280501 -        meets requirements for cost
280502 -        containment........................... 080625, ref SDS 23 IU7R
280504 -         ..
280505 -    9.  Millie's letter to medical team confirms
280506 -        that on 080627 the primary care physician
280507 -        coordinated support by the Infusion Clinic
280508 -        to access the Power Port on 080718 in time
280509 -        for CT test at 1100; and further initiated
280510 -        planning that, if no one else is assigned,
280511 -        the primary care physician will personally
280512 -        press the button for the CT test using
280513 -        the Power Port on
280514 -        080718................................. 080702, ref SDS 28 EQ3T
280516 -         ..
280517 -   10.  Millie's letter to the medical team confirms
280518 -        planning for surgery on 080708, when the
280519 -        doctor will access the new Power Port
280520 -        with a Huber needle.................... 080707, ref SDS 29 RT9I
280522 -         ..
280523 -   11.  Millie's letter to medical team confirms
280524 -        successful surgery implanting Power
280525 -        Port for CT tests...................... 080709, ref SDS 31 TR7P
280526 -        Power Port Patient Packet has a lot of
280527 -        instructions for CT test Power Injection
280528 -        which should be reviewed by CT Test
280529 -        Department............................. 080709, ref SDS 31 TR9X
280531 -  ..
280532 - Ike seemed not aware that the CT Test Department has received any
280533 - coordination on doing a CT test with Millie's Power Port.
280534 -
280535 -            [On 080712 Infusion Clinic reported not receiving
280536 -            correspondence coordinating Millie's CT test on 080718.
280537 -            ref SDS 33 RK5N
280539 -  ..
280540 - Ike had not received a copy of Millie's letter to Kaiser on 080709
280541 - reporting successful surgery implanting a Power Port, ref SDS 31 FK6F,
280542 - and coordinating the CT test on 080718 with the Infusion Clinic and
280543 - using the new Power Port. ref SDS 31 TR5P  He indicated there is
280544 - nothing in Millie's file showing the CT test on 080718 will use a
280545 - Power Port.
280546 -
280547 -            [On 080715 Arlette called and said the doctor solved
280548 -            coordination problems; CT test is good to go on 080718.
280549 -            ref SDS 34 RB4N
280551 -             ..
280552 -            [On 080718 Nora assigned by Interventionary Radiology to
280553 -            support Power Port requirements for Millie's CT test did
280554 -            not receive communications transmitting manufacturer's
280555 -            Instructions for Use. ref SDS 36 2U51
280556 -
280557 -
280558 -
280559 -
2806 -

SUBJECTS
Default Null Subject Account for Blank Record

2903 -
290401 -  ..
290402 - CT Department Notified Patient to Get Huber Needle for Power Port
290403 - Knowledge CT Test with Power Port Slipped Through the Cracks
290404 - Department Starts Develop Protocol Power Port Not Ready Millie's Test
290405 - Protocol CT Test with Power Port Not Enough Time Millie's Test 080718
290406 -
290407 - Millie related the impression from Cal who called representing the CT
290408 - Test Department on 080617.  At that time on 080617, Cal asked Millie
290409 - to schedule a meeting with the Infusion Clinic for accessing the Power
290410 - Port at least 30 minutes prior to the time for the CT test on 080718.
290411 - ref SDS 20 DF55  That sounded like the CT Test Department was ready to
290412 - go doing the CT test with Millie's Power Port.
290414 -  ..
290415 - Ike explained that sometimes things fall through the cracks.
290416 -
290417 -            [On 081219 1140 things "fell through the cracks" again when
290418 -            someone changed the doctor's order for Millie's CT test on
290419 -            081230. ref SDS 46 V76L
290420 -
290421 -            [On 090205 1318 Doctor Johnson wants better communication
290422 -            for coordinating treatment at UCSF of Millie's 6th IBC
290423 -            relapse, so that critical details do "fall through the
290424 -            cracks." ref SDS 48 256K
290426 -  ..
290427 - Problems from "things falling through the cracks" was reported at UCSF
290428 - on 080605 when Millie did not get the Chemotherapy Orders and took the
290429 - wrong dose of Neupogen. ref SDS 15 JO4V
290431 -  ..
290432 - Ike advised today that his boss, the Director of the CT Test
290433 - Department, began discussing this morning plans for training staff to
290434 - get certifications that support Power Port technology.  He noted that
290435 - more customers are beginning to get Power Ports, so the Director feels
290436 - Kaiser's CT testing should provide support.
290437 -
290438 -            [On 080801 Bard asks about Huber needle used for the CT
290439 -            test that failed on 080718 - it could be defective,
290440 -            ref SDS 40 OV5I; Kaiser was trained a year earlier, but
290441 -            adopted policy not to use Power Ports for CT tests, so
290442 -            nobody has experience, ref SDS 40 OV9H, Julie offes to
290443 -            consult during Millie's next CT test. ref SDS 40 OW41
290445 -             ..
290446 -            [On 080822 Arlette reported the Kaiser computer does not
290447 -            show Millie scheduled for the CT test at Kaiser Oakland,
290448 -            ref SDS 43 034E; Arlette called later and advised the test
290449 -            has been scheduled. ref SDS 43 N66E
290451 -             ..
290452 -            [On 080825 Kaiser cancelled Millie's test at Oakland CT
290453 -            Department where personnel are experienced using Power Port
290454 -            and Huber needle technology required for Millie's test, and
290455 -            referred the case back to the CT Department in Walnut Creek
290456 -            where personnel are not trained nor experienced to do this
290457 -            work, ref SDS 44 XF64, and where attempts on 080718 to do
290458 -            the CT test failed. ref SDS 36 LK3R
290460 -  ..
290461 - The initial plan is to contact the HR department to arrange for
290462 - training.  After the training, people have to be tested and certified
290463 - by a State Agency as qualified for performing port access and CT
290464 - testing with a Power Port.
290466 -  ..
290467 - Ike feels there may be delays getting all this done in time for
290468 - Millie's CT test on 080718.
290469 -
290470 -            [On 080715 Arlette called and said the doctor solved
290471 -            coordination problems; CT test is good to go on 080718.
290472 -            ref SDS 34 RB4N
290474 -             ..
290475 -            [On 080718 Kaiser had difficulty accessing the Power Port
290476 -            causing CT test to fail with complications. ref SDS 36 LK3R
290478 -             ..
290479 -            [On 080724 UCSF disclosed that Huber needles injecting
290480 -            contrast medium under high pressure for CT tests have a
290481 -            higher standard of construction and safety than Huber
290482 -            needles used for blood draws and chemotherapy in the
290483 -            Oncology Infusion Clinic, ref SDS 37 OK63, this could mean
290484 -            that, if Millie's port was accessed in the Kaiser Oncology
290485 -            Infusion Clinic, and if the needle for high pressure
290486 -            injection, cited in manufacturer's Instructions for Use on
290487 -            Power Injection Procedures, reported 080708, ref SDS 30
290488 -            JE7N, was not used, then problems doing the CT test on
290489 -            080718 may not have been avoided simply by accessing the
290490 -            port in the Infusion Clinic. as scheduled on 080617 by Cal
290491 -            in the CT Department. ref SDS 20 DF6Y
290493 -  ..
290494 - Millie explained planning by her primary care physician in the
290495 - Oncology Department.
290497 -  ..
290498 - The doctor arranged for a nurse in the Infusion Clinic to access the
290499 - Power Port.  Millie can then walk from the 2nd floor down to the CT
290500 - test department in the basement, where Ike and his colleagues can
290501 - perform the test.  The doctor expects the CT Department will assign a
290502 - qualified person to perform the injection for contrast medium and
290503 - press the button to start the test, monitor the work, and then send
290504 - Millie back to the Infusion Clinic for removal of the Huber needle, as
290505 - related in Millie's letter to Kaiser on 080709. ref SDS 31 TR5P  The
290506 - doctor has further agreed to come down personally and press the button
290507 - for the CT test, if no one else is available.
290508 -
290509 -
290510 -
2906 -

SUBJECTS
Default Null Subject Account for Blank Record

3003 -
300401 -  ..
300402 - CT Tests with Power Port Identical Skills Level of Effort Using IV
300403 - Protocol CT Tests Power Port Patient's Doctor Not Certified
300404 - Training Certification Protocol Coordination All Take More Time
300405 -
300406 - Ike said he feels that Millie's primary care physician cannot provide
300407 - support for Millie's CT test on 080718, as planned in the meeting on
300408 - 080627, ref SDS 27 YX5N, because he is not certified.
300409 -
300410 -            [On 080811 Paula at Kaiser Infusion Clinic investigating
300411 -            solutions to support CT Department for Millie's next test
300412 -            OA 080912; issue has been elevated, but no progress from
300413 -            management reported at this time, ref SDS 42 LD3H; there
300414 -            seems to be at least three (3) solutions. ref SDS 42 CW3O
300415 -            Paula coordinating with primary care physician about
300416 -            contacting Kaiser Oakland to perform Millie's next CT test.
300417 -            ref SDS 42 DE79
300419 -  ..
300420 - Ike explained that people need certification both as a doctor, who can
300421 - treat a central artery, and access the port with a Huber needle, and
300422 - connect the cable from the test equipment to the Huber needle, and can
300423 - also run the CT test equipment.  Ike feels he and his fellow CT
300424 - technologists can run the test equipment.  All they need is someone
300425 - with a certificate to press the button that starts the test.  He feels
300426 - getting training, and then certification from a state agency will take
300427 - time.
300429 -             ..
300430 -            [On 080715 Arlette called and said the doctor solved
300431 -            coordination problems; CT test is good to go on 080718.
300432 -            ref SDS 34 RB4N
300434 -             ..
300435 -            [On 080718 Kaiser had difficulty accessing the Power Port
300436 -            causing CT test to fail with complications. ref SDS 36 LK3R
300438 -             ..
300439 -            [On 080801 Bard asks about Huber needle used for the CT
300440 -            test that failed on 080718 - it could be defective,
300441 -            ref SDS 40 OV5I; Kaiser was trained a year earlier, but
300442 -            adopted policy not to use Power Ports for CT tests, so
300443 -            nobody has experience, ref SDS 40 OV9H, Julie offes to
300444 -            consult during Millie's next CT test. ref SDS 40 OW41
300446 -             ..
300447 -            [On 080905 Paula discussed planning for a nurse with
300448 -            special training (and certification?) for accessing a
300449 -            central artery needs to be present for the CT test using
300450 -            Power Port accessed with a Huber needle, but the actual
300451 -            access is performed by nurses in the Infusion Clinic.
300452 -            ref SDS 45 MK9H
300454 -  ..
300455 - Millie noted Catherine mentioned yesterday at UCSF that CT
300456 - technologists have been using Power Port technology for over a year,
300457 - noted by Brigid during the meeting starting cycle 3 on 080501.
300458 - ref SDS 9 TQ6F  Understandings from this research at UCSF indicates
300459 - that procedures using a Power Port are identical to using a
300460 - conventional IV.
300462 -  ..
300463 - Ike seemed to say that this is true.  After a nurse in the Infusion
300464 - Clinic accesses the Power Port with a Huber needle the CT Technologist
300465 - merely connects the cable for injecting the contrast medium to the
300466 - Huber needle, which is identical to an IV connection, and then press
300467 - the button on the CT test equipment.  These are the same, routine
300468 - tasks that CT test Technologists, like Ike, do many times every day.
300470 -  ..
300471 - Ike cited his background working at Stanford Medical Center.  He
300472 - believes from prior work at Stanford that research institutions, like
300473 - Stanford and UCSF, get special dispensation from the State regulatory
300474 - boards.  Their CT Test Technologists do not have to pass any tests for
300475 - certification.  Kaiser, however, requires the certification process.
300477 -  ..
300478 - So far, the work to be performed appears to be identical to the
300479 - training and experience of Kaiser's CT Technologists and Infusion
300480 - Clinic nurses for handling Huber needle tasks.  The problem at hand
300481 - seems administrative, not a matter of skills, training, and
300482 - experience, though a protocol should be developed to formalize
300483 - processes and assignments.
300484 -
300485 -        [On 081230 Helen in Interventional Services connected CT
300486 -        pressure injection equipment to the Huber needle for Millie's
300487 -        test; identical procedure connecting to IV for CT test pressure
300488 -        injection. ref SDS 47 FF74
300489 -
300490 -
300492 -  ..
300493 - Kaiser Has 3 Doctors Certified for CT Tests with Power Port
300494 - Scheduling 1 of 3 Doctors for CT Test 080718 May Not Be Convenient
300495 - Coordinating Doctors for CT Test on 080718 Requires Mangement Time
300496 -
300497 - Ike related that Kaiser has three doctor's at the Walnut Creek
300498 - hospital who are qualified for this work.  He is concerned there may
300499 - not be enough time to schedule any of these three (3) doctors in time
300500 - for Millie's test on 090718.  Asking one of these three doctors to
300501 - support Millie's test next Friday could inconvenience a doctor's
300502 - schedule.
300503 -
300504 -            [On 080715 Arlette called and said the doctor solved
300505 -            coordination problems; CT test is good to go on 080718.
300506 -            ref SDS 34 RB4N
300507 -
300508 -
300509 -
3006 -

SUBJECTS
Default Null Subject Account for Blank Record

3103 -
310401 -  ..
310402 - Power Port Manufacturer's Instructions Implement CT Test Protocol
310403 - Infusion Clinic Nurse Should Remove Huber Needle in CT Department
310404 - Protocol CT Power Injection Needs Review Manufacturer's Instructions
310405 - Coordination CT Test Department and Infusion Clinic on Power Injections
310406 -
310407 - Ike is also concerned that the Infusion Clinic nurse should come to
310408 - the CT test department and remain for the 20 mintues required to
310409 - accomplish the CT scan, and who can then remove the Huber needle and
310410 - flush the port, as required by manufacturer's instructions (see 080708
310411 - "Power Injection Procedures" steps 10 - 14, ref SDS 30 ML6G), rather
310412 - than the patient return for this work to be done in the Infusion
310413 - Clinic.  He feels timeliness may be a factor flushing the port and
310414 - removing the Huber needle.
310416 -             ..
310417 -            [On 080715 Infusion Clinic says absolutely cannot send
310418 -            anyone to support CT test ordered by Oncology Department
310419 -            because of short-staffing there is not enough time to spare
310420 -            anyone. ref SDS 34 PQ6P
310422 -             ..
310423 -            [On 080801 Bard field service represetative reports efforts
310424 -            to train Kaiser on using Huber needles to access Power
310425 -            Ports for high pressure injection of contrast medium
310426 -            performing CT tests. problem is how to cross-train CT
310427 -            technologists while they gain skill from experience.
310428 -            ref SDS 40 N58H
310430 -  ..
310431 - Millie asked if the CT Test Department has reviewed Power Port
310432 - "Instructions for Use" to perform "Power Injections" with a Huber
310433 - needle," which were submitted to Kaiser with the letter on 080709,
310434 - ref SDS 31 TR9X, citing the report on surgery performed 080708?
310435 - ref SDS 30 JE7N
310436 -
310437 -            [On 080801 Bard field representative volunteered to attend
310438 -            Millie's next CT test for training and consultation that
310439 -            avoids problems using Huber needle for injection contrast
310440 -            medium. ref SDS 40 OW6U
310442 -  ..
310443 - Ike feels review should yield a protocol that includes coordination
310444 - with the Infusion Clinic, if necessary.  This takes collaboration and
310445 - someone with authority to make assignments.
310446 -
310447 -            [On 080712 Millie notified the doctor that proactive
310448 -            support required to accoplish objectives for CT test using
310449 -            Power Port on 080718. ref SDS 33 K13Q
310451 -             ..
310452 -            [On 080715 Arlette called and said the doctor solved
310453 -            coordination problems; CT test is good to go on 080718.
310454 -            ref SDS 34 RB4N
310456 -             ..
310457 -            [On 080718 Nora with Kaiser Interventionary Radiology
310458 -            assigned to access the Power Port for Millie's CT test,
310459 -            ref SDS 36 2U8V; during procedure, Nora requests
310460 -            manufacturer's Instructions for Use on Power Injection
310461 -            procedures, ref SDS 36 NM5V, which was submitted to Kaiser
310462 -            on 080709, ref SDS 31 TR9X, review was requested on 080712,
310463 -            ref SDS 33 K13Q, and again on 080715, ref SDS 34 RB3T;
310464 -            complications occurred on power injection when contrast
310465 -            medium overflowed; CT test with Power Port failed.
310466 -            ref SDS 36 LK3R
310468 -             ..
310469 -            [On 080724 UCSF disclosed that Huber needles injecting
310470 -            contrast medium under high pressure for CT tests have a
310471 -            higher standard of construction and safety than Huber
310472 -            needles used for blood draws and chemotherapy in the
310473 -            Oncology Infusion Clinic, ref SDS 37 OK63, this could mean
310474 -            that, if Millie's port was accessed in the Kaiser Oncology
310475 -            Infusion Clinic, and if the needle for high pressure
310476 -            injection, cited in manufacturer's Instructions for Use on
310477 -            Power Injection Procedures, reported 080708, ref SDS 30
310478 -            JE7N, was not used, then problems doing the CT test on
310479 -            080718 may not have been avoided simply by accessing the
310480 -            port in the Infusion Clinic. as scheduled on 080617 by Cal
310481 -            in the CT Department. ref SDS 20 DF6Y
310483 -  ..
310484 - Millie cited discussion earlier this morning with the Infusion Clinic
310485 - staff.  Currently, Millie is scheduled to have a nurse access the
310486 - Power Port with a Huber needle on 080718 1030, half an hour prior to
310487 - the time of the CT test at 1100. ref SDS 0 PP5J  This was done at the
310488 - express direction of the CT Test Department on 080617 scheduling the
310489 - CT test on 080718. ref SDS 20 DF55  While no one in the Infusion
310490 - Clinic has been assigned to actually support the test by coming to the
310491 - CT Department, as Ike discusses today, Kaiser has had a month to make
310492 - any supplemental arrangements needed to perform the test scheduled for
310493 - next Friday, 080718 1100.
310494 -
310495 -
310496 -
3105 -

SUBJECTS
Default Null Subject Account for Blank Record

3203 -
320401 -  ..
320402 - Delay CT Test to Develop Power Port Protocol or Use Conventional IV
320403 -
320404 - Ike explained that since this just came up today, Millie should
320405 - consider delaying the test a week or so, to give the department time
320406 - for rolling out a new set of procedures.
320408 -  ..
320409 - Millie explained that UCSF has already objected to delaying the test
320410 - until after the Power Port surgery this past Tuesday.  The test was
320411 - actually needed the week of 080618, 4 weeks earlier.  The blood test
320412 - on 080708 for surgery shows the cancer marker, CA 15-3 has increased
320413 - to significant highs in patient history, ref SDS 30 05YW, adding
320414 - urgency to correlate with CT test results for guiding treatment
320415 - decisions starting the next cycle on 080724.
320417 -  ..
320418 - Ike proposed that rather than inconvenience the CT Department to
320419 - expedite arrangements for Millie's CT test using the Power Port on
320420 - 080718, instead, Millie could have the CT test with a conventional IV
320421 - that damages her arm, reported on 080425. ref SDS 7 FP6F  The CT
320422 - Department has enough time to cancel arrangements requested by the CT
320423 - Department a month ago, for the Infusion Clinic to access Millie's
320424 - Power Port on 080718, but not enough time to arrange for the CT test
320425 - to use the Power Port.
320426 -
320427 -        [On 080715 Kaiser working on lining up staff to support
320428 -        Millie's CT test. ref SDS 34 RB8S
320430 -  ..
320431 - Millie began to cry trying to explain the doctor's finding of damage
320432 - to her arm on 080502, ref SDS 10 WX6I, caused by the last CT test on
320433 - 080425. ref SDS 7 FP6F  At that time on 080502, the doctor prescribed
320434 - the Power Port to solve the problem in time for the next CT test.
320435 - ref SDS 10 AA8L  After months of planning, per above, ref SDS 0 7K8I,
320436 - suddenly there are more delays unless the patient undergoes a painful,
320437 - damaging procedure which everything was designed to avoid?
320439 -  ..
320440 - Ike opened a door to the hallway and suggested stepping outside the
320441 - work area away from other patients and staff to continue the
320442 - discussion.  He noted that Kaiser is aware of difficulties patients
320443 - experience with needle punctures for CT tests.  He offered to
320444 - personally set up the IV for Millie to inject contrast medium.  Ike
320445 - related his 24 years experience that ensures minimal inconvenience
320446 - from discomfort to the patient.
320448 -  ..
320449 - We reviewed procedures the anesthesiologist used this past Tuesday,
320450 - 080708, providing a local anesthetic for an IV, so the patient was not
320451 - inconvenienced while drawing blood for a test needed to perform
320452 - surgery, for the purpose of enabling the CT test department to use the
320453 - Power Port on 080718.  For that procedure, the doctor had to use a
320454 - hand pump because blood flowed too slowly through the vein.
320455 - ref SDS 30 ME85
320457 -  ..
320458 - Ike noted that injecting CT contrast medium requires finding a vein
320459 - where flow is normal to optimal.  Millie related experience on 080425
320460 - when the CT test Department Technologist was unable to find a vein in
320461 - Millie's arm.  He had to call in someone else, and that person
320462 - required several more tries.  Like Ike, all of these professionals
320463 - were extremely competent.  The problem is with the arm, not the skill
320464 - of the practitioner, nor convenience of the patient. ref SDS 7 FP6F
320465 -
320466 -
320467 -
3205 -

SUBJECTS
Default Null Subject Account for Blank Record

3303 -
330401 -  ..
330402 - Work Plan Arrange for CT Test with Power Port on 080718
330403 - CT Test on 080718 with Power Port Needs Management Coordination
330404 -
330405 - Ike said he understands requirements.  The CT test department will
330406 - work the issue to use Millie's Power Port for the test on 080718.  He
330407 - expects to notify Millie by next Wednesday on how this matter will be
330408 - handled.
330410 -  ..
330411 - Ike took down the phone number for the primary care physician, and
330412 - Paula, the director of services in the Oncology Infusion Clinic, per
330413 - above. ref SDS 0 RF6K
330414 -
330415 -            [On 080712 Millie notified the doctor that proactive
330416 -            support required to accomplish objectives for CT test using
330417 -            Power Port on 080718. ref SDS 33 K13Q
330419 -             ..
330420 -            [On 080715 Arlette called and said the doctor solved
330421 -            coordination problems; CT test is good to go on 080718.
330422 -            ref SDS 34 RB4N
330424 -             ..
330425 -            [On 080716 Ike called and confirmed that Kaiser has made
330426 -            arrangements for Millie to get a CT test using her Power
330427 -            Port. ref SDS 35 PZ4L
330429 -  ..
330430 - Several work plans were considered on 080617. ref SDS 20 4Q3K  Today,
330431 - there are roughly 10 separate work plans that enable Kaiser to meet
330432 - the schedule using Millie's Power Port for the CT test on 080718 at
330433 - 1100...
330434 -
330435 -    1.  Arrange for one of the 3 doctors certified to work with the CT
330436 -        test equipment, noted by Ike today, per above, ref SDS 0 RG9M,
330437 -        to be availabe for Millie's test on 080718 1100.
330439 -         ..
330440 -    2.  Arrange for a nurse in the Oncology Infusion Clinic to come to
330441 -        the CT Test Department for Millie's test on 080718 at 1100, and
330442 -        support the work, as suggested by Ike today, per above.
330443 -        ref SDS 0 JQ98
330445 -         ..
330446 -    3.  Same as step 1, but change the time of Millie's test on 080718
330447 -        to a time convenient for any one of the 3 doctors.
330449 -         ..
330450 -    4.  Same as step 1, but change the date of Millie's test to a day
330451 -        prior to 080718 and at a time convenient for any one of the 3
330452 -        doctors.
330454 -         ..
330455 -    5.  Arrange for a doctor at another Kaiser hospital who has been
330456 -        trained on using the CT test equipment to be available for
330457 -        Millie's CT test on or prior to 080718 and at a time convenient
330458 -        for the doctor.
330460 -         ..
330461 -    6.  Train and certify another doctor or care provider, for example
330462 -        a nurse practitioner, or nurse in the Infusion Clinic, to work
330463 -        with the CT test technologist for performing Millie's CT test
330464 -        on 080718 1100.
330466 -         ..
330467 -    7.  Perform the CT test at another Kaiser location, e.g.,
330468 -        Pleasanton, San Francisco, or at UCSF, where the protocol for
330469 -        using Power Port technology accessed with Huber needle to
330470 -        inject contrast medium has already been developed.
330472 -         ..
330473 -    8.  Train only at Kaiser Walnut Creek CT Department, and skip
330474 -        certification of another doctor or care provider, for example a
330475 -        nurse practitioner, or nurse in the Infusion Clinic, to work
330476 -        with the CT test technologist for performing Millie's CT test
330477 -        on 080718 1100.
330479 -         ..
330480 -    9.  Train and certify CT Test Technologists to perform injection
330481 -        services for contrast medium in time for Millie's CT test on
330482 -        080718 1100.
330484 -         ..
330485 -   10.  Train only, and skip certification, of CT Test Technologists to
330486 -        perform injection services for contrast medium in time for
330487 -        Millie's CT test on 080718 1100.
330489 -         ..
330490 -   11.  Millie can waive certification on showing that a doctor, nurse,
330491 -        and/or CT Test Technologist has been trained to perform the
330492 -        work.
330494 -         ..
330495 -        This includes review of Power Port Bard manufacturer's
330496 -        instructions for "power injections" in literature received from
330497 -        Kaser on 080708. ref SDS 30 JE7N
330499 -         ..
330500 -        Kaiser should generate a protocol with interdepartmental
330501 -        coordination, as needed.
330502 -
330503 -            [On 080718 CT test with Power Port failed; ref SDS 36 LK3R,
330504 -            manufacturer's "Instructions for Use" were reviewed during
330505 -            the procedure, ref SDS 36 NM5V; CT Department did not
330506 -            receive correspondence coordinating the work to be
330507 -            prepared. ref SDS 36 2U51
330509 -             ..
330510 -            [On 080724 UCSF disclosed that Huber needles injecting
330511 -            contrast medium under high pressure for CT tests have a
330512 -            higher standard of construction and safety than Huber
330513 -            needles used for blood draws and chemotherapy in the
330514 -            Oncology Infusion Clinic, ref SDS 37 OK63, this could mean
330515 -            that, if Millie's port was accessed in the Kaiser Oncology
330516 -            Infusion Clinic, and if the needle for high pressure
330517 -            injection, cited in manufacturer's Instructions for Use on
330518 -            Power Injection Procedures, reported 080708, ref SDS 30
330519 -            JE7N, was not used, then problems doing the CT test on
330520 -            080718 may not have been avoided simply by accessing the
330521 -            port in the Infusion Clinic. as scheduled on 080617 by Cal
330522 -            in the CT Department. ref SDS 20 DF6Y
330524 -         ..
330525 -        Consideration should be given to having a walk through of
330526 -        procedures the day before the actual test, to discover any
330527 -        issues that are overlooked, and can be adjusted in time for the
330528 -        actual work on 080718.
330529 -
330530 -            [On 080801 Bard asks about Huber needle used for the CT
330531 -            test that failed on 080718 - it could be defective,
330532 -            ref SDS 40 OV5I; Kaiser was trained a year earlier, but
330533 -            adopted policy not to use Power Ports for CT tests, so
330534 -            nobody has experience, ref SDS 40 OV9H, Julie offes to
330535 -            consult during Millie's next CT test. ref SDS 40 OW41
330537 -         ..
330538 -   12.  Since Millie is the first patient getting a CT test using new
330539 -        Power Port technology, Kaiser should schedule extra standby
330540 -        staff to be availabe for recovery in the event of problems,
330541 -        indicated by Millie's letter to Kaiser on 080709. ref SDS 31
330542 -        VK5I
330544 -         ..
330545 -        A list should be developed of possible problems, and plans
330546 -        written out to addess any such contingencies.
330547 -
330548 -            [On 080811 Paula at Kaiser Infusion Clinic investigating
330549 -            solutions to support CT Department for Millie's next test
330550 -            OA 080912; issue has been elevated, but no progress from
330551 -            management reported at this time, ref SDS 42 LD3H; there
330552 -            seems to be at least three (3) solutions. ref SDS 42 CW3O
330553 -            Paula coordinating with primary care physician about
330554 -            contacting Kaiser Oakland to perform Millie's next CT test.
330555 -            ref SDS 42 DE79
330556 -
330557 -
330558 -
330559 -
330560 -
330561 -
330562 -
330563 -
3306 -