CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 31 0000. ref SDS 30 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Kaiser Investigating Assignments for CT Test With Power Port on 080718
040902 -
040903 - Follow up ref SDS 31 RA9H, ref SDS 30 2P3N.
040904 -
040905 - Ike called per planning on 080711 that he would notify today Millie
040906 - about arrangements fo the CT test tomorrow. ref SDS 29 JR7Y
040908 -  ..
040909 - Ike confirmed Arlette's message yesterday that the doctor solved the
040910 - problems so that Millie will get a CT test tomorrow using the Power
040911 - Port. ref SDS 31 RB6P
040913 -  ..
040914 - Ike advised that the CT Department has cancelled Millie's meeting in
040915 - the Infusion Clinic for 080718 1030 to access the port for the test on
040916 - Friday at 1100.  Meeting with the Infusion Clinic was scheduled weeks
040917 - ago on 080617 at the request of the CT Department. ref SDS 17 DF6Y  At
040918 - that time Cal indicated patients schedule port access for CT tests,
040919 - because the CT Department was unable to coordinate with the Infusion
040920 - Clinic.  Today, prior cross-departmental coordination seems to be
040921 - improved.
040922 -
040923 -        [On 080718 Infusion Clinic meeting at 1030 was not cancelled.
040924 -        ref SDS 33 2U4S
040926 -  ..
040927 - Ike said Millie should come directly to the CT Department rather than
040928 - go to the Infusion Clinic.  CT Department staff will access the port,
040929 - and after the test, the staff will remove the Huber needle according
040930 - to protocol, so that Millie need not return to the Infusion Clinic, as
040931 - originally instructed by the CT Department on 080617. ref SDS 17 DF6Y
040933 -  ..
040934 - Ike indicated he had not received Millie's letter sent yesterday to
040935 - the medical team thanking him for timely action arranging the CT test
040936 - according to Kaiser's schedule on 080617, and meeting UCSF
040937 - requirements, ref SDS 31 AW9P, and further asking if UCSF should leave
040938 - the Huber needle in the port for chemotherapy treatment on Thursday,
040939 - ref SDS 31 AW9S, so that it can be used for the CT test the next day
040940 - at Kaiser on 080718.
040942 -  ..
040943 - Ike initially noted that since the CT Department made extra effort to
040944 - arrange for Millie to get the CT test with Power Port according to
040945 - Kaiser's schedule presented a month ago on 080617, ref SDS 17 DF55,
040946 - that Millie should get the port accessed at Kaiser rather than Kaiser
040947 - use the access made by UCSF the day before.  Asking the CT Department
040948 - to investigate further seemed like an annoying waste of time and
040949 - expense.
040951 -  ..
040952 - We reviewed Kaiser cost containment objectives cited by Arlette in the
040953 - call yesterday on 080715, when the Oncology Infusion Clinic could not
040954 - spare the expense to send a nurse to the CT Test Department in order
040955 - to access Millie's Power Port, ref SDS 31 PQ6P, as suggested by Ike on
040956 - 080711. ref SDS 29 JQ98  Using port access at UCSF for a CT test the
040957 - next day presents an equal efficiency savings for Kaiser.  Ike was not
040958 - aware that Kaiser had accessed Millie's port on 080708 in Walnut
040959 - Creek, ref SDS 26 BF4K, for use at UCSF in San Francisco 2 days later
040960 - on 080710. ref SDS 28 TZ6H
040962 -  ..
040963 - Another factor is experience of the medical professional who will
040964 - access the port for the test on Friday.  Millie has high confidence in
040965 - UCSF accessing the Power Port, because Catherine has been doing this
040966 - every week for Millie over the past 18 months.  UCSF has been working
040967 - with Power Ports for over a year, reported on 080501. ref SDS 10 TQ6F
040968 - Ike indicated on 080711 that the CT Test Department is just starting
040969 - to contact the HR department to set up training for using Power Ports
040970 - to inject contrast medium on CT tests.  This is a new protocol for the
040971 - CT Test Department at Kaiser in Walnut Creek. ref SDS 29 JQ55  One of
040972 - the more complex tasks in the protocol is accessing the port for
040973 - "power injection," as set out in the manufacturer's "Instructions for
040974 - Use," reviewed on 080708. ref SDS 26 JE7N
040975 -
040976 -               [On 080717 Catherine had no trouble accessing the Power
040977 -               Port for treatment at UCSF, took only about 1 minute,
040978 -               relying on skills from years of experience. ref SDS 32
040979 -               IL7F
040981 -  ..
040982 - Port access skill improves with experience.  Someone who does this
040983 - only occassionally can make mistakes.  Millie's patient history on
040984 - 080409 shows salient example of concern for quality care accessing the
040985 - port with a Huber needle.  At that time, Millie was treated in the
040986 - Emergency clinic.  The nurse had some experience accessing ports, but
040987 - made a big mistake using a needle that was too small, which delayed
040988 - the work and caused pain and suffering to the patient. ref SDS 8 IG6S
040989 -
040990 -               [On 080718 Power Port use failed at Kaiser for the CT
040991 -               test due to port access issues; using the Huber needle
040992 -               that accessed the Power Port for treatment at UCSF the
040993 -               day before would have reduced risks of mistakes at
040994 -               Kaiser for the CT test. ref SDS 33 FL79
040996 -                ..
040997 -               [On 080801 Bard asks about Huber needle used for the CT
040998 -               test today - could be defective, ref SDS 34 OV5I; Kaiser
040999 -               was trained a year earlier, but adopted policy not to
041000 -               use Power Ports for CT tests, so nobody has experience,
041001 -               ref SDS 34 OV9H, Julie offes to consult during Millie's
041002 -               next CT test. ref SDS 34 OW41
041004 -  ..
041005 - Earlier in the Emergency Department on 061027 a nurse who used Huber
041006 - needles infrequently, was training a new nurse and Millie was the
041007 - sample patient, a 2 minute job took 30 minutes due to a series of
041008 - complications that typically occur during training. ref SDS 6 ZP43
041010 -  ..
041011 - Ike decided to investigate UCSF leaving the Huber needle in place
041012 - after accessing the Power Port for Millie's chemotherapy treatment
041013 - tomorrow, so that Kaiser can use the same access for the CT test on
041014 - Friday.  He will call back.
041015 -
041016 -
041018 -  ..
0411 -
0412 -
0413 - 1315
0414 -
041401 - Ike called back, and said he was told by "the powers that be"
041402 - "absolutely not!"
041404 -                ..
041405 -               [On 080717 Catherine had no trouble accessing the Power
041406 -               Port for treatment at UCSF, took only about 1 minute,
041407 -               relying on skills from years of experience. ref SDS 32
041408 -               IL7F
041410 -  ..
041411 - Kaiser will not use a Huber needle from UCSF accessing the Power Port
041412 - on Thursday for Millie's treatment, for a power injection of contrast
041413 - medium required for Millie's CT test the next day on Friday.  Ike said
041414 - he was told this conflicts with Kaiser's quality care standards for
041415 - safe, effective, and sterile Huber needle use.
041416 -
041417 -               [On 080718 Power Port use failed at Kaiser for the CT
041418 -               test due to port access issues, ref SDS 33 LK3R; using
041419 -               the Huber needle that accessed the Power Port for
041420 -               treatment at UCSF the day before would have reduced
041421 -               risks of mistakes at Kaiser for the CT test, ref SDS 33
041422 -               FL75; communication mixup caused extra cost, pain,
041423 -               stress, and anxiety for the patient and staff.
041424 -               ref SDS 33 FL83
041426 -  ..
041427 - Since emotions from stress and anxiety at Kaiser have increased from
041428 - work the past week lining up a CT test using Millie's Power Port and
041429 - to meet the schedule Kaiser submitted on 080617, reported by Ike last
041430 - week on 080711, ref SDS 29 PP7O, there was no further inquiry on
041431 - issues raised by discussion today...
041432 -
041433 -        1.  Kaiser proposed on 080606 to access the Power Port with a
041434 -            Huber needle in the surgery department for use in the CT
041435 -            Department at Kaiser within a few days, and for use at UCSF
041436 -            for Millie's chemotherapy treatment.
041438 -             ..
041439 -        2.  Kaiser accessed Millie's Power Port with a Huber needle on
041440 -            080708 and did a blood draw for laboratory tests,
041441 -            ref SDS 26 BF4K, and then bandaged the Huber needle for use
041442 -            at UCSF 2 days later on 080710.  UCSF used the Huber needle
041443 -            accessing the Power Port on 080710 without incident.
041444 -            ref SDS 28 TZ6H
041446 -             ..
041447 -        3.  Why does Kaiser quality care permit using a Huber needle
041448 -            accessing a port at Kaiser in Walnut Creek for use at UCSF
041449 -            in San Francisco 2 days later not permit accessing the port
041450 -            at UCSF, where there is a lot of experience, for use at
041451 -            Kaiser where there is no experience?
041453 -             ..
041454 -            Reducing the number of complex tasks people undertake
041455 -            starting a new protocol reduces risks to the patient of
041456 -            mistakes being the first patient for the protocol.
041457 -
041458 -               [On 080718 Power Port use failed at Kaiser for the CT
041459 -               test due to port access issues; using the Huber needle
041460 -               that accessed the Power Port for treatment at UCSF the
041461 -               day before would have reduced risks of mistakes at
041462 -               Kaiser for the CT test. ref SDS 33 FL79
041464 -  ..
041465 - Ike said he's looking forward to a good test using the Power Port for
041466 - Millie on Friday.
041467 -
041468 -               [On 080718 Ike was not at work; Dennis was the CT
041469 -               Technologist for Millie's test. ref SDS 33 02DF
041470 -
041471 -
041472 -
041473 -
041474 -
041475 -
041476 -
041477 -
041478 -
0415 -