THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: October 24, 2008 03:52 PM Friday;
Kaiser CT Department called to coordinate next test using Power Port.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 10 0000.
040506 - ..
0408 - Progress
040901 - During the meeting today in Oncology, the primary care physician used
040902 - Kaiser's Knowledge Management system to schedule Millie for a CT test
040903 - on 081107 1330, noted in the letter to the medical team after the
040904 - meeting with the doctor. ref SDS 16 XZ9P The doctor entered in the
040905 - referral notice that the test will use Millie's Power Port to inject
040906 - contrast medium.
040908 - ..
040909 - The test was orignially planned to evaluate progress responding to
040910 - treatment in the clinical study for cetuximab and Carboplatin, which
040911 - the doctor ordered on 070105, and which requires CT tests every 8
040912 - weeks. Millie's last test was on 080911, and so 8 weeks later is
040913 - 081107, noted in Millie's letter to the medical team on 080917,
040914 - ref SDS 6 SH5Q, and discussed the next day to start cycle 8 for
040915 - treatment at UCSF. ref SDS 7 MF5L
040917 - ..
040918 - On 081015 the team was reminded to order CT test. ref SDS 8 K34V The
040919 - next day at UCSF Doctor Ruog expected progression of cancer that would
040920 - require changing treatment to sunitinib clinical study. At that time
040921 - on 081016, the doctor presented a work plan for screening patients to
040922 - participate in the study. The first task was to biopsy a swelled
040923 - lymph node ("lump") to test for cancer in the left supraclavicular.
040924 - This is required for screening to participate in the sunitinib
040925 - clinical study at UCSF. ref SDS 9 J36R
040927 - ..
040928 - Another step in the screening process is a CT test.
040930 - ..
040931 - Planning for a CT test on 081107 was presented in Millie's letter to
040932 - the medical team on 080917 required to evaluate progress under the
040933 - prior treatment for the 3rd and 4th relapse of IBC with cetuximab and
040934 - Carboplatin. ref SDS 6 SG4X A month later on 081015 planning was
040935 - cited again in Millie's letter submitting an agenda for a meeting at
040936 - UCSF the next day on 081016. ref SDS 6 SG4X During that meeting at
040937 - UCSF on 081016, Doctor Rugo suspected progression of cancer. The
040938 - doctor presented a work plan ordering an FNA biopsy to test a swelled
040939 - lymph node in the left supraclavicular. ref SDS 9 J34U Positive test
040940 - establishes progression of disease. In that case, the doctor proposed
040941 - treatment in the sunitinib clinical trial. ref SDS 9 J34R
040943 - ..
040944 - The biopsy was performed at Kaiser on 081022. ref SDS 11 NZ5N The
040945 - next day on 081023 Kaiser reported the pathology was positive for
040946 - cancer. ref SDS 14 4Q9Q Later in the evening, Doctor Rugo notified
040947 - Millie that positive results stop treatment in the cetuximab
040948 - Carboplatin clinical trial, begun on 070201. ref SDS 15 D65G As
040949 - noted, this test finding launches the work plan to begin treatment in
040950 - the sunitinib clnical trial. ref SDS 9 J34R
040952 - ..
040953 - The new work plan on 081016 calls for getting the CT test on 081107
040954 - for screening to participate in the sunitinib clinical study.
040955 - ref SDS 9 J44X Millie's letter to the doctor yesterday on 081023
040956 - submits an agenda for the meeting today, which explains requirements
040957 - for scheduling a CT test at Kaiser in Walnut Creek. ref SDS 12 TH9K
040959 - ..
040960 - Today, during the meeting at Kaiser in the Oncology Department the
040961 - primary care physician ordered the CT test for 081107 1300 at the
040962 - Kaiser CT Department in Walnut Creek, as planned on
040964 - 080917............................ ref SDS 6 SG4X
040965 - 081015............................ ref SDS 8 K354
040966 - 081016............................ ref SDS 9 J44X
040967 - 081023............................ ref SDS 12 TH9K
040969 - ..
040970 - Today, the primary care physician asked Millie to coordinate with the
040971 - CT Department in Walnut Creek about using Millie's Power Port for
040972 - pressure injection of contrast medium. Previously, Millie coordinated
040973 - on 080711 with Paula in the Infusion Clinic, ref SDS 2 OC9G, and then
040974 - with Ike in the CT Department to schedule the CT test on 080718 to use
040975 - the Power Port. ref SDS 2 PP6O Difficulties with technology transfer
040976 - caused problems using the Power Port for the CT test on 080718.
040977 - ref SDS 3 LK3R The next CT test was done at Kaiser in Oakland. On
040978 - 080905, the primary care physician approved coordination to arrange
040979 - for Millie's CT test. ref SDS 4 S28G
040981 - ..
040982 - After meeting with the doctor in Oncology, Millie went to the CT
040983 - Department in the basement floor of the hospital. No one was
040984 - available for coordination. The attendant said that Dennis, the
040985 - manager of the CT Department would call to follow up.
040988 - ..
0412 - Telecon
041301 - When we got back from Kaiser, there was a message on the answering
041302 - machine to call Pat at 925 295 6874 about scheduling Millie's CT test.
041304 - ..
041305 - Pat was the Technician who assisted Dennis doing Millie's CT test at
041306 - Kaiser on 080718.
041308 - ..
041309 - Called the number Pat had left on the answering machine, and got a fax
041310 - sound.
041312 - ..
041313 - Hung up and called the Kaiser general number. Was told to call the
041314 - CT department schedule nuumber...
041316 - 925 295 4798
041318 - ..
041319 - Asked for Pat, returning her call.
041321 - ..
041322 - The schedule attendant said there is nobody in the CT department named
041323 - Pat. There is Ike and Dennis. These are familiar names in the record
041324 - on Millie's patient history.
041326 - ..
041327 - Ike visited with Millie on 080711 to plan Kaiser's first attempt using
041328 - Millie's Power Port for the CT test. ref SDS 2 2P3N Dennis supported
041329 - the CT test a week later on 080718, and complimented Millie for
041330 - holding up well when difficulties occurred using the Power Port for
041331 - the first time at Walnut Creek. ref SDS 3 FM74
041333 - ..
041334 - The schedule attendant transferred the call to the CT Department
041335 - control room. She said anyone who answers can figure out who can take
041336 - the call.
041338 - ..
041339 - Pat answered the phone.
041341 - ..
041342 - Pat confirmed that Millie's doctor has ordered a CT test using
041343 - Millie's Power Port, and the test is scheduled for 081107 1300.
041345 - ..
041346 - Pat said that Millie needs a blood test for Creatinine within the past
041347 - 3 weeks. Since Kaiser's computer shows the last Creatinine test was
041348 - on 080708 for Millie's surgery, ref SDS 1 8U4N, Pat scheduled Millie
041349 - for a blood test at Kaiser later today, because Millie will be on
041350 - vacation until the day before the CT test scheduled for 081107.
041352 - ..
041353 - Millie had a blood draw at UCSF for treatment yesterday. Creatinine
041354 - was 0.54. ref SDS 13 8U4N
041356 - ..
041357 - Pat said this is within the target range for the CT test. Pat
041358 - cancelled the order for Millie's lab today. She asked that Millie
041359 - bring the report from UCSF for the blood test on 081023 to the CT
041360 - Department on the day of the test.
041362 - [On 081106 Virginia in the CT Department called and ordered
041363 - another blood draw for Millie to get the CT test on 081107,
041364 - because the Kaiser computer did not have the record on Pat's
041365 - work today that determined the test at UCSF on 081023 is
041366 - sufficient for Millie to get the CT test at Kaiser on 081107.
041367 - ref SDS 21 ED6H
041369 - ..
041370 - Pat said that coordination is needed to implement the doctor's
041371 - referral for using Millie's Power Port, per above. ref SDS 0 285H Pat
041372 - recalled difficulties from assisting Dennis, and also Nora and later
041373 - Kathi, from Intervential Radiology, that occurred during Millie's
041374 - prior test, which was on 080718. ref SDS 3 A25R
041376 - [On 081107 Dennis, the supervisor of CT tests at Kaiser in
041377 - Walnut Creek, was not available to support the CT test usig
041378 - new technology for the 2nd time, ref SDS 24 VR4L; Pat who
041379 - had worked on Millie's prior test using the Power Port for
041380 - the 1st time, and had scheduled the current test, did not
041381 - remember Millie nor that the test would use Bard Power Port
041382 - technology, ref SDS 24 MX4L, Steve, District Manager for
041383 - Bard, who had talked to Dennis and said Kaiser was ready to
041384 - do the CT test with the Power Port, and Julie, who had
041385 - offered to support the test on-site, did not have time to
041386 - visit Kaiser to support the 2nd attempt to prform a CT test
041387 - using Bard equipment which had previously failed on the 1st
041388 - attempt, at Kaiser in Walnut Creek;, ref SDS 24 2F6S;
041389 - communications to collaborate on coordinating the work,
041390 - failed by relying on memory of people under stress with
041391 - limited time. ref SDS 24 2F32
041393 - ..
041394 - Discussed including the CT department in distribution of work plans
041395 - for Millie's medical team. This enables people to remember critical
041396 - details that avoid past problems. Pat feels this is a good idea. She
041397 - said the CT Techs see so many patients it is hard to remember
041398 - everything. After awhile specifics of each test become confusing,
041399 - essentially just a blur. Pat suggested talking to Dennis, the
041400 - supervisor for the CT Department, about getting communication on
041401 - Millie's CT test.
041403 - ..
041404 - Pat transferred the call.
041407 - ..
0417 - 1635
041801 - Talked to Dennis.
041803 - Dennis recalled working with Millie for the CT test on 080718.
041804 - ref SDS 3 FM74
041806 - ..
041807 - We reviewed practice at Oakland using Millie's Power Port for the CT
041808 - test on 080911. ref SDS 5 2U8V
041810 - ..
041811 - Dennis was pleased to hear that the CT test using the Power Port was
041812 - successful in Oakland, reported on 080911. ref SDS 5 LK3R
041814 - ..
041815 - Dennis asked for background on what was done at Kaiser in Oakland that
041816 - enabled a successful CT test with Millie's Power Port.
041818 - [On 081028 Millie's letter to Dennis at Kaiser in Walnut Creek
041819 - submitted background on the CT test in Oakland on 080911.
041820 - ref SDS 17 PE8X
041822 - ..
041823 - Discussed Angela's point on 080911 that getting a visit from Bard the
041824 - day before Millie's test was a big help for orienation on using the
041825 - Power Port similar to using a conventional IV. There are evidently no
041826 - changes in CT equipment settings required. The connection is the
041827 - same. The CT tech simply flushes the port, verifies blood flow, and
041828 - then executes the test. ref SDS 5 LK3R
041830 - ..
041831 - Recommended that Bard visit the CT Department in Walnut Creek, for
041832 - similar orientation, explained by Angela on 080911. ref SDS 5 3662
041834 - ..
041835 - We considered today that a major factor was accessing the Power Port
041836 - by nurses in the Infusion Clinic, who are experienced doing this work.
041837 - On 080911, Millie was getting weekly treatment at UCSF for 2 years
041838 - accessing Millie's port. On 080911, the Huber needle was left in
041839 - place rather than removed after treatment. On the way driving home,
041840 - Millie stopped at Kaiser in Oakland. Angela, the CT Technician,
041841 - removed the dressing, flushed the needle, and verified blood flow,
041842 - ref SDS 5 LK3R, which is the same thing CT Technicians do using an IV
041843 - in the arm. She then connected the CT equipment and did the test.
041844 - After the test, Millie went next door to the Infusion Clinic, and a
041845 - nurse maintained the Power Port with Heparin, and then removed the
041846 - Huber needle. ref SDS 5 SH5O
041848 - ..
041849 - Dennis feels this should work in Walnut Creek.
041851 - [On 081030 telecon Steve at Bard he has coordinated with
041852 - Agenal who did CT test using Millie's Power Port
041853 - successfully on 080911 at Kaiser in Oakland, ref SDS 20
041854 - XN9C; and has further talked to Dennis at the CT Department
041855 - at Kaiser in Walnut Creek; feels Dennis's team at Walnut
041856 - Creek is good to go for doing Millie's CT test with the
041857 - Bard Power Port on 081107. ref SDS 20 UF5H
041859 - ..
041860 - [On 081107 Dennis, the supervisor of CT tests at Kaiser in
041861 - Walnut Creek, was not available to support the CT test usig
041862 - new technology for the 2nd time, ref SDS 24 VR4L; Pat who
041863 - had worked on Millie's prior test using the Power Port for
041864 - the 1st time, and had scheduled the current test, did not
041865 - remember Millie nor that the test would use Bard Power Port
041866 - technology, ref SDS 24 MX4L, Steve, District Manager for
041867 - Bard, who had talked to Dennis and said Kaiser was ready to
041868 - do the CT test with the Power Port, and Julie, who had
041869 - offered to support the test on-site, did not have time to
041870 - visit Kaiser to support the 2nd attempt to prform a CT test
041871 - using Bard equipment which had previously failed on the 1st
041872 - attempt, at Kaiser in Walnut Creek;, ref SDS 24 2F6S;
041873 - communications to collaborate on coordinating the work,
041874 - failed by relying on memory of people under stress with
041875 - limited time. ref SDS 24 2F32
041877 - ..
041878 - Dennis approved working through the Infusion Clinic this time for
041879 - accessing Millie's Power Port with a Huber needle, and after the test,
041880 - Millie will return to the Infusion Clinic to remove the Huber Needle,
041881 - and maintain the port.
041883 - ..
041884 - Dennis asked that Millie contact the Infusion Clinic to schedule the
041885 - work accessing the Power Port in advance of coming to the CT
041886 - Department for the test on 081107, since that procedure worked well
041887 - for the previous test in Oakland on 080911.
041889 - [On 081029 Florida confirms Kaiser CT department in Walnut
041890 - Creek approves doing test using Millie's Power Port, access
041891 - scheduled in Infusion Clinic 081107 1230. ref SDS 19 4E3G
041893 - ..
041894 - Dennis indicated the CT department is investigating whether a nurse
041895 - must be assigned for the CT test using Millie's Power Port, because CT
041896 - technologists cannot access a venous artery, involved with Millie's
041897 - Power Port. Dennis seemed to say that a Doctor (Al Michales??), who
041898 - heads the Radiology Department at Kaiser in Walnut Creek is
041899 - coordinating with Oakland on how Millie's test was performed in the CT
041900 - Department at Kaiser in Oakland using only a CT Technologist, as
041901 - reported in the record on 080911. ref SDS 5 3650
041903 - ..
041904 - This aligns with Paula's understanding, e.g., recently on 081017.
041905 - ref SDS 10 8Y8O
041907 - [On 081107 Cassandra in the CT Department applied policy for
041908 - Kaiser in Walnut Creek that Technicians cannot connect pressure
041909 - infusion equipment for contrast medium to Power Ports accessed
041910 - with a Huber needle. ref SDS 24 MY92
041912 - ..
041913 - There was discussion today that different Kaiser hospitals may
041914 - interperet regulations differently. This issue might be addressed by
041915 - issuing a memorandum of procedure, protocol, ect., and/or by arranging
041916 - for support during the test from a nurse in Interventional Radiology.
041917 - We considered solving this problem by assigning Nora or Kathi to visit
041918 - the CT Department for Millie's test on 081107 at 1300. They were
041919 - effective at that time assisting the process. ref SDS 3 A39Q
041921 - ..
041922 - [On 081106 Millie subitted a letter to Dennis reminding of
041923 - requirements for doing the CT test on 081107 with Power Port
041924 - technology. ref SDS 22 4J3Q
041926 - ..
041927 - Since the test on 081107 will be only the second time the CT
041928 - Department at Kaiser in Walnut Creek has attempted to do a test with
041929 - Power Port technology, and since the first time on 080718 had problems
041930 - and failed, it is prudent risk management have extra help, just to
041931 - observe and be available in case of unexpected problems.
041933 - [On 081028 letter to Dennis and the medical team associated
041934 - with Millie's CT test discusses assigning a nurse from the
041935 - Radiology Department to assist the CT Technician for Millie's
041936 - test on 081107. ref SDS 17 PF3W
041938 - ..
041939 - [On 081029 called Dennis to coordinate arrangements for
041940 - Millie's CT test on 081107; Dennis plans to read Millie's
041941 - letter and call if he has any questions. ref SDS 18 QK7M
041943 - ..
041944 - [On 081030 telecon Steve at Bard he has coordinated with Agenal
041945 - who did CT test using Millie's Power Port successfully on
041946 - 080911 at Kaiser in Oakland, ref SDS 20 XN9C; and has further
041947 - talked to Dennis at the CT Department at Kaiser in Walnut
041948 - Creek; feels Dennis's team at Walnut Creek is good to go for
041949 - doing Millie's CT test with the Bard Power Port on 081107.
041950 - ref SDS 20 UF5H
041952 - ..
041953 - [On 081106 Millie subitted a letter to Steve, District Manager
041954 - for Bard, reminding of the CT test at Kaiser in Walnut Creek on
041955 - 081107 which would implement Bard Power Port technology, and
041956 - asking for support during the test. ref SDS 23 7U3S
041958 - ..
041959 - [On 081107 Dennis, CT Department supervisor at Kaiser in Walnut
041960 - Creek, was not available to manage use of new technology for
041961 - the 2nd time to correct problems the first time, ref SDS 24
041962 - VR4L; Pat who had worked on Millie's CT test using the Power
041963 - Port for the 1st time, and had scheduled the 2nd test, did not
041964 - remember Millie nor that the test would use Bard Power Port
041965 - technology, ref SDS 24 MX4L; Steve, District Manager for Bard,
041966 - who had talked to Dennis and said Kaiser was "good to go" using
041967 - the Bard Power Port for the CT test, and Julie, who had offered
041968 - to be on-site for the test, did not have time to support the
041969 - 2nd attempt using Bard equipment, which had failed on the 1st
041970 - attempt, ref SDS 24 2F6S; nobody seemed to be prepared for
041971 - applying manufacturer's instructions; communication to
041972 - collaborate on coordinating the work failed by relying on
041973 - memory of very talented, dedicated people under stress with
041974 - limited time. ref SDS 24 2F32