TSWF Low Back Pain CPG AIM Form Training May May-Aug 2020 Form Version “Medically Ready Force…Ready Medical Force”
Recent Changes The following group of slides reflect changes made to the form. “Medically Ready Force…Ready Medical Force”
CORE Compatible Updates Updated the Hepatitis C screening recommendation on the 'Preventive Services Recommendations-All Patients' Ribbon. The new recommendation: 'The USPSTF recommends screening for hepatitis C virus infection in adults aged 18 to 79 years.' “Medically Ready Force…Ready Medical Force” 3
CORE Compatible Updates Updated the wording in the 'Self-Reported Level of Functioning' row on the PHQ-9 OLD NEW “Medically Ready Force…Ready Medical Force” 4
CORE Compatible Updates Updated 'Pain Treatment history' section on the Exit CCP tab “Medically Ready Force…Ready Medical Force” 5
CORE Compatible Updates Updated 'Chronic Pain' ribbon label to say 'Pain Management Care Plan' and verbiage updated within section. Also changed the 'Pain care agreement on file’ to 'Pain Care Informed Consent on File’ “Medically Ready Force…Ready Medical Force” 6
Objectives Training Objective: Identify the clinical workflows, screeners and tools available in the TSWF Low Back Pain AIM form as they relate to the VA/DoD Clinical Practice Guidelines Learning Objectives: At the conclusion of today’s activity, the participant will be able to: • Understand the documentation requirements found on the HPI tab (patient intake/Med Rec/Preventive Services) as well as the importance of noting LBP Red Flags • Demonstrate the purpose and use of the Low Back Pain Chronic Care Plan • Understand the use of various screeners (Travel/Audit-C/Tobacco use/Annual Questions/Learning Assessment/Military Specific Screening) • Summarize the interventions and recommendations for initial and follow-up management of Low Back Pain “Medically Ready Force…Ready Medical Force” “Medically Ready Force…Ready Medical Force”
Why Use a TSWF CPG AIM IM Form? • Integrates recommendations from VA/DoD CPGs • Provides easily accessible references for clinical decision-making • Improves continuity of care and healthcare outcomes • Provides links to references for patient education materials • Standardizes documentation “Medically Ready Force…Ready Medical Force”
Workflow Key Points • Clinical Support Staff (CSS) completes TSWF LBP form or CORE form • Provider takes “ownership” of the CSS note • Provider loads TSWF LBP CPG AIM form • Provider reviews information completed by CSS and completes the note “Medically Ready Force…Ready Medical Force”
TSWF Navigator TSWF Navigator takes you to the most current version of the forms “Medically Ready Force…Ready Medical Force”
HPI/PFSH Tab Form version, links to MilSuite, TSWF Navigator, TSWF Website, and Change Log are listed at the top “Medically Ready Force…Ready Medical Force”
HPI/PFSH Activ ivity Lim Limit its & Pri rior LB LBP His istory ry VA/DoD LBP CPG recommends documentation of patient’s limitation of activity and any prior history of low back pain “Medically Ready Force…Ready Medical Force”
HPI/PFSH Tab Red Flag Flags “Medically Ready Force…Ready Medical Force”
Negative Red Flags (N (Note Vie iew) NOTE: When red “No” is selected for all the ‘Red Flags’, it will emit as negative or “NO” in Note View “Medically Ready Force…Ready Medical Force”
Positive Red Flags NOTE: If only a few positive ‘Red Flags’ are selected “Yes”, then the Note View will only show those selected “Medically Ready Force…Ready Medical Force”
Positive Red Flags (N (Note Vie iew) NOTE: When red “Yes” is selected for all the ‘Red Flags’, it will emit as positive in Note View “Medically Ready Force…Ready Medical Force”
HPI/PFSH Tab “Medically Ready Force…Ready Medical Force”
HPI/PFSH Tab Medication Reconcil ilia iation Text field to input name of patient’s Primary Opioid Provider* Support staff updates medication list (and checks box verifying completion) Provider completes this section *Primary Opioid Provider means that a patient has an agreement in place that authorizes a single provider to write or renew prescriptions for opioid medications. “Medically Ready Force…Ready Medical Force”
Screening Tab Travel Sc Screening/Infectious Di Disease Travel l Sc Screen If appropriate or according to local protocol, complete pre-travel counseling and Infectious Disease Travel Screen Note: blue clinical clues about various diseases “Medically Ready Force…Ready Medical Force”
Screening Tab Annual l Questions/Health Lit Literacy These questions need to be completed annually. If more than 12 months have elapsed since last updated, uncheck the red “ X ” to reset the questions to current requirements The Single Item Literacy Screener (SILS) for assessing health literacy is in the Annual Questions field. If patient’s response is either “often” or “always”, conduct a more thorough assessment (see next slide) “Medically Ready Force…Ready Medical Force”
Screening Tab Healt lth Lit Literacy/Mil ilit itary-Specific If the SILS response is either “often” or “always,” further assessment of the patient’s health literacy is documented here along with an action plan if indicated. While a link to REALM-SF is provided here, any appropriate assessment can be used “Medically Ready Force…Ready Medical Force”
Screening Tab Document if visit is deployment related here “Medically Ready Force…Ready Medical Force”
Screening Tab Mili ilitary ry-Specific Sc Screenin ing ‘Performs Armed Duty’ question “Medically Ready Force…Ready Medical Force”
BH/Other Screening Tab De Depression Sc Screening Note clinical clue on the Depression Screening ribbon “Medically Ready Force…Ready Medical Force”
BH/Other Screening Tab C-SS SSRS Clues give instructions on how to ask the questions “Medically Ready Force…Ready Medical Force”
BH/Other Screening Tab C-SS SSRS (c (cont.) • Complete the summary statement including actions taken • Pre positioned text is included “Medically Ready Force…Ready Medical Force”
BH/Other Screening Tab PTSD Sc Screenin ing “Medically Ready Force…Ready Medical Force”
BH/Other Screening Tab PTSD Checkli list-PCL-5 “Medically Ready Force…Ready Medical Force”
LBP ROS/P LB /PE Tab “Medically Ready Force…Ready Medical Force”
LB LBP ROS/P /PE Tab • LBP-Specific PE is helpful when you are referring to Neurology/ Orthopedics • Spinal Levels on the left correlate with sensation, motor strength and reflexes as you move to the right “Medically Ready Force…Ready Medical Force”
LBP ROS/P LB /PE Tab “Medically Ready Force…Ready Medical Force”
LB LBP ROS/P /PE Tab Cervical l Sp Spin ine/Neck Ri Ribbon “Medically Ready Force…Ready Medical Force”
LB LBP ROS/P /PE Tab Additional Ri Ribbons “Medically Ready Force…Ready Medical Force”
Additional ROS Tab “Medically Ready Force…Ready Medical Force”
Additional PE Tab “Medically Ready Force…Ready Medical Force”
Additional PE Tab Psych Links to resources on the detection of cognitive impairment “Medically Ready Force…Ready Medical Force”
Exit/CCP Tab “Medically Ready Force…Ready Medical Force”
Exit/CCP Tab CCP Ri Ribbons • Patients who have multiple chronic conditions may require additional documentation • Document/update additional chronic care plans (CCPs) here “Medically Ready Force…Ready Medical Force”
Exit/CCP Tab CCP Ri Ribbons “Medically Ready Force…Ready Medical Force”
Obsolete Terms Tab *Complete this step at every visit* The Obsolete Terms tab removes AHLTA past medical history MEDCIN terms which copy forward and are no longer used, or emit in different areas of the TSWF-AIM forms. “Medically Ready Force…Ready Medical Force”
LB LBP In Initial Eval/Mgmt Tab For non-specific and non-severe sciatic LBP, routine imaging and labs in the first four weeks and use of second line medications are not recommended “Medically Ready Force…Ready Medical Force”
Initial Eval/Mgmt Tab In “Medically Ready Force…Ready Medical Force”
Follow-Up/M /Management Tab Sa Sample Alg lgorithm “Medically Ready Force…Ready Medical Force”
Follow-Up/M /Management Tab CPG Recommendations “Medically Ready Force…Ready Medical Force”
TSWF Resource Material The TSWF repository for training/educational materials and updates: www.tswf-mhs.com “Medically Ready Force…Ready Medical Force”
Pri rimary Care Clinical Community Content Working Group ▪ DHA - Maj Matthew J Royall ▪ ARMY - Dr. Robert Marshall ▪ AIR FORCE – Dr. Matthew Barnes TSWF Feedback https://www.milsuite.mil/book/groups/tswf TSWF Website http://www.tswf-mhs.com/ “Medically Ready Force…Ready Medical Force”
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