Clinic Assistant Training: Level 1 •
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Role Overview and Expectations Work‐up Walk‐thru
Scenarios and Mock Work‐ups
Safety Tips and Tricks Frequently Asked Questions
VFC History and Facility Tour
Introductions
VFC Volunteer Services Department [email protected]
(Accessible to all Vol. Services Staff)
Cassie Roque
Volunteer Services Manager
[email protected]
Waverly Paradox
Zahra Ismail
Volunteer Services Coordinator
[email protected]
AmeriCorps Volunteer Coordinator [email protected]
Role Overview and Expectations •
VFC’s Mission (and thus every CA’s Mission): ‒
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Provide quality health care to people in need
Clinic Assistant’s Role
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Provide quality customer service to each patient Provide constant support to the clinic staff
Check vitals on patients
• Expectations
‒ Consistent Attendance
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Three Strikes Rule
‒ Consistent Communication
(see‐I‐care) Guidelines for what is expected of every team member at UCLA Health: Video Connect with Compassion by addressing the patients as Mr./Ms. or by the name that they prefer.
Introduce yourself with Integrity by stating your name and your role.
Communicate with Teamwork what you are going to do, how long it is going to take, and how it will impact the patient.
Ask with Discovery by anticipating the patient needs, questions, or concerns.
Respond with Respect to patient questions or requests with immediacy.
Exit with Excellence by ensuring all of the patient's needs are met.
PCMH: Patient Centered Medical Home
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What is PCMH?
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PCMH is a way of organizing primary care that emphasizes care coordination and communication to improve patients’ and providers’ experience of care.
Clinic Assistant’s Role in PCMH
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Self‐Management Support for targeted patient populations
Depression Screening to provide integrated care
• Expectations
‒ Attend huddles with Nursing Staff, MAs, and Medical Providers at the beginning of each shift
‒ Buddy with MA to improve communication and patient care
What You’ll Need for Your First Shift:
Clinic Assistant Nametag
Watch
Scrubs or Business Casual Attire
Stethoscope
Pen and Pocket Notebook Copy of this Presentation
Role Overview and Expectations •
What to Do Before Your First Shift
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Submit your up‐to‐date immunization records
Review your Clinic Assistant Handbook
Get scheduled by the Vol Services Department
Get assigned an experienced CA buddy
What to Do During Your First Shift
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Introduce yourself to staff and other CAs
Shadow your experienced CA buddy
Get familiar with the flow of the clinic Clinic Assistant Skills Checklist
Name Tags & CA Skills Checklist:
Our Clinic Assistant name tags are color coded to identify each CA’s skills and experience level. GREEN : Clinic Assistant Level 1
YELLOW: Clinic Assistant Level 2
RED: LEAD Clinic Assistant
Clinic Assistant Level 1: Basic Skills Goal: Master Basic Skills tasks ‐‐ Height & Weight, Temperature, Pulse, and Blood Pressure
Congratulations! You completed your Skills Checklist: What’s Next? • Alert the Volunteer Department by emailing us at ‐
[email protected]
• We will print a new yellow (level 2) name tag for you, which will include the “Special Skills Checklist” for you to complete
Vitals by Patient Type
First Visit
• Height Women Visit
• Last menstrual period (LMP) • Specific OGYN Info
Vitals for All Visits
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Pulse
Weight
Blood pressure
Chief complaint • Allergies
• Smoking History (ages 13+) Homeless Visit
• Homeless Screening
Prenatal Visit
• Popra (a prenatal progress form that goes on top of chart)
Peds/Teens Visit (Staff Only)
• Height
• Head circumference (if less than two years old)
• Blood Pressure (if three years of age and annually)
Special Needs Visit
• Diabetic: Blood sugar
• Asthmatic: Peak flow (measures person's ability to breathe out air) and Pulse Ox (measures O2 saturation) Work‐up Walk‐thru
Step‐by‐Step Instructions for Each Work‐up
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Pick up a chart
• Review name, patient ID, DOB, and check for “Staff Only” indicators 2.
Call patient from the waiting room & escort patient to work‐up room
• Introduce yourself; C‐I‐CARE! • Confirm patient’s name and DOB
• Note: Each work‐up room is set up the same
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Take vitals and document on the back of the sticker sheets
Obvious Vitals • Height
• Weight
• Pulse
• Blood pressure
• Chief complaint 4.
Less Obvious Vitals • Allergies
• Smoking History
• Last Menstrual Period
• Glucose (Diabetes) • Peak Flow
Escort patient to exam room
• Add patient to list in doctor’s charting area
• Note patient’s name, exam room number, and any other special details
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Input info into NextGen* • Only available for Level 2 Clinic Assistants Work‐up Walk‐thru
Work‐Up Room Setup
Peak Flow Tubes
Gloves
Women’s Progress Notes
Summit Forms
Peak Flow Tube
Work‐up Walk‐thru
Height & Weight
Height:
1. Ask patient to take off shoes.
2. Ask patient to stand beneath machine. 3. Place measuring device on crown of patient’s head.
4. Refer to measurement indicated by “read here” to obtain the height.  Measure height only at patient’s first visit.
 When measuring height, patient’s shoes must be off.
Weight:
1. Ask patient to step on the Stadiometer. 2. Record whether or not patient has shoes on. 3. Adjust weights until the scale is balanced. 4. Record patient’s weight.
Work‐up Walk‐thru
Temperature ‐ By Mouth: Appropriate for everyone two years of age and older
1. Place thermometer in plastic sheath.
2. Place end of oral thermometer under tongue.
3. Tell patient to close mouth, but not to bite thermometer.
4. Leave in place until device signals, then remove thermometer.
5. Carefully dispose of plastic sheath.
6. Record patient’s temperature.
**If temperature > 102˚F or <95˚F notify a MA or Nurse immediately!**
Work‐up Walk‐thru
Pulse  If you are using a Blood Pressure, it will automatically take patient’s pulse. Manual Pulse:
1. Place index and middle fingers on the inside of wrist, below the thumb.
2. Use a watch with a second hand and count pulse for 60 seconds.
3. Record pulse rate, the date, time, and which side was used to take the pulse. 4. Record anything specific you notice about the pulse, such as that it is weak, strong, or missing beats
**If pulse is greater than 120 beats/min or less than 50 beats/min notify a MA or a Nurse immediately!**
How to Test Blood Pressure
Choosing the Correct Cuff Size:
1. Cuff should cover 2/3 of the upper arm
2. There are four kinds of cuffs: 1. Children’s cuffs
2. Regular adult cuffs 3. Large cuffs for obese patients 4. Thigh cuffs for extremely obese patients
3. Palpate brachial artery
4. Clothing should be out of the way of the cuff
5. Apply cuff snug and evenly, one inch above the elbow
Stethoscope Placement and Inflation:
1. Place diaphragm of stethoscope on bare skin over brachial artery but NOT touching cuff or tubing
2. Apply slight pressure of diaphragm with one hand
3. With the other hand, inflate cuff rapidly, using a smooth, continuous rate, to around 160mmHg initially, or higher if necessary
4. Deflate slowly, 2‐4 mmHg mercury per heart beat
5. Read the manometer at eye level
How to Test Blood Pressure
Readings:
Systolic Blood Pressure: The first audible beat (the number on top)
Diastolic Blood Pressure: The last audible beat or the last beat before a change in volume (this is the bottom number)
Normal Range (Adult) : Systolic 100‐140, Diastolic 60‐ 86 Normal range (Child) : Systolic 90‐ 126, Diastolic 50‐80
Reminders:
• Note which cuff size is used • Always use EVEN numbers when recording blood pressure
• If you are unable to hear, try again after waiting about 1‐2 minutes. Also you may try the other arm. If you are still unable to hear, ask a staff member to help.
Work‐up Walk‐thru
Chief Complaint: Concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for a medical encounter.
Determining Chief Complaint:
1. Ask patient the reason for their visit.
2. Be sure to identify only 1 – 3 chief complaints. 3. Ask patient how long they’ve been experiencing symptoms (i.e. Start of day)
4. Determine intensity and consistency of the complaint.
Work‐up Walk‐thru
Cleaning Rooms  Assist staff to ensure that work‐up and exam rooms are always fully prepped and cleaned!
Preparing Rooms:
1. Check that examination rooms and work‐up rooms are straightened and kept clean.
2. Make sure instruments are put away in their proper place.
3. Replace supplies, as needed. Record pulse rate, the date, time, and which side was used to take the pulse. Cleaning Up:
1. Always assist with clean up at the end of your shift.
2. Clean all parts of exam and work‐up rooms with Clorox and wipe thoroughly with paper towels (including door knobs, chairs, trash cans, tables, Blood Pressure cuffs, etc.).
When should you flag a patient for staff?
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Anyone with a “Staff Only” Indicator
‒ Noted under the Details section of each patient’s Encounter Form
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Anyone exhibiting violent behavior or is very agitated
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Anyone exhibiting any of the following concerns (Staff may then ask you to…)
‒ Eye problems and/or complaints (Perform visual acuity exam – Staff Only)
‒ Urinary complaints (Perform UA – Staff Only)
‒ Complaints of cough (Give mask for client to wear)
‒ Fever (Check O2 saturation (pulse ox))
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When you are unsure about anything! •
Any acutely ill adults…
Acutely Ill Adults Definition: Conditions that require immediate care to relieve suffering & minimize mortality risk
Indicators Include:
1. Complains of shortness of breath, wheezing or choking
2. Pulse Oximetry less than 92% on room air **Ask nearest staff member to notify RN on the floor while checking pulse‐ox
3. Chest pain or pressure
4. Recent drug overdose, ingested poison or recent skin exposure with dangerous chemicals
5. Complains of severe headache starting in last 24 hours or new paralysis of any part of the body
6. Actively bleeding, vomiting blood or recently passing bright red blood in stool, check hemoglobin and report to provider
7. Has an abnormal blood pressure and or pulse:
• Systolic BP greater than 200mm Hg or less than 80 mm Hg
• Diastolic BP greater than 110mm Hg
• Pulse greater than 120/min or less than 50/min
8. Blood glucose: • Less than 70; MUST TREAT with juice and notify provider and/or RN/LVN staff
• >350; MUST obtain UA (urine analysis) to check for ketones
9. Hemoglobin < 8
10.Temperature > 102˚F
Specialties: Hypertension
About Hypertension:
● Hypertension refers to High blood pressure (HBP) Indicators of Hypertension:
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Systolic BP greater than 200mm Hg or less than 80 mm Hg
Diastolic BP greater than 110mm Hg
Pulse greater than 120/min or less than 50/min
**If patient exhibits any of these indicators, notify Nursing Staff immediately!**
Blood Pressure
Category
Systolic
mm Hg (upper #)
Diastolic
mm Hg (lower #)
Normal
less than 120
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less than 80
Prehypertension
120 – 139
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80 – 89
High Blood Pressure
(Hypertension) Stage 1
140 – 159
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90 – 99
High Blood Pressure
(Hypertension) Stage 2
160 or higher
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100 or higher
Hypertensive Crisis
(Emergency!)
Higher than 180
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Higher than 110
Specialties: Common Cold / Asthmatic
Procedures: If patient has a common cold or is asthmatic, test peak flow and pulse oximetry
Peak Flow: Measures patient’s ability to push air out of the lungs. Peak Flow is an indicator of lung efficiency.
How to test Peak Flow:
Peak Flow Machine
1. Locate peak flow machine and tube. 2. Use paper towel to insert tube into the machine. 3. Ask the patient to take a deep breathe and blow into the tube. 4. Record three readings.
5. Use the best reading as an indicator. Tube
Specialties: Common Cold/ Asthmatic
Clinical Procedures
Pulse Oximetry: Measures O2 saturation, which indicates the percentage of air in the lungs. How to test Pulse Oximetry:
1. Locate the machine. 2. Turn on machine
3. Ask patient to stay still and quiet. 4. Clamp machine on patients finger. 5. Record patient’s O2 Saturation reading.
Specialties: Diabetic
Procedures: Blood Glucose Screening
**Level 1 Clinical Assistants are not permitted to administer Blood Glucose screenings. If a patient identifies as diabetic, please notify Nursing Staff or Level 2 or LEAD Clinic Assistant.**
Gather All Supplies BEFORE Starting Test:
1. Gloves — put on BEFORE starting
2. Alcohol pad
3. Cotton balls
4. Small band‐aid
5. Blood glucose monitors — found in the Lab. You have to sign out for the machine
6. Blood monitor strips — also found in the Lab. Make sure the strip code matches the monitor code
Placement and Inflation:
1. Clean end of finger with an alcohol pad and dry with cotton ball
2. Activate NEW lancet
3. Turn machine on and the instructions will read:
a. Insert strip (you should insert the test strip),
b. Wait
c. Apply sample.
4. To remove lancet end cover, twist and pull
5. Apply slight pressure to the finger until some blood appears; wipe away the first drop of blood. Apply slight pressure again, until enough blood for a sample appears
6. Wait until the glucometer beeps, for total blood sugar results and record results 7. Remove used lancet and discard in Sharps container
8. Dispose of other materials (alcohol pad, cotton, etc.) in regular trash
8. Return monitor to its place in the work‐up room
9. Remove gloves and wash hands
Summit Consent Form
• Research program at VFC; Partnership with the National Institute of Drug Abuse
• Data will help society and improve public policy regarding substance abuse • Optional survey for patients at Venice Family Clinic Step‐by‐Step STEP 1: Complete patient survey on alcohol and drugs. Place the original in the chart.
STEP 2: Review patient's answer. If any of the patients answers corresponds to a shaded box (i.e. "3‐4 times"), then the patient qualifies for the summit research program.
STEP 3: Ask the patient if they would like to participate; Each participant will be given $5 i.) If the patient declines, write "C2C" or "patient declined" (either works) on the Summit form
ii.) If the patient accepts, there is a green SUMMIT folder in every work‐up room
Take one Summit consent form and have the patient fill out (signature, date, full name). Then you tear the form at its perforation and put the page with the patient signature, date, and full name in the chart [along with the original copy of the survey]. Then you give the patient the remaining portion of the consent form (it reads "I have agreed to speak with someone about SUMMIT"). Before handing the patient the remaining part of the consent form, YOU MUST PUT 4 PATIENT STICKERS ON IT. STEP 4: When you are done working up the patient, sign them up in charting and place him/her in one of the doctor's exam rooms. If there are no rooms, send them into the waiting room.
STEP 5: Locate the Walkie Talkie behind one of the coordinator's desk. Push the button and say "Hi, my name is _________ and I have a patient in Room ________ (or the waiting room) who qualifies for the summit research program“ in order to contact a Summit Staff member.
Homeless Patient Screening
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It is important to practice positive and conscientious interviewing skills for sensitive topics – drug & alcohol use, gender‐based violence, sexual behavior, sexuality, and housing situation • Be honest and ethical
• Treat all patients with respect
• Seek advise and support from the Nursing Staff on how to ask difficult or sensitive questions
• Do not allow personal judgments or cultural values to influence the patient interaction
Entering Vitals: Next‐Gen Please plan to attend a Next‐Gen Training for more information!
Reminders:
• DO NOT share your account information with anyone • DO NOT forget or lose your account information
• DO NOT enter any information if you are unsure –
the staff is always happy to help!
• REFERENCE the Next‐Gen training information and presentation that we have available online on the Volunteer Resources page
*Level 1 Clinic Assistants should refrain from utilizing Next‐Gen until you have attended a Next‐Gen Training and have completed your Level 1 Clinic Assistant Skills checklist, or are otherwise instructed by a VFC Staff member!**
Language Barriers
How to work with a language barrier •
Review of basic Spanish phrases in each CA handbook
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Free Online Resources – with audio!
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Basic Conversational Spanish •
Medical Spanish Terminology •
Medical Spanish Dialog per Symptom Spanish Translators
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We have Spanish Translator volunteers that are available to assist you! •
Keep an eye out for any volunteers that have a blue “Spanish” tag on their name tag. •
If you are bi‐lingual in Spanish, and you are interested in translating, please sign up for a Spanish Assessment in Volgistics to get your “Spanish” tag.
Reminder: When working with Spanish Translators the conversation and relationship should be with the patient, rather than with the Translator. Be sure to face and maintain eye contact with the patient, and not the Translator. Safety Tips and Tricks Judy De La Torre, Nursing Director
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Gloves
Sharps and Sharps Containers
Blue Charts
Hepatitis B Vaccination
Injuries Overall Safety & Security Next Steps…
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Volunteer Services will follow‐up via email within 1 week to confirm whether or not you are cleared to start!
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In order to be cleared, you will need to submit:
– HIPAA Certification
– Up‐to‐date TB test results: Negative results, within 1 year
– MMR Immunization Record or Positive MMR Blood Titer
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After all documents are submitted, we will ask for your current availability and match you with available shifts
Clinic Assistant Shifts:
Simms/Mann Health Center
Monday to Friday
8:30 AM – 12 PM (Morning)
1 PM – 5 PM (Afternoon)
604 Rose Ave Clinic
Monday to Friday
8 AM – 12 PM (Morning)
12 PM – 5 PM (Afternoon)
5 PM – 8 PM (Evening)
Irma Colen Health Center
Monday to Friday
8 AM – 12 PM (Morning)
1 PM – 5 PM (Afternoon)
Robert Levine Family Health Center
Monday to Friday
9 AM – 12 PM (Morning)
1 PM – 5 PM (Afternoon)
How do I get added to the schedule?
Within the next week, a member of the Volunteer Department Staff will send a follow‐up email to each new Clinic Assistant that has signed in for today’s Clinic Assistant Training session. In this email, we will request any remaining documents that we will need to get you scheduled. Once you are cleared to volunteer directly with patients, we will add you to the Clinic Assistant schedule at any of our four clinical sites, based on your availability and clinic needs. What if I need to miss a shift or two?
If you know that you will need to miss a shift, please alert the Volunteer Department Staff by emailing [email protected]. Notify us at least 48 hours in advance of your absence.
May I buddy with a doctor instead of a CA or MA?
No, you will need to buddy with an experienced Clinic Assistant or MA. We do not have opportunities available for our volunteers to shadow physicians. When can I get proof of my hours?
The Volunteer Department will provide an official Verification of Hours document to any volunteers that have completed our minimum time commitment requirement (at least 8 hours per month for a minimum duration of 6 months). When can I get a letter of recommendation? We are more than happy to commend our exceptional volunteers! However, in order to request a Letter of Recommendation from the Venice Family Clinic, you must complete over 100 volunteer hours at VFC. What do I do when there is nothing to do?
Be proactive and get the most out of your volunteer experience! If it is slow, please ask the Nursing Staff if they need help with anything. There is always something to do, even if you are not working up a patient! VFC History and Site Tour
• Founded in 1970 by Phillip Rossman, MD, and co‐founder Mayer B. Davidson, MD
• Volunteers role in Venice Family Clinic • Facility Tour
Congrats on Completing Your Clinic Assistant Training: Level 1 Thank you for coming!