Charter Information – Charter Date = November 5, 2016 (SAT)
Deadline – November 6, 2016 (SUN): Met by 1630 PSTGarden Grove Health Center
Counter Staff and Scheduling
By Buster D Right – Complaint Management (MSG, 2017)
Blog - TheTorkelSagas
Gallery Up Front Method (GUFM)Editor: Keith Torkelson, MS & PHW
Website for Health Center > http://centralcityhealth.org/
List and Links of Related Articles – Added as Needed (PRN)
Gallery Up Front
Project Logo
Acronyms for Practical Knowledge – Clozapine and Scheduling
-
|
|||
AcroCode
|
Meaning
|
Note
|
|
-
|
|||
BND
|
Brand New Day
|
||
CBC
|
Complete Blood Count (Lab)
|
||
CCCHC
|
Central City Community Health Center
|
||
CCRC
|
Contractor Christmas Report Card
|
||
CMC
|
Clozapine Maintenance Cycle
|
||
CMS
|
Centers for Medicare & Medicaid Services
|
||
CPRP
|
Collaborative Personal Recovery Plan
|
||
DMD
|
Doctor of Medicine in Dentistry
|
||
HRE
|
Health Related Engagement (Dosage)
|
||
PCP
|
Personal Care Physician
|
||
PKL
|
[A Dentist]
|
||
RTS
|
Rate The Staff
|
||
-
|
|||
20161106-SUN: Acronym List for Clozapine (P-1.0)
Results Up Front (RUF)
Patrick Kha Lee (PKL) DMD Review Model applied to CCCHC
Service Feature
|
CCCHC-GG (2016)
|
Boyce, MD (2016)
|
|
-
|
|||
Appointments
|
Too Hard
|
Easy
|
|
Review Us
[THE PROVIDER]
|
Not Solicited
External Work In Progress
|
Solicited by them
|
|
Refer a Friend
|
No
|
Yes
|
|
Preferences
|
Not Honored by Staff
|
Preferences Honored
|
|
As of 20161106-SUN: Table – Review per PKL Model (2016)
CCCHC-GG = Central City Community Health Center – Garden
Grove Clinic
Staff & Resource List of those I have transacted with
for 2012-2016
-
|
||||
Identification
|
Role
|
Detail &
History
|
Note
|
|
-
|
||||
“Nick”
|
Pharmacy Technician
|
Clozapine Cycle
Specialist
|
||
Self
|
Master Scheduler
|
|||
Alan Berkowitz
|
Life Coach
|
Program Management
|
||
Jeff Gibbs
|
Case Manager
|
Housing
|
“I can’t help you”
|
|
Miscellaneous
|
Customer Service
|
Multiple
|
||
Constance Snyder
20130912
|
BND Complaints
VP Medicare Programs
|
Plan Information Yearly
|
||
Anonymous
20130911
|
CMS Grievance
|
Plan Information
Yearly
|
||
Various
|
Counter
|
Drop In Emergency Appointment
|
||
Jennifer
|
Advice Nurse
|
Medication Error
|
||
CCCHC Various
|
Counter Staff
|
|||
Gabby
|
Counter
|
Scheduling
|
||
Beatrice
|
Counter
|
Scheduling
|
||
BND Corporate
|
||||
S. Fuentes
20160331
|
Appeals and Grievance
|
Delta Dental
Fee Schedule
|
||
Stacy F,
20160620
|
Appeals and Grievance
|
Medication Error
|
||
Beatrice
20160426
|
Scheduling
|
Emergency Appointment
|
“I can’t help you”
|
|
Cynthia (Anonymous)
20160503
|
Scheduling
|
Cancelled wrong appointment
|
||
Beatrice
20161101-TU
|
Schedule
|
Routine CBC
|
Your necessary Tuesday (20161129) is not available
|
|
20161106-SUN: Table – BND and Partial Contractor Transaction
Register
BND-GGB = Brand New Day – Garden Grove Brookhurst
Dosage
As of today, November 6, 2016, I have participated in thirty-seven (37) Brand New Day related Health Related Engagements (HREs). Eleven (11) of the HREs were for Complete Blood Counts or CBCs. I have perfect attendance for my medically necessary CBC appointments. I attribute a major portion of my success in sticking with the routine I have sustained since the middle of 2012. Fifteen percent of the days or my appointment dosage rate so far this year has been devoted to BND related engagements. Four point six (4.6) percent of my year was devoted just for essential CBCs.
As of today, November 6, 2016, I have participated in thirty-seven (37) Brand New Day related Health Related Engagements (HREs). Eleven (11) of the HREs were for Complete Blood Counts or CBCs. I have perfect attendance for my medically necessary CBC appointments. I attribute a major portion of my success in sticking with the routine I have sustained since the middle of 2012. Fifteen percent of the days or my appointment dosage rate so far this year has been devoted to BND related engagements. Four point six (4.6) percent of my year was devoted just for essential CBCs.
Number of Transactions
I have negotiated CBC
appointments more that six times during 2016 with Gabby. I have transacted with Beatrice about two
times and both times were problems.
Beatrice’s problem rate far exceeds that of Gabby.
Biggest Stressors
|
Key Detrimental Events
|
Notes
|
Person
|
|
-
|
||||
BND and Contractors
|
Medication Error
|
Huge effort on my part to resolve
|
Multiple
|
|
CCCHC Scheduling
|
Can’t value and address routine
|
Both time of week and time of day appointment errors
|
Three or so
|
|
Housing & Resource Sustainability
|
Helper says he cannot help me
|
Encourage me to author Jeff Gibbs investigational material
|
Jeff Gibbs
|
|
Medication Related
|
Manage without Medication
|
As of today I have to make due without Lovastatin due to 2
scheduling errors
|
Schedulers V PCP’s Yearly Protocol
|
|
-
|
||||
Table – My Biggest Stressors for 2016 - Lovastatin [SPELLED]
A Key Favorable Event
Referred by Derek (BND) to
24-Hour Fitness. A Silver and Fit gym
membership is covered by BND. I linked
myself and go at least once per week.
20161105 Viewership
ComMan (MSG, 2017) – How is it a
Complaint
This issue is a complaint because
its trigger evolution for great harm.
Two fixes are needed: First my next appointment should be moved up from
Thursday to my routine Tuesday. Second
I should be locked in on Tuesday lab work unless I am the one who changes
it. Thus far for 2016 I haven’t met a
circumstance that required me to change my routine CBC away from Tuesday.
Presenting Problem – Real Time
The presenting problem is that after our routine Tuesday CBC blood draw Beatrice would not schedule us for our routine Tuesday for the next CBC appointment. This is a medication management problem because our CBC is always required in advance for the pharmacy to issue our most important medication Clozapine (not Klonopin). We are addressing this complaint in real time. Our next CBC is scheduled for Thursday December 1st – two day too late. We called BND Customer Service and they said they could not help me.
The presenting problem is that after our routine Tuesday CBC blood draw Beatrice would not schedule us for our routine Tuesday for the next CBC appointment. This is a medication management problem because our CBC is always required in advance for the pharmacy to issue our most important medication Clozapine (not Klonopin). We are addressing this complaint in real time. Our next CBC is scheduled for Thursday December 1st – two day too late. We called BND Customer Service and they said they could not help me.
What I Need? – Cope with
scheduling problems
All CBCs are urgent appointments in that if not handled like clockwork I can end up without medication or worse having to restart the Clozapine Protocol. Next week on November 8, 2016 I meet with my PCP to close out my physical. My physical this year was another engagement that had scheduling problems. When I meet with my PCP I am going ask him if he will help me get back on schedule by having he schedulers move my routine CBC back to Tuesday. I wish to have my CBC day (Tuesday) locked in monthly unless I need to periodically change it.
All CBCs are urgent appointments in that if not handled like clockwork I can end up without medication or worse having to restart the Clozapine Protocol. Next week on November 8, 2016 I meet with my PCP to close out my physical. My physical this year was another engagement that had scheduling problems. When I meet with my PCP I am going ask him if he will help me get back on schedule by having he schedulers move my routine CBC back to Tuesday. I wish to have my CBC day (Tuesday) locked in monthly unless I need to periodically change it.
The Clozapine Maintenance Cycle
(CMC)
Clozapine Safety Zone
The Safety Zone in the Clozapine Maintenance Cycle is about one (1) week. Day one you get the pharmacy bills for the prescription. Day twenty the lab results come in. Four weeks from the date on the last Clozapine prescription the new one month supply is billed and delivered. The Emergency Back Up Supply method will be addressed in a later paper (post).
The Safety Zone in the Clozapine Maintenance Cycle is about one (1) week. Day one you get the pharmacy bills for the prescription. Day twenty the lab results come in. Four weeks from the date on the last Clozapine prescription the new one month supply is billed and delivered. The Emergency Back Up Supply method will be addressed in a later paper (post).
Clozapine Maintenance Cycle (Diagram-MSG, 2016)
Figure – Generalized Clozapine
[Not Klonopin] Maintenance Cycle (MSG, 2016)
Clozapine Maintenance Cycle
The generalized Clozapine
Maintenance Cycle is described in the figure above. It is desirable to keep from 8 to 13 day between the CBC blood
draw and the pharmacies day of delivery.
Clozapine Failure & Restart
Cycle
Basically if you miss a dose of
Clozapine it can restart the titration and lab cycle. Rather than labs were being required monthly they will have be
weekly. And rather than have you
necessary daily allowance of Clozapine they restart the titration. It takes about one (1) month to get you back
up to your maintenance dose.
The Volunteer Zone
Now here is were elements in my
schedule work around my standard routine for Clozapine. I first get my CBC on a Tuesday. Next I add any other Health Related
Engagements associated with Brand New Day such as Dermatology or Dental. Then I add my volunteer commitments such as
advising for the Orange County Health Care Agency (OCHCA). Next I add special engagements. Last I work on family therapy. By having routine CBCs each month I can make
and keep volunteer commitments in advance.
Not only do I have 100% attendance for BND HREs, I have 100% attendance
for my volunteer work.
Abstract & Error Rate
Abstract & Error Rate
Basically this scheduling issue
qualifies as an error because after more than four (4) years on at least once a
month appointments that schedulers should know my routine and why it is
necessary to stay on track. Without
getting into the types of errors that can be made in the Helping/Service
Profession. The BND network team have
made several errors the year (2016).
Most errors where made by BND’s contractor Central City Community Health
Center (CCCHC) Garden Grove Clinic.
Single Point Contact (SPC)
After the medication errors earlier this year it would seem prudent that we have assigned a quality control officer that can advocate on our behalf. It would be nice to have any problems that arise solved in good orderly time. Time based upon a reasonable incident fitted moment. Customer Service said they could not help me. I think that when it comes to psychiatric medication issues a SPC candidate will be the Psych Nurse Bethany. I hope to talk with her this Tuesday November 8, 2016 when I am in for my yearly physical.
Dependency V Trauma Bonded
After the medication errors earlier this year it would seem prudent that we have assigned a quality control officer that can advocate on our behalf. It would be nice to have any problems that arise solved in good orderly time. Time based upon a reasonable incident fitted moment. Customer Service said they could not help me. I think that when it comes to psychiatric medication issues a SPC candidate will be the Psych Nurse Bethany. I hope to talk with her this Tuesday November 8, 2016 when I am in for my yearly physical.
Dependency V Trauma Bonded
“Traumatic Bonding Theory: This
theory explains the dynamics of domestic violence and explains why victims stay
with their abuser or return to the relationship. It states “strong emotional
connections develop between the victim and the perpetrator during the abusive
relationship.” When it comes to my
relationship with Beatrice I am dependent.
If I could always deal with another scheduler I would. Because I am stuck in an abusive (she is
passive aggressive) relationship with Beatrice, I might be considered Trauma
Bonded. The point is our relationship
is not very rewarding. Beatrice routinely
instills disappointment and frustration.
Valuing The Client/Consumer’s Time
The scheduling staff, including Beatrice, may think that having my Clozapine Cycle is just a preference. Managing Clozapine is not just a preference it is absolutely a medical necessity. Due to low expectations they think we the clients should be available at all times to meet their scheduling. So how it that we can sustain our other appointments and commitments. Insert time scheduling for September 2016.
The scheduling staff, including Beatrice, may think that having my Clozapine Cycle is just a preference. Managing Clozapine is not just a preference it is absolutely a medical necessity. Due to low expectations they think we the clients should be available at all times to meet their scheduling. So how it that we can sustain our other appointments and commitments. Insert time scheduling for September 2016.
Collaborative Personal Recovery Plan (CPRP)
Our work with the parent organization Brand New Day suggest creating and progressing about a Collaborative Personal Recovery Plan or CPRP. In Phase III – Successful Living the fourth item requests that we be “able to hold…volunteer position for one (1) year. On one hand we have our program BND requesting us to engage while scheduling by CCCHC makes it nearly impossible to be a reliable volunteer.
Our work with the parent organization Brand New Day suggest creating and progressing about a Collaborative Personal Recovery Plan or CPRP. In Phase III – Successful Living the fourth item requests that we be “able to hold…volunteer position for one (1) year. On one hand we have our program BND requesting us to engage while scheduling by CCCHC makes it nearly impossible to be a reliable volunteer.
Staff Friendliness and
Courteousness
It all began with Steve The Scheduler back in 2012. Steve was really grumpy yet for the most part kept us on schedule and on routine with our Tuesday CBC requirement. Since 2012 nearly all if not all of the counter staff have turned over. The 2016 counter group may think I am pushy when it comes to sustaining the Clozapine Cycle. Earlier about the medication errors I told Gabby that she was “freaking me out”. Over all this year the counter staff have failed about friendliness and courteousness. It is not a good idea in the role as helper to freak out your clients. There is a gal that pops in once in awhile who appears to be nicer than the average. I am not demanding. The Clozapine Cycle is what it is. The manufacturer Mylan sets the requirements.
Clozapine Registries – Examples Mylan and Teva
Now I have gone too far. All I am trying to do now is describe the problem and seek out a fix. If you want to learn a bit more, like way too much more, surf the links below. Let us call this post Clozapine Practical 1.0. From lived experience I have learned that the only ones who really understand Clozapine and the Registry are the pharmacy techs. With CVS I had a dedicated technician who kept a binder on me. With Gilbert Pharmacy (my current one) Nick helps me solve difficult issues. If the steps to obtain Clozapine are not kept in tune the result can be no medication. I have no real substitutes for Clozapine. History demonstrates (twice) if I do not get my Clozapine within seventy-two hours I land in the Psych Ward. They either think that I intentionally stopped taking Clozapine or that Clozapine is not working for me. It was worth it: The material linked below was of value for me to learn.
It all began with Steve The Scheduler back in 2012. Steve was really grumpy yet for the most part kept us on schedule and on routine with our Tuesday CBC requirement. Since 2012 nearly all if not all of the counter staff have turned over. The 2016 counter group may think I am pushy when it comes to sustaining the Clozapine Cycle. Earlier about the medication errors I told Gabby that she was “freaking me out”. Over all this year the counter staff have failed about friendliness and courteousness. It is not a good idea in the role as helper to freak out your clients. There is a gal that pops in once in awhile who appears to be nicer than the average. I am not demanding. The Clozapine Cycle is what it is. The manufacturer Mylan sets the requirements.
Clozapine Registries – Examples Mylan and Teva
Now I have gone too far. All I am trying to do now is describe the problem and seek out a fix. If you want to learn a bit more, like way too much more, surf the links below. Let us call this post Clozapine Practical 1.0. From lived experience I have learned that the only ones who really understand Clozapine and the Registry are the pharmacy techs. With CVS I had a dedicated technician who kept a binder on me. With Gilbert Pharmacy (my current one) Nick helps me solve difficult issues. If the steps to obtain Clozapine are not kept in tune the result can be no medication. I have no real substitutes for Clozapine. History demonstrates (twice) if I do not get my Clozapine within seventy-two hours I land in the Psych Ward. They either think that I intentionally stopped taking Clozapine or that Clozapine is not working for me. It was worth it: The material linked below was of value for me to learn.
FYI - Clozapine References and
Links
New Clozapine REMS program
changes monitoring, dispensing requirements (20150918).
Sep 18, 2015 - “If a
patient…Mylan brand of clozapine in the inpatient setting and is originally
registered in the Mylan registry…
[PDF] - Single Patient WBC/ANC
Reporting Form - [NO CACHE]
This form is for submitting WBC
counts and ANC values to the Teva Clozapine Patient Registry. Submit lab
results within 7 days of the blood draw date.Mylan Clozapine Guidelines - Teva Clozapine [FOR PURCHASE]
Clozaril national registry form, what is the maximum dose of
clozapine, teva clozapine patient registration form, clozapine required labs…
Back to Scheduling - CCCHC Staff Comparisons
-
|
||||
Helper
|
2012-2016
|
2016
|
Activity
|
|
-
|
||||
Martha Gil
|
4.5
|
5.0
|
Draws Blood - Plus
|
|
Gabriel “Gabby”
|
N/A
|
4.0
|
Scheduling
|
|
Beatrice
|
N/A
|
2.0
|
Scheduling
|
|
6 Unknowns
|
2.0 – 3.5
|
Problem Solving
|
||
-
|
||||
Steve - Legacy
|
3.0
|
Moved On
|
Scheduling
|
|
Table – CCCHC Staff Star Report for Duration – Five (5)
Stars Being Best
Vitals – Ease of Appointment
Vitals is an online assessment for consumers (clients) to evaluate their professional helpers. On of the items in the standard Vitals assessment asks to rate “Ease of Appointment”. This year CCCHC schedulers earned an 0.0 = Failure = F = Zero Star for their scheduling.
Vitals is an online assessment for consumers (clients) to evaluate their professional helpers. On of the items in the standard Vitals assessment asks to rate “Ease of Appointment”. This year CCCHC schedulers earned an 0.0 = Failure = F = Zero Star for their scheduling.
Dynamics – The principle dynamic
elements in this report are updated timelines, Transaction Update Reports
(TURs), Update Notes (UNs), and Progress Notes.
Timelines (Legacy)
Timeline – Health Related
Engagements (HREs) - September
This is an example of our Health
Related Engagement (HRE) Monthly Planner for September 2016. There were a total of nine (9) Brand New Day
driven HREs. That translates into 45%
of days were devoted to health commitments centering on BND. I try to do as much as possible on Tuesdays
each week. Because of CCCHC lack of
flexibility I was down to only one volunteer day for the month of
September.
Timeline – Complete Blood Count
(CBC) 2016
Parent: 10_BMB_Clozapine_16110601_CBC Register
Parent: 10_BMB_Clozapine_16110601_CBC Register
CBC Lab Work for Keith E Torkelson
#
|
Date
|
Day of Week
|
Time
|
Note
|
|
20151229
|
Tuesday
|
1030
|
|||
01
|
20160126
|
Tuesday
|
1045
|
||
02
|
20160223
|
Tuesday
|
1100
|
||
03
|
20160322
|
Tuesday
|
1045
|
||
04
|
20160419
|
Tuesday
|
130p
|
||
05
|
20160517
|
Tuesday
|
130p
|
||
06
|
20160614
|
Tuesday
|
1145
|
||
07
|
20160712
|
Tuesday
|
1045
|
Progressing Nicely
|
|
08
|
20160809
|
Tuesday
|
1000
|
||
09
|
20160906
|
Tuesday
|
1000
|
||
10
|
20161004
|
Tuesday
|
1015
|
||
11
|
20161101
|
Tuesday
|
1000
|
||
20161201
|
Thursday
|
1015
|
Undesirable
|
||
20161129
|
Tuesday
|
1000-1130
Window
|
Desirable for keeping medication supply flowing
|
||
Table – Clozapine [NOT KLONOPIN] Driven CBC Lab Appointment
Register for Keith E Torkelson for 2016 - Klonopin [SPELLED]
Sample of Client's Schedule for 1 month
The Facilities - Garden Grove Offices
Facility Picture Pirated From The Internet (20161105SAT)
Sample Schedule for Client –
September 2016 [DITTO]
Finally - Let's Rate The Staffs (RTS)
-
|
||||
Professional
|
Profession
|
Stars
|
||
-
|
||||
Lee
|
Psychiatry
|
2.0
|
||
Mojica
|
Primary Care
|
2.0
|
||
Saeed
|
Dentistry
|
3.0
|
||
Nguyen
|
Dermatology
|
4.0
|
||
Boyce
|
Ophthalmology
|
4.5
|
||
Inman
|
Optometry
|
5.0
|
||
-
|
20161106-SUN: Table – Rate The Staffs (RTS) – Brand New Day
(BND) Contractors for Quality of Service 2016
Christmas Report
Each year we derive and share our Christmas Report Card (CRC). Previously we only shared about our high performing professionals. We really are not sure who owns and runs CCCHC. For 2015 our highest performer was our dermatologist Doctor Nguyen. Some assessments such as Healthgrades associate the doctor with the staff. For Doctor Nguyen this fits because he owns and operates his business. For CCCHC and associates this is part of their CRC.
Each year we derive and share our Christmas Report Card (CRC). Previously we only shared about our high performing professionals. We really are not sure who owns and runs CCCHC. For 2015 our highest performer was our dermatologist Doctor Nguyen. Some assessments such as Healthgrades associate the doctor with the staff. For Doctor Nguyen this fits because he owns and operates his business. For CCCHC and associates this is part of their CRC.
CCCHC and Contractors Christmas
Report Card (CCRC, 2016)
Pending Delivery for the month of
December 2016 - Using a Separate Methodology.
I usually deliver it by hand to the highest performing professional.
Stop for
Clozapine Practical 1.0 –
Scheduling and Clozapine Outpatient Maintenance
Start for
Clozapine Practical 2.0 – Will
have a different motivation
Hashmarking
-
#Clozapine
#ClozapineRegistries
#Scheduling
#Necessity
#CostOfError
#Prevention
Project Practical 1.0 Closed On Schedule
End of Report
No comments:
Post a Comment