Present: Steve C, Evan , Jobert, Jason T, Anton, Dave, Eric C , Brian L, Sam, Ron
Trainees: Partha , Matt M, Paul, Steven B, Austin, Alex , Javier
1) Voting in New Members
Eric- motion to vote in Partha, Alex, Matt, Steven today as member of the GMHC.
Steve- Second
Motions pass 0-0-8
Eric- motion to vote in Austin & Paul, contingent on them coming to shift tomorrow 11/20/2011. They will not be able to vote until they completed their shift requirements.
Brian- second
Motion passes 0-0-9
2) Alternate treatment to scabies (10 minutes)
- paul will email out detailed description
- since this is a cost issue, we need to know what the costs are for alternative tx
Brian – motion to table this until we talk to doctors and med section
2 present not voting, 0-0-12 Motion passes
3) Revising front and back of green sheet (20 minutes)
Dave – the 4 questions at the door seems outdated given our current protocols. Might make sense to incorporate the questions into the front of the green sheet. Most of the 4 questions are already covered in the front of green sheet. Do we need clients to fill out the testing history if we are already asking? We should clearly note that medics can only see people with penis.
Eric – Would it be possible to change “HIV risk” to “HIV Testing History”
Dave- Incorporating the 4 questions will reduce time at the door
Ron – Does this mean we are replacing what is on the green sheet right now re: sypmtoms with the 4 questions
Sam- What is the purpose of this change?
Ron – Efficiency at the door
Anton – Are we trying to change this to avoid green/blue ticket confusion?
Dave- I think it will solves a lot of problems –> door people don’t need to decide what to do
Jason – I use the time the client look at the questions to review his chart.
Brian – can’t we just remove the 4 questions all together since its already on the green sheet?
Evan – we should evaluate what we want to say, then decide where we want the content to be.
Jobert – someone should make the edit to the green sheet, then have it vote on during a QM
Eric – can we get rid of the “routine screen” check box?
Jobert – We should make sure people don’t make a bunch of changes that people don’t like and then have a prolonged discussion @ next QM
Brian – We should not get rid of the routine screen check box. We are making assumptions that clients are routine when they may have “forgot”
Partha – Clients may feel they have to mark something, so if there is no routine screen box they may feel like they have to mark something
Sam – In favor of keeping the boxes of symptoms for clients to mark, which is helpful for me as a medic. Would like to keep the level of details
Eric – Can we bold/highlight/italicize certain important keywords
Dave – changes to back of the sheet. Consolidate SOAP. Move the butt/penis pictures so assessment and plan follows right after subjective and objective. Give doctors more room to write assessment to they don’t write over the pictures.
Brian – make additional changes to back of green sheet (move “told when to call for results” ), move “normal test results”
*Dave will make the new sheet and present at the next QM
4) Door (15 minutes)
Evan – want to change door questions to include “experience significant symptoms currently”, to exclude people who have mild symptoms in the past. Use “pus or discharge coming out of your penis”.
Ron – To clarify, we are not concerned about questions 1, 2, 3
Steven B – how would clients have a frame of reference for what significant is?
Evan – it is hard, but this would help us weed out most clients who don’t need green tickets
Jobert – There really isn’t a function for question 2, 3, or 4.
Evan – let’s focus on question 1 for now.
Sam – might make sense for some of our clients to separate out the questions
Brian – What can be the problem
Sam – could be confusing for clients who are anxious or have difficulty reading
Motion by Evan: to change question 1 to read:
Are you currently experiencing significant pain or burning when you pee?
Do you have a drip or pus coming out of your penis.
Second – Eric
1 Present not voting, 0-0-13 . Motion passes
5) Revisiting blue and white tickets (15 min)
Eric – pink for FU, green for results, green/blue for urethral, and the blue and white separately. We should just change the blue for urethral symptoms and white as all other appointments.
Ron – like idea of combining the tickets. This would help us go in order.
Jason – Now that we are re-using mc numbers, it is screwing up the order system if they have urethral symptom (gets push to the front of the queue). We will need to give everyone the same color, and still use green for urethral
Steve- blue and white is historically for fast track medics. This is outdated
Ron – client with old mc number should be follow up? If they have different symptoms they should have a new mc number.
Steve – actually, now all clients will keep same MC number regardless whether or not they are here with new symptoms or just returning within the year
Jobert – quarter sheet should be sufficient to denote urethral symptom clients
Eric – The reason we have the two color tickets is for clients who come in later, and we call people out of order, people won’t get mad
Evan – if we maintain blue/green, we would know where to put the client back in queue after discharge collection
Motion to have pink for FU, green for results, blue/green as urethral, blue for all other appointments.
Evan – second
0-0-14 Motion passes
5) Clinic members who operate double shifts (15 minutes)
Brian – This was Yves’ item. There is an issue when people are becoming bi-sectional where we have access to identifying information where other sections don’t. For instance, if I counsel someone and then call the person for GMHC, that could be problematic. Another issue comes up with test-reading and QA where the person doing both can guess who the person is based on age.
Dave – I have experienced that issue myself. I did lab work and test reading. While doing urine, I got to see their information both in the lab and test reading. One time, one test came back positive and I knew who it was and couldn’t help it. The two pieces of identifying information are initials and date of birth.
Ron – I just want to clarify that this issue is coming up because of the issue of anonymity (yes –Brian) and we are trying to protect anonymity. The problem is that people who are bisectional can become aware of someone’s identity. Is there an issue of anonymity that puts us at risk if someone in QA sees the name
Eric – I think it is best if someone does not do both QA and testreading.
Dave – I also have an issue when I’m medicking. After medicking, they do ask me to test read and that could be a conflict
Brian – I hate to say this, but I think doing GMHC and HPS has greater risk of breaking anonymity then test reading and QA. I think we have to think about anonymity and define it because our clients do see us as a whole clinic and not as sections. Before we go forward, we need to ask ourselves what are we comfortable with?
Sam- For me, if we are to be completely anonymous, we can’t let people be bisectional. I don’t think that is realistic. For me, anonymity should be evaluated on the effect it has on the client and maybe to a lesser degree maybe how it can be seen by an outside agency. But the first concern is my main one. For this, I would want to hear from HPS about what type of standards we would like to see. For us from GMHC being called in when they are understaffed, I think there are more benefits from us being called in.
Evan – I think because anonymity is HPS’ policy and we are honoring their policy, we should refer this to HPS.
Jobert – I agree with what Evan said.
Dave – My biggest concern is that we haven’t identified that this isn’t HPS’ responsibility. Since phleb is a separate section, they should be the ones handling this. I think the chance of finding out is low but we need to be aware that it could occur.
Brian – I also want to point out a significant number of times the phlebotomist know who the positive is
Jobert – They usually know a lot.
Brian – We are not phlebotomy, but it is their issue. I think we should include them in this. It does involve them since Yves is a member of HPS and I am a member of HPS. This also affects Sam who does test reading.
Ron – I guess I’m still struggling with the anonymity part where if I were to see the information, I don’t see it as breaking anonymity. I go along the lines with what Sam said about it impacting staffing, but if we are trying to provide a service that we are saying it’s anonymous, are we saying it to the point where it is totally purely anonymous. I don’t know if there is an expectation of anonymity that it is so pure. If there is an expectation, I don’t know if it is a pure thing.
Dave – The only reason that it is a concern, the one client who I had saw also came back with positive results on Friday.
Brian – This information was only on a need to know basis. I just want to remind people that if we find information about a client, we shouldn’t be disclosing it.
Jason – I wanted to ask about whether HIPPA applies to anonymous clients as far as the need to know basis?
Brian – Anonymity is anonymity. Where I work, it is a team process and we all know about it. The question is whether we work as if we were a clinic or as separate sections
7) Compliance of medics (20 min)
Eric – I just wanted to revisit the compliance of medics.
This is the protocol that we currently have:
1) Medics who have not medicked in the last 4 weeks will have to be shadowed by another medic for a few appointments on shift
2) Medics who have not medicked in the last 3 months will have to talk to TC before they can medic and come up with a plan
I am also proposing:
Medics who do not meet their quarterly requirements will need to have a conversation with the section coordinators before they can medic. Purpose will be to check-in about what's been going on with them and coming up with a plan to return to compliance.
Medics who are Out of compliance > 1 quarter
· Shadow 1 or more individuals for entire shift. At subsequent (or consecutive?) shifts, individual will be shadowed by another medic for entire shift.Medic shadowing the individual will fill out the same sheet as used when signing off trainees. Individual will be allowed to medic by themselves when two medics on different shifts have signed off the individual.
Patterns of compliance issues may result in the coordinators asking medic to refrain from medicking until a quarterly meeting so the group can discuss.
Steve – I move we adopt the following on a continuing basis.
Sam – So, I was under the impression that we had voted on was that it was 2 shifts in a month, not necessarily 2 consecutive shifts. (Steve – right)
Dave – I agree with Sam, they might not even have a place to sign up, we should force someone out of a room just so someone can shadow a client.
Anton – Do we have contingencies if there are no rooms available.
Brian – Part of the motion is if they are continually out of compliance, the issue can be forwarded to a quarterly meeting.
Amendment on Post-Shift 10/7/11
***Compliance discussion*** - please refer to previous emails
+ medics out of compliance and needing to be shadowed should be shadowed on two separate consecutive shifts (within a month). First shift - shadowed. Second shift - evaluated.
+ medics out of compliance for two or more quarters within a years time period
MOTION (Steve): Move to vote on Brian's original proposal with amendment of out-of-compliance medics for one quarter being shadowed two weeks within a four week period. Additionally, medics out of compliance two or more quarters per year need to present their improvement plan to entire collective at a Quarterly Meeting.
SECOND (Brian).
Steve – Motion is to extend this motion permanently.
0-0-12 (1PNV)
8) Annual Assessments of protocols (10 min)
Dave – There are issues on protocols sometimes and we do have written protocols. We need to have a group that are updating the protocols. You would be surprised that some protocols are lengthy.
Jobert – Instead of leather bound, we can create a wiki. That would be a good place to store it. We could even strike through and see what changes were made.
Jason – I’m just worried about the accessibility of the protocols.
Dave – People have talked about protocols of anal warts and they need to be evaluated.
Brian – There is an extensive 2003 protocol written by Jeff Thomas. There are a lot of these things that we have decided like internal wart treatments that are not in protocol. A lot of the operational protocols.
Ron – The point of the protocol is to clean it up.
Evan – I would like to take nominations of people who are willing to update this and decide if we want to use it.
Dave Brian Ron Jason Eric
Partha – I would like to but I don’t want to know what that would entail.
Evan – Would the people please discern a time and place to do this?
9) Vote in trainees who are late
Eric – I would like to make a motion that we vote in Javier contingent that he make up his building and security class tomorrow 11/20/2011.
0-0-9 (1PNV)
A1) Door Discussion 2
Steve – I just wanted to ask if we needed questions 2,3,4? Is this something that feel comfortable removing it.
Jobert – I want to take a straw pool to see if this would be a good idea.
Steve – I make a motion that we only have question number one on the door as agreed upon tonight. I think that this would make this easier for the door.
0-0-13
A2) CSC Meeting
Eric – Steve’s year is almost up.
Steve – My term will be up. Eric will be the primary. The second would be the alternate for a year and then will be the primary for the second year. The role of the CSC is to make emergency items. Generally speaking, its things that are of an urgent nature. Mostly it is just common sense. If anyone is interested in this position and would be around for the next couple of years.
Partha – For the new trainees and members, the question is how often are you meeting and how big is the commitment.
Steve – Theoretically it is once a month. If there is nothing to discuss, then you don’t have to meet. A lot of time we make decisions just through email.
Jobert – Are there any restrictions about it being a medic? (no) Although generally it is good to have at least 1 medic be on the CSC.
Steve – This is generally just business decisions such as whether we can move money. It doesn’t have anything to do with medical knowledge. It is general knowledge type stuff.
Dave – We have a requirement that people be a member for 2 months before they can vote. Is that a problem?
Steve – One thing I want to say is that once someone has served on the CSC, they can no longer serve again.
Brian – I would encourage us to not decide anything today.
Eric – I agree. I want to say that we should have someone by the middle of December.
A2) Post-Shift Decisions Only to Emergency Items
Brian – I also want to bring up the fact that we limit items at post-shift except emergency items.
(Decided to talk about next meeting)
A3) ACO Announcement
Dave – Individuals on our list that have not had an ACO this Monday. This is your chance to fulfill that requirement.
A4) World AIDS Day
Sam – So I sent out an email about Worlds AIDS Days Activities. If you could forward this to people you know, that would be great. If any of you are interested in selling raffle tickets, please let me know.
A5) Next Quarterly Meeting
Evan – Next Quarterly Meeting is the 4th week of January (1/28/11)