In Brief:
Motion to move business meetings to monthly (from quarterly): PASSED
Absentee voting: NO MOTION MADE
Motion to allow 2 weeks for clarifications to minutes by present members, with approval at next business meeting: PASSED
Approval of MC's recommendations for Azithromyacin treatment: PASSED
Approval of the Community Agreements as drafted by working group: PASSED
Revision to medic requirements for shift coordination: PASSED
New volunteer tracking/HIPAA compliance form: NO MOTION MADE
Clarifications of QA protocol: PASSED
Medics out of Compliance: NO MOTION MADE/DISCUSSION TABLED
Wednesday night Steamworks trial run extended, opened to all: PASSED
Present: Evan H., Dave, Brian P., Steve C., Steven B., Troy, Malaya, Partha, Eric C., Wes, Yves, Keith, Joris
Announcements:
John Day is asking folks to help paint our renovated porch over the course of the next 4 Saturdays in May starting at 9am and going until mid-late afternoon. Sign ups to be available via email and on shift, however feel free to show up. This is an opportunity for the church folks (who have done a majority of the work thus far) to meet members of our clinic and help us build positive relationships.
GMHC is hosting the ACO in May on the 20th at 7:30.
A quick refresher on Robert's Rules: When you ask the presenter a question, the presenter may answer, and if you have follow up questions or additional things to talk about, you need to put yourself back on the speakers' list (no back and forth with the presenter). If you ask a question to the group, any member may answer by doing a point of order, at which point if you have additional questions you would like to ask or things to talk about, you need to put yourself back onto the speaker's list and wait for your turn again.
Agenda Items:
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1. Monthly Meeting Proposal, presented by Evan H.
Rationale:
The GMHC currently relies on a two-tiered meeting structure (three-tiered, if you really want to stretch it): the quarterly meeting and the postshift (the elusive third being the very brief preshift). As it stands, a majority of business items are addressed at the quarterly meeting, with postshift primarily responding to items already previously discussed at a quarterly meeting, items that directly pertain to client health and safety, or minor items as brought up at the discretion of members. As such, the agenda for any one quarterly meeting can easily exceed 10 separate items (and often many more), thus creating a backlog of discussions and votes that may prove daunting to any assembled group of members. The end result is usually a lack of justice done to a majority of the items while a few key items take the spotlight.
Provided the limited scope of postshift, the GMHC has the fewest business meetings of any section at the clinic, with the possible exception of Dental (whose meeting schedule is not known to me). A move to a monthly business meeting, with every third meeting focusing on bringing the collective together for a potluck and general merriment, would allow us to better address items as they arise and do more justice to them in terms of consideration and deliberation at a meeting.
Pros:
1) Meetings, while more frequent, would be hopefully be shorter. This would encourage more members and volunteers in our sections to show up as there would not be the possibility of a 4+ hour commitment.
2) Fewer agenda items and announcements will allow us more time and brainpower to address each one, rather than work to stack as many items into a single meeting as possible.
3) Longer-term projects like the community agreements/conflict resolution, section coordinator roles and responsibilities, improvements to QA or the Sunday shift flow, etc, would be able to be addressed and re-evaluated in consecutive meetings rather than getting lost in the 3 months between meetings (Example: in early 2012, we scrapped the client R&I sheets. We decided at that time to continue to work on developing a better means to provide these to our clients. One year later and we still do not have a replacement).
4) Postshift could become more exclusively focused on charts and QA for that evening, thus allowing for shorter postshifts (for anyone at a postshift past 11pm, this one's for you), greater attention to reviewing the clients just seen and educational moments for members and volunteers. Even pressing business items could likely be waylaid to a business meeting that would be at most a few weeks away. This is especially important given that there is no posted agenda for postshift, and thus members not in attendance may be unaware of motions and votes until after they have happened. As the meeting time for postshift is not set, it is for all intents and purposes not a standing meeting in the sense that its start time may vary wildly.
5) Members may select to come to as many or few business meetings as they would like, perhaps in accordance with the posted agenda. Again, an especial emphasis would be on the third monthly meeting, but provided a quorum* is held at other monthly meetings, business may continue to be worked on, discussed, and voted on, even with a reduced membership.**
*I would recommend we develop a quorum for all votes, not just at business meetings, but at postshift as well.
**Given that a quorum may prove difficult (especially at postshift), I would recommend we begin to think about allowing practicing members to vote in absentia within X number of days of a motion being called. The definition of a practicing member could be linked to the number of shifts or offshift tasks (for members who are on leave from shifts for a period of time, but still contributing to the section) a member has participated in in the preceding 90 days. An entire separate set of pros and cons should be developed around this, and receive its own motion.
Cons:
1) It is possible more meetings will unearth simply more, but not necessarily important, items. The current model does cull the most pressing business for the top of the QM agenda, dismissing items that are perhaps less worthy of discussion in that space.
2) We would have to face our lack of rules around quorum, which may prove problematic.
3) We would need to secure a space, preferably at the clinic, for the two additional meetings a quarter.
4) According to the survey I passed out at the last QM, a majority of members said they would like to keep the schedule the same (however, more than half [including many of those who answered in the affirmative to keeping the schedule the same], said wes hould have more than one business meeting a quarter).
Evan: I would recommend we review at the July quarterly meeting the effectiveness of meeting monthly.
MOTION: Move to monthly business meetings, with every standing quarterly meeting continuing to be place and time TBD and interim monthly meetings held on the 4th Sunday of the month at the clinic. 2nded by Eric C.
Dave: Too many meetings will hinder participation. A more reasonable response would be to move to bi-monthly meetings (from 4 meetings a year to 6).
Malaya: Three months is not enough time to determine if this model is successful; need at least 6 months, minimum.
Evan: I meant meeting on Sundays, as opposed to other days of the week, not the actual structure of having monthly meetings.
Keith: I would like to see the option to cancel meetings if there are no agenda items or they are low priority. What is quorum for the GMHC? If there is not a quorum met, the meeting should be canceled. Folks should be RSVPing ahead of time so it is known whether or not quorum will be met. Business meetings on Sundays may allow for more participation by MCs, but I am unsure of how much. It would make for a long Sunday for the MC.
Eric: AMENDMENT: Make the motion read bi-monthly instead of monthly. UNFRIENDLY (Per Evan)
Partha: Sundays will prove problematic because of trainings that happen for a majority of the year.
Malaya: Bi-monthly is a good compromise and a way to ease us into increased frequency.
Evan: Bi-monthly does not address the issue of items being presented at post-shift because of the length of time between meetings. 8 weeks is too long for some items and they will invariably end up at post-shift where there is no agenda and no quorum.
Partha: AMENDMENT: Allow for meetings to be canceled if quorum or agenda are not met. UNFRIENDLY (per Eric)
Steve: We should be stepping it up incrementally, not going from 4 meetings a year to 12 meetings a year. That's too much. We should not be comparing ourselves to other sections because we autonomous in our practices and the GMHC does many things differently than other sections in the clinic. The TC has a lot of schedule and taking away a Sunday a month is not as easy as it sounds. I don't agree with your rationale that we need this.
Troy: Bi-monthly meetings would not add enough meetings; it would only add two more meetings over the course of the whole year.
Evan: Bi-monthly meetings do not address the issue of post-shift handling business and our ability to address issues as they arise, rather than waiting up to 8 weeks.
Brian: Will Evan take the lead on making sure these monthly meetings happen?
Evan: Like, encouraging folks to attend?
Dave/Steven/Eric: The responsibility of ensuring the meetings happen is on the section coordinators.
Steve: Most of what Evan has said is what he feels and thinks. I don't know that this is needed.
MOTION: Move to monthly business meetings, with every standing quarterly meeting continuing to be place and time TBD and interim monthly meetings held on the 4th Sunday of the month at the clinic. 1, 0, 9, 0 - MOTION PASSES
AMENDMENT: Make the motion read "bi-monthly" instead of "monthly". 0, 6, 3, 1 - AMENDMENT FAILS
AMENDMENT: Allow for meetings to be canceled if quorum or agenda are not met. 1, 0, 9, 0 - AMENDMENT PASSES
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2. Absentee voting discussion, presented by Malaya
I'd like to propose that for significant decisions being made (kicking members out, major change in standard procedure, elections, etc.), we have some process whereby we allow a small period of time for absent members to register a vote and/or opinion before the motion is passed and enacted. These absentee votes would be collected by the members who proposed and seconded the motion, and would report back to the rest of the collective through email the results of the final tally, and any dissenting opinions made.
Malaya: This would not be for client-care needs, which need to be addressed quickly.
Eric: If you are not present for the discussion and presentations, you don't have all the necessary info needed to make a vote.
Dave: "Significant" is subjective. Hardly anything is significant enough to warrant absentee voting. It gives people the opportunity to participate less. You cannot do it from afar and still address the issues adequately.
Joris: Could we have a more structured definition of "significant"? Should a motion include how the significance is determined?
Partha: When we make a motion, it should include the significance.
Steven: What would this address that well attended meetings would not?
Yves: We could have multiple votes for items that are controversial. An item is voted on, then a second vote will be taken later, giving time for folks to plan on attending the later meeting to address concerns and vote.
Keith This might be premature given the recent concerns over member participation. We would need clarification of "significance" and the process of the vote.
Troy: To determine if a member is in good standing, he should have been at the last quarterly meeting.
Brian: Even though we now have monthly meetings?
Malaya: When we agree on what is significant, that becomes less subjective. Quorum is just 50+1. I think we should be gathering the opinions of the larger group. We just passed a motion to make meetings monthly and we only have the opinions of a few members.
Evan: Monthly meetings will reduce the frequency of unforeseen situations arising at postshift. Additionally, we need to work to better capture the discussions that happen at our meetings and craft better motions so that an individual can vote on something without having to have been there. A motion should be able to be read and a member should be able to have an opinion without the necessity of the discussion that surrounded it.
Joris: Email is not a good medium for communicating. We trust that votes are representative of the collective. We need to have a minimum number of members present to pass a motion. How often do these issues actually arise?
Eric: Who's counting these votes? There's no way to do it because the votes are anonymous.
Malaya: Votes are only anonymous to folks not present. I know who votes on what at the meeting. The persons responsible for collecting the votes are the person who made the motion and the person who seconded it.
[DISCUSSION ENDED; TIME UP]
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3. Meeting minute approval, presented by Steve
All QM minutes are not considered approved/final, until the minutes as taken at the meetings can be disseminated to the group, so the group can have time to review them for accuracy or corrections and have an opportunity to respond." As it stands now, any decisions made at a QM business meeting are considered the policy of the GMHC, as per the exact wording of what the note taker has written in the minutes of that meeting. Because of the volume of conversations and comments which take place at a QM, it is impossible for the minute taker to take 100% thorough/accurate notes. Hence, I think the GMHC should do as many other organizations do and not consider the minutes of their QM meetings to be final until the members can review them for accuracy and have an opportunity to make comments/corrections prior to them being considered as final/accurate.
Steve: Members present would have two weeks to respond with corrections/additions.
MOTION: Allow a two-week period after a business meeting for members present to suggest changes to the minutes. 2nded by Eric
Dave: "Suggest changes"? Who will be responsible for the changes? They can't be altered after the fact.
Steve: The minute-take records the changes and they have to be approved.
Partha: If two weeks pass, and there are no changes, the minutes pass?
Steve: If people make changes, they have to have them voted on at the next business meeting.
Keith: That's what other organizations do. Two weeks is enough time.
Malaya: This is standard protocol at other places to approve minutes after being reviewed. We don't have audio recordings, so there's bound to be conflations.
MOTION: 2 weeks following a business meeting, members present may make clarifications to the minutes, to be approved at the following business meeting. 0,0,13,0 - MOTION PASSES
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4. Approve MC's recommendation for Azithromyacin protocol, presented by Steven
Background:
A recent New England Journal of Medicine study reported an increased number of
cardiovascular deaths in patients treated with a 5-day course of azithromycin compared
to other antibiotics (amoxicillin, ciprofloxacin, and levofloxacin). The FDA recently
released a statement noting that health care workers "should be aware of the potential
for QT interval prolongation and heart arrhythmias when prescribing or administering
antibacterial drugs" including azithromycin. At the GMHC, azithromycin can be used to
treat the following conditions:
- Non-specific urethritis/chlamydia (NSU) or prophylactic treatment based on known
NSU/chlamydia exposure (Azithromycin 1 gm orally x 1 dose)
- Gonorrhea or prophylactic treatment based on known gonorrhea exposure
(Azithromycin 2 gm orally x 1 dose) [alternative regimen for those with a cephalosporin
allergy)
Based on this information, we suggest the following protocol:
1) If azithromycin is indicated for clinical treatment, the medic should consult with the
MC prior to administering the medication.
2) The MC will assess the client's medical history including but not limited to the
following:
-A history of heart disease
-A history of a medication regimen with multiple pharmacologic agents
-History of recent vomiting/diarrhea/dehydration
-History of allergies to azithromycin or other macrolides
-History of alcohol or illicit substance use that may increase
Cardiovascular risk
3) After reviewing the client's history and medical indication for prescribing
azithromycin, the MC will determine the following:
a) Decide not to recommend azithromycin and suggest an alternative antibiotic agent
b) Agree with medic's recommendation to use azithromycin, and have medic document
in chart that the patient has been advised of the FDA warning indicating azithromycin's
potential for increased QT interval and heart arrhythmias. The client can also be advised
to present to their ER if they develop signs of acute distress after leaving the clinic as per
the usual protocol for prescribing antibiotics at the GHMC (examples include chest pain,
shortness of breath, or dizziness).
Keith: There are no established guidelines at all clinics yet. Given that this warning has been issued, we should aim to be more medically sound and do this.
Dave: We always have a consult before meds go out. I am more interested in knowing the language/questions to cover this so I can do it instead of having the MC do it.
Keith: The language is in the motion.
Yves: This is already what we do, except for 3b. We could update the green and pink sheets. We need to make sure our medics are addressing #2.
Steve: Yes, we do have something similar to this, except it is a consult with a senior medic, not necessarily the MC. If a client answers "no" to everything, could we just do a medic consult?
Keith: The MCs are under the assumption that you would consult with us on this matter. We can check back in on it at the next business meeting.
Dave: Could an MC come in to the current training to explain these new protocols for us?
MOTION: Approve the MC's recommendation for use of Azithromyacin (SEE ITALICS ABOVE) - 0,0,13,0 - MOTION PASSES
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5. Ratification of community agreements, presented by Malaya
The purpose of this document is to provide Gay Men’s Health Collective members and volunteers a set of behavioral expectations upon which we can hold each other accountable. With a diverse group of gay and bisexual men from many walks of life, it is important to set a standard of behavior so that we can foster a community culture of respect, safety, and encouragement.
The aim is to keep this a living document that is revised as deemed necessary by the current membership of the GMHC, and is reaffirmed by majority vote annually at a quarterly meeting.
We respect one another’s bi or gay male identity.
We welcome a diversity of gender expression, which includes ways of presentation or dress that may or may not conform with male heteronormative identity.
We respect one another’s differing life experiences and perspectives.
We welcome different ages, political beliefs, religious beliefs, housing status, socio-economic status, language capability, or level of education. We value this diversity and encourage all volunteers and members to welcome individuals from all walks of life.
We value one another’s opinion and presence in the collective equally.
We welcome all volunteers and members to contribute regardless of capacity, credential or length of participation. We recognize that learning is a continual, two-way process and encourage all volunteers and members to engage in question-asking regardless of length of participation. We value discussion, access to information, and transparency.
We use respectful engagement with one another in all our communication.
We welcome a level of engagement that does not demean, marginalize or dominate in its language, tone, or presentation. We encourage openness, curiosity over criticism, and assuming good intentions. The use of aggressive or intimidating language, however passionate, can be counterproductive and is highly discouraged.
We respect one another’s boundaries.
We welcome active consent for physical/verbal engagement. While we foster the building of close relationships, we respect and value the boundaries we set with one another and with the group, and understand they may change over time. We should always validate someone’s comfort level first and prioritize physical and emotional safety.
We aim to be present in the service of our community.
We welcome active and mindful participation in the work of the collective on shift and at meetings. We understand our primary intention is to serve the community and that is best achieved when we have a positive attitude and intention. While volunteers and members can choose to use substances outside the clinic, we ask that everyone be sober while on shift and in all engagements with the collective.
We encourage compassionate accountability.
We welcome the calling out of issues, not people, because we are all invested in collective growth. While this agreement is a collective responsibility, everyone is also personally responsible for their own behavior. We encourage self-reflection and the solicitation of feedback from one another.
We respect our shared space and the Berkeley Free Clinic at-large.
We welcome the support for, and appreciation of, our shared space and the diverse groups of people who use it. We encourage collaboration and engagement with other sections of the clinic. We ask for the mindful upkeep of the building in recognition that the space is a shared resource for all.
Malaya: These were drawn up at a couple meetings held last month. The second meeting agreed on the work from the 1st (these agreements) and began to work on a conflict resolution policy that we have yet to finish.
Eric: MOTION: Adopt the community agreements. Troy 2nded.
Yves: Totally in favor of this. We did talk about conflict resolution. How will we refer to this? Will it be in the work of a moderator? It might be useful to go over before meetings so as not to lose it.
Joris: I recommend every member sign it as a contract. Are there any punishments for not following the agreements?
Malaya: A subsequent conversation about conflict resolution has been started. We tried to have another meeting to continue to work on that, but it hasn't happened yet. It is in the works. The intention is that this is a living document. It should also be part of membership training.
AMENDMENT: This document should be reaffirmed once every year and can be changed/revised by the current collective to suit their needs. UNFRIENDLY (Per Eric)
Partha: AMENDMENT: It should be a part of member training. FRIENDLY
Evan H: The hope is that this will become a new culture for our collective. Existing members may have to adjust to these, but for new members it should be self-evident.
Brian: I like the idea of going over this before meetings.
Keith: This is an excellent document. It also affects the MCs and we would like to review it and adopt it as well.
Eric: We should incorporate it into the "Who We Are" part of training.
Question called.
Objection - Joris
Objection holds
Joris: AMENDMENT: Members must physically sign a copy of this. UNFRIENDLY (Per Eric)
MOTION: Adopt the community agreements as written [SEE ITALICS ABOVE], and include them in training new members. 0,0,12,1 - MOTION PASSES
AMENDMENT: This document will be reviewed once a year, with the ability to make revisions as needed. 1,1,11,0 - AMENDMENT PASSES
AMENDMENT: Members must physically sign a copy of this agreement. WITHDRAWN.
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6. Revision to medic-requirements to shift coordinate, presented by Eric
Eric: Currently, all medics with 1 year worth of medicking experience must shift coordinate once per quarter. With our new class coming of age in experience, we will have more medics than spaces available in a given quarter. I recommend we change it to once every six months.
[we did some math; there are more than 12 medics who will need to shift coordinate in a quarter]
Yves: Since we still won't have enough medics for everyone to just shift coordinate once in six months, medics who like to shift coordinate will step up and cover additional shifts.
Partha: Could medics co-shift coordinate instead?
Yves: All new class folks need to shadow, though some have already shift coordinated. When will this go into effect?
Eric: The 1st weekend of the 4th quarter, or the 1st weekend in October.
Yves: What about training new medics?
Eric: MOTION: All medics with 1+ year's worth of medicking experience must shift coordinate at least once every six months and must shadow for their first shift. [2nded, not recorded by who]
Joris: I think new medics should shadow before Oct 1.
Steven: Why Oct 1?
Eric: It is easier to track.
Yves: I am fine with the wording and start date. They can still shadow before Oct 1.
MOTION: [REVISION TO EXISTING PROTOCOLS] All medics who have medicked for at least 1 year are required to shift coordinate at least once every six months, with the first shift being a shadow shift. 0,0,12,1 - MOTION PASSES
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7. New volunteer sign in sheets, presented by Steven and Eric on behalf of Jason T.
We do not take down any information from our new volunteers. Also, it is difficult to track when a volunteer has been in 3 times so they can be added to the site. This would be a sheet that new volunteers would fill out their first time here, new volunteers would have to initial something saying that they were told about HIPAA and each subsequent shift they attend, they would date an initial. These would be kept in a binder in the ER and coordinators would use it to add new volunteers to the group.
Volunteer Information
Name:
Email:
Phone:
HIPAA Confidentiality Agreement
All clients have the right to privacy and all persons, including volunteers, must respect this right.
I understand that any information that can identify a client is considered “Protected Health Information” (PHI) Divulging this information by any means can be persecuted under federal law.
I understand that volunteers will receive minimum information necessary to do the job.
I understand that I should never discuss anything about a client unless it is in the performance of my assignment and then only to the proper person and in a manner and location, which ensures that the conversation will not be overheard.
I understand that I should never discuss anything about a client outside of the clinic, including knowledge of admittance. This also pertains to my family and friends who come in as clients at the Berkeley Free Clinic and whom I might see while volunteering.
I hereby agree that I will not discuss, reveal, copy or in any other manner disclose any PHI that I may
see or hear while volunteering for the Berkeley Free Clinic. I understand failure to comply with these
rules may result in dismissal from the BFC and/or legal action against me.
Signature: ___________________________________
Volunteering
1st Time Volunteering (Date): _______________ Position: ____________________
2nd Time Volunteering (Date): _______________ Position: ____________________
3rd Time Volunteering (Date): _______________ Position: ____________________
After your third time volunteering, you will be granted access to our list-serve and our website, where
you can sign yourself up for future shifts. Please notify one of the section coordinators in person to add
you to the list-serve or email them at gmhcbfc@gmail.com.
Date: _____________
Steven: This would be in the interest of tracking new volunteers.
Eric: It also includes the HIPAA confidentiality agreement
Steven: Most volunteers just get a crash course on HIPAA
Eric: This also helps track what roles they've done.
Troy: How long do you intend to keep these? Will you keep them on file until they go through member training?
Eric: Right.
Dave: There is some very strong wording on bullet four. It may lead someone who is new to be scared or unsure of themselves. There are consequences for these things, but this is over the top.
Joris: Who is keeping track of this?
Eric: They only sign it once, and then we keep track of the other info.
Joris: We have these at my work and folks who sign them need to know the risk.
Partha: Since this is for first time volunteers, bullet #3 is vague. Who is the "proper person"?
Keith: Who would be responsible for making sure this happens? The volunteer should get a photocopy and bring it with them each time they volunteer. I agree we should change the wording of bullet #4. Maybe leave room for individuals to only leave 1-2 pieces of information (phone/email)?
Steve: I agree with the idea, but not this document. I think the wording is very strong and needs work. The shift coordinator will need to also be a part of this in case a section coordinator is not around.
Malaya: I agree with Steve. HIPAA compliance is complicated. If we are trying to be compliant with new volunteers, we should work more on the ideas about how to handle health information and not the fear.
Troy: Do we have a legal team?
Yves: The CSC
Troy: Talking to a lawyer would be helpful.
Eric: We will take this back to Jason and work on it for next month's meeting.
Malaya: This copy should be emailed out to for folks to bring their revisions to the next meeting so it's not just Jason having to do it in isolation.
Keith: We have a lot of Cal students at the clinic. There is free legal advice available to them. Maybe one could go and find out from there? Maybe there's someone on the listserv who is versed in medical law?
[END OF DISCUSSION, NO MOTION MADE]
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8. Clarifications of QA protocols, presented by Steven and Steve
Minute taker's note: There were two different versions of these standards present at the meeting. The one presented here (in italics) represents the primary document referred to in the discussion, which were presented by Steve.
Minimum charting standards:
Sex of partners
Number of partners (only to the extent necessary to justify tests)
Time window for sexual contacts
Type of sex: anal, vaginal, oral and whether it was receptive or insertive (when not otherwise obvious) [Type of sex: anal, vaginal, oral - including role (e.g. receptive/insertive) if multiple roles are possible.]
Condom usage for each type of sex with each sexual contact (only to the extent necessary to justify tests)
Syphilis testing: Previously tested? If applicable, Date/Location/Result of last test, and History of Syphilis?
Medication information (when dispensing meds): drug name, dosage, lot #, and expiration date
Medication contraindications (when dispensing meds): allergies, current meds, relevant health conditions
HIV status, if client is willing to disclose
SOAP requirements:
Complaints in the subjective should be addressed in the objective. If something is observed in the objective, then it should also be addressed in the assessment and plan.
Observations, assessments, diagnosis, and/or plans made by an MC should be noted on chart as “per MC”.
Sending tests:
If a test is sent that is not justified by current protocols, a reason must be documented on the chart.
Lab information:
If an in-house urine test is conducted, the information/findings from the in-house lab sheet should be recorded in their respective locations on the client chart. If the “Time since last peed” was not listed on the lab sheet, it is the medic’s responsibility
Steve: I removed Steven's last bullet ("Relevant significant negatives should be listed for symptomatic clients in place of "Physical exam normal". For example, this could include noting an absence of discharge for a client exposed to gonorrhea, or noting an absence of a rash in a client suspected of having syphilis.") because I think that it is too subjective to decide on a medic's choice of significant negatives.
Steven: These are a rewording of the protocols passed at the last QM, with more detail.
Eric: We should include Hepatitis in this as well as HIV and Syphilis.
Evan: I prefer Steven's wording of "Type of sex". "Obvious" is subjective. Different medics may claim that different types of sex are obvious. Steven's wording takes into consideration vaginal sex being always insertive (as there is no multiplicity of roles there) but requires all other types to be clarified.
Partha: Are we deciding on Steve's or Steven's? When we have made a decision, will this be included in medic training?
Keith: I agree with Evan that we should make sex more descriptive. We should have the MCs review this and it would be good if the front of the green sheet was addressed on the back of the green sheet in some fashion.
Troy: I have been told to write down the chief complaint on the back, not what's on the front.
Eric: You read the front, then go with what the client says on the back.
Dave: What we provide clients on the front is limited, so we should be asking about chief complaints on the back.
Steven: Steve expressed concern over my last bullet [SEE STEVE COMMENT IMMEDIATELY FOLLOWING ITALICS]. Significant negatives that pertain to the front of the sheet are part of good charting.
MOTION: Pass Steve's list, with Steven's "Type of Sex", and the last bullet point of Steven's included and reworded as "Significant negatives pertaining to the front of the chart should be listed..." [2nded, not recorded by who]
Keith: What I think you are looking for is a "review of symptoms", not "significant negatives." The front and back of the green sheet are both important. The back is meant to expand on what is on the front of the chart.
Eric: AMENDMENT: Include a bullet point on hepatitis testing. UNFRIENDLY (per Steven)
Steve: This is for QA review a week later. There is some confusion over this and charting standards. I don't agree with Steven's last bullet and do not want this document to have anything subjective in it. We should be including that for good charting, but not for QA.
Question called
Objected
Objection held
Partha: I thought Hepatitis was already a part of QA?
Eric: AMENDMENT WITHDRAWN
Brian: Relevant significant negatives is clear. It is regarding what should not be there [on a client] anyway.
Keith: I agree with Steve that that is too hard for QA to do. Hopefully that can be part of improvements to charting.
Eric: I agree with Steve. AMENDMENT: We should not include the last point (Steven's). FRIENDLY
Partha/Steven: If the client complains of symptoms, then that should be addressed in the first bullet point of the SOAP requirements anyway.
MOTION: Approve Steve's list of QA protocols [SEE ITALICS ABOVE] with the revised "Type of Sex" bullet point [SHOWN IN BLACK NEXT TO A STRIKETHROUGH VERSION OF THE ORIGINAL]. 2,0,9,2 -MOTION PASSES
Clarifications of abstentions made by Keith and Troy: Without a single hard copy to refer to, this motion was difficult to follow.
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Addressing issue of medics out of compliance, presented by Dave
Dave: There are several medics out of compliance right now. Chris A. was told he could not medic until he presented at a QM. This is not in our protocol. Compliance was put into effect 1.5 years ago. Several medics left at that time, but there has been no issues since then, unggil now.
Yves: Could you expand on why this was put into place?
Dave: We had medics coming in only once every 2 months. We weren't having enough folks living up to the requirements. Our MCs were concerned over the competency of certain medics who came in infrequently. It was decided that medics should come in at least once every 30 days.
Steve: A forgotten protocol was that if you were out of compliance for a quarter, you had to be shadowed for two whole shifts.
Yves: There are more than one kind of compliance: membership compliance and medic compliance.
Eric: I'll be honest when I say that I have no clear idea what compliance is.
Steven: I'm out of compliance because I have only been on shift for 5 shifts for the past two quarters. I could not find the protocol that Eric was referring to. I found the 4th quarter minutes from 2011 that said medics who have a pattern of compliance issues have to bring a plan to the coordinators. It then referred to an email that was not included in the minutes so I found it in a postshift notes and inserted it in brackets into the minutes:
[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 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.]
Yves: It would be good to reaffirm what Steven read and place it on the google site in a more prominent place.
Joris: I've been out of compliance. Am I supposed to present? I've had talks with the coordinators and my plan was to not medic and contribute to the clinic in other ways. Then I was told I was out of compliance again, so I'm confused about what I am supposed to be doing.
Eric: We are here to provide competent client care, so these are not harsh penalties.
Troy: Won't this impact new medics with so many of us?
Evan: It is clear that this issue should be set aside because the protocols are scattered between several locations and nested inside emails. We ought to compile all known evidence of protocols and reaffirm them in their entirety at the next meeting and not worry about having medics who are out of compliance present.
Dave: The protocols are located in the Nov 2011 minutes and are very clear and not confusing at all.
Yves: I am in favor of tabling this until we have it in front of us. One of the reasons we put this into play was because individuals needed to reign in their (lack of) participation. I am not concerned about these guys' ability to medic. Not doing anything now will not cause any harm.
Dave: I am fine letting this go for today. I think some other things came out of this discussion that will need to be discussed at a later point in time.
Steven: The motion voted on at the Nov 2011 QM is an amendment to an item passed at a postshift.
[DISCUSSION ENDED]
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Wednesday night Steamworks, presented by Yves
Yves: We should have another 3 month trial run on the 1st Wednesday of the month at Steamworks from 7pm-12am. These will be open to everyone. Some of the issues that have come up from our first three trials:
1. We are understaffed, so we should have more availability for people to go.
2. We need to be doing more detailed charting. No more blank charts.
3. We need support for things like cleaning up. We left a bunch of our signs and stuff there the last time we went.
4. Results go an extra half week than our Sunday night clients. They are done the following week's Friday. Half a week is not significant to warrant another results shift. Jaason T. is currently setting the Steamworks charts separately for the results shift team the following week to handle.
MOTION: Have GMHC join with BBC and/or HPS to hold shift on the 1st Wednesday of the month from 7pm-12am for three more months as a test run, and have shifts count toward compliance.
Steve: I support this, especially now that it's open to all. When this was talked about at the last QM, it was decided that a committee would look into other Steamworks shifts, including other Sunday shifts and possibly changing the time our current Sunday shift runs. What happened to that?
Yves: I can go into more detail with you about what happened to the committee. It was mostly because we jumped on that first Wednesday and have been working on it ever since. Also, the other Sundays are already booked by other organizations. This is why we should have another trial run as well.
Eric: AMENDMENT: That we revisit this at the July meeting. FRIENDLY
MOTION: Have GMHC join with BBC and/or HPS to hold shift on the 1st Wednesday of the month from 7pm-12am for three more months as a test run, and have shifts count toward compliance. This will be revisited at the July 2013 meeting. 0, 0, 11, 1 - MOTION PASSES
ADJOURNED