Durham County (DCHD) Outpatient OB

EPIC Context: DURHAM COUNTY HEALTH DEPARTMENT WOMENS HEALTH

Drag providers from the master list to your name.

Dot phrases (copy from Jasmine Arrington):

• •.PWNOBDCHD — new OB
• •.PWROBDCHD — return OB
• •.RXNOTE — put in comment box for all prescriptions

Workflow:

• •No computers in patient rooms — review everything before you go in.
• •Don’t worry about orders, labs, follow-up — nurses do it all. If you want to order labs, ask the nurse. No In Basket responsibilities.
• •New problem? Talk with supervisor and go over the plan. Important to ask about asthma.
• •Review all new patients with supervisor (may or may not happen depending on how busy).
• •Can send med student in 1st for new OB or returns — have them get subjective + history.

Prescribing:

• •.Rxnote — put in comment box every time on prescription (includes language, allergies, MRN).
• •Select “Durham County Health Department Pharmacy” at the bottom of the order as pharmacy selection — will be ready for pt to pick up on 1st floor upon leaving.
• •Need to click on prescription and “print” to send to the pharmacy so it can actually be dispensed (someone will show you).

Documentation — Prenatal Vitals:

• •Chart every visit.
• •Answer the 4 cardinal questions.
• •Fundal Height — not until 20 wks. Should equal weeks GA; ±2 still normal. If GA greater or less than expected for two consecutive visits, order anatomy ultrasound.
• •Fetal Heart Tones — 110s–150s normal; early in pregnancy, 160–170s may be normal. Use Doppler most of the time; US M-mode for early pregnancies (8–12 wks).

New OB visit — concise but thorough:

• •Is this a desired pregnancy? Was it expected?
• •Do you feel safe at home? Supported?
• •PMH — medical problems they see doctor for.
• •Gynecologic history — most recent Pap smear; STIs (when, treated, test of cure if in pregnancy).
• •Surgical history — ask about uterine procedures specifically (fibroid removal, C/S — pay attention to scars).
• •How do you feel? N/V, constipation, back pain, etc. Counsel on what to expect.
• •Diet + exercise: expected weight gain, 30 min moderate physical activity, no kickboxing.

Return OB visit:

• •How are you feeling? N/V, blurry vision, headache, etc.
• •4 cardinal questions: vaginal bleeding, loss of fluid, contractions, fetal movement.
• •Late 3rd trimester: breastfeeding, birth planning (C/S vs VD), postpartum contraception.
• •If patient wants tubal: Medicaid paperwork signed ≥ 30 days in advance. Begin discussion ~30 wks. Include interpreter ID on form.
• •36 wk visit: position ultrasound (head down?). Curvilinear probe vertical, mom flat, place directly on pubic symphysis. Looking for white circular outline (hyper-attenuated). If round but not white, may be belly → transverse.
• •“I’m going to talk with the team and then we’ll come back and talk about the plan.”

• •Stay at health department to finish notes. Feasible to catch up at lunch. Notes done before leaving.
• •Done 30 min before intern school starts so you can get there — remind the provider you’re with.