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Peds, Psych, Medical Home Case Manager
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jeffsher has 22 years experience and specializes in Peds, Psych, Medical Home Case Manager.

Former Peds nurse, now doing Case Management (Medical Home)

jeffsher's Latest Activity

  1. Yes, your ambulatory care experience will be invaluable. I worked 5 years in-patient (Peds), and then 17 years Primary Care (Peds, Family Practice, and Internal Med). I currently case management elderly and some younger adults, although we will soon be managing all age groups. The field is still evolving, so you will probably be seeing a lot of changes in the coming years.
  2. I work as a PCMH Case Manager (embedded in a clinic, employed by an insurance company), and our primary duty is disease management of patients with COPD and Heart Failure, although with all of the co-morbid conditions, deal with many other diseases and their management. Broad answer as to what I do on a daily basis? Anything and everything. My day starts out checking my voicemail and then daily patient weights, and I then start calling patients at home to check on them (routine follow up calls), in between seeing patients in the office. I also do chart reviews of patients in the hospital, calling SNFs to get a weekly update, call the in-patient care manager to discuss a patient that is hospitalized; and the list goes on. We have protocols for dealing with Heart Failure and COPD exacerbations, and also titrate insulin. The day never goes as planned, as there is always someone calling with an acute problem-if you are obsessive compulsive, that in itself can be unnerving, as you have to put off your routine calls to another day, but not unlike hospital nursing where you have to deal with an acute problem in addition to the other things you do (the difference being that you are responsible for "catching up", whereas in the hospital the next shift picks up the things you didn't get to) Other things I often do are consulting with the PCP, calling the Aging Office to refer for services, calling a DME to setup oxygen, calling for an appointment to get someone in to the specialist asap, consulting with a pharmacist if there are med issues... It's basically micro-managing those with complex chronic health issues. Despite this neverending workload, I love my job. With all of the changes coming to healthcare, this is the place to be. Good luck!
  3. jeffsher

    Any nurses who used to be teachers?

    Baubo516, I've been out of commission for a while (surgery and a med problem that landed me in the hospital 3 weeks after the surgery) and missed your April post up until now. Glad everything is going well. Being a CNA will be an incredibly positive experience in many ways; you'll be able to get the basics down and better prepare you for clinicals. Your teaching experience will not be wasted, since a lot of being an RN is doing patient education. txsuzy-I don't think you'll regret your decision. There are so many opportunities available that your not stuck in one area. The NP field is exploding as there is an increasing shortage of physicians. And if you don't want to do that, there are so many areas of nursing to choose from; you're not locked into anything. Good luck to both of you.
  4. jeffsher

    Telephonic case manager

    I just started as a Telephonic CM back in January. I work for an HMO, and the position was newly created to cover the Medical Home and Community Case Managers in our system (over 100 CMs; there is also 1 other nurse hired as a coverage nurse). In this program, Medical Home CMs are embedded in offices so that they have access to the docs, yet most of the work is by telephone. The main goal is to manage specific diseases (Heart Failure and COPD) more closely, and reduce hospitalizations and ED visits. There is a skill involved in telephone work. You don't have the patient in front of you, so you oftentimes have to drag out information that might not be communicated by the patient. But like anything, you develop those skills over time, and it does get easier (I have 17 years of phone triage experience, so I'm well skilled in that aspect). If you have a decent clinical knowledge base, it's doable. I love the job, and as an added benefit, it works out well for me, as I have a hereditary neuropathy which limits me working on my feet all day. Feel free to message me or post a reply here if you have specific questions.
  5. jeffsher

    Has Anyone Here Worked in a Coumadin Clinic?

    Just had an inservice on Pradaxa this week. It's not good for those with risk of GI bleed, but it carries lower risk of intracranial hemorrhage. Coumadin has a narrow therapeutic index, which is a definite disadvantage, but it's proven therapy. As mentioned, it's not good for those with creatinine clearance of below 30 (?), and it does not have an "antidote" like heparin and coumadin. There are studies that it possibly can be dialyzed out. However, it's duration of action is through the next daily dose, whereas coumadin exerts it's effects longer. If you miss 2-3 days of coumadin, no big deal; it is a big deal if you miss a dose of Pradaxa. Other disadvantages of Pradaxa: cost, it must be stored in it's original bottle or package, and if bottled, is only good for 60 days (although the directions currently indicate 30 days). I think that once it's indicated for more conditions, Coumadin will take a back seat to Pradaxa, but that isn't anytime soon.
  6. jeffsher

    Has Anyone Here Worked in a Coumadin Clinic?

    Pradaxa is a direct thrombin inhibitor, while Coumadin/Wafarin prevents the activation of*4 clotting factors that depend on*Vitamin K. No need for monthly labs and frequent dose adjustments as with Coumadin. Of course, time will tell whether Pradaxa will replace Coumadin in A-fib patients....
  7. jeffsher

    Has Anyone Here Worked in a Coumadin Clinic?

    One consideration: how long will coumarin clinics be needed, as the new drug Pradaxa doesn't require lab work?
  8. I was giving multiple chemotherapy meds to a 2 year old for her ALL, mixed syringes up, and mistakenly gave a hep flush IM (was supposed to give L-Asparaginase). I was fortunate that I had already given the Vincristine IVP and not mixed up THAT syringe. I was just on the receiving end of a major med error last week. I am on Tacrolimus for a kidney transplant and had a recent foot infection leading to Orthopedic surgery. My foot ulcer grew out an opportunistic Candida, and after consulting with ID, the Ortho PA rx'd Fluconazole. When I had my monthly labs done, I was in acute renal failure and Tacrolimus toxicity. The PA surely had a warning of a major interaction between Flucoazole and Tacrolimus, but apparently ignored it, and never consulted with the Transplant doc who manages my Tacrolimus.
  9. jeffsher

    Orientation for new case manager

    I just finished orientation for a CM position after 5 weeks (it was to be 6 weeks, but I was asked if I would mind starting earlier, which I didn't). Personally, I feel that 6 weeks is adequate, as it will be 6 months-1 year before I will be comfortable in the position. I do telephonic cm as a "float" for an insurance company's medical home program.
  10. jeffsher

    Fecal Disimpaction

    Off topic somewhat, but nonetheless interesting: http://researcher.nsc.gov.tw/public/8700307/Data/8123012523371.pdf