Common Outpatient Procedures
We do many procedures here in Bethel in the outpatient clinics. All providers must be trained and credentialed to do specific procedures. Providers are granted privileges to do procedures during the credentialing process based on their experience and training.
In order to add privileges for a procedure after initial credentialing, providers need to be proctored by a credentialed provider, observed performing the procedure, and document the training a proctoring review sheet. The provider can then request an increase in privileges for that procedure.
Time Out should be done and documented for most procedures.
Informed consent should be obtained for most procedures (IUDs, Nexplanon, LEEP, colposcopy, endometrial, excisional, and punch biopsies).
There are autotexts for many procedures, some listed as ..ed and others as ..proc.
Abscess Incision and Drainage (I&D)
- Make sure to obtain a culture if not done so in the ED.
- Change packing as indicated. Subsequent packing changes can be done by health aide in the village if stable to go home.
Digital Block
Laceration Repair
Fractures/casting
- Review previous radiological images.
- Review previous telerad documentation from orthopedic consults. If no previous telerad was sent please send one at this encounter. Please follow procedures for sending Orthopedic Telerad consult.
- Continue with plan of care as documented with casting/cast removal.
Joint Aspiration for Septic Joints
- Any patient who presents with red, swollen joint with or without fever and unable to bare weight requires further evaluation.
- Joint effusions may be tapped in Bethel. Please contact ED physician if you are unable to perform this task in clinic. More complex effusions are evaluated in Anchorage and will require direct orthopedic consultation. Follow procedure for orthopedic consult.
- Please send a culture of the fluid and initiate antibiotics promptly.
