Outpatient Ancillary Services at YKHC

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Lab

Labs in Bethel include cultures/comprehensive chemistries/CBC etc. See the Lab anacronyms for our Panels below. Viral loads and some specialized tests need to be sent to Lab Corp and are not quickly available.

In the village: RST/Urine Dips/Hgb/HCG urine/and glucose finger sticks are available. They can draw most labs and send them out to Bethel.

Paps: We are now doing liquid based – Sure Path. Twist the brush for several seconds on the cervix and then swish in the bottle, then pulling off the brush and leaving it in there. See the desk clerk on how to order the liquid pap. We are doing Reflex high grade HPV only on older patients or those with a hx of ASCUS. see the guidelines.

In the Subregional Clinic there is a lab capability for some of the tests to be done on site while others are sent to Bethel. The SRC labs use Istat equipment for ABG, Cardiac Triple markers, CBC, Chem 8,A1C, and a quantitative troponin. They use dipsticks for CCUA and the lab techs can do a urine micro and wet preps. RST and RST cultures can be done, as well as urine HCGs and hemocults and gastrocults.

Comprehensive Chem panels: will need the LFTs need to be sent out, but the basic within it can be done at the SRC, as well as TSH, Quant HCG etc. Some of the SRCs do set-up their own urine cultures and RST cultures. Others send them to ANMC. Leslie Boelens is the SRC Lab Manager and trains the entire lab Techs. For questions about the lab please contact her at Aniak SRC: 907-675-4556.

Lab Anacronyms / Panels

Explaining Lab Hieroglyphics

  • CBC: Complete Blood Count
  • ABG: Arterial Blood Gas
  • Chem 8: Na, K, CI, CO2, Bun Creatinine, glucose, calcium
  • PIH: Pregnancy preeclampsia lab draw – BUN, creatinine, uric acid, SGOT
  • Cardiac Triple Markers: Troponin, LDH, CK
  • Hep B Carrier Panel: AFP, SGOT, SGPT, Hep B ag/
  • Comp Chem: Chem 8 and LFTs
  • LFTs: Total protein, albumin, total bili, direct bili, SGOT, SGPT, Alk phos
  • Quad Screen: (used to be called the triple screen) HCG, AFP, UE 3, DIA

Radiology

We have a completely digital x-ray system. We have 3 radiologists located in Ohio, Dr. Vanderburg and Dr. Voss and Dr. Warren, who read our x-rays and one of them is available 24 hours a day for consult. They alternate weeks. Once a month, one of them comes to Bethel to do Lower GIs, VCUG s etc. They have a monthly calendar with all their contact info. Call them about any questions about radiological testing.

For questions about ortho or surgery x-rays – you can telerad them directly to ANMC. Find out who the ANMC orthopedic or surgery doctor is for that day by calling ANMC operator (907-563-2662). Fill out a telerad form and the radiology technician can send it there. Then in about 30-45 minutes you can call ANMC and ask for the doctor on call that you had teleraded it to and they and you can look at the x-ray together and decide what to do.

Pharmacy

Our pharmacists are a great resource. We do have a limited formulary- see the medical provider’s toolbox on the Desktop for the complete village, SRC, and Bethel formulary. Always feel free to ask the pharmacists questions. They are always willing to look up things. We do have a limited formulary and the pharmacists will call you if you order something not on the formulary. If you want something not in the formulary you can use a non-formulary request form. This is filled out and the pharmacist can determine if the non-formulary item is allowed.

Pharmacy also manages Coumadin patients and does their INRs in the pharmacy. They will give out INR meters to patients. You need to fill out a pharmacy referral for this to happen. Ask the outpatient pharmacists about it if you have a anticoag patient and they can help you set it up.

Outpatient Pharmacist available for comprehensive medication review, dosing, elders w/ Poly Pharmacy and prior authorization.

Ask pharmacy related questions.

  • Available: Mon – Fri
  • 8:30 a.m. – 5:30 p.m.
  • Phone #: 6377 or 6196
  • Pager: Ambulatory Clinic Pharmacists

Respiratory Therapy

The respiratory therapy department is located in the main hospital off the lobby located in the inpatient unit. They are on call 24 hours/day. They provides/coordinate routine respiratory management in all areas of the hospital. Services include Holter monitor placement, pulmonary function tests, nebulizer distribution and cardiac stress testing. In addition, they provide respiratory management of critical patients on ventilators until patient can be transferred to higher level of care.

Physical Therapy

The Physical Therapy Dept. is located in the main hospital off the lobby opposite the pharmacy. They see any and all patients with physical problems needing rehabilitation occurring from injury or other reasons.

  • individualized and on-going physical therapy evaluations
  • progressive individualized therapeutic exercise programs
  • wound care
  • advice on ergonomics and home safety
  • orthopedic supplies such as braces and exercise bands, etc
  • ordering DME equipment: walkers and wheelchairs
  • stroke and other neuro rehabilitation

They also travel to all of the subregional clinics several times a year to treat patients in these areas.

Diabetes

The program offers a variety of outreach and clinical services to address the changing needs of the people. Our staff includes Clinical Diabetes Educators, Data Entry Coordinator, Healthy Hearts Case Managers, Outreach Coordinators, and Program Coordinator. Outreach Coordinators:

  • provide diabetes education presentations at schools, Head Start programs, pre-maternal home and in the community organizations, PATC, tribal gatherings and upon request
  • conduct blood glucose screenings at health clinics, health fairs, community events and upon request
  • work with communities to encourage physical activity like the exercise program at the Senior Center in Bethel
  • provide schools and communities with physical activity awards or garden awards.

Clinical Diabetes Educators

  • provide diabetes self-management education for clients and their families;
  • provide both inpatient and outpatient services;
  • identify and educate individuals at high risk for diabetes;
  • function as a resource for the health care team providing patient care;
  • serve as patient advocate in delivery of diabetes care;
  • provide education for patients with gestational diabetes;
  • provide medical nutrition therapy;
  • plan and participate in multi-disciplinary subregional clinics in which patients receive a variety of services.

Healthy Hearts Case Managers

  • Serve people diagnosed with Type 2 Diabetes who are Alaska Native/American Indian
  • Offer individualized case management to help reduce their risk of cardiovascular disease
  • Work cooperatively with other diabetes team members to increase awareness of diabetes prevention and control in the community

As a Team They

  • coordinate the monthly diabetes support group, every second Thursday from 12 – 1 p.m. at YKHC’s CHAP Conference Room, on the second floor – across from the hospital (lunch is provided)
  • host the monthly diabetes radio show every second Wednesday at 10 a.m. on KYUK
  • facilitate special community events, like the Senior Health & Fitness Day and the Family Health & Fitness Day

Tobacco Cessation

We ask our patients about tobacco use at every visit and really encourage them to quit chewing and smoking. Chewing tobacco is very popular out here, especially smokeless tobacco mixed with a spruce tree fungus that is burnt and masticated called punk. The punk and tobacco mixed together (Iqmik) cause the tobacco to be directly passed to your blood stream, which gives a nicotine rush almost instantly. This obviously makes it harder to quit.

We have a tobacco cessation office – phone number 543-6312. The toll free number is 1-888-842-7848.

To refer to them order a Refer to Nicotine Cessation. If in Bethel, you can have the patient directly referred to the tobacco cessation office and they will be counseled and prescriptions for patches/gum /inhalers/Wellbutrin/Chantix etc. will be written if appropriate.

If you want to prescribe Chantix, please document that you asked the patient about depression to make sure this is a good choice for them.

Feel free to prescribe any nicotine replacement the patients want but encourage them to see the Nicotine cessation providers to help them with support. The Nicotine cessation providers can select the appropriate strength of nicotine replacement once they have counseled the patient for you as the provider.

If you are in the villages, your best bet is to use the Quit Line – 1- 888-842-7848. This is a State of Alaska sponsored tobacco cessation program that can all be completed over the phone. They will send out free patches or other nicotine products to someone who wants to quit. You can also refer to Nicotine Cessation and they will call the patient.

Women Infant Children (WIC)

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federal assistance program of the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) for healthcare and nutrition of low-income pregnant women, breastfeeding women, and infants and children under the age of five. (See Child nutrition programs.) The eligibility requirement is a family income below 185% of the U.S. Poverty Income Guidelines. If a person participates in other benefit programs, or has family members who participate in the Supplemental Nutrition Assistance Program, Medicaid, or Temporary Assistance for Needy Families, they automatically meet the eligibility requirements. This program is unrelated to the USDA's Supplemental Nutrition Assistance Program. Currently, WIC serves 53 percent of all infants born in the United States.

Supplemental food

Food checks or an EBT card are issued to program participants that allow them to buy nutritious food that meets their needs at stores that have contracted with the government to accept these checks in exchange for merchandise.

Formula

WIC Laws and Regulations state, infant formula can only be changed from a non-contracted brand by medical documentation. It should be noted that the formula vouchers provided to the participant are not selected based upon nutritional or health benefits but upon lowest bidder status:

“Competitive bidding means a procurement process under which FNS or the state agency selects a single source (such as a single infant formula manufacturer offering the lowest price), as determined by the submission of sealed bids, for a product for which bids are sought for use in the Program.”

Nutrition education

WIC participants are offered free health and nutrition education classes which help them understand their specific nutrition needs and learn about health prevention and improvement strategies.

Access to healthcare and other social services

Program participants receive guidance and assistance in accessing other important services such as prenatal programs, immunizations and child clinics, and drug and alcohol treatment programs.

Breastfeeding support

Program participants also receive guidance and support materials from Certified Lactation Educators about the benefit of breastfeeding and proper breastfeeding techniques.

Community Relations/Translation

There are two translators available 9 a.m. – 5 p.m. M–F and on call after hours. We are encouraged to use these interpreters whenever possible rather than relying on family or other YKHC staff to translate. We also have a telephonic language line for additional support in other languages.

category:outpatient