Twelve points: Meeting minutes

2/20/13, 7-9pm, New Day Bakery
In the house: Leigh, Benjamin, Becca, Brooke, Arwen, Wayne, Jerry, Andrea, Elliott, Karen, Intake Donna, Sue

1. Meeting change: We consensed to change our meeting place to the campus Glenwood Restaurant, 1340 Alder St. (at 13th, near LTD “UO Station South,” 28 bus) unless they decline to give us a standing reservation for every Wednesday 7 pm. Sue will request.

2. Gorilla Hair Salon: Benjamin needs help as he has more clients every Sunday than he can minister to. OM will reimburse him for the purchase of disinfectant solution, combs, clipper heads, and shears.

3. Mental Health Team: will meet at 11 Sunday to work on their protocols. Becca reported a “significant escalation” in needs for mental health interventions. Long wait times for clinic contribute to the problem. Some patients need to be seen off the bus, and a fast and flexible liaison is needed between medical (mostly on-bus) and mental health (mostly off-bus) services. We consensed on establishing the position of Resource Nurse to fill this and other roles (see below, Nursing). Becca suggested that collecting some preliminary medical data while folks are waiting would allow Mental Health to make contact with patients while assuring them that they will receive medical care when it’s their turn. Leigh volunteered to provide a sample template form, simpler than the regular Patient Encounter Form, for their use.

4. Nursing Team: The position of Resource Nurse was invented, to be scheduled and briefing/debriefing to be delegated by Karen. The Resource Nurse will liaise between all the teams, assiting with triage, supplies, and flow.

5. Wound Care Clinic: originally was going to be nurse-staffed, but 1-2 MDs have stepped forward to help too, so Nursing will discuss what scope of services will be offered. We discussed two possible locations: the Sprout farmer’s market site at 418 A St in Springfield (market open from 3-7 Fridays year-round), or the Whiteaker Community Center at the corner of Clark Street and N. Jackson Street in Eugene. Both sites have necessary amenities and are interested in the collaboration. We consensed that the Springfield site is preferred as the need in our sister city is tremendous, plus the wound care nurses mostly live in Springfield and are familiar with the community there, while the Whiteaker community already has access to our Sunday clinic downtown and we would be somewhat duplicating services. Donna agreed to contact the coordinator of Sprout.

6. Triage: much discusion of expanding the role of Triage to do more, well, triage (“the process of determining the priority of patients’ treatments based on the severity of their condition”). The team will meet and determine, in addition to how they want to perform triage, also how they want to store supplies, what support from other teams they need, what training they’d like, what responsibilities are appropriate for the team to maintain, etc. Example: should Triage determine who is ok to be seen on the bus, and can this determination be made on the bus, or should triage take place off the bus, and how? Leigh offered to help set up a preliminary triage “decision tree.”
We also had extensive discussion of problems related to patient flow. Effective triage would send appropriate patients directly to Nursing, Treatment, Mental Health, Psychohairapy by Ben, Social Work, Dental, et cetera. We have multiple bottlenecks. We consensed that Brooke would perform an informal efficiency analysis at the next one or two clinics, and report her observations.

7. Security: Due some stressful incidents at our last clinic, we reviewed the idea of having formal security personnel at clinic. Big John had performed this role in the past but wasn’t needed for a while. Sue agreed to contact him and see if he is interested in returning. We also discussed the idea of having a safeword or panic-word – a code word or phrase that would mean “I need help NOW” and evoke an instant response from all nearby personnel. We couldn’t consense as to choice of safeword, and tabled discussion til next meeting.
Arwen will make a sample Incident Report form to document anomalous events at the clinic.

8. Recruiting: Brooke offered to post “want ads” on OE-announce listserv. Teams should write up their “want ads” for recruiting purposes and send them to Brooke. Example: Can you drive a bus? No special license necessary. 2 hours a week to drive and park the Occupy Medical bus. (or something like that).
Jerry is in the process of contacting professional organizations and training programs to offer preceptorship as well as seek volunteers. “Two hours ain’t bad!”
Jerry also mentioned that professional newsletters sometimes offer free ad space to worthy causes, and these might be good places to recruit caregivers.

9. Medical Team: we reviewed that we have a policy of never prescribing scheduled medications, and why (our followup and monitoring resources are inadequate, patients are vulnerable due to the high street value of scheduled meds, and word gets around, attracting drug seekers to the bus, who then sometimes become belligerent when denied medications). We reviewed that patients who disagree with this policy can discuss it with a physician, but the policy is not changing.
We also discussed the difficulties surrounding prescription of antipsychotic and mood-stabilizing medications: they are dangerous if not taken properly, followup and monitoring are not adequate, and they are often very expensive, and our rx-voucher contacts may not be able to fill them on an ongoing basis. Unfortunately, the local safety-net mental-health clinics are closed to new patients, according to an administrator from White Bird last month. It is going to be a judgement call on the part of physicians whether they can ethically prescribe some of these meds. Caregivers should never assure any patient that they will be able to get a refill for any medication – the patient will have to negotiate their care plan with the physician, and await voucher approval via the Treatment Team.

9. Road crew: an entire 2nd road team is needed if we are going to have the Wound Care Clinic in addition to Sunday Clinic. Hat Donna might volunteer to drive the bus Fridays.

10. Dental: Oral Care Access is a mobile dental unit in PDX that is interested in driving down and parking by us. Jerry and Lina are working together to arrange this.

11. Intake: Donna asked for assistance in physical organization of triaged charts, which also has to protect privacy – no small task in a confined space. She was reimbursed in advance for 10 more clipboards.
Donna also asks that everyone occasionally drop by Intake and tidy up the food table, as she is unable to leave the charts unattended to do so.
Donna also agreed to begin, on a trial basis, to give patients estimated waiting times, based on an average patient flow of q 12-15 minutes. It is impossible to predict how this will interface with patients being triaged. Perhaps Triage should assign estimated waiting times?

12. Labs: access to labs are pending: Sarah has been unable to attend meetings due to conflicting responsibilities, but is working on obtaining matching funds from Legacy Lab for the $1500 generously donated by a benefactor and dedicated to providing labs.
Meanwhile, we have an acute need for tests for specific individuals. Leigh and Sue are working together to get these ordered and funded, with results to be sent to Leigh.

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