EMR DOCUMENTATION LYNX. Instructor Script

Transcription

1 EMR DOCUMENTATION LYNX Instructor Script 1

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3 Table of Contents Table of Contents INFORMATION SECURITY AND CONFIDENTIALITY... 4 OVERVIEW... 5 LEARNING OBJECTIVES... 5 AUDIENCE... 5 SIGNING ON... 6 KH ED SIGN IN REQUIRED... 7 eprescribing... 8 Verifying External Plan and Pulling in External Prescription History:... 8 Verifying external plan... 8 Pulling in external prescription history... 9 VERIFYING/ADDING PATIENT PHARMACY INFORMATION Tips for using the pharmacy search PATIENT PREFERRED TAB PROVIDERS: ENTERING A NEW PRESCRIPTION Alternative Medications on the Formulary CONVERTING AN EXTERNAL MED RX TO A PRESCRIPTION: PROVIDER: PRESCRIBING ROUTING ERRORS LOGGING OUT FIRSTNET K-TAP APPENDIX TIPS AND TRICKS HELP FILES SOLUTION TERMS SOLUTION ICONS SETTING UP THE TOOL BAR

4 EMR Documentation eprescribe Emergency Department (Rev. 12/20/2011) INFORMATION SECURITY AND CONFIDENTIALITY When dealing with computerized health care records, specific confidentiality and security issues must be followed to protect the patient. There are increasing HIPAA and Joint Commission regulations that dictate how these records are handled. When signing on to eprescribe use your own User Name and Password, do not share. The application keeps an audit trail, or record, of who enters each chart and when. PowerChart records who signed into the chart and who documented each piece of information in the chart. Do not leave the computer while still signed on. Do not access any information that does not apply to your current job and caseload. 4

5 OVERVIEW This reference guide was designed to supplement a hands-on, instructor led session. Pictures of various screens have been included in order to show general information placement. Please note that these are standard screens and may not match exactly to those at your site. LEARNING OBJECTIVES Send a new prescription to a pharmacy via eprescribing Address routing errors from new prescriptions in the Message Center Verify preferred pharmacy information (add new, delete old information) Pull in external Rx medication hx into medication hx list AUDIENCE Provider (MD and Mid-level/Resident) RN 5

6 EMR Documentation eprescribe (Rev. 1/25/2011) SIGNING ON Objective: This exercise will provide you with the steps necessary to Locate and sign on to the FirstNet Application. Note that after training has been completed you will be using the PROD environment to access the application. 1. Click the Citrix icon from the lower-right corner of your computer taskbar. 2. Select Applications from the shortcut menu that displays. 3. Then select Cerner-Prod Environment>FirstNet. The Cerner Millennium log in window displays. The Domain field is set to Prod. 4. Type the User ID from your Training Card in the User Name field. 5. Press the Tab key to advance. 6. Type the Password from your Training Card in the Password field. 7. Press the Enter key or Click the OK button. The new information dialog window will display. 8. Click OK to close the new information window. 6

7 KH ED SIGN IN REQUIRED Note: Attending Physician name MUST be added prior to obtaining any external medication history. City and state or zip code is required to run a search. 1. Enter ED attending name at the point of ED sign in. The name is entered last name, first initial and the binoculars can be used to search if needed. This step must be completed in order to see any external information and use the erx functionality. 7

8 EMR Documentation eprescribe (Rev. 1/25/2011) PRESCRIBING eprescribing allows a physician or practitioner to electronically write a prescription and transmit the prescription to the pharmacy electronically. eprescribing software utilizes a network to provide a secure, HIPAA compliant encoded communication link to and from participating pharmacies. Providers must be valid prescribers and be registered with our credentialing medical staff office. eprescribing allows the physician or practitioner to electronically write a prescription and transmit it to the pharmacy. eprescribing utilizes a network to provide a secure, HIPAA compliant encoded communication link to and from participating pharmacies. Providers must be valid prescribers and be registered with our credentialing medical staff office. Clicking the Rx Plans button activates the External Rx information. The External Rx History button will access SureScripts and pull in any prescriptions that have been filled at a participating pharmacy. The Patient Pharmacy button is used to add or update the patient s preferred pharmacy. Renewal Request is an ambulatory clinic function and will not be used in inpatient/ed areas. VERIFYING EXTERNAL PLAN AND PULLING IN EXTERNAL PRESCRIPTION HISTORY: By using SureScripts external medication prescription history the nurse and/or provider can use this as a tool to compile an accurate home medication history. Information will be available if the patient belongs to a participating pharmacy and their prescriptions have been filled after reviewing the patient s medication list within the patient s chart at the bedside. VERIFYING EXTERNAL PLAN 1. Open the patient chart. 2. Select the Medication List component of the chart. 3. Click on the Rx Plan button. One of the following displays: o o o Number of plans available. No plan; the patient does not have external prescription history. In error. This signifies that there is an error in the interfaces to subscripts; call TAC if you see this error. 8

9 4. Select eligibility details. 5. Choose a plan if multiple plans are listed. 6. Click the OK button. PULLING IN EXTERNAL PRESCRIPTION HISTORY After verifying the documented home medication with the patient at the bedside, we can now use the external Rx history as a tool to collect a more accurate/complete home medication history. Note: The external history will not display indication or compliance. If any element of the medication has been updated you will not be able to change that individual element. You will need to ADD the medication through the Document Medication by Hx button. 1. Request Verbal Consent from the patient to view their prescription history at their pharmacy. I would like to verify your outside prescriptions from your pharmacy; do I have your permission to do so? Consent Granted: The patient lacks the capacity to consent, OR the patient lacks the capacity to consent but his/her representative consented to access the retail pharmacy information. 2. After verbal consent is granted, click the External Rx History button on the toolbar. 3. When the verbal consent displays, click consent granted. 9

10 EMR Documentation eprescribe (Rev. 1/25/2011) This will only open one time in history of patient. The external data will open. Consent Denied: The patient does not consent to Kaleida s access of their previous medication history. If the patient denies the consent, the History Patient Consent window will display with each new visit. 4. Verify the list of medications with the patient and compare to the documented Medication History list. 5. Highlight the medication (from the external list) you wish to pull into the home medication list. (Note: if medication is not on formulary you will NOT be able to pull in that information) This is denoted by an icon next the medication. If not on formulary there will not be any icon on the external history or an icon. 6. Right-click the medication and select Convert to documented medication. This step must be completed for each individual medication 7. Click the Orders for Signature button to bring in that information. The document home medication screen displays. 8. With the appropriate medication highlighted, enter the indication and compliance information. Repeat this step for all medications. No other medication details can be changed. 10

11 9. Click the Sign button. The medications are now included in the home Medication History in a documented status. VERIFYING/ADDING PATIENT PHARMACY INFORMATION The pharmacy search loads the Pharmacy Directory from the SureScripts database, which contains approximately 95% of the retail pharmacies in the United States. The Search tab is enhanced to support: default search by patient city, state pharmacy directory is updated nightly pharmacy details including address, phone and fax number are available for viewing Providers 1. Ask the patient for their preferred pharmacy for this visit. Note: This information will need to be loaded on all patients. Once populated, it will remain on the patient record and will only need to be updated if there are changes. 2. With patients name highlighted on the ED tracking board, click the patient pharmacy button on the top toolbar. Patient demographic information will populate the city and state information by default. 11

12 EMR Documentation eprescribe (Rev. 1/25/2011) 3. Enter the pharmacy name and either zip code or street address to narrow the search. 4. When the pharmacy name is listed, highlight, right-click and select Add to set as the default pharmacy. 5. Click the Close button. This information will now be available for the provider to route the prescription electronically. TIPS FOR USING THE PHARMACY SEARCH Less is more. Do not enter the entire pharmacy name or address into the search fields. Search with one word from the name or the street name. If you have a pill bottle or paper list in hand, search by the Street Number. Make sure the defaulted city and state are correct. If you do not have the street address and are seeing the patient, search by Pharmacy Name or by Pharmacy Name in combination with Street Name. Make sure the default city and state are correct. Do not enter extra street information into the address like Ave, Dr, St, etc. If the patient has the pharmacy number in a cell phone, it may be used to verify the correct pharmacy if multiple matches have been returned. Call the Pharmacy to verify the address. Have the patient present and engaged them when trying to search for a pharmacy. Applicable to InPatient Nurses with Computer Provider Order Entry (CPOE) rollout at your site. PATIENT PREFERRED TAB The list is automatically updated when new prescriptions are sent. 12

13 PROVIDERS: ENTERING A NEW PRESCRIPTION The eprescribing process begins by placing a new prescription order. Note: With eprescribing, a preference has been turned on that restricts the list of medications that can be ordered to a list of products. This reduces the risk that pharmacies will not be able to recognize what to dispense. It also reduces the potential for eprescribing error messages. For example, brand names and generic names without product details are not descriptive enough. Steps: 1. From Depart click the pencil icon for the prescriptions section. 13

14 EMR Documentation eprescribe (Rev. 1/25/2011) The Add Order Search dialog displays. 2. Make sure the type is set to the Discharge Meds as Rx. 3. Search for and select the medication to be prescribed. 4. Select the appropriate Order Sentence for the medication being prescribed. 5. Click the OK button. 6. Click the Done button to close the Add Order dialog. 7. Complete all required fields. By filling the DAW field you will only see Tier 1 meds Residents and PA s will be required to enter Supervising MD on any prescriptions they write regardless if they are being printed or going directly to Pharmacy. 14

15 Both the Resident/PA and Attending info must display on prescription. Note: This field carries forward from Patient to Patient. As the Supervising Physician changes, Resident/PA must update the field. The Depart Action Item label displays as Modify ED Provider. 15

16 EMR Documentation eprescribe (Rev. 1/25/2011) Attendings/Residents/PA/NP s must update this field upon depart and designate who ED provider was for Patient A NP, PA or attending can be added to this field. This data will interface from Cerner into Eclipsys. ALTERNATIVE MEDICATIONS ON THE FORMULARY Choosing a medication that is NOT on the patient s formulary will show alternative meds. 1. Select the medication and click the OK button. Follow this process for additional medications. Note: If the patient has multiple prescription plans you may change the plan to see if a medication is on another formulary. 2. Click the Cancel button to return to the Order details window. 3. Click the Rx Plan button and select the alternate plan. The system warns and advises that a new plan has been selected and formulary information will change to the new plan. The selected medication is on the formulary of the alternate plan and order details can now be completed. Follow the process for additional medications. 4. When all prescriptions have been entered, highlight all prescriptions you wish to send electronically. 5. Click the Send To: drop-down. 16

17 The Prescription Routing window displays. 6. Select Pharmacy from the Send to list. If you need to add a pharmacy (i.e. 24 hour pharmacy) The city and state populate the search fields based on the patient s demographic information, by default. Either city and state or zip code is required to run a search. You can search within the defaulted location, or enter a different city and state or zip code. 7. Click the Elipsis button. 8. Click the Send To: drop-down and Pharmacy. A list of pharmacies displays meeting the search criteria display. 17

18 EMR Documentation eprescribe (Rev. 1/25/2011) 9. Select a pharmacy and click the OK button, or use the Pharmacy Search functionality on the Search tab. After the order is signed and the order profile is refreshed, the order displays on the profile in an ordered status and the name of the pharmacy displays in the Send To field. CONVERTING AN EXTERNAL MED RX TO A PRESCRIPTION: 1. Click the External Rx button. 2. Right-click the selected medication. 3. Select convert to prescription. 4. Click the Orders for Signature button. Make sure there are no duplicate orders or allergy warnings. 5. With the Medication highlighted, complete all required details. 6. Plan to send non-scheduled medications electronically. 7. Print the scheduled medications. The following is the recommended workflow when there are multiple prescriptions to send to the pharmacy with a mix of scheduled or controlled (pain medications, sedatives) and non-controlled medications (antibiotics, blood pressure medications, etc.) If necessary: 1. Plan to print all prescriptions (per patient request). Enter the scheduled medications first and the printer will default for the remaining orders 2. Plan to send non-scheduled medications electronically. 3. Print only the scheduled medications. 18

19 E n te r the non-scheduled medications first, select the pharmacy, and use this for all nonscheduled orders. Enter the scheduled medications last and the printer will default for the remaining orders. PROVIDER: PRESCRIBING ROUTING ERRORS The following text is displayed when the system is unable to send the prescription to the pharmacy based on the current order details: Send to Pharmacy is not available because at least one of your unsigned prescriptions is not eligible. (Note the default Send to option is Printer in these situations). Send a prescription to the pharmacy is not an available option in the following situations: 1. Schedule medications are excluded by DEA regulation. These prescriptions may be printed, and the print option will default. 2. Critical Patient Demographics are missing (these are viewable on the demographic banner) Last Name, First Name, Gender, Date of birth. 3. When entering multiple prescriptions at the same time, the Send To: option defaults from the previous prescription entered for that patient. 4. The pharmacy the prescription is being routed to is visible in the order details prior to signing to make it easier to check where the prescription will be routed. If the transmission of a prescription order to a pharmacy fails for any reason, a routing error message is sent to the ordering provider s Message Center or a Message Center pool. 19

20 EMR Documentation eprescribe (Rev. 1/25/2011) There are three routing error messages that can be seen in Message Center: 1. Prescription routing temporarily unavailable. 2. Unable to communicate with pharmacy. 3. Prescription too long for pharmacy system. The total length of the combined order details is currently limited to 350 characters. The special instructions field is limited to 255 characters, but a combination of long special instructions, PRN instructions, or other SIG line order details may cause the character limit to be exceeded. 20

21 Once a routing error is received, the prescription should be printed and given to the patient or if the pharmacy calls stating they did not receive the prescription, a verbal phone order is provided. Note: It is not recommended to attempt to re-transmit the prescription electronically because in most cases the cause for failure cannot be corrected by the end user and the prescription will fail again. Within the routing error message, the user can: 1. Click the pharmacy name to view information about the pharmacy and the prescription to place a call to the pharmacy. 2. Click the Med List button to open the patient s Medication List and print the prescription and hand it to the patient. 3. Enter a comment that includes the name of the prescription to the message indicating what action was taken after the prescription is called, faxed or given to the pharmacy/ patient. 4. Note: The body of the error message contains information about what caused the error. After the prescription is called to the pharmacy or printed, the error message should be forwarded to the organization s support team for further investigation. 21

22 EMR Documentation eprescribe (Rev. 1/25/2011) LOGGING OUT FIRSTNET When you have completed your activities, remember to log out of the application you are working on for security purposes. Logging out can be done in one of the following three ways: 1. If you are exiting the application temporarily, but planning on returning to that computer shortly, click Suspend User on the toolbar. This returns the screen to the log on window and place the cursor in the password field. 2. If you want to shut down the application completely, click Exit on the toolbar or the X in the upper right hand corner of your screen. Keep in mind that shutting down the application will require the next user to re-launch the application, which requires a greater amount of time. 3. Select Exit Application, to open the Exit Application window. The first option available allows you to prepare the application for the next user. This returns the screen to the log on window and place the cursor in the user name field. The second option will completely shut down the application and the third option allows you to suspend the application. K-TAP 1. Tap your ID badge on the card reader (if you are already logged in). 2. Maximize the exactaccess Desktop window. 3. Click the Log Off button. 22

23 APPENDIX TIPS AND TRICKS Press and release the secondary (usually right) mouse button and see if any of the menu items apply. Use your cursor to hover over the buttons to see if any of the button names jog your memory. If a single mouse click doesn t work, try a double mouse click. HELP FILES Complete one of the following steps to access Help for the application: 1. Locate the Help file in the winintel folder where the Cerner Millennium applications are stored. The Help file shares the same name as the EXE file, except the file extension in HLP. (i.e., the Help file for PowerChart.exe is PowerChart.hlp). 2. With the application open and running from the appropriate domain, select HNA Topics or Help Topics in the Help menu or press F1 on your keyboard. SOLUTION TERMS In the Help table of contents, located in the left pane of the application s Help viewer, expand the Glossary book and then select the Glossary topic to display the glossary in the main pane of the Help Viewer. Select the first letter of the term you want defined, then click the term to display the definition. Throughout Help, words in green font with a dotted underline indicate terms with definitions. Click on a term in green, dotted underlined text to display the term s definition. SOLUTION ICONS Solutions use unique icons to designate buttons that have specific functionality. To view the icons and their meanings for a particular application, open the table of contents, located in the left pane of the application s Help viewer. Expand the Menus and Toolbars book, and then select the Toolbar topic to display the application s icons in the main pane of the Help viewer. 23

24 EMR Documentation eprescribe (Rev. 1/25/2011) SETTING UP THE TOOL BAR Additional buttons that are not displayed (due to the width allotted for the toolbar) are available by clicking on the drop-down list on the right edge of the toolbar. Clicking here will expand the toolbar menu and display the remaining functions. Button Display Order The display order of the buttons on a toolbar may also be adjusted by right-clicking on the toolbar and selecting Customize from the shortcut menu. Toggling Toolbars On and Off Toolbars can be turned on or off by clicking on View from the Menu bar and clicking on any of the toolbar names in that menu. A toolbar that has a checkmark next to it in the View menu means that it is currently turned on. No checkmark next to the toolbar signifies it is turned off. (Turn it on: click to check; Turn it off: click to uncheck.) Moving/Rearranging Toolbars Toolbars can move around on the screen by clicking on the left edge of the toolbar and dragging the toolbar to another area. You will know you are in drag mode when your mouse pointer turns into the move pointer. 24

25 To customize buttons on the toolbar, perform the following steps: 1. Right-click any blank spot in the gray toolbar area. 2. Select the Customize option from the shortcut menu. 3. With the Customize Toolbars window displayed, click and drag the toolbar buttons to the desired locations. 4. Close the Customize Toolbars window. 25