SCM Training For Nursing Staff UK Hosp, Staff Education August 06 1
Resources and Help Support Center: 323-8586 Useful Web Sites Learning Center Web page http://www.mc.uky.edu/learningcenter ICIS Web page (Careweb) http://www.hosp.uky.edu/careweb/ 2
Other Resources SuperUsers on each Unit if you have questions, ask a co-worker or superusers in your area. Ring cards Resource Book at the Nursing pods Training system on specific floor computers and in room H31a Careweb page; ICIS tab; CPOE-SCM links on the right If you continue to have a problem, call the Support Center. 3
Logging on to SCM At the desktop, double click on the Sunrise Clinical Manager icon. OR At the bottom of the desktop double click on the Citrix icon found in the bottom right of the task tray. 4
Logging on to SCM Type your SCM name and password into the defined fields. Click OK. Note: A Citrix MetaFrame screen may briefly show before the login screen appears. 5
Trouble Shooting Logon Problems Is the Caps Lock On? Did you enter the correct name and password? Is the system in a downtime? Does the computer need to be rebooted? If you still cannot logon, try another computer and notify the Support Center of the problems with logging on (even if you are able to logon to another computer). Support Center 323-8586 (Open 24/7) 6
Changing Your Password The first time you login, the Change Password dialog box opens. In the Old Password field, enter the password given you by your system administrator. In the New Password field, enter a new password chosen by you. In the Confirm Password field, reenter your new password. Click OK to store your new password. Note: You can change your password anytime using the Preferences menu. 7
Password Rules The password is case sensitive The password must be at least 8 characters The password must contain 3 of the 4 categories Upper case letter A through Z Lower case letter a through z Numeral 0 through 9 One special character such as @! # % $ The password will expire every 90 days. The system does not allow you to repeat the last 8 passwords. Example Password: Abcdef01 or 123Exyz% 8
Logoff SCM Do NOT use the X in the title bar to logoff! Improper logoff can cause a slow down of the SCM system. The quick and safe way to logoff is to use the logoff icon on the toolbar. Click the blue Door icon to logoff. 9
Suspended Session Following Medical Center policy, any idle session will "suspend" then auto log-off after a set time. To Suspend manually Click the Suspend Session icon. Resume your session by clicking on Your Name on the Task Bar. Type in your password. Click OK. Resume work where you left off. Tip: Refresh the screen often using this icon on the tool bar. 10
PATIENT LISTS Patient List Tab: The Patient List displays when you start Sunrise Clinical Manager. It provides easy access to patient charts and notifies you about new information regarding those patients. Current List: The first time that you logon, the name of the list that appears in this box will be the Default Patient List based on location which has been assigned to you according to your job function and security privileges. 11
Creating a Criteria Based List Criteria-based List based on Location (Dynamic List) 1. From the Default Patient List, click on File, Maintain List and click on New. 2. This will open up the Client Selection Criteria dialogue box. 3. Click on the Location tab. 4. Decide whether you want to view patients at the workstation where you are logged on or patients at other locations. - Where logged on only select include patients at logon location only. - Other locations select include patients at selected locations only. 12
Creating a Criteria Based List Building a Criteria-based List based on Location (cont.) 5. If choosing selected location only, you will see two lists displayed: Available Locations and Selected Locations. 6. Highlight and then click Add or Remove to add locations to, or remove locations from, the Selected Locations list. 7. Then click OK, enter a name for your list and click OK again. Note: A box with a plus sign in front of a location indicates hidden information. Click on the + to expand the list of choices. 13
Create a Criteria Based List by Order This button enables you to build an order filter. You are able to make a patient list based on a specific type of order. Start building the new list just like building any other Criteria based list. When the Client Selection Criteria box opens, choose the Orders tab. Fill in the check box and then define the filter you wish to use (if you don t know how to build a filter, see the CBL about Filters). The filter defines the order(s) you want to use to build the list. You will need to define at least a provider, provider role, or location for the list to be built. 14
Creating a Personal List (Non-Dynamic List) From the Default list, select the patients Tip Hold down the CTRL key when selecting different patients from the list. Click on the Save Selected Patients button. 15
Creating a Personal List (cont.) When adding or replacing patients to an existing list: Select the Add or Replace option to a selected list. OR When creating a new list: 1. Select the New List Name option. 2. Type the List Name in the box. 3. Click OK. Tip: Once a Personal List is created it will always have an * in front of its name. 16
Removing Patients from a List 1. Select patient or patient(s) to be removed from the personal list. 2. Click on the Remove Patient icon. Or From the menu bar, click on Edit, Remove Patient. TIP: Remember patients can only be removed from a Personal list, not a criteria based list. 17
Finding a Patient 1. Make sure you are on the Patient List tab. From the toolbar, click the Find Patient icon. 2. Click on Name, Identification, Provider or Other tab. 3. Enter required information. Click Search. 18
Finding a Patient (cont.) 4. 6. 5. 7. 4. Select the patient from the Search results. 5. Click Show Visits. 6. Select a visit. 7. Save the patient to a list by clicking on the Save Selected Patients button. 19
Finding a Patient and a Temporary Patient List If you click OK instead of the Save Selected Patients button, this will create a Temporary patient list. Temporary patient lists are automatically deleted when you logoff SCM. 20
The Look and Feel of SCM - Sorting Columns The above patient list is sorted in alphabetical order. The sort is accomplished by clicking on the column header. The up arrow indicates an alphabetical sort. This patient list is sorted in reverse alphabetical order. The sort is accomplished by single clicking on the column header. The down arrow indicates a reverse alphabetical sort. A secondary sort is accomplished by first clicking on the primary sort field (in this case the New Orders column) and then holding down the shift key and selecting the secondary column to sort (in this case the Patient Name column). 21
The Look and Feel of SCM - Moving Columns Moving columns is very easily done. Place the mouse over the column header of the column you wish to move, then click and hold the left mouse button down. You will see the column header lift off the page (left above). Move the mouse and watch the red arrows move until the arrows are in the area you wish the new column to be located (middle above). When positioned correctly, release the mouse button and the column will appear in its new location (right above). 22
Flags Flags will show on the Patient List tab, the Orders tab, and the Results tab. Meaning of the Green Flag: New Results: New normal lab results have been posted or New Text results have been posted New Orders: New routine orders have been written To Sign: New orders need to be signed To Verify: New orders need to be verified 23
Flags (cont.) Meaning of the Red Flag: New Results: Abnormal Test Results are posted New Orders: STAT Orders have been written Unacknowledged Alerts: Generally alerts can only be acknowledged by a physician. 24
Activating New Flag Option From the Patient List, display the Flag New Column. Turn Flag New on/off for a single patient by double clicking in the empty Flag New box. OR Turn Flag New on/off for multiple patients by: 1. Highlight the patients in your list you want 2. From the Actions menu select Flag New On or Flag New Off. 3. Select Yes to turn flags on or off for all highlighted patients. 25
Patient List and Flags When Flag New is turned on, the New Results column will display red and green flags indicating there are new results. Tip: You can click on the flags to view the results from the Patient List screen. 26
The Clinical Summary Tab The Clinical Summary tab shows various information including Alerts, Allergies, Active meds, Lab and Microbiology Results, Documents, and Health Issues. Two views are available with several time frame options. This tab will have more information in the future. 27
Summary Tab The Summary tab displays selected categories from the Patient Info tab in a summarized form. This is a good place to begin to quickly familiarize yourself with important aspects of the patient s chart. Active Alerts Active Medications Active Health Issues Active Allergies 28
Summary Tab (cont.) Each of the four panels can be expanded to display more information, including inactive information, by clicking on the red arrows button to the left of the panel title. Expanded Panel 29
Patient Info Tab The Patient Info chart section contains functions to help you view, edit, delete, or discontinue different types of patient information. Based upon your provider role and security access to SCM, you may be able to enter or change some information in some areas, but not in others. The SCM system will tell you if you do not have the required privileges. 30
Adding Patient Data Allergy 1. From the Patient List, identify the patient on whom you want to enter information, and highlight the name. 2. Check the title bar and the patient header to confirm you have selected the correct patient. 3. Select the Patient Info tab. 4. Highlight Allergy in the Data Entry window. 5. Select the New Allergy or Allergy Status Unknown radio button and click OK. 31
Adding Patient Data Allergy 6. Using the drop down menus, select Type and Allergen. 7. Click on the Add Reaction button to open the Reaction Details box. 8. Select either the Unknown or Select all reactions that apply radio buttons. 9. If you have clicked on Select all reactions that apply radio button, check the reactions. 10. Click OK twice. Tip: The field names listed in bold in the dialogue box must be completed. 32
Adding Patient Data Height and Weight 1.From the Patient List, identify the patient on whom you want to enter information, and highlight the name. 2.Check the title bar and the patient header to be sure that you have selected the correct patient. 3.Select the Patient Info tab. 4.Highlight Height/Weight in the Data Entry window. 5. The Height/Weight dialogue box will open. 33
Adding Patient Data Height and Weight (cont.) 6. Type the patient s height and weight in the appropriate fields. 7. Click OK. Tip: You may enter height and weight information in either pounds/inches or kilograms/centimeters. SCM will auto-convert and calculate the BSA. 34
Adding Other Patient Data Nurses will want to have information on the Patient List that indicates if any patients have been placed in Isolation, and the name of the Nurse that has been assigned to care for each patient. This information will appear in separate columns on the Patient List tab. To add or change information in these columns, double click in the Nurse or Isolation column which corresponds with a specific patient. 35
Results and Documents Tabs The Results and Documents chart sections contain patient procedure results and transcripts. Documents tab: All transcriptions. Results tab: All laboratory, pathology, nuclear medicine, radiology and endoscopy results. Blue Chart: Vascular, Pulmonary Functions, EMG, EEG, EVP, Neuropsychology, Echo and Gamma Knife testing. 36
Results Tab The view in the results Display window can vary, depending on the filters chosen in the View Control Panel. Click on drop-down arrows to see more choices for Chart, Since, and the Result Selection areas of the View Control Panel. 37
Results Tab (cont.) When you see the flags, either click on the Report by Order Display Format or click on the individual Flag itself to view the results. 38
Results Tab (cont.) In the Display Format section, the Report by Order filter will display results sorted by date and time with each result having the associated order as its header. The most recent results of the selected time frame will be found by scrolling down to the bottom of the view. 39
Entering an Order Order entry is initiated by clicking the Order Entry Icon by the patient s name An Order may be written by a Physician or on behalf of a Physician 40
Entering Orders (cont.) Log on and create your list before starting order entry process. 2. Left click on the order entry icon 1. Left click on Patient name to select NOTE: Check the name by the clipboard to verify that you have selected the correct patient. 41
Order Entry Allergy Summary Screen If no information about allergies has been entered for the patient, SCM will ask you to enter allergies first before continuing with order entry. If you encounter the Allergy Summary dialog box, you must click on Add New to enter an allergy for the patient even if the patient does not have any allergies. 42
Order Entry Requested By Screen If the patient already has assigned care providers, Current Providers will be listed in the box below. DO NOT CHANGE! If no physician is listed as one of the care providers, click the radio button Other and type the name in the Name field to display names below. 43
Order Entry Requested By Screen (cont.) 2. Select Source from the Dropdown Menu 1. Click on Physician name to select 3. Click OK 44
Order Entry - Worksheet Screen This will open the Order Entry Worksheet with your patient s name at the top of the screen. The worksheet allows you to set up parameters and select orders to add to the patient s record. 45
Order Entry Start of Browse Search The Browse categories are listed below the Start of Browse field on the Order Entry Worksheet. Click on the (+) sign to expand the category. Click on the (-) sign to collapse the category. 46
Order Entry - Manual Entry Search 47
Order Entry - Wildcard Search To find an order using the wildcard, type % and then all or part of the order you are searching for with no spaces. This will search for all orders with the search word anywhere in the title of the order. DO NOT PRESS ENTER after typing. The list will automatically display in the box below after a short delay. Scroll down until you find the procedure, highlight it and click on ADD button. 48
Order Entry - Order Request Form 49
Order Entry - Order Request Form (cont.).. 50
If an order needs to be repeated, you can click on the Repeat button at the bottom of the Order Request form to open the Repeat Order dialog box. Complete the repetition pattern and schedule dates and times. Click on OK to close the dialog box. Click OK to close the Order Request Form. Example: The Repetition Pattern is daily every day, scheduled times have been specified as 7AM and 7 PM by using the ADD button. The end date has been set 3 days after the start. Order Entry - Repeat Orders 51
Entering Order Sets Order sets are designated by stacked papers on the order screen. Selecting one of these order sets, will open a screen with multiple orders. Click inside checkbox to select the order and then click OK. All the orders will be entered at the same time. 52
Entering Order Sets (cont.) Correcting Alert Warnings Orders with requisitions which have required fields will display in the Orders with Alerts, Warnings or Errors box with a red X. Double click on the order and enter the required fields. 53
Creating a Conditional Order SCM also allows you to write conditional orders. On the Order Request Form, you will see a checkbox labeled Conditional Order. Clicking in the Conditional Order check box will put red stars in the fields to be completed. Type the condition and set the activation times (once, unlimited or specify a certain number). Complete the Order Request Form and click OK. 54
Activating Conditional Orders To activate the Conditional order, you must first display the order. You will see a large blue question mark? with the order which represents a conditional order. Go to Orders Tab, find the conditional order and left click on it to highlight. Then Right Click on the order to open a drop-down menu. From the drop-down menu, select Activate. 55
Discontinue/Cancel Single Order Right mouse click on the desired order. From the drop down click on Discontinue/Cancel. If DC/Cancel on behalf of a provider, select other and enter the name of provider. Select reason from drop down. Select NOW or provide an effective date. Click APPLY for more orders or OK for last order. 56
DC/Cancel Order Set Select Requested by display format in the lower left side of the Orders Panel. Locate and right click on the Order Set. Click on Discontinue/Cancel. Select orders to DC/Cancel. Click OK at the bottom of the panel. 57
Transfers and Discharges MD enters Transfer/Order Review. RN reviews active orders, cancels, and completes appropriates orders. Clerk/RN enters Final transfer/discharge orders in SCM after the patient leaves the floor. 58
Completing Orders Go to the Orders Tab. Find the order and left click on it to highlight. Then Right Click on the order to open a drop-down menu. From the drop-down menu, select Complete. The Status of the order will display as Complete. The text of completed orders will display as italicized. You should clean up your orders by completing all one time orders, such as one time meds, a fluid bolus, or D/C foley. 59
Specimen Add On Type specimen as order type. Select Specimen Add on test. Enter new test to add on. (i.e. Glucose) Enter any other required fields. Click OK. Note: Check with lab to verify condition of the specimen. Ask for the Accession # and enter in the order screen. 60
Specified Time lab labels will print 1 hour prior to time due. Priority of Print The Priority field determines when labels print. Priorities for lab orders are Routine, Lab Am Draw, Specified Time, and Stat. Stat lab labels will print in less than 2 minutes. Am lab draw labels will print during night shift. Routine lab labels will print within 2-7 minutes unless entered a day before the test is to be done (entered as a future order). The label for these tests will print about 10:00 pm the day before the test is to be performed. 61
Labels The intermec printers will print microbiology, pathology, and blood bank labels at time of order entry and when the specimen is collected. Put the extra labels with the specimen. The Blaster Printer The blaster will print a bar coded label for all labs not printed from Intermec. The Intermec Printer 62
Labels (cont.) The laser printer will print a requisition if the order involves pathology, microbiology, or blood bank. The blood bank requisition prints when the order is submitted. All other requisitions are printed after the Add Specimen step is completed. Any changes made on labels for blood gases have to be put in the bag with the specimen. 63
Intermec Label 64
Blaster Label 65
Correct placement of the label on the specimen tube is important for a couple of reasons: Patient safety Efficiency The label should be placed with the wings on the tube stopper. The bar code must be smooth and easily read. Only one label to a tube. Any extras should be placed in the bag and sent to Lab. Labeling the Specimen 66
Adding the Specimen When the specimen has been been collected, you you must must return to SCM and completethe the Add Add Specimen process. process. Select the Patient Select Click Orders the Patient tab Click Highlight Orders correct tab lab test Highlight Choose Add correct Specimen lab test at the bottom of the screen Choose Add Specimen at the bottom of the screen 67
Add Specimen (cont.) The add specimen window will appear. Choose the correct specimen type. Fill in the Check box corresponding to the lab you collected. Enter collection data information. Start time defaults to the system time and can be changed. This is also known as the collect time. Collection time must be accurate. Click OK. 68
If a lab is to be sent to Microbiology or Pathology, a requisition will display. You must fill out the required information (red starred fields) on the order form. Add Specimen (cont.) When finished, select OK and the requisition will print on the laser printer. The requisition must accompany the specimen to the Lab. Complete one set of labels and requisition and send everything to the Lab. 69
Effects of Add Specimen Process Completion Once the specimen has been added, the order status will change to collected and the date column will reflect the date and collection time of the order. 70
Last Step The specimen should be double bagged as usual and sent to the lab. Include all extra labels in the bag. A flag will appear in the results column when the test is completed. 71
Miscellaneous Hints Update your list daily. Turn flags ON at the beginning of shift. REFRESH!! Keep your lists current. Place your name in the Nurse column. Check Allergies. Check MAR vs SCM and reconcile meds. 72
Miscellaneous Hints (cont.) Complete orders that you ve performed (example DC foley, X1 med orders). Keep orders current Make sure there are no duplicate orders (example NPO and Reg diet) If you re entering a Med order and get an alert, STOP Do not enter the order. Contact the physician. Don t forget to enter FINAL Transfer/Discharge orders. 73
Miscellaneous Hints (cont.) Micro specimens must be added by the RN. You must complete the requisition online and print it. Notify Respiratory for ABG and ECG orders. Know how to label a specimen. Make sure you are using the label with the correct DATED/TIMED label. Extra label paper is stored by the unit. If, for some reason you run out of paper and the unit does not have any, Materials Management has a limited supply available. 74
SCM Downtime Procedures If Patient Management (PM) is down, but patient is already registered in PM, continue entering orders on patient. Revert to the paper system for orders and results for patients who have not been registered in PM. If SCM is down, revert to paper system for all orders and results. Additional procedures are outlined in detail in the SCM Resource Book and on the Careweb page. 75