ELECTRONIC HEALTH RECORD (EHR) ENHANCEMENTS FOR APRIL 21, 2015 SUMMARY FACILITY TO FACILITY DISCHARGE CLEAN UP This will affect providers. Currently when a Facility to Facility Discharge is completed it sits as a planned admission medication reconciliation on the patient's chart. These planned admission medication reconciliations are never removed if they are not used. In order to remove clutter and to limit the potential of these old orders being activated on an encounter three months down the road, they will be removed 21 days after being planned if they have not been activated. PROPOSED ORDERS FROM PHARMACIST This will affect providers. All pharmacists have been given the ability to write proposed medication orders to providers. This access will be in addition to the existing Suggest Order used today. What is the difference? Proposed orders activate immediately when accepted by the provider. A suggested order typically comes in a PowerPlan that is reviewed and then entered by the provider. NM NOTIFY ORDER This will affect providers, nursing, allied health and support staff for inpatients and emergency patients. Nuclear Medicine orders will generate NM Notify orders for inpatients and emergency patients. The NM Notify order will alert personnel that the provider has entered a Nuclear Medicine order. The notify order will generate: A nurse review notifying the nursing staff that nuclear medicine has been ordered for their patient P a g e 1
A NM notify task is also available for use for those that choose to add the DI notify task type to their task list Status of NM Notify Order When an NM order is placed, it will automatically generate an NM Notify order in a Future (On Hold) status. When the chart is closed, the order will go to an Ordered status. ED NM icon In the ED s the NM icon will appear as a ToDo event on the tracking board. CHANGES TO ECHO ORDERS REMOVAL OF OTHER IN THE REASON FOR ECHO FIELD This will affect anyone who enters Echo referrals for: LHSC Non-invasive Diagnostic Cardiology Department St. Joseph s Cardiac Investigation Unit This change is a result of accreditation review. P a g e 2
Old Other appears in menu New Other has been removed from menu The Cardiology departments are available to provide education upon request and will target areas that order high volumes of Echos to assist during the transition period. Any questions regarding the choices in the drop-down Reason for Echo Referral field should be directed to the Echo departments. Echo Department Extension UH 34703 VH 55840 St. Joseph s 64221 ECG ORDERABLE REPORTING CHANGE FOR STEGH PATIENTS A dictated result is viewable electronically in PowerChart as well as a link within the report giving access to view the ECG once it is final. A printed text-based report will also distribute through Cerner instead of the manual faxing of the ECG tracing. All users with access to STEGH patient information will be able to view these reports. P a g e 3
ORDER ENTRY CLEAN-UP This will affect providers. Fields that are not in use or functional have been removed in Prescription and Inpatient Order Entry. Prescription Order Entry Clean-up Before P a g e 4
After Inpatient Order Entry Clean-up Before Volume Dose and Volume Dose Unit fields have been removed. After P a g e 5
INTERMITTENT IV CHANGE This will affect providers. There will be a change to the way intermittent IV s look when ordered but there is no change to ordering practice for providers and no impact to favorites. This will fix the problem with the Multi-phase PowerPlans and bring the intermittent IV s in line with how continuous IV s are ordered. Old Intermittent IV New Intermittent IV P a g e 6
DOCUMENT AND CLINICAL NOTES VIEWER AVAILABLE FOR MEDICAL SECRETARIES This will affect medical secretaries. Medical secretaries will now have two additional components on the table of contents menu that will provide alternative ways to view clinical documents and reports. Document Clinical Notes Viewer DISCONTINUE (FUTURE) TPN (EXCLUDING LIPIDS) AND DISCONTINUE (FUTURE) TPN & LIPIDS ORDERS This will affect providers, dietitians, nursing and pharmacy. A new Discontinue (Future) order(s) will provide a consistent method to future discontinue TPN solutions. It will also ensure the patient receives the prescribed amount and avoid manufacturing and delivery of TPN when it s not required. This document explains the workflow for providers, dietitians, pharmacy and nursing. Reasons for the new order Phone calls from the provider requesting future stoppages does not provide a paper or an electronic trail Canceled TPN (amino acid/dextrose) order removes the order from the MAR and pharmacy but it does not reflection the true time period until the TPN is actually to stop Waiting to cancel the order in real time can be costly as pharmacy can create TPNs that are not required P a g e 7
Communication orders do not flow to pharmacy Modifying the stop date/time of the TPN order changes the TPN entry to the base solution it was built from causing confusion about the order Blood Work and glucose related TPN orders within the Total Parental Nutrition (TPN) (Module) are not canceled Provider & Dietitians Workflow Add Discontinue (Future) TPN Order 1. In the patient s chart, click Add on the table of contents menu. 2. In the Search field type discontinue tpn. 3. Select the appropriate Discontinue TPN order, in our example we selected 22:00 hrs TODAY Stop current TPN & Lipids. 4. Modify Order Details if required and Sign the order. Important Discontinue (Future) orders generate two tasks one to pharmacy and one to nursing. P a g e 8
Orders Tab (Patient Care Order) The order will appear under Orders. Important Once both pharmacy and nursing tasks are signed off the Discontinue (Future) order will automatically complete. Pharmacy Workflow The pharmacy task will appear on Pharmacy s Multi Patient Task List (MPTL) under the TPN tab. Pharmacy MPTL 1. Pharmacist or Pharmacy Tech will modify the original TPN (amino acid/dextrose ) order in Med Manager based on the information contained in the Discontinue (Future) task. 2. Pharmacist or Pharmacy Tech will notify the sterile room of the change. 3. Pharmacist or Pharmacy Tech will complete the Discontinue (Future) task. Important When pharmacy signs off the task it does not affect nursing task and vice versa. Once both pharmacy and nursing tasks are signed off the Discontinue (Future) order will automatically complete. P a g e 9
Nursing Workflow Discontinue (Future) orders will appear for Nurse Review. This order also generates a task. Nurse Review Nursing task will appear on the PAL and Task List within chart. The nursing task will provide the following instructions Nurse to discontinue TPN (Module) when the original TPN (amino acid/dextrose) order is finished. Nursing Task on PAL Pharmacy Modifies the Order When pharmacy modifies the original TPN (amino acid/dextrose) nursing will receive the modified order and it will appear under Nurse Review. P a g e 10
Discontinue the Total Parental Nutrition (TPN) (Module) Once the original TPN (amino acid/dextrose ) order is finished, nursing can discontinue the Total Parental Nutrition (TPN) module and complete the Discontinued (Future) task. This action is required to stop other related TPN orders within the Module. 1. Right-click on the order. 2. Select Discontinue on the menu. Important If the module is discontinued before original TPN (amino acid/dextrose) order finishes all related orders will be gone. Complete Discontinue (Future) TPN Task The TPN (amino acide/dextrose) has been discontinued and the task is ready to be completed. The nursing task can be signed off by RNs and RPNs. 1. Click Task List on the table of contents menu. 2. Click in the checkbox for the task to complete it. Important Once both pharmacy and nursing tasks are signed off the Discontinue (Future) order will automatically complete. P a g e 11
CYTOTOXIC AND NON-CYTOTOXIC HAZARDOUS DRUGS ORDERS PLACED This will affect anyone viewing the MAR, Order/ Medication Tab. This will affect orders placed after May 1st. Order comments for CYTOTOXIC hazardous and non-cytotoxic hazardous will appear in the order comments on the MAR and orders profile for new orders. MAR Orders Tab SHORTEN AND STANDARDIZE START AND STOP DATE/TIME DISPLAY IN ORDER SENTENCE DISPLAY This will affect anyone viewing the MAR, Order/Medication tab. Orders placed after April 21 will have shortened and standardized Start and Stop Date/Time displayed. This change will be reflected on all order views including the MAR, Orders/Medication tabs/pal/task List/Med Rec. P a g e 12
Before After P a g e 13