Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Sept 30, 2014 ECO Release - Summary of Changes Sept 13, 2014 ECO Themes: Cardiology Cardiac Surgery CAUTI Immunizations Inbasket MDRO Nursing Navigators Nursing Usability Order Set Updates (Postop) Patient Story Problem List Restraints Sepsis Miscellaneous change by application: ADT Ambulatory Anesthesia ASAP Beacon Clindoc Orders Optime Radiant Willow Cardiology Affects: Ambulatory and Inpatient Providers This optimization project improves usability of specific Cardiology workflows; these improvements will lead to enhanced clinical documentation. Components of the project included: Snapshot & Cardiac Synopsis improvements Afib Tool - new Cardiac Surgery Orders (with Cardiac Surgery theme) LVEF: interface work, measuring, documentation & reporting improvements Problem List improvements (with PL theme) HF Changes: BPA and tool tip in patient list Device Implant – OP/IP navigator & documentation improvements Device Interrogation Work flow - new Reading Work Lists for Modalities- new (all RAD type procedures: echo, nuclear, CT, PET) Ambulatory navigators improvements Cardiology Usability Cardiology Device Management Device Check Job Aid Sept 30 ECO Release Summary of Changes Page 1 of 34 1 Cardiac Surgery ECO Theme Folder Cardiac Surgery Affects: All Clinicians in Pilot Sites Only: WEV, WSH, MSP Cardiac surgery is one of the most complicated and protocol-driven procedures performed. Patients can have hundreds of orders, multiple transitions in care, and multiple conditional protocols. As a result, our current state has led to extensive workarounds and clumsy workflows to ensure safety. The ECO project team has completed a systematic redesign of management/protocol orders, end-to-end workflow analysis, preop vs. day of surgery management, medication updates (afib protocol, ICU restricted meds, etc.) and consistent use of phases of care. The New Heart Surgery order sets have been created to help provide consistent, quality care for patients, improve nursing communication and ease transitions of care through med reconciliation. New Heart Surgery Order Sets to be Piloted at Sacred Heart, Everett and St. Pat’s Affects: Surgeons, nurses, pharmacists Region affected: WA, MT (Only WEV, WSH, and MSP) New Heart Surgery order sets have been created to help provide consistent, quality care for patients, improve nursing communication and ease transitions of care through med reconciliation. These new order sets are being piloted at Sacred Heart, Everett and St. Pat’s. 2854 Heart Surgery Preop 2855 Heart Surgery Postop – Entire Postop Period 2856 Heart Surgery Postop – Ventilation and Sedation 2857 Heart Surgery Postop – After Extubation (to be released when extubated) When placing Heart Surgery Postop – Entire Postop Period, a BPA will display suggesting additional order sets that would be placed in conjunction with the postop order set. These include the Ventilation and Sedation, Heart Surgery – IV Insulin, Electrolyte Replacement – ICU, Heart Surgery Postop – Infusions, and Heart Surgery Postop – After Extubation. None are required to be placed and could be placed preoperatively. The banner displays which order sets have already been placed on the patient to easily determine which order sets should be placed versus which should simply be modified. When releasing postop orders for these patients, users are encouraged to release orders by order set. Orders are intended to follow the standard process of releasing all postoperative orders at the same time with the exception of Heart Surgery Postop – After Extubation. This order set should remain in a signed & held status until the patient is extubated. Once the patient is extubated, the surgeon is able to discontinue the entire Ventilation and Sedation order set via med rec by selecting discontinue by order set and applying the discontinue to all orders in that order set. All other order sets, ex: infusions or insulin, can be discontinued in the same manner when clinically appropriate. This should significantly improve the med rec process. Heart Surgery Order Sets Change Notice Cardiac Surgery Job Aid Sept 30 ECO Release Summary of Changes Page 2 of 34 Many new orders have been created as part of this work and are outlined in accompanying change notices. Do Not Give Medication Orders Affects: Providers, Nurses, Pharmacists Region Affected: All New “do not give” certain medication orders have been created. These orders are medication communication orders that display on the active orders report. In addition, once one of these orders is active, if an order for the type of medication not to be given is placed, a BPA will display to the ordering person and pharmacy stating there is a do not give order for this medication. If the order is placed anyway, and administration of the medication is attempted, a BPA warning will display when the medication is scanned stating there is a do not give order for the medication. Also, the person ordering or administering the medication does not need to know if a specific medication falls into the ‘do not give’ category that was ordered. Epic logic recognizes all medications that contain components of the ‘do not give’ order. Once the do not give order is discontinue, the BPA will no longer display. Do Not Give Med Orders Cardiac Sternal Precautions PRE7 modified Affects: All Region affected: All PRE7 Cardiac Sternal Precautions has been modified to include new process instructions and new question. Cardiac Sternal Precautions PRE7 modified Cardiothoracic vent weaning protocol RT300 modified Affects: Providers, surgeons, nurses, respiratory therapists Region affected: All RT300 Cardiothoracic weaning protocol has been modified. Old process instructions for SIMV have been removed. Ministry specific protocols have been added to the reference link for facilities that have provided protocol documents. Some ministries have also added additional process instructions. Facilities that have not submitted protocol documents or process instructions will see a process instruction to refer to their local protocol. Below is a sample of Everett’s process instructions and reference link, other facilities will vary. Cardiothoracic vent weaning protocol RT300 modified Mechanical Heart Implant Order Sets Affects: Surgeons, nurses, pharmacists Region affected: All New Mechanical Heart Implant order sets have been created to help provide consistent, quality care for patients, improve nursing communication and ease transitions of care through med reconciliation. 2850 Mechanical Heart Implant Preop 2851 Mechanical Heart Implant Postop – Entire Postop Period 2852 Mechanical Heart Implant Postop – Ventilation and Sedation 2853 Mechanical Heart Implant Postop – After Extubation (to be released when extubated) Sept 30 ECO Release Summary of Changes Page 3 of 34 When placing Mechanical Heart Implant Postop – Entire Postop Period, a BPA will display suggesting additional order sets that would be placed in conjunction with the postop order set. These include the Ventilation and Sedation, Heart Surgery – IV Insulin, Electrolyte Replacement – ICU, Heart Surgery Postop – Infusions, and PCA – Adult. None are required to be placed and could be placed preoperatively. The banner displays which order sets have already been placed on the patient to easily determine which order sets should be placed versus which should simply be modified. When releasing postop orders for these patients, users are encouraged to release orders by order set. Orders are intended to follow the standard process of releasing all postoperative orders at the same time with the exception of Mechanical Heart Implant Postop – After Extubation. This order set should remain in a signed & held status until the patient is extubated. Once the patient is extubated, the surgeon is able to discontinue the entire Ventilation and Sedation order set via med rec by selecting discontinue by order set and applying the discontinue to all orders in that order set. All other order sets, ex: infusions or insulin, can be discontinued in the same manner when clinically appropriate. This should significantly improve the med rec process. Many new orders have been created as part of this work and are outlined in accompanying change notices. Mechanical Heart Pump Order Sets Change Notice CAUTI ECO Theme Folder: CAUTI Catheter-associated UTI reduction is a clinical priority. This theme work addresses a gap in Epic content to support the removal of indwelling urinary catheters in a timely manner. Project focused on orders and documentation to improve compliance with removal of catheters and reduce infection risk as outlined in a newly adopted system-wide nurse driven catheter associated urinary tract infection protocol . New Doc Flowsheet to support Nurse Driven Indwelling Catheter Removal Protocol Affects: Ordering providers and inpatient nurses Region affected: All regions A new doc flowsheet group has been created and existing orders modified to support a system wide nurse driven Indwelling Catheter Removal Protocol. The group is available in the Adult PCS, just under Genitourinary Interventions. It includes three rows, requiring a yes/no answer. The group will be expanded by default. Orderables: Insert indwelling urinary catheter and Remove indwelling urinary catheter orders have new process instructions alerting the provider that the protocol will be utilized by the RN. In addition the Remove orderable now has a default of per protocol. A work list task will alert the RN once the insert order is active to assess the need for the catheter every 12 hours. New Doc Flowsheet to support Nurse Driven Indwelling Catheter Removal Protocol CAUTI Tips and Tricks CAUTI Protocol Sept 30 ECO Release Summary of Changes Page 4 of 34 Immunizations ECO Theme Folder: Immunizations Previous town halls, governance groups and ITSM tickets have produced a LONG list of optimization requests for immunizations for inpatient and ambulatory users. The forthcoming Epic upgrade and the developing Population Health initiative are likely to satisfy many of the ambulatory requests, but there is a need to resolve several key usability issues in the interim. The Sept ECO release will: Establish and maintain the Immunization Summary Report as the single source of truth for immunizations info across the care continuum. Improve usability of the Historical Admin Report by updating the template and standardizing the view for all users. Provide screening tools that identify acute care patients in need of influenza and pneumococcal vaccines, and deploy decision support tools (BPA’s) to assist with ordering those vaccines when indicated. o Optimize adult tools o New PEDS tools Provide a screening tool that identifies OB patients at Labor & Delivery who are in need of TDAP vaccine at postpartum. Immunizations Job Aid IP Immunization screening changes - ClinDoc Affects: Nursing Region affected: All We have updated the Adult Pneumococcal and Influenza screenings to comply with CDC guidelines. BPA’s have been created to guide you to the appropriate vaccination when required based on the answers given to the cascading flowsheet rows. (See attachments to view the complete screening tools) IP Immunization screening changes - ClinDoc IMM Screening Tip Sheet Updates to the Historical Immunization Template & Immunization Summary Report Affects: Physicians, Nurses, Mas Region affected: All- AK, WA, OR, MT, CA The Historical Immunization Template has been updated with seventeen additional vaccines and redesigned to list each immunization once with five columns across to document in Updates to the Historical Immunization Template & Immunization Summary Report IMM Reports Tip Sheet Immunization Workflow Enhancements Affects: Nurses Region affected: All Sept 30 ECO Release Summary of Changes Page 5 of 34 Immunization screening questions that eventually present orders (when vaccines are indicated) have been developed for influenza and pneumococcal vaccines. After completing the screening, alerts will clearly indicate if vaccine is indicated, and lead the user directly to the order. These are particularly useful for pneumococcal, as there are multiple products available to choose. If vaccine is indicated after screening, the alert will lead the user to the appropriate choice, taking the guesswork out of which pneumococcal vaccine should be administered. Two new patient list columns are available that will help clinicians and managers determine when immunization workflows are incomplete: indicates that immunization screening has not started indicates that immunization screening is incomplete indicates that an immunization is indicated, but that an order was not written indicates that the immunization has not yet been administered indicated that all steps are complete Immunization Workflow Enhancements In Basket ECO Theme Folder: In Basket The September ECO release continues work that was started and released in July, 2014. Updating additional In Basket folders Action buttons (adding additional buttons, removing unnecessary/redundant buttons, re-ordering buttons) Report/View buttons – adding standard set of reports/views if appropriate Updating My Last Notes view Implementing quick wins (e.g. add requested columns) Per Legal: For Clinical Users, will give user security point to allow them to attach to any user’s In Basket. Excludes non-clinical users (e.g. Front Desk, Registration, Scheduling, Billing) Adding 2 new sections to visit navigators: Instructions & Send Message. This will allow users to create a new In Basket Review Needed message that is more task based, requires some action vs. the existing Follow-up section which triggers In Basket CC’ed Chart that will be used more for FYI cc related topics. This way providers can prioritize and work on Review Needed items without worrying that it will get lost in CC’ed Chart. In Basket Attach to any user’s In Basket - Ambulatory, Beacon, ASAP, HIM, Clindoc, Orders, WebApps Affects: Clinical Users who work in Basket messages Region affected: All In the In Basket, Clinical users will be able to Attach to anyone’s In Basket without requiring the user Grant Access. In Basket Attach to any user’s In Basket In Basket Attach Job Aid Sept 30 ECO Release Summary of Changes Page 6 of 34 In Basket Button/Reports/Columns updates – Ambulatory, Beacon, ASAP, HIM, Clindoc, Orders, WebApps Affects: All Users who receive the updated In Basket messages Region affected: All In Basket Phase II Updates In Basket Button/Reports/Columns updates – ECO THEME - Ambulatory, Beacon, ASAP, HIM, Clindoc, Orders, WebApps MDRO ECO Theme Folder: MDRO MDRO theme focused on usability for infection preventionist including optimized patient banner with easy access buttons and SmartLinks and a new navigator build that will allow for a “one stop shop” for the Infection prevention staff. Scope of work included: Infection Preventionist Workflow: Improve efficiency while decreasing number of clicks to access more data (i.e. side bar reports) Isolation status workflow: Increasing functionality of the isolation banner for more transparent viewing Communications of Transitions of care (internal/external): Improving on the ticket to ride, and other transfer documentation in order to increase handoff communication. Visibility: Increasing the visibility of the MDRO by removing acronyms and replacing with more comprehensive titles. Infection Prevention — IP Affects: Infection Preventionists, Nursing, Providers, Case Managers, Social Workers, ADT, EVS Region affected: All Updates to Infection Prevention workflow tools, orders, reports and functionality around the infection control workflow Infection Prevention — IP MDRO Job Aid Changes to Isolation / Infection Category List used by EVS – ADT / Prelude Affects: EVS Staff Region affected: All Both the Isolation and the Infection Category Lists have been updated as seen below Changes to Isolation / Infection Category List used by EVS – ADT / Prelude Sept 30 ECO Release Summary of Changes Page 7 of 34 Nursing Navigators ECO Theme Folder: Nursing Navigators Navigators throughout the system have provided inefficient and non-standard workflows for RNs. Build/design is inconsistent and there is often more information than needed within a specific navigator causing navigator fatigue and un-helpful information sharing. This project will focus on a systematic redesign of RN navigators for consistent look and feel, similar technical solutions, actionable vs. information sharing options and improving usability for clinician workflows. In addition, the team will create design guidelines and principles to be applied to future/new navigators, so analysts can build workable navigator solutions for end-users. Navigators: Nursing Affects: Nursing – IP Region affected: **NOTE- This project will have technology piloted for one week in production from Sept 30th to Oct 6th at Holy Family, St. Vincent and select departments in MT (Medical Oncology) and Alaska (4 North Surgical). All regions will receive the new navigators on Oct 7th unless otherwise communicated. The Epic Clinical Optimization (ECO) program focused on updates to RN navigators as a theme for the September release and were specific to inpatient, OB and perioperative navigators. With the overhaul of navigators affecting various specialties, ECO found a need to create design standards for a consistent enduser experience. Principles used throughout all of the navigator changes include the following Utilizing the Table of Contents within the navigator as action-oriented items for end-users to complete as part of the workflow Re-organizing information topics, reports, etc., to different areas within the navigator (buttons/sidebar report) Reducing scrolling within the navigator to prevent overwhelming the end-user Consolidating (when appropriate) similar topics, screenings and workflow needs Keeping end-users within the navigator to complete their work and removing table of content items that jump end-users to a different location in Epic Consistent formatting, buttons, colors, icons and naming conventions through all navigators Removing duplicative documentation and using the “right tool” for appropriate documentation Commonalities Each navigator will start with a Communication section which will present pertinent data for that workflow. Toolbars will be above each navigator with convenience buttons for specific activities Sidebar reports will be critical working with navigators. New sidebars will launch upon loading of the new navigators, presenting pertinent information for each workflow. Please do not close the sidebar while working in a navigator. Preferred Language and Advance Directives (in the sidebar) display information collected from Demographics and from Doc Flowsheets. Editable from either. Sept 30 ECO Release Summary of Changes Page 8 of 34 Inpatient/OB: Inpatient: The original ADT navigator will be available for a short time from More Activities for reference. OB: Triage Navigator has been replaced by the Arrival navigator. IntraOp has slight changes to match the changes made within the OR navigators. Transfer navigator is being retired. When transferring OUT, complete usual documentation and utilize the Professional Exchange report. Use new Admit-Arrival navigator when receiving a patient. Admission: Specimen Collect and Signed/Held orders are functions available in Communication section. Required documentation dots (green/red) are now imbedded in the Admission navigator. Several sections have combined the required documentation elements. All must be addressed to turn dot green. (Example: Latex and Allergies are now a single section) History is displayed in a single non-scrolling review. Click buttons to edit. Social history needs Smoking/Tobacco status, which should be anything other than “Never Assessed”. Mark as Reviewed in this section counts for all of History. Latex screening is now imbedded as a link within the Allergy section. Still need to document Latex as allergy if screening is positive. Immunization Screening will cause a sidebar report to appear specific to historical immunizations. The full Immunization activity is available from the navigator menu. The same navigator is used for both adults and pediatric patients. Pertinent documentation sections will display according to age of the patient. Discharge Navigator will display only the communication section initially. The checklist will open in the sidebar. Click on items within the Checklist to perform discharge tasks Checklist will provide information pertinent to each list item. Examples: last filed date, number of unresolved care plans, etc. Follow Up and Discharge Instructions are combined into a single section, utilizing a dual-pane mode. AVS Clinician Name is available for edit directly from Checklist. This adjusts the name of the nurse showing on the After Visit Summary. Link to MyChart Signup will only display for adult patients. Navigators: Nursing IP RN Arrival Navigator Tips & Tricks OB Navigators Updates for Perinatal Nurses Perioperative Navigators Please see attached link for detailed changes to the following navigators: Preadmit (used to be Pre-op Phone Call / Pre-op Visit) Preop Intraop PACU Arrival PACU Discharge Sept 30 ECO Release Summary of Changes Page 9 of 34 Phase II See ECO Theme folder for tips and tricks and job aid documents related to Optime Navigators Periop Nurse Navigators Optime Navigators Overview Nursing Usability: ED Templates ECO Theme Folder: Nursing Usability ED Templates Goal of this theme is to streamline and document the assessments below, including narrator and navigator changes to assist in the standardization process. Headache Assessment Brief Assessment added Pediatric content o 0-90 days o 90 days to 12 years o 13 plus Pediatric Brief Assessment Therapeutic Hypothermia Procedure Nursing Usability ED Template Change Notice Order Set Updates ECO Theme Folder: Order Set Updates The Epic Clinical Optimization program has made changes to postop order sets with a focus on usability. Teams did not do a ground-up redesign, nor did the team make changes to content. Current postop order sets will remain in parallel with the new postop order sets for one month or longer. Below is a summary of the changes to each postop order set and a crosswalk of the old order set name/number and new order set with an improved naming convention and number. 1. GENERAL section a. Admission group – no change b. Code status – no change c. Discharge path – only used in 3 places; removed. d. Nursing – consolidated a lot of other groups, removed redundant and unnecessary orders (such as those handled by standard nursing practice). There are some variations as needed for specific specialties. i. Vital signs – post op vital signs are per unit routine, a single order ii. O2 therapy, pulse ox, incentive spirometry iii. Notifications - a single order iv. Activity - standard activity level, and encourage activity v. Weights Sept 30 ECO Release Summary of Changes Page 10 of 34 2. 3. 4. 5. 6. 7. vi. Strict I/O – routine I/O done as standard nursing practice based on unit routines (every shift, every 8 hours, every 12 hours) e. Drains and Wound Care- standard group used now in all order sets, added ice pack f. Indwelling Urinary Catheter Management - standard group used now in all order sets, designed to maintain SCIP compliance. g. Diet – reduced to NPO and advance as tolerated. h. Ancillary services – OT, PT, Speech, RT, Nutrition Services i. Social work and/or case management, per facility. STUDIES – PACU section a. Contains lab and imaging needed in PACU, with PACU phase of care. Separated so they don’t get confused with studies needed postop. STUDIES – POST OP section a. Lab and imaging needed postop, needed now, in AM, serially, etc. VTE PROPHYLAXIS section a. standard groups used now in all order sets IV section a. Removed “insert IV”. Post op patients have one b. Added “wean IV fluids” to reduce IV’s until not needed. c. IV fluids – contains all commonly used solutions. PCA a. standard group used now in all order sets b. added banner to appear to indicate when patient is at risk for sleep apnea, from preop screening or diagnosis Medications a. Arranged order to flow from head to toe b. Removed certain meds based on extremely low utilization (i.e. Nubain, rectal/oral APAP) c. Most sections are same standard that currently exst (pain, hypnotics, antiemetics, and bowel) d. De-paneled NSAIDS (now ketorolac can be ordered without ibuprofen if desired) e. Stress ulcer prophylaxis was revamped. There are now two sections, Acid Reducers Scheduled and Acid Reducers PRN with streamlined choices. Creation of New and Modified Orders New or modified orders affected include: Activity: progressive ambulation postop (ACT4B). Apply heat to affected area (NUR261) Cold therapy (NUR1) Hip abduction (NUR4) Provide patient with post breast surgery garment (NUR26) Range of motion (ACT12) Remove sutures/staples (NUR413) Sept 30 ECO Release Summary of Changes Page 11 of 34 Strain all urine (NUR386) Strict I&O (NUR2) Weight bearing (ACT13) New and modified orders Updated postop order sets Affects: Providers and clinicians caring for postop inpatients Region affected: All Updated postop order sets Crosswalk Order Sets Patient Story ECO Theme Folder: Patient Story With the September release, we continue the work to improve our documentation and presentation tools that tell our patients story. Goals include: Improve documentation and presentation tools so that the patients story is clear Improve tools that support professional processes of care Reduce clutter and simplify September Scope of work includes: Skin care management OB Professional Exchange Newborn/NICU professional exchange report Update to Ticket to ride Spiritual care professional change report Spiritual care accordion report Update to interprofessional overview · Overview Reports – Inpatient Affects: Clinicians – inpatient Region affected: All Various changes have been made to the Interdisciplinary Overview reports. Sections have been added or removed. Modifications made to existing reports include: Nursing: Removal: Diagnosis (from ADT, non-clinical) Addition: Title, Precautions widget, Specimen Collect widget, Ride Contact Info Modification: Sticky Notes (see Additional Info) Provider Addition: Title, Precautions widget Modification: Sticky Notes (see Additional Info), CDI Sticky update Respiratory Addition: Title, Precautions widget Modification: Sticky Notes (see Additional Info) Therapy Sept 30 ECO Release Summary of Changes Page 12 of 34 Addition: Title, Precautions widget Modification: Sticky Notes (see Additional Info) CM/SW Addition: Title, Precautions widget, Ride Contact Info Modification: Sticky Notes (see Additional Info) Obstetrics Addition: Title, Precautions widget Modification: Sticky Notes (see Additional Info) Pediatrics Addition: Title, Precautions widget Modification: Sticky Notes (see Additional Info) NICU/Nursery Addition: Title, Precautions widget Modification: Sticky Notes (see Additional Info) PCT Removal: Diagnosis (from ADT, non-clinical) Addition: Title Modification: Sticky Notes (see Additional Info) Additional information: Sticky Notes: Various Sticky Note groups will be replaced by newer streamlined ones. Stickies can contain up to 2000 characters and upon occasion obstruct the view of other pertinent data. New versions display a subset of information with links to full/editable content Title bar: Title indicates the actual report that is open, and has up to 3 “jump” links that will take the clinician to specific portions of the report. Specimen Collect: Displays current status (if documented) and provides button for changing status. There may be other slight changes, re-sequencing, etc. on specific Overview Reports IP Overview Reports OB and NB/NICU Professional Exchange Reports Affects: Nursing – OB & NB/NICU Region affected: All Two new Professional Exchange Reports have been created for handovers of care: OB Professional Exchange Report & NB/NICU Professional Exchange Report. Both utilize an Overview style with colored widgets, 3-column format, and better organization of content. Some of the Overview widgets are being re-used, along with several new ones to help provide the best perspective of the patient. Simplify the exchange of information necessary for safe and holistic care Create consistent and effective handover tools Minimize the reliance on memory during handover These are NEW reports, so users who have wrenched changes to their toolbar will have to re-wrench this. OB and NB/NICU Professional Exchange Reports OB NB-NICU PER Screen Shots Sept 30 ECO Release Summary of Changes Page 13 of 34 Inpatient: Documenting Skin Infestation Affects: Nursing Region affected: All New Doc Flowsheet row, in the Adult, OB, Pediatric PCS (Patient Care Summary). Skin Group/ Additional Documentation cascade. Skin Infestation: Able to document infestation, such as lice Additional information: Displays in various reports Problem List Enhancements ECO Theme Folder: Problem List Update to Problem List SmartLinks to remove (HCC) Affects: Providers Region affected: All Problem List SmartLinks are used to import the problem list into provider notes. In February 2014, a change was made to the problem list to include “(HCC)” on all diagnoses that met criteria for Medicare Hierarchical Condition Coding. However, the unintended consequence of this was showing this text in all areas where the problem list is used, including patient facing materials and provider notes. With this change, the vast majority of Problem List SmartLinks (see attached) will remove (HCC) from the problem description unless the provider chooses to show the (HCC) text by updating their SmartLinks. Update to Problem List SmartLinks to remove (HCC) Restraints ECO Theme Folder: Restraints The goal for this theme is to assist clinicians in providing safe & appropriate care to patients in restraints by streamlining documentation & adding alerts. Scope of work included: Documentation/Flowsheets o Non-violent Restraints o Violent Restraints o Seclusion BPA for Restraint/Seclusion care plan template Worklist task – Q2hr Non-violent assessment Patient list columns Orders/BPA Restraint/Seclusion Orders, Documentation and Care Plan — Orders/ClinDoc Affects: Providers, Nurses, Trained Observers Region affected: All BPAs to alert nurses & providers that restraint order has or is about to expire or BPA notice that the patient has no active order Sept 30 ECO Release Summary of Changes Page 14 of 34 Restraint/Seclusion Orders, Documentation and Care Plan Alerts for Restraints and Seclusion IP Nursing Tip Sheet Restraints and Seclusion ASAP Nursing Tip Sheet Restraints and Seclusion ASAP Provider Tip Sheet Restraints and Seclusion IP Nursing Tip Sheet Severe Sepsis Alerting ECO Theme Folder: Severe Sepsis Screening In July 22 ECO release, severe sepsis scoring transitioned from Amalga to Epic for those facilities that were using the Amalga functionality and a pilot for BPA designed to provide early detection of possible severe sepsis was implemented. With the September release severs sepsis alerting is available to other ministries. Possible Severe Sepsis Alerts Affects: Nurses, Providers Region affected: AK, WA, MT, OR, CA, but not all ministries Severe Sepsis is defined as meeting: two of the following criteria: Respiration > 20 Heart Rate > 90 WBC > 12000 or <4000 or bands>10% Temperature > 38.3 or < 36 and one of the following criteria: SBP < 90 Lactate >2 These patients are excluded from qualifying for Severe Sepsis alerts: Patients < 18 years old Patients with comfort care orders Patients with a Problem List Dx of Severe Sepsis or Septic Shock Patients with a Severe Sepsis Management order Several features are available in Epic to identify patients who meet the Possible Severe Sepsis Alert criteria: Alert icon on Patient Lists: MEWS/Sepsis patient lists are available in the MEWS/Sepsis Scoring folder for ALL facilities. Also, staff can add the SEPSIS SEVERE column to their own patient lists, as desired. Alert icon in ED Track Boards: My Patients, All Patients, and My + Unassigned Alert text pages to nursing: Each facility had the opportunity to define which staff (charge nurses, rapid response nurses, house supervisors etc.) to notify when patients met the Possible Severe Sepsis alert criteria. Alert pages are sent no more often than every 24 hours. Provider Best Practice Alert pop-up screen: These alerts offer providers a quick way to order additional tests, such as lactate, or to begin sepsis treatment order sets. If providers select one of the acknowledgement buttons and then click “accept” or “accept &stay”, the alert will not present again for 24 hours. Possible Severe Sepsis Alerts Sept 30 ECO Release Summary of Changes Page 15 of 34 Miscellaneous changes by Application ADT New WQs for Cosmetic Surgery Patients — Prelude / ADT Affects: Central Access Services, Access Services and On-site Financial Counselors Region affected: AK, WA, OR, MT, CA – this does not impact Community Connect There are new Work queues available in all regions for patients that have been marked as “Cosmetic / NonCovered procedure” during Case Entry in OpTime. Preadmission and admission encounters will fall to this WQ for review. Once a Stop Bill has been added of “HB Services Package Pre-payment” the encounters will leave the WQ. The naming for these WQs is: ADT OR ALL VER COSMETIC PATIENTS ADT WAMT ALL VER COSMETIC PATIENTS ADT CA ALL VER COSMETIC PATIENTS ADT AK SA 10 VER COSMETIC PATIENTS Changes to Isolation / Infection Category List used by EVS – ADT / Prelude Affects: EVS Staff Region affected: All Both the Isolation and the Infection Category Lists have been updated as seen below Changes to Isolation / Infection Category List used by EVS – ADT / Prelude AMBULATORY The following changes affect both inpatient and outpatient. For a full list of Ambulatory changes for September 30, 2014 click here Updates to Chart Review Affects: All End Users Region affected: All Live Regions New tools have been added to Chart Review to reduce the time it takes for users searching for information within the patient record. A new “MyChart” tab will be added in Chart Review to aid in locating historical transcripts between patient and providers via MyChart. Additionally, the Patient Email and Refill encounter reports will be updated, and a “Patient Message Review” button created. Together, these changes will shorten the time it takes for providers and staff to locate MyChart related documentation within the patient record. New Quick Filters will also be added to most other tabs for faster searching of notes, encounters, and orders. Updates to Chart Review Sept 30 ECO Release Summary of Changes Page 16 of 34 ECO Theme Folder: Chart Review Improvement ANESTHESIA Anesthesia Multiple Updates – Anesthesia Affects: Anesthesia Providers Region affected: All Multiple Anesthesia Updates: Updates: (Preop, Intraop, Postop navigators) Anesthesia Types New: PNB & IVRA Renamed: “total IV anesthesia” – TIVA Removal: (Preop navigator) Anesthesia Meaningful Use New: Abx Mar tab Updates: (Intraop navigator) MTP Blood administration New: Dual Signoff Transfusion Reaction Reaction Symptoms Product #’s Updates: Added new MTP rows to Blood Transfusion report navigator) Event NG/OG Removed Update: (Preop navigator) Erroneous Encounter – Send Message Friendly reminder to not include PHI when sending note Update: (Preop navigator) History Anesthesia Multiple Updates Anesthesia Job Aid ASAP ED Guide TB Report and navigator updates Affects: ED Guides Region affected: Oregon The ED Guides will receive a new Track board report and a renamed trigger button in the ED Guide Navigator. ED Guide Track board and other ED Guide updates: The ED Guide track board report will display new arrangement Service area flowsheet row is now triggered by the Provider Confirmed Assistance row The new status of Admitted" and "Patient Out of Scope", will displayed in the Guide Status N/A flowsheet row Sept 30 ECO Release Summary of Changes Page 17 of 34 New clinics will be displayed in the “Referred Clinic Type Portland” flowsheet row of the Initial Contact section of the ED Guide navigator; Oregon City Medical and United Urgent Care and Family Medicine. The “Appointment Kept” flowsheet is no longer displayed in the 30 Day dispo section of the telephone encounter ED Coder Critical Care Charge Workflow Affects: All ED Coders Region affected: All ED Coders will now be able to add critical care charges to an account from the facility preference list instead of having the Critical Care E/M row file the charges automatically. This will allow the coders to add the correct provider to each charge. 1. The Critical Care charge has been added to the ED Coder preference list for each facility 2. The automatic charging function on the Critical Care E/M row has been removed. ED Coder Critical Care Charge Workflow ED Coder Critical Care Charges Tip Sheet Multiple (6) ED Optimization Enhancements for ED Staff 1. ED MD More Activities Redesign Affects: Physicians, Midlevel’s and Residents Region affected: All, AK, OC, WM The ED MD More Activities menu has been reformatted to group similar activities together 2. ASAP Add Acetaminophen Overdose & Pediatric Growth Chart to Scoring Tools Activities Affects: ED/UC Physicians, Midlevel’s Region affected: All, AK, OC, WM 3. Add ED Treatment Team to Encounter Summary for Messages in Hospital Chart Completion Folder Affects: All Users Region affected: All, AK, OC, WM 4. ED Physician Call Back Pool Affects: Physicians, Midlevel’s and Residents Region affected: All, AK, OC, WM Physicians will now have the ability to identify patients requiring a clinical call back by documenting in the ED Callback section of the Discharge Navigator. Once a request has been documented the system will route an In basket message to the ED Clinical Nurse F/U Pool or the ED Clinical Provider F/U Pool. Once in the In basket Folder the physician can create a new telephone encounter to document the outcome of the callback. This functionality will only be activated for Emergency Departments who have decided to opt-in with this enhancement 5. Immunization Screening documentation now available on Triage Summary Report Affects: All Users Sept 30 ECO Release Summary of Changes Page 18 of 34 Region affected: All, AK, OC, WM The Immunization Screening documentation will now appear in the Triage Summary Report. This information will in between Immunization History and Medical History. 6. New SmartText for Inpatient Vitals with Pain Rating Affects: All Users Region affected: All, AK, OC, WM The creation of a SmartText to use within Provider’s Notes, that would include the patient's vitals as well as the patient’s last recorded Pain active and resting Pain Rating, as well as the Min/Max vital range over a 24 hour period. ASAP Provider Change Notice ED Guide Follow up Inbasket Messages Triggered by Flowsheet Events Affects: ED Guides Region affected: Oregon ED Guides can now have improved functionality that will allow them to automate ED Follow up message types to existing ED Guide pools when they are due. ED Guide F/U Inbasket Messages Triggered by Flowsheet Change Notice ED Guide Call Back Tips and Tricks ED Clinical Follow-Up Inbasket Messages Triggered by Flowsheet Events Affects: ED Physicians, ED Nurses Region affected: All (If your Ministry has opted in) During the discharge workflow the provider now has the ability to auto generate Inbasket messages to department specific ED Physician and Nurse Follow-Up Pools through use of the ED Call back section of the ED Discharge Navigator. ED Clinical Follow-Up Inbasket Messages Triggered by Flowsheet Events ED Clinical Call Back Tips and Tricks ED Post-Visit Follow-Up Event Based Inbasket Messages Affects: All ED Users Region affected: All (This functionality is available only if your Ministry has opted in at this time, instructions below on more info if your ministry is interested) ED users can now use pools to manage post-visit follow up calls and make telephone encounters. A new Inbasket message type: ED Post Visit F/U has been created and configured to be sent to department specific Follow-up pools based on the ADT discharge events of Discharged, or Dismissed. In addition the system has been configured not to generate this message type if a provider has already requested an ED Clinical call back by a physician or nurse, or if the patient has a status of Deceased. ED Post-Visit Follow-Up Event Based Inbasket Messages ED Post-Visit F/U Call Back Tips & Tricks Multiple ED Optimization Enhancements for ED Staff 1. ED Sticky Note Communication Tool Affects: All Users Sept 30 ECO Release Summary of Changes Page 19 of 34 Region affected: All: AK, OC, WM The ED Sticky Note Communication tool will be used for non-clinical communication between the physician and treatment team. The “Sticky: Provider” note will be used for Treatment Team to Physician communication while “Sticky: Treatment” note will be used for Physician to Treatment Team communication. When a note is entered by the Treatment Team an icon will appear in the “S” column on the My Patients, All Patients and My Patients + Unassigned Track Board Views. When a physician enters a note for the Treatment Team the icon will not activate on the Physician Track Boards. 2. FYI Track Board Column Shows Home Health and Hospice FYIs Affects: All Users Region affected: All: AK, OC, WM ED Staff will now see the “”HH Agency” and “Hospice” FYI types used by the respective caregivers in the track board FYI column. Previously these could only be seen on the patient banner and in the FYI activity. 3. ED Telephone Encounter Navigator and Menu Updates Affects: All ED Staff that uses the telephone encounter functionality Region affected: All: AK, OC, WM ED Staff now have a slimmed down ED-specific version of the telephone navigator. When accessing a telephone encounter either through Post-Visit Callback In Basket Management or through the Epic button the view should match the screenshot below. It includes activities such as Chart Review and Snapshot as well as a shorter navigator. The workflow for each ministry and role may differ but the navigator, activities and menu items will be the same for all users. 4. Sepsis PAF Affects: All ED Users Region affected: All: AK, OC, WM Adding a new Sepsis PAF column to the All Patients and My Patients track board views. New column will appear between the Results and the Comments columns. ED Sticky Note Communication Tool & Others ED Nurse/Tech/BH Narrator and Navigator Changes — ASAP Affects: All ED Nurses, Techs, and ED Behavioral Health Staff Region affected: All ED Techs now have External Catheter LDA in ED Narrator ED Nurse/Tech/BH Narrator and Navigator Changes — ASAP ED Telephone Navigator for MDL, PSMC and AVZ Affects: PSMC, MDL, AVZ Regions affected: WM, AK The staff at Seward, Valdez and Deer Lodge will have a slightly different view and workflow when completing an ED telephone call back. ED Telephone Navigator for MDL, PSMC and AVZ Infectious Screening Tool for Emergency Departments Affects: Nurses and Physicians Sept 30 ECO Release Summary of Changes Page 20 of 34 Region affected: All The Infectious Screening Tool will be available in the Triage Navigator and the ED Narrator. The screening will be viewable on the Triage Summary, Nursing Assessment and Patient Care Timeline reports. Infectious Screening Tool for Emergency Departments Infectious Screening Tool with International Travel Questions for Emergency Departments Affects: Nurses and Physicians Region affected: All The Infectious Screening Tool with International Travel questions will be available in the Triage Navigator and the ED Narrator. The screening will be viewable on the Triage Summary, Nursing Assessment and Patient Care Timeline reports Infectious Screening Tool with International Travel Questions for Emergency Departments BEACON Streamlined Workflow for Treatment Plans with Continuous 5FU Pump Orders Affects: Providers and staff who apply and use 5FU Treatment Plans Region affected: All Continuous fluorouracil “pre-cycle” has been removed. Convert to Inpatient Help is now found in each treatment cycle as a Physician Communication order. During visit pump connect and Home infusion pharmacy prescription orders are both listed within each cycle under Chemotherapy category with wildcard under comment to indicate selection of one continuous 5FU order is required prior to signing. Streamlined Workflow for Treatment Plans with Continuous 5FU Pump Orders Cosyntropin Infusion Therapy Plan – Lab Corrections Affects: All providers and staff who use the Cosyntropin Infusion Therapy Plan Region affected: All Labs in the Cosyntropin Infusion Therapy Plan have been replaced with a communication to place regionspecific labs that will function as expected in each region. In the past the labs in the plan have not functioned properly due to non-standard labs for these various tests being used. Instruction users to place labs specific to their region will correct this Pediatric Oncologists will have a Pediatric-specific navigator section Affects: Pediatric Oncology providers in Alaska and Spokane Region affected: AK, WM Pediatric focused History section will now be on the navigators. Will switch to an adult history section at age 18 Pediatric Oncologists will have a Pediatric-specific navigator section Helper navigators will be available for Providers Affects: All Oncology Providers Region affected: All Sept 30 ECO Release Summary of Changes Page 21 of 34 The Helper navigator will be available for providers. This will include the anti-coagulation navigator and the procedure navigator. This will also include the Results Console. Additional information: Regarding the Procedure navigator, orders will be placed in Order Entry, and then accessed in the procedure navigator for documenting on. The charges for the procedures will then be done in the charge capture section. Three New Options Available for Patient Care Team Relationship Affects: All users Region affected: All Research Coordinator Research Investigator Research Nurse Three New Options Available for Patient Care Team Relationship View Access to Research Studies Activity - Beacon Affects: All clinical and scheduling users Region affected: All All clinical and scheduling users have at a minimum view access to the Research Studies activity after clicking ‘Research: Active’ in the patient header. (Note: This does not impact users who already had a higher level of access for the Research Studies activity.) View Access to Research Studies Activity - Beacon Addition of Physician Procedures Section in Charge Capture – OP clinics - Beacon Affects: Physicians, Billing & Business office Staff Region affected: WA, OR, MT Physicians in Beacon OP clinics do not have an appropriate place to document procedure charges. Therefore, a new section will be added to the charge capture navigator section titled ‘Physician Procedures.’ The new physician Procedure section of charge capture will only be available when the physician is logged into an Outpatient context. This will provide a consistent list and location for OP physician procedure charging. Addition of Physician Procedures Section in Charge Capture – OP clinics - Beacon CLINDOC New Discharge Medication SmartLinks Affects: Providers Region affected: All Discharge Medication SmartLinks have been consolidated and updated to be more appropriate for Discharge Summary, SNF Transfer, and Discharge Readmit usage. With this change, a more consistent and appropriate list of medications will be available for clinicians to include in the various discharge documents that are written. Old discharge medication SmartLinks will be retired and redirected to the new set of SmartLinks. Sept 30 ECO Release Summary of Changes Page 22 of 34 Of note, the new Discharge Medications SmartLinks will create a HARD STOP inside a note (with ***) if medication reconciliation has not yet been completed. This may create new workflows for some clinicians and providers, but yields the most accurate list for patients New Discharge Medication SmartLinks Discharge Med SmartLinks Additional Information Inpatient: Documenting Skin Infestation Affects: Nursing Region affected: All New Doc Flowsheet row, in the Adult, OB, Pediatric PCS (Patient Care Summary). Skin Group/ Additional Documentation cascade. Skin Infestation: Able to document infestation, such as lice Additional information: Displays in various reports Stroke Resource enhancement requests - ClinDoc Affects: Nursing Region affected: All During visits to our ministries/facilities the Stroke Resource users requested enhancements. We have: Added “non-verbal” and “word salad” as selections in the Speech category list Stroke Resource enhancement requests - ClinDoc Updated NAS scale row information - ClinDoc Affects: NICU/Newborn Nursing Region affected: All To assist with scoring the Neonatal Abstinence Score the Row Information boxes were Updated with the instructions for appropriate scoring Updated NAS scale row information - ClinDoc Resp Therapy NEO RT Assessment request - ClinDoc Affects: Respiratory Therapists Region affected: All Adding the Apnea and Bradycardia group and the NICU SPO2 Trending group to the NEO RT Assessment flowsheet and removing the NICU SPO2 Trending group from the IP RT Procedure Monitoring flowsheet Resp Therapy NEO RT Assessment request - ClinDoc Update RT Overview Widgets - ClinDoc Affects: Respiratory Therapists Region affected: All The RT Overview widgets for Respiratory Orders and RT Labs will now look ahead 24 hours for new orders Update RT Overview Widgets - ClinDoc Charting enhancements - ClinDoc Affects: Nursing Region affected: All During visits to our ministries/facilities some enhancement requests were mentioned. We have: Sept 30 ECO Release Summary of Changes Page 23 of 34 Made the “Level of Consciousness” row will remain open for easier access Charting enhancements - ClinDoc Full SBIRT Assessment added to IP - ClinDoc Affects: Nursing, Case Managers/Social Workers Region affected: All The Full SBIRT/AUDIT/DAST assessment has been added to the Behavioral Health Department Admission Navigators and to the Inpatient Nursing and Case Managers/Social Worker list of “wrench-able” Flowsheet tabs Full SBIRT Assessment added to IP - ClinDoc NB Blood Screens Flowsheet Row additions Affects: Nursing – NB/NICU Region affected: All Newborns are sometimes still admitted to our nurseries at the time that their 2 nd and/or 3rd Newborn Screening test is needed. Additional rows have been added to reflect documentation of the second and third Newborn Blood Screen procedure within Infant Screens Group on the NB/NICU Profile if the newborns are still inpatients. These results will also be viewable from the NB/NICU Professional Exchange Report & the Newborn Screens Review report. NB Blood Screens Flowsheet Row additions New SmartLink for Inpatient Encounters Affects: Providers Region affected: All New SmartLink available in Inpatient context for users to pull the first encounter weight, the most recent encounter weight, and the calculated difference New SmartLink for Inpatient Encounters Rehab Plan of Care Smart text Rebuild — ClinDoc Affects: Rehab staff and all users who read Rehab Therapists Plan of Care Notes Region affected: All Rehab Plan of Care Smart texts have all been rebuilt to exclude headers and will now only pull in last filed values for the groups that contain goals. Strength and ROM have also been added where appropriate. 9/30/2014 LDA Types: Remapping Affects: All inpatient Region affected: All Several of the existing LDA’s had less than ideal mapping to LDA type. This has been remedied. This is a subtle change, with most of the effects in reports. Part of this work entailed build 3 new “types” for mapping: Chest Tube, Arterial Sheath, and Urinary Catheter. Reviewed all LDA’s for appropriate mapping, and changed where appropriate. LDA Types Remapping Sept 30 ECO Release Summary of Changes Page 24 of 34 Pediatrics: IP – Sedation Level Affects: All inpatient Region affected: All Ability to easily document the sedation level (Pasero Opioid Sedation Scale) from within the Pediatric PCS, and the Vital Signs screen (Pain group) Pediatrics Sedation Level Patient List Sticky Notes Affects: All inpatient Region affected: All When opening a sticky note for editing while in Patient List, it is sometimes difficult to validate that the sticky is opened on the correct patient. Header has been added to the underlying sticky displaying behind the edit window. Displays the name of the patient, MRN, age and gender along with the name of the specific Sticky note. Patient List Sticky Notes Ticket to Ride report – IP Affects: All inpatient Region affected: All Several important data elements have been missing, or difficult to determine if missing. Isolation and infection columns will now always display, even if nothing present. New alerts section to help with potential mood/violence issues and skin infestations Precaution orders will display (which includes Neutropenic) Better use of screen/paper real estate, using full 3 columns. Most patients will now fit on a single page. However, a header has been placed on the report so that if there are multiple pages, basic PHI will be on each Ticket to Ride report – IP Set Inpatient Charge Capture Filter to Display Pro-fees for Providers. Created Dividers to Improve Display and Organization of folders within Inpatient Professional Charge Capture Preference Lists Affects: All Providers Region affected: All – AK, WA, OR, MT, CA Currently, all filed charges including nurses medication orders display as the default filter in the “my charges” section of Charge Capture for providers. This results to having a huge list of filed charges for providers to review. Filter option for our providers to either display or hide Pro Fees is not currently configured. This will set the Pro Fees to be the default filter Set Inpatient Charge Capture Filter to Display Pro-fees for Providers. Sept 30 ECO Release Summary of Changes Page 25 of 34 ORDERS Update to Specialty Bed orderable — Inpatient Orders Affects: Physicians, Nurses, Clinical Staff Region affected: All Updating EQ111 Specialty Bed order to be a generic specialty bed orderable, with only one question of “Specialty bed type”, a hard stop for the free text answer Update to Specialty Bed orderable — Inpatient Orders Addition of Problem Oriented Notes to Provider Navigators - Orders Affects: Providers Region affected: All Access to Problem Oriented Notes has been added to the Admission, Discharge, and Transfer navigators for providers. Beneath the current problem list activity will be 2 buttons that allow launching of problem oriented notes into the sidebar or in the main window. The generate note button at the bottom of the activity will create an H&P note if opened from Admission navigator, a Progress note if opened from the Rounding or Transfer navigator, and a D/C Summary if opened from the Discharge navigator. Addition of Problem Oriented Notes to Provider Navigators - Orders Sleep Apnea BPA - changes to NURSE BPA – Inpatient orders Affects: Nursing Region affected: All In the July ECO release, a new Sleep Apnea Risk Management BPA was introduced. To review: This BPA fired based upon answers in the Sleep Apnea Risk Assessment Doc Flowsheet, as follows: 1. Answer to “Have you been diagnosed with Sleep Apnea” = yes 2. Total score of sleep apnea questionnaire (STOPBANG) >= 5. This causes a pop up to notify the provider and placed a sleep apnea teaching topic to Patient Education. However, patient education was added to the discharge information (AVS) based on a STOPBANG score of 3 and this was confusing to patients. That has been remedied. The teaching topic will now be placed for a score >3, similar to the AVS criteria. However, the popup to notify the provider will only appear with a score >=5 or the answer “yes” to the diagnosis. Provider Sleep Apnea BPA - Inpatient orders Affects: Nursing Region affected: All In the July ECO release, an new Nursing Sleep Apnea Risk Management BPA was introduced. This is a new BPA for PROVIDERS only (except anesthesiologists). This will have been released as a pilot on September 9 at WSH and WHF. If successful, it will be released on September 30. This is similar to the nursing BPA as far as criteria. It will fire, upon opening the chart, for Sept 30 ECO Release Summary of Changes Page 26 of 34 1. Answers in the Sleep Apnea Risk Assessment Nursing Doc Flowsheet, as follows: a. Answer to “Have you been diagnosed with Sleep Apnea” = yes b. Total score of sleep apnea questionnaire (STOPBANG) >= 5 2. Age > 18 3. No active order for “Sleep Apnea Risk Management” A pop will appear as follows: Provider Sleep Apnea BPA - Inpatient orders Duration of transfusion prompt added to Blood Transfusion-NICU orderset - Orders Affects: NICU Providers Region affected: All Duration (in mins) prompt will be added to platelet order placed from within the orderset Blood Transfusion-NICU (5267). This prompt will be optional Type and screen order change on Blood Admin- NICU orderset - Orders Affects: NICU Providers and Blood Bank staff Region affected: CA The existing type and screen orders for the NICU blood admin (5267) orderset will change for the California ministries. Type and screen order change on Blood Admin- NICU orderset - Orders Activity order change for OPH Retina post op ordersets- Orders Affects: Ophthalmology providers Region affected: All Activity orders for the Retina Postop sets are being reverted to their previous state to include specific positioning requirements for this surgery. Activity order change for OPH Retina post op ordersets- Orders Blood Bank orders added to PED Cardiac ECLS Maintenance [2421] Affects: Pediatric providers Region affected: WA Orders for type and screen, blood products and product availability have been added to the Blood Bank orders added to PED Cardiac ECLS Maintenance orderset. Previously, providers placing ECLS/ECMO orders have had to go to several different ordersets if blood products were needed. Blood Bank orders added to PED Cardiac ECLS Maintenance [2421] Add OWF’s epidural (ERX 74700041 to PRL 2799) Affects: OWF- OB/GYN physicians, L&D nursing, and Pharmacy Region affected: Oregon OWF uses medication order, sufentanil 0.5mcg/mL & ropivacaine 0.1% epidural, exclusively for L&D epidurals, but the only option for OWF OB providers currently is the custom epidural builder. Additional information: ERX 74700041 has been added to PRL 2799 and the PRL is currently in Test Release. This was moved to Beta for Pharmacy Informatics Review and will be fully released and moved to PRD with the 30 Sept 2014 ECO Release. Sept 30 ECO Release Summary of Changes Page 27 of 34 Change to Cosign Requirements for CMS Two Midnight Rule. Inpatient Orders Affects: Resident physicians, Mid-level providers – Nurse Practitioners and Physician Assistants Region affected: All The CMS regulation requiring co-sign of an “Admit to Inpatient order” for the above providers has been in effect for nearly a year. In July, we enacted a tool that requires co-signing for that order (Admit to IP, ADT1). Although the rule was required only for Medicare patients, we were unable to implement that due to technological limitations, and a co-sign was required for all IP admission orders. This caused extra work for these providers in order to prevent significant reimbursement losses for the system. Change to Cosign Requirements for CMS Two Midnight Rule. Inpatient Orders OPTIME Improved Base Procedures RWB Report — OpTime Affects: OR Managers, Preference Card Builders Region affected: All Improvements have been made to the RWB series OR Base Procedures by Service, which is used to identify surgical procedures (ORP) authorized to a particular location. These reports now display authorized locations and services, dates of creation and last change, and essential data maintained on the base procedure including linked surgical history record and procedure level. Improved Base Procedures RWB Report — OpTime Wound Class Definitions — OpTime Affects: Surgical Services IntraOp Registered Nurses Region affected: All A new button has been created for the Intraop navigator toolbar for Wound Class definitions. Wound classes are clearly defined and available for reference in a popup window for the circulating nurse. Wound Class Definitions — OpTime Request Outside Records During Preadmit Testing — OpTime Affects: Preadmit Testing Clinics Region affected: All Staff in preadmit testing clinics will now have access to Request Outside Records (Care Everywhere) within scheduled appointments, matching current access from within the surgical case. This will be located under More Activities. Request Outside Records During Preadmit Testing — OpTime Pick List Supply Data Available for Preference Card RWB Reports — OpTime Affects: OR Managers, Preference Card Builders Region affected: All Four new report columns are available to pull supply information from pick lists in Reporting Workbench preference card reports Pick List Supply Data Available for Preference Card RWB Reports — OpTime Sept 30 ECO Release Summary of Changes Page 28 of 34 Improved Staff Search ( Preop / PACU / Phase II ) — OpTime Affects: Periop RNs Region affected: All The Staff sections in Preop, PACU and Phase II navigators have been improved to allow out-of-area and non-configured staff to be documented through a separate “Database Lookup” field. The standard lookup field has been further restricted to filter out surgeons and anesthesia providers, who are not typically documented here. Improved Staff Search ( Preop / PACU / Phase II ) — OpTime Reporting Workbench report name change - OpTime Affects: Users of the Reporting Workbench (My Reports) tool Region affected: All Operating room Infection control report name change. Old name: PAMC Infection Control Report New name: OR Infection Control Report – PHS Case Print Report - OpTime Affects: Operating rooms that use the Collaborative Build Case print report for picking cases Region affected: All The case print report will now include: Supply comments Drug amount and comments Updated footer with the patient’s name, MRN, and page information **PLEASE REMEMBER: These papers will now need to be shredded and not just recycled in normal trash as they will contain PHI. “OR Case Special Needs” report update - OpTime Affects: OpTime surgery schedulers; users of “OR Case Special Needs” report (#1070821196 Region affected: All This report will now contain the information entered in the “Case Notes” field, in addition to the “Special Needs” field, used by surgery scheduling “OR Case Special Needs” report update - OpTime Chart Review “Surgery” report update - OpTime Affects: Users viewing the Surgery report (Case Information) in Chart Review Region affected: All The “Implants” section of the Surgery report (Case Information) in Chart Review has been updated to include the item’s Model/Catalog number and the implant action. Chart Review “Surgery” report update - OpTime New WQs for Cosmetic Surgery Patients — Prelude / ADT Affects: Central Access Services, Access Services and On-site Financial Counselors Region affected: AK, WA, OR, MT, CA – this does not impact Community Connect Sept 30 ECO Release Summary of Changes Page 29 of 34 There are new Work queues available in all regions for patients that have been marked as “Cosmetic / NonCovered procedure” during Case Entry in OpTime. Preadmission and admission encounters will fall to this WQ for review. Once a Stop Bill has been added of “HB Services Package Pre-payment” the encounters will leave the WQ. The naming for these WQs is: ADT OR ALL VER COSMETIC PATIENTS ADT WAMT ALL VER COSMETIC PATIENTS ADT CA ALL VER COSMETIC PATIENTS ADT AK SA 10 VER COSMETIC PATIENTS Blood Bank Navigator for Spokane, WA Periop RNs — OpTime Affects: Periop RNs Region affected: WHF & WSH Since the Spokane, WA region uses an off-site blood bank, a specialized navigator was launched for WHF and WSH in January, 2014 to assist with their unique workflows. This tool will now be available within surgical encounters to periop RNs at these ministries under More Activities > Blood Bank. For reference purposes only, it provides a centralized place to view blood orders, results and transfusion history. The Shift Note section is used only by blood bank staff, to communicate directly with providers. Periop staff should not use Shift Notes. Blood Bank Navigator for Spokane, WA Periop RNs — OpTime Notify provider order added to the Blood Transfusion – Adult (2267) orderset Affects: Providers Region affected: All An order for when to notify a provider for conditions related to blood transfusion administration orders is being added to the Blood Transfusion – Adult orderset Notify provider order added to the Blood Transfusion – Adult (2267) orderset Optime (Intraop) Safe Surgery Checklist Updates Affects: Optime Intraop RN’s Region affected: All Added 2 new questions to the Safe Surgery Checklist – Time Out Anticipated length of case discussed Critical unexpected steps discussed Formatting consistent in Briefing, Time Our & Debriefing Optime (Intraop) Safe Surgery Checklist Updates Optime(Preop/Preadmit) History Reorg Affects: Preop & Preadmit RN’s Region affected: All History reorganization broke out by Systems with new added questions Optime(Preop/Preadmit) History Reorg New NPO Status review question for intraop nurses— OpTime Affects: OpTime users of the Intra-op navigator Region affected: All Sept 30 ECO Release Summary of Changes Page 30 of 34 New question regarding NPO status review in the Intraop Navigator New NPO Status review question for intraop nurses— OpTime Pre-op Checklist changes— OpTime/Inpatient/ASAP Affects: Users of the Pre-op (Pre Procedure) checklist Region affected: All The blood questions have been moved together. The beta blocker FlowSheet rows from the "Interview Complete" section have been added. There are two new questions regarding the prep the patient performed at home. Pre-op Checklist changes— OpTime/Inpatient/ASAP Update to “Demographics” navigator section— OpTime Affects: OpTime users of the OpTIme navigators Region affected: All The “Demographics” section now has a link to allow updates to patient information Update to “Demographics” navigator section— OpTime Adult PACU Doc Flowsheet – Update to Pain/Comfort Group Affects: PACU RNs Region affected: All Change: To comply with Joint Commission requirements and Standards of Care, the Pain & Comfort section of the Adult PACU doc flowsheet has been updated to pull in the correct CPM Group which includes rows for Pain Management Interventions, Response to Pain Intervention and Sedation Level: Adult PACU Doc Flowsheet – Update to Pain/Comfort Group RADIANT Add ‘Contrast’ to Naming in PRL 1321 (CATH LAB MEDICATIONS) Affects: Physicians, nursing, and radiology personnel who order cath lab medications Region affected: All PRL 1321 currently only contains radiologic contrast products used in the cath labs, but the naming does not indicate the presence of contrast. OSQ (CATH LAB MEDICATIONS - 113339) was edited to clearly identify a section for contrast to reduce confusion. The OSQ name Cath Lab Medications was retained to allow for future addition of non-contrast medications. Additional information: The revised language contained in PRL 1321 is currently in Test Release status and was moved to regional Beta environments for reviewed and testing by Willow Billing analysts. It will be fully released and moved to PRD with the 30 Sept 2014 ECO Release. Addition of CVA Line Type and Power Injectable Questions on IMG4337 and IMG558 - Radiant Affects: All users Region affected: All Sept 30 ECO Release Summary of Changes Page 31 of 34 Per DI Council and IPIW request, FL CENTRAL VENOUS ACCESS DEVICE PLACEMENT [IMG4337] and US GUIDED VASCULAR ACCESS [IMG558] now have two additional questions when ordering via Orders or Ancillary Orders regarding the type of CVA line and power injectable: Addition of CVA Line Type and Power Injectable Questions on IMG4337 and IMG558 - Radiant Update to Default List in Encounters-on-the-fly Button for Radiant Departments - Radiant Affects: All users Region affected: All In order for the Radiant Departments to be able to access certain types of encounters that they are not able to now, the restrictions on our departments have been removed. This will now allow our users to access various types of encounters if needed. Update to Default List in Encounters-on-the-fly Button for Radiant Departments - Radiant Update to ECG Orderables Result Display in Cardio Tab - Radiant Affects: All users Region affected: All In order to better organize and create a standard appearance within the Cardio Tab in Chart Review, the ECG orderables now have the same layout display when resulted as the other orders within that tab. The Order-Level/Encounter-Level documents have been moved below the Update to ECG Orderables Result Display in Cardio Tab - Radiant Update to Provider Display in Footer for External Results Report - Radiant Affects: All users Region affected: All Due to confusion with the provider information in the footer of the external results report, this has been reorganized to display all reading providers with their appropriate read dates as well as the CC’d providers below the reading and signing providers. Update to Provider Display in Footer for External Results Report - Radiant Update Chart Review Display for Resulted Exams/Orders in Imaging and Cardio Tabs - Radiant Affects: All users Region affected: All In order to standardize the look of resulted exams similarly to lab, the Imaging and Cardio tabs will now show a different display only in appearance for resulted exams. The data displayed remains the same. Once the resulting process has begun, the exam changes to display a widget format for the result information. Update Chart Review Display for Resulted Exams/Orders in Imaging and Cardio Tabs - Radiant Go Live for LVEF Data Entry in LVEF Results Console - Radiant Affects: Technologists Region affected: All For the on-going Cardiology Optimization project, the LVEF Results Console will be going live with new data standards when inputting the results. The external result entry within the console will no longer allow: negatives, free text, numbers below 5 or above 95. Go Live for LVEF Data Entry in LVEF Results Console - Radiant Sept 30 ECO Release Summary of Changes Page 32 of 34 WILLOW Deleting 4 Lovenox (enoxaparin) Medication Records — Willow Affects: All Ordering Providers Region affected: All 4 Lovenox (enoxaparin) ERX (medication records) are causing errors in the system, especially when being ordered for outpatient use. These records will be deleted from the system on 9-30-14. Please remove these records from all system preference lists & user preference lists prior to this date. The ERX being deleted are 441005, 441002, 441003, 441004. Here is a grid of the ERX being deleted & its equivalent ERX to use in its place: Deleting 4 Lovenox (enoxaparin) Medication Records — Willow] Prescription combination ERX with greater than 325 mg of acetaminophen will no longer be prescribeable for outpatient use Affects: Ordering Providers Region affected: All The FDA recommended that manufacturers of prescription combination products limit the amount of acetaminophen to no more than 325 mg in each tablet or capsule by 1-14-14. In order to comply with this mandate all prescription combination product ERX containing greater than 325 mg of acetaminophen will be changed so they cannot be prescribed for outpatient use. Please ensure the ERX with > 325 mg of acetaminophen are removed from all system and user preference lists prior to 9-30-14 Prescription combination ERX with greater than 325 mg of acetaminophen will no longer be prescribe-able for outpatient use Addition of diltiazem infusion orderable & order set changes— Willow Affects: Ordering providers, pharmacists Region affected: All A diltiazem infusion orderable ERX is under development. Order sets and panels containing diltiazem IV infusions will be updated with the dilitazem infusion orderable. Affected panels: 115924 (IP Med Diltiazem Open Heart Panel), 129004 (Calcium Channel Blockers) Affected order sets: 1600000051 (ED Narrator Code and Trauma Mixtures), 1600000010 (ED Dysrhythmia Treatment), 3040000075 (CTS IP Surgery Postop), 304000261 (CTS IP Thoracotomy Post Op), 3048000251 CTS IP VATS Post Op), 340000312 (IP CTS Cardiac Surgery Post-op). Addition of diltiazem infusion orderable & order set changes— Willow Remove Bar Code from Pharmacy Labels for Premixed Products Affects: Nursing, Pharmacy Region affected: All Patient-specific pharmacy labels, attached to premixed IV products, will no longer contain bar codes Remove Bar Code from Pharmacy Labels for Premixed Products Sept 30 ECO Release Summary of Changes Page 33 of 34 Require Rate for Large Volume IV Fluids - Willow Affects: Physicians, Nurses, and Pharmacists Region affected: All Large volume IV fluids will now require a rate, before that order can be signed. Require Rate for Large Volume IV Fluids - Willow Moving to charging for scanned NDC vs. dispensed where applicable - Willow Affects: No change to user workflow Region affected: All – including Community Connect Sites Pharmacy Charges: Implement charging for scanned NDC versus dispensed NDC when scanning occurs. No changes to how process is currently functioning for those departments and/or scenarios where scanning does not take place. Misoprostol is preferred for cervical ripening in OB Admit – Labor and Induction order set — Willow Affects: OB providers, OB RNs, Pharmacists Region affected: All Misoprostol is preferred pharmacological agent for cervical ripening. Vaginal and PO routes will both be available in OB Admit – Labor and Induction order set. Dinoprostone will be removed from order set. Its availability on local preference list is determined per facility decision. Misoprostol is preferred for cervical ripening in OB Admit – Labor and Induction order set — Willow Removal of "empty container" ERX's from mixture records— Willow Affects: Pharmacist, pharmacy technicians and nurses Region affected: All Situation/Background: Empty containers ERX’s currently are present in several of our mixture records and they no longer provide any function in our ERX records. These records were previously used in our mixture records to guide our pharmacy staff which was the appropriate container to mix a medication in Assessment: 167 ERX records were included in the list because they contained any “empty containers” records in the ingredient section of the mixture record. 29 ERX records were excluded since these ERX records belong to orderables and the removal of empty container in these records can break the functionality of the ERX orderable Recommendation: Empty container ERX’s have been removed from the majority of our mixture records to keep our records in line with recent build practices Sept 30 ECO Release Summary of Changes Page 34 of 34