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ORCHID ED Provider Quick Reference
Table of Contents
Writing Prescriptions and Medication Reconciliation
........................................................................................................... 16
Getting Started ................................................................................... 1
Follow up appointments ....................................................... 18
Checking in .................................................................................... 1
72 hour treadmill stress test .............................................. 19
Signing up for a patient ........................................................... 1
Work/School Notes ................................................................. 19
Starting a note.............................................................................. 1
Printing Lab Results ................................................................ 19
Incomplete notes ........................................................................ 1
Transfers ............................................................................................. 20
Attending notes ........................................................................... 1
Resident running the board ....................................................... 20
Patient Care ......................................................................................... 2
Adding new/clinic patients to the board ...................... 20
Placing Orders.............................................................................. 2
Physician Ambulance Triage Note ................................... 20
Order sets....................................................................................... 2
RIPT Note ..................................................................................... 20
Patient Weight or Vital Signs ................................................ 3
Calls from the lab, radiology ............................................... 20
Checking on order status and viewing labs / images 3
Pediatric ED specific issues ........................................................ 21
Marking critical/abnormal result as reviewed ............ 4
Customization ................................................................................... 21
ECG viewing .................................................................................. 4
Personal Macros ....................................................................... 22
Procedures .................................................................................... 4
Personal Autotext..................................................................... 22
Ultrasounds ................................................................................... 5
Favorite Printers ...................................................................... 23
ED prelim wet reads ................................................................. 5
Outpatient prescription favorite folder ......................... 25
Consults........................................................................................... 8
Favorite Order Folder ............................................................ 26
Blood Transfusions ................................................................... 8
Adding Common Orders to Your Favorite Folders .. 26
Finishing Notes / End of shift ................................................... 10
Creating Favorite Order Sets .............................................. 27
Signing Notes and Requesting Co-Signature ............... 10
Accessing Your Favorite Folders ...................................... 27
Pickups and Follows ............................................................... 10
Default Note Types .................................................................. 27
Medical Student Notes ........................................................... 11
MSE ........................................................................................................ 28
NP cases ........................................................................................ 11
Miscellaneous Tips:........................................................................ 30
Admissions ......................................................................................... 11
Ordering a blood gas............................................................... 32
Requesting Interqual .............................................................. 11
Ordering drips ........................................................................... 32
Running the admission .......................................................... 11
Ordering medications, use generic names ................... 33
Inpatient team places admit orders ................................ 12
Getting your prescriber information into ORCHID .. 33
Holding Orders .......................................................................... 12
Selecting a patient’s encounter.......................................... 33
Checking for old MRN ................................................................... 12
Continuing a 5150 order....................................................... 33
Checking for PMD, Family medicine ...................................... 13
Patient List for Follow Ups .................................................. 34
Observation and CORE .......................................................... 13
Discharges .......................................................................................... 14
Running the Discharge .......................................................... 14
Printing Spanish Discharge Instructions ...................... 15
Getting Started
Checking in
The system should prompt you to go straight to the check in screen. If not, do so by clicking the icon
of the white man with a green check mark on him. Use your last name as the “display name”.
Choose a color to express your flare, sass, or general mood. Choose a “Provider Role” and “Default
Relation”. Be sure that you checked “Available Provider” and “Available Reviewer”. In the display
name, put your last name, and the VOIP phone you will be carrying for your shift.
Viewing “The Board”
Click the “HAR Provider” tab. “HAR All Beds – Provider” is the same but also shows empty beds.
You can filter the list in much the same way you could in Wellsoft.
Signing up for a patient
Click once on the patient. Then click the icon of the white man. Your name will appear in the ATT
column if you chose Attending as your Provider Role at check-in. They will appear in the RES
column if you chose resident or NP.
Starting a note
Click “Provider Notes” from the tracking list then “+ Add” in the Provider Notes band. Until a
provider starts a note there will be a red clipboard in the “Note” column of the tracking list. To
choose a template, it’s easier to search in the “Reason For Visit” tab. If the nurses put in a reason for
visit, a template may be suggested for you. If you would like a different template, you can search by
system or free text search.
Remember you also need to do an MSE note for all patients! If the M icon is still showing on the
Events column, then click on the MSE button on the toolbar to complete an MSE note.
Incomplete notes
As long as the patient is on the tracking board, you will see a yellow clipboard in the “Note” column
to let you know your note is saved but not signed. Unlike Wellsoft, patients can be removed from
the board before you finish/sign your note. In this case, incomplete notes will show up in the
Message Center.
Attending notes
There are several pre-loaded templates already in place
.edteachsawnotedone
ED Attending Supervisory Note
(acceptable for Medicare billing)
1
I have seen and evaluated the patient. I reviewed and agree with _ the resident/PA/NP’s note.
.edteachsawnonote
ED Attending Supervisory Note
(acceptable for Medicare billing)
I have seen and evaluated the patient. I have discussed the case with the _ resident/PA/NP and agree with the
assessment and plan.
.edteachdiscussed
(Not be acceptable for Medicare billing)
ED Attending Supervisory Note
I discussed the case with the resident. I reviewed and agree with the _ resident/PA/NP’s documentation.
.edteachreviewed
(This would only be used for patients discharged from the PEDS ED without
attending involvement until morning rounds, or with 2nd attending).
ED Attending Supervisory Note
I reviewed and agree with the resident/PA/NP’s documentation.
Patient Care
Placing Orders
Quick Orders page: From the orders tab, click as many of the quick orders as you want or search
for your order manually. When you are finished, click the green folder in the top right. Click “Sign”.
Searching/Adding a new order: Within the Quick Orders page, you can search for an order in the
“New Order Entry” area.
Order Sets: Many order sets are on the Order Sets section of the Quick Orders. Additional ones can
be find by searching in the “New Order Entry” area.
Tip: Use the ED Trauma order set to place the many orders on critical trauma patients quickly.
Blood Transfusion order set is available from within the ED Trauma order set as well.
Tip: -If you order multiple radiology studies, you can fill in the same order details for all studies by
shift-selecting on all the orders after you go to modify them.
Order sets
Order sets can be found in either the search for new order or in the Quick Orders page, there is a
folder for order sets. They are organized by chief complaint/diagnosis vs procedure oriented order
sets. Click on the order set you would like to use. Inside the order set, you can select the orders you
would like to initiate. Some order sets have subphases, which include commonly bundled orders,
for example “ED Peripheral IV Insertion Subphase” which orders a peripheral IV insertion and
saline lock.
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Click on “Initiate” and “Orders For Signature” to review the
selected orders, then click sign.
While inside an order set, after checking the items you would like to order, you have the option to
“Save As Favorite” at the bottom of the screen. Doing so will save this order set in your Favorites
area. (See separate section on creating favorite orders.)
Patient Weight or Vital Signs
You can do this from the “Provider Forms” menu.
Choose “Vital Signs”. The powerform has two bands, one for Vital Signs and the other for
Height/Weight. Enter the weight in the “Dosing Weight” field, as it is the only field which displays in
the banner bar or is connected with drug dose calculations.
***Be aware that there is no maximum dose checking in ORCHID, so you will need to
know the normal adult dose and not exceed it for larger children.
Checking on order status and viewing labs / images
Go to the tracking list and click the refresh button in the top right. In the Lab column, 3/0 means
three labs ordered, 0 resulted. In the rad column, 1/0/0 means 1 study ordered, 0 completed, 0
reported.
There are two ways to view the results on your patient. Highlight your patient, double click on the
lab or rad column from the tracking list, or going to the ED Summary Page when you open the chart.
To change the date range of the listed results, right click the grey date banner bar at the top. Then
change the range to your desired dates by selecting “change the search criteria…”.
To view the images in Synapse, select the image you would like to view. Then on the upper right
tool bar there is picture icon called “view image” which will link you to Synapse.
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Marking critical/abnormal result as reviewed
A red star
on the tracking list indicates a critical lab or vital sign. It is very important that
these are marked as reviewed. Leaving the tracking list littered with red stars is a patient safety
risk, as it obscures the arrival of the next critical value. Marking the result as reviewed clears the
star for everyone, so each team should designate who should be responsible for clearing the star
(generally the senior resident on the case).
-When signing in the for the day, be sure “Available Reviewer” is selected.
Reviewing
-Double-click on the vital sign or the lab results column.
-Choose the Quick View tab.
-Look for the critical value in RED.
-Click “Review” and “Close”.
ECG viewing
If a patient had an ECG performed, double click the ECG column from the tracking list to view the
ECG. If the patient had an old ECG in ORCHID, then you can view it by going to Flowsheet in the
patient’s chart.
Procedures
Two steps:
1. Order: In the Quick Orders page, order the procedure (necessary so that the procedure is
auditable, and the coders know a procedure was done). There are also some order sets for
procedures that may be useful to you.
2. Documentation: Click “Provider Forms” from the tracking board toolbar. Select “ED
Procedures,” which will start a note. For central lines, select “Central Line Insertion (CLIP)”.
Select the note for the procedure being performed. At the bottom on the form, select the
performing provider, supervising provider, and attending provider. Do not use the procedure
documentation tool that is within the ED Powernote Provider Note.
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Ultrasounds
Like procedures, two steps (order and documentation):
1. In the Quick Orders page, order the “ED ultrasound by clinician”, then sign the order (necessary
in order to have ultrasounds be auditable).
2. Click “Provider Forms” from the tracking board toolbar, select “ED Ultrasounds.” Choose the
type of ultrasound performed. Fill out the necessary information. Don’t forget to mark who
performed, supervised, etc. at the bottom of the note. To sign, click the check mark at the top
left.
ED prelim wet reads
1.
2.
3.
4.
Once a radiology order has been completed, the Radiology Order/Activity Count column,
labeled “Rad” will show a clipboard icon.
In the patient's Tracking List row, right-click the Radiology Order/Activity Count column.
The Order Information dialog box is displayed.
If a radiology test has a Department Status or Order Status of Completed, +Add is
displayed under the Wet Read column in the Order Information dialog box.
Click +Add. The Wet Read dialog box is displayed.
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5.
6.
Select a positive or negative interpretation of the x-ray.
a) If you want to make a predefined interpretation of the x-ray, make a selection from the
Predefined Interpretation list.
b) If you want to enter a free-text interpretation of the x-ray, enter the text in the box.
Click OK. A red exclamation mark is displayed under the Wet Read column. This indicates
that a wet read exists. To view or add another wet read, click the exclamation mark.
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Previous comments are displayed in the Previous Comments box.
Additionally, a wet read comment can be entered from PowerNote ED.
Complete the following steps to enter a wet read comment from PowerNote ED:
1.
2.
From PowerNote ED, click Launch Wet Read in the Radiology Results section of the Medical
Decision Making encounter pathway.
Enter the wet read information and click Save. Wet Read text is pulled back into the note.
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Consults
In the Quick Orders page, go to the “Other,” then the “Consults” subfolder. Choose the consult order,
then sign the order. This will generate an icon for the consult on the tracking board. You will also
need to separately page the consultant. (FirstNet does not have paging capabilities yet…).
Blood Transfusions
Blood transfusion consents are now in iMed Consent. Log in to iMed Consent. Search for
“Transfusion” via the “Search” field at the top. Double click on “Blood Transfusion”. Choose
“LADHS English Consent WITH Blood”. It may list “Cardiac Surgery” next to it as the specialty. That
is fine, as the consent is just for blood. Click OK.
How to Order Blood Transfusions:
1) Search for the appropriate ‘Blood Transfusion Order Set.’
2) Select which orders you would like. Right click on orders that have a blue X, then choose
Modify to fill out the required details.
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TIP: Be sure to click “Initiate” then “Orders For Signature.”
FYI - There is NO TYPE & CROSS order anymore! If there is not a T&S already done, the
order set will automatically prompt you to order one. Be sure to choose Continue & STAT!
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3) Remind the nurse that they will need to order the “Pick Up Slip” from the Quick Orders Page
under “Nurse Triage Protocol Orders” when the blood product is ready. This slip will
automatically print out for them to bring to the Blood Bank.
Finishing Notes / End of shift
Signing Notes and Requesting Co-Signature
Interns: Once you have completed your provider note, “forward” it to the senior resident to sign.
Residents: Once you have completed your provider note, click on “Sign/Submit.” A new window will
pop up. Click on “Request endorsement.” Then click inside the yellow area under “Endorser” and
click the binoculars icon to search for the attending you would like to co-sign your chart. Click OK.
Under “Type” make sure that “sign” is selected (not reviewed). Then click sign to close the window.
Attendings and Residents supervising notes: In “Message Center” you can view the notes needing
your signature in the “Documents.” Choose the “Correct” icon to change a note and write an
addendum. If you want to write a separate note before the intern/resident has completed their
note, you can do so using the “Note” function (rather than Provider Note).
Selecting the Correct Attending to Sign:
1. With few exceptions, you should select the attending who is on the same shift with you. For Peds
overnight, select the Peds attending coming on in the AM, unless you presented the patient to an
AAED attending overnight. Do not select more than one attending without discussing it with your
attending.
Pickups and Follows
2. For patients signed out at rounds and not discharged by previous team: Oncoming resident
should write a brief note using the Notes functionality (not Provider Notes) subject “ED
Signout Note”. This should contain, at a minimum:
a. Acute problem list
b. Plan from rounds for each acute problem (whether changed or not)
This addendum will be signed by the second attending coming on shift with you.
3. On the less common occasion that you present a case to the attending on the shift before or after
you – ask them if you can assign them to sign your note, (E.g. for patients seen near the end of shift
that were not staffed with the attending on your shift).
4. On days where attending and resident shifts are different (12 hour coverage for ACEP, etc) –
assign the attending you presented the case to initially. Sign-outs should get the same addendum by
the oncoming resident as for regular shifts.
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Medical Student Notes
Medical Students will document with the same reason for visit templates or brief notes as residents.
When completed, the student will save their note (not sign). They will then forward it to the
resident with whom they worked for signature. The resident will correct / or modify (addend) as
necessary, sign, and send to the attending to sign.
NP cases
If a NP staffs a case with an attending physician, the workflow will be same as for resident cases.
The NP will sign their note and send to the attending to co-sign. The attending should co-sign the
note before the patient is discharged from the ED. The attending will place his or her name in the
attending column and write an ED Attending Supervisory Note. If the NP dispositions a patient
independently, he or she will leave the Attending column blank and will not request a cosignature
on their note.
Admissions
Requesting Interqual
From the tracking board, click “Events”, “Request Event”, “Interqual Request”. An orange “REQ” icon
will appear in the ADT column. This will change to yellow “IP” when it is in progress, and then
green “MET” if approved or red “DEN” if denied.
Attending Admit Notes
In the Notes function, add a new note, subject as ED Attending Admission Note, using the autotext below.
.edattadmit
ED Attending Admission Note
Reason for admission: _
Admit team: _
Level of care: _
Attending Override Notes
Documented in a brief ED Note, titled “Interqual Override”.
Running the admission
Multi-Step process:
1.
From the tracking list, click “Admit/Discharge”. Click the pencil next to “Diagnosis”. Click the blue “+
Add” in the upper half of the window “Diagnosis (Problem) being Addressed this Visit”. Search for and
select the main diagnosis then click “OK”. You must then click “OK” again. Then click close. If you did it
correctly, you will see your diagnosis under the corresponding band on the left.
2.
From the tracking list, go to “Place Orders”. Click “Request For Admit” in the “Top Other” Section. Click
the green folder and click “Modify”. Fill in the bed type, service, and admitting MDs. In the “special
instructions” area put in the name and contact info for the admitting team. Click Sign.
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The ED order "Request for Admit" will trigger Bed Control to change the patient from an Emergency
Patient to an Inpatient and moves the patient into a Virtual ED bed, indicated on the track with an
"A" next to the room number. Bed Control will also switch the ED attendings name to the Inpatient
attending's name on the banner bar.
Once the patient is in a virtual bed, the inpatient teams will use "Admit to Inpatient" in their admit
orders, which allows the patient to physically leave the ED.
There are 4 Bed Types: Medical/Surgical Unit = Ward; Telemetry; Stepdown/PCU, and ICU.
The inpatient teams will assign themselves to the patient in the "Primary Contact" on the banner
bar. For now only names will be listed, and staff will need to go to Amion.com to search for the
pager numbers. In the future, pager numbers will be incorporated into this field. They are also
writing "communication orders" to list their contact info as well.
Remind the inpatient teams that they will need to do order reconciliation and decide what ED
orders they want to continue/discontinue. They can do this by "Merge View" icon while they are
placing admit orders.
Inpatient team places admit orders
When the admitting team places orders, a hospital icon will appear in the ADT column.
Holding Orders
To write holding orders, you can use the order set titled “Med Gen Admit.” Search for the order set
under the Add Order area. Select what you would like to order, then sign.
***Remember that you must talk to the team BEFORE writing holding orders in order to prevent a
patient being sent up without their knowledge.
Checking for old MRN
Find a patient’s old Wellsoft/Affinity MRN in the chart the “Demographics” tab on the
left.
It is in the “Identifiers” box as “Historical MRN”.
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Checking for PMD, Family medicine
If the PCP is within the DHS system, their name will appear in the banner bar inside the patient’s
chart.
If the patient has seen family med post ORCHID GoLive, you should see family medicine listed as a
previous visit. Early on, you will probably have to check Affinity.
In the ED summary, the Patient Information box will soon have additional PCP and empanelment
information
In the ED Summary, the Visits list will give you a history of recent visits:
Within the chart go to the
tab. The Visit List and RPR Summary tabs have
more useful information about past visits and provider relationships.
Observation and CORE
For OBS, order “Place in Observation” through the Quick Orders page. For CORE, select “Events”
from the tracking board toolbar, then “request event,” and select “CORE placement.” (You will still
need to call and discuss the case with the CORE provider).
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Discharges
Running the Discharge
When discharging patients, do as much as possible from the Provider Note. You can launch
diagnosis, prescriptions, patient education, and follow up from the note itself. By doing this,
the information you enter will also be documented in your note. The remaining fields of
"Dispo Question" and "Schedule Follow Up" (for Clerk to make an appointment) will still
need to be done from the Admit/Discharge button.
Highlight the patient you would like to discharge. Go to “Admit/Discharge” button from the tracking
board tool bar. Enter the required fields in yellow: diagnosis, medication reconciliation (including
placing new prescriptions – see below), patient education, follow up, and disposition questions.
Some areas may already be filled out if it was completed in your provider note. Medication
reconciliation is where you will write new prescriptions (see next question). Once the required
fields are completed, click on “sign/print.” Do not choose “DISCHARGE” unless you are actually
going to send the patient out of the ED yourself.
The list of follow up clinics in the follow-up section of the discharge process is for all of DHS. Many
of our local clinics begins with “Harbor”. Note the address to be sure you do not send the patient to
the wrong location.
In the discharge process, there is a required field called “Disposition questions” and currently
contains one of the ways patients who be entered into the Trauma Registry.
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Printing Spanish Discharge Instructions
To print Spanish discharge instructions, it takes two steps:
1) Under templates, choose “Harbor Spanish Discharge Instructions.” This will print the generic Harbor
ED visit discharge information in Spanish.
2) In the Instructions tab, change the Language to “Spanish” or other language. This will print the
Patient Education canned text in Spanish.
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***If you as the provider are going to physically discharge the patient yourself (instead of the
nurse) then click the bottom left “Patient demonstrates understanding of discharge instructions
given” and then select “Discharge” pencil and fill out the required fields. This will remove the
patient from the tracking list completely. ***
Go back to the quick orders and place an order to “Discharge Patient”.
Sign the discharge order. A green house will appear, indicating to the nurse to discharge the
patient.
Writing Prescriptions and Medication Reconciliation
Licensed providers: When in the Admit/Discharge window, click on “medication reconciliation.”
Click on “+Add” on the top left to add a new prescription. A new window will pop up, change the
“Type” to “Prescriptions” on the top right. Common prescriptions will be listed here with the
required fields already pre-filled. To search for a prescription, start typing in the “search” box. Once
you select the medication, fill out the required fields. Choose the green play button to indicate the
patient must continue that medication, the pill bottle to prescribe or refill a medication, or red stop
button to discontinue a medication. Once completed, click sign.
If for some reason you need to reprint the prescription, right click the prescription and choose
“Print Rx.” [See section “favorite printers” for instructions on how to set up printers for printing Rx]
Unlicensed residents will write prescriptions as “Proposals”, which must be signed and printed
by a licensed physician or resident. Begin by writing the prescription. Don’t forget to choose the
appropriate printer. You will be presented with a box to choose a licensed physician. The ability to
sign is not restricted to the person whom you choose.
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After the intern signs, any licensed physician can then go into “Review Orders” on that
patient. The Proposed prescription will appear with a ? next to it.
The licensed physician then right-clicks and chooses “Accept” to sign and print the
prescription.
Narcotic prescriptions need to be handwritten on triplicate pads. In order that a record of the
rx appears in ORCHID, enter it like any other prescription, but choose a printer of “Do Not Send –
Other Reason”.
If you would like to let pharmacy know to print instructions in Spanish for the patient, you can
indicate that in the “eRx Note to Pharmacy” field.
Special Discharges to Castroom, Psych, Ophtho, etc.
Complete the discharge process as above. In the Quick Orders page, place an order to “Discharge
Patient”. Click ‘Modify.’ The Order Details window will open. In the “Special Instructions” box, write
where you would like the patient to be discharged to.
The clerk will need to make same day appointments for specialty clinics, such as Castroom and
Ophtho, so enter the clinic information in the Follow-Up Date section, then click the “Schedule
Follow Up” section of the discharge process. A black star icon will appear on the track to let the
clerk and RN know the patient needs an appointment before being discharge.
As in Wellsoft, moving patients between the Medical and Psych EDs remains a process of
discharging them from one area and re-registering them for a new encounter in the other. (Still
communicate this to the nurse!)
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Follow up appointments
All clinics where you would like the patient to follow up should be placed in the “Follow Up Date” of
the discharge section. You can list multiple clinics. You can search by provider, organization/clinic,
or free text.
Is patient eligible to be seen at Harbor?
Registration will write “OOP” (Out of Plan) or “OOC/S” (Out of County) in the comment column after
full registration if the patient is not eligible for follow-up. You know full registration has been
completed when the key icon is gone from the events column.
If a clerk needs to schedule an appointment:
When in the Admit/Discharge window, click the “Schedule Follow Up” section. A black star icon will
appear in the ADT column of the trackboard warning the nurse not to discharge the patient until
the appointment has been made.
1) We have no ability to schedule a patient for primary care anymore.
2) Patients with non-urgent (> 2 weeks) needs to see a specialist should be referred back to
their PMD for referral via e-consult.
3) We should only be scheduling for specialty care f/u at Harbor those patients who
need to be seen in specialty clinic within 2 weeks of their ED visit. (Of course, these also
need to be patients who are eligible to f/u at Harbor, i.e. self pay or “refer to Harbor”. No
third party insurance patients!)
For all patients needing f/u within 2 weeks, you must first speak to the specialty service to
OK the visit (“OK to overbook”). You need to get an approving consultant MD’s name. Then,
under the “Follow-up Date” screen in the “Admit/Discharge” process, you will put the name
of the clinic, the requested timeframe for followup, and the approving MD’s name.
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The clerk will then be able to schedule into that clinic. If there are open slots, the patient will leave
with a clinic appt in hand. If there are no open slots available, the clerk will put the requested
timeframe and approving MD’s info into a “request queue” function in ORCHID, to be scheduled the
next business day by a superuser scheduler (outside of the ED), who will call the patient with the
appointment time/date.
Please do NOT to put “next available” as your timeframe. This varies greatly from clinic to clinic.
Please put something more specific, like “1 to 2 weeks”, or “Thursday 11/6/14” if the consultant
tells you exactly when s/he wants the patient to return. If it’s the next day, and there are no open
slots, we are still going to do what’s best for the patient and tell the patient to show up. The same
process of “request queue” will go on in the background so there’s an electronic paper trail for
clerks/schedulers to see.
Also, as an FYI, when we discharge to another clinical setting for same-day visit, i.e. discharge to
cast room or eye clinic, the clerk will need to now use the same process we used in the past for gyn
UC. The ED clerks will need to book an “appointment” for cast clinic so that there is a
FIN/registration for that patient. This allows the clinic staff to put in orders and document on the
patient. For these patients, click on “schedule follow up appointment” in the Admit/Discharge
window. A black star icon will appear in the ADT column of the trackboard warning the nurse not
to discharge the patient until the appointment has been made.
72 hour treadmill stress test
Clerks can again schedule 72 hour treadmill tests. You will first need to place the order for
“Exercise Treadmill Test”. Then ask the clerk to schedule the appointment.
Work/School Notes
When in the Admit/Discharge window, click the patient education section. Choose the “Custom”
folder on the top right. Once an excuse note has been selected, you can click into it to add or modify
it. When finished, click sign.
Printing Lab Results
While viewing the lab results, click ‘Print’ on the upper right.
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Transfers
Go to the Quick Orders page under the Top Other Orders and select “Transfer Patient” and fill out
the necessary information (accepting doctor and facility, service, bed type, etc). Once this order is
signed, an ambulance icon will be displayed on the ADT column of the tracking list.
The EMTALA form is printable from ORCHID via the “Admit/Discharge” process. Change the
“Templates” selector to “Harbor-EMTALA”. Print it, fill in the accepting doctor information and
obtain the patient’s signature. Place a barcoded sticker on the form. The nurse will document the
last set of vitals. Have the clerk make a photocopy for the transfer chart.
Resident running the board
Adding new/clinic patients to the board
Click “Pre-Arrival/Referral” on the tracking board toolbar. In the Pre-Arrival Type in the top left,
select either referral or EMS. Fill out the necessary information, then click “ok” when complete.
Physician Ambulance Triage Note
Add a note in the “Notes” function.
.edambutriage
Delete sections not done or not relevant.
RIPT Note
Add a note in the “Notes” function.
.edript
Calls from the lab, radiology
Write a brief note using the Notes functionality (not Provider Notes).
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Pediatric ED specific issues
Requesting NP lab check, phone check, etc
Go to the Admit/Discharge process. Click the pencil next to Post Visit Follow-Up Instructions
Complete the form that appears and press the green check mark.
Once the patient is discharged, they will appear on the
tab.
Notes on overnight shifts
If no attending was involved in the care of the patient before discharge, the night resident will sign
and send his or her note to the morning PEDS attending. The morning attending will place his or
her name in the Attending column on the chart and will cosign the note, adding his or her teaching
attestation at the end.
Customization
Precompleted note
You can save a precompleted note with all of your most common documentation already completed. This will
allow you to open the note in the future with all of your most common documentation already completed. You
may then add any additional documentation and customize this note for your patient. To save a document as
a precompleted note, complete the following steps:
1.
Once the note has been documented, click Documentation on your toolbar
Precompleted Note. The Save As Pre-completed Note dialog box opens.
2.
In the Note Title box, enter a title for the precompleted note
it something personalized to you that you will remember.
3.
Click the
and select Save As
. Be sure to title
button in order to save the note.
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Personal Macros
Setting up a Macro:
Macros can be used inside Provider Note (PowerNote), and are used by note sections. For example,
in ROS, click the answers to questions you typically ask a patient. Then right click the Review of
Systems title at the top of the note section, select “Save Macro As.” Be sure to title it something
personalized to you that you will remember.
Click the
button. An M will now appear to the right of the section header
.
Note: You may also create macros at the sentence level by right-clicking the sentence header.
Using a personal macro
Click on the “M” next to a note section, and choose the macro you would like to insert into the note.
Personal Autotext
Setting up Autotext:
Autotext can be used in free text areas of Provider Note (PowerNote), and the notes from the Note function.
1.
Once you have opened a note click in a free text field and select manage auto text
.
2.
The manage auto text window will pop up, to create your own phrase select new phrase
own abbreviation.
3.
Once your abbreviation is created you can click
appear.
and create your
to add text and a formatted text entry box will
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4.
5.
Once you have entered in the desired text click OK.
That sentence will now be saved. If you wish to insert that save text in a future note, simply type in the unique
character and select the appropriate option from the drop down menu.
Note: If you use an underscore (_) anywhere in your auto text you will be able to hit the F3 key on your
keyboard to skip straight to that section. This will allow you to fill in the blanks in the note.
Favorite Printers
To configure my favorite printers:
A: Favorite printers will need to be set up with each login and each computer used. (Yes, we’ll have to do this
a few times before our favorites are set up on all the computers we use).
When completing discharge reconciliation you will be able to save printers as a favorite so you can choose
from that list in the future. This will allow you to print to nearby printers without searching each time. To do
this follow the steps below:
1.
From the orders screen, select discharge reconciliation:
2.
From the Discharge Order Reconciliation window select a prescription and navigate to the details portion
of the screen.
From the details portion of the Prescription screen select the send to option and click other.
3.
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After selecting other you will see a prescription routing screen. From this screen select other output devices.
4.
From this screen select the appropriate facility by clicking on the plus sign next to your facility.
5.
Once you have found the printer that is in your area, right click on the printer and select
.
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6. Continue steps 1-6 as needed.
ED Printer Names:
AAED Plain
ph011J27pl
AAED Rx
ph011J27rx
PED Plain
ph011H27pl
PED Rx
ph011H27rx
RME Plain
ph01E23pl
RME Rx
ph01E23rx
Outpatient prescription favorite folder
The prescription folder contains many of the common prescriptions with the required fields pre-filled. (Much
like the Quick Orders page). They are organized by folder for each area of the ED.
1. In the Discharge Medication Reconciliation. Click “+Add” to write a new prescription.
2. Change the “Type” to “Prescriptions”
3. Select the folder, and search for the prescription desired.
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Favorite Order Folder
Create a Favorite Order Folder
If you are commonly ordering several labs, imaging, or any other orders frequently, saving these orders as
your favorite will be beneficial. Your favorite orders will be tied to your login and will be available to you
regardless of which patient chart you are viewing.
The first step to adding favorite orders is to build favorite folders. To build these folders, complete the
following steps:
1. Open a patient’s chart.
2.
Click Orders from your Menu. Click the
3.
Click the down arrow to the right of the star icon
4.
Click the
this folder
button. The Add Orders window will now appear.
and select the option to Organize Favorites.
in order to create a new folder. A new folder will now appear. You may name
whatever you wish.
Note: You may organize your favorites however you wish. Some users prefer to categorize their folder
based off of a specific diagnosis.
5.
Once you have entered the appropriate name for your first folder, you may now create a second folder. To
create an additional folder, highlight the Favorites folder
folders.
6.
and select
once again. You may complete this step as many times as necessary to build all of your
Once you have completed adding favorite folders, click the
Orders window.
button to return to the Add
Adding Common Orders to Your Favorite Folders
Once you have built out your folders, you may now add orders to these folders. To add an order as your
favorite, complete the following steps:
1.
2.
Click the
button on the Quick Orders page. The Add Order window
now appears.
Choose the orders you wish to add as a favorite. Many of the same orders from the Quick Orders page
with pre-filled required information are available in folders. Once you have selected the orders, click
Done.
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3.
4.
Make sure all the required fields are filled out. Highlight all the orders you have selected using Ctrl. RightClick the selected orders and select Add to Favorites. The Add Favorite window will appear. Select the
folder that you wish to add this order to and click
.
This order is now saved as your favorite. You may repeat steps 2-3 in order to add as many favorite
orders as necessary.
Creating Favorite Order Sets
While inside an order set, after checking the items you would like to order, you have the option to “Save As
Favorite” at the bottom of the screen.
Accessing Your Favorite Folders
Once you have saved these orders as favorites, there are a few ways to access your favorite orders.
To find a favorite order from the Orders screen, complete the following steps:
1.
Click the
2.
Click the
icon. A list of the folders that you have created will now appear. Click the name of the
appropriate folder. All of the orders that you have saved to this folder will now display.
Select the appropriate order from this list.
3.
button within the Orders window. The Add Order window now appears.
Another way to access your favorite orders is through the Quick Orders. To add a favorite order from your
Patient Summary window, complete the following steps:
1. Click Patient Summaries from your Menu, then click Quick Orders. Orders will be found within the New
Order Entry section.
2.
Within the New Order Entry section, click the name of the favorites folder that you wish to access. All of
the orders that you added within this folder will now appear.
Note: If you want to organize your favorites folders, go to the Add Order window, click the down arrow to the
right of the star icon
organize.
and select the option to Organize Favorites. There you can rename and
Default Note Types
Change your default note type to “ED Note- Provider.”
Go to the
section of the chart. Go Documents Menu  Options.
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Move any note types you want to appear on your personal list into the field on the right. Choose
your default where it says “Default Document Type”.
MSE
Documenting MSE: All patients need an MSE initiated.
Providers that are screening a patient need to do both 1) MSE PowerForm and 2) Note with the
MSE autotext.
MSE PowerForm (All ED providers must do this step)
-
Choose MSE from the tracking list toolbar
Fill out the MSE PowerForm
Click the checkmark to complete. This will make the M icon disappear from the tracking list.
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MSE autotext Note (For NPs and RME MDs)
-
Choose Provider Note from tracking list toolbar
In the “Note” section, click +Add to add a new note.
Click on the top left paper icon to start a new note.
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-
Insert the MSE autotext by typing “.edmse”
-
Use F3 to jump to the underscore. Delete sections that are not relevant
Click sign to complete the note.
Miscellaneous Tips:
Blood cultures can only be ordered via an order set. There is a link to the blood culture order
set in the “Sepsis Bundle” section. Always mark “Collected” as “No”.
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iMed Consent has been upgraded. Your login is now the same as for ORCHID. Make sure the
consent stays in the patient’s paper chart.
For now, continue to complete the paper consent for IV Contrast. You do not need to
complete the yellow or blue CT/Ultrasound order paper.
For now, continue to use the paper AMA form.
Important nuances to selecting a final diagnosis
When you choose your final diagnosis from the admit/discharge screen, always leave the type as
“Discharge” even if the patient is being admitted.
Also, leave Confirmation as “Confirmed.”
-Click the binoculars to start your search.
-If you try to search for a diagnosis and nothing comes up: Check that Within: is set to
“Terminology”.
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Ordering a blood gas
When you order a laboratory blood gas (not POC), you must enter the oxygen flow rate or FiO2
so that the lab can make the correct calculations. It is not a required field.
Ordering drips
When ordering IV medication infusions such as vasopressors (drips), do not change the
concentration or volume of the drip in the order, just the rate.
Orders for post-intubation sedation and narcotic drips are in the “ED Rapid Sequence
Intubation” order set under the section titled “Post intubation sedation.” Ex. Versed & Fentanyl
drips are in the intubation order set. Some of these are not available except within the order set for
patient safety reasons.
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Ordering medications, use generic names
When ordering medications, first search for the generic name. You can modify the dose and route
in an order, but note the form. For example, don’t choose the order for oral Dilantin tablets and try
to modify it to be given as an IV load.
Getting your prescriber information into ORCHID
If you would like to have your DEA, NPI, and license number print on your prescriptions,
submit an “IT Service Request” via the icon on the right side of the Harbor intranet home page or
call 323-409-8000.
Second-year residents: When you receive your DEA and license numbers, submit an “IT
Service Request” from the Harbor home page asking to have your DEA, NPI, and License number
added to your prescriptions. Request to have your role upgraded from “Physician – Resident - NonCredentialed” to “Physician – Resident Credentialed”. Congratulations and happy prescribing.
Ordering body fluid tests collected by the physician
(eg, CSF, synovial, ascites, cervical, etc)
Don’t mark specimens as collected, even if you already have collected it. This will cause no label to
print. Instead, keep it as “Nurse Collect” and “Collected”=no. Label the specimens, initial and time
them, and give them to the nurse to mark as collected.
The “Cell Count w/ Diff Synovial Fluid” order on the quick orders page and ED Arthrocentesis Order
Set
change the name to make this clearer.
includes the crystal exam. We are working to
Selecting a patient’s encounter
If you need to select a patient’s encounter, check that you pick the right encounter/FIN. It will not
be the top of the list if they have future appointments scheduled. If you pick a future or past
encounter, you will be documenting/ordering on the wrong encounter. (If this should happen, you
have to cancel your orders and reorder/re-document in the correct encounter)
Continuing a 5150 order
When an adult patient arrives on a hold placed by law enforcement or an authorized mental health
practitioner, an EM provider needs to place the “5150-72 hours” order, with the “Action on hold” of
“Continued (no action)”. This reflects that the EM provider is not placing the hold, but documenting
the presence of a hold placed by an authorized individual. The start time and date should be the
time the hold was written by law enforcement.
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Patient List for Follow Ups
Use a patient list to build and view your patients in one list. You can view by patient location, or
your assignment, or create a custom list for interesting patients you would like to follow up.
To view your Patient List, click on the “Patient List” button on the toolbar.
Building a Patient List
Click the List Maintainence “wrench icon,” then click “New” to create your personal list.
Choose “Custom” then “Next.” Enter a “Name” for this Patient List. Then click, “Finish” to add the
new list to the Available Lists on the Modify Patient List dialog box. Move the list to the Active List
by selecting the newly named Patient List to “Active List” by clicking the right arrow button. Click
“Okay” to save your changes.
Adding a Patient to the Patient List
To add a patient to a list, open the patient’s chart. Then click the “Patient” menu on the toolbar, and
“Add patient to patient list.” Select the patient list you would like to add the patient to.
Removing a Patient from the Patient List
Open the Patient list, select the patient, then select “Remove Patient from Patient List.”
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