Download Before Class starts… Rosters: Ask question …” Have you passed

Nurse Resident
2012
Training ID: TRAIWIW… NURSE
1. 4 hour classes
a. July 16: 2 Adult Classes : Monday 0730-1130a 1010 OH and B319
b. July 17: 2 Adult Classes: Tuesday 0730-1130a 407 OH and B319
c. July 13 Peds: Friday 8a-11:30a
d. July 13: Peds: Friday 12:30-4:30p
Supplies

Playback RN orders: TRAIAKO Before class

Trainer’s Manuals: (2) in B319 (2) in 407 OH and (2) 1010 OH

Wireless Scanner for Trainer (1)in each training room

Rosters with column to check “Passed boards”
Handouts:

Guided note-taking sheets

Laminated POS and Lab Req - – can share

Take Home Tip Sheet
Setup:
1. Amanita:
o
Job Title: RN … Role: Nurse
o
Dept: Other
o
Lookup, change, acknowledge
o
If boards not passed after class, change Amanita to MR, Other… use roster during class to
check who just passed board… then verify in database
2. Acudose – RN change to non-clinical if don’t pass boards
3. Armband and PMM - given access to final unit at Match time
LCD Slides: (ALT/ESC to Toggle)
1. Objectives HED
2. Principles of Assessment
3. Nurse Summary
4. Objectives HEO/Wiz and StarPanel
5. Admission History Sections
6. Flu Vaccine
7. HEO/Wiz Legend
8. Processing Orders
9. Steps to Acknowledge Orders
Access: RN but if have not passed boards change to Title: Nurse Residents, Role: MR/other. Acudose
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– Non Clinical,
PMM as Float pool
1
Before Class starts…
1. Rosters: Ask question …” Have you passed boards” to the people not listed
on Roster as PASSED. Update roster and check data base to confirm did pass
before changing amanita
2. Open PPT slide displaying Class Objectives
Introduction
Trainer: Welcome to Clinical Computer Class Training, taught by our department,
Systems Support Services.
A. My name is ……….
B. Restrooms are….
C. Length of class is 4 hrs, with a break
Objectives for today are….( PPT Slide 1)
HED
Care Organizer, HED,
Admin-RX
OBJECTIVES: HED Nursing Documentation
LCD Slide 1
 Document Interventions, Assessments Commit to use HED system safety checks
 Set Preferences & Create Assignment

View Confirming Med Orders
 Commit to use HED system safety checks
Trainer: HED (Horizon Expert Documentation) is the nursing documentation system.
There are 3 sections to HED that will be discussed: documentation of Interventions/
Assessments, Care Organizer, Admin-RX which is bar code scanning of med and
Engage Learners and acknowledge past experiences: “Who has used an electronic
nursing documentation? Anyone used HED? At Vanderbilt or elsewhere? Who has
done Bar-code Scanning of meds? Did you like it”?
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Brief overview of
Screensaver

This is a HIPAA-compliant screensaver view of the Inpatient WB that displays on
CWS.

The columns are Bed, Patient Name displaying only initials, Age, LOS.

The Status Column displays the admission type. IA is an Inpt admission and OT
is an Observation Admission.

The PB column defines the patient's status for release of information.

The Attending column displays the admitting attending.

The Orders column displays with red and blue boxes alerting the nurse that
there are orders to be acknowledged. Red= STAT Blue= standard

Links to flowsheet, MAR and labs

The screen prompts the user to press the spacebar to log on
TRAINER: Sign-On. Note StarBrowser displays in lower tool bar ... this is
StarPanel, the electronic med record system. We will cover this later in class
when reviewing this application.

Click on the Go To Desktop Icon from StarBrowser

Double-click on the HED TRAIN.

Care Organizer – used to identify your patient assignment for the day and
what meds to give hour by hour. This will be covered in the scanning
portion of the class.

Find the patient from the laminated sheet and click on it and Click HED
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HED
Documentation
Main Screen
Quick overview
Pt name- click on down arrow to see full census
Allergies are imported from HEO/Wiz
Scanner Reset is used for resetting med scanner
Links: to additional resources such as Micromedex
What’s New in HED
Review tab for review of documentation
Tabs: Training computers have all tabs for all units. You will only see the
tabs for unit you are working on for current rotation
Additional Tabs: click the upside down triangle with double lines
to
see additional tabs
Left Menu Bar: use to navigate charting area
VUH VS I&O tab always opens first
Click “Show ALL” – Jump to INTAKE section, then Jump to PAIN. Notice
documentation area to the right jumps to that section.
Left bar: Note also under VS / I&O tab: Vents, Med Drips, CTs, Wound Vacs
Vertical Column and Previous Documentation
Note DATE and TIME of column and white boxes to chart in
Click Cancel at bottom
Scroll bar on Right side for up and down
Arrows for back & forward in time.
New Admission
Scenario: Billy Bob’s O2 sats were 89 % on room air and O2 initiated at 2L. He
arrives on your unit, complaining of nausea and pain. 2 IVs are infusing to CVC:
Heparin drip and D5 ½ NS with 20KCL. He was given codeine for pain prior to transfer
and vomits dark green emesis into a towel just as he arrives on the unit.
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Vitals / I&O Tab
1. Click VS on left Bar
2. Click Chart
3. Click SHOWALL next to ADD to display all items in the VS category
4. Change time to 30 min ago: Double click or use arrows
5. Click Temp # 1 in F. Type 101.4 oral
6. Click oral from the drop down box
7. Click exclamation point. Highlight value in red; significant finding
8. Click heart rate/DAS. Type 112
9. Click Apical from the drop down box
10. O2 Sats: 93%....On Oxygen
11. O2 Liter flow: 2L…Nasal Canula
12. Scroll to IV Site Check: add
How often are IV sites checked? Peds is every hour, Adult every 2h. Site
assessment done every shift
1. From Left Bar, Click Pain
2. Click Show ALL next to ADD
3. Pain Site: chest
4. Pain Description: Aching/constant
5. Pain Scale: numbers
6. Pain Score: 8
7. Pain Goal: 3
8. Pain Intervention: see MAR and emotional support
When should pain be reassessed after an intervention…in this case
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medication and support? Within 2 hrs– Frequently missed and Vanderbilt is cited/
fined. Note “Response to Intervention” tab. Do not chart response and
intervention at the same time.
Document 300ml D5 ½ NS with KCL, Emesis (O) with note of small green amount
1. Click Intake on left bar
2. Click SHOWALL next to ADD. Note Oral is listed first
3. Scroll to D5 ½ NS with KCL: 300
4. Add Comment: Infused in ED
5. Click Output on left bar
6. Click SHOWALL in next to ADD
7. Scroll to find Emesis (O)
8. Type (1) Occurrence, unable to measure
9. Annotate with sticky note details, i.e. small amt green
Yellow check mark indicates unsaved data. Click Save
10.
Review data entered, time and date.
11.
Click Confirm
Trainer: Note I&O summary in LEFT bar. HED displays shift and 24 hours.
Trainer: Monitored VS/DAS = Downloads VS from bedside monitors. You will learn
how to on unit
Blood Transfusion
Demo Only
Trainer: Click on the upside down triangle with double lines
to add the Blood
Transfusion tab to your view
Review only
Consent and Teaching section at the beginning
Scroll to view various blood product categories, PRBC, platelets…
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Unit # on TAR –
Product verified with 2 licensed personnel – Trainer: checkmark this
Infusion status…. Started, etc
Special Equipment
Trainer: Click save and point out that confirm screen is ideal way to cosign blood
products. (But will practice how to cosign after the fact later in class with Insulin.)
Where are VS documented? VS or Blood Transfusion Tab. Documenting one
place will display in the other
Assessments and
Interventions
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LCD Slide 2 Assessment Principles
 Beginning of shift or change level of care
 Items in ALL CAPS on gray bar charted each shift
 Line Manage charted each shift
 Vanderbilt charts to Standards & only denotes variances
Systems
Assessments

Click on the dropdown triangle and add Med/Surg/Assessment
Intervention Tab

Click SHOWALL on Left Bar

Click CHART and Change time to 0730

Click Neuro, click show all: Document Standard Met

Click Cardiovascular, click show all:
a. Standard Met Except
b. Click drop down for Pulse: Standard display in ALL CAPS as Regular &
60-100 BPM. Here’s where you find standards for each assessment
c. Click Edema site #1
d. Edema location: BLE – add comment “ankles”
e. Edema scale 1 + pitting
f. Scroll to Telemetry alarm settings – must enter / won’t download

Click Pulmonary/respiratory: click show all
a. Click STANDARD MET EXCEPT. Standards in ALL CAPS
b. Click RLL & select fine crackles
c. Click LLL & select fine crackles - If make a mistake, click again
to deselect
d. Click cough
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e. Click productive
f. Secretions: Make up some nasty secretions!
g. Incent Spirometer: (600 X 5)

Scroll to Pulm Intervention: D B & Cough and NT suction
Trainer: Most interventions at end of systems section

Renal/Urinary: Document

Skin: Review section only
Standard Met
Trainer: Note skin assessment done here, checkmark Braden score documented in
WIZ/HEO. This will be reviewed later.

Falls risk: Review section only
 Everyone is at least STANDARD risk.
 “Any 1” or “Any 2” factors will designate HIGH risk; also 4 Meds
 Be sure to complete FALL RISK ASSESSMENT portion for everyone
Line
Management

CVC: Scenario Dr. Golightly inserted the triple lumen in the ED.
Document the CVC with information you know.
a. Click CVC from Left bar
b. Click Start New CVC Site
c. Line Type: Central Line
d. Site: Internal Jugular
e. Side: Right
f. Lumen description: proximal, distal, middle
g. Dressing: Chlorhex Drsg, Transparent
h. Secured With: Sutures
i. Type “T” in Date and Time to insert current date and time. Can
change
j. Inserted by: Dr. Golightly
k. Location: VUMC ED
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l. Response: c/o pain on insertion, site comfortable after procedure
m. No comments
n. Click “Save”

Site Assessment: Note Boxes to document site after Line information…
a. Proximal Lumen Status: Intact, patent, flushed no resistance (address
each lumen as appropriate for real pts)
b. Proximal Lumen Fluid/Med infusing: D5 ½ NS with KCL
c. Site Appearance: Dry & warm
d. Surrounding Skin: Dry & Intact
e. Site Dressing: Dry & Intact
f. Click Save and Confirm

Discontinue IV: Click on magnifying glass. Review section only.
When ready to discontinue the CVC, just click on the ICON and complete lower
section. PIV, wounds and urine catheters work in the same way.
Interventions
1. Click Chart and Show All
2. Activities of Daily Living: under Hygiene
a. Mouth care
b. Bed Bath
3. Nutrition by Nursing – point out only
4. Procedure on Unit:
a. Documentation of procedures on unit, such as chest tube placement
b. Codes are documented on resuscitation record on crash cart. Click box
if code… “on resuscitation record”
5. Click Save and note option to change time here as well and buttons in lower
right
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Trainer: Notice different options:

Save and Confirm = save data

Save and Chart new = saves current data and opens chart to current time

Continue = returns to previous screen – can change current charting

Discard All = exit without saving- ie wrong patient
ALL Click SAVE & CONFIRM
COPY
Is there a way to copy your previous documentation and change only what
is different? Yes
1. Click Assessment/Intervention tab
2. Chart must be CLOSED, Click in space between date a time
3. Click copy from the drop down box
Trainer: Data pre-fills new med time column. Change one thing about your
assessment and save. Remember, the Entire column is copied so make changes to
copied data based on reassessment. Change Pulmonary Assessment from fine
crackles to coarse crackles. Save and Confirm.
What data can’t be copied?
Numerical data
Annotations/ comments
Other people’s data
Into the future
After 30 hours… so it works for same assignment multiple days
All or nothing, but remember you can edit what you copied.
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Changes
Trainer: You documented the temp incorrectly. Change it to 102.4 and add a
comment “MD notified”
1. Click VS Tab
2. Click 101.4
3. Click blue boxes
4. Type 102.4. Other fields can be modified from this window.
5. Click on ! (Significant Data).
6. Change to yes.
7. Click Save
What Changed? Parenthesis around the value means data has been changed.
Trainer: Time Limits on Making Changes
72 hours on admitted pts to correct mistakes
48 hours on discharged pts
Information YOU enter
Point out when hovering over a data field, click on hyperlink to display
trended data. This cuts down on scrolling.
Plan of Care
1. Click on the upside down triangle with double lines
to add the Plan of
Care tab to your view. Click Chart and ShowAll in left gray bar.
2. Pathway Pneumonia
3. Phase Admission. This is going to match the pathway to be added in EMR
StarPanel.
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Guided Discussion
As Billy Bob’s nurse, what problems will you focus on during your shift?
1. Pulmonary-Gas exchange
2. Pain-Acute pain
3. Physical Regulation-Infection
Do you expect the problems to IMPROVE, STABILIZE, or DECLINE?
1. Click Pulmonary on Left bar, middle way down
2. Click Start Priority Problem
3. Select Gas Exchange from dropdown
a. Maybe related to – shortness of breath
b. Expected outcome- Improve
c. Start time now…type T in box for current time
4. A short term goal of “Maintain O2 Sats > 94% on supplemental O2”, at the
beginning of the shift and at the end of the shift, you would document
whether goal was met or not.
5. Click Save and Confirm
Nursing Summary
for Next Shift
LCD Slide 3
Nursing Summary - Click on Plan of Care from left gray bar
 Brief synopsis of your shift before Shift change
 Include major clinical events & information
 For oncoming RN..does not replace face-to-face report
 Prints on OPC as reference for nurse during shift
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6. Type brief shift summary: temp controlled with Tylenol. No further
nausea, oxygen saturations improved on NC
7. Plan Priorities, type PCV in a.m. at 0500
8. Goal Status, met
9. Save and Confirm
Exiting out of HED

Click file exit to close HED

Click file exit to close Care Organizer
Guided Note Taking
HED Nursing Documentation
1. The best way to edit a single item is to click on it.
2. To copy a column of information, click between the date and time.
3. Information that can NOT be copied: someone else’s charting, numbers, comments, older than 30 hrs
4. Capital letters in the gray bar tell the nurse to document every shift.
5. V/S will display in multiple tabs. List some: I&O, blood, quick assess for ICU.
6. It’s important to click “Show All” at least once a shift from the gray bar and when chart is open.
7. Documenting in a timely manner is important because providers view nursing data in StarPanel.
8. Plan of care includes documentation either at the beginning or end of shift.
a. Beginning of shift tasks short term goal, changes to pathway, phase of pathway.
b. End of shift tasks nursing summary, planned priorities, actual outcomes for goals.
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Care Organizer,
Admin Rx, IV
Manage
Trainer: We will go into the medication scanning portion of the class that
includes: Care Organizer, Admin Rx, and IV Manage. First we will need to set up
your preferences in the live region when you start your first rotation.

Click File and Exit

Click Exit and go to HED Production
NR will set preferences in PRODUCTION and TRAIN.
Preference Settings:
1. ROLE and SHIFT TIME (set to DAY/NIGHT shift)
2. Department… their first rotation (will rotate for 6 weeks before final placement)
Set Preferences
In Production and Train
Trainer: You will use CO to create patient assignments & view meds schedules
1. Click View on top left hand side
2. Confirm that “Meds” & “IVs” checked
3. Click “Configure”
4. Click Default Care Relationship….Select Primary Nursing
5. Click radial button Exclude in middle of box
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6. Scroll Available groups…select PHM. Hold CTR key down and select RES
7. Click ADD….OK
Trainer: PHM and RES move to the R side, blocking ordered meds from displaying
until checked by Pharmacy and schedules attached
1. Click Create Assignment button in upper tool bar. Pop-up box displays
2. Provider Type: click arrow- select RN
3. Care Relationship: Primary Nurse
4. Shift: Select the shift you work first. Click OK
5. Back time 15 min and up time 15 min.
6. Patient Dept: Unit you will work on – NR set to first rotation but must
change each time they rotate to another location
7. File…Save Configuration
8. Click EXIT
9. Click “Create Assignment” again
Trainer: Does everyone have their preferences saved?
10.
Click Search box
11.
Type your last name
12.
click FIND
Raise your hand if your name is NOT in the production data base
13.
click Cancel
14.
Click Exit out of assignment box DO NOT USE THE X TO CLOSE, USE EXIT
Trainer: Will NOT create an assignment in the production region but will create
an assignment in TRAIN.
15.
Click Exit BOX… upper right corner
16.
Click on the X to close out login box
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17.
Click HED TRAIN to open training region
18.
Click view to confirm meds, IV checked
19.
Repeat the configure, set preferences and create assignment in Train
(use laminated sheets for patient name and department).
20.
Click Refresh to see assigned patient in Care Organizer.
Trainer: Locate the laminated sheets
Physician Order sheet. On many units the nurses are transitioning from
using the POS to electronically acknowledging orders online. In StarPanel
portion we will point where this is done but Please work with your
preceptor on how to acknowledge orders.
Medications and your patient’s armband sheet
1. Locate the laminated POS. It contains detailed information about who ordered
med, the order #, description and date
2. Make sure you are in Active view. Check overdues periodically.
3. Click on patient name. Click view and confirm/unconfirm
4. Expand Screen
5. Locate PCM number and compare with Wiz number on POS on left hand side
6. Compare items on Med History Screen (Med name, dose, route, frequency, start
date/time, comments, status, and schedules) with order. Med schedules at the
bottom of the screen
7. Clicks CONFIRM if order and schedule are correct
8. Click OK
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Trainer: Famotidine displays to send message missing dose
1. Locate PCM number and compare with Wiz number on POS
2. Send a message to PHM for next med “Dose missing, please send”. Type
unit’s phone number so PHM can call back if needed.
3. Click OK
Trainer: Confirm the rest of the meds on your own. Make sure schedules are
present and accurate
4.
Click Famotidine and notice that the confirm button to the right now says
Details. All information about the order can be found here
5.
Click Cancel to close History Box
a. What color displays in CO when order need confirming/verifying by RN? Yellow
b. What do you check on to confirm orders? View – Confirm
c. What button displays contents of the order including schedules? History
d. What view should display when confirming orders? Active
e. If a patient comes from surgery, CCL, or an unimplemented unit, will old orders
(not new) display and should you confirm them? Yes, yes
f. Why is it important to stagger meds back on the standardized schedule instead
of sending Pharmacy a message to change the schedule when a pt meds get
delayed? Drug Compatibilities and saves nursing time when meds can be
given together. Also causes PHM delays in filling new meds if constantly
changing schedules . Have one hr window to give med
g. If PHM touches the med order in their system, whether anything is changed or
not, will it come across to be confirmed again? Yes
PRNs &Timelines
1. Click ACTIVE view
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a. PRN meds display after scheduled meds. Click TO DO view. Locate
Acetaminophen 325mg
b. Under STATUS column, note last time given
Trainer: H indicates IV hanging & moves along timeline. M indicates meds due
2. Click on the 5M due at 10AM-1200. Meds due display in the upper frame.
RX-Scan
MOM refused,
Potassium late
Trainer: Instruct learners to go to HED/ Admin-RX
Scenario: Billy Bob was off the unit for his CT and now has 2 meds overdue
.
You take the meds to his room but he refuses the MOM.
1. Click Chart
2. Click Admin (no scanning of med is needed for MOM since he refused)
3. Select “Not given, patient family refused” from the dropdown
4. Scan Potassium: Note 2 warnings “Incorrect Amount” and “Admin Too
Late”
5. Type 8 meq in dose field and Press ENTER. Incorrect Dose warning is gone
6. Scan Armband and ask for 2nd identifier
7. Override box comes up. Select “pt off unit” from the drop-down box.
Click “ok”
8. Check Admin Review Screen and Administer med. Then Save and confirm.
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a. Why did you learn about giving K+? Get warnings: “Too late” and
“Incorrect amount”
b. How did you fix the incorrect amount warning? Type in correct
amount and press Enter
c. How did you fix the too late warning? Forced to select a reason when
scanning armband
Famotidine, Isopto
Drops
Trainer: Give 2 meds…no issues Isopto Drops, Famotidine
1. Review Care Organizer (from lower tool bar). View 5 meds on timeline
due at 1000. Insulin will be given next as a separate med
2. Click “Horizon Expert Documentation” from lower toolbar to jump back to
Admin-RX
3. Scan Isopto drops from vertical barcode
4. Scan Famotidine (2 tabs, each barcode once). Press ENTER
5. Scan armband and ask for 2nd identifier
6. Administration Review Screen: make sure all meds scanned display
7. Give meds
8. Click CONFIRM
Insulin SS &
Scheduled
Trainer: Meal times vary up to 2hrs to provide better fresher food for our pts.
Nursing judgment should be used to determine if Insulin is given early or late.
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Pharmacy adds two barcodes to insulin vials in the event the patient requires a
scheduled and sliding scale dose.
1. Scan tadpole barcode
Trainer: Note Matched Med Box displaying both SS and Scheduled Insulin. Blue
display is the dose selected. Blood Glucose is 240.
1. Select Sliding Scale dose
2. Hover over blue area or click on underline name to view scale. Note 4 units
ordered
3. Click OK
4. Tadpole always scans 2units; change to 4 units
5. Warning-Site Field Required: Pick site field from small drop down box next
to the !
6. Scan vial barcode
7. Select scheduled dose 5U
8. Click OK
9. Warning-Incorrect Amount: Dose displays 1unit. Type 5U. Press ENTER
10. Warning-Site Field Required: Pick same site field
11. Scan Armband.
12. Point out cosign box for real-time cosigning.
Cosign Insulin
Trainer: Note Co-Sign option if another nurse is in the room. Not commonly done.
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Trainer: The norm is to find the patient via the census dropdown to document cosignature
13. COSIGN: Partner up… co-sign insulin by selecting partner’s pt from list of
pts, then click documented insulin.
14. Click on the dose under co-sign select “click to co-sign” and Save.
Trainer:

Nursing judgment should be used to determine if Insulin is given early or
late based on meal time.

Note Co-Sign option by going to another patient, and click on Administered
Insulin… Click Co-Sign. No prompt at end of shift to remind you to CS. Your
responsibility
Warnings
MOM
Scenario: Billy Bob changed his mind about the MOM.
1. Scan MOM, make sure you are back on your patient
Trainer: Note Warning.
1. Scan MOM : Note warning- “ No current schedule Found – early for
schedule…”
What schedule are you getting ready to take/steal? 12noon (Afternoon
class 1600)
In this case, do you think it’s OK to take the 12noon (afternoon class 1600)
schedule of MOM? No. Pay attention to the time the med is due. If it’s not a good
idea to take the next dose, document as an extra dose.
2. Click third button on popup – “Extra Dose”
3. Click ok, change dose to 15 ml
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4. Scan Armand. Click Ok for Override Reason
5. Save and Confirm
Can you think of a legitimate reason for overriding a warning?

Too Early: might be legitimate if pt leaving unit and want to give dose
before procedure, etc.

Too Late: pt returning from procedure

Recently Given: Just FYI for nurse in case of duplicate administration but
same med in various forms (IV and PO, PRN and Scheduled, or meds with
Q2hr frequency)

MED
LABEL
Potassium
MEDICATION SCHEDULES FOR ADMIN-RX CLASSES 2012
DOSE
8 Meq
ROUTE
PO
FREQUENC
AM
PM
Y
SCHEDULE
SCHEDULE
BID BL
0700 –
Chloride oral sol
TRAINING
Late
1200 noon
Famotidine
40 Mg
PO
TID cc
1000
1400 1700
On time
MOM
15 ml
PO
Q4H
0800
1600
Pt refused
1200 noon
2000
1000
1400
Isopto Drops
1 drop
Each eye
TID
1700
Insulin Regular
5U
Sub q
TID cc
1000
1400 1800
Human
At end
Insulin Regular
Sliding
Human
Scale
D5 ½ NS + KCL 20
125
IV
MEQ/L
ML/hr
infusion
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On time
Sub q
TID cc
1000
1400 1800
On time
At end
Now
IV
23
Reset Scanner
Link – Point Out
1. Trainer: Over 95% of scanning issues can be resolved when the scanner is
reset. Synthroid is a complex barcode that can be hard to scan so using
the reset scanner link will resolve most issues.
Ask preceptor how to do
this on unit.
2. Occasionally, resetting the scanner will not correct the problem; label is
damaged or med is new in Vanderbilt’s system. For meds that won’t scan
after the scanner is reset, place in red bin on top of the Acudose cart and
document the issue. Pharmacy will pick up and take corrective action to
fix.
IV Manage
Trainer: IV maintenance fluids, PCAs and epdiurals are not scanned into Admin –
Rx but are scanned into IV Manage
1. Go to Care Organizer
2. Click on patient’s name from the bottom of the screen so only your
patient displays at the top of the screen.
3. Look in Group column to note meds charted in IV manage (Maintenance
fluids, TPN/L, fluid boluses, Med drips PCA syringes, Epidural bags).
4. Scan Armband on laminated sheet
5. Click IV Manage
6. Scan barcode of new bag of D5 ½ NS w 20KCL
7. Dosing Wt = 0
8. Infusion Rate = 1 started
9. Click SAVE. Note color change
10.
End other bottle – checkmark end bottle and save
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11.
Click Exit and refresh
Trainer: Mention in Vitals I&O a zero placer will display when a new bag is ended
or Dc’d.

What are the steps involved with bar code scanning of meds? Scan Med, Scan
armband and ask for 2nd ID, Give med, Confirm

If med will not scan, what should be done first? Reset Scanner

Can the scanner be reset from the CWS? Scanner Reset from HED

Most times meds will not be given at the exact time they are due. What’s
Vanderbilt’s standard for administering? 1 hour before and 1 hour after due
Guided Note Taking
Break 10 Min …Lock Screen …Click LOCK left lower tool bar
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LCD Slide 4
OBJECTIVES: HEO and StarPanel
 Explore StarPanel.. EMR

◦
Look up test results and documents
◦
Complete Admission History form
◦
Assign a Pathway (Plan of Care)
Enter orders in HEO/Wiz… CPOE
◦ Enter Nursing Orders for New Admission
StarPanel
Inpatient Whiteboard
TRAINER: Click on StarBrowser displays in lower tool bar ... this is StarPanel

Patient List: Census view

Black bar: Many options including MR # or name search

Go TO Icons: left of the black bar

Print

Desktop

Signoff the workstation

Wiz Production

HED Production …others

Teletracking

Veritas

Locate RED CARD on monitor. This is your patient.

Navigating:
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a. Single click to open documents
b. Frames: Adjust by double clicking in any white spot or dragging
frame with double arrow
c. Yellow tabs: specific to the opened patient i.e., patient note
d. White tabs: Generic, i.e., groups of patients
e. Click “Pt List” to return to this view of pt’s
1. Click Blue ACTIONS text next to your patient’s name
2. Click My Actions – Change
3. Select Inpatient Nurses from yellow box
4.
Click FAST LABS (24 HR Labs will not display data) Drag frame up.
Displays in Reverse chronological order with Abnormal values display in red
a. Hover over lab to display entire name and reference ranges
b. Click on PCV to see TRENDS
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c. Click GRAPH
d. Close by clicking in Trends box and X out of Graph
6. MAR: Click ACTIONS, MAR… ALL DAYS
 Meds display from Admin-Rx and VPIMS, the OR system
 Open boxes mean “not given” or “given by another nurse”
 Closed “given”
 Yellow “comments”
 note K, and blood glucose graph help track why med not given
 Click Levofloxacin 750 mg q24
 Red Line indicates there was a Downtime and see paper MAR
 Drug Reference: Hold CTRL and click on drug name in Blue
Trainer: Point out ED and OR documents can be accessed via the ACTIONS menu
7. Click ALL DOCS from ACTIONS menu: notes, communication, reports

Type in search field “Progress” and to view all progress notes

Open a progress note & view in frame below
7. Click OPC from column

Overview of Patient Care

Used to give and receive report… Handover tool

Pulls in information from orders, test results, nursing & MD documentation
Trainer: Point out the following as learners locate
Situation: SBAR format
 Team Text Page can be done from here
 Blue text is a link to the document
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 Admit History can see Contact info and present on Admission info
 Clinical Alerts: Code, Allergies, Isolation, Fall, Braden, Adv. Directives, No
Information pt
Background: past medical/surgical history
Assessment:
 Plan of Care includes Pathway, Nursing Summary and Plan Priorities, and
goals
 Assessments that have NOT met standards for a specific system/pain
 Progress Notes/Consults/Rad/Rehab: replaced with new notes if
documented.
 24hr labs Weight, V/S, I&O, pain
 Invasive line and vents info
Recommendations:
3.
Current, Active orders from HEO Wiz
DEBRIEF: Can you see the overall benefit of using this tool?
Admission
History
Scenario: 57 year old Billy Bob is admitted to your unit after being seen in the ED
with fever and cough. CXR revealed lower lobe pneumonia bilaterally.
When a new patient is admitted, how many hours to complete an
Admission History? complete within 24h
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LCD Slide 5
Trainer: Admission History form is divided into 3 sections with specified times to
collect information.
 Section I: 1-2 hrs with critical information for safe patient care
 Section II: 6-8 hrs for planning care
 Section III: Collect 20-24 hrs for discharge plans and functional screens
What’s the quickest way to access an Admit History form on a patient? ACTIONS
1. Click Adult Admission History from ACTIONS menu.
Trainer: Follow along to complete the form. Some data from previous admission
might be pre-populated. Always confirm pre-populated data i accurate.
Section I
a. Height: 5 ft 11 – stated and data collected today- use calendar to select
b. Weight: 189 lbs stated.. Peds 16kg measured
c. Admitted today @ 0850
d. From ED
e. No religious, cultural or ethical practices to consider. Confirm any
prepopulated data is accurate
f. Patient has NOT been exposed to TB
g. Reason for admission: Cough
h. How Long: 1 week
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i. How does patient care for problem: Robitussin
Legal Documents
j. Advanced directives/ Living will scanned in chart
k. Family to bring in Durable Power of Attorney document
Communications
l. Historian Family Member:
m. Sally is patient’s sister and support person who is staying with patient
n. Her phone 333-3333
o. Relationship: Sibling
p. First Person: Same as designated support person
q. Second Person: Information can be shared with John
r. Instructions, Care For After Discharge, Transportation: same as
designated support person
Trainer: There is a link to gather the Home Meds List (PAML). This will be
demoed in HEO/Wiz.
s. Allergies: Verify with patient that all allergies are correct. Remove
one allergy by clicking on the Red X.
t. Add allergy for Morphone by clicking New. Enter reactions, severity.
u. Save
Present on Admission
q. CPAP: used at home but the patient did not bring it
r. Alcohol Screen: Denied intake…
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v. If you are unable to complete section I then save as draft
Section II
Patient Summary: Receives all updated information from inpt and outpt visits.
Most accurate patient information source. Click to expand or collapse.
Tobacco Screen: Denies use
Immunization Screen
1. Open Immunization Record: Click Blue link
a. Barcode scan of immunization med will electronically update record
b. Manual entry can be done if patient states given at earlier date
2. Stop Screening:
a. If ICU, STAT name with incorrect birthday or patient unable to provide
history
b. Complete immunization screen when correct data is obtained
c. Stop Screen if pt <6 months old
3. Flu immunizations Screening – will see this in Fall.
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LCD Side #6
TRAINER:

Nursing Protocol order electronically enteredd into HEO/Wiz

10 a.m. administration time scheduled for next day

Better for our patients and Medicare/Medicaid requirement

Pediatrics: Pharmacy will give all the flu immunizations, not pt’s nurse
4. Pneumovax: Same type of screen as flu… do NOT complete
5. Scroll through Religions, Pain, Nutrition, Social Work, & Learning Readiness to
end of section II. do NOT complete
6. Verify Pre-pop data
7. Save as DRAFT
Amend Admit History
Trainer save your form as FINAL and demo how to add amendment
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 Is it OK to complete all sections at the same time? Yes
 If all sections are not complete, what should you do? Save as Draft
 What if someone changed the data you entered? tracked electronically
 What’s the timeframe for completing section I? 2 hours of admission
Assign Pathway
Trainer: a Plan of Care should be assigned to each patients medical record.
Vanderbilt’s POC are called Pathways.
1.
Click ACTIONS
2.
Click E-Docs Pathway
3.
Search for Pneumonia
4.
Select
5.
Click on ACTIONs menu next to patient’s name.
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6.
Click AllDocuments to view E-Docs Pathway
Pathway is in AllDocuments and can be accessed easily by team. Also available as
a hyperlink in Assessment section of OPC.
Guided Note Taking
1. Clicking on ACTIONS opens a menu for quick access to patient information & documentation.
2. OPC is an acronym for Overview of Patient Care & contains most recent documentation/tests.
3. The Admission History form is divided into 3 sections.
a. Section I: Critical information needed to deliver safe care, i.e., Allergies. Complete in 2 hrs
of admission
b. Section II: Positive screenings for Flu and Pneumovax generate Nursing Protocol order in
HEO/Wiz with a schedule time of tomorrow 1000. In Peds, Pharmacy administers .
Complete within 6 to 8 hours.
c. Section III. Functional screens for PT/OT/Speech/CM should be completed within 24 hrs of
admission and on short stay areas at least 8 hrs before discharge.
4.
Existing data imported into the Admit History data base should always be Verified.
5. Meds documented in Admin-RX display in StarPanel in the Actions menu by clicking on MAR.
6. The Plan of Care (Pathway) is accessed from StarPanel by clicking on ACTIONS button & selecting eDocs Pathway
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HEO/Wiz
1. Click Desktop Icon
2. Click Green Wizard (Wiz Train)
Trainer:
 Census derived from Medipac, application for Admit, Transfer and Discharge
 Computers in this training rooms are set to display the census of _____unit
Symbols
LCD Slide 7
HEO/Wiz Census Legend
Security Indicators

N: No information

S: No information…Usually police involved

G: Can give general information out according to policy
Search
A. Under Stations, click the unit you will work on. Note census change.
B. Type (ZTEST) in search box and press ENTER. Displays pt’s from all units.
C. Click Refresh button… don’t forget to refresh if pt not found on census.
D. Click back on training census.
Paper Documents
Still a few
Computerized Physician Orders
pages 1 and 2
Generally print to Medical Receptionist’s printer when orders entered in
HEO/WIZ
Patient information and MD who authorized order at top
Each order has a number
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STAT orders display bold … see page 2
Start & stop times (right side of page)
 Open-ended orders (continuous) display start time. Remain until
deleted or pt discharged – see #10 NHO
 One-time orders - see #13 culture urine bacteria
 Timed orders – See #14 (pg 2) Percocet. 72 hrs stops
Far right column provides a place for MRs to note when dept called, etc
MR & RN initials at the bottom when orders are processed and verified
Computerized POS is not a permanent chart document
Requisitions: Lab pg 3
► Reqs print on unit if procedure if test done on unit i.e. RT and EKG
► Other Reqs print in performing department, i.e. Radiology, Nutrition Svc.
► Lab Reqs are bar coded:
 2 barcode above double line are patient information
 Barcodes below line defines tests
 Lab scans Req when specimen is received
► Multiple tests print on same Req if tests can be run in same dept (CBC and PCV)
► Full signature, VUNet ID, dates & time from person collecting specimen.
► Text in center section gives directions on how to collect specimen, color of tube
► If test ordered STAT, MR calls the performing department, except for Labs.
► Batch Reqs print after midnight if the test is to be done after MN, ie, next day’s
labs
TRAINER: Demo how to reprint reqs
1. Double click on patient’s name
2. Click on Reprint Requisitions
3. Select your test
4. Click Reprint Checked Requisitions. (Note: If it is red with an accession
number, it cannot be reused)
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Nursing Protocol Orders
New Admission
Scenario: Billy Bob arrives on your unit, now that a bed is available, after spending 8
hours as an admitted patient in the ED. The nurse in the ED completed the Admission
History. It’s time for you to enter some orders in HEO/Wiz.
1. Double click name on red card or slips of paper on monitors on laptops
2. Select Enter Orders
3. What order type? Protocol (Nurse to nurse order will pass along information
and doesn’t require Co-Signature from MD)
4. Physician? TEST
5. Press Enter & Select Dr. Test from right upper window
Trainer: Screen is divided into left and right windows

Top Left window: Name, rm. # MR #, Sex & UserID. Verify correct pt

Inside left window: Orders with numbers

Organized by categories
Always review active orders before entering new ones
 Right Window - Upper window displays common orders for that unit
 Center window - colored text asks questions or gives instructions
 Bottom window - Flashing cursor. Type here.
 Toolbar @ Bottom of Screen: OOPS and DONE
Trainer: Instruct learners to NOT enter beds or pressure ulcers. Can demo on the
screen but do NOT accept. Lots of cleanup involved.
BRADEN:
6. Type Braden: (Braden Q for Peds) Pressure Ulcer Management- Braden Scale
(Skin risk). Be creative. Skin Assessment is done in HED.
7. Demo adding a pressure ulcer
a. Click Add a Pressure Ulcer
b. Location: Buttocks
c. Side: Left, medial, superior
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d. Click Select Stage: 1.
e. Pressure Redistribution Item: Chair Cushion
f. Click Save
g. Click Done
SYMBOLS: Left Window
 Sun: new order
 Paragraph sign: order will drop off in 24 hrs… one time order
 Note order # assigned after order accepted
7. PAML- Pre-Admission Medication List (Home Medications)

Includes: prescriptions, over the counter, herbal or vitamin supplements

Complete within 2 hours of admission

Providers reconcile PAML during patient’s admission and time of discharge

Across top in gray area: patient’s information

Top left is the Medication Search box

Box underneath is the Patient Summary. This is the patient’s current
home med list from clinic. Ask the patient if she/he is still taking the
medications. If yes, click on the yellow arrow to move med to right side of
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the screen under Pre-admit List. This box is where all home meds are
updated.
8. Click DONE…Accept
Trainer: Review orders. If Corrections? Return to order entry. Exit w/o accepting if
wrong patient. Orders are correct. Click ACCEPT
More Orders
Trainer: Billy Bob complains of pain and you page Dr. Test from the OPC pager
link. (Starbrower open on lower tool bar) While on the phone, Dr. Tests gives you
several verbal orders to enter.
1. Double click name on red card
2. Select Enter Orders
Trainer: What order type? Telephone
3. Type TEST, press Enter. Select Dr. Test from right upper window
Discontinue
a. Click Guaiac from left window
b. Discontinue
c. Reason (Dr. cancelled)
Modify: to 75ML: D5 1/2 NS with 20 KCL @ 125 ml/h
a. Click current IV order in left window
b. Select Modify.
Trainer: Notice order in Upper R window. Identify parts: Name, Frequency, Priority,
Duration, Comments
c. Click Rate to modify
SYMBOL: Symbol for modify? Square
New: PCV in AM 0500 – “don’t draw L arm”
a. Type PCV in the right bottom corner. Select from List
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b. Select PCV blood –LAB
c. How Often: in AM- 0500
d. When to Start? Routine
e. Comments: Don’t draw from left arm
f. What Symbol displays before the new order? Sun
Switch: Change diet to Regular
a. Click on NPO left window
b. Click Regular. Trainer: Treated as new order
c. No Comments: Press Enter
Medication Order: Morphine 30 mg PO q4h PRN
a. Type Morphine
b. Select # 2: Morphine Immediate release tab
c. Dose: 30mg
d. Route: PO
e. How Often: q4h PRN
f. When to Start: Routine…in green
g. How Long: 3 days or click ENTER
h. Comments: for abdominal pain > 4 (required) NHO if nauseated
Blood: Dr. Test ordered 2 U of blood to be transfused because your patient has a
PCV of 21. This is not an urgent request and as a nurse you determine when it’s
best to give to the patient, i.e, after a test, or bath. Type and Screen req will
print if no results in StarPanel within the last 72 hrs when transfuse order is
entered.
1. Click on Transfuse Order in left window
2. Click Request Blood Product from Blood Bank
3. Review information – confirm accurate
4. Request 1 unit
5. Click SEND, DONE, ACCEPT
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LCD Slide 8
Processing of Orders
by Medical Receptionist
 Orders & Reqs print to Medical Receptionist (MR) and placed in unit appropriate area
 MR: Notifies RN of STAT Orders and Labs
 MR: Notifies Department of Other Tests
 RN: Acknowledges Orders online
Emergency Departments: Orders do NOT print. Lab Requisitions generate to printer closest
to pt’s room
LCD Slide 9 Steps to Acknowledge Orders Electronically
TRAINER: Review slide steps
Guided Note Taking
1. To ENTER a new order without using an order set, just type it in.
2. To MODIFY or DELETE an order, just click on order in left window.
3. Identify the two places where Allergies alerts can be entered. Nursing Admission History Form and
HEO/Wiz.
4. Skin is assessed in HED and Braden Skin Risk is documented in HEO/Wiz.
5. When taking a verbal order from an MD, always verify who will Enter the order.
6. When requesting a unit of blood, click on order in left window and Request blood product.
7. PAML is an acronym for Pre-admit med list (home meds). Nurses review home med list with
patients when they arrive on the unit and as needed.
TRAINER: If time permits, have students complete Seek and Find
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Trainer Responsibilities after class is over
Update Amanita
1. Check sign-in roster where you noted that they said they passed boards
2. go to this web site: http://health.state.tn.us/Licensure/default.aspx confirm they have passed boards
3. If passed, take training flag OFF
4. For those who have NOT passed boards
a. Change Role to Medical Receptionist – Other
5. place in comments “Nurse Resident Training completed m/d/y
Discontinue all orders after each class-MD training ID TRAIAKO…
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