Ever wondered what Health Maintenance was? Here's your answer...
As an effort to continue moving forward with Meaningful Use (MU) Stage II efforts, we would like to provide more detailed education about Health Maintenance.
Below is a little about Health Maintenance. Please select the link to the handout at the bottom for the full tutorial, including information on Invitations and Reminders.
As part of the progression of Meaningful Use, SNOMED codes associated with diagnosis on user's family history quick list tool will need to be updated with current codes. In order to do this, they must purge, or "blow-out", all the existing custom quick list setups.
This is planned currently to happen on June 30th.
Any assistence needed to rebuild your list, feel free to contact any of the HELP desks.
Also to assist with this transition, a "Common List" has been added to all users family history tool. It sits directly under the Quick List. It is standardized across all users and specialties.
Changes when viewing a Physician’s Schedule within PowerChart
Starting Next week, the Physician’s OR schedule will appear along with the clinic schedule.
In order to see what the surgery is:
Select Schedule from the toolbar and click on Preferences
Select the Day View tab and move Primary Order from the box on the Left to the box on the Right. Do this by first clicking on Primary Order and then selecting the arrow in the center.
You will now be able to see what surgery is scheduled in the Primary Order Column.
A blog article by John Lynn, the founder of the HealthcareScene.com blog network. 
FYI – If a non-RxNorm prescription has been saved within an outpatient prescription favorite, when it is inactivated in our system, it will be automatically removed from that favorite. You will need to add the medication again and resave.
In an effort improve patient safety and to reduce the amount of medications that are non-compliant with the RxNorm standard, ALL active, non-controlled, prescriptions that are older than 14 months AND/OR that have an actual stop date that has passed, will be “Completed” on June 16, 2014. Controlled substances (CIII-CV) will be “Completed” when the prescription is greater than 6 months old. Completing the prescriptions will move the prescription to the “Inactive” section. Schedule II substances that require written prescriptions will NOT be inactivated. The Use and Standards Committee members feel that this clean-up effort should be continued on a daily basis to improve patient safety and RxNorm compliance. Medication errors have occurred when old prescriptions have been converted to inpatient orders.
ALL active, non-controlled, prescriptions that are older than 14 months AND/OR that have an actual stop date that has passed, will be “Completed”.
The prescriptions will still be visible within the “Inactive” prescription section. To reactivate the prescription, simply right click and “Copy”. The computer will prompt you to choose the RxNorm compliant version.
If it is an over the counter item, something that does not actually require a prescription, the medication should be listed in “Documented Medications by Hx”.
RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, and can mediate messages between systems not using the same software and vocabulary.
It is required that all medication orders in our system are in an RxNorm format so that drug interaction rules can be correctly applied and also so that patient data can be transferrable between different systems.
The reason this is an issue for us is that in an effort to make things easier for providers, we have continued to allow the use of drug names or particular formulations of drugs that are no longer available and thus do not have NDC or RxNorm codes available.
As a result of our efforts to make life easier for our providers, we've created several thousand of ese synonyms and those now have to be cleaned up.
Does the PowerPlan you are using have a PowerForm associated with it?
If you choose a plan that opens a PowerForm requiring documentation, please us the "green check" in the upper left-hand corner to complete the documentation. You will then be able to sign off your orders.
New color coding is being activated in the near future for PowerPlans...enjoy!
1. For patient safety related notes within a PowerPlan so that the ordering provider can see something that could be harmful or life threatening, the comment would be highlighted in red with white text.
Must have Patient Safety Committee approval.
2. For notes within a PowerPlan for the ordering provider to have a visual queue as an important item, the comment would be highlighted in yellow with black text. This should be used selectively.
3. White on Black will be used to divide patient populations or disease states, such as:
Due to recent incidents with activation (or lack of) of PowerPlans, we would like to post some reminders and tips:
Did your ADMIT or POST-OP orders get initiated: If you are reviewing your patient’s orders profile and see a plan sitting in a ‘Planned’ state, this plan is not yet active. If your patient is on the correct unit and these orders should already have been acted upon, notify the primary or charge nurse ASAP. If your plan was initiated, but you feel an order has not been acted upon appropriately, please notify the primary or charge nurse (or a member of their admin team) ASAP.
Know the proper use of the OCTOR (on call to OR) frequency vs. One-time. If you are ordering an antibiotic or other medication to be given in the OR or PACU, please use the ‘OCTOR’ frequency, not one-time, to help prevent the accidental administration of the medication on the unit.
Don’t forget to use the MERGE VIEW functionality!
Feel free to call any of the HELP desks for further questions or clarifications.
Cerner will be building the new Transition of Care (Summary of Care) and Visit Summary MPage soon. More detailed education will be provided in the next several weeks. But for now, if you see any new functionality or changes, this is what it will be related to.
Here are some screen shots of what the final product might look like...
New option in "Communicate" drop-down:
New option in Message Center:
New items on the Table of Contents (Menu):
1. Make sure you consult Social Services ASAP!
2. At discharge, choose the appropriate disposition. NOTE: Choosing "Home with Home Health" does NOT consult social services if you have not already consulted them. You must enter the appropriate order as shown above.
3. You can also confirm that social services has been arranged by looking at the "Services to be Arranged" section of the Discharge Plan. This section is filled out by social workers once services have been arranged.
When placing lab orders, it is important to not place a STAT order with a frequency of other than One Time. If a STAT order and a serial follow-up order is necessary, then two orders should be placed. A One Time order placed with a priority of STAT, and a second order with a priority of Routine and the desired frequency. Placing STAT orders with a frequency causes confusion with the nursing staff, because all of their collection tasks fire and labels print immediately.
New order sentences will soon be available when ordering vancomycin, gentamicin, tobramycin, and amikacin. These sentences will ease the ability to consult pharmacy for dosing according to the pharmacokinetic dosing protocol. The pharmacy consult is optional, and may be added or deleted. Lab draws, which can be modified, will be defaulted in based on common ordering practices.
The existing handout within PowerChart for your overweight patients has undergone an update and now has an added underweight component.
After May 19th, you will also notice the addition of a new component within the nursing intake forms. This field will function exactly as the overweight one does. If your patient has a BMI less than 18.5 (patients 18-24 years) or less than 22 (patients 65 years and older) it will present as yellow (mandatory field) and you will simply fill out the applicable date for that patient.
To meet Meaningful Use Quality standards for weight assessment and counseling for nutritional and physical activity for children and adolescents (NQF-24), the automated calculations will now be visible on the flowsheet. Nothing needs to be done differently by the providers/nurses who collect the BMI data. This will be present on children ages 3-17.
Short Version
Lots of the medications in our system have synonyms that have been made obsolete over the years either because they are no longer manufactured in their branded form, or for reformulation issues, or some other reasons. Pharmacists with IT will be going in and updating these over the next few weeks. This will save physicians and other providers hundreds of errors over the next few months.
Long Version
In an effort to allow computer systems used for patient care to communicate to each other and to the Health Information Exchange (HIE) system, the NIH U.S. National Library of Medicine has developed a Unified Medical Language System (UMLS). Medications will use a vocabulary termed RxNorm to communicate. Medications in Cerner must be matched to a medication in the RxNorm vocabulary. Many brand names that are no longer manufactured are not listed in the RxNorm vocabulary, for example, Phenergan™. One must use promethazine when ordering this medication.
Use and Standards has approved a massive clean-up of prescriptions that are not matched to something in the RxNorm vocabulary to begin immediately. Initial clean-up is being done to limit the impact on end-users. The first step is to allow a pharmacist to modify current prescriptions that are not matched to something that is matched to RxNorm. For example, a prescription for Phenergan 12.5mg PO q6h PRN nausea would be changed to a new prescription for promethazine 12.5 mg PO q6h PRN nausea. All other aspects of the prescription will be retained. If a prescription must be modified beyond what is allowed by law, the pharmacist will contact the provider for approval. Providers WILL NOT receive an alert in their message center. The medication list will appear as follows once the prescription has been “fixed”:
The discontinued order will retain the history of “Obsolete Synonym” as the reason for discontinuation:
Due to popular demand, we have moved the outpatient referral documentation folders to a new, easier-to-find location. Also, for those that scan their own forms, we have a new folder called "Referral Requests". This will be a great addition so everyone will no longer have to scan these outside documents into the "consult/referral request worksheet" folder that used to be nested in Nursing Documentation. Enjoy...
Many of you have most likely heard the news already, but for those of you that haven't, ICD-10 implementation has been delayed until at least 10/1/2015.
For an entertaining explanation of the ICD-10 delay implications, watch the video below and enjoy. Sometimes, you just have to laugh...
P.S. No Shamu's were hurt during the production of this video.
