For Dynamic Documentation Users:
Please remember that problems in the Consolidated Problem List are shared.
If problems are deleted, another provider will have to add them back in.
Also, our on-site support for Dynamic Documentation ends this week.
Please work with your support team to set up any auto text, and other settings, before Noon on Friday.
Cerner Workflow and Dynamic Documentation will go-live on December 11, 2018 for:
The format of the notes created by these service lines will change.
No matter your service line, there are several items to take note of beginning December 11th.
Navigate to PowerNote Documentation. Select the filter drop-down and select All Physician Notes.
How to ensure the notes received from residents and advanced practice providers (APPs) are sent to you for signarture and not for review when notes need attestation statments and attending signatures:
Residents and APPs must select ‘Sign’ when forwarding notes to the attending. If they fail to select ‘Sign’ the notes will appear in the Documents to Review.
You must notify the provider to forward the document to you and request ‘Sign’ so that you can add your attestation statement and sign the document.
Click Refuse. Select Additional Forward Action of Review and search the resident/APP’s name that sent the document to you. Write in the comments ‘Please resend note as document to sign’
In order to make changes to the note, add attestation statements, etc., you will need to modify the note. You will not have the ability to correct these notes anymore. You may strike through the documentation and add an addendum only.
Click on the modify icon in order to modify as necessary
You can strike through by highlighting the term and click the ‘strike through’ icon
If you would like to strike through an entire selection or data auto-populated into the note, you need to click the ‘X’ icon located in the section that the data is in
Changes to Ambulatory Cardiopulmonary and Vascular Lab orders:
Due to the upcoming changes with Dynamic Documentation, the first five services lines converting will notice a small difference when ordering either Vascular Lab or Cardiopulmonary orders.
The folders will look the same; the difference will be that most of them are no longer caresets. The Schedule Heart Station Procedure order has been removed. That order will be placed automatically for you via a rule in the system. The nurse/scheduling staff will still receive the task and PowerForm as before.
When placing the non-careset orders, you will no longer receive the pop-up screen (Figure 1).
As always, please call any of the HELP desks for questions.
SmartZone
NEW GOLIVE DATE: February 4th, 2019
SmartZone is a decision support tool for clinicians. It provides referential information and noncritical notifications in a manner that does not disrupt your workflow, allowing you to view these patient-specific items and take action on them as needed.
SmartZone displays the following information:
View of PowerChart with SmartZone notification:
Can be collapsed by selecting Hide>.
Note: smaller screens will default to the collapsed view
Current SmartZone Content:
ASP Workflow:
1) Notification when preliminary/final susceptibility results are available
2) Notification when a patient has been on a Restricted antibiotic for more than 48 hours
Ideally, de-escalation would occur at this time, and would prevent the 72 hour alert from firing
and slowing your workflow
Provider Notification: New order for referral to Social Services to assist patients with Advance Directive/MPOA Planning
“Social Service for Advance Directive/MPOA”
New Powerplan – Acetylcysteine and Albuterol Plan
Per policy UMC SPP # 1.6.44 Acetylcysteine (Mucomyst) inhalation must be administered in conjunction with a bronchodilator. To facilitate this, we have built a new powerplan Acetylcysteine and Albuterol Plan. The plan can be ordered utilizing the brand name Mucomyst as well Mucomyst and Albuterol Plan.
The scheduled go-live date for the new plan is December 5, 2018. Upon release of the new plan the acetylcysteine/Mucomyst inhalation orders will only be available within the powerplan. The oral form of acetylcysteine/Mucomyst will remain available for one off orders.
Electrolyte Replacement Changes
Annual Cerner Fall Time Change - Fall Back
Process will start with Cerner at 0045 hours, November 4th
Anticipated downtime of no longer than two hours
PopUP:
Ambiguous Time Message
This dialog could appear for some users after the time change occurs. Please note this is not an error and perfectly normal.
If a clinical action is scheduled to occur during the duplicate hour (from 1:00 am to 1:59 am) a user could potentially get this popup.
Select “Daylight” If the action is to take place in the FIRST 1:00 to 1:59 hour
Select “Standard” If the action is to take place in the SECOND 1:00 to 1:59 hour
The system will display a phase header in the Orders for Signature view that displays the plan status and the number of orders you are about to place. The logic behind it is to bring more visibility to the clinicians on powerplans that are pending initiation.
The first change you will notice is when placing a powerplan in a “Planned” state the button that said Orders for Signature now says Plan for Later. The intent is to ensure the provider is aware that the orders are not active at this time.
The most noticeable change will occur after clicking the Plan for Later tab.
Now the Orders for Signature button is available.
After signing, the first phase has been initiated while the others are in a planned state. Only the 3 orders in the first phase are active.
Some powerplans are set to initiate automatically such as the Admit/Observation Plan. These plan types will give you the Orders for Signature button we are used to seeing, not the Plan for Later.
When you click the Orders for Signature button you will now see a new line (or lines) at the top of your orders window telling you the action you are taking. Here we are placing 3 orders.
When a plan is discontinued or voided you will see…
Here is an example of a powerplan that has the first phase automatically initiate while the other phases remain in a planned state.
***** ATTENTION *****
On Saturday October 20th, all Cerner applications (PowerChart, FirstNet, SurgiNet, etc…) will undergo an update. There will NOT be a downtime; however, there could be interruptions in patient admissions, transfers, discharges, patients turning green in clinics and tasks between 11:15 AM and 12:45 PM.
IT Staff will be available during this time to provide any necessary support.
There have been issues identified with the "Activate All" functionality and the Oncology PowerPlans. The decision has been made to turn this functionality off.
We will remove this from all inpatient plans so that the nurse will activate individual days of treatment instead of activating all. This will help with the rescheduling of medications and days of treatment. The nurse will activate the day of treatment as she is ready to. This will follow the workflow of nursing in the outpatient setting. This will furthermore allow the outpatient chemotherapy plans we currently have built to be used in the inpatient setting.
This is the current look to the Oncology Inpatient PowerPlans. The nurse clicks “Activate All” and all of the days of treatment are activated.
This is how it will display for the nurses. The nurses will no longer have the option to “Activate All”. They will click on the triangle next to “Actions” and click on “Activate”. This will activate the individual treatment day. In doing this, this will also allow the nurse to clearly see what day of treatment the patient should be on, especially since most of the time the same nurse does not have the same patient every day of the patient’s treatment.
Once the “Activate” button is clicked the process is the same. The day of treatment goes into an “Initiated Pending” state. The nurses will click “Orders For Signature”
The nurses will then review the orders and click “Sign” to finish the activation process.
After signing, they should “Refresh” the screen. Day of treatment 1 is now in an “Initiated” status while the other days of treatment remain in a “Future” status to be activated when needed.
UMC has transitioned from Cerner to Phillips Intellispace Cardiovascular (ISCV) for Cardiovascular Nuclear Medicine reports. ISCV replaced Xcelera and comes with more options and enhancements.
If you are having trouble finding Final reports, follow the steps below:
The ambulatory departments are joining the Baby-Friendly initiative with the documentation for breastfeeding mothers.
The process will include the addition of the Breastfeeding field in the ambulatory nursing intakes. If a clinician is ordering a medication and the documentation states the patient is breastfeeding (not just lactating) that alert will present itself as you are adding the medication to the scratchpad. You will be able to cancel the order at that time, or override it and continue.
The alert will present to anyone who is placing the order.
Per decisions made in the OB Collaborative:
There will be a new RhoGAM process implemented on Wednesday, October 3rd around 0900 (inpatient only).
When a mother has a documented delivery on the active visit (encounter) and her blood type is negative, an order for the RhoGAM workup will be placed automatically if no RhoGAM workup exist. Once the blood bank completes their workup and determines the mother is to receive a RhoGAM injection, the blood bank will then receive an order to send the RhoGAM to the floor.
As a final step, at the time of delivery and mom has a positive Rh factor and there is an active RhoGAM workup order, the system will cancel the RhoGAM workup order.
This process will not replace existing workflows such as ordering the type and screen and RhoGAM workup at the same time but will help to place orders when orders are not present.
Always double-check that a mother receives/doesn't receive RhoGAM injections as appropriate.
For questions regarding this process, please call FBC or UMC Clinical IT
Clinicians may now review telemetry strips within PowerChart
Within a patient's chart, go to clinical notes:
Under the folder Diagnositic Report > Cardiology Diagnostics > ECG 12 Lead > Telemetry Monitoring Strips
