SmartZone: Coming Soon

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:

• Passive notifications that do not require immediate action
• Patient-specific referential information
• Information or notifications that are present when you initially open the chart or refresh it

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

November 4th - Time Change

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

Message Center Preferences-How To Opt Out Of The No-Recipient Warning

Drug-Breastfeeding Contraindication Alert

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.

New Alert for C. diff by PCR Orders

In the next few weeks, there will be a new alert added that will aid in the prevention of ordering unnecessary C. diff by PCR testing.

As approved by the Use & Standards governance committee, the alert will impact inpatient ordering only.

There will be an alert that will prevent ordering C. diff by PCR if a previous C. diff has been ordered within 7 days.  

According to Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA), it is recommending to not repeat Clostridium difficile testing (within 7 days) during the same episode of diarrhea.  As a result, all Stool C difficile toxin by PCR orders placed within 7 days of the previous order will be rejected.

IDSA Clinical Practice Guidelines

Infectious Disease Documentation and Alert Updates

TLTR: On July 30th there will be an update to the current infectious disease nursing intake screening. It will include an expansion of the current Ebola and Zika alerts as well as integration of Tuberculosis, Yellow Fever, and Measles as well as the ability to assess outbreaks within the United States.

Infectious Disease Documentation and Alert Updates

After a systematic assessment of workflow and clinical decision support (CDS) related to infectious diseases documentation in PowerChart, it was found that an enhancement was needed. This enhancement includes updating existing nurse intake documentation and development of new alerts for nursing staff and providers. It was developed with several goals in mind:

• ·         Improving patient AND staff safety
• ·         Preparation for emerging AND re-emerging infectious diseases (i.e., the recent resurgence   
•           of Ebola)
• ·         Preparation for contagious diseases re-emerging within the United States (i.e., Measles and
•           Mumps due to anti-vaccination movement)
• ·         Standardize forms between inpatient and outpatient

To prepare, as well as to align ourselves with the national Centers for Disease Control and Prevention (CDC) initiative (CDC, 2018), we had round-table discussions with subject matter experts and selected several disease processes found to be either underdeveloped or non-existent in the system that needed the highest attention:

• ·         Ebola (exists, undergoing update)
• ·         Zika (exists, undergoing update)
• ·         Yellow Fever (new build)
• ·         Tuberculosis (enhanced build)
•           MERS (new build)
• ·         Measles (new build)

The existing PowerForm, Infectious Disease Screen, has been updated to aid in easing the transition for the nursing staff. It is the same form currently used, only with upgrades and modifications.

As of July 30, 2018, if applicable algorithms are met, an alert will be fired for Ebola and Zika (already exists), as well as Yellow Fever, Tuberculosis, and Measles and MERS (new). Other disease processes will be added later as the need arises or by subject matter expert request.

Continue to rely also on your clinical critical thinking skills when working with potentially infectious patients; always follow your institutional protocol. Clinical decision support provides guidance, but your clinical expertise will aid in whether the situation calls for further action or not.

References

Centers for Disease Control and Prevention. (2018). Adapting clinical guidelines for the digital age. Retrieved from https://www.cdc.gov/ophss/WhatWeDoACG.html

Centers for Disease Control and Prevention. (2018). CDC travelers’ health, 2018. Retrieved from https://www.cdc.gov/ncezid/index.html

Infectious Disease Intake Updates

Deceased Patient Alert

Beginning May 8^th, when end users attempt to place orders on patients that are marked as ’Deceased’ in the banner Bar, they will receive an alert preventing them from signing the order.

If an end user misses the banner bar message, and place an order a deceased patient, after they click Sign on the order they will receive a prompt stating that the patient has been identified as Deceased and the order will be cancelled.

SmartZone: Alerts for Antimicrobial Stewardship

SmartZone: a decision support tool for clinicians that provides referential information and non-critical notifications in a manner that does not disrupt your workflow, allowing you to view these patient-relevant items and take action on them as needed.

Alerts for Antimicrobial Stewardship Program:

Susceptibility results available (shown above): This alert will populate in SmartZone as an information-only alert when a new susceptibility result is available in the Microbiology Viewer in PowerChart.

Level II Restricted Antibiotic Active for at least 48 hours: This alert will show in SmartZone at 48 hours after the initial administration of a Level II antibiotic if there is no gap in therapy of greater than 28 hours. The alert below will state the name of the antibiotic that meets the criteria instead of just saying “Level II antibiotic.”

Level II Restricted Antibiotic Active for 72 hours: This alert will pop up in PowerChart when the provider attempts to close the chart if the patient has had a Level II antibiotic active for 72 hours after the initial administration if there is no gap in therapy of greater than 28 hours. A consult order will fire to pharmacy after the medication administration documentation at 72 hours so that pharmacy can evaluate the antibiotic therapies as well.

If they click the “Document” button, a PowerForm will open with options to document why this antibiotic should be continued.

Are you the primary provider that can assess the need for ___________?

                                No – suppresses the alert for that user for that antibiotic

                                Yes – move to the next question

                Reason to continue abx

                      Results still pending – suppress alert for all users for all antibiotics for 24 hours

                      Results deem therapy necessary – suppress alert for all users for that specific antibiotic

                      Do not wish to narrow therapy at this time – suppress alert for that user for that antibiotic

Updates from the mCDS Committee

To help reduce the number of drug-drug interaction pop-up alerts when you are switching therapies:

To easily see how many days a patient has been on antibiotics, look towards the bottom of the Microbiology tab

Drug-Food Alerts: Review and Suppress for Encounter

Coming in January-- Drug-Food Alerts:  Review and Suppress for Encounter.

Functionality: Will allow providers to filter a Drug-Food alert for themselves only for a specific patient for the duration of the patient’s encounter. Providers and IT personnel will have the ability to remove filtering.

How to Suppress the Drug-Food alert:

1)      Select ‘Review & Suppress for Encounter’ as an Override Reason on the alert

2)      Select ‘Continue’

How to remove suppression:

1)      Select ‘Check Interactions’ at the top of the patient’s Order Profile

2)      A red sphere appears to the left of all orders with interactions. Find the medication in question and click to view all interactions for the order. See allergy example below.

3)      Under Provider Filtered Alerts, check the box under ‘Unfilter’

4)      Select Continue.

5)      This will cause the alert to fire again upon order entry of that medication.

Duplicate Checking: Hemoglobin A1c

Hemoglobin A1C now has restricted duplicate checking of 7 days (it was a warning for less than 1 day). If the test needs to be performed within a 7-day period, the lab would need to override the restriction.

This restricted duplicate checking will not prevent future orders if the requested collection day(s) are separated by more than 7 days.