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
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.
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.
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.
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
The issues identified earlier this week regarding the new Social History Control data not being able to be pulled into PowerNotes has been updated. The notes and the control were not "broken", but Cerner no longer supports this type of documentation, so there was no existing way to accomplish populating the notes with the nursing documentation.
The clinical PowerChart teams worked to find a better solution this week. As of this morning, there are serveral popular PowerNotes that have had a new template added to the Histories section.
To amend your existing notes to include this (including any precompleted notes), when you are offered the Auto Populate option upon opening a new note, you will have to check the box shown below for each note template you use (one time only):
All PowerNotes will have the new template added shortly, but this effort takes time due to the amount of notes that need to be modified. In the mean time, if you have a note that does not yet have the new template, the following is instructions as to how you can manually add the same template wherever you want within your note.
Click a "white" spot in between categories within your note, such as by the Histories section as shown below. Then select the "insert template" icon in the toolbar. If there is Social History nursing documenation already completed, it will now be pulled where your cursor is located. The template you are looking for is called "Social History Control."
This is an update in regards to calls surrounding the new Social History Control that underwent its required installation Monday, July 16th.
Due to Cerner's trajectory towards Dynamic Documentation and no longer truly supporting PowerNotes, this new Social History control has not been integrated into PowerNotes. There is no current existing functionality to pull any Social History nursing documentation data into PowerNotes, and it is not on Cerner’s roadmap to do so.
At this time, PowerChart teams are investigating any other possible options, and we will update clinicians if anything is discovered. Until then, any social history information will be the responsibility of the provider to transcribe or free text that data into their note.
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:
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:
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
Powerforms for documenting lab results from another facility are being introduced and will replace some existing forms. Results documented on these forms will display in the patient flowsheets in Powerchart and are readily identified as coming from an outside source. The name of the facility that processed the lab is a required field and the form cannot be completed without this field. The forms are similarly named "Outside Lab..." followed by the type of results that the form entails (CBC, Chem, FOB, HIV Screen, etc).
Lab results that are not available on these forms will continue to follow the same process previously defined by your clinic (i.e. scan into chart, reviewed by provider, etc).
These forms can be found in your Ad Hoc folders begining May 23, 2018.
Starting 4/3/2018, the bedside sedation process will become electronic
The following plans will be available for your use and should be placed prior to using sedation for a procedure at the bedside.
You will notice the plans have four phases. The Provider will ONLY complete the FIRST THREE phases. (Pre, Intra, Post-Procedure). Nursing will complete the Fourth phase.
The first order is the Sedation History and Physical Update Order and this order has a form attached to it that the physician will complete after signing the powerplans.
Once the plan is signed by you, the following form will appear. This form must be completed by the physician.
There will also be two new PowerNote Templates available for use with this process.
Fecal Occult Blood (FOB) Outside Source section has been added to the Basic Labs Outside Source Ad Hoc form to document FOB results a patient may have received from a provider other than UMC, UMCP, or TTP. This section can be accessed from the Basic Labs Outside Source form or from the Health Maintenance tab under Colorectal Cancer Screening. Results will satisfy HM for 365 days.
The Performed on date should reflect the date the test was resulted, not the day it is being charted in Powerchart.
The Katz Index of Independence in ADL’s has been added to the ADLs, Disability, and Cognitive Screening Ad Hoc form. The results populate the All Results Flowsheet and can be pulled into Review / Management section of the Powernote.
A new component is being installed onto the Inpatient Summary View called, Additional Significant Events. It will be located next to the existing Significant Events component.
This new component is for PowerChart in the Emergency Center. When a patient presents to the EC within 30 days of inpatient discharge, the component will become visible to alert you regarding possible readmission status. The component should no longer be visible if the patient is admitted.
