Provider Notification: New order for referral to Social Services to assist patients with Advance Directive/MPOA Planning
“Social Service for Advance Directive/MPOA”
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
BB Send Blood Product Order Updates
Changes made to the three BB Send Blood Orders and the BB Blood product Cancel order.
Removed the existing order sentences from the 4 orders (BB Send, Pediatric BB Send, NICU BB Send and BB Blood product cancel.) Added a drop down with the needed options.
Current and Future State:
Current:
When you place the above orders you receive this pop up screen with prebuilt order sentences.
Future State:
The 4 orders will now have no prebuilt order sentences but have a drop down with the 5 selections and only allow for 1 selection to be made.
Changes To NICU Blood Orders
The NICU blood orders listed below will no longer have the Lab Alert or Override Reason Form pop-ups when the orders are placed and the patient is in the NICU. The change was requested by the NICU because the Lab Alert and Override Reasons do not apply to the patient population within the NICU. The order has been updated to require a reason for administration of the blood product.
Example – No alerts because the patient is in the NICU location.
New required field – Reason for Cryo Order with NICU specific options.
When the orders are placed and the patient is outside the NICU the Lab Alert and Override Reason Form pop-up will continue to open as they do today.
New Order/Update to Fall Policy
Attention Providers: New Order/Update to the Fall Policy
The UMC fall policy has been updated to state that “any patient that is a high fall risk and is requesting to leave the unit, must have a provider order on the chart and they must be accompanied by a family member or caregiver”.
Due to this change a new order has been created to be used in this situation and is available now.
The order name is “patient may leave Unit/Floor accompanied by family/caregiver”.
The easiest way to search for this order is by typing in “patient may” in the orders search bar.
Deceased Patient Alert
Beginning May 8th, 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.
Lung Cancer Screening Workflow
Lung Cancer Screening
Based on the results of the 2011 study from the New England Journal of Medicine on low dose CT screenings, UMC now offers lung cancer screening through the Southwest Cancer Center.
This service is covered by Medicare as health maintenance if the following guidelines are met:
- The patient must have a documented shared decision making visit at a Screening Center
- The patient must meet the USPSTF requirements for screening
- Ages 55 to 80
- Smoking history of 30 years or more (an average of one pack a day for 30 years)
- Currently smoking or have quit within the last 15 years
- No current cancer symptoms requiring a diagnostic workup
- Counseling must be provided on the importance of maintaining cigarette smoking abstinence if the patient is a former smoker; or the importance of smoking cessation if the patient is a current smoker and they must be furnished with information about tobacco cessation interventions, if appropriate.
- The patient must be entered into the National Lung Cancer Screening Registry through the American College of Radiology
Patients referred to the Lung Cancer Screening program will have a shared decision meeting scheduled with either Dr. Yepes or Dr. Islam. Our pulmonologists will order the screening CT and provide follow-up on the results of the scan; e.g. regular visits for observation of a nodule, biopsy of a nodule, yearly follow-up for surveillance of a negative CT.
To order your patient’s lung cancer screening, please select the Consult/Referral SWCC Lung Screening order in PowerChart. Please educate your patients, they will be receiving a phone call from the SWCC Lung Cancer Screening Program Patient Navigator for scheduling of the initial screening appointment, which will take place at the SWCC, and scheduling of the Low Dose Screening CT of the chest.
Discharge Patient Process
Laryngectomee Speech Consult Order
A new order is available for use on patient’s that have had a laryngectomy. The order is called “Laryngectomee Speech Consult”. When placed, this order will consult Speech/Language for evaluation and treatment and also for care of the patient. If a speech therapist is not available, it references the policy and procedure for nurses to follow on how to care for a patient with a laryngectomy. This order should be considered for use on a patient that is status post laryngectomy, has a permanent tracheostomy, or history of laryngeal cancer.
Diagnosis Requirement on All Outpatient lab orders
Announcement per UMC Clinical IT:
As of 8:00 AM Monday, February 19th, 2018 all Outpatient Lab Orders (orders placed from a clinic encounter in a future state) will require a diagnoses associated with it. As shown below, the diagnosis tab will show the blue ball/white “X” indicating the need for a diagnosis code to be added. This workflow is the same as the current radiology order process.
This change will require all ordering clinicians to associate the appropriate diagnosis at the time the outpatient order is placed.
NOTE: All EXISTING Future Lab Orders that are still active will require the diagnosis to be added to the order when activated in the lab. This means any orders placed from the clinics prior to Monday, awaiting your patient to get their labs drawn, will require the UMC laboratory registration staff to try and identify a patient’s diagnosis for that visit from the chart. If there is no diagnosis associated, then additional steps will be required to perform the order; including possibly calling the ordering provider/clinic, and ultimately canceling the order if no diagnosis can be found or ordering provider approval cannot be reached (UMC Laboratory is solidifying this workflow).
This change is being implemented to improve the amount of rejected lab charges declined due to the lack of diagnoses.
Changes to Social Services Orders
UMC Anticipated Discharge Order
Sent on behalf of UMC
Use of ‘Patient Discharge Anticipated in 24 Hours’ Order is now being tracked by service and provider. Prizes, including weekly gift card drawings and monthly pizza parties, are awarded based on documented use. See attached report for week of Jan 21-27.
