Dynamic Documentation: Changes to Ambulatory CP and VL Orders

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.

Educational Handout

PowerPlan: Acetylcysteine and Albuterol Plan

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.

Educational Handout

Upgrade Enhancements to PowerPlans

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.

Oncology PowerPlans - Removal of "Activate All" Functionality

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.

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.

Admission PowerPlan: Oncology Patient

When admitting a patient for Oncology (typically 4E) we must use the ONC General Inpatient Plan. You can find this plan by searching the word General just like you would the General Medicine Plan.

Once in the plan you will notice several differences that is important to oncology patient care. In Patient Care you have the Access Implanted Port, and Perform Neurological Checks.

In the ONC General Inpatient Plan there is also a medication section. This section includes biotene mouthwash, lidocain-prilocains topical (lidocaine-prilocain 25%), and heparin flush.

The final difference in the plan is under Consult MD. You will see in this field a required order, Consult MD. This allows you to choose to choose what service to notify. You can notify either Oncology or Hematology.

Automation of Bedside Sedation Process

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.

1. UMC Pediatric Sedation Brief H&P (This note is specifically used for sedations done in PICU)
2. UMC Procedural Sedation Note (this will also be available to Insert as a Sentence in any existing note that has a Procedure Paragraph (Ex: Central line Procedure Note)

Diagnosis on Outpatient Surgery PowerPlans

UPDATE: This process has been delayed pending further review.