Outpatient Surgery Plans
It has been brought to our attention that the Adult Outpatient Surgery Plan is not being utilized as designed. When this plan is not used correctly, it affects patient care. This causes a delay in care and results in a waste of resources. To ensure your requested orders are done efficiently and correctly, please perform the following workflow:
Place the Adult Outpatient Surgery Plan on adult patients only. The Pediatric Outpatient Surgery plan is for pediatrics only.
The Plan is divided into phases. Each phase is very specific for the area. PACU needs ALL orders placed in its phase.
To avoid confusion and delay of patient care, place PACU orders in the PACU phase. When “one off” orders occur, the nurse cannot see the order. To add an order to the PACU phase, click the “Add to Phase” button. This will keep all PACU orders together.
By keeping all the area specific orders within its designated phase, phone calls of clarification can be avoided. When we work as a team and follow this workflow, we become more efficient and provide a better level of care to our patients.
~UMC Clinical IT
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.
- UMC Pediatric Sedation Brief H&P (This note is specifically used for sedations done in PICU)
- 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)
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.
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
Required Indicationf for Level I Restricted Antibiotics
Albumin Indications
Albumin now has a required Albumin Indications field at order entry in PowerChart. None of the choices prevent it being ordered. This is only being used to track its use.
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.
Tamiflu Dosing Reminder
Per manufacturer and pharmacy recommendations, Tamiflu should be adjusted for renal impairment.
Flu Season is upon us and with so many providers prescribing Tamiflu, it is important to remember that this drug needs to be renally dosed.
(there has been a large influx of Dose Range Checking Alerts on patients with poor renal function)
See screenshot below:
Changes to Social Services Orders
Diagnosis on Outpatient Surgery PowerPlans
UPDATE: This process has been delayed pending further review.
DIGIPASS Mobile Application Update
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.
New Note for Violent Restraints
New Inpatient Component - Additional Significant Events
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.
Cerner Scheduled Direct Messaging Downtime
There will be a Cerner Direct Messaging downtime on February 1st, 2018 starting at 8 PM and lasting approximately 4 hours.
During this time Cerner Direct Messaging will not be available for use.
The Cerner functionality listed below will be down for 4 hours (until 12 am).
- Sending/receiving secure messages to/from patients utilizing MyTeamCare
- Sending/receiving secure messages, ToCs, and CCDs to/from providers outside of Cerner
- Patients will be unable to generate a Record Summary/summary of care in MyTeamCare
We apologize for any inconvenience.
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.
