DUPLICATE LAB ALERT UPDATE

Available on August 17, 2020.

Reducing Unnecessary Labs

Hospitalized patients frequently have considerable volumes of blood drawn for diagnostic testing during short periods of time. Phlebotomy is highly associated with changes in hemoglobin and hematocrit levels for patients and can contribute to anemia. This anemia, in turn, may have significant consequences, especially for patients with cardiorespiratory diseases. Additionally, reducing the frequency of unnecessary phlebotomy can result in significant cost savings for hospitals.

 

This duplicate lab alert exists for the 4 labs at UMC that are most commonly ordered within the same timeframe.

  • ·         CBC

  • ·         CBC with Differential

  • ·         BMP

  • ·         CMP

If the requested time for the lab you are placing is within 2 hours of one already placed, you will see this alert.

Recommendation: Cancel the duplicate lab order.

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GONORRHEA & CHLAMYDIA TESTING

Effective – 8/6/2020

Due to a reagent shortage UMC will be sending out Gonorrhea & Chlamydia by PCR. The test will be sent to CPL in Austin.

If you are sending any Gonorrhea & Chlamydia to the UMC Lab understand there could be a delay in results.

The new order will be a combined order  “ Gonorrhea & Chlamydia by PCR (CPL)

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A new collection kit is required for this test (pictures below).  All Care Set Orders have been updated with the new order code for ease of use for all physicians. 

Aptima Yellow, includes pipette – URINE collection – Fill between the viewing box

Aptima Orange, includes swab – Endocervical Swab

Do NOT puncture the foil lid.

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The order is in several other care sets so please be aware that if you are using any of the care sets below these orders will be sent out to CPL in Austin to result.

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** If you are sending the testing to the OB Lab this will stay the same. This change will only impact any testing that is being sent to the UMC Lab **

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Please contact UMC Microbiology at 775-8361 with any questions

PEDIATRIC BLOOD ORDER CHANGES 07/29/2020

Beginning 7/29/2020 all blood orders for patients will be separated based on weight.  Below are how the orders will appear.

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Once you find the blood product you need, you click on it.  Each blood product order goes to the same plan.  The plan is BB Transfuse Blood Product Plan for Patients LESS than 20 kg.  The names above are alias for this plan.  You can only order a blood product through the plan.  The individual orders are hidden. 

Here is the plan you will be ordering blood products from.

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You will notice that there are medications in the plan that are also weight based to help with transfusion reactions and potential fluid overload. 

 

Once you order PRBCs and platelets you will see they are ordered in mL(s) NOT units.  This is following the guideline of usual dose is 10-15 mL/kg.   This will ensure safety for our patients less than 20 kg.

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HHS NEW MANDATORY REPORTING REQUIREMENTS FOR COVID-19 TESTING

Effective 08/03/20

The U.S. Department of Health and Human Services now requires the following patient information to be entered at order entry for all COVID testing.

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Please note the Reference Text icon on the order with the added link to the CDC for a list of symptoms and the HHS list of examples for Congregate Care Settings:

 

Refer to the CDC for a list of symptoms for COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

 

Congregate care setting includes:

  • ·         nursing homes

  • ·         residential care for people with intellectual and developmental disabilities

  • ·         psychiatric treatment facilities

  • ·         group homes

  • ·         board and care homes

  • ·         homeless shelter

  • ·         foster care or other setting

Vaping in Social History

On Wednesday, June 24, staff will see a change to the Vaping section of the intake form.

We will be able to document Never, Former, Current use of a vaping device. The Nicotine Use question remains the same; if the device contains nicotine then answer Yes, if device does not contain nicotine then answer No.

Click Here for Printable Intructions

Cortisol Response to ACTH Stimulation” Careset Change and Addition

The existing careset “Cortisol Response to ACTH Stimulation” has the new note added to it as a reminder to place the Cosyntropin medication when placing the careset. It is to be administered after the baseline lab value is drawn.

Note that the “Cortisol 15 Minutes” lab order has been removed from the careset as requested.

You will note these changes in the production environment if the careset is placed.

REMINDER: There is a new “ACTH Testing Procedure Plan” in production as of this week available for use as well.

Naming Convention of “Dobhoff” will be change to “Post Pyloric Feeding Tube”

The following Orders will have the name “Dobhoff” changed to “Post Pyloric Feeding Tube”

Maintain Dobhoff

Discontinue Dobhoff Tube

Cleared for use – Dobhoff Tube

The following Nursing Tasks will have the name “Dobhoff” changed to “Post Pyloric Feeding Tube”

Dobhoff Tube Placement

Dobhoff Tube Insertion Charge

The following Charges will have the name “Dobhoff” change to “Post Pyloric Feeding Tube”

Dobhoff Tube Insertion Charge

New Power Form- Outside Lab-Cervical Cancer Screening

A new PowerForm to help meet the Cervical Cancer Screening measure. This PowerForm allows users to document an outside lab discreetly into our system alongside scanning the outside lab document.

It is recommend for users to continue scanning the LabCorp/outside source lab document into its appropriate bucket/folder, but to also input the data from the document into this PowerForm to meet DSRIP and other quality programs. This PowerForm will also be added to Recommendations for providers or end-users to easily document the outside lab information.


Update to Lines/Tubes/Drains Workflow Component

In an effort to reduce CLABSI rates and help remind providers about how long lines have been in place, the Inserted Date on the Lines/Tubes/Drains Workflow Component will turn red for central lines when 72 hours have passed from the Inserted Date/Time. The sooner a catheter is removed, the less likely the chance of infection.

CLABSI at UMC 

2019 (Medicare)

 

2020 (All Payer)

Click HERE for printable intructions

Vasopressor Order Education

*** Go live date June 1st***

 

What is changing and why

The current order entry layout for titratable drips has specific titration parameters required depending on the medication. We have received feedback that the current required parameters are not appropriate for all situations.  In order to accommodate this request, we have designed a new form that allows the primary and additional titration goals to be customized in order to meet the needs of individual patients.

Current form:

Redesigned form:

The same options that are on the current form will still be available in a drop-down menu. In addition, a free text ‘Other Titration Goals’ will be available.

MAR – There is a character limit on the MAR.  If all of the titration goals & values are utilized as well as the ‘Other Titration Goals’ that character limit may be exceeded.

To see all the information from the MAR, Orders Menu, or INet right click the order > Order Info or View Order Info > History

Medications Impacted – titratable drips containing the following medications

DOPamine

EPINEPHrine

norepinephrine

phenylephrine

DOBUTamine

milrinone

isoproterenol

nitroGLYCerin

nitroprusside

 


Click HERE for printable Instructions

Upcoming New Radiology Orders

COMING 4/28/2020

Upcoming New Radiology orders:

  • NM Bone Limited : Acquisition of images localized to a single area (knees, feet, lumbar spine, etc…)
  • US Guided Midline/Vascular Access : For CT and MRI outpatients that may be hard to start IV on
  • US Thoracentesis : Will now be a power plan with options of US Thoracentesis (Left), US Thoracentesis (Right) and US Thoracentesis (Bilat)

 

Power Chart Touch Apps Authentication Issues

                                        Authentication Issue Introduced by iOS 13.4

 

Recently, Apple released iOS 13.4.  This caused the Powerchart Touch apps to require a new access code when you received a certificate error.  Last Friday April 10, 2020, Cerner released new versions of the apps that have a fix for this issue.  If you were waiting to update your iOS to 13.4, you can now update your apps and then update your device with the current iOS.  This should keep the certificate error from occurring.

Please note that if you have already upgraded your device to iOS 13.4 and are receiving the certificate error, then you will need to call to receive a new access code. Please update all Cerner applications on your phone (PowerChart Touch, Message Center Mobil, Instanote, Camera Capture, Fetalink Mobil, CareAware Connect Messenger) before obtaining a new access code.

This does not apply to Cerner PowerChart accesses through Citrix Receiver or Citrix WorkSpace.

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COVID-19 Cerner Updates

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IT has made updates within Cerner to assist in COVID-19 related notifications and ordering. Below are the updates made over the past few days.

COVID-19 (Coronavirus) Detection  Alert

This alert will fire for any patient that has a “Detected” result documented in Cerner in the past 21 days. This will launch daily for each person entering a chart, no more than 1 time a day per patient.

 

 

Once the COVID-19 IP *AMION for APPROVAL* Plan is approved

The specimen will be collected and sent to lab

Currently, all specimens are send out tests, so the “Generic” order in the plan will ALWAYS be cancelled and replaced with the correct send out order by lab staff

The order name within the plan has been updated to clearly reflect the process

**This order name will change once we are able to perform the test in-house**

COVID-19 Results

All COVID-19 results performed by UMC and UMCP Clinics will store to the flowsheet in the same location:

Lab flowsheet à Reference Lab Tests

Clinic results will have the lab results scanned in under Misc. Lab/Rad Test Results

SmartZone Notifications

We have added COVID-19 SmartZone notifications to most positions to inform that tests have been ordered, pending and resulted. There are a few key things to note about SmartZone:

Some alerts can be dismissed. Those alerts are indicated by an X in the upper right-hand corner. When an alert is dismissed it will no longer appear and the alerts window collapse

Clicking the blue circle will open the window in full screen. To close the alert, click on

 

New COVID-19 Notifications

An order has been placed on a bedded patient and the results are pending

When an COVID-19 test on a bedded patient has been collected and received In-Lab an Information alert will appear. This alert will remain on the chart until the test has been resulted

 

When a COVID-19 test is complete the result will display

When a patient has a new visit on any encounter, this will notify if a patient has a COVID-19 test performed at the UMCP clinics. It will be replaced with the result alert when it is documented

 

 

Click HERE for printable instructions

Provider Hand Off Tool

Provider Handoff

Click on the Provider Handoff to open the Provider Handoff tool, this will assist with end-of-day handoffs and a snapshot of the patient for rounding use.

After opening the Handoff, select the needed Patient List from the dropdown.  Then establish a relationship with listed patients.

The handoff will load all patients from the Patient List selected if you have an established relationship. 

Double clicking the patients name will launch the patient’s chart.  A single click on the various fields will allow for status changes, quick glances and options to route to specific portions of the patient’s chart.

By clicking the expand arrow on each patient, the ability to utilize IPASS, quickly view Clinical Data and manage the Care Team is available. 

 The Provider Handoff also offers the ability to print and perform Patient Assignments.

Printing

Patient Assignments

 

Call the UMC Provider Support line for assistance or for more education 775-8255

 

 

 

Click here ofr Printable Instructions

Recommendation Changes

 

 Recommendations is currently being updated to reflect the latest version of quality measures linked to recommendations. To ensure you are seeing the most up-to-date recommendations, please proceed with updating your “My Role” favorites to show all recommendations.

How to Show Hidden Recommendations

Hidden Recommendations occur when new recommendations/expectations are created, or personal favorites have been created and organizational defaults are not visible. In order to show all new or hidden recommendations, follow the steps below to align with our organizational recommendations and quality programs.

  1. Navigate to the Recommendations Workflow MPage component
  2. Select the “hamburger” icon above the component

Click “Manage My Role Filter…” to display all settings applicable to the Recommendations component

Navigate to Manage My Role Filter and click REVERT  to unhide hidden items that align to our organizational recommendations and quality programs

Click REVERT to commit changes to revert favorites to organizational defaults

 

Reviewed selected recommendations and click SUBMIT

Click Here for Printable Instructions