Changes have been made to the name of the order "NM Bone 3 Phase" to make the order easier to find when searching.
This order can now be found under "NM Bone Scan 3 Phase" and can be found by searching "Bone Scan".
Social Services is responsible for assessing, recommending, and facilitating the services needed for a patient during discharge planning. Examples of common services include equipment, rehab, and home health.
Common orders placed for Social Services include:
During a patients stay, Case Management is responsible for assessing medical necessity, level of care, and length of stay. The most common service Case Management is consulted for is Inpatient Psych Placement.
On 12.19, a new order will be available called "Consult Case Management for Inpatient Psych Placement".
Due to the high volume of "Consult Case Management" orders with the reason of "Psych Placement", we have created this new order for efficiency and easy access.
As on 12.19, the "Consult Case Management" Order will be removed.
As of 12.19, the order below will be used:
PT Burn/Wound and Skin Care Services have requested to optimize the Wound orders and documentation to help aid in providing clarity. A new order has been created to include a dropdown with a Team request. The options of this dropdown are “Appropriate Team for Patient Needs”, “PT Burn and Wound” and “Skin Care/Ostomy Services”. This order will be shared by the 2 services, and they will manage their tasks accordingly. The previous PT Burn/Wound orders and Skin Care orders will be removed from orders selection. Below is a screenshot of the new order and its synonyms.
The Clinical Notes folder that will now contain both services’ documentation to help simplify in finding needed information regarding wounds is below as well.
New order:
Synonyms of new order:
Dressing change by PT Burn Wound/Skin Care Services
VAC Dressing Change by PT Burn Wound/Skin Care Services
**(Skin Care Team Follow-up order will remain as is)**
New Clinical Notes folder containing both services documentation:
When you create a provider letter and select the recipients, you can select recipients from the Recent Recipient and Favorite tabs of the Provider Letter Recipients dialog box. In the Recent Recipient and Favorite tabs, the address, email address, or fax number of the recipients may not be up-to-date. If you select a recipient with an old address, email address, or fax number, the provider letter may not be delivered to the correct recipient.
In this example, the first message was sent with the fax number of 806-123-4567.
Assume that the provider moved locations and swapped phone numbers to 806-999-9999. Clinical IT updates the number on the backend.
When you go to send another Provider Letter for the same patient, Cerner populates a “Recent Recipient” to assist. However, the fax number does not change even though the number has been changed on the backend. If you were to look up the provider in the Address Book, the correct number would then populate. However, you would then be shown 2 available options, which can cause confusion.
Therefore, it is recommended not to use the “Favorite” or “Recent Recipient” tab and ONLY use “Search for Provider”.
Do not to use the “Favorite” or “Recent Recipient” tab and ONLY use “Search for Provider”
Effective 11.21.2022
The outstanding orders component has previously been pulling in information that is not helpful when viewing the component in the workflow MPages. This cluttered view has lead to information being hard to find within the component.
As of 11.21, this component will ONLY be available on the Ambulatory Workflow. Inpatient Providers can still view all information from the Order Profile Component.
Evaluation and Management
Procedures
POC Basic
Referral
Pharmacy
Dermatology Inpatient Workflow
Women's Health – OBGYN Inpatient
Women's Health – GYN Inpatient
Effective 11.21.2022
Currently the note type that EKG Treadmill/Stress Test results post to is set to display when the note is ‘In Progress’, which means the final interpretation has not been confirmed/made available. This could lead to a patient care decision being made on preliminary results only. Do to this possibility, we are removing the display of 'In Progress' results and only making 'Auth (Verified)' available in Clinical Notes or Documentation.
Only ‘Auth (Verified)’ results will be available Clinical Notes or Documentation. This means that only finalized results will display.
Process of EKG Treadmill Stress Test Results:
Exams will still be forwarded to cardiologist for final interpretation and sign-off, but only the originating end-user and the user it was forwarded to will be able to view it until it is in a result of Auth(Verified).
Turn Around Time for Auth(Verified) Results?
Always less than 24 hours with most turn around times being 2-3 hours.
Will I still receive a call for critical results?
Yes, providers will still receive a phone call for critical results.
End users have been reporting various issues with Cerner on their MacBooks. Please see the below notification from Cerner.
New MAC OS Version - Ventura Issues
On 10/24/2022, Apple released Mac OS Version – Ventura. This version of the Mac OS has not been validated and is not currently supported for client use by Oracle Cerner. Clients who downloaded and installed this new OS version from Apple have been experiencing application issues while using Oracle Cerner products. Oracle Cerner is recommending not upgrading to Ventura at this time.
If the end user has already upgraded, they will need to reach out to Apple support.
For anyone taking calls about issues with Cerner on MacBooks, please find out the Mac OS version and their Citrix version and what workflow they are performing in Cerner (placing med orders, creating a note etc).
Changes have been made to the Social Services for Transportation Order to provide better clarification on modes of transportation.
Addition of a new field named "Mode of Transportation" with the drop-down list below.
Addition of reference text "Discharge Transportation Reference Guide" to clarify the modes of transportation.
Starting the afternoon of 11/21, providers will now place the Consult Neurology for Continuous EEG order, which will consult Neurology to evaluate for how long the monitoring is needed and they will place the actual continuous EEG order.
When searching "EEG" the following orders will be available:
Consult Neurology for Continuous EEG
Used by clinical staff to contact the On-Call Neurologist
Neurology defaulted as Medical Service
Continuous EEG defaulted as Reason for Consult
Continuous EEG Request (Neuro Only)
Used by Neurologists' Only
EEG Request
No changes to this order
The specialty bed type and the reasons for bed have been updated to match policy and documentation which will be effective on 11/14/22
To maintain best practices, the Antimicrobial Stewardship Committee and Microbiology have decided to suppress susceptible ceftriaxone results for Enterobacter cloacae. Ceftriaxone should not be used to treat this organism due to high probability of inducing AmpC beta lactamase that may result in treatment failure. Additionally, piperacillin/tazobactam and amoxicillin/clavulanate susceptible results will be suppressed for all Extended Spectrum Beta Lactamase (ESBL) producing isolates as outcome data suggests higher mortality when these are utilized in the treatment of ESBL producing isolates.
Discontinued Rapid Rotavirus Detection –> Alternate testing : PCR testing for Rotavirus is currently included in the Stool Enteric Panel by PCR
Discontinued Culture Viral Blood with CMV – discontinuing due to lack of interest in this testing. -> Alternate testing: Reference Lab testing for Viral Blood culture.
CMV by PCR can be tested at UMC on Bronchial Alveolar Lavage and Bronch Wash sources.
During this time Cerner applications (PowerChart, FirstNet, SurgiNet, etc) will not be available for use. Please follow the appropriate downtime procedures for your department (reference unit-specific policies on the UMC Intranet).
Pre-Downtime (at 11:45pm)
· One hour prior to downtime please print a transfer med rec for all patients to be kept by the charge nurse. This is in preparation for any potential transfers during downtime.
· One hour prior to downtime look at all patient’s orders and Initiate any appropriate powerplans that are in a “Planned” status.
· Review Specimen Collection and/or Orders for any labs pending to be drawn during the downtime. Print any necessary lab labels through Specimen Collection or Collections Inquiry.
· MARs will not be printed to the nursing units. See How to Print Downtime MARS instructions below [page 3].
· There is a designated computer on each unit with 724 installed. 724 can be used during a downtime to view previous orders, labs, radiology, I&O, etc. Instructions on how to access and use 724 are on [pages 4-6].
Downtime (12:45am – 1:15am)
· Orders will be written on Paper during the downtime.
o Pharmacy Orders- will need to be tubed down to Pharmacy. (If the department does not have a tube station or the tube station is down, then fax pharmacy at 775-9186.)
o Radiology Orders- call Radiology directly for STAT orders. Routine exams will be ordered and completed after the downtime.
o Laboratory Orders- will need to be tubed down to Laboratory. Use the paper requisition and the specimen with a patient label with your initials, date, and time the specimen was drawn. Lab will only run STAT labs. Routine labs will be held until after the downtime.
o Respiratory Therapy Orders – For any STAT orders or immediate needs, contact the therapist assigned to the unit.
o EKGs - Keep up with all EKGs performed. You MUST transmit the EKGs once Powerchart is up and have an order for each EKG performed. Pull a worklist after the downtime to sync the current time.
· All Physician Documentation and Orders will go into the patient’s binder.
· EasyWeb – Labels and documents for existing patients can be printed from EasyWeb; however, new registrations or transfers will not appear, and none of the automatic print jobs will work until the downtime ends. Revert to downtime procedures to obtain labels as needed.
· New patient admits and/or transfers will NOT appear or update in the following applications: Pyxis, Teletracking, Hill-Rom dashboard and EZWEb (EasyID).
· Pyxis machines will be placed in override mode.
· Radiology – Images will only be available on the imaging machines. If a provider needs to view an exam, they will need to go to Radiology. EC and Trauma images will be viewed from the radiology machine and reports will be faxed to them.
· Lab – Lab results will be printed and tubed to the units. Critical labs will be called to the unit. POC testing, such as glucometers, will store results and will be uploaded after the downtime.
· Blood gas, Glucometer, iStat and Sofia results will NOT be available in Cerner until after the downtime.
· VitalsLink – The Philips vital sign machines will not transmit vital signs during the downtime. Vital signs taken during the downtime will need to be manually charted. The machines should automatically update with the new time with the first login or when the monitor is powered on after the downtime.
· BMDI/IAware – Vital sign and I&O data from prior to the downtime will be available. Vitals taken during the downtime will need to be manually charted. If post downtime the vital signs do not pull in, please check that the time on the Philips monitor updated. If it did not update, reboot the Philips monitor by turning it off, waiting 15 secs and turning it back on. If this doesn’t resolve the issue, please contact Biomed.
· Auto Pump Programing - During the downtime you will not be able to associate/program any IV pumps. When the program is brought back online, you may need to back associate any infusions.
· Fetalink – Monitoring can occur during the downtime; however, strips cannot be finalized, nor can new patients be associated to a monitor.
· CareAware Messaging, Nursing and Voice will not be available.
· Hill-Rom Bed data will not be available in Cerner.
Post- Downtime (If downtime is less than 6 hours, all documentation must be completed in the EHR per hospital policy.)
· Pharmacy will transcribe all Medications Orders that were written on Paper during the downtime.
· Any Future or Serial Lab orders that have not been drawn and ordered on the paper requisition form will be transcribed in PowerChart once the system is back up.
· Any Future radiology orders that were not completed during downtime will need to be transcribed into PowerChart once the system is back up.
· Patient Care Orders, Communication Orders and Diet Orders will need to be transcribed into PowerChart once the system is back up, except for one time orders that have already been completed by the licensed staff member.
· Miscellaneous Orders and ancillary orders for PT/OT/ST and RT will need to be called into the appropriate departments and then transcribed into PowerChart.
· Once all orders have been transcribed by licensed staff, the HUCs will scan the documents into PowerChart then place in the shred bin.
· ALL admission paperwork MUST be completed in the computer once PowerChart is back up - NO matter the length of the downtime. (This includes any outpatient areas).
· **If you initiate any restraints during the downtime, you will need to make sure you go and initiate them in PowerChart, backdating to time of application, after the downtime.
· Discard any copies of the printed transfer med rec not used during the downtime once the system is back up.
Documentation Notifications:
· If you do any documentation that occurred during the “duplicate hour”, you will receive a pop-up window that prompts you to select Daylight or Standard time. Choose the appropriate response.
For detailed information and a guide on the steps above as well as Documentation Notifications, How to Print Downtime MARS, 724Access Downtime Viewer Instructions, and more, please click the Printable Instructions button.
The Outpatient Anticipated Nerve Block Workflow is a new workflow designed to facilitate communication to Anesthesia about patients needing pre-op blocks in SASU
1) The Outpatient Surgery Plan Scheduling Form has the option of “Single Shot Nerve Block”, "Continuous Nerve Block,” or “None” for anticipated nerve blocks
2) This updated field will automatically place a Consult order called Consult Anesthesia for Nerve Block on the surgery encounter when it is created by scheduling
3) The attending may see the order in their inbox for co-signature
Note: If the plan for the block changes, physicians will need to find the order on the surgery encounter under Consults and cancel or modify the order determining what the change will be
4) Patients with active Consult Anesthesiology for Nerve Block orders on their surgery encounters will show on a report for OR Staff. They are then added to the Anesthesia Nerve Block tracking board
5) Anesthesia uses this tracking board to facilitate administrations of the blocks for that day
Automatically pull into the Assessment and Plan
The items above that are checked This Visit will populate into the Assessment and Plan, as shown.
If Active Chronic Problems are not automatically pulling into your note, an autotext will be needed.
Use ;problems
Automatically pull into notes under the Past Medical History Section
Peri-Operative
When patient arrives, assess puncture site for bleeding or hematoma. There should be no bleeding.
If there is any bleeding, inject 2-3 mL of air into the port marked “air” and notify the fellow. Do not exceed a total of 18 mL of air.
Patient will remain in bed, but able to sit up and ambulate to the bathroom.
TR Band will remain in place for:
1 hour post-procedure for Non-Intervention procedures
2 hours post-procedure for Intervention procedures
TR Band Removal
Non-Intervention
Withdraw 2-3 mL of air after 1 hour
If bleeding occurs, re-inject 2-3 mL of air and wait 30 minutes and withdraw 2-3 ml of air again. Repeat removing 2-3 mL every 15 minutes until all air is removed.
Remove T.R. band and apply tegaderm and observe for 30 min. Hold pressure and call fellow if patient develops a bleed.
Intervention
Mandatory: (please check one box)
NO ACT needed
If 2BIIIA (Aggrastat or Integrilin) is infusing, begin removing air 2 hours after procedure is complete. No ACT is necessary.
If patient received Angiomax, begin removing air 2 hours after drip is discontinued. No ACT is necessary.
ACT Needed
If patient received heparin (specifically for intervention - not just for radial access), check ACT before removing air. If greater than 160 seconds, DO NOT
REMOVE and repeat ACT every hour until ACT is less than 160 seconds.
Withdraw 2-3 ml of air after 2 hours
If bleeding occurs, re-inject 2-3 mL of air and wait 30 minutes and withdraw 2-3 mL of air again Repeat removing 2-3 ml every 15 minutes until all air is removed.
Remove T.R. band and place tegaderm and observe for 30 min. Hold pressure and call fellow if patient develops a bleed.
Post TR Band Removal
Apply a 2x2 Tegaderm to the puncture site and secure with Kerlex wrap to arm board.
Instruct patient not to manipulate wrist for 24 hours. Arm board may be removed after 1 hour post a non-intervention and reassess the site for bleeding.
Instruct patient not to manipulate wrist for 24 hours. Arm board may be removed 6 hours after anticoagulation if a Percutaneous Coronary Intervention was performed then reassess the site for bleeding.
Educate patient on:
Leave puncture site open to air after 24 hours post-procedure. If minor oozing, patient may apply Band-Aid and remove after 12 hours.
No soaking wrist for 3 days
No driving for 24 hours
No lifting more than 3-5 pounds with affected wrist for 7 days.
Hold pressure with thumb against puncture site and finger against back of wrist for any frank bleeding and call 911 for immediate help.
Reportable Conditions:
Notify the doctor of any uncontrolled bleeding.
If wound is bleeding then elevate the arm and apply manual pressure to the area just above the wound by pressing the thumb above the wound and encircling the hand around the wrist for 20 minutes. After 20 minutes slowly remove pressure and assess if bleeding has stopped.
Notify the doctor if there is a loss of circulation in the hand or the hand has a sudden color change and appears cool and blanched accompanied by tingling and numbness
Source: Cardiology Services Date: 10/17/2022 Reference Text Version 5
In an effort to expedite discharge planning we have added a field to the Social Services for Transportation Order. This field is a drop with 5 options for discharge transportation.
This field is required to be completed prior to signing the order.
If you have any questions, please reach out to Social Services or Clinical IT.
Positions Affected:
Anyone with an iPhone currently using CareAware Connect Messenger.
Summary:
Updating to the iOS 16 software in iPhone could cause issues within CareAware Connect Messenger.
Key Points:
Ensure you have the 3.22 version of CareAware Connect Messenger from the App Store to avoid issues. This is the most current version of the application.
Go-live is September 27, 2022.
Problem:
Mammography order names have historically been inconsistent, which leads to difficulty when searching and placing orders.
Solution:
The following changes have been made to standardize how the location appears:
List of Order Name Changes:
Mammo screen with Tomo becomes Mammo Screen
Mammo Screen becomes Mammo screen without Tomo
MA Mammo Tomo ScreenBL w/Diag/US if needed
MA Mammo Tomo ScreenLT w/Diag/US if needed
MA Mammo Tomo ScreenRT w/Diag/US if needed
MA Mammo Screen Bilat w/Diagnostic/US if needed MA
MA Mammo ScreenLT w/Diagnostic/US if needed MA
MA Mammo ScreenRT w/Diagnostic/US if needed MA
MA Mammo Tomo Diag (Bilat) w/US if needed
MA Mammo Tomo Diag (Left) w/US if needed
MA Mammo Tomo Diag (Right) w/US if needed
MA Mammo Diagnostic (Bilat) w/ US if needed
MA Mammo Diagnostic (Left) w/ US if needed
MA Mammo Diagnostic (Right) w/ US if needed
MA Mammo Screen (Bilat)
MA Mammo Screen (Left)
MA Mammo Screen (Right)
MAMammo Screen w/o Tomo (Bilat)
MA Mammo Screen w/o Tomo (Left)
MA Mammo Screen w/o Tomo (Right)
MA Mammo Diagnostic (Bilat)
MA Mammo Diagnostic (Left)
MA Mammo Diagnostic (Right
MA Mammo Diagnostic w/o Tomo (Bilat)
MA Mammo Diagnostic w/o Tomo (Left)
MA Mammo Diagnostic w/o Tomo (Right)
Ex. Ultrasound in Order Comments
