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:
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
Go-live is September 20, 2022.
Positions Affected:
Physician’s, Nurses, APP’s placing an MRI, CT, Nuclear Medicine or PET/CT order.
Summary:
Beginning the afternoon of Sept 20th , you will no longer have to address the CareSelect window. CMS has put a hold on the requirement to complete this consultation. Once a new date is released we will revisit putting this in place.
K e y P o i n t s
CareSelect window will no longer appear.
Problem: The order CXR Portable is currently defaulted to STAT. This is causing a high number of orders to be placed as STAT, when it is not necessary.
Solution: The CXR Portable Order will now default to the priority of Routine. This order will now be consistent with the primary order of Dx Chest Portable, or other diagnostic orders, which default to Routine.
During this time, Cerner will be available. There will NOT be a downtime; however, there will be brief interruptions in service during the following time periods:
8:00pm - 9:00pm
Pyxis
No new or transferred patients or orders will show
Pyxis machines will be placed on override during this time
Radiology Imaging
No new or modified radiology orders will cross to McKesson PACS
No new reports will be available in PowerChart
OnRad reports will be faxed
A radiologist will be onsite for any STAT requests
RapidComm blood gas and RALS/Sofia results will not populate in PowerChart
Quest results will not populate into PowerChart and orders will not send to Quest.
Orchard Orders and Results will not post for TTU Student Health.
South Plains Rehab-Encompass, Lubbock Heart Hospital and Montford orders will not populate into Cerner and results will not pass to the vendors.
Telemetry strips will not show in Clinical Notes
Kronos will not show new or transferred patients
ePrescribing
Prescriptions will queue up and be sent once the interfaces are back up
If a prescription needs to be sent immediately, please print or call in the prescription
Teletracking will not show new, updated or transferred patients
EasyID will not show new, updated or transferred patients
IDX will not show new, updated or transferred patients
Hill-Rom Dashboard will not show new or transferred patients and beds cannot be associated in Cerner.
** By 9:00pm, all patients and orders will be released and the above systems will be updated. Radiology systems will receive the updates and the reports will cross over once the orders are reconciled. **
Scheduled reports will need to be printed manually (ex. Dietary reports)
Batch label printing (Meds/Labs) will be run early, but any new orders during that time will need to be run manually
** At 9:00pm, all scheduled reports and batches for label printing will resume as scheduled **
You will be prompted to log out at least once during this event. If you receive this notice, then please log out. You will be able to log right back in without issue.
With the system being available during the maintenance event, there is a potential for odd issues to occur.
If you experience any issues, then please call the IT Helpdesk at 59109.
The below will be available on August 29, 2022.
This new component will already appear in their components list, so they will not need to add it manually. They will be able to see all current outpatient referral orders and historical ones within the past 3 years. This component will provide them with easy access to referral information on the patient, which will ease their current workflow. The document attached outlines the application features and functionality. Please pass this along to all tech clinics.
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).
There is a designated 724 computer on each unit. The 724 computer can be used during the downtime to view previous orders, labs, radiology, I&O, etc. If needed, don't hesitate to contact the Service Desk at 775-9109 for assistance with the functionality of these downtime computers.
Please utilize the education attached to help guide you through downtime procedures.
Former Careset with 5 items for deletion in red:
Updated Careset:
Items deleted:
Factor XIII Antigen
Mixing Study PT Based
Antiplatelet Antibody Direct
Von Willebrand Factor Activity
Von Willebrand Factor Antigen
Items added:
Protein S Activity
Plasminogen Activator Inhibitor Antigen
Phosphatidylserine Ab
Effective: 9.6.22
Positions Affected: All Positions who can currently complete discharge medication reconciliation
Summary:
As of Sept 6th, you will now be able to partially complete discharge medication reconciliation, which allows you to save current selections and complete later. This allows for you to go and assess results that may impact medication ordering, discussions with patients, or interruptions during the process of completing discharge medication reconciliation.
Key Points:
Once the change is in place, you will now be prompted with option to Reconcile and (Plan or Sign).
Choosing Sign will complete the process and it stands today, including the task to pharmacy for review.
Choosing Plan puts the med rec into a Partial Pending state
no task is sent to the pharmacy for review
prescriptions will not send and/or print
Places the planned med rec symbol (green arrows in a circle with a small P for planned orders) instead of the completed med rec symbol (green check).
Ensure you return and complete discharge medication reconciliation prior to placing the discharge patient order
Hovering over either icon will provide additional information.
In our Additional Assessments folder within the Ad Hoc Charting parent folder, you will notice a new powerform labeled Behavioral Health Patient Health Questionnaire.
This new powerform does not include the conditional logic for the PHQ9 questions like the Patient Health Questionnaire-2 form. This means if you prefer to complete the PHQ9, either by bypassing the PHQ2 or regardless of the result of the PHQ2, you can select either or. Please use the appropriate form that will meet your needs as a clinic or visit.
Patient Health Questionnaire-2
Behavioral Health Patient Health Questionnaire
All users that use the Pool radial button in the Message Center Address Book to communicate a General Message or Reminder in PowerChart, FirstNet, or SurgiNet will have to search for the pool name to find who they intend to send to. We are no longer able to immediately display Pools because we have a reach a limit that is allowed to show without searching in the “Type a name or select from list:” field.
General Steps most Users Follow to Communicate with a Pool
Click Communicate Button on the toolbar
Alternate options - Choose General Message or Reminder from the Communicate dropdown list
Click Binoculars icon next to the “To:” or “CC:” field
Address Book will open to display the Internal Address Book
Click the Pool radial button
The internal Pool address book will be blank which is an expected outcome
4. Type or Search for the specific clinic pool you want to communicate with
General terms to use to quickly find specific pools
o UMC
o UMCP
o TTU
o TTP
o SON
o EXT
o DERM
Users can input the asterisk symbol to display all possible clinic pools, if needed.
5. Once the desired clinic pool is displayed, the user can choose that pool to communicate with.
Positions Affected: Physician’s, Nurses, APP’s placing an MRI, CT, Nuclear Medicine or PET/CT order. NOTE: Will not pop-up for ED pts with a tracking acuity of 1 or 2.
Beginning July 26th, you will not be able to use the cancel button when the CareSelect window appears.
CMS requires consultation to be completed for advanced imaging orders or it will result in financial penalties. The program was updated on June 16th, which should allow for more appropriate indications, based on the type of exam chosen.
∙ If ordering an MRI, CT, NM, or PET order, you MUST address the CareSelect window as the “Close”
option will no longer be available.
