Changes to Procedural Sedation Note

Go-Live: November 10, 2023

Summary

The Procedural Sedation Note has been renamed to UMC Moderate Sedation Note. This note has also been modified to meet regulatory requirements.

Where to find UMC Moderate Sedation Note

Dynamic Documentation

  • PICU Providers

    • Linked in the Dynamic Documentation Note Templates below the components.

  • All other Dynamic Documentation Service Lines

    • Search for the UMC Moderate Sedation Note from the Documentation search screen.

    • Choose the Bedside Procedure Documentation Note Type.

Moderate Sedation Note Autotext

  • In the Moderate Sedation Note, type ;moderate_sedation to populate the autotext.

PowerNote

  • Search for UMC Moderate Sedation Note.

  • The Note Type will auto-populate.

UMC Code Sepsis Note

Go-Live: November 8, 2023

Where to find UMC Code Sepsis Note

Dynamic Documentation

  • Internal Medicine, Family Medicine, Hospitalist, and General Surgery:

    • Linked in the Dynamic Documentation Note Templates below the components.

  • All other Dynamic Documentation Service Lines:

    • Search for the UMC Code Sepsis Note from the Documentation search screen.

    • Choose the Progress Note Type for your Service Line.

PowerNote

  • Search for UMC Code Sepsis Note.

  • Save the note under the Progress Note Type for your service line.

Lab Cancelation Update

In order to better communicate with providers when the laboratory cancels a lab test unexpectedly, a message will be sent to the ordering provider’s inbox in Message Center for all inpatients and outpatients (excluding ICUs) when a lab test is cancelled for the following reasons:

-Blue Top not filled properly

-Order Cancelled in Lab

-Order Entry Error

-Patient refused

-Specimen clotted

-Specimen hemolyzed

-Specimen not received

-Specimen mislabeled

-Specimen Quantity not sufficient

-Specimen Unacceptable for testing

The message will include the test name that was cancelled, the time and date the order was placed, the cancel reason, the time and date the order was cancelled and any documented communication between the lab and the nursing/clinic staff about the cancellation.  Below is an example message:

Microbiology Susceptibility Update Cascade Reporting for E. Coli

Go-live: October 16, 2023

Background

Best practices dictate that de-escalation of antibiotics occur as soon as an organism is identified, and susceptibility results are available. Broad-spectrum antibiotics use in hospitals is inevitable in the era of multidrug resistance. Preferential use of narrow-spectrum agents may reduce the emergence of multidrug-resistant organisms, prevent toxicities associated with broad-spectrum agents, prevent superinfections such as Clostridioides difficile, and reduce health-care expenditure.

Cascade reporting (CR) is a less resource intensive tool that hospitals can utilize to encourage de-escalation. The Clinical and Laboratory Standards Institute (CLSI) describes Cascade Reporting (CR) as a strategy of reporting antimicrobial susceptibility test results in which secondary (i.e., broader-spectrum or costlier) agents may only be reported if an organism is resistant to primary agents within a particular drug class. There are some exceptions such as if a patient has an allergy or adverse reactions to primarily reported antimicrobial.

Each antibiotic/organism combination will follow an agreed upon cascade that is reviewed by the antimicrobial stewardship committee and approved by the pharmacy and therapeutics committee. Results that are suppressed on the antibiotic susceptibility panel are available in the microbiology lab and may be released upon request by provider (i.e., and allergy, adverse reaction, prohibited by renal or hepatic function to a released antibiotic).

The Antimicrobial Stewardship Committee and approved by pharmacy and therapeutics committee has agreed to initiate this practice with a single source and organism combination before rolling out to all sources and organisms. The initial cascade will be a urinary source growing E. coli. See below for an example:

Cascade Reporting

Background

Best practices dictate that de-escalation of antibiotics occur as soon as an organism is identified, and susceptibility results are available. Broad-spectrum antibiotic use in hospitals is inevitable in the era of multidrug resistance. Preferential use of narrow-spectrum agents may reduce the emergence of multidrug-resistant organisms, prevent toxicities associated with broad-spectrum agents, prevent superinfections such as Clostridioides difficile, and reduce health-care expenditure.

Cascade reporting (CR) is a less resource intensive tool that hospitals can utilize to encourage de-escalation. The Clinical and Laboratory Standards Institute (CLSI) describes cascade reporting (CR) as a strategy of reporting antimicrobial susceptibility test results in which secondary (i.e., broader-spectrum or costlier) agents may only be reported if an organism is resistant to primary agents within a particular drug class. There are some exceptions such as if a patient has an allergy or adverse reactions to primarily reported antimicrobial.

Each antibiotic/organism combination will follow an agreed upon cascade that is reviewed by the antimicrobial stewardship committee and approved by the pharmacy and therapeutics committee. Results that are suppressed on the antibiotic susceptibility panel are available in the microbiology lab and may be released upon request by provider (i.e., an allergy, adverse reaction, prohibited by renal or hepatic function to a released antibiotic).

The Antimicrobial Stewardship Committee and approved by pharmacy and therapeutics committee has agreed to initiate this practice with a single source and organism combination before rolling out to all sources and organisms.

The initial cascade will be a urinary source growing E. coli. See below for an example.

Changes to Child Life Specialist Order

Go Live: August 29, 2023

Summary

On August 29, 2023, the Child Life Specialist Order will be available with the attending physician field removed so any clinician can place the order. This order will fire a task to the Child Life Specialists' multi-patient task list containing all the details filled out in the order. The Child Life Specialist will then fill out their documentation in a Powerform that is visible to Providers in the Ancillary Documentation Folder.

Order

Child Life Specialists’ do NOT have ordering privileges, so this order must be placed by the clinician.

How to see if consult task is completed

documentation location

Provider View: Documents Component -> Change Filter to Ancillary Documentation

Clinical Notes: Ancillary Documentation Folder

DFPS CPS Reporting Update

Department of Family and Protective Services (DFPS) CPS reporting process, specific to the toll-free telephone number.  The details of the changes are below. 

 

As a result of HB 63, effective 9/1/2023,

  • All reports of child abuse or neglect made through the DFPS toll-free telephone number are no longer anonymous

  • Oral reports are recorded

  • The reporter’s identify will remain confidential with DFPS and law enforcement

  • Reporters may still make anonymous reports to law enforcement

FLASH Alert: Provider Letters may be sent to a Recipient's old contact list

In the Provider Letter Recipients dialog box, Cerner has reported that old addresses, email addresses, and fax numbers may be displayed for recipients in the Recent Recipient and Favorite tabs.

Description:

This flash applies to U.S. and non-U.S. clients who use Message Center.

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 recipients' address, email address, or fax number 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.

Impact:

Patient privacy may be impacted if the incorrect recipient receives the patient's information because a provider letter is sent to an old address, email address, or fax number. Patient care may be impacted if the correct provider does not receive the letter and the correct provider does not have information about what care the patient needs.

Resolution:

The flash does not delete the current Recent Recipient and Favorites tabs. UMC is working on cleaning up the system to ensure all recent and favorite recipients are deleted. UMC is diligently working on getting this resolved.

Plan Change: Neuro 3% Hypertonic Saline

The Neuro 3% Hypertonic Saline Protocol Plan will change to Neuro 3% Hypertonic Saline Plan.  The pharmacy stated the reason below:

Please remove "protocol" from the title as this doesn't meet the IT requirements for a protocol ("Minimal clinical judgment is needed, what judgment that is needed is outlined by the protocol, otherwise provider should be contacted for assistance)... This plan should always be patient-specific and ordered/manipulated by the provider, not the nurse.

The pharmacy has also requested that the Infusion rate be changed to mL/kg/hr, and the Intermittent Dosing will remain at mL/kg/dose

Primary Contact on Banner

Starting July 3rd, all staff will see the Primary Contact display on the banner bar. This improves communication, ensures the correct provider is contacted, and prevents patient care delays. Currently, only the Hospitalist Team and Internal Medicine Teams 1-4 will be utilizing this, so not every patient will show a Primary Contact.  Physicians from each medical service will manage who displays as Primary Contact.

 

Hospitalists

You may see a provider name and the Provider Care Team phone #. If a Provider Care Team phone # is displayed, you may contact them via the phone number or via CareAware. 

**For after-hours and night call, please continue to refer to AMION for Primary Contact. **

Internal Medicine Teams 1-4

You may see a provider name and phone number or a team name. 

**Please note that the phone number listed may be a fax number, not the actual phone number to call.**  You can quickly determine the phone type by hovering your mouse over the Primary contact.  If you see the phone type of Provider Care Team, this is a valid number.  If you see Fax Business, you will continue contacting the provider via traditional means of CareAware.

**For after-hours and night call, please continue to refer to AMION for Primary Contact.**

All other Services and Teams

For teams that are not yet utilizing Primary Contact, you will see “View Details.”  This means that no primary contact has been assigned, and you would continue to utilize AMION to determine whom to call.

Cerner (MPages & Millennium) Upgrade

Saturday, May 20th, from 9:00am – 5:00pm

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:

9:15am – 10:00am

  • Radiology Imaging

    • No new or modified radiology orders will cross to CHRS Radiology PACS.

    • No new reports will be available in PowerChart.

    • A radiologist will be on-site.

  • RapidComm blood gas, Glucometer, iStat, and 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.

  • 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.

  • CBORD

    • No new or transferred patients or orders will show.

    • No new or updated allergies will show.

  • Breeze results will not post in Cerner. New orders nor pt demographics will appear in Breeze.

  • XSolis

    • No new patients

    • No new notes and results

  • Hill-Rom

    • New patients nor transferred patients will appear on the dashboard.

    • Bed alarm automation will not be functional for new admits or newly identified fall-risk patients. Staff will need to use downtime procedures of manually turning on/off bed alarms.

** By 10:00 am, 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. **

10:00am – 10:45am

  • 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 printed manually.

You will be prompted to log out at least once during the upgrade. 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 upgrade, there is a potential for odd issues to occur. If you experience issues, we will have to wait until the upgrade is complete to troubleshoot.

IT staff will be available during the upgrade. If you experience issues, please call the IT Helpdesk at 59109.

DrFirst MedHx

Go-Live: May 4, 2023


Summary

On 5/4/23, DrFirst Medication History will be replacing External Rx History.

DrFirst Medication History uses Artificial Technology Intelligence (AI) to pull real-time responses whenever the page is loaded in Cerner. Using the patient's last name, first name, date of birth, gender, and zip code, DrFirst Medication History can retrieve an updated list of home medications from various data sources such as surescripts, local pharmacies, insurance payers, and more. Clinicians can import these medications into the Cerner Medication List, providing more accurate and up-to-date patient medication information. This new solution aims to streamline the medication history-gathering process for clinicians, making it more efficient and reliable.

Where is DrFirst Medication History Located?
DrFirst Medication History and Cerner Existing Medications List can be found on the Workflow Mpage or the Summary Mpage, depending on the user's position.