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.

New Component Added to All Inpatient Workflow Pages: Workplace Violence

Summary

• We are adding a new component to all inpatient workflow pages called Workplace Violence.

• Patients with a Security Code Flag of Violent or Inappropriate on the patient list have documentation by nursing detailing the event.

• This component will allow providers to see this nursing documentation within their inpatient workflow.

Security Code

A Security Code Flag will populate on the Patient List if the patient has documentation from nursing. To view the nursing documentation, open the Workplace Violence Component on the patient.

Workplace Violence Component

Renaming Opiod Review on Table of Contents to Provider View

Positions Impacted

• Anesthesia DBC

• Anesthesia Non-Physician Provider

• Anesthesia Provider

• Anesthesia Resident

• CV Physician/Radiologist

• Non-Physician Provider

• Office/Clinic: Non-Physician Provider

• Office/Clinic: Physician

• Office/Clinic: Resident

• Physician

• Phys-Utilization Review

• PNS Non-Physician Provider

• PNS Physician

• Private CV Physician

• Psych Physician

• Psych Resident

Summary

Opioid Review on the Table of Contents has been renamed Provider View.

New Global Autotext: ;preop

Go-Live 4/17/23

Summary

To help with compliance of documentation, a new global autotext has been created and will be live April 17th. To invoke the autotext type ;preop. This will invoke this text "This surgery is urgent, and the patient is medically optimized for the proposed procedure and requires no further medical evaluation. Further comments, if any, are documented below."

Key Points

• Type ;preop into a free text field

• The following autotext will appear:

SKYVue LOGGING EVENT

Scheduled for Monday, April 24th at 1 PM

Summary:

Cerner SkyVue continues to have frequent problems with freezing and crashing that have been difficult to diagnose. To gather as much troubleshooting data as possible, we will enable SkyVue debug mode for all users on Monday, April 24th. The only difference you will see is an additional debug window that displays white text on a black background when opening SkyVue. You may ignore or minimize this window but DO NOT close it, or your SkyVue session will end. SkyVue can be used as you normally do, and performance data will be collected in the background.

Debug Window:

• Ignore or minimize this window but DO NOT close it, or your SkyVue session will also end.

• Leave open for the rest of the day.

If SkyVue begins to open and then immediately closes:

Please call the UMC IT Service Desk (806)775-9109 with the following information:

1. User Name

2. Workstation Name

3. Approximate time of occurrence

Workaround:

• Try to launch SkyVue again.

• See if a different user can view the study for you.

FREE TEXT FIELD ADDED TO DISCHARGE SUMMARY: "ITEMS FOR FOLLOW UP"

Summary

A new free text field titled "Items for Follow up" will be added to provide a separate area in the DC Summary to call out specific items that the PCP or other providers need to know and follow-up on after discharge.

Key Points

As of 3/14/23, the Items for Follow up Section will be available in the following note templates:

Items for Follow-up Section:

This section is a free text field

PT BURN/WOUND IMAGES MOVED TO WOUND EVAULATION FOLDER

Summary

• PT Burn/Wound image documentation can now be found in the same Clinical Notes Folder as Skin Care.

• All images for burn/wounds will now be seen in the Clinical Folder named Wound Evaluation.

Notification of Cancelled Referrals in Clinical Pools

Summary

To increase transparency and alleviate confusion for referring clinics, a message will be sent to the referring clinic's clinical pool informing them of a patient's referral cancellation.

Example

1. Dr. Barker refers patient to Southwest GI.

2. Referral is sent to Southwest GI and the referral is cancelled in Referral Management with reason listed.

3. Dr. Barkers Clinical Pool, UMCP Barker Clinical, receives a message of the patient's cancellation.

Message of Cancellation

NEW ORDER: WOUND EVALUATION AND TREATMENT BY PT BURN WOUND/SKIN CARE SERVICES

Summary

On February 1st, 2023, a new order called "Wound Evaluation and Treatment by PT Burn Wound/Skin Care Services" will be activated. This order will replace the majority of existing PT Burn Wound and Skin Care Service Evaluation and Treatment Orders.

Key Points

New Workflow

• Order is placed and Team Requested is selected: Appropriate Team for Patient Needs, PT Burn and Wound or Skin Care/Ostomy Services.

• This order adds the patient to a Task List.

• Skin Care Team owns this Task List and will assess the patient to determine the correct team needed.

  • The Skin Care Team will place the Wound Care by PT(Skin Care Services ONLY) Order if PT is needed for the patient. This order will be hidden to Providers.

The Following Orders will be removed:

• Consult PT for Wound/Dressing Change

  • This order will still be available in the following PowerPlans (Pediatric Burn Plan, Snakebite Plan, Surgery Burn Plan, Trauma and Surgical ICU Plan)

• PT Wound/Dressing Change

• Wound Care Eval and Treatment by PT

• VAC Dressing Eval and Treat by PT

• VAC Dressing Change by Skin Care Services

• Wound Evaluation by Skin Care Services

The following order will still remain available but is only used by skin care services:

• Skin Care Team Follow-Up

DrFirst: RxInform

What is RxInform?

RxInform is a secure platform that automatically triggers a text message to patients whenever they get a new prescription. The text message includes a link to a HIPAA-compliant website, which provides timely and relevant information designed to reduce prescription abandonment.

Features

Text Message

Patients receive a text message minutes after medication is prescribed. The text message includes a secure link (URL) which directs patients to their personalized microsite.

Authentication

When patients tap on the secure link, they are directed to an authentication page. Once the correct date of birth is entered, patients are allowed to access the microsite.

Microsite

Upon authentication, patients can view the pharmacy name and phone number. The prescribed medications are shown alongside an option to schedule a pickup reminder.

Pick-Up Reminders

Copay Assistance

Copay Assistance information is available for some branded medications. This type of savings opportunity applies to patients with commercial insurance (not enrolled in Medicare/Medicaid).

Discount Card

RxInform also offers a Discount Card that can lower the cost for many generic medications, especially when patients lack insurance, have high insurance co-pays, or have high deductibles.

Educational Videos

RxInform provides access to 1,200 drug-specific videos that easily explain to patients why they need to take their prescribed medication(s), how to manage side effects, and how to avoid drug interactions.

New Feature In Referral Management Assignment

Go Live: Code Upgrade

Summary

On 4/22, a new feature will be available in the List Maintenance Section of Referral Management called Assignment. Referral coordinators can use this new parameter by searching for a referral coordinators name and creating a new work list. This new list will enable them to review what referrals are assigned to that user.

Key Points

1. Select List Maintenance

2. Choose Assignment

3. Search for User's Name

4. Name the List

Assignment List

**Please remember to add as many parameters as needed for your work list to load efficiently**

Opioid Review Replacing PDMP Component

Go-Live March 21, 2023

All Providers currently using the PDMP component within Powerchart will be impacted.

Where will THE Opioid review be located?

Opioid Review will be replacing the current PDMP Component.

Opioid Review will be found on the Workflow MPage or the Table of Contents, depending on the provider's position.

**NOTE: If you currently view PDMP via Summary MPage you will need to access Opioid Review in the Table of Contents.**

EC Physicians and EC Residents Only

These users will access Opioid Review from the ED Workflow Tab in the Table of Contents and select the Opioid Review Component.

Required Field Added to Social Services DME Orders

Go-live March 22, 2023

Summary

On 3/22/23, a required field will be added to all Social Services DME Orders called "Length of Time Equipment/Supplies Needed." This change will provide information that insurance companies need and help decrease discharge delays or denials for equipment.

Orders Impacted

• DME CPAP/BiPAP

• DME General

• DME Orthotics

• DME Respiratory

• Social Services for DME for Home

• UMC Cancer Center Navigator Home DME

• Durable Medical Equipment for Home

Required Field

Do’s and Don’ts

DO - If the equipment will be needed indefinitely, the provider should enter 99 years.

DON’T - Providers should NEVER enter unknown.

DO - Providers can speak to the Social Worker on the unit if they are unsure how to answer the question.

Forced Encounter Selection

Go-Live March 20, 2023

Summary

As of 3/20/23, users must select an encounter when searching for a patient to open their chart. This change will be implemented to decrease billing, ordering, and other errors due to users being on the wrong encounter.

Key Points

• Applications: PowerChart, FirstNet, and SurgiNet.

• When searching for a patient, users must also select the specific encounter they want to open.

  • Users can no longer double-click the patient’s name to open the chart.

New Workflow as of March 20th

1. Search for the patient as normal.

2. Select the encounter from the bottom window.

3. Once the encounter is selected, the OK button will become un-dithered. Select OK to open the patient’s chart.

FAQs

• Does this impact Patient Lists, Tracking Boards, Physician Handoff, etc.?

  • No, this is specific to searching for a patient. You will not need to select the encounter for the lists above since an encounter is already attached.

• If I search by FIN, do I still need to select the encounter?

  • Yes, you must select the highlighted encounter from the bottom window.

• Does this apply to opening a chart from a message or notification in Message Center?

  • Yes, if an encounter is not specified, you will receive an error message asking you to select or add an encounter.

Refused Orders Refresher

Process for Refused Orders

When a provider refuses an order, the order will be routed to a designated person’s Message Center within the clinic.

The designated person will then research whether the order needs to be forwarded to another provider for signature.

If the order needs to be canceled, the designated person can cancel it and forward it back to the ordering provider to sign off on.

The same process will apply to future orders, co-signature orders, and cancellations or discontinued orders.

The co-signature provider will receive a notification in Message Center, and then they can cosign the order.

NEW POWERPLANS: CONTINUE INSULIN PUMP & DISCONTINUE INSULIN PUMP

GO LIVE march 1, 2023

Summary

To improve patient safety, two new Powerplans have been created for admitted patients who will continue using their own insulin pumps. These orders are called Continue Insulin Pump and Discontinue Insulin Pump.

New workflow

1. Patient presents for admission with their own pump. The nurse will document this in their head-to-toe assessment under medical devices. This will fire a task for them to complete the Admission Insulin Pump Assessment.

2. Within the Admission Insulin Pump Assessment, nurses will complete the Patient Competency Check Powerform, ensuring they meet the criteria to continue using their insulin pump. Second, nurses will complete the Patient Insulin Pump Assessment Powerform. The patient must also complete three documents regarding their continued insulin pump use.

3. If the patient meets all necessary criteria, the provider places the Continue Insulin Pump Powerplan.

4. The nurse will complete the Patient Insulin Pump Assessment Powerform once per shift during the patient's stay.

5. If the patient needs to be taken off of their pump for any reason, the provider will discontinue the Continue Insulin Pump Powerplan and place the Discontinue Insulin Pump Powerplan.

New PowerPlans

Patient unable to use insulin Pump inpatient:

• Patient is in DKA, SI, or an Altered Mental State

• If the patient meets any criteria deeming them unable to manage their own pump

*The PowerPlans will automatically be taken off for any traumas or if the patient is not conscious on arrival*

Argatroban for HIT Infusion Nomogram

• All orders for anticoagulants (i.e. heparin subcutaneous, enoxaparin, warfarin) must be discontinued

• The standard argatroban preparations are 50mg/50 mL IVPB or 250mg/250mL IVPB. Final product is to be determined by the pharmacy based on rate, expected duration, and available products.

Monitoring:                                                                                                                                                                          

• Baseline PTT should be drawn 3 hours after heparin has been stopped or 8 hours after the last dose of enoxaparin. Argatroban drip should be started 15-30 minutes after baseline PTT is drawn.

• May decrease to daily PTT once two consecutive PTT levels are within the therapeutic range. If any daily PTT level is outside of the therapeutic goal, PTT levels must be resumed every 2 hours after adjusting the infusion rate until two therapeutic levels are obtained again.

• Baseline CBC, then every other day, or more frequently if ordered by the provider

• Notify Physician

  • If PTT exceeds 100 seconds

  • If Hemoglobin decreases by 2 g/dL

  • If signs of bleeding occur

  • Argatroban rate exceeds 10 mcg/kg/min

* Once two consecutive PTT levels are within range, may collect daily with AM labs

** Maximum rate is 10 mcg/kg/min.  Notify provider if patient reaches this rate.

Reviewed by: UMC Pharmacy

Date: 10/1/2022

Version: 2

Potassium Chloride Replacement Plan- Pharmacy Recommendation

Changes to Potassium Chloride Replacement Plan.  Removing the comment “Administer at 10 mEq/hr” to allow for physician to change the rate as the Infuse over field determines the rate.  The provider may change that field and comments would not match.