Changes to How Code Status is Ordered

Go-Live: December 16, 2024

On December 16th, the Code Status order will be removed from the Admit/Observation PSO Plan. It will be placed in select powerplans and will be available as a one-off order. The system will automatically place an Assume Full Code order upon admission, which will be cancelled when the Code Status order is placed.

If the Code Status order has not been placed within the last twelve hours and a provider opens the chart, then a pop-up alert will appear.

If the patient had a Code Status order that was DNR or Care Limitations within the last year, then the pop-up alert appears as seen below.

Cerner Powerchart Touch Access (View Only)

Update as of September 27, 2024:

UMC has extended their hours for help setting up PC Touch in the McInturff to the following dates/times:

• Saturday (9/28) from 6a - 10a

• Sunday (9/29) from 6a - 10a

Powerchart Touch is available for providers for historical chart review on mobile devices during our IT outage. If you need an access code or help utilizing PC touch, please go to the McInturff tonight 7 pm - 11 pm or tomorrow 6 am - 8 pm . Refer to the screenshots below for information on how to download the application prior to heading to the McInturff. As a side note, if you already have Cerner apps on your phone, such as CareAware, then you already have access to PC touch. 

Step 1: Download the Powerchart Touch application via your mobile app store.

Step 2: Go to the McInturff to obtain the access code tonight 7p-11p or tomorrow 6a-8p, if needed.

Update to Diabetic Flowsheet

The diabetic flowsheet was recently updated to add additional labs, meds, and diet for a more comprehensive overview of diabetic patients.

New SmartZone alert for EC Patients when DKA is suspected

This smartzone alert will fire on patient in the EC with the suggestion to order Acetone if all the following are true: CO2 is 17 or less, Anion Gap is 18 or greater, Glucose is 200 or higher, and no acetone has been ordered.

New PowerPlans: Adult Nutritional Support Plan and Pediatric Nutritional Support Plan

Go-Live: Monday, September 23, 2024

Will be replacing the current Parenteral Nutritional Support Plan.

You will be able to search for the plans by Nutritional Support, TPN, or Tube Feeding.

'Do Not Turn' Order

Appropriate patients for this order:

• Hemodynamically UNSTABLE without recovery/stabilization of vitals within 10 minutes after turning.

  • Hypotension

  • Brady/Tachycardia

  • Oxygen desaturation

  • Tachypnea

  • Increased ICP

  • Life-threatening arrhythmias

  • Active Hemorrhage

Inappropriate patients for this order:

• Hemodynamically STABLE

• Hemodynamically unstable with recovery/stabilization of vitals within 10 minutes after turning

• Patients who refuse to turn

• Patients complaining of pain

More Information:

• Nurses can find it in the orders and Kardex!

• Must be initiated and discontinued with a physician order.

• Should be discontinued as soon as the patient stabilizes.

Experian and OneSource

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Referral Management

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Education Guides for RevCycle

Click on the button to download the education guides for each topic.

Citrix Server OS 2019 Upgrade / Migration

Visual Changes

With Citrix Server OS 2019, the frames around active application windows shift from thick bright blue border to a thin bright blue border or will seem borderless at times. Application / Window titles and font are smaller and left-aligned.

Previous View (Powerchart)

New View (Powerchart)

Previous View (PMOffice)

New View (PMOffice)

Another visual change is how idle timeout and maintenance logoff notifications are displayed. Notifications no longer display as the prominent purple banners that span the entire screen, but as light-blue modal dialog windows in the middle of the screen and will darken any applications delivered via Citrix.

Previous View

New View

Changes to Sedation History and Physical Update Powerform

Summary

The Sedation Plan Section of the Sedation History and Physcial Update Powerform for Moderate Sedation now includes an option indicating the discharge instructions were discussed before administering the sedation.

Sedation History and Physical Update Powerform

Sputum and Respiratory Culture Orders

The individual Culture Sputum and Culture Respiratory orders will be removed and replaced with the Sputum Culture Plan as a sub-phase in the following plans on 8/21/24: COPD Plan, Diabetic Ketoacidosis (DKA) Plan, MICU Direct Plan, Neurosurgery Plan, NICU Sepsis Evaluation Plan, Pediatric Cystic Fibrosis Plan, Pediatric PICU Trauma Plan, PICU General Plan, PICU Respiratory Failure Plan, Pneumonia Plan, Sepsis Plan, Targeted Temperature Management Plan.

UMC will be hiding the Culture Sputum with Gram Stain for all inpatient encounters, so the providers will choose the Sputum Culture Plan instead. This is to encourage providers to order the correct culture for their patients and reduce sputum contamination rates.  This update will happen on 8/19/2024. The clinics can still order the Culture Sputum with Gram Stain, as needed.

Blood Culture Bottle Shortage Restrictions and Recommendations

Effective immediately

Go-live to stop the 2nd blood culture orders is July 22, 2024.

We are experiencing an ongoing national and critical shortage of all Blood Culture Bottles (Pedi & Adult) that is anticipated to last through the end of 2024. Our supplier has asked that we reduce utilization by 50%. Restrictions to ordering processes are vital to ensure we do not exhaust our blood culture bottle supply.

Restrictions:

• *Blood Culture collections are restricted to 1 set (1 anaerobic and 1 lytic), in place of 2 sets.

• *Hard stop for all Blood Cultures ordered within 48 hours of a prior culture.

• *No future orders for all Blood Cultures

Recommendations:

• Prevent contaminations and thoroughly disinfect & ensure proper fill volumes are collected

  • UMC is well poised for this bc our contamination rate is extremely low, regularly <2%

  • Phlebotomists and Nurses who collect blood are cultures are well trained and demonstrate a very high competence in blood culture drawing techniques

• Blood Culture bottle fill volumes are evaluated monthly and all areas are compliant with appropriate fill volumes, which drastically reduces false negative cultures

• Body fluids other than blood should NOT be placed in blood culture bottles for culture

• Peripheral collections are strongly encouraged – Only draw from a line if you are trying to determine if the line is infected

• Do NOT collect blood cultures before an order is placed

• Do NOT discard a bottle to ‘try again’ and get a better fill

• In addition, blood cultures are NOT recommended in the following scenarios:

  • Patient with elevated WBC & no other signs/symptoms of sepsis

  • Patient with fever but no chills, leukocytosis or other signs of sepsis

  • Stable patient with prosthetic joint infection

  • Stable patient with post operative infection, planned for I&D w/OR cultures

  • Patient with repeatedly negative blood cultures in past week

  • Patient with UTI infection

  • Patient with non-severe pneumonia

  • Patient with non-severe cellulitis

  • Daily cultures to document blood stream infection clearance

For special circumstances or requests, please call:

Marisol Martinez, Clinical Laboratory Director @ 806-775-8399 or

Jayton Zachary, Clinical Laboratory Asst. Director @ 806-775-8381 or

The Microbiology Department @ 806-775-8375

*IT Tickets have been placed for these changes to be implemented as soon as possible

Dietary Supplement for Stage 3 & 4 Pressure Injuries

Estimated Go-Live Date: July 24, 2024

Juven is a therapeutic dietary supplement that supports wound healing. National Pressure Injury Advisory Panel (NPIAP) guidelines recommend providing additional nutrients (i.e., arginine, glutamine, HMB, multi-vitamin) for the prevention and treatment of pressure injuries as a standard of care.

A dietary supplement order for for Juven BID will be added to the Stage 3 & 4 Pressure Injury Standing Delegation Order which is initiated on patients with Stage 3 or 4 pressure injuries by nursing staff.

Juven is mixed with water or juice for oral administration. Can be mixed with soft foods (i.e., applesauce or ice cream) for patients with fluid restriction concerns or patient preference. Ability to administer via feeding tube as well.

Scan QR code to learn more about Juven.

For reference material or any questions/concerns, contact:

Hanna Cunningham MSN, RN, CWOCN

Wound Care & Ostomy Services Supervisor

806-775-8873

hannah.cunningham@umchealthsystem.com

Newborn Nursery SDO Change

Estimated Go-Live Date: July 25, 2024

The Newborn Nursery SDO - Dr. K. Robinson PowerPlan will be adding Total and Direct Bilirubin lab draws based on TcB and infant DAT+.

Pediatric Traumatic Splenectomy Vaccine Plan Update

The PowerPlan, Pediatric Traumatic Splenectomy Vaccine Plan (Less than 15 Years of Age), will remove notes in the Immunizations section and leave only the pneumococcal 20 as the only vaccine within the PowerPlan.

Consult MD Order Update

There is a new required field for the Consult MD order. It will default to “No'" but you can change it to “Yes” if applicable. A report will be ran to track this Advisory Consult usage field.

Influenza Vaccination Update

Go-Live: August 1, 2024

The 2024-25 flu vaccine is moving from a quadrivalent to a trivalent immunization.  To consolidate and ensure proper ordering and documentation, all influenza orders will only be available in a new care set called "Vaccinations Influenza w/chg".  The new set will be available beginning 8/1/2024.  You will no longer find influenza vaccines in the age-specific vaccination care sets.

New PowerPlan: Sputum Culture Plan

Go-Live: June 19, 2024

Synonym: Respiratory Culture Plan

This plan includes notes that are meant to guide the provider to selecting the correct order.

Please note that this plan will be placed as a sub-phase in multiple other PowerPlans in the coming months.

PICU Sedation and Pain Med Plan Updates

Go-Live: June 13, 2024

Weight filtering was added to both the Initial Dose and Intermittent Dosing of morphine, propofol, midazolam, and fentanyl.  Pentobarbitol pediatric was removed from the plan.