Transcript HED and HEO/WIZ Downtime - Vanderbilt University Medical Center

HED AND HEO/WIZ
DOWNTIME
Be Prepared
HED AND HEO/WIZ DOWNTIME
Saturday May 12, 2012 at 700pm
Till approximately
Sunday May 13, 2012 at 1200pm
Downtime for:
Order Entry (HEO/WIZ), Nursing Documentation (HED),
Nursing Med Administration System(Admin_Rx)
PREPARING FOR DOWNTIME
 Downtime Kits must be replenished, this kit includes:
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A. Downtime Policies;
B. Laminated Downtime Checklist;
C. Physician Order Sheet (POS); E-Procurement: Order ASAP
D. Nursing Flowsheets;
E. Medication Administration Records (MARs);
F. Downtime Requisitions;
G. Other unit-specific documents.
H. NEW Documents to be added to the downtime kit:
 VCH Patient Discharge Instructions (MC 4085); VUH Patient Discharge
Instructions (MC 2418) COPY CENTER: ORDER ASAP
 Policies: Insulin and Heparin Gtt Protocol, Restraints , Braden, Fall Risk,
PCA, Epidural
 Assessment Guidelines VUH and VCH
PREPARING FOR DOWNTIME
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Order Copier Paper
Order Labels
Order Addressograph Labels
Order Black Pins
Increase Staf fing
Replenish Downtime Kits
WHAT TO DO WHEN
MEDICAL RECEPTIONIST ( C O N T )
 Early Saturday Morning – For pts. not being discharged by 5p
 Place Physician Order Sheets (POS) in blue charts TWO per chart,
with patient labels attached on all three pages, DO NOT
ADDRESSOGRAPH
 Print 2 Downtime Flowsheets for each patient place labels, DO NOT
ADDRESSOGRAPH
 Print 2 Fall Risk Assessments for each patient place labels DO NOT
ADDRESSOGRAPH
 Print 30 labels for each patient
 Pharmacy Fax Numbers posted near fax with time of day
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VUH
VUH
VCH
VPH
VPH
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7a-7p 39879
7p-7a 31640
anytime – 66402
pharmacy rounds during day,
7p-7a – 31630
WHAT TO DO WHEN
MEDICAL RECEPTIONIST ( C O N T )
 5pm Saturday
 Check printer for paper (Paper MAR’s will be coming)
 PRINT OPC and any other routine shift change printing
 Transfer Order Sheets on all patients.
 Place TOS in patient’s chart
 Pharmacy will generate MAR, place in blue chart
 Print Assessment Guidelines, place in every blue chart
 Charts to Bedside
 During Downtime
 Process Physician Orders – See algorithm
 If electronic scanning, scan POS in EMR
 MR will annotate “DT” on POS beside all non -medication orders to indicate
to RN orders need to be entered into HEO/WIZ
 Transcribe Medication orders to MAR
 Complete requisitions (lab, radiology) and call ancillary departments PRN
 Requisitions with serial times (i.e., Q6H), will be filled out through end of
downtime on 5/13 at 1200p
WHAT TO DO WHEN
MEDICAL RECEPTIONIST ( C O N T )
 During Downtime Continued
 Remind Physicians to give POS to the Medical Receptionist
 Rounding on Blue Charts for Orders
 Transfers: Physician will amend TOS, and transfer patient. Receiving
unit will process TOS as if it were a Physician Order Sheet .
 Scanning Units
 After 7am Sunday Morning
 Blue Chart Check to look for documents to be scanned
 Nursing Flowsheet
 POS’s missed
 other
WHAT TO DO WHEN
RN’S
 5pm Saturday
 Renew all restraint orders
 Planned Priorities and Nursing Summary complete on all patients
 Night Shift WILL NOT do Priority Problems or Nursing Summary
 Nurses will need to transcribe cumulative Intake and Output for their
shift on the 7p-7a downtime flowsheet
 Ensure OPC and Transfer Order Sheet are printed (MR to Complete)
WHAT TO DO WHEN
RN’S ( C O N T )
 During Downtime
 Helpful Information (Downtime Kit )
 Assessment Guidelines will be in each chart
 Policies for Restraints, Braden, Epidural, Fall Risk, Insulin gtt protocol and heparin gtt
protocols
 How to complete a MAR
 How to complete a POS
 Process and Verify Physician Order Sheet (POS) requires signature
 Verify and Process Medication Administration Record (MAR) requires
signature
 Transfers: After MR processes Transfer Order Sheet (TOS), RN will
verify and process orders as if it were a POS requires signature
 Admission History:
 VCH/VUH: Positive for CPAP, POS will need to be filled out and respiratory called.
 Adults: If a positive screen for pneumovax, POS will need to be filled out and sent to pharmacy
WHAT TO DO WHEN
RN’S ( C O N T )
 During Downtime Continued
 Discharge: Discharge will be written on POS and prescriptions printed through
Rx_Star. Discharge Instruction Sheet completed and sent home with patient
 MAR’S for Sunday will print after midnight Saturday. MR’s place in Blue Chart
 RN’s will verify Sunday MAR with Saturday MAR, annotate changes and
schedule changes and fax to pharmacy.
WHAT TO DO WHEN
AFTER DOWNTIME
( A P P R O X I M AT E LY N O O N S U N D AY M AY 1 3 )
 RN’s
 HEO/WIZ
 From the POS and TOS, all non-medicated orders to be entered into
HEO/WIZ, only exception completed one -time orders
 NOTE: PHARMACY WILL ENTER ALL MEDICATION ORDERS
 Admission History
 Consult orders will need to be entered.
 Care Organizer
 Confirm Medication Orders with paper MAR. Send message to pharmacy
via Care Organizer for corrections
WHAT TO DO WHEN
AFTER DOWNTIME
( A P P R O X I M AT E LY N O O N S U N D AY M AY 1 3 )
 RN’s Continued
 HED
 Admin Rx, medications with outstanding schedule need to be addressed
 Asmnt/Interventn Tab, document start of downtime and end of downtime.
 RN Enters Cumulative Intake and Output for Saturday and Sunday
 Example of Back time for Saturday’s Cumulative from paper flowsheet, (3/12/2012, 0645).
 Will need to subtract what was charted from 7a-7p on 3/12 in HED from 24 hour cumulative
from the paper flowsheet.
 Sunday’s cumulative will be the current cumulative from the paper flowsheet.
 Restraint Orders renewed
 Priority Problems with goals back time to morning shift, and completed at
end of shift Planned Priorities and Nursing Summary.
WHAT TO DO WHEN
AFTER DOWNTIME
( A P P R O X I M AT E LY N O O N S U N D AY M AY 1 3 )
 MR’s
 Scanning Units will scan documents in to EMR
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Downtime flowsheets
Downtime POS (physician order sheets) that were missed
TOS (transfer order sheets) that were missed
Re-locate charts per unit protocol back to location for scanning
 All units
 Remove and Discard all unused downtime documents with patient labeled
attached.
 Remove and reuse any downtime documents that haven’t been labeled or
used and place back in downtime kit.
 Remove Transfer Order Sheets
POS KEY
MAR MR KEY
MAR RN KEY
LAB REQ KEY
CRITICAL CARE
RESPIRATORY CARE LAB KEY