Transcript EPIC for Paramedics CBT 12-062 2579KB Jan 14 2015 08:21:47

EPIC for Paramedics
Introduction to the EPIC
EMR System at
Salem Hospital
Logging Into Hyperspace

To log into Hyperspace
a

User ID and password is required
Salem Hospital will issue a user ID and
password to you
 You
will need to change your password at your
first log in

Never share your password with anyone
 It
is your electronic signature
Hyperspace log in Screen
Epic Rules
A “Stop” sign
indicates information must
be entered
 If “Accept” and “Cancel” are choices, you
must choose one
 An ellipsis requires an exact choice from a
drop down list
 Searching using the first 3 letters of key
words will assist in finding information

Ellipsis
Ellipsis
A drop down
menu will
appear when the
ellipsis is
clicked
More Epic Rules
Work spaces are usually highlighted in
dark blue
 If there is an ellipsis for time and date you
can use the following:

T= today (If you want to say 2 days ago use t-2)
 W = week (If you want to say last week use w-1)
 M = Month (If you want 3 months ago use m-3)
 Y = Year (If you want 5 years ago use y-5)
 N = Now (If you want a time 1 hour earlier use n60)

Home Workspace

After login
 Home

workspace appears
Create a “My List” for your list of assigned
patients
 You
only need to create your “My List” once
 May add and remove patients on a daily basis
to reflect your current patient list
Home Workspace
Creating a “My List”

With “My Patient’s List” highlighted in dark blue
 Click





on “Create” button
Enter your name in the stop sign row
Click “Copy”
Click “A Nurse List”
Click “Accept” in the small box
Click “Accept” in the big box
Create A “My List”
1. Give your
“My List” a
name
2. Click “Copy”
3. In “Available
Columns” box,
click on
“A
Nurses List”
4. Click “Accept”
Adding Patients to Your “My List”

There are two ways to add patients to your
“My List”
 Drag
and drop unit home list into “My List”
Find unit list under expandable list - “System List”
 Look under “Units” to find your nursing unit

 Once
List”
you find your unit, drag it up to your “My
Adding Unit List to “My List”
Click and hold your Unit - drag and
drop in your “My List”
Add Patients to Your “My List”

To add specific patients to your “My List”
(must know patient name or room number)
using room number – drag and drop
individual patient from your “Unit List” into
your “My List”
 If using patient name – highlight in blue - “My
List”
 Click on “Add Patient”
 Use the “3,3” rule – first three letters of their
last name and first three letters of their first
name to search for patient
 If
Add Patient Using “3,3” Rule
First 3 letters of last
name, comma & first
3 letters of first name
Add Patient Using “3,3” Rule
Click “Add Patient”
Use the “3,3 Rule” to find
your patient
Click “Accept”
How a “My List” Looks with Patients
Removing Patients from “My List”
Your patients (with black icons next to their
name) will stay in your “My List” until you
remove them
 To remove a patient

 Click
on patients name
 Click on “Remove” button

Your “My List” (with red and blue icons
next to it) will be automatically updated as
the unit census changes
Removing a Patient from “My List”
Highlight the patient name & click “Remove”
Opening a Patient’s Chart & Getting Report

To open a patient’s chart from your “My List”
 Highlight

patient name & click “Open Chart”
Patient Summary Activity opens
 Activities

are gray tabs on left side of chart
To get report on a patient
 Look
at all reports under “Patient Summary
Activity” – (more reports are available under
double arrows on the right hand side of screen)

Receive verbal report from off-going nurse
Patient Summary Activity – Get Report
Reports
Activities
Chart Review Activity

Chart Review
 Best

for looking at old records on patients
Lab Results, Imaging Results, Past
Medications are all located here
Chart Review Activity
Lab results under this tab
Documenting Vital Signs - I&O - Lines
& Drains

Found in Doc Flowsheet activity
 Documentation
of vital signs, I & O, Lines and
Drains

Vital signs flowsheet is the default flowsheet
 Automatically

opens when clicked
To add columns
 For
current time, click “Add Column” button
 For any time from the past, click “Insert Column”
button - change time and date if necessary

Blank columns will disappear
Vital Signs – Doc Flowsheet
To move up or
down in flowsheet
click on gray
boxes above, or
scroll on the right
Notice a column is
placed for the top
of the hour
Documenting Vital Signs

Document vital signs, ADL’s & Intake & Output at
time taken
 Value
documentation is done at time of care
 Details box provides choices from a row with an
“ellipsis”
 May make multiple choices from “ellipsis” rows
Example:
 Documenting
Oxygen source, charges the patient
for the use of the O2 and th equipment for the day
(only charges them once a day no matter how often
you document source)
Documenting Vital Signs
Doc Flowsheet – Saving Information

Changing flowsheets, activities or closing
the chart will automatically cause data to
be saved

Note: Any information entered into a
Doc Flowsheet will automatically be
saved - whether you file the data or
not!!
Doc Flowsheet – Saving Information

Editing data
 Click
on data to be changed
 Type in new data
 Click “File”
This triggers the “Show Audit” alert to
display on bottom of screen
 Note:
Edited Data on Doc Flowsheet
See “Hide Audit”
hyperlink on bottom
of screen
Initial data and
changed data are shown
Documenting On Intake Flowsheet
Anything going into
the patient is
documented on
the “Intake” flowsheet
Adding a Line to Intake Flowsheet

Adding a line (Peripheral IV line, PICC line, Central Line
or Enteral Feeding line) - must be in “Intake Flowsheet”




In “Properties” screen fill in the appropriate areas


Click “Add LDA” button
Choose line type for ellipsis
Click “Accept”
Click “Accept”
A “line” on the Intake Flowsheet is added

Blue hyperlink describing a line is created
Properties Screen for Adding Line
Intake Flowsheet - Lines Added
Note: line groups
added to gray keys
Note: blue
Hyperlinks for
each line within
the flowsheet
Intake and Output Documentation

Documented in “real time”
 Includes:
PO intake, IVPB’s, IV boluses, bolus tube
feedings, and water/saline flushes

Maintenance IV fluid volumes, continuous IV
drips, continuous drips
 Documented

at end of each shift
Voided, straight cath, incontinent urine and all
stools
 Recorded
as they are noted by the caregivers
Output Flowsheet Documentation

“Output Flowsheet”
 Document

all output’s
Adding a drain, chest tube, urinary
catheter or ileal conduit
 Click
on “Add LDA”
 Follow same steps as adding a line to “Intake
Flowsheet”
Output Flowsheet with a JP Drain
Note: document
drain output
in this row
Intake & Output Activity

“Intake & Output” activity
 View
only activity
 Provides summary of I&O per shift

Viewed in
 Table
form
 Graph form (note the 3 days graph and 7 day graph
buttons)
Note: Quickest way to see any shift’s total I&O
Intake and Output Activity
Notes Activity

Notes - written for significant events
 Admission,
transfer, discharge, patient fall,
etc.
Nurses write “Progress Notes”
 Click on “Notes” activity

 Click
“Progress Note”
 Click “New Note” to create new note
Notes Activity
Free type your note in this blank space
Click “Accept” when completed
Results Review

Review new lab or imaging results
 Go
to “Results Review” activity
 May be viewed by test, by all results, by date, by
multiple dates, etc.
 To change views click on “View” button
 To change dates - click on “Hide Data Prior To”
then change date

To mark you have seen results
 Click
on “Time Mark” button
Results Review
Clicking on “Time Mark”
will change results from
italics to bold, and will
cause them to not show
as new results
Point of Care Tests

Three point of care tests that result into EMR
 Capillary
Blood Glucose
 ABG’s
 ACT

Example: CBG
 Scan
Namebadge
 Scan patient’s armband
 Scan glucostrip bottle
 Perform test and read result
 Dock glucometer in docking station (sends results
to patient chart)
Medication Administration Record

The MAR Activity
 Documentation

of medications administered
Legend
 Identifies
meaning of specific colors, icons,
and codes
MAR Legend
Tabs of the MAR

MAR tabs
Tab – all medications alphabetically
 Scheduled Tab – all scheduled medications
alphabetically
 PRN Tab – all prn medications alphabetically
 Continuous Tab – all maintenance IV fluids and
continuous IV drips alphabetically
 Protocols Tab – all protocol medications
 RN Verify Tab – a list of new medications that RN must
verify against written order before administering first
dose
 RT tab – all RT administered medications alphabetically
 Discontinue tab – list of discontinued medications
 All
Tabs of the MAR
Legend
TABs
Administering Medications

Steps to medication administration
barcode patient’s armband first (this
ensures you always have the right patient - also
opens patient’s chart to the MAR)
 Barcode each medication
 Change any details for the medication – i.e. action
of given, held, missed, due, the rate or dose
 Type in any comments
 Click “Accept”
 Scan your name badge
 Always
Admission of a Medication Screen
Medication
information
Medication
Information
Action types
to choose from
when documenting
any action for a
medication
Given Medications on MAR
Given meds
are green and
underlined
IV Piggybacks

Administering IVPB
 Mark
action as “Given” on MAR
 Note amount of fluid to be infused
Open “Doc Flowsheet” activity
 Open “Intake Flowsheet”

 Document
amount of volume
Documenting IV Fluids on the MAR

Documentation of maintenance IV fluids
 Navigate
to “Continuous” tab of MAR
 Locate IV fluid to be administered
 Click on “white” space time frame
 Choose “New Bag” action
Ensure correct rate
 Click “Accept”

Documenting IV Fluids on the MAR
Note action of new bag
Changing IV Fluid Rate on MAR

Changing IV fluid rate
 Change
rate on IV
 Click “Continuous” tab of MAR
 Click on the “white” space for IV fluids
 Administration screen opens
Change the action to “Rate Change”
 Change the rate
 Click “Accept”

Changing Rate of IV Fluids on MAR
Note: Action of rate change
and rate changed to 150
A warning of the pink “i” in a circle
alerting change in rate from ordered rate
IV Bolus on the MAR


Open MAR
Administering bolus from a current IV fluid bag
 Click
“white” space for time to begin bolus
 Choose action of “Bolus”
 Change rate
 Click “Accept”

Administering bolus from different IV fluid
 Locate
bolus under te “prn” tab of MAR
 Click on “white” space for time
 Choose action of “Bolus”
 Click “Accept”
IV Bolus on MAR
Action is “Bolus”
Documenting IV Volumes on Doc Flowsheet

Document Maintenance IV volumes
 Open

Doc Flowsheet Intake flowsheet
At end of shift or at transfer
 Document
IV volume infused during shift
(Note: You can chart left to count fluid in the left to count row - it
is an information only row)

Document IV Bolus volumes
 Open
Doc Flowsheet Intake flowsheet
 In IV volume row

Document bolus volume as bolus begins
Titratable Medications on MAR

Titratable medications
 Located
in “Continuous” tab of MAR
 Also on “Intake” flowsheet

Administering new titratable drip medication
 Open
MAR
 Locate medication
 Click on “white” space for time
 Enter action of new bag
 Ensure correct rate/dose
 Click “Accept”
Titratable Medication on MAR
Ensure rate is correct
for patient weight
Titrating Medications

Titrating medications after adjusting rate on pump
 Open

“Intake” Flowsheet
Locate correct medication group
 Add
column for real time
 Click on dose or rate row
 Click on syringe icon
 MAR opens
 Choose action of “Rate Change” - change rate
 Click “Accept”
 “Intake” flowsheet opens - shows changed dose
and rate
Titrating Drips on MAR
Calculating Titratable Medication Volumes

On “Intake” flowsheet
 Volume

row is seen for each titratable medication
Calculating volume and clearing row for next
shift
 Add
column
 Click on volume row for drip
 Click on calculator in that row (this brings up
calculated volume)
 Verify volume matches volume on pump (if not use
the pump volume if it was cleared by last shift)
Calculating Volumes on Intake Flowsheet
Calculator
opened
Calculator
Closing a Patient Chart

To close a patient chart, click on the “x”
Logging Out of the System

Click on “Log Out”