Transcript “ Hit ” or “ Myth ” - Vanderbilt University Medical Center

WELCOME
1. This class follows a standardized structure. The learner is expected to:
•
Listen and watch the instructor demonstrate and explain at the
beginning of each lesson with HANDS OFF THE WORKSTATION.
•
Practice individual exercises
•
Participate in knowledge check activities
•
Practice working through group activities.
2. The material presented in this class is a foundational overview of the
Clinical Systems. Unit specific information and practice will be covered
when you are active on your unit.
CLINICAL SYSTEMS
STARBROWSER/STARPANEL
VIDEO INTRODUCTION: STARBROWSER/STARPANEL
1. Click here to load video
STARBROWSER/STARPANEL
LOGGING ONTO THE SYSTEM
INDIVIDUAL ACTIVITY
1. Log onto the system using the training ID.
CLINICAL SYSTEMS
THE ACTIONS MENU
VIDEO INTRODUCTION: ACTIONS MENU
1. Click here to load Video
ACTIONS MENU
QUIZ SHOW
ACTIONS MENU
KNOWLEDGE CHECK
1. The link in the Actions Menu that is a record of
any document that pertains to a patient’s
medical history at Vanderbilt University
Medical Center.
ACTIONS MENU
KNOWLEDGE CHECK
All Documents
ACTIONS MENU
KNOWLEDGE CHECK
2. The link in the Actions Menu that displays
medications, dosages and time administered
for a specific patient.
ACTIONS MENU
KNOWLEDGE CHECK
MAR
ACTIONS MENU
KNOWLEDGE CHECK
3. The link in the Actions Menu that allows you to assign or view a pathway.
ACTIONS MENU
KNOWLEDGE CHECK
E-Docs Pathway
ACTIONS MENU
KNOWLEDGE CHECK
4. The link in the Actions Menu that provides a
snap shot of important information charted for
a patient using the SBAR format
ACTIONS MENU
KNOWLEDGE CHECK
OPC
ACTIONS MENU
KNOWLEDGE CHECK – TIE BREAKER!
5. The link in the Actions Menu that provides an overview of lab results from
a patient’s hospital stay.
ACTIONS MENU
KNOWLEDGE CHECK
Fast Labs
CHARTING A NEW PATIENT’S ADMISSION HISTORY
CHARTING A NEW PATIENT’S ADMISSION HISTORY
LEARNING OBJECTIVES
1. Locate required sections of the Admission History and define the completion
deadlines for those sections.
2. Demonstrate the ability to complete a patient admission history.
ADMISSION HISTORY FORM ACTIVITY
 With a partner, please complete an admission history form.
 Make sure to include information in each section and do not skip
sections.
 After the allergies section, please save the form as a draft and
switch roles with a partner.
 Take turns being the nurse and the patient, providing information
for completion of the form.
 Each partner should have an opportunity to practice!
CLINICAL SYSTEMS
ORDER ENTRY – HEO/WIZ
VIDEO INTRODUCTION: HEO/WIZ
1. Click here to load the video
ORDER ENTRY – HEO/WIZ
LEARNING OBJECTIVES
1. Define the purpose of the HEO/Wiz system.
2. Demonstrate searching for and locating active orders.
3. Demonstrate entering orders.
ORDER ENTRY – HEO/WIZ
LOCATING ACTIVE ORDERS
INDIVIDUAL ACTIVITY
Use patient name on the patient card.
1. Practice selecting a patient and locating a diet order for the patient on your
patient card.
2. Practice locating the tranfuse PRBCs order.
ORDER ENTRY – HEO/WIZ
ENTERING ORDERS
INDIVIDUAL ACTIVITY
1. Practice entering a telephone order from Dr. Physician Test for a routine,
one-time CBC w/platelets for 5 a.m. tomorrow.
2. Click done and Accept Orders.
ORDER ENTRY – HEO/WIZ
REQUESTING A BLOOD PRODUCT
INDIVIDUAL ACTIVITY
1. Practice requesting your remaining blood product from the blood bank for
your training patient.
ORDER ENTRY ACTIVITY
Enter the following order:
• Protocol order
• Test, Physician
• Diabetic diet consistent cho
• Daily
• NXT meal
• Until discontinued
IT’S LUNCH TIME! PLEASE LOG OFF OF YOUR WORKSTATIONS
BEFORE EXITING THE ROOM!
CLINICAL SYSTEMS
CHARTING HED
VIDEO INTRODUCTION: HED
1. Click here to load the video
CHARTING HED
LEARNING OBJECTIVES
1. Define the purpose of the HED system.
2. Demonstrate the method for assigning patients in Care Organizer.
3. Demonstrate the method for reviewing and completing labs in Care
Organizer
4. Demonstrate confirming a medication in Care Organizer.
5. Locate and define the purpose of primary menus in HED.
NOTIFICATION AND COMPLETING LABS IN CARE ORGANIZER
1. Demonstrate cicking the to-do radial button
2. Demonstrate clicking the Complete button
3. Demonstrate completing the Urinalysis lab order
4. Demonstrate closing the box
MEDICATION ADMINISTRATION
CONFIRMING A MEDICATION ORDER
1. Practice verifying that you are in “Active view” prior to confirming
medication.
2. Practice selecting your patient from laminated sheet and confirming Haldol
using the confirm button.
3. Confirm the remaining medications using the view confirm/unconfirmed
menu.
4. Using any medication, demonstrate sending a message to the
pharmacy.
5. Click the refresh button.
CHARTING NAVIGATION AND PROCESSES
CHARTING A NEW PATIENT’S VITALS IN HED
INDIVIDUAL ACTIVITY
1. Open HED Train.
2. Click “Show All”
3. Practice entering the following in the Vital Sign section of the chart:






Change time to 30 minutes ago.
Enter temp of 102.4 Oral.
Click exclamation point to make significant finding.
Enter heart rate/DAS of 116 apical.
Enter O2 Sats of 95% on Oxygen
Enter O2 Liter Flow of 2L, Nasal Cannula
4. Click “Save and Confirm” after vitals have been entered.
CHARTING
1.
2.
THE
PHYSICAL ASSESSMENT
AND
CARE PLAN
IN
HED
Click HED train and the “ICU/SD Asmt/Interventn” tab.
Click “Show All” Demonstrate entering the following in the Pulmonary section of the chart:
•
Select Respiratory ASMT (Problems) and select Gas Exchange
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Chart abnormal breath sounds using the following:
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Click Chart then SHOW ALL
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Click RLL and fine crackles
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Click LLL and fine crackles
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Click cough
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Click productive
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Make up nasty secretions
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Incentive Spirometer: 600X5
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Scroll to Pulmonary intervention: D B and Cough and Suction
•
Chart a Braden skin assessment and a Falls Risk Assessment
4. Click “save and confirm”.
CHARTING NAVIGATION AND PROCESSES
BEGINNING AND DISCONTINUING A LINE IN HED
1. Start a new CVC line using the following information:
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Line Type: Central Line, Site: Internal Jugular
•
Side: Right, Number of Lumens: Double, Lumen Description: Proximal,
Distal
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Dressing: Chlorhex Drsg, Transparent, Secured with: Suture
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Type “T” in date/time, Inserted by: Dr. Golightly, Location: VUMC ED
•
Response: c/o pain on insertion, site comfortable after procedure
2. Click “Save”.
3. Chart an assessment of an existing line.
4. Type the letter “T” in line removal to automatically enter the correct time and date.
5. End your existing line.
6. Save the line removal information so that *Ended* is displayed next to each piece of
charted information.
CHARTING PRIORITY PROBLEMS, NURSING SUMMARY, PLAN PRIORITIES, ADDRESSING GOALS
AND DISCHARGE PLANNING
Use the “Start Priority” hyperlink to start a new pulmonary problem and enter the
following:
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Click Gas Exchange
•
May be related to - Secretions
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Expected Outcome – Improve
•
Start Time “T”
•
Document a short term shift goal using the following:
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Maintain O2 Sats>94% on supplemental O2
1. Click the “Care Plan” tab in HED and enter phase.
2. Enter the following free text in the “Nursing Summary” field:
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Temp 102.4 with Tylenol Q4h. 02 Sats 94% with 2L.
3. Enter the following Plan Priority:
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Continue to wean 02 as ordered, encourage PO intake, encourage ambulation,
and draw trough after 1800 dose of Vancomycin.
4. Chart short term goal status was met.
5. Save the “Nursing Summary” and “Plan Priorities”.
6. Hover over the yellow note in the middle column to display text that has been entered.
7. From the magnifying glass, end the priority problem.
8. Click “Show All” to find the “Discharge Plan” section of the tab. Chart the review of d/c plan.
WORKFLOW OF CHARTING
BEGINNING OF YOUR SHIFT TASKS
END OF YOUR SHIFT TASKS
 Review Nursing Summary and
Plan Priorities of previous shift
from OPC.
 Assess the phase of Plan of Care
for appropriateness, found in
StarPanel.
 Complete physical assessment,
charted in HED.
 Chart Nursing Summary and Plan
Priorities, charted in HED.
 Select 2-3 problems identified on
assessment to create Priority
Problems with Short Term Goals.
 Chart “Met/Not Met/Improving”
after revaluating Short Term
Goals, Charted in HED.
CHARTING NAVIGATION AND PROCESSES
CHARTING PATIENT EDUCATION
INDIVIDUAL ACTIVITY
1. Click the “Education Record” tab in HED.
2. Click “Show All” to find the “Care Contact” section of the chart.
3. Document one care contact.
4. Click “Show All” to find the “Pulmonary Education”.
5. Chart the following information:
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Pulmonary->pulmonary care education->teachback/verbalize
understanding-> patient and care contact #1
CHARTING IN HED ACTIVITY
Chart the following sections:
Chart the following sections:
• Vitals
• Physical Assessment
• Plan of Care
• Education
MEDICATION ADMINISTRATION
LEARNING OBJECTIVES
1. Demonstrate the use a barcode scanner and explain the 5 rights.
2. Demonstrate administering a matched medication.
3. Demonstrate the cosigning of a high alert medication.
MEDICATION ADMINISTRATION
ADMINISTERING MEDICATION
INDIVIDUAL ACTIVITY
1. Locate the “To Do” view in Care Organizer and showing your worklist.
2. Click HED and locate and click the Admin Rx tab.
3. Administer using the barcode scanner

Haldol,

hydralazine

Milk of Magnesia
4. Address warnings if necessary.
MEDICATION ADMINISTRATION
MATCHED MEDICATION
1. Administer scheduled insulin.
2. Administer sliding scale insulin.
Blood sugar 255mg/dL.
3. Chart the sliding scale accordingly using hover feature to determine amount
of insulin needed to treat this blood sugar.
4. Practice cosigning a partner’s for the High Alert Medication insulin.
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Coin toss to see which team goes 1st.
MEDICATION ADMINISTRATION
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
1. Calling the pharmacy via telephone is the best method of communication
about a medication.
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Myth
Clicking “Send Rx a message” is
the best method for communicating
with the pharmacy.
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
2. IV manage in Care Organizer is for continuous medication drips and the
Admin Rx tab in HED is for scheduled medications.
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Hit
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
3. Medications are confirmed in Care Organizer.
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Hit
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
4. Warnings from the system will only occur when no medication order is
found.
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Myth
Warnings from the system
will occur when an incorrect dose is
selected, medications is administered
too late or too early, or when no
medication order is found.
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
5. Multiple orders can be confirmed for the same patient in Care Organizer.
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Hit
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
6. The Five Rights are:
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The right dose
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The right medication
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The right patient
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The right route
•
The right unit
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Myth
The five Rights are:
The right dose, the right medication,
the right patient, the right route and
the right time.
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH” TIE BREAKER
7. To confirm medications you do not have to be in Active View in Care
Organizer.
HIT
or
MYTH
MEDICATION ADMINISTRATION
KNOWLEDGE CHECK – “HIT” OR “MYTH”
Myth
TIE BREAKER
To confirm medications you do have
to be in Active View in Care Organizer
MEDICATION ADMINISTRATION GROUP ACTIVITY
With a partner, administer the following medications:
• Milk of Magnesia
• Ondansetron (Zofran)
• Hydralazine
Partners can provide patient information as needed.
Each partner should have an opportunity to practice!
FINAL KNOWLEDGE CHECK
SURVEY AND ASSESSMENT
Rules