Meeting Time

Transcription

1 Minutes Purpose Attendees Meeting Location 606 The Chester County Hospital Staff Informatics Council July 17, 2012 To discuss Informatics related issues: new functionality, revisions and patient safety at TCCH; design electronic documentation forms; to facilitate the adoption of technology amongst nurses and other clinicians. See Attendance Record Meeting Time Review of Minutes, General Announcements/Updates and Feedback from the group Kathy Review and approval of minutes Put council minutes on the groups everyone drive New member from L and D Tara replacing Rebecca Wagner Minutes approved Lindsay and Donna HIT and Heparin Allergies.Benefits of MAKing flushes (James Curtis Clinical Pharmacy) James reviewed Heparin allergies and the need for heparin flushes It is necessary to MAK the Heparin flush to identify the time frame involved for the exposure and the Heparin dose related to Heparin Induced Thrombocytopenia. This can occur a month after exposure. There is a push is to minimize heparin flushes. The NI team will work with James to get the information into MAK after the final decisions are made. Donna H. identified that there are multiple antibiotics with flushes after each dose as well as multiple administration times per day. James will work with Lois from the IV team to review the amount of heparin flushes. Feedback from group, General Announcements/Updates (Kathy): Soarian Revision Requests: o Need to add Unable to Determine to the Advanced Directives o Can we add Flexiseal to the output screen choices (Donna) Policy states that an order is required to place Flexiseal and that it should be included into Output totals. Need order to say Place Flexiseal and record output every shift. Flexiseal can only be left in 29 days. Workflow could possible generate alert to remove the Flexiseal Currently there is no place to document that the Flexiseal was inserted. Recommend a new field for insertion and discontinue be added to the Shift Assessment. o Falls Prevention field on ADL form Committee meets every 2 months so there is no update. o Clinical Summary labs abnormal values only? Feedback. 1 of 6

2 Clinical Summary currently shows abnormal values only. There are other groups that need to see all of the labs. SIC agreed to add all labs to the clinical summary view Soarian Financials Update o Go Live is the first weekend in November and we are planning education sessions starting the middle of October. o There will be separate classes for charging o o There will be one hour classes for nursing There will be specific one hour classes for the ED to include the Quick Reg process Specimen Collect Work list feedback o Kathy demonstrated the Specimen Collect process o Interventional Radiology orders may show up in the Specimen Collect Worklist will be sending out a Quick Tip o If the specimen has already been collected the Specimen in Hand must be checked to send the order to the lab. The OR may revise the order to add the checkmark if they are collecting specimens in the lab and do not have a census. o The Specimen Collect Worklist is below the OTBA Worklist on the home screen Visit Start Date and Time o Joyce is printing notices for patient access to change the admit date/time to the time of the physician order for admission o Hopefully this will prevent the error message that prevents orders from being discontinued because they are before the registration time. Tele pilot of Soarian Discharge feedback? o Nichole reported that patients like the new discharge plan and things are going well. TELE nurses and Unit Coordinators are very happy that they do not have to type into the Word document anymore. o Printing too small on the calendar Pat will follow up o It is important to complete documentation before printing the discharge e.g. discontinue the IV or port as they will show up on o One advantage of the report is that it saves time because the last date and time are completed o Nichole brought up that If the hospital med is not used for the Discharge Med Rec (the same Home Med is moved over to the Discharge Medication List) the last date and time is not filled in Pat will follow up o Follow Up appointments PA and NP are entering as orders instead of using the Discharge Instructions form. Nichole will instruct them as there is no connection between the order and the form. o Donna requested that the IV discontinue be easier to access than the shift assessment NI will investigate o Kathy reminded the staff to save the patient education Form to In Progress. Only the discharging nurse should sign the form as Complete. o The form can be worked on during the patient stay and does not need to wait until the patient is discharged. o When the form is printed, it needs to be reviewed and the documentation updated before printing the final version. The patient and facility version can be previewed rather than printed to identify corrections that need to be made. 2 of 6

3 o Kathy demonstrated the preview and printing function from the Patient Record Tab by selecting the Print Menu. o Pat noted that the pilot is going very well. The physicians are happy with the discharge order set. The nurses are doing well learning a new process. o Kathy noted that some physicians are using the Discharge Med Rec to order studies and equipment so they can print a prescription. It has been requested that Soarian add this functionality. A discussion is ongoing about when to use the nursing order source vs per protocol. Readmission Risk Report o Kathy demonstrated the High Risk for Readmission report in Soarian Work Flow reports. There is a committee that is looking at the report requirements to filter the list more appropriately. Currently the previous stay is looking at 6 months and is being changed to 3 months. Home Med List Report o Kathy demonstrated the Med Rec Form Home Med List in the Soarian Work Flow report. o The reports take a full minute to run. o Only need to look at the rows highlighted in yellow to identify records with missing information. o Kathy recommended that one person run for the unit. Post Discharge Documentation o A few of the SIC members have had to add a late note. o Kathy reviewed the new Soarian form to replace the paper form both were attached to the SIC handouts. o Patrice identified that HIM would not accept the paper version of the form. HIM only wants to use the electronic addendum form. No resolution was identified. o Physician daily progress notes in Soarian will start July 25 with a soft roll out. o The Late Addendum form is not yet built in Soarian. Multi Disciplinary Rounding form Clinical Note vs form? o Anne is working with WWI at looking at having the Multi Disciplinary Note vs Form. Per Lindsay the goal is being able to see the flow of the patient stay. o The Case Management Discharge form can be used as an example o Lindsay will follow up with Anne Removing from Soarian Links o There is an issue with Soarian shutting down after they are using e mail from the Soarian Links. IT will be removing the Link from Soarian Co Chairing the Staff Informatics Council o Kathy noted that the Magnet Executive Coordinating Council recommended that nurses have opportunities for leadership. Kathy discussed that the co chair could be for an extended period of time, for a limited time (month, 6 months) or rotating. Any SIC member who is interested in being SIC co chair should contact Kathy. New Combined Status, Service and LOC order on p. 2 of the minutes o Pat Bria requested that the Physician name be blanked out for nurses but Marie Kania confirmed that this cannot be done for only the nurses and most of the orders are written by physicians. 3 of 6

4 Nursing IT Priorities next few months (Kathy) The list of priorities are included in the SIC handout. Only the top 5 are listed. Improve Discharge Process and other Transitions in Care moving house wide and need to expand to Maternal Child areas. Soarian 3.3 will be available for testing in the winter and we will be looking at Transfer Level of Care and Pending Activation Orders. Support Soarian Financials Initiative Nursing Informatics staff has been pulled into testing, process and education. Promote Universal Electronic Documentation there are still areas who do not document electronically. There have already been implications for use of the Discharge Form in these areas. We have met with Soarian to identify a way to meet the needs of the Critical Care Areas and this is ongoing. Enhance Current Functionality to Facilitate Throughout and Patient Safety Working on CPN LAB interface. Joyce is testing the ability to keep the orders active 1 hour after discharge. Remedy Inefficient Processes, Maximize Flexibility and free up resources for higher priority project looking at process for enrollments for staff and students. Downtime Forms (Maria) Marie provided list of forms and is requesting that the SIC members complete a list of documents and identify which need to be included in the downtime forms and give to Marie at the end of the meeting. Items needing to be removed from Preop Checklist (Pat) Pat provided copy of the form with the number of fields completed from a review of 15 charts. o General Information SIC agreed this should section is valuable and should be kept o Donna noted that she does not necessarily contact the physician if the H&P or consent is not in the chart. Joanne stated that she does review the form as part of her research to assure that all of the information is complete before surgery. o Kathy noted that this should be considered as documentation that the sending nurse adequately prepared the patient for the OR. o SIC members discussed the Medication section. Pat will have a smaller focus group to create clearer questions particularly related to beta blockers. There is a specific issue related to patients that are NPO upon admission and no meds ordered. o Recommendation to add Consent Absent to help the OR identify patients that need a completed consent form. Point of Care Discussion Next Steps Pre survey have a group work on it definition, perception, outside of MAK what percent of time do you document in the room? Angela s blog Angela agreed to have POC as a topic but would need to be after the Pre Survey is completed. 4 of 6

5 Contribute to Journal Club blog? o Kathy demonstrated the Point Of Care article on the Journal Club and requested that each SIC member add a comment to the blog Screen savers to define POC Anne will add. Shadowing council members are more computer savvy than other staff members so we should follow another user maybe a charge nurse or NI member could initiate the point of care documentation Scripts SIC broke down into 3 groups to work on: Pre Survey Scripts Screen Savers Scripts Group Need to follow up on the following TCCH policies regarding Determining the Patient s Right to View Information on the Computer: What the physician s allow What HIM allows What the TCCH policy is What is the law The following scripts were developed: Privacy/HIPAA Concerns o Pull the curtain and tell the patient that you are giving the patient their privacy. o Keep the curtain pulled around the device. o Close the door if people in the hall. o Ask visitor to wait in the lounge during the admission assessment to allow the nurse private time to ask about the personal and domestic violence questions. Slow PC Mrs. S please bear with me while the computer catches up. Exit Script to leave for the nurse to continue rounds or other responsibilities Mrs. S I am finished with my documentation now, is there anything else you need right now before I move onto the next patient? I will see you in an hour. Exit Script to leave a needy patient. I am finished with my charting now, is there something I can get the nursing assistant can help you with? Chatty Kathy can t complete documentation efficiently and thoroughly Mrs. S, I need to finish charting in this section and then I will update that. Or I will finish up your charting and then we can go back to your question/request. 5 of 6

6 Charting in the computer Mrs. S I am going to be charting right here in the computer so that all of your care team always have timely access to your most current information. After I finish charting this assessment, using the computer I can review your plan of care with you. Bridging Orders Roll out to other areas? (Marie Kania) Marie distributed and reviewed the Soarian Bridging Order Set Navigation Manual One of the primary reasons is to make sure the ADT orders are included in the admission orders. We would like to roll this out to the rest of the hospital. Education needs for implementation discussed and Kathy noted that the biggest change is that the nurse needs to guide the physician from the order set to be effective. Next Meeting: Tuesday, August 21 from in 606 Training Room A Respectfully Submitted, Mary Louise DeMarco MSN, RN BC 6 of 6