The Chester County Hospital Clinical Informatics Council Meeting Minutes

Transcription

1 Present: See Attendance Sheet Chair: Kathy Zopf-Herling, MSN, RN- BC and Lindsay Pritchett, BSN, RN, CMSRN Date: October 21, 2014 Time 7:00 AM to 11:00 AM Location: Building 606 Training Room A Absent: See Attendance Sheet Recorder: Mary Louise DeMarco, MSN, RN- BC Guest: Review and Approval of Kathy and Lindsay reviewed the September CIC Minutes Minutes. Diane made a motion to approve the (Lindsay and group) minutes. Linda Kelnock seconded the motion. CIC members congratulated Andrea Hubert on receiving a Bachelor s Degree in Nursing. Kathy welcomed Ayesha to the Nursing Informatics team as part time complement to Mary Louise who is also working part time. Feedback and General Announcements (Kathy): Magnet gap analysis (never too early to prepare!) Kathy referred to page 14 of the minutes which is a gap analysis of Magnet renewal requirements put together by Patty Pauley. Kathy noted it is not too early to begin to preparing for Magnet recertification even though we have not yet received our Magnet designation. Kathy relayed that all councils should be looking at pre and post assessments but we will not be able to use anything that is completed now. However we can be looking for quality improvement projects to begin after Magnet designation is received. 1

2 MU update We have finished our attestation and there is a significant amount of money involved in this effort. We have met all of our measures. The most difficult was patient provisioning. We are up to 6.9% for patient s accessing their records after inpatient discharge. This is now added to the discharge report.. Face Sheet Issue There have been several Midas issues related to the Kathy will send an informational face sheet. There was a new face sheet tested but to the staff re the face sheet there are still issues. As of this week when the face link. sheet icon is selected, it will open up EDM to the Soarian Financials Face Sheet where the information is accurate. Depression Screening live October 20 NICU dietitian forms- Live October 22 Patch removal updatelive October 14 Updating Attending physicians (including MICA) New process Live October 29 o Does the armband or labels need to be reprinted? Anne reports no feedback from the staff re the Depression Screening. Per Athena no one has qualified for moderate to severe as she is monitoring the workflow. Janet Daily asked about the depression screening on the ACC form. Anne reports the ACC form was put into production Monday at 9 am; Anne also noted that there is an empty space on the form which is populated when additional questions are triggered. Going live on October 22. Patch removal is live with no comments from CIC members. Kathy reviewed page 17 of the CIC Meeting Handouts. Kathy reviewed that MICA physicians change responsibility for attending based on their schedule. In the new process, the night time hospitalist will go into the visit tab before 6am Sunday thru Thursday and revise the attending. On Friday afternoon the MICA physicians will revise the Kathy 2

3 ADT order for the Unit Coordinator to update the Attending for the weekend. The physicians will also be taught to change the Consulting Physician on the Visit tab. This does not go to Soarian Financials but the coders will get the info from the physician documentation. MICA will no longer be managing the spread sheets they currently are using.. Heparin flushes This is not complete at this time. Desensitization protocol Starting to put the desensitization orders in Soarian Clinicals. There are six medications with different doses. It is a complicated process that is still being worked on. ED project update The decision was made not to implement the T- (ASAP) System in the ED. The plan from Penn is now to implement Global Registration in early Spring, maybe April. There needs to be a Master Patient Number for all of Penn s patients. After that we can implement EPIC software. We will be implementing Epic s ASAP ED system. Penn has already started for the other hospital and we now anticipate a fall, 2015 go live. ASAP will not speak with Soarian or MAK but there are 2 reports Hall Pass and Hand off which we will use to view the ASAP documentation. We do not know if there will be a different medical record from EDM. Stephanie Didonato has used EPIC previously and there is bar coded Medication Administration available in the application. Epic inpatient documentation at Penn is called Penn Chart. That initiative is kicking off next month. We may be having staff in addition to Nursing Informatics staff participating in that group. This Thursday Penn will be coming to CCH to tour 3

4 the ED and give a demo to a small group. With the purchase of Siemens by Cerner, CCH is no longer pursuing Soarian. However the timing with MU3 is important and may need the updates to Soarian to attest to Meaningful Use 3. Chart Check Kathy presented a request to discontinue the Chart Kathy recommends CIC Members Checks in Soarian. Lindsay relayed that there is a bring the meaning of chart check need for the written DNR report to stay in the paper back to their units to discuss at next chart. Lindsay noted that a patient was transferred month s CIC meeting. without the chart and there was an issue in Echo where there was no CVD device for quick access. It was also noted that the Ethics committee wants the DNR form to remain in the paper chart. There was discussion whether the Chart Check should include checking the paper chart to make sure it is in sync with the most recent DNR order. Kathy noted that the nurse is ultimately responsible for the Chart Checks. Provider doc- Where to find older items? Kathy demonstrated Provider Doc in Soarian Clinicals in the Clinical Navigator Clinical Summary. Kathy reviewed that the scroll bar is used to see all of the documents. H&P s completed without Provider Doc will be found in the Progress/Transcribed/Dictated section. The date is all the way at the top. Marie notes this is the lifetime clinical record so all old records will appear in the list. H&P s drop off after 7 days under the documentation section. If not in the Clinical Summary, the H&P should be available in EDM. Sarah noted that the NICU H&P s are documented in another system and questions whether they become available in the Clinical Summary or EDM and when. Marie to bring access to NICU physician documentation back to the PIT team. Marie 4

5 Marie also thought the H&P will be kept for 30 days. Marie to follow up on access to Donna asked about the hand written H&P s for H&P s in the Clinical Summary. surgical patients. She still has difficulty finding some of them and notes that the written H&P s are not always in the paper chart. It is thought that they are not scanned into EDM until after discharge. Marie noted that if the patient has an H&P from the doctor s office, currently PA s dictate the H&P. In January the PA s will start documenting the H&P in Provider Doc. H&P s must be within 30 days. Kathy noted that Donna is requesting the H&P be in a consistent place. There are 4 places to look for the H&P. Per Donna Patrice has suggested looking at the Admission Assessment for the Med Surg History. Donna suggested a checkbox on the pre-procedure checklist.to identify the type of H&P. This was not agreed upon however CIC members identified that a consistent method to find the H&P is needed. Advanced Class in Soarian navigationcurriculum ideas (Sandy) Sandy reviewed an initiative from the Education Council to provide a voluntary Advanced Soarian Clinicals class for the nursing staff. Sandy requested possible topics from the CIC members. Suggestions included the following: Printing of Transmittal. Donna states hers are not printing. Jen states that meetings with lab resulted in the transmittal not being printed. There are issues with OR specimens. There are issues where the transmittal is printed when the patient moves between ACC and the OR. Transmittal process should be discussed in more detail. Clinical Navigator and H&P s How to make folders in the box Kathy to ask Joyce and lab representative to come to next meeting to discuss lab printing. Marie 5

6 Clean up orders Kill Soarian Process Chart Audits Finding Documents in EDM. Chart Checks Reprint Facility Expand the day, time range and how to find things in the Patient Record In Progress Assessments and report Alerts Operational Reports Legal issues of the Legal Medical Record gaps, issues, documentation missing Revise medication in MAK Charted List in MAK Reminders in MAK Revision Requests and documents to be approved: Workflow to trigger stat lab for critical POC blood sugars >400 <45 (Jules to come to meeting) Preferred times for class were discussed. Linda Kelnock stated that 8 to 9 would be best for night shift. 1 to 5 was suggested for day shift. Bev expressed that evening classes are not well attended. Three minute captivates were also recommended for each topic. Jules states there is a workflow that if there are 3 point of cares within 24 hours that are >200, an alert goes to the Diabetes Educators. There are alerts to physician for A1C >8% outside of the hospital. The workflow triggers after the admission assessment is complete if there is a history of Jules to send written workflow documentation of current process to Kathy to distribute to CIC members. Jules will write up the criteria for workflow related to the abnormal blood sugars and creating a Stat Lab Order. Jules Jules 6

7 Diabetes, or an insulin pump. If the insulin pump has been documented, a Diabetes Educator consult is ordered and a clinical note is documented. The workflow checks 2 different databases for A1C>8%. If not done in CCH within the last 60 days, an alert goes to the physician with the option to create an order to recheck the A1C. Jules reports workflow also checks for wounds documented in a patient with a history of Diabetes which sends an alert to the Diabetes Educators. Bill questions why the blood glucose must be documented in MAK when the Point of Care result goes into Soarian Clinical. The nurse must manually enter the blood glucose in MAK to correlate to the insulin dosage. This is double entry but the Point of Care goes into Soarian from the glucose machines. Workflow to identify Beta Blocker Sarah described the protocol order for Stat Lab. Sarah states that the nurses are usually working with the patient with abnormally high or low point of care values. The finger stick is repeated to confirm accuracy of first test. It was reported that the repeat finger stick is not done in ICU. Andrea noted that the NICU policy does not allow for repeat Point of Care testing. Donna noted that the AC and HS blood sugars without coverage are being missed as they are in the patient care orders and the nurses are not reminded in MAK. There are inpatient surgical patients who have Beta Blocker on the Home Med List and it is not ordered Jules will contact Debbie Drescher to find out the requirements of the Jules 7

8 Workflow to request for the patient. The SKIP measure is to reorder the measure. Will also need follow up physician order beta Beta Blocker within 24 hours. with the PIT team. blockers if patient on beta Diane suggests there is the same issue for Prednisone blocker at home. with an Adrenal patient. Kathy notes we are looking for trends and do not want to create Alerts for Kathy confirmed there is no way for nurses to enter Med Rec as a verbal order. UCSPW Enhancements Kathy reviewed page 19 of the CIC Meeting Add new field for RASS score to Postpartum flow sheet and possibly Obstetrical Transfer form Add check box to state that 'Patient belongings to be held in ACC for delivery to patient room. Handouts for the UC SPW Enhancement Requests. Pacemaker Interrogations Limit Total Fluids to/fluid Restrictions Order Donna noted that if there is a fluid restriction, they revise the diet order to add comments as to how much fluid to send each meal. Nurses should continue this rather than adding an encoded value. Point of Care Glucose Testing the tech can enter their own order to go to the SPW if they are in a combined Tech/UC role. NPO for 2 hours post bronchoscopy Resume Diet Order Go Live planned for 10/29. ED Techs may be seeing these on their SPW. CIC Members approved CIC Members approved CIC Members approved CIC Members approved CIC Members approved NI Team/Athena NI Team/Athena NI Team/Athena NI Team/Athena NI Team/Athena Kathy recommends an ED Tech Kathy come to the next UC meeting. Sedation scale. Approved NI Team Approved NI Team Add tachypnea to resp Approved NI Team 8

9 chapter Bundle Branch Block Approved NI Team IV chapter: make Insert Approved NI Team and removal lengths carry forward in IV chapter; add US guided peripheral IV to encoded value list under type. Add Penn Home Infusion Liaison to Multidisciplinary Round Carry forward of the comments field on the past med/surg history (to feed discharge plan TURBT instructions (Patrice) Education Document on Blood transfusion Reactions (Patrice) Request a new EV for Pregnancy test. NA - D&E procedure or similar Kathy demonstrated the IV chapter of the Shift Assessment. The US Peripheral IV is at the bottom of the list so that this method can be tracked. The ED staff may be trained in this insertion method. Diane questions how the ED will document this if they are using this technique. Anne reported that the Pre-Hospital IV will carry forward. When the IV is discontinued, the nurse will enter the discontinue date and then clear the IV. Kathy also demonstrated the Dialysis fields on the Genitourinary chapter. The Dialysis access site location will carry forward but not the bruit/thrill as requested by the CIC members. Mary Ellen noted that trialysis is a triple lumen catheter. Kathy demonstrated the Past Med/Surg History on the Admission form. Reviewed the document on page 21 of the CIC Meeting handouts. Marie noted that the call physician if is in the order set and is preselected. Kathy reviewed the ExitCare document on p 22. Add encoded value to Pregnancy Test required. NA For D&E today Approved Approved Approved as Library Document Patrice will review the ExitCare document. Approved. NI Team NI Team Selene Patrice NI Team 9

10 wording (Patrice) SAM nurse assessment form (ML Demarco) PCA/Epidural form with scan of nurse badge (Pat) ML reviewed the draft version of the documentation form for the Remote Telemetry RN s. No suggestions for changes were made. ML discussed the placement on the Clinical Summary. The physicians would like to see a separate tab but Kathy expressed concern that there will be too many tabs. ML will show the physicians both versions and try to persuade to combine with the Telemetry Monitor Tech documentation. The physicians have requested a separate tab because the Telemetry techs document every shift and the physician does not want to scroll through their documentation to see the Telemetry RN s as needed documentation. Pat reviewed the PCA-Epidural Assessment on page 23 of the CIC Meeting handouts. Pat to trigger one time pop up message. Epidurals use a different pump. Pat will check the pump for the correct name. Remove Number of Attempts/Demands/Number of Injections. Pat will check the Epidural Policy. Donna noted that there is a new Epidural policy released within the last few months. Pat will check into the History cleared field. HOB elevated Need level of anesthesia Dermatome. Linda states this this on the new PCA form. Pat will check pop up message Pat will coordinate the paper forms, orders, and new Check with SAM nurse about patients being discharge and staff nurse discontinues the telemetry and the SAM Nurse picks up later. There will be a time discrepancy. Pat to clarify if the RASS and a 2 nd sedation Score are required. Pat to check if there is a current PCA Assessment Criteria document to link to for reference. CIC members agreed to remove: Loading Dose Demand Dose Lockout Continuous//Basal Rate Continuous Demand Syringe Bottle Changed Investigate level of anesthesia dermatome. Pat will review forms and procedures ML Pat Pat Pat 10

11 procedure to update the form. with the above suggestions. Pat demonstrated how to scan the nurse badge for the Co signature on the form. Review of Diabetes Educator form (Anne) Downtime (Anne) Discuss which paper order sets (all or some) will be in the downtime boxes. Downtime box placement on the nursing units Clinical Summary Update (Pat) Mary Ellen suggests order pop up but Pat states that cannot be done. Anne reviewed the new Diabetes Educator Assessment on pages 25 and 26 of the CIC Meeting handouts. Anne reviewed the items selected to view on the clinical summary. CIC members did not recommend any changes. Anne stated that additional information could be added in the future. Anne also reviewed the request from the Diabetes Educators to add Survival Skills document to the Education Topics on the Patient Education Form. It was agreed that the Diabetes Educators could document in the current boxes. Anne reviewed pages 27 to 30 of the CIC Meeting handouts which shows the order sets used in the last 6 months. There will be a new tab for Critical Care. The nursing version of the patient story will also be in a separate tab. Kathy demonstrated the new version of the nursing clinical summary. The Go Live is scheduled for 10/22. On the Patient Story, only the documented items will be displayed. CIC members to review with their unit councils. Anne will send an electronic version to the CIC members. CIC members to Anne within 2 weeks with their feedback so the downtime boxes can be updated. Anne 11

12 Council goals (Lindsay) Lindsay reviewed the CIC goals. Lindsay asked CIC Lindsay will send out the goal form members to look at what the next project on their to prepare for next meeting. units to improved documentation. Updates on already approved items (NI team) Discharge plan-changes- Phase 1- (Done) Patch removal on admission assessment- (Done) Depression screening assessment and workflow- (Done) Setting MAK pop up at 72 hours to read PPD after PPD admin is MAK d (Done) MAK pop up to remove scopolamine patch at 72 hours (Done). Sputum orders not collected- add DC in 48 hours if not collected- (Done) Pre-med orders (prednisone and benadryl) as OTO unspecified orders Joe spoke to pharmacists. Resolved. Add IV line tracings completed to IV chapter- Done Nutrition forms for Lindsay 12

13 NICU/Peds - Live October 22. Add falls prevention steps to falls chapter in addition to ADL form (In Infant Driven feeding - NICU Flowsheet and Peds Shift Assess (In. Move Braden Scale to Shift Assessment; remove as standalone form (In Critical Care- Removal of CC ADL form (in AV fistula- Remove carry forward on bruit present/absent; Allow carry forward of access site type in, Add second access site with CF (In IV Chapter- addition of Central line insertion length and Central Line Removal length. Other forms? NICU, etc.? (In Diabetes Educator form- (In Wound measurement date- for each 13

14 type/location- (In Heparin Flushes in Soarian and MAK- (In Make comment field (Vascular Check form multi-line with ellipsis ( ) (In In Neuro flow sheet, move Glasgow coma scale, motor section, no response choice to last under decerebrate. (In Add 4 additional spots for Pressure Ulcer (In Add 4 additional incision and drain sites (In Progress ) Pain Scale Used to Carry forward (In Progress) Next Meeting: Tuesday, November 18 from in 606 Training Room A Kathy/Lindsay 14