The Chester County Hospital Clinical Informatics Council Meeting Minutes

Transcription

1 CICMinutes_ pdfPresent: See Attendance Sheet Chair: Kathy Zopf-Herling, MSN, RN-BC and Lindsay Pritchett, BSN, RN, CMSRN Date: 11/18/2014 Time Location: 7:00 AM to 11:00 AM Building 606 Training Room A Absent: See Attendance Sheet Recorder: Mary Louise DeMarco, MSN, RN- BC Guest: Kathy Jones, Diabetes Educator Review and Approval of Kathy demonstrated the Poll Everywhere web Minutes application. Members answered a few questions and (Lindsay and group) Kathy was able to display the results on the screen after members texted the answer to a designated number. Marie shared a picture of the Word Cloud as this was not supported by the web browser. Kathy notes this may also be called a wordal. Minutes were reviewed. Lindsay reviewed some of the highlights including the Magnet Gap Analysis. Lindsay notes there is a Magnet phone call on Thursday in the Mira room and all CIC Members are invited to attend. Lindsay noted nothing has changed with the CIC goals. Marie noted the Heparin Flush will not go to order set committee until 12/10/14 which will mean a January go live. Okie is a member of this committee. 1

2 Marie notes Desensitization will be going live December 3. Kathy noted that Penn is getting a sense of our Emergency Department and toured our ED. There is a high level meeting this week to determine the strategy for EPIC ASAP in the ED. Kathy is hoping that CCH will have our own project which will allow us to clean up and simplify our processes. There will be more to come. Marie made a request to change the minutes to change discontinue Chart Checks to discontinue Orders Transcribed by Unit Coordinator. Marie is still following up on this issue. Marie noted 25% of the H&P s are written. There is no easy answer to how to find the H&P s. Marie confirmed that there is no way to see the NICU H&P s in Soarian. Lab transmittals will be discussed in January. Bev Drake made a motion to approve the corrected minutes and Monica Sekela seconded the motion. Feedback and General Announcements (Kathy): Update on Current Kathy reviewed the list of current approved items Approved Items. and their status. Mary Ellen notes Critical Care is happy with the ADL form changes. Kathy reviewed the new Diabetes Educator form in Soarian Clinicals. Anne noted that there is a new Diabetes tab in both the Clinical Summary Nurse Correct the October CIC minutes. Request Joyce and Lab representative attend January meeting. ML Kathy 2

3 View Shift and Clinician Navigator views. Blood Transfusion document deferred to future CIC meeting. Kathy reviewed that CVU is closed and PINU is accepting ICU step-down patients. The NI team is working with Siemens to add all PINU beds to the Critical Care flowsheets. Dina will help with the education and training. ACC will be using the previous CVU unit as an Need to match CVU to ACC orthopedic surgery. workflow for housekeeping pages. 4 North is now opened and has had 10 hours of utilization. It is planned to be opened continuously and will be staffed by IHR nurses. This will be a telemetry unit so will be managed by Tina Maher and Joanne Callahan. PINU is now being managed by Maura and Suzanne. WW Ground is now changing from telemetry to a post-surgical unit. We are contracting with Dr. Lyons and Dr. Manza to perform surgery at CCH routinely so we expect a higher orthopedic surgery census. Feedback- shift assessment changes, ED beds, Patient Story; Updating Attending physicians (including MICA)? ED Beds - Lisa noted that there have been issues with the unit coordinators discharging the patients Kathy reviewed the Soarian Financial Census and the Soarian Clinicals Census. There is a no unit in the drop down that the supervisors are using to pull the three ED units, There were no issues identified related to pulling the patients from the ED into other units. Maureen reported that patients seem to be transferred quicker into the OR. Athena Patient Story: Kathy notes she has received positive 3

4 feedback re the patient story. Kathy demonstrated the patient story in Soarian Clinicals. This displays what is being documented, test results and assessment. Assessments left in progress will be marked with a half moon. This is the only place to actually see the vital signs without scrolling through the whole document. Updating Attending Physicians: Dr. Sowti found that the weekend MICA attending physicians were not updated last weekend. The NI team will make rounds on Friday afternoon to make sure the Unit Coordinators are aware of the process. MICA lists are no longer being used. Kathy demonstrated the Physician list in Soarian Clinicals and notes that the active physicians are in bold. Oakie requested that Kathy review a case they were having an issue with. The issue was not related to the new process; there was an order for a level of care change by the nonattending physician and the unit coordinator changed the attending as well. Bev expressed that having two different processes is confusing from a training perspective. Mary Ellen requested Kathy demonstrate how to change the consulting physician. This is on the Visit Tab of Soarian Clinicals and physicians can add their own name as consultant. Marie noted that if there is a physician consult order, there is no need to change the consulting physician as this will add the physician to the physician list for that patient. It was noted the Physician Managing Care Order is not being used. Oakie noted that on her case the 4

5 MICA physician who was consulting changed the level of care and the attending name was changed. Marie to follow up with the PIT team Marie reviewed an sent to physicians regarding covering physician instructing them to change the consulting physician process. to the covering physician. Marie notes MICA is reviewing and the process is still in transition. E-prescribe- pharmacy entry Kathy noted our e-prescribe statistics are 4 to 6% of discharges. Doctors are not using e-prescribe because the pharmacy is not listed. Kathy demonstrated how to enter a pharmacy on the Soarian Clinical Home Med List through the Rx Retail. Pharmacy selection can use a search by zip code to filter the list. If there is no previous pharmacy, use or West Chester. Search can also use a partial pharmacy name search. Kathy confirmed that if the ED adds the pharmacy, it will not mess up the ExitCare process for outpatients. Kathy verified that the pharmacy selected carries forward from visit to visit. Both Rx Retail and Mail Order can be selected for the same prescription. Narcotic prescriptions still need to be written our and this may be one reason why physicians are not using e-prescribe. Pat did a review and found that only 3-4 e-prescribes are being sent per unit. We may do a focused push in the future to increase the E-prescribe percentage. ED and Penn Chart Phase Kathy informed CIC members that PennChart Phase 2 project update II design begins in November DNR order printing issue Matt and Joyce are looking into the DNR printing issue. This was originally thought to be an issue with the DNR revision order but is more complex. PINU and Critical Care The CVU monitors are being moved to PINU. Marie 5

6 PINU may use the Critical Care Flowsheet for documentation. Insulin Pump documentation (Kathy Jones) Kathy Jones reports that she is working with Marie on the order set. Nurses need to document that the patient has an insulin pump. Kathy Jones provided a demonstration of an actual insulin pump cannula which is 6 to 8 mm long and sits under the fat in the skin so it is much different from IV devices. There are 7 FDA approved devices in the US and CCH will see them all. They all have proprietary tubing and CCH will not stock the tubing. The patient has the skill and will use their own supplies to care for their own insulin pump. The insulin is changed every 3 days. The pump can be disconnected when the patient is taking a shower. CIC Members need to determine what and where to document the insulin pump. Kathy Jones recommends documenting the type and location and quality of Subcutaneous Insulin Infusion Set to include the location, integrity and appearance so it can be documented that it is in intact. Kathy Jones notes she is seeing about 4 Insulin pumps per month. Monica questions whether there should be a place to document if the patient cannot manage their own pump or it was discontinued. This can be documented in the comment section. Kathy Jones is updating the current policy and will include the documentation in Soarian Clinicals. CIC members recommended documenting the Insulin Pump on the Nursing Shift Assessment in the IV chapter after the IV Site above the trigger for more than 3 IV s. This will include: Location carry forward o RL Upper Arm o buttocks, thighs o 4 quadrants of abdomen Placement Date (ask on admission) o Update on reinsertion carry forward Site check once per shift Comment MAK insulin when patient refills their pump. Patient changes the site when indicated. The patient needs to come to the hospital with their equipment. If the patient does not have their equipment, cannot manage their own pump or if the pump was discontinued, the physician will need to order subcutaneous insulin. NI Team 6

7 CIC members noted that outpatient surgery does not need to document the insulin pump placement date. The ACC form was reviewed. Sandy suggests adding the insulin pump fields to the IV section of the Ambulatory Procedure form. Kathy reviewed the Post-Partum Flowsheet. Mary K questions how to trigger the work flow. It may be possible to trigger the form so questions are hidden. We also need to make sure this is included in CPN. Add the insulin pump fields to the IV section of the Ambulatory Procedure form. Add the fields to the Post-Partum flowsheet. Add Insulin Pump to CPN. NI Team NI Team ML Downtime (Anne and Marie) Soarian class Update (Sandy) Mary Ellen asked if there needs to be a worklow for the pump as the insulin and tubing need to be changed every 3 days. Kathy Jones states the pump will prompt the patient to refill. Anne reviewed feedback re the order sets for downtime use per unit. Anne still needs feedback from L&D, WW2, 3Lasko, TELE (can use 4 Lasko), PINU (Kelly with follow up), 4 North, PACU, ENDO (does not have box). The order sets are now available on the downtime PC s. There will be changes to the User Interface for the downtime PC s. Changes to the downtime PC are anticipated to occur in December. Sandy reviewed the topics for the advanced Soarian education planned by the Education Council. Plan of Care was suggested as a topic with a high priority. Cleaning up Orders Pharmacy selection on the Home Med List Anne will send directions to access the downtime PC which will involve using a combination of keys on the keyboard. Plan is for a 2 hour class to be held in February with one in the morning and one in the evening. Anne Sandy 7

8 Time Filter options on the Patient Record Addressing Alerts Sandy questions how to address; Lindsay states she uses the Open Nursing Alerts report in the Workflow Reports. It was reported that NICU always has a long list of alerts Reprint Facility Plan for the class is to review a list of topics and allow enough time for questions. Kathy recommends that the class be planned as a way to use our documentation tools. The class s goal is to teach short cuts and not be policy oriented. Meaning of Chart Deferred to a future meeting Checks? Revision Requests and documents to be approved: Can we add D5W with 20 Approved by CIC members. KCL onto the I/O Available Intake? UCs would like to know Kathy states this is a request from the Unit CIC Members request that the Unit if they can stop or reduce Coordinator meeting. Bill and Mary Ellen state they Coordinators continue to use the the Orders transcribed use the Orders Transcribed by Unit Coordinator. order, Orders transcribed by Unit by Unit Coordinator The Place Order for order, which is often used for Coordinator. CBC and PTT orders, goes to the UC SPW for the unit coordinator to enter the actual lab order. Lindsay/Kathy NI Team Athena and Kathy note that there is a Unit Coordinator order that will go to their work list. This is a communication order for the Unit Coordinators to send reminders in a professional manner. Nurses can also use this to send reminders to the unit coordinator. Kathy suggests the nurse review with their unit Anne to follow up with ICU and PINU re the new Unit Coordinator communication order. CIC Members to let Kathy and NI Anne 8

9 coordinator to follow a consistent process. team if the UC s are not using the Anne demonstrated the SPW for 4 Tower. Anne SPW and NI team will provide noted that on 3 Lasko are dividing the SPW by the education/support. two unit coordinators at the two nurses stations. Clinical Summarynavigator view Council goals (Lindsay) Kathy gave a brief overview of the Clinical Summary with the goal of creating a Non-physician navigator view. CIC Members will need to review both views and determine what will work best for them. Lindsay reviewed the current CIC Goals Plan of care meeting scheduled for 12/1 with members from 3 different councils, Education, Professional Development and Clinical Informatics. The issue currently is how to get buy in from other interdisciplinary groups. Plan to give a presentation to other groups, nutrition, dietary, respiratory, etc. and communicate to improve the value placed on the plan of care. Patient Story support and communicate to the units Completed. Continue to facilitate electronic documentation and eliminate paper forms. NI team works with other disciplines to create and update their forms. Respiratory wants an assessment form. NICU and speech therapy assessment are being worked on. Point of Care Documentation Maternity is charting outside the room but not timely. It was noted that one of the telemetry nurses now charts in the room and is finished her am charting by 8:20. ML suggested doing a follow Follow up point of care documentation survey to be reviewed at the next meeting. Lindsay/Kathy/ML 9

10 up point of care survey now that all of the CIC members recommend including devices have been upgraded and the rooms are the benefits of Point of Care charting private. Athena suggests including the benefits in the Advanced Soarian Clinical of Point of Care charting in the Advanced class. Soarian Clinical class. Stephanie DiDonato from NICU identified that they cannot do Point of Care charting. They write down info and then enter into computer. They have 12 to 18 babies and 6 to 8 computers. It is often not practical because of the baby, family or the gowning and gloving. NICU is also requesting the Critical Care Flowsheet. Kathy notes this is planned and is in the budget. Kathy recommends the focus be on timely charting in the NICU rather than focusing on the actual charting at the bedside. Lindsay suggests putting ownership back to the staff. NICU states they do not need the computer to give report. Pat requests the NICU Unit Council give Pat information from the SBAR so the clinical summary could be adapted for NICU s shift report. CIC members recommend Point of Care screen savers. Sandy NI Team The ED is not going to implement the T-System and will be going to EPIC ASAP as part of PennChart. The planning for PennChart is starting in December with the anticipated go live in Continue to participate in the creation and/or review of all new NI initiatives. Mary brought up Spanish documents in the D/C Plan library. Send out education re Heparin Flush Sandy/Nancy Rutz 10

11 Kathy reviewed the Spanish documents in MAK. currently in the library. Implement MAK for Heparin Flushes 2 orders are being worked on and being tested with go live on January 6. The order will be daily for Central, PICC and midline IV s and a PRN order for medication administration or blood draws. The IV team will place an order if needed. Nurses can also place order if needed. Sandy demonstrated the orders in Soarian and MAK test. Sandy notes that if the scheduled Heparin flush is not needed because of a lab draw or an IV med was given, the scheduled heparin flush must be non-admined. Kathy asked if the scheduled could be given instead of PRN with 1400 meds but this may be confusing. Increase member visibility and communication to end users on their units. CIC members are sending out s to their units. The OR has a bulletin board. Critical Care Support Phase 2 PINU will be first to have Critical Care. The other project that is being worked on is to have the Monitor Strips automatically go to EDM so they would be accessible from Soarian Clinicals. Review quality of electronic documentation and follow up on unit based issues. Kathy suggested that we use the same issues as this past year to get metrics and outcomes. Another suggestion is to work collaboratively with Pharmacy to improve the use of e-prescribe for Meaningful Use. Kathy reiterated that the topics that we 11

12 work on need to be outcome based for Magnet. If not doing the Home Med list, CIC members can identify if staff issue. Updates on already Add falls prevention steps to falls chapter in approved items (NI addition to ADL form (Done) team) Upcoming changes to UC SPW (Done) Move Braden Scale to Shift Assessment; remove as standalone form (Done) Critical Care- Removal of CC ADL form (Done) AV fistula- Remove carry forward on bruit present/absent; Allow carry forward of access site type in, Add second access site with CF (Done) Add Tachypnea to resp chapter assessment as encoded value (Done) NICU VS form: add 4 LPM as visible selection on O2 LMP field (Done) Add Bundle Branch block in CV chapter under Rhythm (Done) Pain Scale Used to Carry forward (Done) IV chapter: add US guided peripheral IV to encoded value list under type; Add Carry forward to Prehospital IV insert (Done) TURBT instructions (Done) Add check box to state that 'Patient belongings to be held in ACC for delivery to patient room. (Done) Request a new EV for Preg test. NA - D&E procedure (Done) IV Chapter- addition of Central line insertion 12

13 length and Central Line Removal length. (Done) Diabetes Educator form- (Done) Infant Driven feeding - NICU Flowsheet and Peds Shift Assess (Live 11/19 NICU; December for Peds). Make comment field (Vascular Check form multi-line with ellipsis ( ) (Live 11/19) In Neuro flow sheet, move Glasgow coma scale, motor section, no response choice to last under decerebrate. (Live 11/19) Wound measurement date- for each type/location- (In progress) Heparin Flushes in Soarian and MAK- (In progress) Add 4 additional spots for Pressure Ulcer (In progress) Add 4 additional incision and drain sites (In Progress ) Add RASS score to Postpartum flow sheet and Obstetrical Transfer form (In Progress) Add Penn Home Infusion Liaison to Multidisciplinary Rounds Education Document on Blood transfusion Reactions Workflow to trigger stat lab for critical POC blood sugars >400 <45 (Jules to come to meeting (In progress) Workflow to request physician order beta blockers if patient on beta blocker at home- (Referred to PIT team) 13

14 Next Meeting: December Meeting is Canceled!!!! Happy Tuesday, January 20, from Holidays! 1100 in 606 Training Room A Kathy/Lindsay 14