An Introduction to FirstNet for Nurses
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- Brendan Stafford
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1 V3 : An Introduction to FirstNet for Nurses Nursing Staff Induction Program The Townsville Hospital June 2017
2 1. Log into FirstNet 1. Double click on iemr icon form desktop screen 2. Enter user name and password into login screen & click Log On 3. Double click on the First Net icon 4. Enter user name and password and press enter or click OK 2. Flip with My User Console If you are unable to log into FirstNet initially, whilst in Powerchart -Click the top tool bar button from 1. Your position will show R3 Registered Nurse 2. Select R3 Nurse Emergency 2
3 3. Click NOT 3. The ED Floor Plan Once you are logged into First Net to view the floor plan, select from the top tool bar Select the appropriate area you wish to view using the drop down arrow in the first window This will show you an overview of that floor area When you click on a bed location you are able to see the patient information as shown on the Tracking board 4. The ED Tracking List The default starting screen after logging in to FirstNet is the ED tracking List: 5. Using the tracking screen The tracking screen shows the list of patients in the department, their demographics, bed number, presenting complaint, most recent set of vital signs and the status of various ED processes. The first time you access the ED Tracking List it will show all the patients in the department including any prearrivals. You should narrow it down to your assigned working area (either Acute, FastTrack or Short Stay) by selecting either the TTH Acute/Resus or TTH FTrack/Paeds/Streaming or TTH Short Stay tab: 3
4 The order on the default tracking screen has patients not yet assigned to a treating clinician (TC) at the top of the list, ordered by triage category (T) and within each category, by length of stay (LOS): Patients who have been assigned a treating clinician appear lower in the list, sorted alphabetically according to treating clinician. There is a lot of information displayed on the tracking list, most of which is easy to figure out and better learnt while on the floor using the program. If you hover the mouse pointer over the various icons you will be given information about what they mean, for example the red sun icon in the allergies column indicates that allergies have been recorded for that patient, and hovering the pointer will pop up a list: The column NR displays the nurse assigned to the patient. RN initials will appear 4
5 5. Important Icons on the tracking screen Open Patient Chart. Gives you access to the selected patient s documentation Add Order. Click on this to place orders for pathology, radiology, or to record referrals Documentation, Interactive View, and Managing Deterioration. Short cuts to these screens can also be accessed via the Open Chart icon. Patient Summary Report. Tells you what has been done and what is still pending. Not the same as the ED Summary Depart Process. Doctors will click here to insert a working diagnosis, write a discharge letter, and discharge your patient. 7. Checking In The first thing to do at the beginning of your first shift is to check in to FirstNet. This must be done so you can assign yourself to patients. Do this on the ED Tracking List by clicking on the green tick icon: This box will open: In the Display Name text box enter your first name and last initial (last initial if you have the same first name as another nurse i.e. EmmaH, EmmaC. In *Provider Role: assign yourself as the Nurse Select the appropriate Default Relation from the drop down box Registered Nurse Click the Assign-> button repeatedly until all the available teams move from the left Available Teams box to the right Assigned Teams box Ensure Available Provider box is ticked Click OK to complete the process. 8. Assigning yourself to a patient Make sure the tracking screen is set to your area (Acute or FastTrack). 5
6 On the default screen the filter should match the name on the tracking screen tab. If not, select this yourself: This results in a list of patients with those not yet assigned to a treating clinician at the top of the list, displayed in order of triage category and length of stay: The Team column is colour coded for either Acute (blue), FastTrack (green), Paeds (pink), Streaming (yellow) or ACT/mental health (black). If you hover over the team colour it will remind you what team that colour is. When you have received handover for a patient and will be their ongoing nurse providing care, double click in the NR column for that patient: 6
7 The Assign/Unassign Providers box will open: Find and select your name in the Nurse drop down list. Click OK. (If it s not there, check that you have Checked-In, also make sure the All providers box is ticked). Your name will now appear in the NR column for that patient on the tracking screen, and the patient is now your responsibility. 9. Completing the initial ED Assessment (Adult/Paediatric) 1. Double click on the clip board icon located in your patient Activities column 2. Put a tick in the box next to ED Assessment Adult/Paediatric task and click Document Complete 7
8 3. Complete Initial Clinical Handover and Primary Assessment field as a minimum. Documentation should include a brief summary of the clinical findings from the first nursing assessment conducted on the patient after receiving the handover. 4. Complete by clicking the sign button 10. Opening the patient chart First ensure you have the right patient highlighted on the tracking screen. There are 3 ways to confirm this: in Patient box on tracking screen, highlighted in grey and name in top right banner There are a number of ways to open the patient chart: Double clicking on the blue triangle (1) at the far left of the tracking screen, clicking the patient chart icon (2), right clicking on the patient s name (3), clicking on the dropdown menu next to the patient s name on the top right of the screen (4) Chart Overview The Patient Chart can be navigated on the left hand side of the screen and gives you access to vital signs (Managing Deterioration), Orders (new and old), Allergies, Alerts (eg contact precautions, behavioural 8
9 disturbance), Documentation, previous ECGs (in Clinical Notes), Nursing documentation eg FWT urine results (Interactive View), Discharge Summaries (in The Viewer). 12. Documenting your patient encounter 1. To document your notes click on the Documentation icon on the ED Tracking screen 2. Then click +Add 9
10 3. You then choose the type of document you want to create: Type: Select Progress Notes Emergency Title: Team Role Reason eg: ED Nursing FT1-9 AM Shift 4. Select the Progress Note Blank template 5. Complete your documentation. Sign and submit your notes as you go. Only when you Sign/Submit will there be a permanent entry in the patient s electronic record. If you don t generate a document, you effectively haven t written any notes. A new nursing note should be created for the patient at the start of each shift, using the naming convention: ED Nursing; Location; Shift (e.g. ED Nursing A1-8 Night Shift) All additional notes by any nursing staff members for that patient for that shift should be added using the Addendum feature onto the original document. Addendums can be added at any time by navigating to the Documentation tab and double clicking on the signed nursing document you wish to add your additional notes to, or by clicking on modify in the Documentation menu. Type your additional notes and sign your new notes will be time and date stamped against the original note as an addendum. 10
11 13. RAT/ re-rat Documentation A RAT/re-RAT is triggered by the nurse caring for any patient whose physiological observation meet the RAT/Re- RAT criteria displayed above each clinical bedspace, or for any patient that the nurse is concerned about even if they don t meet any of the RAT/Re-RAT criteria. The process for triggering a RAT/Re-RAT is outlined on the bedside posters. More information on this process can be obtained from the ED Nurse Educator, Clinical Nurse Consultant, Shift Coordinator or any permanent ED nursing staff member. The RAT/ re-rat must be documented as a separate standalone clinical document within the patients iemr, no progress notes are to be included within the RAT/Re-RAT document. The RAT/Re-RAT document should include the following details: If it is the first RAT/ re-rat entry in the patient s iemr for the current encounter then a new progress note must be commenced with the following title ED RAT/ re-rat,shift, e.g. ED RAT/ re-rat AM SHIFT or SSU RAT/ re-rat ND SHIFT. The same note is to be used to document any further RAT/re-RAT requests during that shift by using the Addendum process outlined previously. If the patient remains in the ED/ SSU across multiple shifts then each shift requires a separate RAT/ re- RAT progress note. Each entry in the RAT/ re-rat progress note must include the standardised RAT template as illustrated below. This template can be set up as an auto-text function within iemr (please see the ED Nurse Educator, CNC or Clinical Facilitators to load this template onto your iemr profile). RAT/re-RAT template: RAT/RE-RAT Time Requested, Consultant/Registrar name: Reason (brief description): Intervention/Plan (actions taken, follow up plan & timeframe): 14. Vital Signs 1. To add a set of vital signs select the Interactive View icon from the Tracking List with your patient line selected 11
12 2. Double click on the dark blue box under the relevant time column and enter vitals 3. Click Sign button when complete 15. PIVC Documentation 1. PIVC insertion is also completed in Interactive View in the ED Resuscitation band: 2. To create a line you must first select Peripheral IV, then the Dynamic group icon and set the line parameters 12
13 3. Double click on the dark blue box to activate the column and enter relevant details 4. Click sign to complete 16. Specimen Collection Specimen Collection uses positive patient identification checks and scanning to record collection and print labels in FirstNet. The Specimen Collection window can be launched within a patient s chart or from the ED Tracking List. The Specimen Collection button appears in the iemr toolbar. To collect a specimen for a patient: 1. Highlight the patient on the tracking screen or open the patient chart to the current Emergency Encounter. 2. Click Specimen Collection from the iemr toolbar 3. The Collection Details window will open. Confirm the patient s identity. 4. Scan the patient s wristband using the barcode scanner or 5. Click on only if a wristband is not available Refer to site specific guidance and procedures for specimen collection. 13
14 6. The Collection Details window will open and display a list of orders available for collection in the selected encounter Filter icon Refresh Suggested pathology specimen containers will be displayed under the test/s name. These may need to be cross referenced with your hospital policy. Indicates priority or urgent collection Print icon Do not select Not Collected, as this will cancel the order or Reschedule. 7. Hover the mouse over the name of the specimen to view a text box with details of the collection 8. To print out specimen labels, click on the Print drop down arrow Select Print All Labels. The Print Labels window will open. The Select All check box will be selected as a default. All specimens will have the corresponding checkbox ticked. 9. Select required specimen labels for printing 10. Select the printer from the dropdown list or scan the square barcode on the printer. 11. Click the Print button 12. The label/s will print to the selected printer. 13. Once the specimens are in their containers, initial and time and date the label/s. Affix the appropriate label to the correct collection container. The barcode must be horizontal and straight, and over the existing tube label. 14. Use the barcode scanner to scan the labels attached to the specimen containers. The system will confirm that the patient chart and the specimen container label are matched to the correct patient. The specimen order will be displayed with a tick to indicate it has been collected. 15. If a barcode scanner is not available it will be necessary to manually change the collected status from the Specimen Collection window. Hover the mouse over the specimen collected, the line will highlight and the Status menu will be available. 16. Click on the to the right of the specimen order 14
15 17. A menu will be displayed. Select Collected. 18. A warning message will display as the label was not scanned. Click Yes if you have verified the container and label. 19. Click to certify you have collected the correct samples from the correct patient and labelled each container appropriately. The status of the specimen will automatically change to Ordered (Collected) in PowerChart and will drop off the Specimen Collection window. Marking the samples as Collected will create an entry in AUSLAB for the tests indicated on the label. 20. Click Close to close the Specimen Collection window 17. Discharge process Most often a doctor will complete the patient discharge within FirstNet. However this can also be completed by nursing staff if required. Select your patient on the tracking screen, and then click the Depart Process icon: Yellow menu items are mandatory fields and require completion. The Doctor will complete the Working Diagnosis mandatory field and complete their Discharge Letter (if required). The Departure Ready Time needs to be completed as soon as the patient is ready for discharge, along with the Evaluating Impact of Alcohol in ED Presentations field. Make sure there s a Working Diagnosis Complete the mandatory fields for ED Departure and Depart Ready Adding an Actual Departure date and time will discharge the patient from the tracking screen only complete this field when the patient has physically left the ED. Currently there is an additional field to complete on discharge, regarding the impact of alcohol. Remember to click on this field and complete it as part of the discharge process: 15
16 Click the green arrow to save and close the Impact of Alcohol screen once completed. If the patient is being admitted to hospital or Short Stay the Working Diagnosis, Depart Ready Time, ED Departure and Evaluating the Impact on Alcohol tabs still need to be completed. 16
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