NURSE COLLECT/I&O 2G Nurse Collect/I&O 2G Overview For RNs/ LPNs/ PCTs
Activating Charting When charting an entire column double click on the time at the top of the column to open the entire column. When documenting only one section double click on that section header and open that section. When documenting on only one item right click in that cell and click on Add Result. The check marks indicate that charting can occur.
Dynamic Groups To document on an item that you may have more than one of, such as chest tubes, ostomy s, catheters, etc. you can open and add as many of the items as needed. Simply click on the grid with the blue arrow and it will open the label box allowing you to label the item.
Dynamic Groups Continued When the label box is opened you must select the site, size, and type. All three are not always required but you can t select OK until required fields are complete. When you have completed the selections click OK and you will return to the flowsheet.
Dynamic Groups Continued When you return to the flowsheet you can chart on that item. The answers you selected become the name of that dynamic group. You can add as many groups as needed as long as you label each one. If you do not label each item you will not be able to sign the charting.
Customizing Your View To customize your view to add or take away an item from your flowsheet (such as adding a route of urine output) you select the Customize View Icon
Customizing Your View Continued When the customize window opens check each item that you want to add to your flowsheet and select OK. To take away items that you do not need on your flowsheet (if they have never been documented) take the check mark out of the box. When you return to your flowsheet it will be updated.
Click on Reference text (blue text) to open the reference text window. Reference text provides charting guidance, care plan information, or policy and procedure. To close the window click OK. Reference Text
Nurse Collect Hovering over the Need to Collect/Task Description area causes the Container View description pop up box to appear. This box displays the specimen collection information sorted by the required container. If you click on the Order View button, the pop up box changes to reveal the same collection information sorted by the specific labs ordered.
Nurse Collect/Collections Inquiry Nurse Collect/Collections Inquiry When collecting laboratory specimens, go to the Nurse Collect tab on the task list. The routine and AM lab task will populate the Nurse Collect tab10 minutes before it is due to be collected. Urgent, Emergent, and Timed Studies as appropriate will populate the task list immediately. Once you have collected the specimens, click on the yellow square and sign off the collected labs. You must complete the task on the task list or the lab will not run the test. When The collections collecting laboratory associated specimens, with the chosen go to task the will Nurse have Collect check tab marks on the defaulted task list. in the The box routine beside and them. AM If labs you will were populate the unable Nurse to Collect collect tab all specimens 10 minutes seen before in the it is window, due to be uncheck collected. the items Urgent, you Emergent were not able and to some collect. Time Then, Study click labs OK. will To populate see what the collections Nurse Collect are due tab during immediately. your shift, Once click you on Collections have collected Inquiry your in the labs top click right on of the page. yellow The square list of all and labs complete the ordered lab you will are open. submitting. If you have If for the some same reason task twice you were on the not task able list, to look collect at the one orders of the and specimens be sure it uncheck really is a that duplicate. box, then click If it OK. is a duplicate If you want complete to see one what and is due then throughout chart not done your shift on the click other on task. Collections Inquiry at the top right of the page. When you collect the lab make sure you complete the task before you send the blood to the lab or the lab will not run it.
Nurse Collect/Collections Inquiry Continued When you click on Collections Inquiry, the screen above opens. It contains a list of all the ordered labs for a patient. The status of Dispatched means the label has already printed and a task should exist. The status of Pending is a future lab collection. Click on all of the labs for which you need labels and tasks or replacement labels. Then, select the correct label printer for your unit. Next, select Labels and the window to the right opens up. Click Print. If you are drawing labs early, when you print your labels early it will cause the task to fire early so you can complete it prior to sending the specimen.
Point of Care Testing (POC) Point of Care Testing Accucheck POC testing results results will display will be in located the Chemistry on the lab Section results of Lab tab of Results. the chart. These These results include flow automatically Glucose, Hemoglobin, when the machine is docked Hematocrit, and the full ABG s, patient and account some number Chemistries. entered correctly. The full account number must include leading zeros and the last four suffix numbers. DO NOT enter the patient s MRN. You MUST also enter at least one comment in the Accucheck machine. Every patient test must include the comment meter cleaned. Please add any additional comments as appropriate. Specimens resulted utilizing IStats will display in the Hematology, Chemistry, or ABG bands depending upon the test resulted. They will have POC listed in front of the test name to distinguish them from a specimen resulted by the laboratory. Other Point of Care test results such as Rapid HIV, Urinalysis and ACT, will be in the Point of Care Testing section.
Graphing Create graph icon To graph go to the Graphs tab and select the graph you want to see. Select the elements you want graphed and the graph To create will new generate or view to the existing right. graphs You can of graph numeric BMDI, data Intake for a patient, and Output go to and the Vital Graphs Signs tab. Graph Existing to populate graphs all available at one time to all but users you are will BMDI need Acquired to scroll to Data, see each Intake one. & Output This is Totals the same and Standard for ICU or Graph Med-Surg. Vital Signs graph. To see the graphed data, select the desired graph from the available options and the data (based on the data charted for the time period identified at the top of the graph window) will generate as illustrated above. Multiple graphs can be displayed at the same time in the graph window, but you may need to scroll to see each one. This band functions the same for ICU and Med/Surg area.
Administering IV Piggy Backs Over Time When administering IV medication intermittently, check to see that the Infused Over box has a time displaying. If it does not already have a time populated by the pharmacy, add the amount of time that you want the medication to infuse over, for example 6 hours is 360 minutes. If no time is defined, the full medication volume will chart at one time.
Administering IV Piggy Backs Over Time, Continued When the Infused Over time is entered correctly, the medication will be divided evenly over the defined period. In the example above, infusing the medication over six hours will document 42 ml on the I & O for each of the six hours.
Confirming Intermittent IV Medication on the I&O Tab The volume to infuse each hour will populate the I&O tab with a checkmark and a question mark beside it. As the time becomes current time or past time the checkmark becomes green and the question mark becomes blue. They will stay these colors and serve as a reminder to the nurse to confirm the intake as it actually infuses. The nurse confirms the results by right clicking on the amount and selecting confirm for that infusion volume and question mark disappears. If the nurse does not confirm the infusion the checkmark and question mark continue to display and the volume will not be added to the I&O totals. (You do not have to confirm each hour as it occurs, you can wait until the infusion completes or you are ready to do your shift totals to confirm the amounts.)
Documenting PCAs To begin bag, open the chart details box and complete the required fields, Remember the dose per hour and the rate/volume per hour are not the same unless the concentration is 1:1. Fill in the dose and the unit of measure (mg/hr, kg/mcg/hr, etc.). Basal rate in this example is 2 mg/hr.
Documenting PCAs After the dose of 2 mg/hr is entered, the rate of 10 ml/hr fills in automatically. Once all fields are completed, click Apply and then the green check mark to return to the MAR.
CPOE Orders Management Policy The CPOE Orders Management Policy determines the conditions under which nurses can enter orders. All nurses must be familiar with the orders Management Policy and Provisions. The policy covers emergent events, PowerPlan initiation, verbal orders, conditional orders/protocol orders, suspending orders when transferring between units, canceling/reordering labs, etc. A copy of this policy is located on each unit in the CPOE reference Manual. Ordering Labs The Pathology Lab manual is a reference manual located on the MCG Home Page which includes information such as names of tests, common names and abbreviations, type of tube & volume of specimen required for testing, special requirements for transporting specimen to lab, reference or normal ranges for result interpretation & any notes pertaining to patient care, causes for rejection, turnaround time or approximately when results should be expected, etc.
Laboratory specimens are cancelled for a variety of reasons. Some of the more common reasons for cancellation hemolyzed quantity not sufficient (QNS) improper transport (i.e. Ammonia or Lactic Acid not on ice, Methotrexate not wrapped in foil) incorrect specimen container labeling issues (name on labels sent with specimen and label on specimen do not match, unlabeled specimens) To get a label for a lab that must be re-drawn, right click on the original lab order entered by the physician and choose Copy. The collection priority should be Timed Study and the Collection Start date/time must be the current date and time. This will ensure you get a label immediately after ordering.
Completing the Specimen Label **Only use ballpoint pens on the specimen labels. Lab will reject your sample if the label smears. Make sure the proper label is being used. The accession number will match the task. You can look at the task details to identify the correct accession number. Accession Number PRINT the date and time of the Specimen collection, not the task time. This must match what you enter as the performed date/ time on the task list. PRINT your username this is your PowerChart login name. Label the specimen container according to the instructions available in the unit resource manual. Some examples are in the following slides. Send all pieces of the label with the specimen to the lab, even if you think you have extra parts. If you have more than 1 label which requires the same specimen container, a single specimen can be sent with all the labels in the bag if the samples all go to the same processing lab and the sample is of a sufficient quantity. Make sure one of the labels is attached to the specimen. The specimen label includes the information about the patient, the accession number, the test ordered, the container required, the ordering physician and the order priority.
Quick Facts on Laboratory Label Printing If a laboratory test is ordered with: Routine Priority with no Frequency and no Duration Labels: The specimen labels will qualify to print at the next scheduled Collection List time if the specimen type is Blood or Urine. Any other specimen type will print immediately. Collection times are: ICU every even hour, non-icu 0400, 1200, 1700, 2200 and Behavioral Health 0700. Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/rt will be able to view this task at the appropriate time. This order will not repeat. Routine Priority with ONCE frequency (Duration not applicable) Labels: The specimen labels will qualify to print at the next scheduled Collection List time if the specimen type is Blood or Urine. Any other specimen type will print immediately. Currently the non-icu times are 0400, 1200, 1700, 2200; ICU times are every even hour; Behavioral Health is 0700. Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/rt will be able to view this task at the appropriate time. This is a one time order. Routine Priority with AM LAB, MTH LAB, MWF LAB, TTHSA LAB Frequency with no Duration Time Routine should always have a designated Duration and Duration Unit. Without the defined duration, the lab will be ordered for every defined day until the order is discontinued or patient discharges. Label: The specimen labels will print at the scheduled AM collection time designated by the unit if the specimen type is Blood or Urine. Any other specimen type will print immediately. Contact the nursing unit for the specific collection times. Collection times are: ICU 0200, non-icu 0400 and Behavioral Health 0700. Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/rt will be able to view this task at the appropriate time.
Quick Facts on Laboratory Label Printing Continued Routine Priority with AM LAB, MTH LAB, MWF LAB, TTHSA LAB Frequency with Duration Time Routine should have a designated Duration and Duration Unit. Labels: The specimen labels will print at the scheduled AM collection time designated by the unit if the specimen type is Blood or Urine. Any other specimen type will print immediately. Collection times are: ICU 0200, non-icu 0400 and Behavioral Health 0700. Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/rt will be able to view this task at the appropriate time. Timed Study Priority with Q Interval Frequency with Duration Time Timed Study must always a Start date and Time Timed Study must always have a designated Duration and Duration Unit. Labels: With a Start Date & Time entered as Today & Now the first specimen label will print immediately. The remaining orders (if the Duration is >1 time) will print with the closest previous Collection List to the time set by the interval time assigned to the order if the specimen type is Blood or Urine. Any other specimen type will print immediately. If the assigned time for any of the remaining orders is after the closest previous list has printed, the label will print immediately. With a Start Date & Time entered as a specific date & time the label will print with the closest previous Collection List to the time set by the interval time assigned to the order if the specimen type is Blood or Urine. Any other specimen type will print immediately. If the assigned time for any of the remaining orders is after the closest previous list has printed, the label will print immediately. Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/rt will be able to view this task at the appropriate time. Urgent Priority with ONCE Frequency (Duration not applicable) Urgent Priority can ONLY be used with the Frequency of ONCE. Labels: Specimen labels will print immediately. Tasks: Nursing/RT collection task will show immediately. Emergent Priority with ONCE Frequency (Duration not applicable) Emergent Priority can ONLY be used with the Frequency of ONCE. Labels: Specimen labels will print immediately. Tasks: Nursing/RT collection task will show immediately.
How to read and complete a laboratory specimen label Patient name & MRN Collection Date Collection Time Cerner Username Tube Type Tests Ordered Ordering Physician Collection Tube Label Accession Number Aliquot Labels Only use aliquot labels on 0.5mL microtainers Priority Laboratory Specimen label sets are divided into 3 areas: Demographic Label Large label on top of the label set Specimen Tube Barcodes 1 to 2 tube labels per label set Aliquot Labels - 4 aliquot labels for lab use or for Microtainers.
Examples of Properly labeled tubes:
Multiple labels on one tube This slide shows examples of incorrectly labeled specimens Best Dressed Tubes Chart from Beckman Coulter TOP Training CD