Emergency Care, Rx Writer, Exit Care

Sunrise Emergency Care Emergency Care, Rx Writer, Exit Care May 2013 v. 1.0

ED Display Board Log into Emergency Care/SCM. The View dropdown box will be populated with the views appropriate for your role -- the table on the next page describes which views are available. If necessary, you may need to switch your view to the location that you will be working for that shift. Slide 2

ED Display Board (Cont) View.ED All.WR Admit View Area All North Decatur ED Areas ED Waiting Room Behavioral Rooms ER 24-26 Inactive Patients Main 1 Main 2 Main 3 Patients assigned to temporary ED bed while waiting to be admitted Patients that have been removed from the board within the previous 72 hours. Note: If the patient was removed from the board due to an inpatient transfer/admit, they will NOT be displayed in the Inactive Patients view ER 3-10, HW 3-10, TR01 ER 11-19, HW 11-19, TR02 ER 27-32, HW 27-32, TR01, TR02 RTA RHW 01-04, RTA 01-03 Triage Urgent Care WR Inner Urgent Care Patients waiting for Triage. All patients will default to this view upon presentation to ED. ER 33-41, HW 33-35, HW A-E ED Inner Urgent Care Waiting Room Slide 3

ED Display Board (Cont) To switch to another view: Steps Actions 1 From the Emergency Care main screen, click on the View dropdown box 2 Select the view associated with your assigned location Slide 4

ED Display Board Emergency Care Views The Patient Tracker Board may be viewed from a static display board on large display monitors that will be strategically located in the ED. Users may also access their own personal view of the Patient Tracking System (containing a subset of data from the display board) by logging onto Sunrise Emergency Care at a PC workstation. Note that what you have access to view and change on the Patient Tracking System will be controlled by the security settings applied to your logon ID. Slide 5

ED Display Board Display Board Summary View Time of Refresh the display board is updated by information that is entered into Sunrise Emergency Care by various users on workstations throughout the hospital. The board view is configured to automatically refresh and show the latest data every 60 seconds. This area will display the actual time of the last refresh in the upper right side of the board. Summary Information This area will display a summary of information such as total number of patients on the unit, total number of patients in triage, etc. This summary data changes based upon the displayed Patient Tracking System view. Slide 6

ED Display Board Columns Display Board Column Room Patient SBP/DBP/HR Age ESI Description Displays the room/area where the patient is assigned Displays the name of the patient (depends on the view you are in) Displays the most recent vital signs Displays patient s age. Note: The system turns this cell pink if patient is a female and blue if a male. The priority of the patient from the Nurse s Triage Note. Slide 7

ED Display Board Columns Display Board Columns (cont) Display Board Column Chief Complaint Status (STS) ED LOS Nurse MD Description From the Nurse s Triage Note patient s stated complaint Displays the status of the patient or the bed (status descriptions detailed later) Length of time patient has been in the ED location Nurse assigned to this patient ED provider assigned to this patient Slide 8

ED Display Board Columns Display Board Columns (cont) Display Board Column New Orders D/C Sts (discharge status) Dispo Timer Description New physician orders have been placed in SCM Paper icon will appearwhen the physician has entered a discharge order Triggered when the disposition order is placed. When timer is greater than 15 minutes the cell background color starts blinking green. Timer stops when the patient is removed from the board. Inpt Timer Triggered when the status is RA (room assigned). When timer is greater than 30 minutes the cell background color starts blinking green. Timer stops when the patient is removed from the board. Slide 9

ED Display Board Columns Display Board Columns (cont) Display Board Column Comments Consult Lab/Urine/RAD/EKG/Meds/ Nursing Description Any additional comments for communication Triggered when the physician enters a consult order. Shows complete when the OSA completes the order (consulted MD has called back) May show a ratio (0:3) - first number shows how many results are ready and the second number displays the total number of orders placed. A single order will only show the status of that order (performed, comp, ordered) Slide 10

ED Display Board Columns Display Board Columns (cont) Display Board Column Previous Visit Description Keeps a rolling count of the number of times the patient has been in the ED within the previous 72 hours Admitted fr ED to Rm PADM BedReq Assigned inpatient room (by the Throughput Coordinator) Patient is waiting to be admitted Patient is waiting for bed (Provider has checked Bed Req) Admit order has been entered Displays a checkmark if a Bed Req has been ordered by the physician MD Timer The time that a patient has waited for a physician. This timer is triggered when the patient has completed triage and the room status has been updated (WR, WRFC, actual ED Room, etc.). The timer will stop ticking when the MD is assigned. Slide 11

Bed/Patient Status Column Status Description Notes (Icons, Timers, etc) Ready (BED) The bed has been cleaned and is READY for the next patient The line turns lavendar when the status is chosen signifying it is ready for an admission. Dirty (BED) This denotes a terminal clean room. The line turns brown. OOS/Blocked (BED) Room is Out of Service or Blocked The line turns red. Reserved (BED) Nursing has reserved the room for a patient after receiving a call from ambulance stating that they are on the way with a patient. The line turns red. Treatment in Progress (TIP) Provider is treating This status is automatically engaged when the provider assigns him/herself to the patient. Sends notification that patient is ready for full registration. Consult Pending Consult ordered, has not been received Pending Admission Bed Request has been received This status will be automatically engaged when the provider checks the Bed Req column Inpatient Admit Bed Request and Admission orders have been received, but bed has not been assigned or is not ready This nurse will manually change to this status once Admission orders and the Bed Req have been ordered by the provider Remove From Board Removes patient from the board Room Assigned Bed is assigned and ready for patient The 30 minute discharge timer begins ticking Waiting to be Seen (WTBS) Waiting to be seen Triage Nurse will change to WTBS once the Triage Note is completed. Triage Patient is waiting for triage Slide 12

Provider Responsibilities The provider has the following responsibilities: Assign him/herself to the patient Computerized Physician Order Entry All orders will be done through the Electronic SCM systems including Discharge, Admit, Meds, Labs, RAD, etc.. Order Bed Request for Inpatient Admits ED Disposition Orders for Patient Discharges from ED Create and Print Discharge Instructions using Exit Care Write electronic prescriptions using Rx Writer Sign off on electronic orders placed by Nursing Slide 13

Assign Provider to Patient To assign yourself to a patient: Steps Actions 1 Select the desired patient 2 Double-click in the MD column for the desired patient and select your name The MD Timer will stop ticking and you will be assigned to the patient Slide 14

Computerized Physician Order Entry With Emergency Care system, ALL orders will now be placed electronically using Computerized Physician Order Entry (CPOE). To assist you in this process, there are several Order Sets that have been built specifically for ED Providers. Slide 15

CPOE (Cont) To place an order: 1. Select the desired patient 2. Click the Enter Order icon from the patient header section Slide 16

CPOE (Cont) To place an order (cont): 3. Select the appropriate order set or type in an individual order item name. 3. Double click on the order set/order item name to open. Slide 17

CPOE (Cont) To place an order (cont): 5. Select desired options 6. Click OK Slide 18

CPOE (Cont) To place an order (cont): 7. Review Order for Accuracy 8. Click Submit Please see Module 3.4 in the SCM Acute Care Clinical System folder Order Entry CBL. Slide 19

To place an order (cont): ED specific order sets have been built in Acute Care. While you can certainly search for them manually, it is often easier to set your default browse point to these particular order sets. Default Browse Point Slide 20

CPOE (Cont) Setting Default Browse Point for Order Entry: 1. From the menu bar, select Preferences/Order Entry. 2. The Order Entry Option box will open. 3. From the Browse Start Point tab click Add New. Slide 21

CPOE (Cont) Setting Default Browse Point for Order Entry (cont): Select the browse option you wish to display as the default. This example displays Common Order Sets By Unit/Common Orders ED. Click OK. Slide 22

CPOE (Cont) Setting Default Browse Point for Order Entry (cont): Highlight the selection you wish to set as the default. Click on Set As Default, then Click Close. Slide 23

Disposition Orders When a patient is being admitted, transferred, or discharged, the ED-Disposition Orderset should be used. Slide 24

Disposition Orders (Cont) Disposition Orders 1. Select ED-Dispositions 2. Click Add Slide 25

Disposition Orders (Cont) Disposition Orders 3. Select desired options - You will need to doubleclick the order item to complete the required information - All orders with required information are preceded by 4. Click OK Slide 26

Disposition Orders (Cont) Disposition Orders 5. Click Submit Slide 27

Disposition Orders Bed Request (for Inpatient Admissions) 1. Using the ED-Dispositions orderset, double-click the ED-Bed Request order Slide 28

Disposition Orders Bed Request (for Inpatient Admissions) 2. Complete all mandatory fields (fields with are required) 3. Click OK Slide 29

Disposition Orders Bed Request (for Inpatient Admissions) 4. Click Submit Slide 30

Disposition Orders Inpatient Admissions Once the Bed Request Order has been submitted, the following will take place on the board: The Row will turn orange, signifying an inpatient admit 5. Click in the Bed Req checkbox to place a checkmark in the column A small bed icon will appear in the PADM column The Bed Req Timer begins ticking The STS column will change to PADM Slide 31

Alerts While using the system you may notice pop up alerts. These have been used to inform you that ACTION needs to occur. Some of the alerts you might see: -admission orders while a patient is in the ED need to be entered in a Hold session type -duplicate orders- users may not realize another practitioner has entered orders on the patient. Please see Module 3.4 in the SCM Acute Care Clinical System folder for more details on how to find patients and patient data. Slide 32

Exit Care Exit Care is the application that is used to print Discharge Instructions and Work/School excuses. To access Exit Care: 1. Select desired patient 2. Click on the Discharge Instructions icon OR Right-click the patient and select Discharge Instructions Slide 33

To access Exit Care (cont): 1. Click Login (the system recognizes your SCM log in) Slide 34

To select your document: 1. Select the desired document by clicking in the checkbox 2. Click Preview Highlighted Item if you would like to view the document OR Click Done to move to the next screen Slide 35

Alternatively, you can also use the Search feature to locate a document using free-text: 1. Free-text any part of the name of the document you are looking for 2. Select one of the following options: 1. Title begins with 2. Title contains 3. Search within the text of ALL document 3. Click Find Note: The available translations pane will display the translations available for that document. As documents are chosen, the documents selected will display in the selected documents pane. Slide 36

To edit your document: 1. Click the View Document tab 2. Click the Edit button Note: Edits are only available in English. The system is unable to convert English edits into other translations. Slide 37

To edit and print your document: 1. Make any necessary edits 2. Click the Save button 3. Select Save for Current Patient Only 4. Click the Print/Fax/Email link to print the document Note: The language and size option allows the user to print documents in the desired translation (available translations will be available in bold. Unavailable translations will be grayed out). If another language is selected, there is an option to print an English copy. The font size of the document can also be changed to accommodate patient needs. Slide 38

To add a work or school excuse: 1. Click the Add Excuse Form link from the left panel 2. Complete necessary information Slide 39

To add an additional Care Provider: 1. Click the Add a Caregiver button 2. Select desired caregiver 3. Click OK Slide 40

To add a follow up Care Provider: 1. Click the Add a Follow-up button 2. Select follow-up number of days 3. Select follow-up provider 4. Click OK Slide 41

Additional notes provides an area to document meds given in the Ed and meds given to take home. Adding Additional Notes: 1. Click the Lookup Notes button 2. Check the desired note 3. Click Add Selected Slide 42

Additional notes provides an area to document meds given in the Ed and meds given to take home. Adding Additional Notes: 1. Click the Lookup Notes button 2. Check the desired note 3. Click Add Selected Slide 43

The notes will be pulled into the document and you can free text additional information in the space provided Slide 44

Rx Writer/ePrescribe Prescription Writer is an application within Acute Care that allows providers to do the following: Create and maintain a list of home medications Electronically transmit new prescriptions Convert listed home medications into prescription refills View a history of changes for prescriptions and home medications Before eprescribing any medications, the provider must ensure the patient s preferred pharmacy is entered in the system. To enter the patient s preferred pharmacy Select your patient. Click the Rx Writer icon Click on the blue writing next to preferred pharmacy Click on the arrow. Enter the pharmacy name, state, and zip code. A list of pharmacies participating in eprescribe will display Slide 45

If the pharmacy name has this icon next to it, it is not a participating pharmacy in esubscribe. FYI: DO NOT USE THE ADD NEW SIGN TO FIND OR ADD NEW PHARMACIES. Click on the patient s preferred pharmacy from the list. If the patient s pharmacy is not a participating pharmacy, the Provider should print all prescriptions. Click on the add to preferred icon Click on close Slide 46

To enter your user preferences Click on the Rx Writer icon Click on the user preferences icon Select the location you are practicing from. Select the phone number that a pharmacist can contact you with any questions. Click OK. Close out of Rx Writer application for the changes to take effect. You only have to select the location and the phone number once. If the phone number listed in not correct or if you have a change in phone number/address please call 15757. Slide 47

Entering a Prescription Select your patient from the patient list or PTS board Click the Rx Writer icon Once the Rx Writer dialogue box opens up, click on the enter prescription icon If your user preferences are set to favorites, you will see this list. Pick the category you would like to select your prescriptions from (full catalog, quick list, favorites). Failure to enter all required fields will result in an error for esubmit. (Dose, Dosage Units, Route, Frequency, Days, Refills, Quantity, Dispensed Unit NOTE: Medications on the favorites list have most of those fields pre-filled. Slide 48

If you need to add more medications, click add to list When you are finished adding all prescriptions, Click Review and Submit. The following screen will appear Slide 49

If your user preference is defaulted to esubmit, the prescriptions will default to esubmit. Schedule II medications are not eligible for eprescribe and orders will default to Print. If the patient does not want to participate in eprescribe/esubmit, the Provider can manually change the submit method to print. Once you have entered all Prescription(s), click Submit Slide 50

Managing Prescriptions There is a new Notification icon that displays to indicate pending e-prescribing refill requests, e-prescribing errors, unsubmitted prescriptions, and new medication dispense history. Medications listed in blue are unsubmitted prescriptions Medications listed in red have submission errors The errors that display are specific to the user that is logged in For example, in the screen shot below, the notification icon indicates there are 5 items that the logged in Provider needs to review. There are 3 unsubmitted orders, 1 submission error on levothroid, and 1 error that exists on another patient the logged in provider has cared for. Other providers will see the medications listed in blue or red and can address the errors. Slide 51

To manage the errors, click on the Notification error icon, then Click on the item you would like to address. You will then receive a listing of the specific errors. Click on the plus sign to see more details Slide 52

Right click on the medication with the error or in unsubmitted status A dialogue box with additional actions will pop up Select View/Modify When the prescription box pops up, make the changes to address the errors or review the medication, then Click review and submit Once all errors have been addressed, the writing of the medication will turn black and the number of errors on the Notification icon will decrease. Click close when finished. Slide 53

Signature Manager The following orders will need to be signed in signature manager within Emergency Care, or in Sovera if the patient's visit is no longer active: - Verbal orders entered by nursing - ED protocol orders To launch Signature Manager, click on the icon on the toolbar. Click Get List button. Check the orders you wish to sign. Click Sign Slide 54

Congratulations! You have completed the Emergency Care CBL Slide 55