Present: See Attendance Sheet Chair: Kathy Zopf-Herling, MSN, RN- BC, Lindsay Pritchett, BSN, RN, CMSRN, Mary Kretschmar, BSN, RN Date: 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 Donna Hagerty made a motion to approve the Minutes (Lindsay, Mary minutes and Bev Drake seconded the motion. and group) Mary reviewed that Sue Petley sent an e-mail requesting assistance with implementation of Penn Key and Knowledge Link. Kathy noted that CIC members agreed to support the enrollment of Penn Key for staff members. Kathy referred to page 11 of the handouts and reviewed an e-mail that went out to the system analysts. This refers to the Penn Key training which will be held during this CIC meeting. Penn Key includes access to knowledge link where we will be able to access training videos. Kathy would like CIC members to start completing those training videos. Feedback and General Announcements: Penn Chart updates (Kathy) Kathy notes last month there was a round of validation sessions which included high level discussions but weather kept some people from attending. If a decision could not be made because 1
the appropriate people were not there, the attendees used a red cow to indicate additional follow up is needed on that issue. Donna noted that she is disappointed that there are 29 clicks to order blood and hopes that Epic takes that into account. Kathy reviewed the Penn Chart Clin Doc content sessions which occur Tuesday at 10:30. 2 CIC members will attend the meeting with Pat and Ayesha. These sessions are looking at the model content and Pat is is looking at the encoded values. Kathy noted that Foundation is the Epic model system. The group is looking at the model values and looking at the current system for each hospital. Pat noted that it is a struggle as the decisions that are being made are based on the type of patients at each hospital which are different than the CCH population. The plan is to build the system and then do a final tweak. Pat described the flowsheet as similar to our columnar build. Pat also described a cascading function where depending on the nurse s selection a new window may open for additional documentation. If you open a, A1, A2, A3, A4 will open. If you select b, other screens will open. There will be sections that are not relevant. Pat notes there are 60 flowsheets to review as well as navigators. Kathy referred to page 3 of the CIC handouts which describes the Flight Plan Process. Pat is describing the In Flight phase 3 of the process. 10/16 is the end of Phase 4 which will be when the first hospital goes live and they do not know which hospital will go first. CCH may go first because we are small but on the other hand we do not have any of the systems 2
in place, like radiology or Optime for the OR. This includes the need to build and test the interfaces for these systems. Rollouts will continue through Spring/Summer, 2017. Kathy then referred to page 4 of the CIC handouts which describes the PennChart Phase II Clinical Project Teams. Kathy noted that sometimes we do not get invited to everything we need to, for example scheduling sessions. There are monthly updates and Kathy asked CIC members to post them on their units. Soarian Updates (Kathy) Kathy referred to page 5 of the CIC handouts which Talk to Cerner about Propietary is an e-mail to nursing with the latest Soarian Image displaying on the CCH revisons and new items. Anne noted that the updates Intranet site for the SC screen prints. are also posted on the Nursing Intranet site. When Kathy reviewed Proprietary Image displayed instead of the screen print. MSAP discussion on eprescribe (Kathy) Kathy noted that the MSAP members were supportive of the CIC initiative to include the PIAA project to improve Med Rec. Adding the pharmacy was also mentioned as part of this project. Kathy noted that for the physicians it is difficult if they have to order a narcotic which must be written and so they then print out all of the prescriptions. Donna Hagerty noted that it is difficult to tell on the Discharge Plan if the prescription is written or e- prescribe. Kathy and Pat note that this was corrected on the discharge Plan within the last 2 months. There is a different section for Prescriptions Electronically Sent to Retail Pharmacy (eprescibe). Kathy demonstrated how to tell if the prescription was printed or e-prescribed by the icon on the Discharge CIC members to inform Pat if the Discharge Plan report does not display the separate section for e- prescriptions. Kathy 3
Med List. In the next version of Soarian Clinicals, it will say e- prescribe and e-prescribe with copy. ML noted that the copy could be for the mail order pharmacy. Kathy notes that if the patient is using the Walgreens program someone must change the pharmacy to Walgreens in the Home Med List after the patient has decided. The Walgreens representative is supposed to discuss timing with the patient. Prescriptions can be e-prescribed to Walgreens. Bev noted that the pharmacies need to be educated and on board to accept e-prescribe. She feels there are too many issues with e-prescribe which leads to patient dissatisfaction. Pat noted that there is a mechanism to notify us if there are failures and we have had only 2 failures since our implementation although it is noted that we have a very low percentage of eprescibes. Patient Story Anyone Using? (Kathy) Penn Chart feedback to Clin Doc committee (2 volunteers every SIC Kathy demonstrated the Patient Story Tab of the Clinical Summary Nurse View Shift. This is where everything shows up. Items are compressed and can be opened up. Mary notes that she forgot that it was available. Donna asked if it could be sorted by types of assessment. Kathy demonstrated that types of assessments can be filtered from the display. Pat notes that it is meant to be sorted by time. Kathy demonstrated the Clinician Navigator which was designed for the physicians and only displays the physicians documentation. The nurses decided to include other information except the orders. CIC members to promote use of the nurse view of the Patient Story on their units. Linda Kelnock and Nicole will attend the Content session today with Pat and Ayesha. 4
meeting; others interested in attending the other weeks?) PINU and Critical Care The Soarian Critical Care module was rolled out on (Kathy) PINU. Soarian Class Heparin Flush update (Sandy) New Plan of Care Tab in Clinical Summary Mary Ellen asked Sandy for feedback about the Soarian Class. Sandy noted that it went well but it was poorly attended. Mary Ellen requests more notice as the ICU schedules were already completed when the class schedule was released. Mary Ellen feels there is a great need for it. Sandy noted that the Education Council is planning Excel, Outlook, Word and Power Point classes. Sandy reviewed the Heparin Flush Protocol which is scheduled to go live April 7. Sandy demonstrated the Directions field of the order where the IV nurse will add the color to the directions after each line number. Sandy demonstrated how the order looks in MAK. The nurse will have to non-admin any heparin flush that is not given. Mary Ellen recommended adding a non-admin reason of IV infusing rather than using Per protocol medication held. Donna expressed concern that she is going to be using non-admin frequently and also notes that she is flushing lines multiple times per shift. Sandy confirmed that there is a PRN order to address the multiple meds given per shift. Donna requests that Port flushing is included in the education to the nursing staff. Very few CIC members reported using the Plan of Care tab in the Clinical Summary. Anne Sandy will bring feedback to the Education Council. CIC members agreed to add a nonadmin reason of IV infusing to MAK for use with the Heparin Flush Protocol. Include Port flushing in the education provided to the nursing staff. Anne requests CIC members share the Clinical Summary Plan of Care Sandy Sandy Sandy/Kathy 5
Feedback? demonstrated the Plan of Care in the Clinical view with their units. Summary under the Multidisciplinary Tab. The Other list includes PT and Rehab goals as well as the rounding information. Mary Ellen notes that she still has to go the Patient Education Form to do any updates. Anne demonstrated how to open the form from the Clinical Summary to edit the Care Plan Chapter of the Patient Education form. Mary Ellen asked about the physician s view for case management. Anne demonstrated that the physician view does not include Plan of Care but does have a Case Management tab. Order Filters (Anne) Anne has been working with Joyce to clean up the CIC members instructed to open a Orders filters and the description now matches the Help Desk ticket if the Order filter results. results are not accurate. ICD Code on Discharge Prescriptions for Follow Up Tests and Therapies Anne presented an issue that was identified with the discharge process where the prescriptions for lab and radiology services do not have a diagnosis code. Anne proposed that nurses and unit coordinators check the prescription for the presence of the ICD-9 code. What is happening is that patients are bringing the prescription to the lab or radiology department and the services cannot be performed without the code. Bev states that this is a physician issue and should be sent back to the physician team. Other CIC members describe that issues are that the physician does not know the ICD-9 codes and the patients are anxious to leave the hospital when discharged. SC discharge med rec is not set up for these type of prescriptions which would include a field and prompt for the diagnosis code. Kathy demonstrated the Discharge Med Rec Free Anne will bring CIC members concerns to the Physician Informatics Team that this is not a nursing responsibility. CIC members recommend physician education before making nursing responsible. Anne 6
Text order that the physicians are using. Kathy demonstrated the Diagnoses available in Soarian Clinicals that might be used as a tool but these may not include the diagnosis pertaining to the lab or radiology follow up. There will also be additional issues with the use of ICD-10 which has many more codes than ICD-9. Procedure codes were also mentioned but these are identified by the provider of the service. Penn Key Inservicing and schedule (Sue Petley and Janice Fritsche) Sue Petley gave a presentation about Penn Key. This gives the staff access to Knowledge Link which includes e-learning modules for Lawson and Epic. It will include HIPAA, Education on the Go and ICD- 10 training. There are new Photo ID Badges which will be rolled out at the same time as the Penn Key implementation. There are new regulations for health care badges including an expiration date on the card. HR is asking for CIC member support for the enrollment sessions. There are 2 assistant roles Check-in and Technical Support. Kathy will forward the sign up e- mail out to the CIC Members to assist with the Penn Key rollout. Kathy CIC members enrolled in Penn Key during the CIC meeting. One of the specifics of the Penn Key is the password requirements which include a length of 8 characters, cannot be a dictionary word and include both letters and numbers. Bev recommends nurses be sent the password requirements in advance so the enrollment is not delayed. When enrolled the staff will receive a sticker with a HIPAA training reminder and a place to write down 7
the Penn Key and Password. Enrollees are given a set up code but it can only be used once so there is no need to keep it or write it down. Bev recommended special sessions for low literacy and employees with language difficulties. If that cannot be done Bev recommended that 1 computer be designated for literacy and language issues. Sue informed the group that direct care workers will be notified if they need a new badge. Sue notes that the ID badge is a separate task force so non-penn physicians will not have Penn Key. Nichole Flynn will be working with the other physicians if they need a new badge. Mary informed the group that she could not open the sign up document sent by Kathy. ML suggested this might be a function of Web Outlook. Kathy reviewed how to access the sign-up sheet through the folders by using the following steps: Find and expandmicrosoft Office on the Menu Open Excel Go to the File tab and select Open Navigate to My Computer Then to Groups Pick the Everyone folder Open the Penn Key Rollout folder Pick Pennkey Rollout Coverage Schedule Monica expressed concern that anyone can go into the schedule but Kathy stated that shared spreadsheets are often used for sign-ups without an issue. ML also noted that previous versions can often be found to identify who changed the file if there is an issue. 8
Revision Requests and documents to be approved: Fix pain interventions CIC members agreed to add the Pain (Sandy) Intervention values from test into ADL : Foley care under Peri care (Lindsay/Mary) Add Unit Coordinator to Multidisciplinary Rounds Form (Nichole Coleman) Additional Soarian Clinicals Request (Donna) In the Pain Assessment Columnar Interventions Sandy referred to page 9 of the CIC meeting handouts. Sandy demonstrated the list of values in Production is much shorter than the values in test. Kathy recommends adding all of the values from Test into Production. Critical Care is not using the Pain Assessment form. Mary Ellen asked about double documenting with MAK and it was identified that these are non-medication interventions. There is a question of where Subcutaneous pain pump should be documented. Sandy noted that the same field is used on Admission Assessment has a different label. Under Musculoskeletal on the Shift assessment under Additional Devices add Back Brace Welcome to EPIC Part 3: Medication Administration (Kathy) Council goals and Group work (Lindsay and Mary) Review of goals Continue design of Plan of Care in progress Implement Patient Story functionality with new Clinical Summary continue to roll out production with these exceptions: Remove epidural from Admission Assessment Add steroid injections Remove TENS Remove acupuncture CIC members agreed to Add Foley Care given to the ADL form under Peri-care CIC Members approved the request to add Unit Coordinator to the Multidisciplinary Rounds form. CIC members agreed to add Back Brace to Additional Devices on the Shift Assessment. Deferred to next CIC meeting. Plan of Care will be included in a larger committee. CIC members to present to their Unit Council and Staff members Sandy NI Team NI Team Kathy 9
Continue to facilitate electronic documentation and eliminate paper forms o PCA/Epidural Flow sheets o PACU, OR and ENDO Optime timeline has been moved up. o Electronic documentation for medical patients in the ACC Continue to promote and facilitate Point of Care CIC members agreed to resend the Documentation Survey sent in the summer of 2013. ML notes that other barriers may be identified with the implementation of the new in room devices. Support implementation of the T-System Goal is changed to support implementation of PennChart in the ED. Participate in the creation and/or review of all Pharmacy entry by nurses in Home Med List (group project) new Nursing Informatics initiatives Implement MAK for Heparin Flushes Review quality of electronic documentation and follow up on unit-based issues Increase member visibility on their units Participate in Criticare Care Phase 2 Lindsay requests the Pre-Data be sent to Mary. NICU would like to look at their alerts for their council project. ML stated there is an alert report that they could use to gather data. Heparin Flush go live scheduled for April 15. PACU going to Optime Critical Care in NICU deferred related to issues with Monitors and will implement device integration with PennChart. CIC members to send Pre-Data to Mary. ML offered NI team can assist with data compilation and analysis. 10
Updates on already Insulin Pump documentation (Done) approved items (NI Wound measurement date for each team) type/location (Done) Add 4 additional spots for Pressure Ulcer (Done) Default Home Med List Review at top of Medication topics on Patient Education form (Done) Add urostomy/ureterostomy/nephrostomy as an output option for I and O. (Done) Add Nursing Assistant to members present for Multidisciplinary rounds (Done) Make the line tracing box more visible on the IV screens. (Done moved over)) Add "Lap Belt" to ADL form, Falls Prevention (Done) Add Q pump to pain interventions options on the pain assessment form. (in progress). Peds shift assessment Move the Infant Driven Feeding elements to the end of the shift asmt columnar form. Determine if a trigger can make these elements only display when the infants age warrants the use of Infant Driven Feeding (Done) Add choice in ADL for a chair cushion (Donut) that will carry forward (In progress) Heparin Flushes in Soarian and MAK (April 15) Add RASS score to Postpartum flow sheet and Obstetrical Transfer form (In Progress) Workflow to trigger stat lab for critical POC blood sugars >400 <45 (Jules to come to meeting 11
(In progress) Workflow to request physician order beta blockers if patient on beta blocker at home (Referred to PIT team) Next Meeting: Tuesday, April 21, from 0700 1100 in 606 Training Room A Kathy/Mary 12