Present: See Attendance Sheet Chair: Kathy Zopf-Herling, MSN, RN- BC and Lindsay Pritchett, BSN, RN, CMSRN Date: 09/17/2013 Time 7:00 AM to 11:00 AM Location: Building 606 Training Room A Absent: Recorder: Mary Louise DeMarco, MSN, RN- BC Guest: New Members Kelly Buckman PINU Review of Private Room listwas sent to Mark. Minutes/assigned Transmittal printing in ACC is resolved. followups Multidisciplinary vs Interdisciplinary (Anne) Council Accomplishments and Siemens presentations were downloaded but NI team needs more time to review Anne presented Interdisciplinary Documentation from the Clinical Summary and Multidisciplinary from the Patient Record in Soarian Clinicals. Anne changed the Clinical Summary to display Multidisciplinary which now displays selected elements from the multidisciplinary forms, for example PT, OT, ST. The Patient Record displays a Multidisciplinary view that includes links to the multidisciplinary forms. SIC members agreed that we should remove the new results outpatient worklist from the list. Pat will be working on changing the filter on the new results worklist so that only new results display. Review of Siemens presentations is tabled to next month. Pat Kathy/ML Anne 1
Goals for rest of this year (Lindsay/Group): Pre Procedure Forms Plan for 10/1 go live. Sandy Point of Care Tap In Data ML presented the preliminary tap in data for the SIC members recommended keeping ML quarter of the Point of Care Survey (1 st quarter, 2012) all of the user profiles in the data and and the quarter after the survey. There is not a both tap in and password entry. It significant difference in in room device use at this was also agreed to look at the in point. room and mobile computers ML noted that the data is 6 months behind so we separately and together. need to wait until the end of September to report on the 3 rd Quarter of FY 2012. ML The data includes all user types that log into the CVD devices. It also includes those that tap in and log in with a password. Kathy and Lindsay will report the preliminary data at ML the Nursing Retreat at the end of September. Final Review of our Clinical Informatics Annual Report and Goals for Retreat on 9/27 Lindsay reviewed the goals for next year in the Clinical Informatics Council Annual Report included in the handouts. Lindsay reviewed Unit Rounding with the goal of making the SIC more visible to the nursing users. Kathy noted that the original thought was to pick a theme and review the plan in SIC and then spend the last 30 minutes of the meeting going to the floors. One example Kathy discussed was completing orders and this means reviewing the patient records and then reviewing with a nurse, it does not mean that the SIC member would complete the orders. This particular topic would not apply to OR, ACC, or ED. Kathy recommended that the data be looked at in relationship to patient days to eliminate differences related to patient census fluctuation. Kathy requested all of the units display on the report with the comparison between quarters not between units.. Kathy suggested that we make a master list of items to review with nursing staff on each unit which could include: All Tab Look up old chart In progress assessment Soarian stores history ED order acknowledgement and specimen collect PACU look up old charts, Kathy/Lindsay 2
Another member suggested reviewing in progress review discharge process shift assessments. Kathy demonstrated how to run the Workflow report for In Progress reports. SIC members should follow up with the last person who signed the record. For Patient SIC members should send e-mail to Education Forms on discharged patients, SIC Kathy and Lindsay if they have other members should follow up with the nurse who topics to review during rounds. discharged the patient. Lindsay noted that some nurses are still not comfortable completing a form started by another person. Kathy reviewed how to look at the history in Soarian Clinicals. This would be helpful to show the nursing staff that Soarian keeps a log of who documents what when completing a form. Kathy reviewed the Assessment History Detail to show the history of who changed what when. The Patient Education record is a good way to show the history to users as it is usually includes entries by multiple staff. Pat noted that the printing of the Discharge Instructions is not related to the status of the Patient Education Form. The nurse may complete the discharge form after they have reviewed the Discharge Instructions with the patient so they can select the correct Discharge Documentation option. Are the Council meetings of value to you? What could be done differently? Lindsay reviewed that part of the role of the SIC member is to bring information to and from the Council to each member s unit. Kathy noted that Irene did a good summary of the last SIC meeting. Irene stated that she is trying to get the NICU staff to use the Clinical Summary to do 3
report. Kathy reviewed Irene s e-mail to her staff with information and gentle reminders. Kathy forwarded Irene s summary to the Staff Informatics Council. Review of new ACC Post Procedure forms- Can anyone else use? (Anne) Patient Record Pre/Post Procedural (Sandy) Anne reviewed the Ambulatory Post-Procedure form. VS will carry forward to the VS form. Patient with a Bronchoscopy who is recovered in the Endo suite could potentially use the form. Anne is reviewing with Cardiac Cath. If a patient is admitted, the inpatient nurse would not have to complete this form but could review in the patient record. Sandy reviewed the new Patient Record view Pre/Post Procedural. This will include the Pre Procedure Checklist, Ambulatory and ACC Post Procedure forms. The Pre-Procedure View will be removed from Patient Record. There will also be a Clinical Summary view with selected data from these forms. If the patient is admitted, findings that are common to the Admission Assessment or the Shift Assessment will carry forward to the problems. For patients admitted, the Ambulatory Procedure will be considered the Admission Assessment. Sandy reviewed the Ambulatory Procedure assessment and the Admission chapter. It was suggested the Patient is expected to be admitted; Admission chapter is complete statement be moved to the end. Sandy was afraid this would be missed if all sections of the Admission are not required. This is responsible for creating the Go Live planned for 10/1 for ACC and PEDS patients. NI team will work with Endo, Cath Lab and PACU to review the form, make adjustments and provide education and rollout. Go Live planned for 10/1 Anne Anne Sandy 4
Admission alert if the patient is admitted. Athena suggested the Patient Admission Chapter completed be made mandatory. Sandy and the ACC team had considered this but had decided against it small staff, monitor Added an additional discharge documentation statement for ACC to include reviewed instruction on medical equipment. ACC will continue to use the patient belongings form for patients scheduled to be admitted. Re-ordering of Discharge Plan sections (mock up) Pat reviewed the reordered Discharge Instructions starting on page 15 of the SIC meeting handouts. Pat reviewed the SIC recommendation to remove Religion from the header. This is valuable information for another facility. Pat discussed with the new report writer who may be able to make the Religion blank if Unknown or Non-Religious entered by registration. Kathy noted that she reviewed with Lauren who is relooking at the options and also educating the staff. Kathy suggested moving the statements on page 12 to after the appointments and before the calendars. SIC members agreed. Pat noted that identification of new medications and new dosages need to come from Med Rec. This should be in a future Soarian Clinical release but we do not know when. Some additional changes had been previously requested for the Vaccine section and they have not been made in the report yet. Pat noted that there are still some General SIC members agreed to move the statements on page 12 to after the appointments and before the calendars. Pat Pat 5
Instructions to Remember statements prior to the SIC members agreed to the new Primary Contact Information. SIC members in format with the above exception and agreement. Pat will take to the report writer. Pat noted the combination of General Patient Information/Patient Condition at Discharge sections. Janet questioned what to do when the physician writes a prescription but does not include the medication in the Discharge Med Rec. Kathy suggested making a copy of the prescription and writing on the copy that the medication was added to Discharge Med Rec. Then the medication could be added to Med Rec with the prescription serving as the verbal order. Announcements/Updates (Kathy) Logo changes- Update your email! Follow up on request to make nurse communication orders mandatory opening (Selene) - put in packet email from 08-28 Revision Requests to be approved: Kathy reviewed the Logo Files and Templates under the Marketing section of the Intranet Page. Some SIC members cannot get logo to display on the Web Mail Signature. Selene is investigating. A list of Penn Logo Do s and Don ts is included in the meeting handout. Kathy demonstrated the Nursing Communication Order with forcing the Order Detail form open so that the information could be entered at the time of order rather than reopening later. New naming conventions for sequentials? Intermittent Pneumatic Compression Devices? Jen noted that CCH is trialing multiple devices so a generic name would be helpful. Anne noted that the name is long. Sandy SIC members approved. SIC members approved need to coordinate with Athena for DVT workflows. Also need to confirm terminology with Debbie Drescher. Selene NI/Athena 6
recommended Compression Therapy. Athena noted that the terminology must be an approved documentation term for appropriate coding of the chart. Sequential and Foot pump refusals by patient. SIC members approved Request to add Patient declined other DVT measures NSY FS- add fields for Newborn Summary when SIC members approved Admission Assessment is done in NICU Addition of planned readmission checkbox to SIC members approved CM discharge forms to distinguish between planned and unplanned readmissions Peds - move pain scales from Peds Shift to VS SIC members approved and trigger scale by age. Item on the discharge chapter of the Patient Education form for ACC SIC members approved Add the reviewed medical equipment option to the Discharge Documentation list NSY- new field with choice of breast, bottle, SIC members approved Athena breast or bottle. will have to review implications for Mary requested that the breastfeeding Work Flow documentation flow to the I and O form but Pat stated that is not possible. Workflow to pull in pending labs into the DC plan under Test results not available prior to SIC members approved. Pat will add discharge. This may be able to be pulled into the to report writer list and follow up report rather than using Work Flow. with Work Flow if necessary. Add date pressure sore was measured. Lindsay Conceptually the SIC Members noted that pressure sores need to be measured agreed but needs review with Donna every 3 days. Kathy questioned whether the date H and Shelly Haas perhaps work of documentation could be used. flow is needed rather than an NI 7
additional field. Revision Requests Anne completed respiratory findings and added Acid completed (NI team) Reflux to Gastroenterology chapter of Shift Scheduled Completed Assessments List (Kathy) Performance Issues Order Filters- which are used? Which are missing things? Desired new filters? Assessment. Kathy presented a Scheduled/Incomplete Assessments list presented on the List Serve. Kathy demonstrated the time line. Users can change the view to the time line. There have been multiple issues with performance. This is even more pronounced in the ED. It takes 5 to 9 seconds to sign orders. Mike Ward will be taking this on as a project. There is a disparity between what is displaying on the screen CVD timeout changed from 3 hours to 90 minutes. Some staff have not noticed any changes and others think may be improved. MAK timeout is 1 hour. OR noted that they would have to re-log in and find the patient and then hope that they could find the patient bracelet to rescan. Kathy reviewed the Order Filters used by nursing. The plan is to eliminate duplicative or not used order filters. There will also be a standard length of time (possibly 7 days) for orders to display as only 500 orders can be displayed at one time. Group indicated use of filter for Active Entered Orders, Orders by Date and Time and Active and Inactive Orders. Some duplication exists with the active and inactive orders filters. NI team uses Past 3 Days, others use RN group, past 7 days, inactive filters. Discharge Instructions some staff cannot see this order set. Kathy demonstrated how to change the Order Filters that they see. Some users like the Informational. Council members unsure if this would be beneficial to them. Kathy recommended that Help Desk tickets/sos need to be entered for performance/equipment issues. Further review, followed by larger CPOE/interoperability team. NI 8
Meds/IV s filters. Active Entered Order Filters default for nursing Orders by Date and Time- default for UCs Registered Nurse Group used to find Dietary Category and Nursing Orders (Informational and Patient Care Orders) has Inactive Orders NICU Active Orders used by NICU for reportnow duplicative? Critical Care Module Soarian Critical Care Project Team did a site visit to SIC council to review changes to Lankenau last week to see the module in use. assessments as Critical Care team The project will be kicking off soon. There is no progresses. definite time frame identified but plan to move the project along to standardize documentation. Kathy/Pat/Sandy OK for Case Mgmt to complete their CM consult orders when done. OK for Case Mgmt to mark the actual discharge order in progress. Shift Assessments Flow Sheet Will need wide screen monitors. SIS in Spring and then Plan of Care Deferred to next meeting. Deferred to next meeting. Unit Rounding Deferred to next meeting. Kathy Next Meeting Tuesday, October 15 from 0700-1100 in 606 Training Room A Kathy/Lindsay 9