from 7 to 9 and Mira Room 9 to 11

Minutes Purpose Attendees Meeting Time Meeting Location The Chester County Hospital Staff Informatics Council April 17, 2012 To discuss Informatics related issues: new functionality, revisions and patient safety at TCCH; design electronic documentation forms; to facilitate the adoption of technology amongst nurses and other clinicians. See Attendance Record 0700 1100 606 from 7 to 9 and Mira Room 9 to 11 Review of Minutes, Feedback from group, General Announcements/Updates (Kathy): Kathy attended the ANIA conference in Orlando and what was evident was how far along CCH is in comparison with other hospitals. We sometimes don t identify our own successes. Introduced and welcomed new SIC member Mary Kretschmar from Maternity Discussed Documentation Presentation from last meeting o CCH charts by exception. Kathy and Bev noted that Clinical Notes should be entered for exceptions and for significant normal. Lindsay made a motion to approve the minutes and they were approved. Soarian Revision Requests: o SCDs Build into the Shift Assessment under Cardiovascular? Carry forward? It is currently on the ADL Flowsheet Agreed to add to the Shift Assessment This is a core measure and must be documented o Clinical Note for the CV nurse post discharge phone calls is being reviewed. o Specialty Beds documented on Admission Assessment if this is selected it goes to a report used by Bernie Mascherino and the patient may not be on a specialty bed. Kathy is recommending moving this to the Shift Assessment. SIC in agreement. o Wound Vac on the Admission Assessment was also discussed. Patients do come to the floor with Wound Vacs when admitted from the OR. The ER does not remove the Wound Vac unless part of the reason for the patient s ED visit. Nursing Journal Club Kathy encouraged SIC members participate. MAK Timeout feedback changed to 1 hour. SIC members state there are many complaints. Sandy will check with IT to see if the number of calls to unlock MAK users is down and will bring to next month s SIC meeting. Confirmed SIC members know how to print a Demand MAR. Performance issues What is being done reviewed issues list provided in the handouts. o ED Tracking Board if left open when user leaves for the day there is a memory leak on Internet Explorer 7 o Sessions remain on the server for 3.5 hours if Menu Exit Log Off is not used when the staff leaves for the day. o Staff asked to let Kathy know of specific performance issues, e.g. lag each time dropdown selected in Soarian. Latest CPOE stats o Percent of CPOE orders has increased from 64% to 80% in the last year. 1 of 5

o The number of verbal and telephone orders has not changed. o Pharmacy Intervention Form will decrease the number of Siemens Pharmacy orders. Isolation Work flow changes o ITN s will no longer be notified on a patient transfer if the patient has a positive MRSA/VRE result. o Outpatients in a bed are now included in the Isolation in Workflow o VRE processes the same as MRSA. o All outpatients will get alerts if they have they have a history of MRSA/VRE o All outpatients with a history of MRSA/VRE will have their Isolation Code automatically set to CONTACT in Soarian. o The higher level of isolation should display in Soarian if patient meets multiple Isolation criteria. o ITN s will be notified of all negative MRS/VRE changes. o SIC members did not feel an e mail to the nursing staff was warranted. Soarian Financials has been delayed. The new date has not been decided, potentially fall or winter 2012. They are working on revenue cycle issues. Testing and development of documentation and processes will continue Order Completion and Discontinuation removal of roadblocks. o 2 West went live with using the Clinical Summary for shift report o Identified 2 issues with orders which were corrected Changed the security level of the ADT orders so that nurses can discontinue Increased the time to discontinue or complete orders to 14 days to prevent date has expired message. Cannot discontinue Micro orders until the final results are complete. Working on issue with completing orders where there was an add on to the lab order. This happens frequently in the ED. Kathy confirmed that the nurses can complete Chart Check Orders to remove from the active order list. Identified that there are multiple Isolation Kit Orders. Gave example MR numbers to Athena to bring back to Jules for review. 0ED Bridging Orders Report (Marie) and feedback (Pat and Patience) Marie reviewed statistics from the implementation of Bridging Orders. o 54 patients o 10 charts reviewed in detail o Most non bridging orders were troponins and CPK s even though they are part of the Bridging Order Set. o Pat Bria thought the time in the sample statistics is low. Pat thought nurses may be signing orders multiple times to make sure they do not lose anything. Roll out to other areas? Pat recommends rolling out to the rest of the hospital. Lindsay has used the order set but did not use the Bridging Order Set protocol to direct the physician in the order of taking the orders. Kathy will communicate to the nursing staff. Donna informed the SCU staff at their staff meeting. Pat Bria noted that the ED nurses are having an issue with the NPO orders as it defaults to 10 am and they are trying to change it to start at 6 am. Marie will follow up. 2 of 5

New AMR functionality in SP10, nurses are able to enter verbal orders. Testing is ongoing but this would assist the nurses in taking Admission Orders. Soarian Discharge Report for Patients (Kathy and Pat) Med Rec, Discharge Chapter, Case Management and CPOE Discharge Orders all feed into the Patient Discharge Plan Report and the Facility Report. Reports are still being revised. Sample reports have additional data for data validation. Reports use a larger font for patient readability. Medication List includes the last dose given Extended directions on Medication List are not displaying properly should be for your blood pressure type simple instructions Reviewed Discharge Instruction Chapter in Soarian Clinicals Test and sample report in meeting handout. Kathy reviewed order set for physician to order patient s follow up appointments. Reviewed Facility Discharge Instructions Report includes General Patient Information, Patient Condition at Discharge and Vital Signs and Results Within 24 Hours of Discharge SIC Members expressed concern that the physicians will not complete the information needed to have a complete form. Donna asked about the implementation of electronic documentation in other areas like OR, ICU and ED as priorities rather than adding new initiatives to the current users. Kathy stated that these are priorities but not under the scope of the SIC council. The OR, ICU and ED all require additional software be budgeted. It is hopeful that at least Critical Care and ED be approved for the next fiscal year. There are always users (physicians and nurses) that are more proficient than others. There is also electronic documentation that is not done frequently and may be difficult for users to remember. Kathy reiterated that the SIC is doing a good job of moving the organization forward. May 1 Anesthesia is going live on CPOE in L&D. MAK pop ups and alerts review (Sandy) Review of vial medications needing fractional dose alerts SIC agreed to keep partial dose alerts. Sandy will review with Joe in Pharmacy. Review of other current alerts and popups o Donna requested Duragesic patch reminder also be removed. It would be more useful to have a PCA alert to remove the Duragesic patch if present. Sandy will research the Duragesic alerts as they were not on the list that was reviewed. o Discussed Lovenox Alert for Epidural contraindication. Requested this be a pharmacy check but the medication checks come from First Data Bank. Bev noted that the alerts often come from the Safety Medication Committee following an adverse event. Sandy will check the clinical checking of these 2 medication orders. o Peak/Trough SIC recommended not entering the Peak and Trough values because something would have to be entered for each drug administered. SIC recommended 3 of 5

the alert remain because of random orders and for nurses that are pulled to different units. o Kathy asked if nurses are using MAK reminders. Some are and some are entering them as an Instructions to the Nurse order. The reminder might be more helpful where the exact dose can be identified. Nitropaste Feedback from Med Safety analogous to a patch alert. While P&T recommended the alert, the SIC members noted that they cannot see the previous location so documenting the location will not assist in removal. Recommended having the patch alerts entered as a separate order that can be completed rather than a popup. SIC members would like the alerts for patch medications to be separate orders like the Nitropaste if that ability is confirmed with Pharmacy. Sandy will follow up. Phenergan Go Litely also asks for a dose Sandy will follow up with Pharmacy. Point of Care Documentation How can we promote and support? (Kathy) Point of Care Documentation is the goal of this council for this year. We have been looking at what the impediments are, first of which is the slowness of the devices. IT is working on this. While working on this, the SIC needs to plan strategies for implementation. Kathy reviewed the concept of Polarities relating to change and Point of Care Polarities look at the pros and cons, the assets as well as the impediments. We have to look at the advantages of the non point of care as well as the upside of point of care documentations. The SIC needs to start planning while the IT issues are being worked on For example, promoting to the nursing staff and looking at issues like the guilt nurses feel if they are sitting down so sitting down and documenting relieves the guilt and gives the nurse a rest. Portable devices were suggested. Kathy reviewed the use of the IPAD to access Soarian. It is only available while in the hospital. Privacy in the room, multiple users vying for the one in room device was identified as an issue. The SIC will break out into groups next session to come up with action plans. Staff Informatics Council Poster for Nurse s Week (Ann) reviewed the draft of the poster. SIC members reviewed the poster, confirmed their membership and gave Ann feedback at the end of the meeting. Downtime Document List (Marie Kania) Marie passed out list of documents in the Downtime Box. Marie requested each unit review the documents for their unit and give Marie any additional forms that need to be added to the box for their unit. 4 of 5

Next Meeting: Tuesday, May 15 from 0700 1100 in 606 Training Room A Please no parking in 606/602 area! Respectfully Submitted, Mary Louise DeMarco MSN, RN BC 5 of 5