Paragon Clinician Hub for Physicians (PCH) Reference Logging in to the Clinician Hub Paragon Clinician Hub (PCH) is available on any Carroll Hospital Network. VMWare View must be utilized to open the application. Double Click on the VM View icon on your desktop Note: Please make sure the Domain is hospital.com and the Environment is LIVE. Now enter your USERNAME and PASSWORD LIVE 1 P a g e
Searching and Adding Patients to Your Census 1. If you have no desire to see anything other than patients you are the attending, admitting, consulting or primary care provider for, leave your filters alone. You will see all of those patients inpatients and outpatients. 2. However, if you wish to always see yours and your group s patients, and only see patients that you are rounding on, you must set up and save a filter. First, click on Groups row in left hand filter column. The groups you are part of will appear. 2 P a g e
3. Check the individual group boxes, or the All box and X out. 4. Next, click on Patient Type in the left hand column and choose the patient types you would like to see on your list. All clinicians should choose Inpatient and Observation. Others may want to add Emergency Room, Psychiatric, L&D Outpatient, Partial Hospitalization, or Series Wound Care, Triage, or whichever patients you commonly round on. 3 P a g e
5. To remove Pre-Registration and/or Recently Discharged patients from your census, click on Status then uncheck Pre-Registration and/or Recently Discharged. Then, click on the x to the right of the field. 6. After your patients display, click the Save (Filter) Button. Type in the blank field, My Group s patients (or whatever you prefer) and click the save button to the right of the field. 7. Click the Set as Default link. You are finished setting up your filters! 4 P a g e
You now have your Census! You can view your work list or select an individual patient. t Performing A Patient Search 1. The Patient Search field provides the ability to search for patients by name, medical record number (MRN), or Visit ID. 2. To see all patients and patients that have been discharged, click Options, then uncheck Include Active Only As you start typing in the Name, MRN, or Visit ID, options will start to populate. Note: A minimum of three characters must be entered for the name before the system begins a search. The patient search results list 15 patients that have the last names containing the characters entered. Last name matches are displayed first, followed by first name, and then middle name. 5 P a g e
3. Click on the desired patient. Patient List Information A CodeStatus, if applicable. For example, DO NOT RESUSCITATE. (Placing the mouse pointer over this field displays the entire code status description.) An Isolation indicator, if ordered. Number of Alerts in the Workqueue for the patient Number of Tasks in the Workqueue for the patient Pregnancy indicator (if yes) Patient name(last, First, MI) Note: If the Secure check box was selected for the patient on the Visit Maintenance window in Registration, the text SECURED displays in red text to the MRN. DOB, Current Age, Gender Medical Record Number The text "Aliases" displays followed by the number of aliases for the patient Location(Nursing Station/ Room/ Bed or Outpatient location) DECEASED displays in red if the patient has been marked as deceased/expired in Registration. The text "Patient Alerts" followed by the number of active patient alerts. Hover to view. Admit date and time followed by the length of stay in parentheses Hover to view. 6 P a g e
Attending physician Race Primary Care Physician(PCP) name(if entered) Admitting diagnosis and any additional diagnoses Registering Facility Visit Status Patient Type Service Length of Stay(in days) Discharge date(if applicable) Clicking the More Hyperlink opens the list in expand view. Reports Here you can choose an action: 7 P a g e
Rounding Report: This report is sorted by facility, nursing station, and room-bed. Patient/visit information includes the patient s age, sex, admit date, attending physician, primary care physician, and admitting complaint if entered at the time of registration. The report also includes a calculated length of stay. Face Sheet Report: The face sheet generated from Clinician Hub is a pre-defined report that includes the following types of data: Patient Information, Emergency Contact, Visit Detail, Caregivers, Guarantor Information (primary), and Payor Information (for each pay or in order of primary, secondary, tertiary, etc.). **Note: The patient must be highlighted before clicking the dropdown Select An Action Selecting a Patient Click on the Patients blue name. It will open the patient to the Overview screen. Unlocking an Application: (Replacing the Black Lock in WSP) 1.) Have the patient in Focus 2.) Click the down arrow for your username and select Super User option. 3.) The Super Authority window opens and you can unlock the application 8 P a g e
Patient Overview The Overview window includes the following information about a patient: Vital sign data Intake and output data Active and recently ended inpatient medications and IV therapies Laboratory, Radiology and Ancillary results Active and recently ended orders You can change the time frame while viewing from the Overview window. Click the Overview Time Interval field Select value; 4,8,12,24,48,or72hours 9 P a g e
Documentation With the patient in focus, click on the DOCUMENTATION tab. 10 P a g e
Viewing Medical Records Have patient in focus and click dropdown Select Medical Records MPF will launch One Content now displays. If you wish to display a document or report on the right, click on it in the left-hand column (document tree). 11 P a g e
**To exit out of Medical Records, Click on another tab. Do Not click CLOSE on the top right if you want to stay on that patient** ***If you want the document to take up your whole screen, click on the little up arrow to collapse the side column*** Patient Sidebar The patient sidebar provides access to the Patient Work queue and the Patient Profile data for the patient in focus. 12 P a g e
Allergies: To view allergies click on the Patient Workqueue and select Allergies. Existing active allergies display in a collapsed view below the Manage button. The system also displays whether the data is Unverified or Verified. Clicking the Manage button will bring up the Manage Allergies window Clicking the button will allow you to edit the Allergies. If a yellow triangle will appear if the Allergy is non-coded. 13 P a g e
To Add an Allergy Click the Add button The New Allergy window will open Type in the first few characters of the allergy in the Allergy field. The allergies matching the characters entered display in the drop-down list. If you want to enter any notes regarding the allergy, type them in the Notes field. Up to 150 characters can be entered Inactivating an Allergy In the Allergy window click the pencil icon next to the Allergy you want to inactivate. Scroll to the bottom of the window and select Inactive in the Status field. The Reason for Inactivating window opens. 14 P a g e
Type in the reason and click the Accept button. Patient Demographics To view the patients demographics, select Demographics in the drop down. 15 P a g e
Family History Select family history in the dropdown. You can view more information by expanding on one of the names or hovering over the name. Click the Manage button to open the Manage Family History window. To add family history click the Add button. Immunizations Select Immunizations in the dropdown. Existing active immunizations display below the Manage button Click the Manage button to open the Manage Immunizations window. Medications and IVs Select Medication and IVs in the drop down. All medication and IV orders are displayed for the patient. The data is view only. The orders are grouped as follows: Stat, Routine, PRN, and IV Solutions 16 P a g e
Non-Hospital Medication Non-hospital medications include pre-arrival medications and home medications Select Non-Hospital Medications in the dropdown list. The Home icon displays next to Home Medications. The text "(Pre-Arrival)" displays in green next to pre-arrival medications. To see additional information about the medications, click the Expand down arrow. To manage home meds, change the All Meds dropdown to Home Meds then Manage. 17 P a g e
Click the pencil to edit or the ADD button to add a medication. Clicking the ADD button will bring up the Medication Search window. 18 P a g e
Viewing Non-Med Orders Select Non-Med Orders in the dropdown The orders are grouped as follows: Active (including Future orders), On Hold, and Recently Ended. You can change the Time Interval by clicking on the drop down and selecting 4 Hours, 8, Hours, 12 Hours, 24 Hours, and 72 Hours Viewing and Editing Problems and Procedures Select Problems and Procedures in the dropdown. The default is ALL but you can change it to Active, Inactive, Chronic, Intermittent, or Rule Out in the dropdown Click the Manage button to open the Manage Problems window 19 P a g e
Note: By default, the Current List displays all entries regardless of their status. The Full List displays Active entries. The Note icon displays if there are notes entered related to the problem. To add a problem click the ADD button. The Problem Search window will open. In the Search String field, type three or more characters for the problem. As you type, a drop-down list appears matching the characters entered 20 P a g e
Once you select the desired entry, the New Problem window opens To edit a problem, click on the pencil next to the problem and the Edit Problem window opens. Select the desired status (Active, Inactive, Chronic, Intermittent, Recurrent, Rule Out, Ruled Out, Resolved, Completed, or Entered in Error) in the Status drop-down list. Flowsheets You can access the flow sheets two ways: 1. Click on the patient s name so they are in focus. On the overview tab you can click on the in the top right corner of a pane to open the corresponding flowsheet. 2. Have the patient in focus and click on the flowsheet tab at the top 21 P a g e
You can choose to view one or multiple visits at once. Note: Icons to remember when viewing Flowsheets Icons Description Significant icon - Indicates a value that is considered significant for the patient. Abnormal icon - Indicates a value that is considered out of range based on normal ranges Multiple Folder (multi-views) icon - Indicates the presence of multiple entries for the time interval. Progress Note icon - Indicates the presence of a progress note. Clicking on this icon opens the Progress Note pop-up window displaying the note. Note icon - Indicates the presence of a note. 22 P a g e
Intake and Output Flowsheet: Information entered in Clinical CareStation is display in this flowsheet. Medication Administration Record Flowsheet: The standard MAR flowsheet groups medications as follows: Routine, including all active medications on the patient's Pharmacy profile with the exception of PRN medications: Unscheduled medications Scheduled medications Intravenous (IV)medications IV piggy back (IVPB) medications Chemotherapy medications Respiratory medications PRN, including all medications with a PRN frequency Icon Description Multiple folder icon - Indicates the presence of multiple entries for the time frame. Medication not given Medication is on hold Medication had a scheduled dose Medication is currently overdue 23 P a g e
Nursing Documentation Flowsheet: The following will display on the Nursing Documentation Flowsheet: Vital Signs (including pain scores entered as vital signs) Ventilator/Bed data Measurements Assessments (including pain scores entered as part of an assessment) Progress Notes 24 P a g e
Results Flowsheet The Results Flowsheet includes lab, microbiology, diagnostic imaging (radiology), cardiology, and other. You can view multiple visits at once by clicking the Select Visit drop down and select your visits. More Flowsheets: You can customize what flowsheets appear Click on More Flowsheets and then Manage Flowsheets 25 P a g e
Once you find the flowsheet on the left, click and drag it to the right. You can have them in any order. Click CONFIRM when you are finished selecting your Flowsheet. **The Flowsheet with the lock icon cannot be removed. You can only change the order. CPOE (Computerized Provider Order Entry Have your patient in focus and select the Ordering tab You will be able to search for orders by using either Order Sets or individual orders. Click on the Search button. For this example, I wanted to search the order sets for Potassium Aliquots. All order sets are preceded by an asterisk (*). 26 P a g e
In this example, I will select Potassium Chloride IV Aliquots Order Set. Once you have entered the order, select your desired dose. Your order will appear on the right hand screen. Then Click Submit. Lab Ordering To order a lab, click on Search. In the search field enter the desired lab. Once you have found your lab, click on it. 27 P a g e
Complete the areas with a red asterisk (*) When all required fields are completed, click on Submit. To save all of your orders, click on Save. Please LIMIT saving orders and order sets. It is ALWAYS preferable to submit your orders at the time of entry to reduce the likely hood of forgetting to sign the orders. Submitting orders is equal to signing orders. Radiology Orders: Enter your Radiology order into the search field. With Radiology ordering, you will have an additional required field which is the reason for performing the test. Medication Orders: Medication will be entered in the same fashion. You will have opportunity for practice during your computer training 28 P a g e
Order Sign-Off: You can sign off orders two ways: 1. Once the patient is in focus, you select the Bulk Order Sign option in the MORE drop-down. 2. In My Workqueue you can click on BULK SIGN OFF Once selected, the patient s orders window will appear. Select the orders you would like to sign off then click the Sign-Off button. 29 P a g e
Work queue In clinician Hub there are two work queues: My Workqueue and Patient Workqueue. Patient Workqueue shows to the left of the screen when the patient is in focus. My Workqueue shows to the right of the screen and includes tasks for all your patients. It can be viewed at any time. Icon Description CriticalAlert Selected and Not selected Abnormal Result Regular Alert - Not selected Regular Alert - Selected Task- Not selected Task- Selected 30 P a g e
My Workqueue: You can filter your workqueue by clicking on the View or Sort By dropdown. Note: Critical Alerts display at the top of the list and are highlighted in red. The ordering physician and all members of the care team for the patient receive Abnormal and Critical Result alerts. The system removes an Abnormal or Critical alert from the Patient Workqueue and My Workqueue for all who received it and replaces it with a New Result alert if the results are corrected to be normal. In addition, if New Result alert is later corrected to Abnormal or Critical, the Patient Workqueue and My Workqueue are updated accordingly. Tasks that can be found in your Workqueue are the following: Complete Document Co-Sign in CPOE Co-Sign PhysDoc Medication Reconciliation Medication Order Renewal Sign Off for Orders Sign-Off Reject (Wrong Physician) Unsubmitted Order Click on any item in your workqueue to view. 31 P a g e
Click on the drop down to select an action Select VIEW RESULT REPORT or PUT PATIENT IN FOCUS ONLY CHOOSE ACCESS CPOE, ACCESS FLOWSHEET, and ACKNOWLEDGE if you are planning to take action. It will remove that task from yours and your group s workqueue. Medication Reconciliation To begin, click on the green Admission Medication Reconciliation START tab Home meds vs Inpatient meds will display to prevent duplication 32 P a g e
You will be required to Continue, Defer, Hold, Modify, or Discontinue medications. Be mindful that the Green home icon identifies the home medication. With Paragon, click on the Add order button to automatically order the reconciled medications. You must do this prior to clicking on the complete button. You may experience messages such as seen below. It is important to almost ALWAYS replace a home med with a formulary item. Only in rare cases are patients allowed to take their own home meds. 33 P a g e
You will know the Med Rec is complete by the checkered flag. This is McKesson s nod to NASCAR since Paragon is based out of Charlotte, NC. 34 P a g e
Deferring a Home Medication on Admission Med Rec On Admission Med Rec, chose to Defer this Home Med - Nexium. Shows us like any other Home Med would on both the Transfer Med Recs and D/C Med Recs. No indication it was deferred unless you go back to the Admission Med Rec Report and open it. 35 P a g e
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