array_files=new Array(); array_files[0]=new Array(0,1,"./new_response.html","2008-10-27","38K","POE - User Response ","",""," POE - User Response Your feedback has been forwarded to the POE staff. Please allow 1-2 business days for a response. October 27, 2008 "); array_files[1]=new Array(0,1,"./index-U_I.html","2008-10-27","39K","POE - User Info ","",""," POE - User Info User Information The USER INFO menu option provides access to supplemental information that addresses questions in each of the following categories: Common Miscues—descriptions of and recommended solutions for mistakes generally committed by users new to POE; Emergency Access—instructions for Attending Physicians, who have not undergone POE training, and need temporary POE access for the purpose of placing DNR and Chemotherapy orders; Meet the POE Team—mini-biographies, photographs, and email addresses for each of the POE Team members; Questions (FAQs)—questions repeatedly asked by users, often referred to as frequently asked questions; and Useful Websites—listings (links) to other Internet/Intranet sites that may be of interest to POE users. October 27, 2008 "); array_files[2]=new Array(0,1,"./index-U_F.html","2008-10-27","41K","POE - Updates (Roll-Outs) ","",""," POE - Updates (Roll-Outs) Updates & Roll-Outs Within POE, the term updates refers to changes made to the underlying POE program code that either address system operational problems or introduce new features that expand POE functionality. The term roll-out refers to the initial configuration/installation of POE within one or more JHH units. The UPDATES & ROLL-OUTS menu option provides access to: summaries of all changes to the POE system since its initial roll-out on June 1, 2004, and concise notices that mark POE roll-outs to specific JHH units. Summaries and notices available via the drop-down menu are grouped into two categories. Most Recent Updates & Roll-Outs Links to the most recent POE updates and roll-outs appear in the uppermost region of the drop-down menu—just above the Past Updates & Roll-Outs option. The date that a specific change was made to the POE configuration is noted to the immediate right of its displayed title. Individual descriptions will remain in this region until the installation of a newer change necessitates their relocation to the Past Updates & Roll-Outs listing. Links to the most recent updates are also available within the Whats New About POE? section of this websites home page. Past Updates & Roll-Outs Descriptions of POE configuration changes installed prior to that identified within the Most Recent Updates & Roll-Outs region will be maintained here. Descriptive titles of past changes appear in alphabetical order. The date that each update was placed into service is noted to the immediate right of its title. October 27, 2008 "); array_files[3]=new Array(0,1,"./index-Trng.html","2008-10-27","39K","POE - Training ","",""," POE - Training Training POE training is conducted by the staff of the CISEducation Center. You may obtain more information, ask questions, or make comments relating to the training center by contacting: John Frankenfield Training Supervisor 410-502-5980 (telephone) jfranke9@jhmi.edu You may also gain training information by visiting the CIS Education Center Website. October 27, 2008 "); array_files[4]=new Array(0,1,"./index-QD.html","2008-10-27","39K","POE - Quick Demos ","",""," POE - Quick Demos What are Quick Demos Quick Demos are condensed online presentations intended to familiarize the viewer with specific POE features/functionality. These demos, which may be viewed via the workstations Internet browser, generally focus on a single topic and require minimal time to view. Please note that pressing the F11 function key, as the demo begins, will place your browser in full-screen display mode allowing you to see the entire visual region required by your selection. Once you have finished, click on the Close icon at the right end of that toolbar associated with the window that displayed the demo. October 27, 2008 "); array_files[5]=new Array(0,1,"./index-Pubs.html","2008-10-27","40K","POE - Publications ","",""," POE - Publications Documents This menu option provides access to publications associated with each of the categories described below. Bulletins summarize changes made to POE functionality and/or the user interface. Downtime Data (Generic) provides information that will allow clinical users to continue to function in their assigned roles during periods of POE non-availability. Fact (Info) Sheets / Quick Guides / Survival Tips provide condensed instructions for the performance of specific clinical tasks supported by POE. User Guides & Manuals provide in-depth coverage of overall POE functionality. Viewing & Printing All of the linked publications are provided in a PDF format, which allows them to either be viewed on-line or printed. To access a specific publication, you need only to select the appropriate publications category from the Publications menu and then click on the document of specific interest within the subsequent display. The selected document will be displayed in a separate window. October 27, 2008 "); array_files[6]=new Array(0,1,"./index-Cont_Us_Form.html","2008-10-27","41K","POE - Contact Us Form ","",""," POE - Contact Us Form Should you have any questions or comments about POE or its use, please complete the following form to request assistance from the POE staff. Complete each of the required data elements that follow and then click the Send button to submit your inquiry. Please allow 1-2 business days for a response. If you need immediate assistance with a POE problem, call 5-HELP (5-4357) Name: Email Address: Department: Topic: Feedback: October 27, 2008 "); array_files[7]=new Array(0,1,"./index-Cont_Us.html","2008-10-27","42K","POE - Contact Us ","",""," POE - Contact Us Contact Us There are many reasons for contacting members of the POE staff. Review the following options to determine the one most appropriate for your particular situation. Immediate (Telephonic) Assistance Use this option when you are having problems interacting with POE. This option is intended to provide immediate assistance to JHH staff members having problems using POE in the performance of their assigned duties. It should NOT be used for routine issues that would be appropriately accommodated through the use of the email form. Call 5-HELP (5-4357) Training Issues If you wish to schedule a class or pose a question about POE training, you should contact the CIS Education Center at the number provided below. You may also select the Training tab (in the menu bar) for additional information. Call 410-614-0958 Email Form Use this option to either ask a general question or make a suggestion about the design/implementation of POE. October 27, 2008 "); array_files[8]=new Array(0,1,"./index.html","2008-10-27","45K","POE - Home ","",""," POE - Home What Is Provider Order Entry (POE)? The Johns Hopkins Hospital (JHH) computerized Provider Order Entry System (POE) is a tool that facilitates automated order entry, and the display and retrieval of information reflective of patient orders. – Heparin Usage Guidelines – Click the Heparin Notice button to view the Johns Hopkins Hospital P&T Committees Guidelines for the use of this medication. POE Access There are two requirements for an otherwise authorized JHH staff member to gain access to POE: completion of a clinically-appropriate training session available through the CIS Education Center Website; and possession of a valid JHED ID. The POE Team Click the button provided below to view photos and mini-biographies of the POE team members. October 27, 2008 "); array_files[9]=new Array(0,4,"./Publications/QRG_Discharge_WkSht_Psychiatry_Supplement.pdf","2008-10-27","1470K"," Discharge Worksheet Psychiatry Supplement ","","","AXIAL DIAGNOSES The new Psychiatric Discharge Worksheet has an Axis section where Psychiatry will enter their medical diagnoses under Axis III, not the Health Issues section of the discharge worksheet: HOME MEDICATIONS INSTRUCTIONS The Home Medications Instructions section is a new addition to the Psychiatric Discharge Worksheet and it can be found within the Browse sidebar located on the left part of the display. Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide describes those aspects of the current POE Discharge Worksheet that apply to the members of the JHH Psychiatry Clinical Staff. Refer to the Quick Reference Guide titled Discharge Worksheet Basics for descriptions of basic worksheet functionality ­ accessing, completing, and finalizing, etc. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe SENSITIVE DIAGNOSES Contains diagnostic information that is limited to viewing only by members of the JHH Psychiatric Staff. DISCHARGE/REFERRAL The section of the worksheet previously titled Follow-Up Appointments is now labeled Discharge/Referral To. Psychiatry Supplement. Version 4.5 XA 23 October 2008 ©2008 Information Technology @ Johns Hopkins. All Rights Reserved. Quick Reference Guide POE Quick Reference Guide­Discharge Worksheet ­ Psychiatry Supplement This is the initial release of the Discharge Worksheet ­ No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. ACTVITY AND TREATMENT The Activity and Treatment section of the worksheet is located under the Discharge Instructions heading within the navigation sidebar. CORE MEASURES A Core Measures section consists of information that function as quality care performance indicators. Information within this section will be collected and submitted to the Joint Commission. REVIEWING Clinicians may initiate a review from either within the editor or outside of the editor. The review document is a reasonable facsimile of the printed version of the discharge worksheet. Review worksheet ­ within editor 1. Click the button (bottom of the worksheet). PRINTING The following step-by-step instructions describe the method used to print the discharge worksheet. NOTE The following steps assume that the desired patient is already selected within POE. 1. Click on the Documents tab. 2. Click on (highlight) the discharge worksheet listing. 3. Click on the printer icon within the POE toolbar. 4. Click on (highlight) the JHH JHH Discharge Worksheet-Psychiatry entry within the Report Selection dialog listing. 2. Examine the content of the worksheet. 3. Click the button to return to the editor. Review worksheet ­ outside editor This process can only be performed after the worksheet has been finalized. 1. Click the Documents tab. 2. Select Report as the Display Format (within the sidebar along the left side of the display). MANAGEMENT ISSUES Management Issues may be accessed within the Browse sidebar located on the left side of the display. One sub-section within the Core Measures area is annotated with a red star. The red star indicates that you must check (select) one of the options displayed within the subsection. You will not be able to submit the discharge worksheet, even as incomplete, without making one of the selections. 3. Select (highlight) the discharge worksheet entry from within the resultant list (similar to the following example) 4. Click the button. 5. Click on the Print button to initiate printing of your discharge worksheet on a local printer. 5. Examine the content of the worksheet. 6. Click the button to return to the editor. "); array_files[10]=new Array(0,1,"./index-POE_Team.html","2008-10-27","54K","POE - Meet the POE Team (Photographs) ","",""," POE - Meet the POE Team (Photographs) The JHMCIS IT POE Team The JHMCIS IT staff members pictured below, perform workflow analysis, customer liaison, software development, and other user-focused support activities — appropriate to their indicated roles — that are required to sustain the POE Program and ensure its meaningful evolution. Ardolino, Peggy POE Program Director pardoli@jhmi.edu Hamburg, Marty Manager, Technical Development Team mhambur2@jhmi.edu Kimball, Patty Manager, Clinical Documentation pkimbal6@jhmi.edu Sherman, Deb Manager, Systems Development dsherma2@jhmi.edu Smith, James Manager, Implementation Team jsmithi@jhmi.edu Zeller, Pat Manager, Orderset Development Team pzeller@jhmi.edu Campbell, Ross Project Leader, Clinical Decision Support & Systems Development acampb27@jhmi.edu Green, Crystal Project Leader, Ordersets cgreen39@jhmi.edu Hunter, Perry Project Leader, Ancillaries Team phunter@jhmi.edu Joehar, Nuredin Project Leader, Technical Services njoehar1@jhmi.edu Kemp, Dawn Project Leader, Customer & Production Support dkemp4@jhmi.edu Knuth, Meg Project Leader, Medication Management mknuth1@jhmi.edu Lee, Dorothy Project Leader, Roll-Outs & Implementations dlee93@jhmi.edu Adeniyi, Nancy Programmer Analyst, Clinical Documentation nadeniy1@jhmi.edu Amos, Chuck Programmer Analyst, Clinical Documentation camos1@jhmi.edu Baldwin, Desiree Programmer Analyst, Medication Management dbaldwi7@jhmi.edu Brennan, Alison Programmer Analyst, Ordersets abrenna8@jhmi.edu Clark, Myra Programmer Analyst, Clinical Documentation mclark66@jhmi.edu Denton, Wendy Programmer Analyst, Implementation Team wdenton2@jhmi.edu Diaz, Cindy Programmer Analyst, Clinical Documentation cdiaz7@jhmi.edu Fariss, Jim Programmer Analyst, Ancillaries Team jfariss1@jhmi.edu Haggerty, David Programmer Analyst, Clinical Decision Support & Systems Development dhagger3@jhmi.edu Harkless, Damon Programmer Analyst, Technical Services dharkle3@jhmi.edu Jay, Madeline Programmer Analyst, Technical Services mjay1@jhmi.edu Jones, Bill Clinical Systems Development, Database Administrator wjones21@jhmi.edu Kent,Spartak Programmer Analyst, Technical Services skent4@jhmi.edu Kowalczyk, Jackie Programmer Analyst, Interfaces jkowalc@jhmi.edu Leandro, Jose Programmer Analyst, Clinical Documentation jleandr1@jhmi.edu Lovewell, Tim Programmer Analyst, Interfaces tlovewe1@jhmi.edu Mathew, Rekha Programmer Analyst, Ordersets rmathe10@jhmi.edu McCoy, Bonnie Programmer Analyst, Ordersets bmccoy@jhmi.edu McNeir, Mac Developer – Demos, Documents, & Websites wmcneir1@jhmi.edu Miranda, Rose Programmer Analyst, Medication Management rmirand3@jhmi.edu Pereira, Tony Programmer Analyst apereir2@jhmi.edu Sheranko, James Programmer Analyst jsheran1@jhmi.edu Sokolina, Margarita Programmer Analyst, Reports & MLMs msokoli1@jhmi.edu Stutzman, Carolyn Programmer Analyst, POE Support Pool cstutzm2@jhmi.edu Sutanto, Irma Programmer Analyst, Clinical Decision Support & Systems Development isutant1@jhmi.edu Turyna, Karin POE Educator, Training kturyna1@jhmi.edu Van Meter, Garrett Programmer Analyst, MLM Development gvanmet1@jhmi.edu Wagner, Joan Programmer Analyst, Pediatric Ordersets jwagne44@jhmi.edu Wagner, Kathy Programmer Analyst, Clinical Documentation kwagne15@jhmi.edu Weber, Diane Programmer Analyst, Ancillaries Team dweber7@jhmi.edu Welker, Cindee Programmer Analyst, Ancillaries Team cwelker1@jhmi.edu Wilt, Monica Programmer Analyst, POE Nursing Support mstrick5@jhmi.edu Winner, Paul Programmer Analyst, Medication Management pwinner1@jhmi.edu October 27, 2008 "); array_files[11]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_PICU_Rollout.html","2008-10-27","3K","Updates & Roll-Outs, June, 2008, PICU Roll-Out ","",""," Updates & Roll-Outs, June, 2008, PICU Roll-Out June, 2008 PICU Go-Live POE was implemented in the Pediatric Intensive Care Unit (PICU) on Sunday, June 1, 2008. Enhanced functionality provides critical care clinicians with the ability to continue their established standard of care. October 27, 2008 "); array_files[12]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_WICU_Rollout.html","2008-10-27","3K","Updates & Roll-Outs, WICU Roll-Out (February 2008) ","",""," Updates & Roll-Outs, WICU Roll-Out (February 2008) February, 2008 Weinberg Intensive Care Unit (WICU) Go-Live POE was implemented in the Weinberg Intensive Care Unit (WICU) on Monday, February 18, 2008. New (Suspend/Unsuspend) and enhanced functionality provides critical care clinicians with the ability to continue their established standard of care. October 27, 2008 "); array_files[13]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_SICU_IMC_Rollout.html","2008-10-27","3K","Updates & Roll-Outs, SICU/IMC Roll-Out (January 2008) ","",""," Updates & Roll-Outs, SICU/IMC Roll-Out (January 2008) March, 2008 Surgical Intensive Care Unit (SICU) / Intermediate Care Unit (IMC) Go-Live POE was implemented in the SICU/IMC units on Monday, March 3, 2008. Enhanced functionality provides critical care clinicians with the ability to continue their established standard of care. October 27, 2008 "); array_files[14]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_CSICU_CPCU_Rollout.html","2008-10-27","3K","Updates & Roll-Outs, January 6, 2008, NICU Roll-Out ","",""," Updates & Roll-Outs, January 6, 2008, NICU Roll-Out April, 2008 CSICU / CPCU Go-Live POE was implemented in the Cardiac Surgery Intensive Care Unit (CSICU) and the Cardiac Progressive Care Unit (CPCU) units on Sunday, April 13, 2008. Enhanced functionality provides critical care clinicians with the ability to continue their established standard of care. October 27, 2008 "); array_files[15]=new Array(0,1,"./WP_Updates_and_Fixes/Quarterly_Update_Mar_2008.html","2008-10-27","16K","Updates & Roll-Outs, Quarterly Update - March 2008 ","",""," Updates & Roll-Outs, Quarterly Update - March 2008 March 18, 2008 POE Quarterly Update – March 2008 Functionality associated with this POE Quarterly Update includes the following enhancements Order Forms & Order Sets 1. New Oxygen Order Form All non-mechanical ventilation oxygen administration routes have been combined on this form Nasal cannula is the only route that can be combined with other delivery modalities Does not include bi-pap or cpap 2. Revised Adult Tube Feed Form Only bolus feeds have changed Two options - modular v. non-modular If additives are needed use modular option 3. New EEG Form The form will display medications that will effect the EEG exam - Medications that were administered within the last 72 hours Medications that were ordered within the last 72 hours 4. New Declot Orderset Declot orderset for central lines 5. New Mechanical Ventilation Order Form (ADULTs ONLY) Redesign of order form Ventilation choice will now pre-check other necessary orders (e.g. Nursing Protocols, Chest X-Ray) eMAR Enhancements 1. Factor Products Bolus factor products will now populate the eMAR 2. Midazolam Warning Message Message on eMAR that states - NO MIDAZOLAM - for contraindicated medications Additional Tabs 1. Vital Signs tab A Vital Signs tab will be displayed on the unit census Any patient from an ICU will now have Eclipsys SCC data available under this tab This data is review only 2. Clinical Summary (PEDs ONLY) The Clinical Summary tab will be available to all nursing units October 27, 2008 "); array_files[16]=new Array(0,1,"./WP_Publications/Heparin_Notice.html","2008-10-27","4K","POE - Heparin Notice (April 4, 2008) ","",""," POE - Heparin Notice (April 4, 2008) April 4, 2008 Notice — Heparin Injections The POE Team was directed to immediately enable the following functionality given the critical need to minimize use of Heparin. A browse (pop-up message), which requires the user to click OK, will be displayed every time an order for Heparin Inj is placed in POE. The content of the displayed message is summarized below. Due to a nationwide shortage of heparin 5000 unit/mL injection the P&T Committee has approved the following guidelines for use of this product: Patients with acute renal failure Patients on dialysis (i.e., HD, PD, CVVHD) Patients with an epidural or intrathecal catheter in place or with 12 hours of insertion or removal Adult patients weighing less than 45kg Please contact the pharmacy for alternative therapy choices if your patient does not meet one of the above criteria. October 27, 2008 "); array_files[17]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Surgery_Phase_III.html","2008-10-27","3K","Updates & Roll-Outs, Dept of Surgery Roll-Out (Phase III - January 2007) ","",""," Updates & Roll-Outs, Dept of Surgery Roll-Out (Phase III - January 2007) May 15, 2007 Department of Surgery Roll-Out, Phase III The Provider Order Entry (POE) system was implemented within Nelson 8 (Department of Surgery) on Tuesday, May 15, 2007. October 27, 2008 "); array_files[18]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Surgery.html","2008-10-27","3K","Updates & Roll-Outs, Dept of Surgery Roll-Out (January 2007) ","",""," Updates & Roll-Outs, Dept of Surgery Roll-Out (January 2007) January 15, 2007 Department of Surgery Roll-out The Provider Order Entry (POE) system was implemented within the following Department of Surgery units on Monday, January 15, 2007-Weinberg 4A, 4C, and 4D. Services within these surgical units that are using POE include: Otolaryngology (OHNS); Surgical Oncology; General Surgery; Plastics; and Ear, Nose, and Throat (ENT). October 27, 2008 "); array_files[19]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Peds_Phase_I_Roll-Out.html","2008-10-27","7K","Updates & Roll-Outs, QI Pack 1 (Pediatrics Phase 1 - May 2006) ","",""," Updates & Roll-Outs, QI Pack 1 (Pediatrics Phase 1 - May 2006) February 18, 2007 Childrens Center (Pediatrics Phase I) Roll-Out Overview: A roll-out of the Provider Order Entry System, tailored to meet the needs of the JHH Childrens Center takes place on the morning of Sunday, February 18, 2007. To accommodate the special needs of the Childrens Center, POE now features a pediatric medications catalog (consisting of new orders and order sets). Affected units include CMC-4, CMC-9, and the Pediatric PACU. Changes to POE Operation: A summary of key operational issues, which may be of interest to the clinical staff, resulting from this roll-out is accessible via the button below. A summary of changes resulting from the preparatory downtime that took place on February 11, 2007 is accessible via the button below. October 27, 2008 "); array_files[20]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Peds_Phase_II_Roll-Out.html","2008-10-27","4K","Updates & Roll-Outs, QI Pack 1 (Pediatrics Phase II - May 2006) ","",""," Updates & Roll-Outs, QI Pack 1 (Pediatrics Phase II - May 2006) March 18, 2007 Childrens Center (Pediatrics Phase II) Roll-Out The second phase of the Provider Order Entry System (POE) integration into Pediatrics is scheduled to take place on the weekend of March 17-18, 2007. The units included within this roll-out are identified as: CMSC 3, Child Psychiatry CMSC 6, Infant/Toddler Med/Surg PCRU, Pediatric Clinical Research Unit Unit preparation will commence on Saturday, March 17th. Integration of existing (paper) patient orders into POE is scheduled to begin at approximately 9:00 AM on Sunday, March 18th. It is anticipated that actual clinical utilization of the POE System will begin at approximately 3:00 PM on Sunday, March 18th. October 27, 2008 "); array_files[21]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_NICU_Rollout.html","2008-10-27","3K","Updates & Roll-Outs, NICU Roll-Out (January 6, 2008) ","",""," Updates & Roll-Outs, NICU Roll-Out (January 6, 2008) January 2008 Neonatal Intensive Care Unit (NICU) Go-Live POE was implemented in the Neonatal Intensive Care Unit (NICU) on Sunday, January 6, 2008. New system functionality included Downtime Reporting, Clinical Summary Pediatric Nursing Kardex, Assigned RN and Assigned Provider columns. October 27, 2008 "); array_files[22]=new Array(0,1,"./WP_Updates_and_Fixes/Quarterly_Update_Dec_2007.html","2008-10-27","16K","Updates & Roll-Outs, Quarterly Update - December 2007 ","",""," Updates & Roll-Outs, Quarterly Update - December 2007 December 18, 2007 POE Quarterly Update – December 2007 Functionality associated with this POE Quarterly Update includes the following enhancements VTE Smart Orderset This orderset is included within admission ordersets for the following services: General Surgery Internal Medicine Orthopedic Trauma Actions on Alerts Ability to take action on an alert. Clicking on the View Actions button when the alert dialog box appears, provides the user with the ability to: Cancel This Order Modify This Order Keep This Order Dose History Dose history will be available on eMAR. Hovering over the administration cell will result in the display of the exact dose given. Additionally, users will be able to view medication history, which displays the doses administered. Pediatric Prescribers Only 1. NICU Census Changes - Supporting the NICU Go-Live, scheduled for January 6, 2008. NICUs census consists of four separate rooms; therefore, Prescribers will have to build the NICU census adding all four rooms in order to see NICU patients. 2. Pediatric Dose Cap Functionality Dose cap functionality applies to weight based items. When the dose exceeds limit, Eclipsys SCM POE will adjust the ordered dose to the Pharmacy approved amount. Please see the attached documents for additional details about the indicated topics. DEMOs Slide-Shows Fast Fact (Info) Sheets Quick Reference Guides October 27, 2008 "); array_files[23]=new Array(0,1,"./WP_Updates_and_Fixes/Downtime_(Pediatric_Roll-out_Prep).html","2008-10-27","11K","Updates & Roll-Outs, Prep for Childrens Center Roll-Out, February 2007 ","",""," Updates & Roll-Outs, Prep for Childrens Center Roll-Out, February 2007 February 11, 2007 Planned Outage — Prep for Childrens Center Roll-out The POE system requires an outage in order to support the POE implementation in the Childrens Center, which is scheduled for mid-February. The outage is planned to occur on Sunday, February 11th from 1:00 AM - 6:00 AM. However, the POE application will be available in a modified fashion during this special outage. Changes to POE Operation: A description of the operational changes that users of POE will encounter after system operation is restored may be accessed by clicking on the Fact Sheet button below. The PowerPoint button provides access to a slideshow containing additional information about clinical tasking during this downtime period. Outage Information: What Will Be Available: The eMAR - Please continue to use the eMAR to document the administration of existing medication orders. What Will NOT Be Available: Order Entry- Please use the yellow POE Downtime Order Sheets for all new orders. Timeline: 12:10 AM (approximate) Downtime MARs will begin to print on every nursing unit as an emergency backup. 1:00 AM (approximate) Clinicians will no longer be able to enter orders in POE. Please use the yellow POE Downtime Order Sheets to place orders. Remember, the eMAR will remain available to nursing for documenting medication administration. NOTE A broadcast message will appear on the system prior to each of the above times to remind you of the outage. 6:00 AM (approximate) Operation of POE order entry will be restored. Back Entry of Paper POE Orders: Physician and Nursing staff members of the POE Support Pool will be deployed to each of the POE units to assist in the recovery process. Only orders with recurring tasks need to be back-entered into POE! The POE Team will be onsite for the entire outage as well to ensure that the process goes as smoothly as possible. October 27, 2008 "); array_files[24]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Urology.html","2008-10-27","2K","Updates & Roll-Outs, Urology Roll-Out (July 2006) ","",""," Updates & Roll-Outs, Urology Roll-Out (July 2006) July 2006 Urology Roll-out POE is scheduled for implementation in Marburg 2 and Marburg 3 and the Weinberg PACU & OR units on July 31, 2006. October 27, 2008 "); array_files[25]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Transfusions_2006-07.html","2008-10-27","14K","Updates & Roll-Outs, Documenting Transfusions on the eMAR (July 2006) ","",""," Updates & Roll-Outs, Documenting Transfusions on the eMAR (July 2006) July 31, 2006 Documenting Transfusions on the eMAR This upgrade provides Nurses with the ability to document transfusions on the POE eMAR. The intent of this implementation is: to minimize the potential for overlooking transfusion orders, and to provide a standardized method for documenting the administration of blood products within POE. Which Blood Products? Currently, only the blood products listed below may be documented on the eMAR. ú Autologous RBCs ú Fresh Frozen Plasma ú Red Blood Cells ú Cryoprecipitate ú Platelets ú Rhogam When & How Should Documentation Be Performed? You should be aware of the following facts prior to documenting transfusions on the eMAR. When the blood product is hung, you document Mark as Done on the eMAR. Time actual will appear (vs. hourly time) as the default. You do not need to document the completion of the transfusion on the eMAR since that is reflected on the flowsheet. When multiple units are ordered, the schedule for administration of subsequent units will be calculated and displayed based upon information already contained within the order. Additional Information The following links provide access to supplemental information about this new capability. Quick Demo - a computer-based animation that demonstrates the process used to document transfusions on the POE eMAR. Quick Guide - illustrates the steps performed to successfully document transfusions on the POE eMAR. It also summarizes the more important information that Nurses should know about the process. Power Point Presentation - provides complete coverage of all aspects of this new capability. Fast Facts Sheet - provides a condensed (single-sheet) overview of this new capability. October 27, 2008 "); array_files[26]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_SCM_V45.html","2008-10-27","18K","Updates & Roll-Outs, Version 4.5 Upgrade (October 2005) ","",""," Updates & Roll-Outs, Version 4.5 Upgrade (October 2005) October 21, 2006 SCM Upgrade to Version 4.5 XA CHANGES TO FUNCTIONALITY Changes to POE functionality and visual components of the graphical user interface that resulted from the installation of this upgrade have been described below: Patient Header • No patient data is displayed when a user either initially enters POE or selects a new patient list. • The date of birth of the selected patient appears as a parenthetical suffix of the displayed age. Patient List • First patient in the list is no longer selected automatically. • Patient list usability has been improved through the use of alternating line colors. • All listed patients are selectable via a single button click. Order Entry Worksheet • The patient name now appears on the Submit Order(s) button. • New rules are now enforced for rounding of patient weight data. • Calculated values—trailing zeroes are no longer displayed. • New Available Message (Order Entry) icon. • Visual focus indicators now appear within the order form. • Automatic selection of a lone drop-down list option. • Default selection within the Retain Original Requested By Provider dialog has changed. eMAR Incorporation of the SCM 4.5 Upgrade introduces the capability to reschedule all order instances (active and pending). Order Summary • New display filter functionality • Improved Modified Order icon operation • Coloration of the Pharmacy Verification icon has been improved • DC/Cancel functionality associated with order sets has been improved DOCUMENTATION Documents that may be of interest to clinical staff members who use POE in the performance of their duties are identified below. POE Upgrade Summary The following link provides access to the POE Upgrade Summary for Version 4.5 XA. This document provides illustrated information pertaining to the changes noted above. It also contains each of the downtime procedures called-out in the following topic. Downtime Procedural Guides Five (5) downtime guides have been developed for clinical users of POE to direct them through the activities necessary to field the SCM Version 4.5 XA upgrade. These guides provide direction for the activities performed before, during, and after the downtime period (scheduled to occur begin at midnight on the evening of October 20th). Please note that the Post-Downtime Procedure is for units receiving patients who were transferred from either the PACU or the OR during the downtime period. Click on the button corresponding to the downtime document that you would like to access. October 27, 2008 "); array_files[27]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_QI_Pak_3.html","2008-10-27","8K","Updates & Roll-Outs, QI Pack 3 (May 2006) ","",""," Updates & Roll-Outs, QI Pack 3 (May 2006) October 5, 2006 POE Quality Improvement Pack 3 Overview This improvement focuses upon remedying a situation that previously resulted in the creation of many erroneously-generated, unsigned physician orders within the POE system. Requested By Dialog-Source Option Whenever orders are being discontinued/canceled on behalf of a physician because of a patient transfer, nurses should select the D/C Per Transfer Policy option. Discontinue/Cancel Orders Dialog-Reason Option This modification also removes the requirement for a user provided Reason in the Discontinue/Cancel Orders dialog box. Effective Date/Time This change will be available for use after 6:00 am (time approximate) on October 5, 2006. October 27, 2008 "); array_files[28]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_PACU.html","2008-10-27","2K","Updates & Roll-Outs, PACU Roll-Out (July 2006) ","",""," Updates & Roll-Outs, PACU Roll-Out (July 2006) July 2006 PACU Roll-out POE was implemented in JHHs Carnegie PACU Unit on July 10, 2006. October 27, 2008 "); array_files[29]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_New_Pharmacy_Source.html","2008-10-27","4K","Updates & Roll-Outs, QI Pack 2, Clear Intent Orders (June 2006) ","",""," Updates & Roll-Outs, QI Pack 2, Clear Intent Orders (June 2006) June 27, 2006 Clear Intent Orders (New Pharmacy Source) The roll-out of QI Pack 2 provides Pharmacists with a new Source option — RPH change per Provider order — to be used whenever a medication order written with clear intent needs modification (discontinuance and reordering). It should be noted that: Orders modified in this manner will not require co-signatures. The RPH change per Provider order source code is not available to anyone other than Pharmacists. Example Prescriber writes an order for gabapentin 300 mg PO TID, then writes in the comments section Give 600 mg qam, 600 mg at noon, 900 mg qpm. In this case, the Pharmacist would D/C the original order and re-order — write two new orders POE — using the RPh change per Provider order source code. October 27, 2008 "); array_files[30]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_IV_Diluent_Changes.html","2008-10-27","3K","Updates & Roll-Outs, QI Pack 2, IV Diluent Changes (June 2006) ","",""," Updates & Roll-Outs, QI Pack 2, IV Diluent Changes (June 2006) June 27, 2006 IV Diluent Changes The roll-out of QI Pack 2 introduces a time-saving feature for making IV Diluent changes. Diluent form changes may be written by either prescribers or nurses on behalf of a prescriber. In the later case, the diluent change order will require a co-signature. This order will apply to all IV medications that are currently active. As illustrated in the following example, two types of diluent change are available — Mix all IV meds in NS except IV Push and Mix all IV meds in D5W except IV Push. October 27, 2008 "); array_files[31]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_HLC.html","2008-10-27","2K","Updates & Roll-Outs, Harriet Lane Clinic Phase I (July 2006) ","",""," Updates & Roll-Outs, Harriet Lane Clinic Phase I (July 2006) July 2006 Harriet Lane Clinic—Phase I The first phase of ED Manager was implemented in the Harriet Lane Childrens Clinic on April 18, 2006. October 27, 2008 "); array_files[32]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_QI_Pak_1.html","2008-10-27","4K","Updates & Roll-Outs, QI Pack 1 (May 2006) ","",""," Updates & Roll-Outs, QI Pack 1 (May 2006) May 24, 2006 POE Quality Improvement Pack 1 Input from POE clinical customers has resulted in changes that streamline POEs display of patient medications. These changes include 5 new eMAR views (Kardex; Routine, One Time and Stat orders; Meds Due; and Med History), and a new Pharmacy Verification icon (with more easily understood labeling). These changes will be available for use after 5:00 am in the morning (time approximate) on May 24, 2006. The attached Quality Improvement Pack 1 Presentation provides information about these changes for the clinical users of POE. October 27, 2008 "); array_files[33]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Obstetrics.html","2008-10-27","2K","Updates & Roll-Outs, Obstetrics Roll-Out (May 2006) ","",""," Updates & Roll-Outs, Obstetrics Roll-Out (May 2006) May 2006 Obstetrics Roll-out POE was implemented in JHH Obstetrics Units on May 31, 2006. October 27, 2008 "); array_files[34]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_NF_Meds.html","2008-10-27","11K","Updates & Roll-Outs, QI Pack 2, Nonformulary Medications (June 2006) ","",""," Updates & Roll-Outs, QI Pack 2, Nonformulary Medications (June 2006) June 27, 2006 Nonformulary Medications The roll-out of QI Pack 2 enables prescribers to view and order NF medications as part of the order entry process. As indicated by the following example, medications categorized as nonformulary will be immediately recognizable by the appearance of the - NF annotation at the end of the medication name. Subsequent dialog activity will be determined by whether the nonformulary medication has an identified alternative. NF Medications Without an Identified Alternative Selection of a nonformulary medication that does not have an identified alternative will result in the display of the following message. All subsequent ordering activity is performed in the same manner as before. NF Medications With an Identified Alternative Selection of a nonformulary medication that has an identified alternative will result in the display of a message similar to the following example. At this point you need to decide whether you will continue to order the originally specified nonformulary medication or cancel the order and initiate an order for the identified alternative. All subsequent ordering activity is performed in the same manner as before. Currently there are eight (8) NF medications that have identified formulary alternatives. The following table identifies each of these NF medications and their alternatives. NF Medication Formulary Alternative Ticarcillin/Clavulanate Inj - NF Piperacillin & Tazobactam Sodium (Zosyn) Ceftazidime Inj - NF Cefepime cefurOXIME Enteral - NF Cephalexin or Cefixime cefurOXIME Enteral Susp (50 mg/mL)- NF Cephalexin or Cefixime Imipenem / Cilastatin Inj - NF Meropenem Ampicillin Enteral - NF Amoxicillin Famciclovir Enteral - NF Vallacyclovir Nafcillin Inj - NF Oxacillin October 27, 2008 "); array_files[35]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_New_Toolbar_Icons.html","2008-10-27","3K","Updates & Roll-Outs, New Toolbar Icons (May 2006) ","",""," Updates & Roll-Outs, New Toolbar Icons (May 2006) May 24, 2006 New POE Toolbar Icons New Icons that provide for quicker access to Micromedex, Online Formulary, and Hopkins Nursing are now available for insertion and use within the POE toolbar. These icons will be available after 5:00 am in the morning (estimated) on May 24, 2006. Instructions for inserting these icons into your toolbar (if they are not already there) are provided by the Inserting Toolbar Icons Demo. October 27, 2008 "); array_files[36]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_New_Rad_Orders.html","2008-10-27","6K","Updates & Roll-Outs, New Radiology Orders (April 2006) ","",""," Updates & Roll-Outs, New Radiology Orders (April 2006) April 27, 2006 New Radiology Orders Attention All POE Ordering Prescribers: In order to ensure that ordering Body CT Studies is easy and accurate, the Department of Radiology is changing how these items are presented by POE. This same change has already been successfully implemented for all CT Neuro and MRI exams. This change allows you to order Body CT exams as a protocol rather than the multiple billing codes that often define an exam of this type. These protocols are disease and body-part based. Being based on the technical protocols used by Radiology for imaging, this change will better communicate what imaging is needed. Typing CT on the order entry screen will bring up the entire list of protocols. We also encourage you to search through the browse tree on the left side of the order entry dialog. This protocol tree has been completely revised in an attempt to help prescribers locate the correct item more easily. When an order is placed for a protocol and subsequently transmitted to Radiology, it is translated into the individual Radiology billing exam codes that make up the protocol (there may be several for each exam). Once the protocol is tracked (begun) in the Radiology system, the individual Radiology codes that are part of that protocol will appear in POE. There is no change in the current procedure to discontinue/cancel an order placed for Radiology! You can cancel any procedure up until the time that Radiology has begun to process the procedure. Once Radiology tracks the exam and the Radiology billing codes appear in POE, canceling the exam in POE is no longer possible. If you want to cancel at this point you will need to call Radiology. If you have any questions about ordering please call Body CT at 5-5050. This change will be in effect as of 1:00 pm on April 27, 2006. October 27, 2008 "); array_files[37]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Dose_Changes.html","2008-10-27","3K","Updates & Roll-Outs, QI Pack 2 - Dose Form Changes (June 2006) ","",""," Updates & Roll-Outs, QI Pack 2 - Dose Form Changes (June 2006) June 27, 2006 Dose Form Changes The roll-out of QI Pack 2 introduces a time-saving feature for changing medication dose forms. Dose form changes may be written by either prescribers or nurses. The form change order will apply to all appropriate medications that are currently active. As illustrated in the following example, two types of form change are available — Change liquids to tablets and Change tablets to liquids. October 27, 2008 (Revised) "); array_files[38]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Advance_As_Tolerated_Diets.html","2008-10-27","4K","Updates & Roll-Outs, Advance as Tolerated Diet Orders (April 2006) ","",""," Updates & Roll-Outs, Advance as Tolerated Diet Orders (April 2006) April 27, 2006 Advance as Tolerated Diet Orders In response to numerous requests, POE now provides the Advance As Tolerated Diet Order Set. This order set permits prescribers to easily place all of the necessary orders that will allow patients to progress from NPO to specified goal diets. Once placed, this order set provides nurses with the ability to manage patients diets as their conditions warrant without the need for further system input by prescribers. This order set will be available for use as of 1:00 pm on April 27, 2006. The attached Advance As Tolerated Diets Quick Reference Guide provides information for the prescribers and nurses who will use this order set. October 27, 2008 "); array_files[39]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_New_Lab_Label_Times.html","2008-10-27","6K","Updates & Roll-Outs, New Print Times for Lab Barcode Labels (April 2006) ","",""," Updates & Roll-Outs, New Print Times for Lab Barcode Labels (April 2006) April 27, 2006 New Print Times for Lab Barcode Labels Currently, lab barcode labels are configured to print up to six hours before the scheduled time of the test. In an effort to decrease the amount of time that labels sit on the unit before they are needed, this time is being shortened to four hours. This should make it easier to manage labels and blood draws while decreasing the number of labels that are canceled after printing but before the blood is collected. Please note that if you place a routine unit collect order, there will be three periods each day when the label will not print right away. Routine orders placed between 3:30 pm and 3:59 pm will post for 8:00 pm and will not print until 4:00 pm. Routine orders placed between 8:00 pm and 10:29 pm will post for AM Labs (2:30 am in the system) and will print at 10:30 pm. Routine orders placed between 2:30 am and 5:29 am will post for 9:30 am and will not print until 5:30 am. This change will be in effect as of 1:00 pm on April 27, 2006. October 27, 2008 "); array_files[40]=new Array(0,1,"./WP_User_Info/U_I_Emerg_Access.html","2008-10-27","4K","POE - User Info - Emergency Access ","",""," POE - User Info - Emergency Access January 2006 Emergency Access — Attending Physicians Attending Physicians who have not undergone POE training may obtain temporary POE access—for the purpose of placing DNR and Chemotherapy orders—by calling the Help Desk @ 5-HELP. October 27, 2008 "); array_files[41]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_VLab_Service_Items.html","2008-10-27","3K","Updates & Roll-Outs, Vascular Lab Service Items (June 2005) ","",""," Updates & Roll-Outs, Vascular Lab Service Items (June 2005) June 1, 2005 Vascular Lab Service Items (Orders) VLAB service items (orders) available for ordering within POE (as of June 1, 2005). These items are listed within POE as individual orders rather than sub-components of a comprehensive service category. POE Bulletin 005 provides additional information. October 27, 2008 "); array_files[42]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_VAT_Services.html","2008-10-27","3K","Updates & Roll-Outs, New Vascular Access Team Services (July 2005) ","",""," Updates & Roll-Outs, New Vascular Access Team Services (July 2005) July 12, 2005 New Vascular Access Team Services On Tuesday July 12, 2005 (between 6:00 and 8:00 am), the collection of previously defined nursing orders will be replaced by new VAT Services (orders). POE Bulletin 008 provides additional information. October 27, 2008 "); array_files[43]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Shortened_Suspend_Int.html","2008-10-27","3K","Updates & Roll-Outs, Shortened Suspend - Inactivity - Interval (September 2005) ","",""," Updates & Roll-Outs, Shortened Suspend - Inactivity - Interval (September 2005) September 16, 2005 Suspension (Inactivity) Interval Shortened POE will now enter Suspend Mode after 5 minutes of workstation inactivity. As before, users whose sessions have been suspended need only to re-enter their passwords to regain access to POE. Users will be logged out of POE if no activity is detected for an additional 15 minutes. POE Bulletin 011 provides additional information. October 27, 2008 "); array_files[44]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Rehab_Exp.html","2008-10-27","10K","Updates & Roll-Outs, Dept of Rehab Roll-Out (Expanded Description - October 2005) ","",""," Updates & Roll-Outs, Dept of Rehab Roll-Out (Expanded Description - October 2005) October 18, 2005 Dept of Physical Medicine and Rehabilitation Roll-Out, Expanded Description POE was implemented in the Department of Physical Medicine and Rehabilitation (hereafter referred to as the Rehab Unit) on October 18, 2005. Changes to POE functionality and visual components of the graphical user interface associated with this roll-out have been described below. Rehab Orders & Order Sets New orders and order sets have been developed to accommodate the needs of the Rehab Unit. These new orders (order sets) are generally recognizable by the presence of the REHAB suffix appearing at the end of each order (order set) name. Event-Based Orders Whereas most POE orders are time-based—given/repeated at specific times for a specific duration—some Rehab Unit orders are event-based (referenced to a specific event–performance of a bladder scan, introduction of a straight catheter, application of EPC cream, etc.). Preadmission Orders The lack of provider staff after 7:00 pm on week days and on weekends has necessitated that Rehab Unit nurses be allowed to release preadmission (hold) orders. Large Volume Fluids Rehab staff members will mark large volume fluid orders as done when the bag is hung rather than when the empty bag is removed. New Ancillary Orders Only send requisitions to the appropriate ancillary departments (as listed below). Neuropsychology Recreational Therapy LowVision Center Evaluation Physical Medicine and Rehabilitation Physician Consult New Nursing Orders Multiple nursing orders have been added to the POE inventory that address REHAB equipment and those activities related to wounds and mobility. These orders follow the standard POE order entry process—the suffix REHAB appears at the end of each Rehab Unit order. New Order Sets Five (5) new order sets have been specifically defined for use within the Rehab Unit. Pharmacy There are some medications that have been built in POE as IV default since Pharmacy never sends only minibags to any of the nursing units, except for the Rehab Unit. Rather than having Pharmacists build a minibag each time a provider on the Rehab Unit (Halsted 3) orders these medications, specific Rehab orders have been developed for this purpose—ensuring that the medication is available to the Pharmacists within BDM (the Pharmacy Software System). User Privilege Users of POE are provided with a set of privileges that are based upon their role—provider, nurse, clerical associate, etc. This roll-out necessitated the assignment (definition) of privilege(s) for Rehab Unit Support Associates and LPNs. October 27, 2008 "); array_files[45]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Rehab.html","2008-10-27","4K","Updates & Roll-Outs, Dept of Rehab Roll-Out (October 2005) ","",""," Updates & Roll-Outs, Dept of Rehab Roll-Out (October 2005) October 18, 2005 Department of Physical Medicine and Rehabilitation Roll-Out POE was implemented in the Department of Physical Medicine and Rehabilitation on October 18, 2005. October 27, 2008 "); array_files[46]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Neurosciences.html","2008-10-27","2K","Updates & Roll-Outs, Neurosciences Roll-Out (January 2006) ","",""," Updates & Roll-Outs, Neurosciences Roll-Out (January 2006) January 2006 Neurosciences Roll-out POE was implemented in JHH Neurosciences Units on January 15, 2006. October 27, 2008 "); array_files[47]=new Array(0,1,"./WP_Training/Trng_Class_Sched.html","2008-10-27","4K","POE - Training Schedules ","",""," POE - Training Schedules Scheduling Classes Training is a prerequisite for anyone desiring to gain access to POE. POE training for all clinical users—Physicians, Nurses, Clerical Associates, Pharmacists, Radiologists, Technicians, etc.—is conducted by the staff of the CIS Education Center. Registration & Cancelation You may register for (or cancel) a POE training session by either: calling the CIS Education Center at extension 410-614-0958 or sending an email to CisTrain@jhmi.edu. You may also register for training by visiting the CIS Education Center Website. October 27, 2008 "); array_files[48]=new Array(0,1,"./WP_Training/Trng_Class_Loc.html","2008-10-27","5K","POE - Training Room Locations ","",""," POE - Training Room Locations Classroom Locations Classrooms are currently located in two different regions of the JHH facilities—on the 6th floor of the 1830 E. Monument Street Building and in the basement of the Rutland Building. Directions for getting to a specific classroom may be obtained by clicking on the room numbers highlighted in the text that follows. 1830 Building Classroom The classroom located on the 6th floor of the 1830 E. Monument Street Building is designated as Room 637. Rutland Building Classrooms Classrooms in the Rutland Building are designated as B101K, B101AA, B101AD and B101AE and are physically located in the basement of the building. October 27, 2008 "); array_files[49]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_SCM_V40.html","2008-10-27","16K","Updates & Roll-Outs, Version 4.0 Upgrade (October 2005) ","",""," Updates & Roll-Outs, Version 4.0 Upgrade (October 2005) October 29, 2005 SCM Upgrade to Version 4.0 XA Changes to POE functionality and visual components of the graphical user interface that resulted from the installation of this upgrade have been described below: Security System—Passwords User passwords are now case-sensitive and must be entered exactly as defined—correct characters, correct sequence, correct capitalization. Inactive Orders—Italicized Text Any order that is not currently active—discontinued, cancelled, hold orders, etc.—will appear as italicized text within the Orders tab display. Patient Allergies A new row displaying patient allergy information has been inserted between the row displaying MAR column headers and the one occupied by the initial order display. Patient Lists Users now have the ability to sort patient list content and to reposition list columns by dragging and dropping. Patient Info Tab Data Entry options within the Patient Info display are now determined by the security rights of the current user. Options requiring specific rights not possessed by the user will not be displayed (accessible). Order Entry Worksheet In an attempt to minimize the potential for a POE user selecting the wrong command button, the Submit and Cancel buttons have been separated by the relocation of the Hide Worksheet button. Mark As Done Functionality The first occurrence of one or more orders may be marked as done as they are entered via the Order Entry Worksheet. Sliding Scale Orders Functionality associated with modifying (adding a row to) the content of the Variable Dosage dialog, which is accessible when writing either a Regular Human Insulin or Insulin Aspart sliding scale order, has been enhanced. Order Sets—Reordering/Copying Nurses and providers may now reorder/copy a previously generated order set. Order Sets—Review Component Orders Users have been provided access to a new dialog—Order Set Information—that allows review of all component orders and the data that defines them. Orders/Results—New Since Options Two additional Since options have been added to the displays accessed via both the Orders and Results tabs. These options allow the display of orders/results up to Two years ago and Three years ago based upon the current date and time. Orders/Results—New Filter Text Message Previously, when a filter was applied to the displays accessed via either the Orders or Results tab, a filter icon was displayed in the upper left corner of the display—immediately above the initial header for the orders/results display to serve as a visual cue (alert) to the user that not all of the orders/results were currently being displayed. A text message has been added to the icon to ensure that users new to POE will be aware of the fact that not all orders are being shown. PRN Trough Displays Troughs associated with PRN orders associated with frequencies of BID, TID, QID, and Daily has been enhanced—functionality of PRN orders associated with frequencies of Q#h values remains unchanged. Previously, the MAR displayed PRN orders as one continuous trough for the duration of the order regardless of the specified frequency. Now, placement of a PRN order with one of the daily frequency designations (BID, TID, QID, and Daily) will result in a series of troughs (appropriate for the specified frequency and the user specified cell duration). MAR Orders Display Active orders will no longer drop-off of the MAR display simply because there is no pending task within the currently defined filter region. Continuous Tasks—Mark As Not Done The functionality associated with the display of continuous orders by the POE MAR has been modified. Users may now mark specific segments of a continuous order as not done. Personal Work Lists—Showing All Tasks User defined work lists (MARs) may now be configured by the user (owner/creator) to display all tasks regardless of filter criteria. Order Forms The use of forms for defining/generating orders—on a limited basis—is being introduced as part of this upgrade. The main advantage of this feature is that forms allow direct access to order components (dose, duration, frequency, etc.) rather than going through a series of dialogs to view/modify the same information. Linked (Discharge) Order Sets Discharge order sets have been rebuilt as linked sets. Linked order sets enable definition of controls on groups of orders which must be carefully managed during entry, verification, modification, or discontinuation. Within linked order sets, some items may be grouped so that they must be discontinued or reordered together. The following link provides access to the POE Upgrade Summary for Version 4.0 XA. October 27, 2008 "); array_files[50]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_SCM_V35_Exp.html","2008-10-27","15K","Updates & Roll-Outs, Version 3.5 Upgrade (Expanded Description - November 2004) ","",""," Updates & Roll-Outs, Version 3.5 Upgrade (Expanded Description - November 2004) November 21, 2004 Expanded Description of the SCM Upgrade to Version 3.5 XA Changes introduced by the incorporation of this upgrade include: Personal Patient Lists Installation of the SCM Version 3.5 XA upgrade will cause personal lists of patients created by individual users to be lost (deleted during the upgrade process). Users are encouraged to recreate their personal patient lists as soon as possible after entering the upgraded POE system for the first time. Icons & Dialogs Order Summary Icons Two icons have been added to POE that allow users to quickly identify PRN and STAT orders listed within the selected patient’s orders summary Worklist (MAR) Pending STAT orders appearing within the work list (task list, MAR) will now display a red flag within the associated task description and time cells—note that both of these cells will possess a yellow background for as long as the order remains uncompleted. New Features & Functions Allergies Version 3.5 XA, provides a more intuitive way to specify a patient’s allergy status within POE. Clinical users of POE may now select either No Known Allergies, Allergy Status Unknown, or New Allergy for any patient that has not been assigned an allergy status (type). Warning Messages—Alerts The functionality associated with the generation of POE Warning! messages (dialog boxes) in response to orders being entered into POE—based upon POE background checking for out of range dosages, potential allergic reactions, and drug interactions—has been modified. The new Alert Detail dialog box takes the place of the previous Warning! message and displays the patient’s name and a description of the alert. A new Available Actions dialog box is displayed when the situation (evaluation of the order definition) warrants its display, and the user has the appropriate permissions to take the available actions. An Orders with Alerts, Warnings or Errors dialog box is displayed when information is either incorrect or missing on one or more of the forms contained within an order set. This dialog box provides access to the associated orders to allow you to assess the nature of the problem and determine the most appropriate course of action. Automated Medication Order Checks Four new order checking routines have been added that provide the following functionality. QAM Order Check - displays a message that the associated medication will not be administered until the following day if the order was placed after 8:00 am. Daily Order Check - displays a message that the associated medication will not be administered until the following day if the order was placed after 10:00 am. PRN Order Check - ensures that the PRN Reason field within the order form contains an entry. STAT Order Check - ensures that the requested Frequency is set to once. Multi-Column Forms A number of previously defined POE forms have been converted to a multi-column format. The use of multi-column forms makes more of the associated form data immediately visible and minimizes the need for user scrolling to view data currently located outside of the display region. Dose Calculations & Creatinine Clearance The Dose Calculation dialog box now features automated performance of creatinine clearance calculations. Limitations All known limitations to the upgraded POE system that the user is likely to encounter are listed as follows: A programmed POE mechanism to automatically discontinue orders when patients are transferred to a different level of care/service does not currently exist—Version 3.04. Estimated creatinine clearance calculations performed as part of POE dose calculation make use of the Cockcroft-Gault equation. Other calculation methodologies (equations) are not available—Version 3.5 XA. The numbers appearing at the end of each limitation identify the hosting software version associated with the appearance of the associated limitation. Publications The following link provides access to the POE Upgrade Summary for Version 3.5 XA. October 27, 2008 "); array_files[51]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_SCM_V35.html","2008-10-27","6K","Updates & Roll-Outs, Version 3.5 Upgrade (November 2004) ","",""," Updates & Roll-Outs, Version 3.5 Upgrade (November 2004) November 21, 2004 SCM Upgrade to Version 3.5 XA This upgrade of the SCM software that hosts the POE system affects previously defined personal patient lists, selected icons and dialog boxes. New functionality has also been introduced with regard to: allergies and warning messages (alerts); automated checking performed as medication orders are being written; creatinine clearance calculations; and, multi-column forms. The following link provides more detailed information about the Version 3.5 XA upgrade as well as the current status of system limitations. October 27, 2008 "); array_files[52]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Respiratory_Services.html","2008-10-27","3K","Updates & Roll-Outs, Revised Repeating Lab Test Order Functionality (July 2005) ","",""," Updates & Roll-Outs, Revised Repeating Lab Test Order Functionality (July 2005) July 21, 2005 Revised Repeating Lab Test Order Functionality On Thursday July 21, 2005 (at approximately 5:00 pm), functionality was introduced to reduce the number of pending lab orders appearing within the review display. Repeating Lab test order occurrences will now only be generated for the current day and one day into the future. As each day passes another days worth of occurrences will be generated. The net result is that the review display will always show the current days occurrences plus the next days occurrences—until all of the ordered occurrences are exhausted. This update also introduced the Change Order order type and revised order form logic. POE Bulletin 009 provides additional information. October 27, 2008 "); array_files[53]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Radiology_Form.html","2008-10-27","3K","Updates & Roll-Outs, Improved Radiology Forms (June 2005) ","",""," Updates & Roll-Outs, Improved Radiology Forms (June 2005) June 26, 2005 Improved Radiology Form On Sunday June 26, 2005 at 7:00 am, changes to radiology forms designed to clarify request times, collect new data, and provide enhanced logic were introduced through the combined efforts of the POE Staff and the Department of Radiology. POE Bulletin 007 provides additional information. October 27, 2008 "); array_files[54]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Psychiatry.html","2008-10-27","2K","Updates & Roll-Outs, Department of Psychiatry Roll-Out (March 2005) ","",""," Updates & Roll-Outs, Department of Psychiatry Roll-Out (March 2005) March 29, 2005 Department of Psychiatry Roll-Out This roll-out tailored POE to meet the needs of the Department of Psychiatry and introduced a new feature set that provides the ability to create orders for preadmission patients and subsequently release those orders once the associated patient has been admitted. October 27, 2008 "); array_files[55]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Pharm_Intfc.html","2008-10-27","4K","Updates & Roll-Outs, Bidirectional Pharmacy Interface (March 2005) ","",""," Updates & Roll-Outs, Bidirectional Pharmacy Interface (March 2005) March 14, 2005 Bidirectional Pharmacy Interface The incorporation of this interface allows POE and BDM to exchange medication ordering information electronically as HL7 data with the eLink and Impact systems transparently providing the necessary data translation. The major advantage of the bidirectional interface is that pharmacists will no longer need to copy order information retrieved from a printed requisition into BDM. This results in more time being available for pharmacists to pursue clinical duties rather than performing order transcription. A description of the order process using the new interface is provided as follows: Prescribers enter orders via POE workstations, these orders are electronically transmitted to BDM via the interface. As was the case previously, the order also contains patient allergy, height, and weight information. Pharmacists receive these orders on BDM configured workstations. Pharmacists review the orders in BDM for appropriateness/accuracy and then electronically verify those orders. Feedback is provided to nurses and prescribers—to POE workstations via the interface—indicating that pharmacists have reviewed and verified the indicated orders. October 27, 2008 "); array_files[56]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Pat_Lists.html","2008-10-27","4K","Updates & Roll-Outs, Patient Lists & More (March 2005) ","",""," Updates & Roll-Outs, Patient Lists & More (March 2005) March 24, 2005 Patient Lists & More This update provided Nurses and Clerical Associates on JHH POE equipped units with the operational enhancements/functionality listed below. All POE toolbar icons will now be displayed—those not appropriate for the logged user will exhibit a grayed-out (faded) appearance. A reason for accessing patients outside of your unit (the unit associated with the workstation being used) is no longer required. The Current List drop-down listing (accessed via the Patient List tab) now displays the label Unit Census indicating the patient population associated with your unit—as determined by the location of the workstation. A listing of all DoM units will no longer be displayed. See new Patient Lists & Searches Quick Reference Guide for additional information. October 27, 2008 "); array_files[57]=new Array(0,1,"./WP_User_Info/U_I_Quest_Trng.html","2008-10-27","3K","POE - User Info - Questions - Training ","",""," POE - User Info - Questions - Training Questions—Training Do I need POE training? If you are an attending physician, provider, nurse, or clerical associate in a department that has implemented the POE system you will need to attend the appropriate training for your role before using the system. If your department has not yet implemented the POE system, you do not need to attend training classes. Before the system is implemented in a department, an analysis of the departments needs will be performed and appropriate training will be developed and scheduled to take place about a month before the implementation date. JHH staffers in these departments will receive ample notice of the classes as they are scheduled. October 27, 2008 "); array_files[58]=new Array(0,1,"./WP_User_Info/U_I_Quest_Printing.html","2008-10-27","10K","POE - User Info - Questions - Printing ","",""," POE - User Info - Questions - Printing Questions—Printing CURRENT QUESTIONS How do I print a Medication Administration Record (MAR)? How do I print a list of a patients current medications? How do I reprint a Lab label? 1. How do I print a Medication Administration Record (MAR)? To print a Medication Administration Record (MAR) that includes medications scheduled from the immediately preceding midnight to the next midnight: 1. Select the Patient List tab and highlight the patient of interest. 2. Click on the printer icon and select the report category Administrative Rpts. 3. Select JHH Interim Medication Worklist. 2. How do I print a list of a patients current medications? 1. Click the Patient Listtab and highlight the patient of interest. 2. Click on Save Selected Patients to create a list. 3. Click on the printericon and select the report category titled Orders Rpts. 4. Select JHH Active Medications by Patient for My List of Patients. 3. How do I reprint a Lab label? The order ID of the order for which the label was originally printed, should be entered in the Reprint Lab Label order entry form. To obtain the order ID-right-click on order/order detail/get order id. You may either cut and paste the obtained ID or enter it directly from the keyboard. October 27, 2008 "); array_files[59]=new Array(0,1,"./WP_User_Info/U_I_Quest_Meds_Orders.html","2008-10-27","12K","POE - User Info - Questions - Orders/Meds ","",""," POE - User Info - Questions - Orders/Meds Questions—Orders/Medications CURRENT QUESTIONS How do I print a Medication Administration Record (MAR)? When should I use the Physician Free Text order and the Nursing Free Text order? How do I correct a PRN order marked in error? How do I print a list of a patients current medications? 1. How do I print a Medication Administration Record (MAR)? To print a Medication Administration Record (MAR) that includes medications scheduled from the immediately preceding midnight to the next midnight: 1. Select the Patient List tab and highlight the patient of interest. 2. Click on the printer icon and select the report category Administrative Rpts. 3. Select JHH Interim Medication Worklist. 2. When should I use the Physician Free Text order and the Nursing Free Text order? The Physician Free Text Order should only be used when an order is needed but is not available in the system. The order is titled Patient Care Order, Free Text and should only be used for orders that require an ordering provider signature. The Nursing Free Text Order should only be used when an order is not available in the system. The order is titled Nursing Order, Free Text and should only be used for orders that do not require an ordering provider signature. 3. How do I correct a PRN order marked in error? 1. Right-click on the appropriate MAR cell. 2. Click Edit. 3. Click Reset Task Status. 4. How do I print a list of a patients current medications? 1. Click the Patient Listtab and highlight the patient of interest. 2. Click on Save Selected Patients to create a list. 3. Click on the printericon and select the report category titled Orders Rpts. 4. Select JHH Active Medications by Patient for My List of Patients. October 27, 2008 "); array_files[60]=new Array(0,1,"./WP_User_Info/U_I_Quest_JHED_ID.html","2008-10-27","3K","POE - User Info - Questions - JHED ID ","",""," POE - User Info - Questions - JHED ID Questions—JHED ID What is a JHED ID and why do I need one? The Johns Hopkins Enterprise Directory is a tool utilized to ensure that only authorized individuals have access to people, applications, and online resources within the Johns Hopkins organization. A fundamental aspect of this directory is the assignment of a specific identifier (JHED ID) to each person contained within the directory. The directory is updated nightly from the various systems of record across the institution. Both your JHED ID and POE password are required in order for you to access POE. [Access JHED Website] October 27, 2008 "); array_files[61]=new Array(0,1,"./WP_User_Info/U_I_Quest_Gen.html","2008-10-27","8K","POE - User Info - Questions - General ","",""," POE - User Info - Questions - General Questions—General CURRENT QUESTIONS What is POE? When Should I suspend a session? 1. What is POE? The Johns Hopkins Hospital computerized Provider Order Entry System (POE) is a tool that facilitates automated order entry, display, and retrieval of patient orders. It has replaced OrderNet, the system previously used by the Department of Medicine and ultimately be deployed to every service within The Johns Hopkins Hospital and to other Johns Hopkins sites in the community. The system will be used by all physicians to electronically place orders for medication, lab tests, radiology exams, consults and other specialty services. POEhas been refined through thousands of hours of input from physicians, nurses, pharmacists and ancillary personnel and includes alerts for drug-drug interaction, drug-allergy, and dose range checking for medications. Nurses, clinical support staff, and other ancillary personnel may use the system for specific reasons, including medication administration. The foundation of the JHH POE system is the software application Sunrise Clinical Manager (SCM) which is marketed by the Eclipsys® Technologies Corporation. Members of the information technology staff have worked closely with clinical representatives of JHH and advisors from Eclipsys to tailor the system and its interface to meet the unique needs of JHH. 2. When should I SUSPEND a session? Only suspend a session if you must walk away from the workstation and plan to return to complete the session at that same workstation. If you have finished a session, log off of POE. October 27, 2008 "); array_files[62]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Ord_Freq.html","2008-10-27","2K","Updates & Roll-Outs, Modified Order Frequency Abbreviations (September 2004) ","",""," Updates & Roll-Outs, Modified Order Frequency Abbreviations (September 2004) September 28, 2004 Modified Order Frequency Abbreviations Order frequency abbreviations fielded as part of the original POE installation have been modified in order to maintain compliance with JCAHO regulations—see POE Bulletin 001. October 27, 2008 "); array_files[63]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Order_Summary_Display.html","2008-10-27","3K","Updates & Roll-Outs, Order Summary Display (June 2005) ","",""," Updates & Roll-Outs, Order Summary Display (June 2005) June 15, 2005 Order Summary Display (New Header Sequence) As of June 15, 2005, use of either the By Department or By Department/Status display filter will reveal a new sequencing of departmental headers within the POE Order Summary display. POE Bulletin 006 provides additional information. October 27, 2008 "); array_files[64]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Intensive_[Critical]_Care.html","2008-10-27","3K","Updates & Roll-Outs, CCU/ICU/MCU Roll-Outs (July/August 2005) ","",""," Updates & Roll-Outs, CCU/ICU/MCU Roll-Outs (July/August 2005) July/August 2005 Department of Medicine ICU Roll-outs POE was implemented in the Medical Intensive Care Units on July 19, 2005 and the Cardiac Critical Care and Progressive Care Units on August 2, 2005. Enhanced functionality provides critical care nurses with the ability to continue to practice to their established standard of care. October 27, 2008 "); array_files[65]=new Array(0,1,"./WP_Updates_and_Fixes/U_and_F_Init_Rel.html","2008-10-27","3K","Updates & Roll-Outs, Initial Roll-Out of POE (June 2004) ","",""," Updates & Roll-Outs, Initial Roll-Out of POE (June 2004) June 1, 2004 Initial Roll-Out of POE (SCM Version 3.04) Baseline POE functionality introduced as a replacement for OrderNet in nine (9) JHH Department of Medicine Units. October 27, 2008 "); array_files[66]=new Array(0,1,"./WP_User_Info/U_I_Com_Miscues_Pat_Focus_header.html","2008-10-27","4K","POE - User Info - Patient Focus Header ","",""," POE - User Info - Patient Focus Header Common Miscues Incorrect Patient Focus Example Patient Header: You should be sure that the patient name, as well as the unit/bed information, is correct before proceeding with a data entry session. October 27, 2008 "); array_files[67]=new Array(0,1,"./WP_User_Info/U_I_Com_Miscues_Pat_Focus.html","2008-10-27","6K","POE - User Info - Patient Focus ","",""," POE - User Info - Patient Focus Common Miscues Incorrect Patient Focus You must always ensure that POE focus is on the correct patient before you enter any data, mark orders as given, etc! You should be aware of the following: When you log into POE, system focus will always be placed on the first patient in the list associated with the default unit of the workstation being used. If you leave the workstation without logging off, someone else may have changed the patient focus to a different patient [see Miscues - Log On (Off)]. Always check the POE header (located immediately below the POE menu bar) to verify that the name of the desired patient is displayed before you begin entering data [see example header]. When orders have been entered for the wrong patient: The cognizant provider should be notified that the inappropriate orders need to be discontinued and if necessary, rewritten for the appropriate patient. The cognizant nurse should be notified by the provider that the inappropriate orders are being (have been) discontinued. October 27, 2008 "); array_files[68]=new Array(0,1,"./WP_User_Info/U_I_Com_Miscues_Log_On_Off.html","2008-10-27","5K","POE - User Info - Log On / Off ","",""," POE - User Info - Log On / Off Common Miscues Improper Log On/Off Users of POE should always log on to the workstation at the beginning of a data entry session and always log off upon completion of that session. Users should never leave a POE Workstation unattended without first logging off! You should be aware of the following: Logging on at the beginning of a data entry session ensures that the correct user is identified as the source of the data entered during that session. Leaving a POE workstation unattended without first logging off could result in either of the following situations. Another user (someone other than yourself) could enter information that will be identified as having been entered by you. Protected healthcare information (PHI) could be viewed by unauthorized persons, which is a violation of patient confidentiality as defined by HIPPA. October 27, 2008 "); array_files[69]=new Array(0,1,"./home-insert.html","2008-10-27","4K","What is POE? ","",""," What is POE? What Is Provider Order Entry (POE)? The Johns Hopkins Hospital (JHH) computerized Provider Order Entry System (POE) is a tool that facilitates automated order entry, and the display and retrieval of information reflective of patient orders. It replaces OrderNet, the previous system used by the Department of Medicine and will ultimately be deployed to every service within JHH and to other sites within the Johns Hopkins community. POE is used by all physicians to electronically place orders for medications, laboratory tests, radiology examinations, consultations, and other specialty services. POE evolved from thousands of hours of effort on the part of physicians, nurses, pharmacists, and ancillary personnel and includes alerts for drug-drug interactions and drug-allergies, as well as dose range checking for medications. In general, physicians, nurses, clinical support staff, and other ancillary personnel will use POE to review patient orders and to document medication administration. The foundation of the JHH POE system is the Sunrise Clinical Manager (SCM) software application, which is marketed by the Eclipsys® Technologies Corporation. Members of the information technology staff have worked closely with clinical representatives of JHH and advisors from Eclipsys to tailor the system and its interfaces to meet the unique needs of JHH. POE is designed to reduce medication errors and the potential for adverse drug events, standardize patient care, improve the efficiency of patient care delivery, and largely eliminate the need for paper requisitions. October 27, 2008 "); array_files[70]=new Array(0,4,"./Publications/QRGs_List.pdf","2008-10-13","96K"," List of POE Quick References ","","","TITLE Quick References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Actions-on-Alerts ADT Overview (IN-Patient) Allergy Info, Entering Attending Physicians Clerical Associates Diets ­ Advance as Tolerated Discharge Worksheet Basics Discharge Worksheet Integration (with EPR Discharge Summary) Discharge Worksheet, Viewing/Printing ED (HMED) Visit Summary, Viewing eMAR, Pushing Meds to the eMAR, Using the Filters - Graph, Creating Filters - Results, Creating HLC ­ MD Acute Care Note HLC ­ Nurses ­ Phase I HLC ­ Patient Services Coordinator ­ Phase I HLC ­ Providers ­ Phase I Lists ­ Columns, Adding/Deleting Lists ­ Dialysis-Focused, Creating Lists ­ Orders-Based, Creating Lists ­ Patient, Searching Lists ­ Service-Based, Creating Lists ­ Unit, Creating/Modifying (Adding/Removing Locations) Name Alert Feature Nurses Ordering, Blood Tests Ordering, CTs & MRIs (New Radiology Forms) DATE 17 October 2007 30 September 2005 20 March 2008 15 November 2004 9 October 2008 24 April 2006 4 September 2008 18 March 2008 18 March 2008 23 April 2008 19 April 2007 9 April 2007 16 March 2007 16 March 2007 15 December 2006 25 May 2006 23 March 2006 22 May 2006 12 December 2007 3 October 2007 6 February 2007 24 March 2005 24 June 2006 22 June 2005 15 February 2005 15 November 2004 9 March 2007 12 September 2007 TYPE 3-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 4-Panel 4-Panel 4-Panel 3-Panel 4-Panel 3-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 1. 2. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. TITLE Quick References Orders, Adult PCA (Epidural) Modification, Nurse Acknowledgment Orders, Adult PCA (Epidural) Modification by Prescribers Orders, Now-Then-Routine Orders, Nursing Review Orders, Preadmission/Pre-Transfer ­ Providers Orders; Repeating Labs, Creating Orders, Signing Orders, Sorting Orders, Verifying PEDs, Managing Pediatric Chemo Orders in the PICU PEDs ­ Orders, Insulin Correction, Administering PEDs ­ Orders, Potassium Bolus, Entering PEDs ­ Orders, Variable-Dose/Sliding-Scale, Entering PEDs ­ Structured Pain Service Note (Part 1) PEDs ­ Structured Pain Service Note (Part 2) Pharmacists Pharmacy Interface Basics Pharmacy Interface Basics for Care Providers Prescribers Print-outs, Managing POE Printing POE Reports Sign Out Note, Creating Transfusions, Documenting Weight & Height Data, Entering Survival Tips Blood Products Orderset, New & Improved Dialysis Implementation DATE 1 June 2007 1 June 2007 15 November 2004 11 January 2006 11 January 2006 19 April 2007 4 January 2007 15 March 2007 3 April 2007 29 May 2008 16 February 2007 28 February 2007 16 February 2007 29 March 2007 29 March 2007 21 March 2008 20 March 2008 20 March 2008 12 April 2007 23 May 2006 8 December 2005 24 June 2008 26 July 2006 11 January 2006 TYPE 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 3-Panel 3-Panel 4-Panel 4-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 3-Panel 3-Panel 14 September 2007 11 October 2007 3-Panel 4-Panel listing of stocked qrgs users-20081013.doc Monday, October 13, 2008 "); array_files[71]=new Array(0,4,"./Publications/QRG_CAs.pdf","2008-10-09","577K"," ","","","SEND TRAY ORDER: 1. Click Order Entry Worksheet icon. NOTE It may be necessary to close the Allergy Summary dialog box (by using the Close command button) before proceeding to the next step. Provider Order Entry (POE) ­ Quick Reference Guide REPRINT LAB BARCODE LABELS: 1. Select the Orders tab. On the Order Entry Worksheet, make sure that the Type here to enter order name field is highlighted before proceeding to the next step. If it is not, click within the field to highlight this phrase. LOG IN: 1. Select POE command from the Start menu. 2. Type your user name in the Name field. 3. Type your password in the Password field. 4. Click OK. If your username and password are correct, the system will log you on to POE NOTE If you are using POE for the first time, the Change Password dialog box opens for you to change your password. 2. Type Send using the workstation keyboard. 3. Click (highlight) the Send Tray option. 4. Click Add. 5. Click Submit. 2. Find the order associated with the order that you need to reprint. 3. Double-click the order. 4. Copy the Order ID. 5. Click Order Entry Worksheet icon. 6. Locate field: Type here to enter order name. 7. Type Reprint. 8. Click Add. 9. Complete Requested Date, Requested Time and Collected By data fields. 10. Paste the Order ID in the Order Number to Reprint field. Order ID LOG OUT: 1. Click the Log off toolbar button. 2. Click Exit within the Logon dialog box to completely exit POE. CHANGE PASSWORD: 1. Select the Change Password command from the Preferences menu. 2. Type your current password into the Old Password field. 3. Type your new password into the New Password field­it must contain at least six characters. 4. Type your new password into the Confirm New Password field. 5. Click OK. Provider Order Entry Quick Reference Guide­Clerical Associates Version 4.5 XA 9 October 2008 This revision of the Clerical Associates QRG supersedes all previous editions. Those dated prior to 9 October 2008 should be destroyed. ©2004­2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. TRANSFER PATIENT TO POE UNIT Whenever a patient is being transferred to another unit, the provider will enter a transfer order in POE. Whenever the patient is being transferred to a unit that is using POE, the clerical associate must complete the following tasks. 1. Print Reports (see Printing for step-by-step instructions) · JHH Medication Administration Record · JHH Medication Reconciliation Report TRANSFER PATIENT TO NON-POE UNIT Whenever a patient is being transferred to another unit, the provider will enter a transfer order in POE. Whenever the patient is being transferred to a unit that is not using POE, the clerical associate must complete the following tasks. 1. Print Reports (see Printing for step-by-step instructions) · JHH Cumulative Order Summary · JHH Medication Administration Record · JHH Medication Reconciliation Report NOTE Prior to performing the following step, you should check with the Charge Nurse to ensure that all orders associated with the patient have been discontinued. PRINTING Use the following steps to print a specific POE report. 1. Click the Print Reports icon . NOTE In the following step, select Orders Rpts if you wish to print either the JHH Cumulative Order Summary or the JHH Medication Reconciliation Report. Select Administration Rpts if you wish to print the JHH Medication Administration Record. 2. Select Order Rpts. 2. The clerical associate on the receiving unit transfers the patient using the electronic bed board (EBB). 2. Transfer Patient ­ using the electronic bed board (EBB). 3. Select name of desired report from listed options. 4. Click Print. NOTE If you wish to print another report, repeat steps 2 through 4 before proceeding to the next step. 5. Click Close. "); array_files[72]=new Array(0,4,"./Maps/Rutland_POE_Tech_Lab.pdf","2008-09-11","320K"," Rutland Building, POE Tech Lab ","","","Rutland B uilding B asement -- NOTE -- These elevators may be accessed on the west side of any Rutland Garage level/floor or the ground floor building entrance on Rutland Avenue ­ located directly across from the Turner Auditorium. You can gain access to this lobby by walking in a northerly direction (for approximately 200 feet) from the intersection of Monument Street and Rutland Avenue. . POE Tech Lab POE Tech Lab B101-AC Classroom B101-AD Knock on door and wait to be admitted. Elevator Elevator Classroom B101-AE (Rutland Basement) This diagram is intended to provide the reader with a general idea of the classroom location only. It is not true in scale or the depiction of all structural (architectural) features of the depicted JHH areas. View Down the Hallway "); array_files[73]=new Array(0,4,"./Maps/Room_&_Cubicle_Map_(Rutland).pdf","2008-09-11","232K"," Rutland Bldg. Basement Cubicle Assignments ","","","POE (JHMCIS IT) Cubicle Assignments B101K Conference Room Elevators QC03 QC02 QC01 Tech-Writer Euipment Dawn Kemp Dorothy Lee QC17 QC04 Mac McNeir QC05 QC10 QC11 QC16 Dana Stout QC18 Betty Taffe QC06 Robert OConnell QC09 Vacant Jose Leandro QC15 Chuck Amos QC19 QC12 SCC Ann Fariss QC08 Wendy Denton QC13 Vacant Nancy Adeniyi QC20 QC07 QC14 Val Price B101AE B101AD B101AC B101AB B101AA Rich Butler B101Z Vacant B101Y Sherry Thorpe Cindy Diaz B101X Consultants J. Engel A. Meacham M. Godwin Consultants Vacant POE Tech Lab S. Azadian E. Fanning E. Ferrencik S. Rollins T. Barcomb Copier Room John Johnson James Smith Patty Kimball Last Updated on Friday, August 29, 2008 "); array_files[74]=new Array(0,4,"./Maps/Room_&_Cubicle_Map.pdf","2008-09-11","213K"," 1830 Monument Street, 6th Floor POE Cubicle Map ","","","Vacant 631 Marty Hamburg 633 Bob Belleman 635 Damon Harkless 637A Madeline Jay 637B Cindee Welker 6-19 Desiree Baldwin 6-16 Crystal Green 6-14 Jackie Kowalczyk 6-12 Bonnie McCoy 6-9 Meg Knuth 6-6 Pam Caple 6-18 James Sheranko 6-15 Rose Miranda 6-13 Paul Winner 6-11 Joan Wagner 6-8 Alison Brennan 6-5 Karen Romanczyk 6-17 Rekha Mathew 6-20 Kate Lighty 6-10 Jim Fariss 6-7 Spartak Kent 6-4 Silvano Piferi 6-3 CONFERENCE ROOM 602 Vivian Foster CONFERENCE ROOM 601 Supplies Perry Hunter 609 Nuredin Joehar 607 Equip. Charlene Smith 6-2 Kesi Edmonds 6-1 20 Copier Clinical Help Desk 21 Stephanie Reel 621 Pat Zeller 619 Steve Mandell 617 LUNCH ROOM 615 Peggy Ardolino 613 David Li 611 Revision 29 ­ July 7, 2008 "); array_files[75]=new Array(0,4,"./Maps/POE%20JHMCIS%20Area_CRB_Bldg_Map.pdf","2008-09-11","351K"," Cancer Research Bldg. JHMCIS IT Cubicle Assignments ","","","Directions to the POE JHMCIS Area within the Cancer Research Bldg. JHMCIS Area E N T E R 1. Walk into the Jefferson Street entrance of the Cancer Research Building ( on the map above) and then turn right when you see the elevators. 2. Continue walking until you see a coffee shop on your right; turn left after you pass the shop at the end of the hall. NOTE Please note that the elevators at the front of the building DO NOT get you to the JHMCIS IT (POE) area, you must use the elevators at the back of the building ­ the elevators closest to Orleans Street not the cafe. 3. At the end of this hall, take either the stairs or the elevator to the next floor up (1M). Then turn right if you took the stairs or turn left if you took the elevator. 4. Turn left as you enter the suite area and you are there. 07/03/2008 10:06:00 AM POE JHMCIS Area_CRB_Bldg_[2008-07-03].doc 2 1 3 Tim Lovewell Margarita Sokolina 4 5 Tony Pereira 8 Ross Campbell 9 Initial Release, June 12, 2008 "); array_files[76]=new Array(0,4,"./Publications/QRG_List_-_Users.pdf","2008-09-09","99K"," List of POE Quick References ","","","TITLE Quick References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Actions-on-Alerts ADT Overview (IN-Patient) Allergy Info, Entering Attending Physicians Clerical Associates Diets ­ Advance as Tolerated Discharge Worksheet Basics Discharge Worksheet Integration (with EPR Discharge Summary) Discharge Worksheet, Viewing/Printing ED (HMED) Visit Summary, Viewing eMAR, Pushing Meds to the eMAR, Using the Filters - Graph, Creating Filters - Results, Creating HLC ­ MD Acute Care Note HLC ­ Nurses ­ Phase I HLC ­ Patient Services Coordinator ­ Phase I HLC ­ Providers ­ Phase I Lists ­ Columns, Adding/Deleting Lists ­ Dialysis-Focused, Creating Lists ­ Orders-Based, Creating Lists ­ Patient, Searching Lists ­ Service-Based, Creating Lists ­ Unit, Creating/Modifying (Adding/Removing Locations) Name Alert Feature Nurses Ordering, Blood Tests Ordering, CTs & MRIs (New Radiology Forms) DATE 17 October 2007 30 September 2005 20 March 2008 15 November 2004 12 March 2007 24 April 2006 4 September 2008 18 March 2008 18 March 2008 23 April 2008 19 April 2007 9 April 2007 16 March 2007 16 March 2007 15 December 2006 25 May 2006 23 March 2006 22 May 2006 12 December 2007 3 October 2007 6 February 2007 24 March 2005 24 June 2006 22 June 2005 15 February 2005 15 November 2004 9 March 2007 12 September 2007 TYPE 3-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 4-Panel 4-Panel 4-Panel 3-Panel 4-Panel 3-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 1. 2. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. TITLE Quick References Orders, Adult PCA (Epidural) Modification, Nurse Acknowledgment Orders, Adult PCA (Epidural) Modification by Prescribers Orders, Now-Then-Routine Orders, Nursing Review Orders, Preadmission/Pre-Transfer ­ Providers Orders; Repeating Labs, Creating Orders, Signing Orders, Sorting Orders, Verifying PEDs, Managing Pediatric Chemo Orders in the PICU PEDs ­ Orders, Insulin Correction, Administering PEDs ­ Orders, Potassium Bolus, Entering PEDs ­ Orders, Variable-Dose/Sliding-Scale, Entering PEDs ­ Structured Pain Service Note (Part 1) PEDs ­ Structured Pain Service Note (Part 2) Pharmacists Pharmacy Interface Basics Pharmacy Interface Basics for Care Providers Prescribers Print-outs, Managing POE Printing POE Reports Sign Out Note, Creating Transfusions, Documenting Weight & Height Data, Entering Survival Tips Blood Products Orderset, New & Improved Dialysis Implementation DATE 1 June 2007 1 June 2007 15 November 2004 11 January 2006 11 January 2006 19 April 2007 4 January 2007 15 March 2007 3 April 2007 29 May 2008 16 February 2007 28 February 2007 16 February 2007 29 March 2007 29 March 2007 21 March 2008 20 March 2008 20 March 2008 12 April 2007 23 May 2006 8 December 2005 24 June 2008 26 July 2006 11 January 2006 TYPE 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 3-Panel 3-Panel 4-Panel 4-Panel 4-Panel 3-Panel 3-Panel 3-Panel 3-Panel 4-Panel 4-Panel 3-Panel 3-Panel 14 September 2007 11 October 2007 3-Panel 4-Panel listing of stocked qrgs users-20080909.doc Tuesday, September 09, 2008 listing of stocked qrgs users-20080909.doc Tuesday, September 09, 2008 "); array_files[77]=new Array(0,4,"./Publications/QRG_Discharge_WkSht_Basics.pdf","2008-09-04","696K"," QRG_Discharge_WkSht_Basics_[2008-09-04].pub ","","","· Finalization ­ only authorized prescribers are allowed to finalize (unfinalize) a discharge worksheet. Finalization results in the worksheet being available for printing and its routing to the EPR (electronic patient record of the associated patient) upon patient discharge. ACCESS DISCHARGE WORKSHEET 3. Click on the Enter Document icon. 4. Replace the Type here to enter document entry by typing in the first few characters of the desired worksheets name. NOTE Steps 8 & 9 are not applicable to JHH Department of Medicine Units! 8. Enter the necessary Health Issues/Diagnosis data (see figure on back of this sheet). 9. Enter Significant Events data (see figure on back of this sheet). 10. Edit the Order List for Pharmacy orders (see figure on back of this sheet). · One Per Visit ­ only one discharge worksheet is allowed per patient visit. PROCESS OVERVIEW The process used to access, complete, and finalize a discharge worksheet are categorized into the following sub-tasks: Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide describes latest generation of POE Discharge Worksheets and the process used by members of the JHH Clinical Staff to access, complete, and finalize those worksheets. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe · · · · · · · · selecting the appropriate patient; accessing the appropriate discharge worksheet; filling-out the discharge worksheet; editing an incomplete worksheet; submitting (saving) the un-finalized discharge worksheet; reviewing a discharge worksheet; finalizing the discharge worksheet, and, printing a discharge worksheet. Example........ Entering Neuro would result in the display of both the Neurology and Neurosurgery discharge worksheets, requiring you to select the one that you wanted. 5. Select (highlight) the desired worksheet appearing within the document listing. 11. Enter Additional Medications data. (see figure on back for fields identification). NOTE Step 12 only needs to be performed if the patient requires more medications than could be listed (identified) in steps 10 and 11. 12. Complete the Is patient taking more meds? section. 13. Complete the Discharge patient To section. 14. Complete the Patient Follow-Up Instructions section. 15. Complete the Follow-Up Appointments section. 16. Complete the Discharge Diets section. NOTE The discharge worksheet components addressed in the following steps differ for individual departments (units). The Neurosurgery worksheet is used as the focus of this quick guide. The selection of an appropriate diagnosis in the following step is necessary and will result in the appropriate data entry components being displayed in the subsequent steps. 17. Complete the Discharge Instructions for section. 18. Complete the Homecare Care Services section. (continued on back) SELECT APPROPRIATE PATIENT NOTE The following procedure assumes that the appropriate departmental (unit) list is displayed. 1. Select the Patient List tab. KEY POINTS Before you begin working with a POE Discharge Worksheet, you should familiarize yourself with the following key points: 6. Click the command button. FILL-OUT DISCHARGE WORKSHEET NOTE · Multiple Versions ­ discharge worksheets that specifically address the precise needs of each POE equipped department are available. Clinicians should be sure to select the correct worksheet at the time that document entry is initiated. 2. Select (highlight) the row displaying the information associated with the patient of interest. The previously entered header information is carried over into the discharge worksheet. You may temporarily remove the header and directory information from the display to gain additional viewing space by clicking on the collapse/expand icon. NOTE Clinicians may navigate through the components of the discharge worksheet by either selecting a component within the navigation sidebar (on the left side of the display) or using the scroll bar (slider) located on the right side of the display. 7. Enter the necessary Provider Information into text fields. · Dynamic Content ­ selections made and data provided by clinicians will determine the specific content of each worksheet. · Worksheet Tailoring ­ the majority of worksheet content will be the same for all JHH departments except for the Discharge Instructions section, which has been designed to meet the specific needs of the department with which the form is associated. POE Quick Reference Guide­Discharge Worksheet Basics Version 4.5 XA Revision--4 September 2008 This revision of the Discharge Worksheet Basics QRG supersedes all previous versions. Those dated prior to 4 September 2008 should be destroyed. ©2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. SUBMIT/FINALIZE WORKSHEET NOTE The This document has been completed and is ready for printing. check box should not be checked until the discharge worksheet is complete and ready for "); array_files[78]=new Array(0,4,"./Publications/Svc_Int_20080724-28.pdf","2008-07-23","11K"," POE Service Interruption - 7/23/2008 & 7/28/2008 ","","","Dear POE Customers, Tomorrow, Thursday, July 24th from 4:00am - 5:00am, POE will have a system outage to convert to a new Storage Area Network. A second outage will occur on Monday, July 28th, from 1:30am - 3:30am. Clinical Implications: 1. Orders cannot be placed in POE 2. POE eMAR is unavailable Prescribers When system is available 1. Only STAT and critical orders should be written during downtime 2. Write orders on yellow Downtime/Crash Order sheet (Form # 00964) 3. Notify nursing that new orders have been written 4. LABs and RAD need orders written on paper and paper requisitions 5. LAB results will be available in EPR and SCC (Eclipsys) When system is available 1. Orders with future activity need to be entered into POE 2. Discontinued orders need to be DCd in POE Nurses When system is available 1. FAX new medication orders to Pharmacy 2. Use printed LAB labels for LABs ordered prior to downtime 3. New LABs and RAD need orders written on paper and paper requisitions When system is available Reconcile the medications in POE with paper MAR Thank you for your continued support of POE. Dawn E. Kemp, RN, B.S. Project Leader - Customer Service and Production Support IT@ Johns Hopkins dkemp4@jhmi.edu (443) 287-6284 "); array_files[79]=new Array(0,4,"./Publications/QRG_Pediatric_Chemo_Orders.pdf","2008-05-29","365K"," QRG_Pediatric_Chemo Orders_(Final).pub ","","","PRESCRIBERS This section of the guide describes oncology prescriber placement of two distinct orders within POE. The first is one or more Chemo Placeholder Only orders that alert the PICU nurses to the existence of a chemotherapy agent, to be administered by a pediatric oncology nurse, that have been ordered using the current paper-based practice. The second is the OK for Chemo order that informs the nurses that administration of the associated course of chemo is authorized. NOTE The following processes assume that the appropriate pediatric patient has already been selected within POE as indicated by the display of appropriate patient information within the header region. Provider Order Entry (POE) ­ Quick Reference Guide 5. Select the Frequency option from the drop-down list or type an appropriate value. NOTE Only numeric frequencies are permitted! For example, q24h instead of daily, q12h instead of BID, etc. NURSES Chemo Placeholder Rescheduling The timing of the chemo placeholder on the eMAR should be determined by the patients nurse together with the pediatric oncology nurse. 1. Click on the eMAR (Worklist Manager) icon located within the POE toolbar. 6. Time Critical is the default priority and 2300 is the default time. 7. Select start date (current date is the default) and enter the duration in terms of # of times. 8. Use the Comments field to provide protocol timing information to assist the nurses in sequencing the chemo and ancillaries. For example, at t=0 after anti-emetics, or at t=42. 9. Click on the OK button. 10. Click on the Submit Order(s) for... button. OK for Chemo Order 3. Select the All Instances... option. 1. Click on the Enter Order icon POE toolbar. located within the 4. Reschedule the medication (placeholder) by entering new date and time values. 5. Select Task Rescheduled option from the Reason drop-down list. NOTE Please note that when initially displayed on the eMAR, the first scheduled instance of all chemo placeholder orders is set to 2300; unless the prescriber has specified otherwise. PURPOSE This guide is intended for users of the Provider Order Entry System (POE), who place and administer chemotherapy orders for pediatric patients. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe Chemo Placeholder Orders 1. Click on the Enter Order icon POE toolbar. located within the 2. Right-click within the Task Description cell of the placeholder order to access the Reschedule menu option. 2. Type Chemo into the field displaying the text Type here to enter order name. PROCEDURE OVERVIEW This quick guide focuses upon two specific areas. · Placement of pediatric chemo placeholder orders by the pediatric oncology prescribers · Management of those orders by nurses 3. Locate and double-click on the Chemo Placeholder Only order option. 2. Type Chemo into the field displaying the text Type here to enter order name. 3. Locate and double-click on the Chemo: OK for Chemo order option. 4. Click on the OK button. 5. Click on the Submit Order(s) for... button. Ancillary Orders The pediatric oncology prescriber should provide a copy of the paper GE/BDM chemotherapy orders to the PICU prescriber and review in detail the ancillary fluid, laboratory, and medication orders that the PICU prescriber will order in POE. (continued on back) 4. Select the preferred Medication from the drop-down list or type in the medication name. Provider Order Entry Quick Reference Guide­Pediatric Chemotherapy Orders Initial Release, Version 4.5 XA 29 May 2008 ©2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Changing Numeric Frequency Schedules NOTE The scheduled time(s) will appear in the box to the left. Impact of POE Roll-Out upon Existing Ordering Processes and Practices The impact of the POE Roll-Out upon established Chemo and related medications ordering processes and practices is summarized as follows: NOTE New/modified processes are dark red in color and are annotated with a five-pointed star. 1. The oncology prescriber orders chemo and all adjunct medications using the GE/BDM online chemo system and generates a paper orders report. 2. These orders remain on CMSC-8 (in the patient record). 6. Select either earlier or later from the Move checked tasks drop-down list. 7. Enter the number of hours and/or minutes that the currently scheduled date/time will be adjusted. 3. The oncology prescriber enters a chemo placeholder order in POE. a. Chemo placeholder order goes to the eMAR (no pharmacy verification) with a scheduled administration time of 2300 unless the prescriber has specified a different start date and time (can use User Schedule capability to specify times if appropriate). b. A boilerplate message will appear as part of this order, as displayed on the order summary and eMAR: To be administered by oncology nurse. Adjust timing to coordinate with adjunct meds. 8. Click the OK button. NOTE Click on the Refre "); array_files[80]=new Array(0,4,"./Publications/Manual_POE_Downtime_Reporting_System_User_Guide.pdf","2008-05-29","300K"," POE Downtime Reporting System User Guide "," 3.5 XA "," ","Provider Order Entry Version 4.5 XATM ­ May 29, 2008 Information Technology @ Johns Hopkins An online version of this publication is available for viewing on the POE web site accessible via the following URL: http://www.jhmcis.jhmi.edu/poe/index-Pubs.html POE Downtime Reporting System User Guide Revision History The revision history page identifies changes made to this publication beginning with its release on December 28, 2007. Change Listing Page(s) Description Revision [Date] 1 ..................................................................... Modified Functional Overview ..............................Revision 1, January 3, 2008 1 and 3 through 8 ........................................... Physical/Functional Changes ...............................Revision 2, May 7, 2008 (previous page 7 deleted) 1, 3, & 8 ......................................................... content changes ...................................................Revision 3, May 29, 2008 ©2007­2008 Information Technology @ Johns Hopkins. All rights reserved. No part of this User Guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sunrise Clinical Manager (SCM) is the property of the Eclipsys Technology Corporation. All other product and brand names are trademarks or registered trademarks of their respective companies. Revision 3 May 29, 2008 POE Downtime Reporting System User Guide Introduction PURPOSE The purpose of the POE Downtime Reporting System is to provide the JHH clinical community with sufficient information to sustain patient care on their units should POE (the Provider Order Entry System) become unavailable. FUNCTIONAL OVERVIEW This capability is made possible by a dedicated workstation--referred to as either the downtime reporting workstation or the downtime PC. The downtime reporting workstation serves as a data repository for information pertaining to all active patients on the associated unit. During POE downtimes, clinicians may use the dedicated workstation to retrieve patient information in the form of an Adult & Pediatric Downtime Active Orders report and a Downtime MAR (medication administration record) report. Information contained within the DOWNTIME MAR report spans a time period beginning 24 hours prior to the time of data storage and extending 12 hours into the future. NOTE It is important to note that two copies of each report will be maintained on the downtime reporting workstation­one copy reflecting the most recent reporting period and another copy reflecting the immediately preceding reporting period. Older versions of the reports are not archived on the units downtime reporting workstation. Each report is automatically updated every 30 minutes to ensure that the designated units downtime reporting workstation has the most up-to-date information possible should POE become temporarily unavailable. Each of these reports may be printed using the units designated POE downtime-printer. ADDITIONAL INFORMATION Additional information about the POE Downtime Reporting System may be obtained from the following sources. General Usage ....................................... Contact your units clinical manager Hardware & Software Issues ................ Contact the Help Desk @ 5-HELP Revision 3 1 May 29, 2008 POE Downtime Reporting System User Guide Accessing/Printing Downtime Reports The step-by-step process used to access the Downtime Reporting System, to view reports, to print reports, and to exit the system are described as follows. LOGGING IN 1. On your units designated downtime workstation, perform the appropriate action. a. NCCU7, MICU, & PICU ­ press and release the pushbutton on the black-box located near the workstation monitor b. MPC4 & CCU5/CCP ­ press and release the Scroll Lock key twice on the designated downtime workstations keyboard c. PACP ­ this downtime workstation does not require the user to perform any preliminary actions d. All Other Units ­ press and release the pushbutton located on the back of the designated downtime workstation monitor 2. Click the Start button. 3. Click on the POE Downtime Reporting option. A welcome screen--similar to the one below--will display for approximately five seconds . Revision 3 3 May 29, 2008 POE Downtime Reporting System User Guide The following Security Warning will then appear. NOTE Clicking the No button will close the application. Also, if you do not respond to this message within 50 seconds, the application will close; however, you can always restart it. 4. Click Yes to access the Downtime Reporting System. The following Logon dialog box will appear. NOTE In the following step, should you be unsure of your units passcode, please refer to your units downtime procedures manual for directions on obtaining that code. Generally, the passcode is stored within the PCA key drawer of your units medication Pyxis machine. The passcode is changed every 180 days. If your current passcode is not accepted in the following step, see your Nurse Manager (or designee) for the current (updated) passcode. 5. Enter "); array_files[81]=new Array(0,4,"./Publications/Pending_Dn-time_Procedures_(May-2008).pdf","2008-05-16","100K"," Pending Downtime Procedures - May 16, 2008 ","","","May 2008 There will be two POE Downtimes in May 1. Monday, May 12 from 1:30am to 3:30am 2. Monday, May 19 from 1:30am to 3:30 am Implications for Clinicians 1. Orders cannot be placed in POE during the outage. 2. The POE MAR will be unavailable. 3. Laboratory and Radiology orders will need to be placed using paper requisitions. To Prepare: All POE Nursing Units should ensure they have the following items. Downtime/Crash Order Sheets from Standard register (Form # U96-004) Paper MAR (utilized for new admissions during Downtime) (Form # JHH 15-252120) During the Downtime: 1. Restrict the number of new handwritten orders to time sensitive orders. 2. Utilize the Downtime/Crash Oder Sheet when writing orders. 3. Notify the nurse when an order has been written. 4. Medication orders will need to be faxed to Pharmacy. 5. Medication administration will need to be documented on the Downtime MAR. 6. Radiology and Laboratory orders will need to be written as paper orders and paper requisitions will need to be completed 7. You will need to call to schedule x-ray exams. 8. View Lab results in either EPR or Eclipsys, or call 5-2648. For Nursing Units WITHOUT a Downtime Computer: 1. A Downtime MAR will begin printing on each unit at approximately 2330. This MAR will contain 8 hours of information. 2. The Downtime MAR should be placed in the Medication section of the patients chart. 3. Medication administration will be documented on the Downtime MAR. 4. Use the 24 Hour Order Summary to review orders after the system is down. Pending_Dn-time_Procedures_(May-2008-revised).doc 1 of 2 JS/wam/20080516 May 2008 For Nursing Units WITH a Downtime Computer: Currently, these are the only units equipped with a downtime printer ­ NICU, SICU, SIMC, WICU, CSICU, and CPCU. 1. Begin printing the DOWNTIME MAR and the JHH Adult & Pediatrics Downtime Active Orders Report from the Downtime PC at 0100. 2. The Downtime MAR should be placed in the medication section of the patients chart. 3. Medication administration will be documented on the Downtime MAR. 4. The Downtime Active Orders Report should be placed in the Order section of the patients chart. Responsibilities After the System Comes Back Up 1. The POE Support Pool will not be deployed to back enter orders. 2. PRESCRIBERS will need to back enter any standing orders that were written. STAT and one-time orders do not need to be back entered into POE! 3. NURSES will need to: Ensure that overdue tasks are signed off on the POE eMAR. Ensure that new medications populate the POE eMAR correctly. Review orders that were written on paper. Make sure that any orders discontinued on paper are also discontinued in POE. 4. For assistance please call 4-Help! Pending_Dn-time_Procedures_(May-2008-revised).doc 2 of 2 JS/wam/20080516 "); array_files[82]=new Array(0,4,"./Publications/Downtime_Procedures_CAs.pdf","2008-05-08","68K"," Downtime Procedures - CAs "," 20080507 ","","Prior to POE Being Brought Down Note ­ all times stated below are approximations! Place an ample amount of paper in the POE printer. 1. Ensure that you have an extra printer cartridge as well as enough Downtime/Crash Order Sheets--may be ordered from Standard Register-Order # U96-004 2. Place 2 Downtime/Crash Order Sheets behind the orders tab in all patient charts. Printed Reports 3. The Downtime MAR will start automatically printing prior to the beginning of downtime (typically 1-2 hours). Each functional unit is responsible for determining where these will be placed--they can be either placed in the blue chart, bedside chart, or kept by the nurse. 4. The 24-hour Order Summary will print automatically­starting at midnight. Place these summaries behind the Orders tab in the patient chart. 5. The Historical MAR will start printing automatically at midnight. Place this document in the medication section of the blue chart. While the POE System Is Down 1. Notify the nursing staff when paper orders are written. 2. Notify the Nurse immediately of any STAT orders. 3. Transcribe all medication orders onto the printed Downtime MAR. The nurse will then verify the transcription and determine the medication administration times. NOTE ­ If a patient is admitted after downtime has started, the clerical associate or assigned nurse will need to transcribe medication orders for the new admission onto a paper MAR [form number ­ JHH 15-252120]. Transcribed orders will need to be verified by a second person (typically a nurse). 4. Fax/scan all medication orders to the appropriate pharmacy: Carnegie 6 Fax....... 5-4026 Osler 2 Fax ............ 2-0606, Stat Fax........... 2-0618 Peds Fax.................. 5-0283 Weinberg Fax .......... 5-6371 5. Complete laboratory requisitions for all labs written after downtime begins and place in the appropriate unit designated location. For labs written prior to downtime, labels will print in the appropriate location. This includes AM labs. 6. Call 5-2648 for time-critical blood draws and AM Lab orders. 7. Page Respiratory Services for any STAT respiratory orders. Remember to stamp all paper requisitions for x-rays, MRI, CT, etc. 8. Call the Radiology Department for STAT X-rays. Remember to send a paper requisition for all patients traveling to radiology. After the POE System Comes Back Up Ensure that the Downtime MAR is placed within the medication section of the blue chart. For assistance during downtime, contact the POE Command Center or the POE ON-Call Representative. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ Dn-time_Procedures_CAs_(Rev_B_20080507).doc DK/wam/20080507 "); array_files[83]=new Array(0,4,"./Publications/QRG_Viewing_ED_HMed_Visit_Summary.pdf","2008-04-24","1090K"," QRG - Viewing ED Visit Summary "," 20080424 ","","FINDING THE PATIENT 1. Click on the Find Patient icon toolbar. located within the POE ACCESSING THE DOCUMENT NOTE Your patients name should now be displayed within the POE title bar and immediately above the selection tabs. NOTE You have the option of selecting a tab other than the Identification tab in the following step and providing the necessary information for adequately identifying the patient prior to performing step 5. 2. Click on the Identification tab within the Find Patient dialog box. Provider Order Entry (POE) ­ Quick Reference Guide 9. Click on the Documents tab. 10. Select the All Available option from the Chart drop-down list. PURPOSE This guide is intended for users of POE who wish to view the Emergency Department (HMed) Visit Summary for a specific patient. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe NOTE Ensure that the date (range) selected in the following step encompasses the date of the ED visit. 11. Specify an appropriate date range within the Since region. 3. Select MRN as the ID Type from the drop-down list of options. 4. Enter the patients MRN into the ID field. 5. Click on the Search button. 6. Examine the Search Results region of the dialog box and double-click on the appropriate patient name. 7. Click on (highlight) the appropriate visit within the Show Visits dialog box. 12. Click the Apply button. NOTE If an ED Visit Summary does not appear within the list of documents region of the display, verify that the filter settings made in steps 10 and 11 are correct. ASSUMPTIONS This process assumes that a visit summary for the patient of interest exists. PROCEDURE OVERVIEW The two-step process described includes the following sub-tasks. · Locating the patient · Accessing the document NOTE POE should not be used to obtain a printed copy of the ED visit summary. Printed copies of all ED visit summaries should be obtained directly from the HealthMatics Emergency Department (HMED) System. 13. Double-click on the ED Summary listing (see example document on back of this guide). 14. Click on the Close button when finished viewing the document. (See figures on back) 8. Click on the OK button. Provider Order Entry Quick Reference Guide­Viewing ED (HMed) Visit Summary Initial Release, Version 4.5 XA 23 April 2008 ©2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. ED (HMED) Visit Summary Listing ED (HMED) Visit Summary Example Chart Options Since Region Be sure that the date (range of dates) specified in the Since region encompasses the visit date(s). Apply Button "); array_files[84]=new Array(0,1,"./WP_Demos/QD_Create_Jira_Issue.htm","2008-04-08","0K","QD - Create JIRA Issue ","",""," QD - Create JIRA Issue "); array_files[85]=new Array(0,1,"./WP_Demos/QD_Actions_on_Alert_Draft.htm","2008-04-08","0K","QD - Actions on Alerts, Overview ","",""," QD - Actions on Alerts, Overview "); array_files[86]=new Array(0,4,"./Publications/FF_eMAR_Enhancements_[3-8-2008].pdf","2008-04-02","72K"," eMAR Enhancements [Effective 3/8/2008] "," 20080308 ","","POE eMAR Enhancements [effective as of 3/8/2008] 1) Enhancement View #1: eMAR views PRN 12 Hr and PRN 8 Hr will now default to interval TASK ACTUAL. In the old view, PRN tasks completed more frequently than q1hr were not captured by an interval of 1 hour: OLD VIEW The new enhancement view will allow tasks completed more frequently than q1hr to be viewed with the actual time completed in the column header: NEW VIEW eMAR Enhancements [3-8-2008].doc 2) Enhancement View #2: A new view is added on the eMAR called Orderset. The new Orderset view will allow all medications included in an orderset to be shown together. Medications not in an orderset are listed at the bottom. 3) Enhancement View #3: The view Med History will now include cancelled medications. This change will allow the following circumstances to be viewed on the eMAR view Med History: a) Medications for which a comment was written, but no dose documented b) Medications discontinued after the order start date and time, but prior to any dose being documented. However, medications discontinued prior to the order start date and time cannot be viewed. For example: It is Monday and you admit a patient who needs his fentanyl patch changed on Tuesday. The doctor writes the order for the fentanyl patch to start tomorrow. Later the doctor decides to not use the fentanyl patch at all and discontinues the order. This order will not show up on the Med History because it was ordered to start Tuesday and then d/cd on Monday, before the first dose was due. eMAR Enhancements [3-8-2008].doc "); array_files[87]=new Array(0,4,"./Publications/QRG_Order_Review_Nursing.pdf","2008-03-31","385K"," QRG- Orders, Nursing Review "," 20060111 ","","TEMPORARY FILTER CHANGE NOTE If you change the filter selection using this procedure, the next time you logon, this filter selection will be returned to its default--By Department. If you wish to make the Requested By details option your permanent filter selection, perform the steps listed under the PERMANENT FILTER CHANGE heading. Provider Order Entry (POE) ­ Quick Reference Guide PERMANENT FILTER CHANGE NOTE This procedure will permanently change the default filter selection from By Department to Requested By details. Each time you logon to POE, the orders display will reflect selection of the Requested By details option. 1. Click on the Orders tab. 1. 2. Click on the Orders tab. Click the Requested By details filter option within the 2. Select the Preferences menu option. Order Review... This guide is intended for use by JHH providers, nurses and pharmacists. OVERVIEW This guide provides guidance in obtaining a detailed listing of patient orders in a reverse chronological sequence using POEs display filter functionality. Also provided is a description of the process used to make the orders display default to the Requested By details filter option upon selection of the Orders tab. A few hints about interpreting the resultant orders display are provided on the back of this sheet. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. STARTING POINT This guide assumes that you have been trained and possess the required user ID and password to access POE. It also assumes that you are currently logged into POE and have the proper unit/patient selected. Display Format filter region of the POE display. NOTE Refer to the INTERPRETING ORDERS DISPLAY topic on the reverse side of this sheet for information about interpreting the resultant orders display. 4. 5. 6. 7. 3. Select the Display Format tab. Select (highlight) the Requested By details option. Select the Reverse Chronological radio button (the most recent orders at the top of the listing). Click the Set as Default command button. Click the Close command button. (continued on back) Provider Order Entry Quick Reference Guide­Order Review­Nursing Version 4.0 XA Revised 11 January 2006 The revision of the Order Review­Nursing QRG supersedes all previous editions. Those dated prior to 11 January 2006 should be destroyed. ©2005-2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. INTERPRETING ORDERS DISPLAY Some aspects of the orders display illustrated to the right of this column are provided for the following topics. · Recognizing original orders. · Recognizing order status changes. · Determining the currently selected Order Selection filter. · Determining the currently selected order Status filter. Order Selection Filter The currently enabled Order Selection filter is reflected in the title bar of the orders display. See callout Status Filter The currently enabled Status filter is reflected in the title bar of the orders display. See callout Original Orders The information associated with the originally placed order may generally be recognized by the absence of information under the date/time header at the far left of the display; however, current status is specifically stated at the right side of the display . See callout Options include: · All (normal selection) · Clinical Paths · Non-Clinical paths · Order Sets Options include: · Active Only · All (normal selection) · Completed · Discontinued Order Status Changes Orders that have undergone a change of status are generally annotated in two places. For example, Discontinued (the status change) appears in the status column of the original order with the date/time that the change was made indicated to its immediate right. Discontinued (the status change) also appears under the date/time header associated with the date and time of the status change. See callout NOTING PERFORMANCE OF A REVIEW After reviewing current patient orders, you should use the standard POE order entry process to enter a Nurse Order Review order (marker)--to indicate the date and time that the order review was conducted. Any orders subsequently appearing in the patient order summary display after the Nurse Order Review marker will require review. Once all orders appearing after the original marker have been reviewed, you should enter a new Nurse Order Review marker (order). "); array_files[88]=new Array(0,4,"./Publications/User_Guide.pdf","2008-03-31","8187K"," User Guide, POE Version 4.0 "," 20060115 "," ","Provider Order Entry Version 4.0 XA ­ January 15, 2006 ATTENTION! Also see both POE Upgrade Summaries (Versions 3.5 XA and 4.0 XA) and the Bidirectional Pharmacy Interface Guide for more detailed information about the features and fixes that have been incorporated into POE since its initial installation in June of 2004. Information Technology @ Johns Hopkins An online version of this publication is available for viewing at the following URL: http://www.jhmcis.jhmi.edu/poe/index.html POE User Guide ©2004­2006 Information Technology @ Johns Hopkins. All rights reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sunrise Clinical Manager (SCM) is the property of the Eclipsys Technology Corporation. All other product and brand names are trademarks or registered trademarks of their respective companies. Version 4.0 XA January 15, 2006 POE User Guide Revision History The revision history page is a listing that allows the reader to quickly identify changes made with this publication since the release of Revision B on October 29th 2005. Change Listing Page(s) Description Revision [Date] ii-iii ........................................................................ new/modified content ............................................POE Version 4.0 [January 15, 2006] 4-5 ........................................................................ new/modified content ............................................POE Version 4.0 [January 15, 2006] 14, 16-30, 93 ........................................................ new/modified content ............................................POE Version 4.0 [January 15, 2006] 117 ....................................................................... new/modified content ............................................POE Version 4.0 [January 15, 2006] 243 ....................................................................... new/modified content ............................................POE Version 4.0 [January 15, 2006] A Version 4.0 XA January 15, 2006 POE User Guide CONTENTS REVISION HISTORY ......................................................................................................A PREFACE ................................................................................................................... XIX 1 1.1 1.2 1.3 2 2.1 2.1.1 2.1.2 2.2 2.3 3 4 4.1 4.2 4.3 4.4 5 5.1 PURPOSE OF POE .......................................................................................... XIX Name .............................................................................................................xix Hosting System .............................................................................................xix Current System Limitations ...........................................................................xix PURPOSE OF GUIDE........................................................................................ XX Use of Guide.................................................................................................. xx Figures..................................................................................................... xx Online Availability .................................................................................... xx POE Guidance & Institutional Policy ............................................................ xxii Changes to this Guide .................................................................................. xxii POE USE & PATIENT CARE ........................................................................... XXII UPGRADE TO SCM VERSION 3.5 XATM ....................................................... XXIII Upgrade Overview....................................................................................... xxiii Display Component Appearance & Coloration ............................................ xxiv Order Frequency Designations.....................................................................xxv Personal Patient Lists...................................................................................xxv UPGRADE TO SCM VERSION 4.0 XATM ....................................................... XXVI Upgrade Overview.......................................................................................xxvi GLOSSARY .............................................................................................................. XXIX POE OVERVIEW ............................................................................................................ 1 1 2 2.1 2.2 2.3 2.3.1 2.3.2 2.3.3 2.3.4 2.3.5 2.3.6 2.3.7 3 3.1 3.2 3.2.1 3.2.2 3.2.3 INSTITUTIONAL POLICIES & THE POE GUIDE ................................................. 1 USER (GROUP) OVERVIEW................................................................................1 Definitions........................................................................................................ 2 User Access ............................................................................................... "); array_files[89]=new Array(0,4,"./Publications/Upgrade_Summary_4.5.pdf","2008-03-31","686K"," Upgrade Summary, POE Version 4.5 "," 20061021 "," ","Provider Order Entry Version 4.5 XATM ­ October 21, 2006 Information Technology @ Johns Hopkins An online version of this publication is available for viewing on the POE web site accessible via the following URL: http://www.jhmcis.jhmi.edu/poe/index-Pubs.html POE Upgrade Summary (SCM 4.5XA) ©2006 Information Technology @ Johns Hopkins. All rights reserved. No part of this Upgrade Summary may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sunrise Clinical Manager (SCM) is the property of the Eclipsys Technology Corporation. All other product and brand names are trademarks or registered trademarks of their respective companies. Initial Release October 21, 2006 POE Upgrade Summary (SCM 4.5XA) CONTENTS PREFACE....................................................................................................................................III 1 1.1 1.2 1.3 2 3 USE OF THE POE UPGRADE SUMMARY ................................................................. iii Figures ................................................................................................................... iii Tables .................................................................................................................... iii Online Availability...................................................................................................iii POE GUIDANCE & INSTITUTIONAL POLICY ............................................................ iii POE USE & PATIENT CARE.......................................................................................iv INTRODUCTION .......................................................................................................................... 1 1 2 3 UPGRADE OVERVIEW ............................................................................................... 1 UPGRADE CONTENT ................................................................................................. 1 CURRENT LIMITATIONS LISTING ............................................................................. 1 NEW/CHANGED FUNCTIONALITY ............................................................................................ 3 1 1.1 1.2 2 2.1 2.2 2.3 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 4 5 5.1 5.1.1 5.1.2 5.2 5.3 5.4 5.4.1 5.4.2 PATIENT HEADER CHANGES ................................................................................... 3 No Header Data ..................................................................................................... 3 Patient Data Displayed: ......................................................................................... 3 PATIENT LIST.............................................................................................................. 3 First Patient Not Automatically Selected................................................................ 4 Patient List Displays Alternating Line Colors ......................................................... 4 Select All Patients Button....................................................................................... 5 ORDER ENTRY WORKSHEET ................................................................................... 6 Patient Name on Submit Button............................................................................. 6 Metric Weight Rounding Rules .............................................................................. 6 Calculated Fields--Trailing Zeroes........................................................................ 6 New Available Message (Order Entry) Icon........................................................... 7 Order Form Checkboxes--Visual Focus Indicators............................................... 8 Drop-Down List Options--Auto-Selection.............................................................. 8 Retain Original Requestor Dialog .......................................................................... 8 eMAR (RESCHEDULE ALL INSTANCES) ................................................................ 10 ORDER SUMMARY ................................................................................................... 11 Order Summary Filters......................................................................................... 11 Standard Tab.............................................................................................. 12 Alternate Tab..............................................................................................13 Improved Modified Order Icon Operation ............................................................ 14 Pharmacy Verification Icon .................................................................................. 15 Discontinuing Order(s) within an Orderset........................................................... 15 Previous Functionality ................................................................................ 15 New Functionality ....................................................................................... 15 DOWNTIME PROCEDURES FOR THE 4.5 UPGRADE ......... "); array_files[90]=new Array(0,4,"./Publications/Upgrade_Summary_4.0.pdf","2008-03-31","772K"," Upgrade Summary, POE Version 4.0 "," 20051029 "," ","Provider Order Entry Version 4.0 XATM ­ October 29, 2005 Information Technology @ Johns Hopkins An online version of this publication is available for viewing on the POE web site accessible via the following URL: http://www.jhmcis.jhmi.edu/poe/publications.html POE Upgrade Summary ©2005 Information Technology @ Johns Hopkins. All rights reserved. No part of this Upgrade Summary may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sunrise Clinical Manager (SCM) is the property of the Eclipsys Technology Corporation. All other product and brand names are trademarks or registered trademarks of their respective companies. Version 4.0 XATM October 29, 2005 POE Upgrade Summary Revision History The revision history page is a listing that allows the reader to quickly identify changes made to the pages contained with this publication. Change Listing Page(s) Description Version [Date] All ......................................................................... Initial Publication Release ........................................ SCM 4.0 [October 29, 2005] A Version 4.0 XATM October 29, 2005 POE Upgrade Summary CONTENTS REVISION HISTORY................................................................................................................... A OTHER POE PUBLICATIONS ..................................................................................................... v PREFACE................................................................................................................................... vii 1 1.1 1.2 1.3 1.3.1 1.3.2 2 3 4 USE OF THE POE UPGRADE SUMMARY ........................................................ vii Figures............................................................................................................vii Tables.............................................................................................................vii Online Availability ...........................................................................................vii Links .........................................................................................................vii PDF Reader Navigation Devices ............................................................. viii POE GUIDANCE & INSTITUTIONAL POLICY ...................................................viii CHANGES TO THIS UPGRADE SUMMARY ...................................................... ix POE USE & PATIENT CARE ............................................................................... ix GLOSSARY................................................................................................................................. xi INTRODUCTION .......................................................................................................................... 1 1 2 3 UPGRADE OVERVIEW ........................................................................................ 1 UPGRADE CONTENT .......................................................................................... 1 CURRENT LIMITATIONS LISTING ...................................................................... 3 NEW/CHANGED FUNCTIONALITY ............................................................................................ 5 1 2 2.1 2.1.1 2.1.2 2.1.3 2.1.4 2.1.5 2.2 3 4 4.1 4.2 5 5.1 5.1.1 5.1.2 5.2 5.3 5.4 SYSTEM SECURITY--PASSWORDS..................................................................5 PATIENT LISTS .................................................................................................... 5 Sorting by Column ........................................................................................... 5 Default Patient List..................................................................................... 6 Patient List­Ascending Patient Name Sort................................................ 6 Patient List­Descending Patient Name Sort.............................................. 6 Patient List­Multiple Column Sort.............................................................. 7 Sorting Non-Alphabetical Characters ........................................................ 8 Column Repositioning ..................................................................................... 8 Patient Info Tab ..................................................................................................... 9 ORDER ENTRY WORKSHEET ............................................................................ 9 Submit / Cancel Command Buttons ................................................................ 9 Mark As Done Functionality........................................................................... 10 ORDERS & RESULTS ........................................................................................ 12 Sliding Scale Orders...................................................................................... 12 Add A Row............................................................................................... 13 Automated `From Value Determination............................ "); array_files[91]=new Array(0,4,"./Publications/Upgrade_Summary.pdf","2008-03-31","969K"," Upgrade Summary, POE Version 3.5 "," 20050314 ","","Provider Order Entry Version 3.5 XATM Revision A ­ March 14, 2005 Information Technology @ Johns Hopkins An online version of this publication is available for viewing at the following URL: http://www.jhmcis.jhmi.edu/poe/publications.html POE Upgrade Summary ©2004-2005 Information Technology @ Johns Hopkins. All rights reserved. No part of this Upgrade Summary may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sunrise Clinical Manager (SCM) is the property of the Eclipsys Technology Corporation. All other product and brand names are trademarks or registered trademarks of their respective companies. Version 3.5 XATM Revision A March 14, 2005 POE Upgrade Summary Revision History The revision history page is a listing that allows the reader to quickly identify changes made to the pages contained with this publication. Change Listing Page(s) Description Revision [Date] Except for those pages noted below .................... Initial Publication Release ........................................ SCM 3.5XA [November 15, 2004] v, vii and xi ........................................................... new content .............................................................. Revision A [March 14, 2005] ix ........................................................................... new content .............................................................. Revision A [March 14, 2005] 1 ........................................................................... new content .............................................................. Revision A [March 14, 2005] 23 through 27 ....................................................... new content .............................................................. Revision A [March 14, 2005] 29 ......................................................................... new content .............................................................. Revision A [March 14, 2005] A Version 3.5 XATM Revision A March 14, 2005 POE Upgrade Summary CONTENTS REVISION HISTORY................................................................................................................... A OTHER POE PUBLICATIONS .................................................................................................... V PREFACE.................................................................................................................................. VII 1 1.1 1.2 1.3 1.3.1 1.3.2 2 3 4 USE OF THE POE UPGRADE SUMMARY ........................................................ vii Figures............................................................................................................vii Tables.............................................................................................................vii Online Availability ...........................................................................................vii Links .........................................................................................................vii PDF Reader Navigation Devices ............................................................. viii POE GUIDANCE & INSTITUTIONAL POLICY .................................................... ix CHANGES TO THIS UPGRADE SUMMARY ...................................................... ix POE USE & PATIENT CARE ............................................................................... ix GLOSSARY................................................................................................................................ XI INTRODUCTION .......................................................................................................................... 1 1 2 3 UPGRADE OVERVIEW ........................................................................................ 1 ORDER FREQUENCY DESIGNATIONS..............................................................1 PERSONAL PATIENT LISTS................................................................................2 ICONS & DISPLAYS .................................................................................................................... 3 1 2 3 4 DISPLAY COMPONENT APPEARANCE & COLORATION ................................. 3 STAT & PRN ICONS ............................................................................................. 4 WORKLIST (MAR) ................................................................................................ 5 TOOLBAR ICONS ................................................................................................. 6 NEW FEATURES & FUNCTIONS................................................................................................7 1 2 2.1 2.2 2.3 3 3.1 3.2 3.3 3.4 4 5 ALLERGY CHANGES ........................................................................................... 7 WARNING MESSAGES--ALERTS ...................................................................... 9 Alert Detail Dialog Box................................................................................... 10 Available Actions Dialog Box........ "); array_files[92]=new Array(0,4,"./Publications/ST_Dialysis_Implementation_Overview.pdf","2008-03-31","244K"," Survival Tips, Dialysis Implementation Overview "," 20071011 ","","· When verifying orders, the renal providers must be careful to ONLY verify the dialysis orders. Do not use Select All because there may be other orders pending verification that do not belong to the renal provider. Rehab patients: When a patient is discharged from the inpatient area & admitted to rehab, all orders are discontinued. Dialysis must be reordered upon that patients admission to rehab. Dialysis orders are entered in a standard session except for the TBE patients. Orders become active at 00:01 AM on the day the treatment is scheduled ­ they will appear on the order summary as pending at the time of order entry. CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) ORDER ENTRY NURSING FACTS · · · · When ordering CRRT, ALWAYS order a total of 4 bags of dialysate, whether of one type or multiple types. Within the CRRT orderset, renal providers can ONLY DC/reorder CRRT settings (blood flow rate). All other CRRT orders are linked & changing them means entering a new orderset. All HAR-4 order notices will print on patients floor (the assigned ADT location). · Treatment completion: When the hemodialysis treatment is finished, the dialysis nurse will discontinue the entire HD orderset on behalf of the renal provider. The nurse must select D/C per treatment complete as the source. POE Survival Tips · NOTE ICU providers can change the ultrafiltrate rate using a separate order. Perform the following steps to DC/reorder ONLY the blood flow rate: 1. Select (highlight) the CRRT settings order in order review tab. 2. Right-click and select D/C Reorder. 3. Proceed with reorder until it is in the scratch pad. 4. Select (highlight) the order. 5. Click on EDIT. 6. Modify the blood flow rate (if desired). 7. Click OK and submit. · Check orders flags: Dialysis nurses clear ONLY dialysis-related flags. · Floor nurses should only clear orders that pertain to them. Do not clear dialysis related flags. HD (HEMODIALYSIS) ORDER ENTRY · TBE PROCESS: The provider must manually change from a Standard ordering session to the Pre procedure ordering session. · Any meds to be given in dialysis must continue to be sent to HAR-4 with patient. Provider checks To Be Evaluated order in HD orderset. To find the TBE order, type TBE in the manual entry field on the order form. Upon receipt of the TBE release order, dialysis nurse releases the HD orderset. **Do Not implement TBE HD orders until a TBE release order is entered. · Floor nurses will continue to document PD dialysate bag exchanges on their I&O flowsheet. The PD nurse will sign off dialysate bags that contain antibiotics on the POE eMAR. · PD nurses will create screen shots of the peritoneal dialysis orders to use as a shopping list when initiating treatment. PURPOSE This document summarizes the features introduced by the POE Dialysis Implementation and their use. ORDERS TAB: ORDER STATUS DEFINITIONS Active............................... good-to-go for today Pending .......................... ready, but not for today Pending verification ....... not good until a renal provider verifies it Preliminary ..................... almost good; the renal nurse or provider needs to release these TBE orders; then theyre active. NOTE Order requisitions will not print for TBE orders until they are released. LAB FACTS · · Lab MLM affects ONLY HD patients. How the lab MLM works: 1. It looks to see if the patient has an active Hemodialysis Protocol order (mandatory in the HD orderset). 2. If the protocol order is present, it displays a checkbox option Draw in dialysis (Labs ordered within the HD orderset have this box pre-checked). 3. If this box is checked, it looks at the most recent HD orderset Treatment location entry. 4. Based on this entry, the label will either print on the floor (if Bedside selected) or in HAR-4 (if Dialyze in unit). GENERAL ORDER ENTRY · Patients on POE units: For each scheduled dialysis treatment, the HD orderset needs to be entered in POE. For PD and CRRT treatments the orderset is entered once and remains continuous until there is a change. At that time a new orderset will be placed. Patients on Non-POE units: No changes to the current workflow. These patients will remain on paper. ED & EACU patients will remain on paper. · The only HD item that can be DC/reordered is the hemodialysis dialysate. This should be done during a treatment only; not when ordering future treatments. PD (PERITONEAL DIALYSIS) ORDER ENTRY · · · · Dialysate orders: **Provider MUST specify exchange frequency in the comment field. PD dialysate will appear on the eMAR and will have a cyan blue continuous bar. (continued on back) POE Survival Tips­Dialysis Implementation Version 4.5 XA 11 October 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. LAB FACTS ­ continued DIALYSIS SECURITY- ADULT & PEDS ORDER AVAILABILITY 3. Peritoneal Dialysis Orders Printout Description: This report prints a full list of orders within the PD dialysis orderset. Purpose: Serves "); array_files[93]=new Array(0,4,"./Publications/ST_Blood%20Products_[Final].pdf","2008-03-31","192K"," Survival Tips, Blood Products "," 20070914 ","","ABOUT THE NEW ORDERSET The features of the new blood products orderset are summarized as follows. Name ­ Blood Product orderset Used By ­ all departments except Pediatrics New Emergent/Uncross-Matched Blood Ordering Process · During an emergency, it is NOT necessary to place an order for emergent/uncross-matched blood using POE. · To receive emergent/uncross-matched blood, POE Survival Tips Type and Screen ­ the ABO, Rh Antibody Screen order is now clearly identified as Type and Screen. If an order to transfuse blood products is placed and no Type and Screen order is currently active, a warning message will be displayed to the prescriber instructing them to place a Type and Screen order. Within the Orderset Each type of blood product contains the following two orders. · An order, which is sent directly to the blood bank, to prescribers must call the blood bank at 5-6580. · After the emergency has been resolved, the prescriber will use POE to order the emergent/uncross-matched blood product. · When ordering, the prescriber must check the Blood already received check box. · Each blood product ordered will populate a cell on the eMAR. · The nurse will: cross-match the number of units. · A order instructing the nurse to transfuse the mark each cell as Done; change the administration time to reflect the actual time of product administration; and enter Blood given during emergency into the Comment section of the administration form. product. This order indicates the number of units to be transfused and tells the nurse when and how fast to transfuse the product. WHAT The Blood Product orderset has changed. The nurse will still need to fax a blood products request form to the blood bank. New Platelet Ordering Process · Prescribers will be allowed to order only 1 adult · In the event a prescriber needs to order more WHEN This new version of the Blood Product orderset will be available for use on... platelet dose at a time. · The number of units contained within the bag will emergent/uncross-matched blood, the Blood already received checkbox should be left blank. Conditional Heme 8 Lab Orders · Prescribers can place an order to draw a September 18, 2007 at 1:00 WHY PM not be contained in the order ­it is determined by the Transfusion Medicine Resident ­ Dr. Platelet (pager number - 3-9792). · The comment section of the ordering form displays the Heme 8 after the transfusion. · The Heme 8 order is a conditional lab order. · The nurse: The rationale for developing and fielding this new blood product orderset is summarized below. · To simplify the ordering of blood products by creating one comprehensive orderset as a replacement for the multiple ordersets that were previously available in POE. · Address the previous inability of providers to order emergent/uncross-matched blood in a timely manner. · Reflect the fact that pre-medication for blood transfusions is not routinely recommended. POE Survival Tips­New Blood Products Orderset Version 4.5 XA, 14 September 2007 following message ­ One adult dose of platelets contains approximately six equivalent units of platelets. Each adult dose (dispensed in a single bag) contains enough platelets to raise the platelet count in a normal individual by approximately 50,000 per micro-liter. · Only 1 cell will populate the eMAR. · After the nurse marks the eMAR as done a form will activate this lab when the condition is met per the prescribers order; and must select the next appropriate/ available round time, which should be at least 1 hour post transfusion. appear that requires the nurse to Enter the # of units in this product (bag). The nurse will document the # of units contained within the platelet product bag on this form. ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. . "); array_files[94]=new Array(0,4,"./Publications/QU-20080317_Oxygen.pdf","2008-03-31","69K"," Quarterly Update - Oxygen Orders (New Form) "," 20080317 ","","Quarterly Release March 18, 2008 New Oxygen Order Form Teaching Point #1: All of the non-mechanical ventilation oxygen administration routes have been combined into one order form called Oxygen, General Teaching Points #2: The Nasal Cannula option is the only one which can be combined with any of the other choices. It will not, for example, allow both a Face Tent and Venturi Mask to be ordered simultaneously on this order form. The system will automatically deselect the first option. Once the Oxygen device/delivery method is selected, the appropriate mandatory fields will appear so the order can be completed. This form does not include bi-pap or cpap. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Oxygen-FINAL_1.doc "); array_files[95]=new Array(0,4,"./Publications/QU-20080317_Mech_Vent.pdf","2008-03-31","115K"," Quarterly Update - Mechanical Ventilation, Adults (New Order Form) "," 20080317 ","","March 18, 2008 New Mechanical Ventilation Order Form (ADULTS ONLY) Teaching Points #1: The order form has been redesigned; can be found by typing vent in the browser. Affects the adult form only; the pediatric mechanical ventilation order remains the same. For standard mechanical ventilation, click on the blue grid; all the vent parameters needing to be ordered will be on form which opens (form shown below). Quarterly Release NOTE: There is also now a separate order form for independent lung ventilation. Blood Gas Order is automatically checked. Chest X-Ray can be ordered Nursing Protocols automatically checked Teaching Points #2: Standard Mechanical Ventilation Order Form The ventilator settings will not populate until a mode is selected. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Mech Vent-FINAL.doc Teaching Points #3: Below is the new order form for Independent Lung Ventilation Modes for both the right and left lung must be selected Teaching Points #3: As with the mechanical order form, once the mode is selected all of the appropriate fields for that particular vent mode will populate Though not designated by a red asterisk, under the Ventilation Management section, the prescriber must select a cuff inflation designation. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Mech Vent-FINAL.doc "); array_files[96]=new Array(0,4,"./Publications/QU-20080317_Factor_Products.pdf","2008-03-31","286K"," Quarterly Update - Factor Products "," 20080317 ","","Quarterly Release March 18, 2008 Factor Products NEW: EMAR Population and Documentation 1. There is no change for the prescriber in how factor product is ordered. 2. This shows how it will appear on the Order Summary for Nursing. Notice the Authorized Dose the prescriber orders does not appear on the Order Summary. While not shown here, it can seen by RIGHT clicking on the order, selecting VIEW and then DETAILS. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Factor Product-FINAL.doc 3. 4. 5. Factor Product for bolus administration will now populate the EMAR Continuous Factor Product Infusions will not populate the EMAR yet, but will in the future. In this example below, the prescriber ordered the Factor Product to be given every 12 hours with the first dose being administered today. Because it is not known when the product will be available for administration, a solid yellow bar is generated. This means the system will assign the schedule after the RN documents the first dose. 5. RNs will need to go in to the appropriately timed cell and Mark as Done C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Factor Product-FINAL.doc 6. This is the form that will appear. RNs will get the Number of Units Administered from the vials supplied by blood bank. 7. RN enters the value and clicks OK: C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Factor Product-FINAL.doc 8. This is how it will look when its been signed off on the EMAR 9. A look into the future shows that the next task has been correctly set. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Factor Product-FINAL.doc 10. One way to view the Number of Units Administered: 11. The dose along with the date and time of administration can be seen here: C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Factor Product-FINAL.doc "); array_files[97]=new Array(0,4,"./Publications/QU-20080317_EEG.pdf","2008-03-31","39K"," Quarterly Update - EEG Form, New "," 20080317 ","","Quarterly Release March 18, 2008 New EEG Form Mandatory Fields The Diagnosis, Precautions and Abstract History/Neurological Findings fields are free text. Medications: The system will automatically look at the POE system for the following medications: Ativan, Lorazepam Carbatrol, Carbamazepine Cerebyx, Fosphenytoin Depakene, Valproic Acid Depakote, Valproic Acid Dilantin, Phenytoin Felbatol, Felbamate Gabatril, Tiagabine Keppra, Levetiracetam: Klonopin, Clonazepam Lamictal, Lamotrigine Mysoline, Primidone Neurontin, Gabapentin Pentobarbital Phenobarbital Propofol Tegretol, Carbamazepine Topamax, Topiramate Trileptal, Oxcarbazepine Valium, Diazepam Versed, Midazolam Zarontin, Ethosuximide Zonegran, Zonizamide Meds given in the past 72 Hours: the system will search the POE EMAR for the administration of any of the above medications in the past 72 hours and will automatically populate the field with the information. The field is blank in this example because none of the applicable medications have been signed off. Meds ordered in the past 72 hours (not given): the system will search the system for any of the above medications which have been ordered, but not administered. Remember: if the patient was just admitted, the prescriber will have to manually review the home medication list to ensure the patient has not received any of the above medications within the past 72 hours. If the provider needs to add any home medications to this form, the Special Instructions field should be used. The 2 medication fields which are grayed out will not accept new entries. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317EEG-FINAL.doc "); array_files[98]=new Array(0,4,"./Publications/QU-20080317_Declot.pdf","2008-03-31","68K"," Quarterly Update - Declot Orderset, Reminder "," 20080317 ","","Quarterly Release March 18, 2008 Reminder: Declot Orderset Teaching Point #1 A new orderset for declotting central lines has been available since February 2008. It can be found by typing declot or central into the browser. Teaching Point #2: This orderset allows the VAT nurse to assess the line, obtain an x-ray if needed, and infuse the Alteplase in all the lumens required. Only VAT may activate the conditional order C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Declot-FINAL_1.doc "); array_files[99]=new Array(0,4,"./Publications/QU-20080317_Adult_Tube_Feed.pdf","2008-03-31","95K"," Quarterly Update - Adult Tube Feed Form, Revised "," 20080317 ","","Quarterly Release March 18, 2008 Revised Adult Tube Feed Form Teaching Point #1: There are now Non-Modular v. Modular options in the catalog This example shows two options for Modular Tube Feed; they are to be used when customization will be necessary. Teaching Point #2: Changes to the Non-Modular (or Non-customized) Tube Feed Options Only the Bolus Feeds have changed. The continuous and cyclic options have remained the same. JT and NJ have been removed from the route drop down choices If customization is necessary (i.e. additives etc.), use the modular option C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Adult Tube Feed-FINAL.doc Revised Adult Tube Feed Form (Continued) Teaching Point #3: The new Modular order form The Base to be used will automatically be defaulted to the tube feed being ordered. The changes made in the standard form for bolus feeds will apply here also. C:-- POE --POE Construction AreaPublications(N)_Miscellaneous_PubsQuarterly Updates20080317Adult Tube Feed-FINAL.doc "); array_files[100]=new Array(0,4,"./Publications/QRG_View_Prnt_Disc_WkSht.pdf","2008-03-31","918K"," QRG - Discharge Worksheet, View/Print "," 20080318 ","","Select Appropriate Patient 1. Select the Patient List tab. Preview Patient Version of Discharge Worksheet 10. Select Documents from the Report Category dropdown list of options. 2. Select the patients unit from the Current List drop-down menu. NOTE The displayed title of each report includes the associated unit name. 3. Click on (highlight) the listing associated with the patient of interest. Provider Order Entry (POE) ­ Quick Guide Access Document Display 4. Select the Documents tab. 12. Click on (highlight) the desired JHH Discharge Worksheet Report item. 13. Click the Preview command button. 14. Click on the paging arrows ( ) within the toolbar to view each page of the selected report. NOTE Do not initiate printing of the discharge worksheet from within the Preview display. Doing so will result in a single copy of the report being printed rather than the required three--for the chart, the unit, and the patient. Proceed to step 16 to print this report. However, you may initiate a print request within the Preview display, should you desire to print additional copies of the worksheet on the unit and nowhere else. PURPOSE This guide is intended for use by JHH Nursing Staff and Clerical Associates. It describes the process used to view and print selected patient discharge worksheets. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. Select/Verify Data Filter Settings 5. Verify that the Since and To fields contain appropriate date information. ASSUMPTIONS It is assumed that you: · · 15. Click on the close 6. Ensure that Report is selected from the Display Format drop-down. icon to exit the preview. are currently logged into POE, and have attended appropriate POE training. Print Discharge Worksheet NOTE The discharge worksheet cannot be printed until it has been finalized by a prescriber. Attempting to print an un-finalized worksheet will result in the display of an error message similar to the example provided on the back of this sheet. Using the Print command button to generate a printout of the discharge worksheet will result in the production of three copies--one for the provider, one for the unit, and one for the patient. OVERVIEW This process consists of the following subtasks: · · · · · Preview Provider Version of Discharge Worksheet NOTE Performance of the following step will result in the providers version of the discharge worksheet being displayed within the Document Details display. It will likely be necessary to use the vertical scroll bar (slider) to view the entire report. selecting the appropriate patient, Accessing the POE Document display, selecting/verifying appropriate data filter settings, selecting the discharge worksheet, previewing the provider version of the discharge worksheet, · previewing the patient version of the discharge worksheet, and · printing the patient version of the discharge worksheet. 7. Double-click on the discharge worksheet listing. 8. Click the Close command button when finished previewing the discharge worksheet. 16. Click the Print command button. 17. Click the Close command button. Preview Patient Version of Discharge Worksheet 9. Click on the discharge worksheet listing. 10. Click the Print Reports icon within the POE toolbar. (illustrations on back) Provider Order Entry Quick Guide­View/Print Discharge Worksheet Version 4.5 XA Revision­18 March 2008 This version of the View/Print Discharge Worksheet QG supersedes all previous editions. Versions of this document dated prior to 18 March 2008 should be destroyed. ©2005­2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Discharge Worksheet Previews Preview of the Patient Discharge Worksheet Preview of the Provider Discharge Worksheet Discharge Worksheet for patient cannot be printed because the document has NOT been finalized. Example ­ Message displayed when attempting to print an unfinalized discharge worksheet. "); array_files[101]=new Array(0,4,"./Publications/QRG_Verifying_Orders.pdf","2008-03-31","1638K"," QRG - Verifying Orders "," 20070403 ","","Part 1--Verify Orders for a Specific Patient NOTE The appropriate Patient List should be currently displayed on your workstation monitor screen. Figure 1, which is illustrative of the following procedure, is located on the back of this sheet. Provider Order Entry (POE) ­ Quick Reference Guide Part 2--Specify a Verifying Prescriber NOTE This description assumes that you are in the act of writing an order that requires verification and that you have just clicked on the Submit Order(s) for... button. Figure 2, which is illustrative of the following procedure, is located on the back of this sheet. 1. Double-click on the flag appearing in the To Sign cell of the appropriate patient. The displayed flag may appear as either (at least one unsigned order exists) or (at least one unsigned order exists that requires YOUR signature). 2. Review all of the orders that have check marks ( ) in the box appearing to the immediate left of each pertinent orders. NOTE Before proceeding, you may unselect any checkbox associated with an order that you do not wish to verify. If you choose to not verify a specific order, you should contact the ordering Prescriber to discuss your reason(s). PURPOSE This guide describes the POE processes used by JHH Prescribers for verification of orders written by other Prescribers within the same clinical group. The verification process described herein consists of two distinct activities: · · 1. Click on the button (within the Verify Order Provider Selection dialog box). 2. Click the radio button. NOTE Be sure to verify that your selection in the following step is assigned to the appropriate Organizational Unit and displays the correct Occupation. confirmation of medication orders flagged for verification within the Patient List display, and the specification of a Prescriber, in response to the Verify Order Provider Selection dialog box, when submitting (placing) an order requiring verification. 3. Select (highlight) the preferred Prescriber­the person who will verify this order (order set)­from the list of displayed candidates. 4. Click the button. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. 3. Click the button (part of the Signature Manager dialog box). 4. Click the button. NOTE 5. Complete submission process for the associated order (order set). NOTE Orders requiring verification will not become active (filled by the Pharmacy) until they have been verified by the specified Prescriber. ASSUMPTIONS It is assumed that you: · · · At this point, all of the verified orders will be active within POE ­ marked as Active within the POE Order Summary. They will also be transmitted to the Pharmacy for processing. 5. Click on the Orders tab and confirm that these verified know your JHED ID, have attended appropriate POE training, and are currently logged into POE. orders are annotated as being Active. NOTE The label that appears after this note will be part of each listed order that is awaiting Pharmacy Verification. 6. Make the Prescriber, who was identified in step 3, aware of those orders that require verification. Provider Order Entry Quick Reference Guide­Verifying Orders Version 4.5 XA 3 April 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Step 1 Step 1 Steps 2-4 Steps 2-4 Step 5 "); array_files[102]=new Array(0,4,"./Publications/QRG_Vari-Dose_Slid_Scale_Orders_PEDs.pdf","2008-03-31","1034K"," QRG - Variable-Dose/Sliding-Scale Orders (Peds), Entering "," 20070216 ","","ENTER ORDER 1. Click on the Enter Order icon. 2. Enter insulin: into the field initially containing the following phrase. 3. Double-click on displayed within the list of options. NOTE Illustrations of the dialog boxes encountered in the following steps are provided on the back of this sheet. Provider Order Entry (POE) ­ Quick Reference Guide 12. Repeat step 11 as necessary. NOTE In the following step, be sure to leave the corresponding To field blank. 13. Enter the if BG is (if blood glucose is greater than) value. 14. Click in the Dose/Instructions field. 15. Press the F2 key followed by the End key. 16. Press the Backspace key on your workstation keyboard until all of the _____ characters are removed. 17. Enter your instructions. 18. Click within the blue box associated with each empty row that you wish to delete. 19. Click the Delete command button. 20. Click the OK command button. NOTE Steps 21 and 22 are only necessary if you wish to enter a comment­ being careful to not delete information already there. In the majority of instances, this order set will be used in conjunction with both meals and snacks, so be sure to select both orders (meals and snacks) in the following steps. PURPOSE This guide is intended for use by JHH Prescribers who need to place variable-dose sliding-scale pediatric orders within POE. NOTE Currently, insulin is the only medication associated with this order process and is only available through a POE order set. 4. Click (select) the Carb Coverage/Correction with Meals order­a check should appear in the associated check box. 5. Click (select) the Carb Coverage/Correction with Snacks order­a check should appear in the associated check box. 6. Double click on Insulin Aspart--with meals; SubQ grams carbohydrates consumed to initiate entry of this orders details. 7. Enter the number of units to be given. 8. Enter a value for the number of carbohydrate grams per unit. 9. Click on the drop-down arrow associated with the Correction Factor/Variable Dosage field. NOTE If the blood glucose value is below that entered in the following step, the RN will follow the instruction ­ NHO and give 4 oz juice. The Prescriber can change the amount of juice or the instruction within this first line by performing steps 14-17. Be sure to leave the corresponding To field blank. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. 21. If desired, click within the Comments field and press the End key. 22. Enter desired comment text. 23. Click the OK command button. NOTE Repeat steps 6 through 23 for the remaining order. Substitute Insulin Aspart--tid PRN; regulate blood glucose; SubQ grams carbohydrates consumed for Insulin Aspart--with meals; SubQ grams carbohydrates in step 6. ASSUMPTIONS It is assumed that you: · · · · know your JHED ID, have received appropriate POE training, are currently logged into POE, and that POE focus is upon the appropriate patient. 10. Enter a the low amount value into the From field. 11. Enter appropriate From, To, and Dose/Instructions in the next row as appropriate. 24. Click the OK command button. 25. Click the Submit Orders for. . . button. POE Quick Reference­Variable Dose / Sliding-Scale Orders (Peds), Entering Version 4.5 XA 16 February 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 4 5 6 7 10 11 12 8 9 18 13 19 15 16 (Not Shown) 14 17 20 21 22 23 24 25 (Not Shown) "); array_files[103]=new Array(0,4,"./Publications/QRG_Using_the_MAR.pdf","2008-03-31","348K"," QRG - eMAR, Using the "," 20070409 ","","5. Click OK. The Pharmacy Med Comment Form will open. The Administered At Date and Time fields are completed for you. No other fields are mandatory 6. You may enter Comments if desired. 7. Click OK. The corresponding MAR cell displays a check mark, pen and the initials of the person who administered the medication. RESCHEDULING ADMINISTRATION TIME: Remember! You should always reschedule an instance (order administration) prior to marking it as done on the eMAR. 1. Right-click the cell representing the medication and scheduled time of administration. 2. Select Reschedule. 3. Select either This Instance or All Instances. 4. Select the instances from the list by clicking in the check boxes next to each instance of interest. 5. Select Later or Earlier from the Move Checked Tasks list. 6. Select the number of hours and/or minutes to move the tasks. 7. Select a Reason. 8. Click OK. The MAR now reflects the new scheduled administration time. RESETTING MED STATUS Use this procedure if you have accidentally documented the wrong medication/patient to reset the associated status. You can only reset the status of medications that you documented. 1. 2. 3. 4. 5. Right-click on incorrectly documented cell. Select Edit. Select Reset Task Status. Select or type the Reason for resetting the status. Click OK. DOCUMENTING ALL MEDS­ONE TIME INTERVAL 1. Click on the time interval at the top of the MAR grid. All medications scheduled to be administered in that time interval will be highlighted. 2. Right-click on any highlighted cell. 3. Select Mark As Done. The Mark As Done dialog box appears. 4. Click on one medication to mark as done. The Pharmacy Med Comment Form will open. The Administered At Date and Time fields are completed for you. No other fields are mandatory. 5. You may enter Comments if desired. 6. Click OK. eMAR FILTERS The content of the eMAR may be specified via selection of one of the following filters. You should note that you have the capability to alter the filter data ­ date, time, etc. ­ to meet your specific needs. · Provider Order Entry (POE) ­ Quick Reference Guide NOTE All of the tasks described herein assume that POE focus is on the correct patient and that the eMAR is displayed. SECOND SIGN-OFFS: Within Pediatrics, the second signature requirement for Insulin Correction Orders differs with the process described below. Refer to the Quick Reference Guide titled Insulin Correction Orders (Peds), Administering for second signature instructions appropriate for that order. The following describes the steps taken by the second (verifying) nurse after performance of a double-check of the associated order. 1. Right-click the cell representing the medication order that requires a second sign-off (verification). 2. Select the Add Comments... menu option. 3. Enter the following statement in the lower data region of the Add Comment dialog box. Double-checked by name, RN Type your first initial and last name in place of name. An asterisk will now appear within the commented cell . 4. Click on the Logoff icon. The administering nurse will subsequently administer the associated medication and document the event by the steps listed for the Documenting MEDS GIVEN BY YOU topic presented earlier in this document. DOCUMENTING MEDS GIVEN BY YOU 1. Right-click on the cell representing the medication and its time of administration. In the following step, you may enter a different time of administration by overwriting the displayed value. 1. Select Mark as Done. The Pharmacy Med Comment Form will open. The Administered At Date and Time fields are completed for you. No other fields are mandatory. 2. You may enter Comments if desired. 3. Click OK. The corresponding MAR cell displays a check mark and your initials. DOCUMENTING MEDS GIVEN AT ANOTHER TIME: 1. Right-click the cell representing the medication and actual time of administration. This cell will currently be blank as the medication was scheduled at another time. 2. Select Add Completed Task. 3. Click Yes. 4. The Pharmacy Med Comment Form will open. The Administered At Date field is completed for you. 5. Type the time of administration in the Time field. 6. You may enter Comments if desired. 7. Click OK. The selected cell displays a check mark and your initials. · · DOCUMENTING MEDS GIVEN BY SOMEONE ELSE 1. Right-click on the cell representing the medication and time of administration. 2. Select Mark as Done by Other. The Performed By dialog box appears. 3. Begin typing the last name of the person whom administered the medication. 4. Select the appropriate name from the resultant list of names. POE Quick Reference Guide­eMAR, Using the Version 4.5 XA 9 April 2007 DOCUMENTING MEDS NOT GIVEN 1. Right-click the cell representing the medication and scheduled time of administration. 2. Select Mark as Not Done. The Task Not Done dialog box appears. 3. Select an appropriate reason from the list. 4. You may enter Comments if desired. 5. Click OK. The associated MAR cell displays a red X. This revision of the Using the eMAR QRG supersedes all previous editions. Those dated prior to 9 April 2007 sh "); array_files[104]=new Array(0,4,"./Publications/QRG_Transfusions_eMAR.pdf","2008-03-31","704K"," QRG - Transfusions, Documenting on the eMAR "," 20060726 ","","NOTE This procedure assumes that you are logged into POE and that system focus is upon the patient of interest. NOTE­continued Blood products must be administered within 4 hours of the time that they left the blood bank. 1. Click the Worklist Manager icon eMAR. to access the For Second & Subsequent Transfusions NOTE If only one transfusion is associated with the order, proceed directly to step 11. NOTE As illustrated below, transfusion orders appear at the top of the eMAR display. 6. Right-click in the cell associated with the next transfusion. Provider Order Entry (POE) ­ Quick Reference Guide 7. Select the Mark as Done option from the resultant menu. 2. Right-click in the cell that corresponds to the date and time that the bag was hung. 3. Select the Mark as Done option from the resultant menu. NOTE If the order is for either platelets or cyroprecipitates, you will need to enter the number of units in step 4; otherwise, proceed directly to step 5. NOTE If the order is for either platelets or cyroprecipitates, you will need to enter the number of units in step 8; otherwise, proceed directly to step 9. PURPOSE This guide is intended for use by JHH Nurses and describes the process used by them to document the transfusion of blood products. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. 8. Enter the appropriate value into the Enter # of Units in This Product (Bag) data field. 9. Click the OK button on the resultant nurses comment dialog (Nur Comment). NOTE If this is the last transfusion associated with this order, proceed to step 10; otherwise, repeat steps 6 through 9. WHEN & HOW TO DOCUMENT When the blood product is hung, you document Mark as Done on the eMAR. Time actual will appear (rather than hourly time) as the default. You do not need to document the completion of the transfusion on the eMAR since that is reflected on the flowsheet. When multiple units are ordered, the schedule for administration of subsequent units will be calculated and displayed based upon information already contained within the order. BLOOD PRODUCTS Currently, Nurses may document transfusion of the following blood products on the POE eMAR. · Red Blood Cells · Autologous RBCs · Platelets · Fresh Frozen Plasma · Cryoprecipitate · Rhogam 4. Enter the appropriate value into the Enter # of Units in This Product (Bag) data field (see figure on back). 5. Click the OK button on the resultant nurses comment dialog (Nur Comment). NOTE As indicated by the following graphic, your initials and a check mark will appear within the cell that you selected in step2. If this order requires multiple transfusions, POE will calculate the date and time that the next transfusion should occur--based upon the documented date/time that the first bag was hung. 11. Click the Close button to return to the Orders display. NOTE Click on the Orders tab if the Orders display is not visible. Note that POE automatically marked the associated blood product order as Completed after the last unit (bag) was hung--marked as done. Review the comments on the back of this guide for a concise discussion of overdue transfusions and how they are treated by POE. Please remember to document the amount of transfused blood product on the patients I&O form--depending on your unit, the I&O form may be either a paper or electronic form. ©2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference­Documenting Transfusions Revision­Version 4.0 XA 26 July 2006 About Overdue Transfusions POE determines if a transfusion is overdue based upon the date/time that the initial bag was hung (administered). You must therefore be aware of the following situations. 1. Overdue indications will never be displayed for blood products requiring but a single transfusion. 2. Overdue indications will also never be displayed for blood products requiring multiple transfusions if the initial bag was never hung. Indications of an overdue transfusion will appear 4 hours after the transfusions scheduled time and result in the background color of the associated task description and date/time cells turning red. Blood Products and the Yellow-Trough 1. Whenever the provider has specified When Available as a frequency, a yellow trough will be displayed by the eMAR prior to the first unit being hung. 2. Whenever the provider has specified either Emergent or Urgent as a frequency, only those individual cells appropriate for the order will be highlighted. · · Only the eMAR date/time cells associated with the initial transfusion and any subsequent transfusions will possess a yellow background coloration. The initial cell (transfusion) will be annotated with a red flag as well. Nurses Comment Dialog This data field is displayed for platelet and cryoprecipitate orders only. It will not appear on the NUR Comment form associated with any other blood product. "); array_files[105]=new Array(0,4,"./Publications/QRG_Struct_PS_Note_Peds_Pt_2.pdf","2008-03-31","1085K"," QRG - Structured Pain Services Note, Part 2 (Consults & Procedures) "," 20070329 ","","PRIOR TO BEGINNING You should: · · · know your JHED ID, have attended appropriate POE training, and logged into POE. NOTE Inactive as well as Active medications appear within this listing. Use the horizontal scroll bar (slider) to access the right-side of the list and view the status of all displayed orders. You may need to click on the expand icon ( ) to view medications within a currently collapsed list. 12. Place a check mark ( ) in the box associated with each medication displayed by the Orders List that you wish to appear in the note (see back of sheet). 13. Click the 14. Click the command button. command button. PROGRESS NOTE ­ DAY 3 AND BEYOND NOTE Prior to performing step 22, you should ensure that the patient of interest is selected. 22. Click on the Document Entry icon. 23. Click within the data field containing the text shown below. You should have also begun a structured note for the patient of interest following the instructions provided within Part 1 of this Quick Guide. PROGRESS NOTE ­ DAY 2 Create Note Provider Order Entry (POE) ­ Quick Reference Guide 24. Type Peds into the data field. 25. Double-click on the Peds Pain Service option. 26. Click the command button in the lower right-hand corner of the display. 27. Select the note with the most recent date & time­ from the list within the left-most region of the display (see back of sheet for steps 27­29)). 28. Select the Progress Note check box (a check mark will appear) within the center region of the display. 29. Click the command button. NOTE Click on the appropriate note section in the display sidebar to perform the following step. 30. Review, amend, and update note as appropriate. 31. Select Current Medications in the dialog sidebar. 32. Click on the Pharmacy expand icon ( medications listing is compressed. ) if the NOTE Prior to performing step 1, you should ensure that the patient of interest is selected. 1. Click on the Document Entry icon. 2. Click within the data field containing the text shown below. Print Note NOTE Prior to performing step 15, you should select the patient of interest (via the Patient List tab). 15. Click on the Documents tab. PURPOSE This guide is intended for use by JHH Prescribers, who are unfamiliar with the POE process used to develop a structured Pediatric Pain Service Note. OVERVIEW The process used to develop Pediatric Pain Service Notes is cumulative and typically takes place over a period of several days. Initially, a Prescriber will create the Consult and Procedure portion of this note. Prescribers will amend the note with Progress Note information that will be sequentially updated over the course of the patients stay. This Quick Guide is divided into two distinct parts. Part 1 covers the development and printing of the Consult and Procedure segments of the note; while, Part 2 focuses upon the development and update of Progress Notes over the duration of the patients visit. 3. Type Peds into the data field. 4. Double-click on the Peds Pain Service option. 5. Click on the Progress Note listing within the sidebar (left side of dialog-see back of sheet). NOTE Enter data into required data fields in the following step while leaving inappropriate fields blank. 6. Enter data into all appropriate Details region data fields (see back of sheet). 7. Click on the command button. 16. Select Report as the Display Format (left sidebar). 17. Right-click on the document (note) displaying the correct date and time and select the Print Selected Documents menu option (see back of sheet). 18. Ensure that the Documents is displayed in the Report Category field. 19. Select (highlight) the JHH Peds Pain Progress Note NOTE . NOTE You may need to scroll to the right side of the display to determine order status­active or inactive. 33. Ensure that a check mark appears next to all medications you wish to appear within the note. 34. Click on the 35. Click on the command button. command button. ADDITIONAL INFORMATION Before beginning, please note that additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe 8. Enter data into appropriate Assessment region data fields (see back of sheet). 9. Click on the command button. 10. Enter data into all appropriate Plan data fields (see back of sheet). 11. Click on the command button. NOTE In the following step, ensure that a check mark appears to the immediate left of all medications that you wish to appear within the progress note. There is no visual feedback that indicates your print request is being (has been) processed. Please do not click the Print icon again without first checking your units POE printer for the requested report. 20. Click the 21. Click the command button. command button. NOTE To print the updated note, perform the Print Note procedure (steps 13--19) in the preceding panel. POE Quick Reference Guide­Structured Pain Service Note­Peds, Part 2 of 2 Version 4.5 XA 29 March 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any Steps 6 & 31 Step "); array_files[106]=new Array(0,4,"./Publications/QRG_Struct_PS_Note_Peds_Pt_1.pdf","2008-03-31","1176K"," QRG - Structured Pain Service Note, Part 1 (Consults & Procedures) "," 20070329 ","","PRIOR TO BEGINNING You should: · · · know your JHED ID, have attended appropriate POE training, and logged into POE. 11. Click on the Order List icon to access the Order Entry Worksheet. 12. Enter pain in place of the following highlighted. 13. Double-click on the preferred order set­Pain Epidural Orders PED, Pain IV PCA PED, or Pain NEONATAL Epidural Orders PED (see back of sheet). 14. Review and complete orders within the Order Set Summary (see back of sheet). 15. Click the command button. NOTE You may need to respond to the Peds Dose Calculator for one or more medications prior to proceeding to the next step. It may also be necessary to use the vertical scroll bar (slider) in order to review all of the orders in the following step. 16. Review the orders list within the Order Entry Worksheet (see back of sheet). 17. Click the command button. 18. Click the command button. 19. Enter data into the Consult (Plan) section of the note as appropriate (see back of sheet). 20. Click the command button. 21. Enter data into the Placement of Epidural Catheter for Pain Management section of the Procedure Note (see back of sheet). 22. Click the command button. 23. Click the command button. Print Consult & Procedure Note NOTE Prior to performing step 1, you should select the patient of interest (via the Patient List tab). 1. Click on the Documents tab. 2. Select Report as the Display Format (left sidebar). DAY 1 Create Consult & Procedure Note NOTE Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide is intended for use by JHH Prescribers, who are unfamiliar with the POE process used to develop a structured Pediatric Pain Service Note. Prior to performing step 1, you should ensure that the correct patient is selected (via the Patient List tab) and then review, modify, and discontinue orders as necessary. 1. Click on the Enter Document icon. 2. Click within the data field containing the text shown below. 3. Type Peds into the data field. 4. Double-click on the Peds Pain Service option. NOTE You will likely need to enter data into a few select data fields in the following step­simply leave those fields that you deem inappropriate blank. You may need to use the vertical slider (scroll bar) to access all of the fields. 5. Enter data into the History section as appropriate (see back of sheet). 6. Click the command button. 7. Review/update the contents of the Allergy List (see back of sheet). 8. Remove the check mark, located to the immediate left of any allergy that you wish to omit from the note. 9. If you need to add an allergy (allergies), click on the icon (Allergy List), and complete the necessary fields in the resultant Allergy (Adding New) dialog box; otherwise, proceed to the next step. 10. Click the command button. 3. Right-click on the document (note) displaying the correct date and time and select the Print Selected Documents menu option. 4. Ensure that the Documents is displayed in the Report Category field. OVERVIEW The process used to develop Pediatric Pain Service Notes is cumulative and typically takes place over a period of several days. Initially, a Prescriber will create the Consult and Procedure portion of this note. Prescribers will amend the note with Progress Note information that will be sequentially updated over the course of the patients stay. This Quick Guide is divided into two distinct parts. Part 1 covers the development and printing of the Consult and Procedure segments of the note; while, Part 2 focuses upon the development and update of Progress Notes over the duration of the patients visit. 5. Select (highlight) the NOTE . There is no visual feedback that indicates your print request is being (has been) processed. Please do not click the Print icon again without first checking your units POE printer for the requested report. 6. Click the command button. NOTE If you wish to print the procedure note, repeat steps 5 (select JHH Peds Pain Procedure Note) and 6; otherwise proceed to step 7. 7. Click the command button. ADDITIONAL INFORMATION Before beginning, please note that additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe POE Quick Reference Guide­Structured Pain Service Note­Peds, Part 1 of 2 Version 4.5 XA 29 March 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any Step 14 Step 5 Step 16 Step 7 Step 11 Step 13 Step 19 Step 21 "); array_files[107]=new Array(0,4,"./Publications/QRG_Sign-Out_Note_Creating.pdf","2008-03-31","1079K"," QRG - Sign-Out Note, Creating "," 20070622 ","","NOTE Refer to the Quick Reference Guide titled Patient Lists & Searches if you need help creating a patient list prior to performing the following steps. Enter Access Data 18. Select the check boxes associated with the venous access sites. 19. Enter any additional free-form information as appropriate. Enter Condition Data 20. Select the radio button reflective of the patients condition. Enter Significant Event Data 21. Click the Significant Event icon. 22. Select the appropriate Type option from the drop-down list. 23. Enter a brief yet descriptive label into the Event field. 24. Enter a more detailed Description of the event. 25. Click the drop-down arrow associated with the Full Date list and select the appropriate date. NOTE A check mark must be present in the check box associated with each significant event that you wish to have displayed by the Sign Out Note accessed via the Clinical tab or the associated report. 26. Click the OK command button. 27. Click the Submit command button. 28. Click the Close command button. Enter To Do Data 29. Click the Patient Info tab. 30. Click on the Comment option within the Data Entry region. 31. Click on the appropriate Type option­Anticipated, Cross Cover, Heads Up, or My To Do. 32. Enter appropriate information into the Comment field. 33. Click the OK command button. NOTE Repeat steps 29 through 33 if additional To Do info needs to be added. 34. Click on the Clinical Summary tab. 35. Click the refresh icon to view completed Sign Off Note. NOTE If you need to create/update a Sign Off Note for another patient, proceed to the following step; otherwise proceed to the Printing Sign Out Note instructions. 36. Click on the Next Patient icon tool bar. 37. within the POE CREATING/UPDATING SIGN OUT NOTES 1. Highlight the patient(s) of interest that are displayed on your patient list. 2. Click the Clinical Summary tab. 3. Make sure that Sign Out Tool is displayed within the View drop-down window. Provider Order Entry (POE) ­ Quick Reference Guide Repeat steps 3 through 35 for next patient. PRINTING SIGN OUT NOTES 1. Click on the Orders tab. 2. Click on the printer icon in the POE tool bar. 3. Click on the report titled .JHH Sign Out Report. 4. Click on the Preview command button. 5. Use the VCR-like controls (left side of title bar) to navigate between pages. 6. Click on the printer icon. 7. Click the OK command button. 8. Click on the icon (right side of title bar) to close the print preview display. 9. Click the Close command button within the Report Selection dialog. 4. Right-click within the Documents region of the Clinical Summary display. 5. Select the Document Entry menu option. 6. Click within the field containing the text Type here to enter document. 7. Type the letters si. 8. Select (highlight) the Sign Out Note option displayed within the Document Name region. 9. Click the Open command button. Enter Patient History Data 10. Click within the white-colored cell of the History row. 11. Enter/modify contents within the History dialog box. Enter Health Issues / Problem List Data 12. Click the Health Issues icon. 13. Select the appropriate option from the issue Type drop-down list. 14. Enter a Health Issue into the Short Name data field. 15. Enter additional information into the Description field. 16. Enter appropriate data into the Dates region. NOTE A check mark must be present in the check box associated with each problem that you wish to have displayed by the Sign Out Note accessed via the Clinical tab or the associated report. 17. Click the OK command button. PURPOSE This guide is intended for use by JHH Residents within the Department of Medicine and describes the process used to create a Sign Out Note. The method used to view and subsequently print the Sign Out Note is also described. Please note that additional information about other aspects of POE operation is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe PRIOR TO BEGINNING It is assumed that you: · · · · know your JHED ID, have attended appropriate POE training, have logged into POE, and have your list of patients selected (via the Current List drop-down menu accessible via the Patient List tab). SIGN-OUT NOTE COMPOSITION An example of the POE online Sign Out Note is provided on the back of this sheet. You should note that this note consists of seven parts--Sign Out Note, Diagnoses, Medications, Significant Events, To Do Items, Allergies, and DC Worksheet. The DoM Resident will provide the information for all but three of these sections The sections titled Medications, Allergies)and DC Worksheet are automatically populated (filled-in) by POE. POE Quick Reference Guide­Sign Out Note, Creating Version 4.5 XA Revised 22 June 2007 This revised QRG--Sign Out Note, Creating--supersedes all previous editions. Those dated prior to 22 June 2007 should be destroyed. ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 3 2 1 (Not Shown) 4 5 13 14 15 1 "); array_files[108]=new Array(0,4,"./Publications/QRG_Signing_Orders.pdf","2008-03-31","599K"," QRG - Signing Orders "," 20070104 ","","METHOD 1 Sign All Orders Written by the Care Team for a Specific Patient Provider Order Entry (POE) ­ Quick Reference Guide METHOD 2 Sign All of Your Orders for All of Your Patients NOTE A patient MUST be selected (highlighted)­within the patient list­in order for the Signature Manager icon to be available (functional). If the Signature Manager icon within the toolbar appears faded (grayed-out) you need to make a selection within the patient list before proceeding with the following procedure. NOTE Supplemental information about the following steps may be found on the back of this sheet. NOTE The appropriate Patient List should be currently displayed on your workstation monitor screen. Supplemental information about the following procedure may be found on the back of this sheet. PURPOSE This guide is intended for use by JHH Prescribers and describes the processes used to sign off orders for either: · · all orders written by the care team of a specific patient, or orders for all patients written by the prescriber who is currently logged into POE. 1. Double-click on the flag appearing in the To Sign cell of the appropriate patient. The flag may appear as either (at least one unsigned order exists) or (at least one unsigned order exists that requires your signature). 2. Click the button (in the Signature Manager dialog box) to select all of the listed orders. NOTE Before proceeding, you may unselect any checkbox associated with an order that you do not wish to sign. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. 1. Click the Signature Manager icon displayed within the POE tool bar. NOTE All of your orders for all of your patients will be pre-selected (checked). ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. 3. Click the 4. Click the button. button. 2. Click the 3. Click the button. button. TWO METHODS Two methods are described herein that may be employed to sign orders. Method 1......... Sign all orders for the care team of a specific patient. Method 2......... Sign all orders for all of your (the currently logged user) patients. Provider Order Entry Quick Reference Guide­Signing Orders Version 4.5 XA, Revision 1 4 January 2007 This Quick Reference Guide replaces all versions (dated prior to January 4, 2007). All previously issued versions of this guide should be destroyed . ©2006-2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Patient Selection Defaults Method 1--To Sign Flag (Care Team Orders) This Patient--This Chart Method 2--Signature Manager (Your Orders) All Patients These check marks indicate orders requiring a signature. Orders associated with other prescribers will appear blue in color. Your orders (the currently logged user) will appear black in color and be pre-checked. NOTE Using either method described on the front of this quick reference will automatically result in the selection of the appropriate Patient Selection and Provider Selection filter options. There will generally be no need to change these settings! Check boxes associated with your orders will be pre-checked as exemplified by the following example. Check boxes associated with orders of other prescribers will not be checked by default--you will need to select those orders that you wish to sign. Provider Selection Defaults Method 1--To Sign Flag (Care Team Orders) All Providers Method 2--Signature Manager (Your Orders) My Signatures The presence of this icon (to the immediate right of an order check box) indicates that an alert is associated with the order. The nature of the alert may be determined by first, highlighting the associated order and then clicking the dialogs Alerts button. Note the appearance of a signed-off order icon. These icons will be cleared once the Close button is selected. "); array_files[109]=new Array(0,4,"./Publications/QRG_RN_Ack_Mod_of_PCA_&_Epi_Orders.pdf","2008-03-31","1149K"," QRG - Adult PCA & Epidural Order Modification, Nurse Acknowledgement "," 20070601 ","","ACKNOWLEDGING ORDER MODIFICATION NOTE This procedure assumes that the appropriate patient has already been selected and that the Order Summary is displayed. Phase 1 ­ Review the Modification History 1. Right-click within the Order Summary description of the order displaying the DOSE ADJUSTMENT label. Provider Order Entry (POE) ­ Quick Reference Guide OVERVIEW This guide is intended to inform JHH Nurses of a new requirement when dealing with either a modified adult PCA / Epidural order within POE. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. IMPACT OF NEW FUNCTIONALITY Prescribers now have the ability to modify existing PCA and Epidural orders without having to discontinue and reorder those existing orders. This creates the potential for situations where an existing PCA or Epidural order may be modified and the Nurse administering that order might not become aware of the modifications in a timely manner. For that reason: · 2. Select the menu option. 3. Review the content of the Order Modification History dialog and note the indicated modifications to the order. 4. Click on the command button. 9. Note that the DOSE ADJUSTMENT label previously displayed within the order description field of the POE Order Summary has been replaced by the ACKNOWLEDGED label. Phase 2 ­ Acknowledge the Dose Adjustment 5. Right-click within the Order Summary description of the order displaying the DOSE ADJUSTMENT label. 6. Select the menu option. 7. Review the content of the resultant order form (dialog) and note that indicated modifications reflect those observed in step 3. 8. Click on the command button. NOTE Performance of the next step indicates your awareness of the fact that a prescriber has modified the selected order and that you have reviewed the associated Order Modification History. This acknowledgement has nothing to do with order administration, which is a separate act whose performance is recorded following established POE eMAR procedures. Prescribers have been advised to contact the appropriate nurse whenever they modify existing PCA/Epidural orders. Nurses will acknowledge that notification (and their awareness of the order modification) by making an appropriate data entry within POE. · This quick reference describes the methodology used by Nurses to make that acknowledge. POE Quick Reference Guide Adult PCA & Epidural Order Modification ­ Nurse Acknowledgement 1 June 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. This label indicates that the order has been modified by a prescriber. Steps 1 & 5 Step 9 This label indicates that a nurse has reviewed the order modification(s) and is aware of the changed value(s). Use this dialog to review modifications made to the associated order. Closing this dialog triggers the insertion of the ACKNOWLEDGED label into the Order Summary display. Steps 3 & 4 Steps 7 & 8 "); array_files[110]=new Array(0,4,"./Publications/QRG_Repeating_Lab_Orders.pdf","2008-03-31","775K"," QRG - Repeating Lab Orders, Creating "," 20070419 ","","CREATE A REPEATING LAB ORDER 1. Click on the Enter Order icon. 2. Enter (type) the name of lab order in place of the highlighted entry ­ . 3. Double-click on the preferred order option. 4. Click on the Requested Time drop-down arrow to access list of collection time options. 5. Click on the preferred Requested Time from the displayed list of available options. 6. Click on the command button. 7. Perform the steps appropriate for the desired Repetition Pattern only! · Daily Repetition­perform steps D1­D3. · Weekly Repetition­perform steps W1­W4. NOTE Hourly Repetition Patterns are set in a manner similar to those used to set Daily and Weekly patterns, which are described below. 8. Verify Start date­if the default entry is unacceptable, modify by clicking on the drop-down arrow and selecting the preferred start date. 9. Indicate a preferred Start time by either clicking on the drop-down arrow and selecting the preferred time option or entering a specific time (using the 24-hour clock) directly into the data field. 10. Perform only those steps appropriate for defining the desired End point only! · End After­perform steps A1­A3. · End by­perform steps B1­B3. End After A1. A2. A3. End by B1. B2. Click on the radio button. Click on the calendar drop-down arrow and select the preferred date. Indicate a preferred stop (end) time by either clicking on the drop-down arrow and selecting the preferred time option or entering a specific time (24-hour clock) directly into the data field. Click on the radio button. Enter a whole number into the data field. Proceed directly to step 11­be sure to read the associated note. NOTE If you wish to add another scheduled time for collection, repeat steps 11 and 12. If you need to remove a currently scheduled time, proceed with step 13; otherwise, skip to step 15. 13. Highlight the scheduled time that you want to remove. 14. Click on the command button. Provider Order Entry (POE) ­ Quick Reference Guide NOTE If you need to delete another scheduled collection time, repeat steps 13 and 14; otherwise, proceed to step 15. PURPOSE This guide is intended for use by members of the JHH Clinical Staff and describes the processes used to a lab order that will be collected more than once. The documented process will allow you to write lab orders that will repeat at a specified rate (hourly, daily, weekly) until either: · · 15. Click the command button. NOTE Ignore the asterisk within the Requested Time data field. The fact that this data field is grayed-out indicates that no data entry is required. Daily Repetition Pattern D1. Ensure that the (default) option is selected. D2. Enter a whole number into the data field to establish the Repetition Pattern. D3. Go to step 8. Weekly Repetition Pattern W1. Click on the radio button. W2. Enter a whole number into the data field to establish the Repetition Pattern. W3. Enter a check mark ( )into the check box associated with each day of the week that you wish to have this lab collected. 16. Click the command button. a specified date and time of expiration, or a specified number of occurrences has been reached Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. B3. NOTE The upper order displayed in the following step is the master lab order while the lower order represents the subsequent occurrence of the order over the next 24 hours. 17. Review the orders listing at the bottom of the dialog box for accuracy. NOTE If an error is discovered while performing the following step, right-clicking over the order containing the error and selecting the Edit... option will allow you to correct the inaccuracy before proceeding. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. NOTE The default collection time(s) Daily and Weekly Repetition Patterns are displayed in the Scheduled Time(s) region of the dialog. If the currently displayed value is acceptable, proceed directly to step 15; otherwise, proceed to step 11. NOTE POE focus should be established on the patient of interest prior to performing any of the following procedures. Screenshots have been provided on the back of this sheet that illustrate the following process. POE Quick Reference Guide­Repeating Lab Orders, Creating Version 4.5 XA 19 April 2007 W4. Go to step 8. 11. Click on the drop-down arrow and select another time option. 12. Click on the Add button. 18. Click the command button, when the order is correct. ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 1 2 3 4 10 Not Shown 5 13 7 17 18 D1 D2 W1 D3 Not Shown W4 16 W2 W3 11 A1 6 8 9 A2 A3 Not Shown 12 14 15 B1 B2 B3 "); array_files[111]=new Array(0,4,"./Publications/QRG_Pushing_Meds.pdf","2008-03-31","309K"," QRG - eMAR, Pushing Meds to "," 20070419 ","","Select Appropriate Patient 1. Select the Patient List tab. 2. Select the patients unit from the Current List drop-down menu. 7. Enter an appropriate Reason in the Rx Verification Override Reason dialog box. 8. Click the OK command button. Provider Order Entry (POE) ­ Quick Guide 3. Click on (highlight) the listing associated with the patient of interest. Document Administration of the Order 9. Click on the Worklist Manager icon to access the eMAR. NOTE It may be necessary to click on the update icon one or more times to have the pushed order appear within the eMAR. PURPOSE This guide is intended for use by the JHH Nursing Staff and describes the process used to push an unverified medication to the eMAR. The net result of this process will allow a nurse to administer and document a medication that in their medical judgment needs to be given to the patient even though it has yet to be verified by the Pharmacy. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. Access Unverified Order 4. Select the Orders tab. You should also note that the icon indicating that the drug is yet to be verified will appear within Task Description field of the eMAR display until the Pharmacy verifies the associated drug. ASSUMPTIONS It is assumed that you: · · NOTE Selection of the By Department as the Display Format option will facilitate location and selection of the desired order in the following step. 10. Right-click within the date/time cell associated with the time that you administered the drug. have attended appropriate POE training, and are currently logged into POE. 5. Right-click on the order of interest. 11. Select the Mark as Done... menu option. 6. Click on the Rx Generate Task menu option. Provider Order Entry Quick Guide­Pushing Meds to the eMAR Initial Release­Version 4.5 XA 19 April 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[112]=new Array(0,4,"./Publications/QRG_Providers.pdf","2008-03-31","386K"," QRG - Prescribers "," 20070412 ","","2. Type your current password into the Old Password field. 3. Type your new password into the New Password field--it must contain at least six characters. 4. Type your new password into the Confirm New Password field. 5. Click OK. PATIENT LIST TAB The Patient List is the starting point for users of POE. It provides easy access to patient charts and notifies you about new information associated with patients within POE. Provider Order Entry (POE) ­ Quick Guide 5. Click Selected Roles. 6. Select Housestaff/resident or consultant as applicable. 7. Click OK. FIND A PATIENT NOT ON YOUR LIST 1. Click Find Patient toolbar button. 2. In the Find Patient dialog box, enter either full or partial information to define search criteria. 3. Click Search. A list of patients found is displayed in the Search Results window. 4. Double-click on patient name. The Show Visit dialog box opens, and displays a list of patients visits. 5. Select desired visits and click Save Selected Patients. Flag Descriptions FLAG Unacknowledged....... Alert New Order .................. ................................... New Result ................. ................................... To Verify .................... To Sign ....................... LOG IN 1. 2. 3. 4. Select POE command from the Start menu. Type your user name in the Name field. Type your password in the Password field. Click OK. If your username and password are correct, the system will log you on to POE. NOTE If you are using POE for the first time, the Change Password dialog box opens for you to change your password. DESCRIPTION An alert that has not yet been acknowledged. Double-click this flag to view unacknowledged alerts. A new order (non-stat) Double-click this flag to view the new orders. A new stat order. Double-click this flag to view the new orders. A new normal result. Double-click this flag to view the new results. A new abnormal result. Double-click this flag to view the new results. An order needs to be verified Double-click this flag to verify these orders. An order which needs to be signed. Double-click this flag to sign these orders. An order was entered on behalf of the provider who is logged on. Double-click this flag to sign these orders. LOG OUT 1. Click the Log off toolbar button. 2. Click Exit within the Logon dialog box to completely exit POE. SUSPEND Click the Suspend Session button. RESUME 1. Click on the suspended POE session on the task bar to maximize the Resume Login dialog box. 2. Type your password in the Password field. 3. Click OK. CHANGE PASSWORD 1. Select the Change Password command from the Preferences menu. Provider Order Entry Quick Guide­Prescribers Revision-01­Version 4.5 XA 12 April 2007 ................................... BUILD A CRITERIA BASED LIST 1. Select Maintain List command from the File menu. 2. Select New to create a new list or select Modify to change an existing list. 3. Click Your Role tab. 4. Click Check this box if you want to create a list that includes patients where you are a Provider. ADD YOURSELF AS A CARE PROVIDER 1. Click Add Care Provider toolbar button. 2. Type and Name will be pre-populated for you. 3. Select the role from the list. ©2004-2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. This revision of the Prescribers QRG supersedes all previous editions. Those dated prior to 12 April 2007 should be destroyed. 3. Click in checkbox next to orders to verify or sign. 4. Click Verify or Sign button. By Provider: 1. Click the Order Signature Manager toolbar button. 2. Click in checkbox next to orders to sign. 3. Click Verify or Sign button. 4. Double-click the order to select it. 5. The order form displays when there are mandatory fields to complete as noted by the presence of blue stars. Complete the fields and click OK. 6. Click Submit button. ORDERS TAB The Orders tab displays all orders for the selected patient visit. You can use filters to limit what is displayed. The view control panel (occupying the left side of the display) provides access to the various filter options. The right side of the screen displays the list of orders. REORDERING 1. Locate the order to reorder. 2. Click the right mouse button over the order to be reordered. 3. Point the mouse to ReOrder from the menu. 4. Select Current to reorder with the current order details or select from the other order details for the same item. 5. The new order item does not immediately display on the Order tab. The order is waiting for submission on the order entry worksheet. 6. Open the order entry worksheet by clicking on this button either on the toolbar or in the patient header. 7. Review the order and click Submit. RESULTS The Options Control Panel contains various filtering options. The right side of the screen displays the results based on the filters applied. Each result displays the test name, result, normal result in parentheses, and status. The display of a single arrow indicates a high ( ) or low ( ) resu "); array_files[113]=new Array(0,4,"./Publications/QRG_Printing_POE_Reports.pdf","2008-03-31","227K"," QRG - Printing POE Reports "," 20051208 ","","POE On-Demand Reports Matrix Title of Report (as it appears in POE) JHH Interim Medication Worklist JHH Medication Administration Record JHH Allergies by Unit - Only Patients Admitted in the last 3 hours JHH Active Medications by Patient for My List of Patients Provider Order Entry (POE) ­ Quick Reference Guide Title on Report (as it appears on the printed report) Administration Reports Interim Medication Worklist Medication Administration Record Patient Allergies by Unit Order Reports Active Meds by Patient (My List of Patients) Active Orders by Patient (My List of Patients) Active Order List - All Patients on Unit Active Order List - Only Patients on Unit with Active Orders AM Phlebotomy Draws for (Current Date) Cumulative Order Summary Nursing Worklist Nutrition Active Orders Specimen Collection Worklist Transfer Order Summary Patient List Reports Patient List (Sort by Location) Patient List (Sort by Patient) Patient List (Sort by Location) Patient List (Sort by Patient) Scheduled Reports See Note 1 None None None User Selectable Parameters User may specify Begin Date/Time and End Date/Time. None JHH Active Orders by Patient for My List of Patients JHH Active Orders by Unit - Print All Patients on Unit JHH Active Orders by Unit - Print ONLY Patients on Unit with Active Orders JHH AM Phlebotomy Worklist JHH Cumulative Order Summary JHH Nursing Worklist JHH Nutrition Active Orders JHH Specimen Collection Worklist JHH Transfer Order Summary JHH Current Patient List by Location sort by Location User may specify Unit/Clinic, Department. User may specify Unit/Clinic, Department. None None--Prints orders from start of visit or start of chart. None--Prints orders from start of visit or start of chart. None User may specify Begin Date/Time and End Date/Time. None User may include/omit current provider information. User may include/omit current provider information. User may include/omit current provider information. User may include/omit current provider information and Unit/Clinic information. None PURPOSE This guide is intended for use by JHH clinical users and describes the process they should use to print On-Demand Reports. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. ASSUMPTION It is assumed that you are currently logged into POE. PRINTING REPORTS 1. Click on the printer icon in the POE toolbar. 2. Click on the Report Category down-arrow. 3. Select the desired Report Category from the drop-down list. NOTE Refer to the POE On-Demand Reports Matrix for a categorical listing of available reports. JHH Current Patient List by Location sort by Patient JHH Patient List by Location sort by Location JHH Patient List by Location sort by Patient JHH 24 Hour Summary 24 Hour Order Summary 4. Select the desired report from the resultant listing. 5. Click the Print command button. This column lists the name of the report as it appears within the POE Report Selection dialog box. This column lists the report name as it actually appears upon the report. NOTE 1 This column lists the parameters (if any) that may be used to tailor the content of the associated report. ©2005 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Although the 24 Hour Order Summary report is in actuality a scheduled report, it may be selected for on-demand printing. The content of the report will reflect the previous days orders. Printing an on-demand copy of the 24 Hour Order Summary will have no effect upon the normally scheduled printing of this report. Provider Order Entry Quick Reference Guide­Printing POE Reports Revision-001­Version 4.0 XA 8 December 2005 "); array_files[114]=new Array(0,4,"./Publications/QRG_Preadmit_Orders_Providers.pdf","2008-03-31","1227K"," QRG - Preadmit Orders, Providers "," 20060111 ","","NOTE The following procedure assumes that you are currently logged into POE and that the patient of interest has been admitted-- into either a Preadmit, EDHD, hold, or compatible temporary hold location. Write the Order(s) NOTE If the patient is being transferred from one POE unit to another POE unit, it is very likely that there are active orders that should follow the patient to the new unit. This is accomplished by performing a reorder process for those orders. If there are either no active orders or this is a preadmission, skip steps 12 through 19 and proceed directly to step 20. NOTE Select the appropriate Session Type--either Preadmission or PreTransfer--in the following step. Locate Appropriate Patient 1. Click on the Find Patient icon. NOTE You may substitute the Identification tab in the following step and enter information such as the MRN rather than patient name in the subsequent step. Provider Order Entry (POE) ­ Quick Reference Guide 21. Select the appropriate Session Type. NOTE At this point you may enter pre-admission/pre-transfer orders using the standard POE order entry process. Successful entry of a preadmission/pre-transfer order will result in an Order Summary display similar to that shown within Figure 1. Do not change the preadmission classification. Changing the classification to anything other than Preadmission will result in the presentation of an Alert dialog, which will need to be cleared--see Figure 2. Reorder Appropriate Active Orders PURPOSE This guide describes the process (used by providers) to create orders for patients in either a preadmission or pre-transfer status and the subsequent release of those orders--once the associated patient has been admitted or transferred. Also addressed, is the process used to correct date and time inconsistencies that may result in the generation of alerts during the order release process. As illustrated by Figure 1 (on the back of this guide), these orders are recognizable by the presence of the label within the POE Order Summary display. The term Hold will also appear in the Status column for all preadmission and pre-transfer orders. Additional information on this topic is available in the POE User Guide--available either in a paper or online format. The following link provides access to all currently available POE documentation. 2. Click on the Name tab. 3. Enter appropriate patient information (last name, given name, etc.). 4. Click on the Search command button. 5. Select (highlight) the patient of interest in the Search Results region of the dialog. 12. Click on the Enter Order (clipboard) icon to initiate order writing process. 13. Select PreTransfer as the Session Type. 14. Click on the Minimize icon in the Order Entry Worksheet dialogs title bar. 15. Select the Orders tab. 16. Select the Reorder command button. 17. Place a check mark in the box associated with each active order that is to be reordered and forwarded to the new unit. 18. Click on the OK command button. 19. Respond to (clear) any alert (warning) dialogs that may be generated. NOTE If no new orders are to be written, skip steps 20 and 21 and proceed directly to step 22. Write New Orders 22. Click the Submit command button, once all orders have been entered. Select Appropriate Visit 6. Click on the Show Visits command button. 7. Select (highlight) the visit entry annotated with the desired PREADMIT location--or EDHD (ED hold) as appropriate. 8. Click on the OK command button. RELEASING ORDERS All currently active orders associated with a pre-transfer patient must be discontinued (canceled) before any preadmission/ pre-transfer orders may be released! Discontinue Active Orders NOTE This process assumes that the POE system focus is on the correct patient and that the Orders tab is currently selected. Assign Patient to Temporary List 9. Click on the Patient List tab. 10. Ensure that Temporary List is displayed in the Current List data field. 1. Click on the DC/Cancel command button. 2. Ensure that the Discontinue/Cancel radio button is selected. NOTE You should review each order individually while performing step 3 and are discouraged from using the Select All function. http://www.jhmcis.jhmi.edu/poe. CREATING ORDERS Different processes are used for the creation of each type of order identified below. Select Patient 11. Select (highlight) the patient of interest. NOTE If no existing items were reordered as part of the pre-transfer process, begin with step 20. If existing items were reordered, skip steps 20 through 21 and proceed directly to step 22. · Preadmission orders--the process begins with step 1. · Pre-transfer orders--the process begins with step 11. 20. Click on the Enter Order (clipboard) icon to initiate order writing process. 3. Place a check mark in the box associated with each order that is to be discontinued. (continued on back) POE Quick Reference Guide­Preadmission/Pre-transfer Orders­Providers Version 4.0 XA Revised 11 January 2006 ©2005-2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by "); array_files[115]=new Array(0,4,"./Publications/QRG_Preadmit_Orders.pdf","2008-03-31","290K"," QRG - Orders, Preadmit "," 20050324 ","","NOTE This procedure assumes that you are currently logged into POE and that the patient of interest has been admitted--into either a Preadmit or EDHD hold location. NOTE At this point you may enter pre-admission orders using the standard POE order entry process. Successful entry of a preadmission order will result in an Order Summary display similar to that shown within Figure 1. Do not change the preadmission classification. Changing the classification to anything other than Preadmission will result in the presentation of an Alert dialog, which will need to be cleared--see Figure 2. Locate Appropriate Patient 1. Click on the Find Patient icon. NOTE You may substitute the Identification tab in the following step and enter information such as the MRN rather than patient name in the subsequent step. Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide describes the process for creating orders for preadmission patients and the subsequent release of those orders--once the associated patient has been admitted. Also addressed, is the process for correcting date and time inconsistencies that may result in the generation of alerts during the order release process. As illustrated by Figure 1 (on the back of this guide), preadmission orders are recognizable by the presence of the label, which appears immediately below the item (order) name in the POE Order Summary display. The term Hold will also appear in the Status column for all preadmission orders. Additional information on this topic is available in the POE User Guide--available either in a paper or online format. The following link provides access to all currently available POE documentation. http://www.jhmcis.jhmi.edu/poe/PUBLICATIONS.html. 2. Click on the Name tab. 3. Enter appropriate patient information (last name, given name, etc.). 4. Click on the Search command button. 5. Select (highlight) the patient of interest in the Search Results region of the dialog. Select Appropriate Visit 6. Click on the Show Visits command button. 7. Select (highlight) the visit entry annotated with the PREADMIT location--or EDHD (ED hold) as appropriate. 8. Click on the OK command button. Assign Patient to Temporary List 9. Click on the Patient List tab. 10. Ensure that Temporary List is displayed in the Current List data field. Select Patient 11. Select (highlight) the patient of interest. Write the Order(s) 12. Click on the Enter Order (clipboard) icon to initiate order writing process. RELEASING PREADMISSION ORDERS All previously written preadmission orders will need to be released in order to be acted upon. Release of orders should take place once the pre-admitted patient has been assigned to a unit. NOTE This procedure assumes that you are currently logged into POE and that the previously pre-admitted patient now occupies a bed within a JHH unit. It is also assumed that the Order Summary is displayed with POE focus on the appropriate patient. 1. Click on the Release... command button. NOTE All of the pre-admit orders are displayed by the Release Orders dialog. A check mark should appear in the check box associated with each displayed order that may be released. 2. Click on the check box--to remove the check mark--associated with each order that you do NOT wish to release. CREATING PREADMISSION ORDERS The preadmission order creation process requires the performance of the following subtasks: · · · · · 3. Click on the OK command button. NOTE Hold will no longer be displayed in the Status column of each released order and the Preadmission Order label will also have been removed--see Figure 3. (continued on back) Provider Order Entry Quick Reference Guide­Preadmission Orders Revision­Version 3.5 XA 24 March 2005 location of the appropriate patient, selection of the appropriate visit, assignment of the patient to your temporary list, placing POE focus on that patient, and writing the order. ©2005 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. CLEARING ORDER ALERTS Alerts resulting from the attempt to release preadmission orders are generally due to timing issues resulting from the relationship between requested date and time and the release date and time. NOTE This procedure assumes that you are currently logged into POE and that the Release Orders dialog is displaying current alerts. Preadmission Order Label Hold Status Indicator 1. Select (highlight) the order to be cleared (corrected). Figure 1. Order Summary Display of Preadmission Orders 2. Click on the Change Date command button. 3. Click on the down arrow ( Date drop-down menu. )associated with the Alert Dialog Improperly changed order type (classification) 4. Select the desired date from the calendar. 5. Click on the down arrow ( )associated with the When drop-down menu and select the desired time. 6. Click on the OK command button. NOTE Repeat steps 1 through 6 until all alerts have been cleared. Figure 2. Alert Dialog Note that the Status column no longer r "); array_files[116]=new Array(0,4,"./Publications/QRG_Pharmacy.pdf","2008-03-31","298K"," QRG - Pharmacists "," 20080321 "," ","3. Click the All locations radio button. 4. Examine the content of the display. NOTE See the example for more information about interpreting this dialog. · If the patient has no allergies--as displayed by the Allergies Summary dialog--the prescriber can either Add New allergy information or Close the dialog through the selection of the appropriate command button. Viewing Dose Schedule You may view the associated dose schedule by performing the following steps: 1. Right-click the order in question within the order summary listing. 2. Click View Task Schedule. (See Dose Scheduling, Frequencies, and Priorities on back) Transfer Verification Example The Temporary Locations dialog lists, in chronological order, all of the locations occupied by the patient--refer to figure in the preceding column. Look at the last 2 lines of the dialog. The patients profile in POE should show active orders that were written after that. In this example, the patient was transferred from NEL4 to MPC4 on 6-14-04 at 16:02 PM. all POE orders ordered prior to 6-1404 at 16:02 need to be discontinued and re-ordered. If you identify medications for the patient that were not discontinued prior to transfer to the new unit (and are still active on the patient)­call the unit and inform the nurse of those orders that need to be discontinued and those that the prescriber will need to reorder with regard to the new patient location. Provider Order Entry (POE) ­ Quick Reference Guide TRANSFERS · Transfer Verification Process Pharmacy can verify the status of the patients transfer by checking the location history within POE. Perform the following steps to check patient location history: If prescribers choose to Close the dialog, they can still enter orders, but no allergies will have been entered. Suggested resolution­in this situation, page the prescriber and ask him/her to enter the patients allergies into POE. DOSE SCHEDULING Dose Scheduling To determine a dosing schedule for a medication ordered in POE, refer to the table titled Dose Scheduling, Frequencies, and Priorities located on the back of this guide. Definition­Time Critical As a general rule of thumb, if Time Critical is used in conjunction with a frequency that has a number in it (i.e. q4h), the schedule will start based upon the specified Time Critical time. Example: If a medication is ordered as q4h, with a Time Critical start of 15:00, POE will schedule the medication every 4 hours starting at 15:00. NOTE Be sure that POE is currently focused upon the patient of interest before proceeding. 1. Click on the bed icon. 2. Click History tab within the Temporary Locations dialog. ALLERGIES (SUMMARY) Pharmacy staff members need to be aware of the following aspects of allergy data display within POE. Prescribers are NOT forced to enter allergies on a patient. Prescribers are forced to look at allergies, the first time they view the patients profile, whether or not allergies exist. POE Quick Reference Guide­Pharmacists Revision--Version 4.5 XA 21 March 2008 This revision of the Pharmacists­QRG supersedes all previous versions. Those dated prior to 21 March 2008 should be destroyed. ©2004­2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Dose Scheduling, Frequencies, and Priorities Frequency q1h Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine Time Critical Routine q10min Time Critical q15min Routine Time Critical q30min Routine Time Critical q45min q14days q30days q3days q7days once ac acpc after meals and at bed-time at bed-time before meals and at bed-time bid bid diuretic bid pantaprazole daily daily pantaprazole daily warfarin every other day pc q3pc qam qam insulin qid every other day twice daily qpm qpm insulin tid tonight with meals Time Critical defaults to standard times; matches schedule in Centricity Time Critical Routine Time Critical Routine Routine Time Critical Routine Task must be created manually by RN, then charted on MAR schedule. Starts when 1st dose is charted by nurse schedule is based upon Time Critical start time defaults to standard times; matches schedule in Centricity schedule is based upon Time Critical start time defaults to standard times; matches schedule in Centricity defaults to standard times; matches schedule in Centricity defaults to standard times; matches schedule in Centricity schedule is based upon Time Critical start time defaults to standard times; matches schedule in Centricity schedule is based upon Time Critical start time defaults to standard times; matches schedule in Centricity schedule is based upon Time Critical start time starts when 1st dose is charted by nurse schedule is based upon Time Critical start time starts when 1st dose is charted by "); array_files[117]=new Array(0,4,"./Publications/QRG_Pharm_Intfc_Basics_Care_Providers.pdf","2008-03-31","450K"," QRG - Pharmacy Interface Basics for Care Providers "," 20080320 "," ","OVERVIEW­continued · POE DISPLAYS As illustrated by the figure below, medication orders placed in POE will be annotated with the Unverified by Pharmacy label until verified by a pharmacist. Once the order has been verified, the label will be removed in most cases. The lone exception is administration of a medication before pharmacy verification when the clinician decides that circumstances necessitate the immediate administration of the order. An example of verified/unverified orders, as they appear on the POE Order Summary and MAR displays, is presented below. Changes to diluents require the Pharmacy to discontinue the existing order and rewrite the order in POE reflecting the correct solution. Providers may request a change in diluents by writing a pharmacy message order. · Provider Order Entry (POE) ­ Quick Reference Guide This guide is intended for use by JHH MDs, Nurses, Nurse Practitioners, Physician Assistants, etc. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. Other publications of interest are also available at this web site. OVERVIEW Users of the bidirectional pharmacy interface should be aware of the following: · · Unverified Order Verified Orders Providers should use the POE NF medication order form to order non-formulary medications. Providers must enter information about patient allergies (even if limited to marking as Unknown) before medication orders will be processed by the Pharmacy. Changing the medication form (immediate release liquid to immediate release tablet, immediate release capsule to immediate release liquid, etc.) requires either the RN or the Provider to write a pharmacy message reflecting the desired change. · POE Quick Reference Guide­Pharmacy Interface Basics for Care Providers Version 4.5 XA Revised 20 March 2008 This version of the Pharmacy Interface Basics for Care Providers QRG supersedes all previous versions. Those dated prior to 20 March 2008 should be destroyed. ©2005-2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[118]=new Array(0,4,"./Publications/QRG_Pharm_Intfc_Basics.pdf","2008-03-31","286K"," QRG - Pharmacy Interface Basics "," 20080320 "," ","POE QUEUE ICONS An icon is displayed to the immediate left of each order displayed within Centricitys POE queue. This icon provides a visual indication of the associated orders classification and/or status. Each of the available icons is summarized as follows: (green) ......... regularly scheduled order (green) ......... regularly scheduled order with Note(s) attached (white) .......... errored order - due to invalid data in the HL7 record Provider Order Entry (POE) ­ Quick Reference Guide FIELDS THAT MAY BE CHANGED Fields that the pharmacist may change prior to completion of the verification process include: · · · · · · · IV rate for piggyback dose form (i.e. change immediate release tablet to liquid) diluent for piggyback (i.e. NS to D5W) diluent volume for piggyback free text notes in IV attributes order notes (General, MAR, Fill List) (white) .......... pending order­ currently being processed by another pharmacist (at a different workstation) (magenta) .... discontinued order (magenta) .... interrupted (Hold) order (red).............. STAT order status (red).............. STAT order status with Note(s) attached (brown)......... discharged patient (yellow)......... either a patient unknown to Centricity (link to ADT system is down) or a Patcom mismatch exists (bed occupied by another patient) (black) .......... changed/modified order FIELDS THAT MAY NOT BE CHANGED Fields that the pharmacist must NOT change prior to completion of the verification process include: · · · · · · · · · · · drug* (see exception below) dose dose unit of measure (i.e. mg, gm, ml) route schedule duration start/stop date start/stop time IV type­the pharmacist may use IV Type of piggyback when building a mini-bag or large volume bag drug volume IV rate for large volume This guide is intended for use by JHH providers, nurses and pharmacists. OVERVIEW This guide provides basic guidance for users of the bi-directional interface (between POE and Centricity) in the following areas: · · · Interpreting the icons appearing within the CPOE Processing dialog­POE queue. Identifying those Centricity data fields that the pharmacist may change. Identifying those Centricity data fields that the pharmacist must NOT change. NOT ALL CENTRICITY FIELDS MAY BE MODIFIED With the introduction of the bi-directional interface, pharmacists need to become aware of the fact that Centricity now functions in an environment where changes to any data field will have an impact upon other automated information systems and the users thereof. NOTE It is the responsibility of the individual pharmacist to adhere to the following requirement. The introduction of the interface has resulted in the theoretical division of Centricity data fields into two categories--one consisting of data items that may be changed and another consisting of data items that must remain unmodified. Neither the Centricity or POE systems nor the interface that connects them will enforce this limitation. *Exception Changing from a tablet to a liquid is acceptable, as long as the dose forms are therapeutically equivalent. Example: mnemonic APAP325T (Acetaminophen 650mg tablet) maybe changed to APAP650L. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. Other publications of interest are also available at this web site. Provider Order Entry Quick Reference Guide­Pharmacy Interface Basics Revision ­ Version 4.5 XA 20 March 2008 This version of the Pharmacy Interface Basics QRG supersedes all previous versions. Those dated prior to 20 March 2008 should be destroyed. ©2005-2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[119]=new Array(0,4,"./Publications/QRG_Patient_Lists_&_Searches.pdf","2008-03-31","97K"," QRG - Patient Lists & Searches "," 20050324 ","","NOTE Users are no longer required to enter a reason when attempting to access a patient located in a unit other than the one associated with the workstation being used. Deleting Currently Displayed List NOTE This procedure assumes that you are currently logged into POE. 6. Click on the Show Visits command button. 7. Select (highlight) the appropriate visit entry. 8. Click on the OK command button. NOTE The patient will be displayed on a temporary list that will be deleted when you logoff. Provider Order Entry (POE) ­ Quick Reference Guide 1. Select the Edit Delete current List menu option. NOTE Performance of the following step will result in the display of the default unit listing--the unit associated with the workstation being used to perform this task. 2. Click the OK command button. CREATING A PATIENT LIST NOTE This procedure assumes that you are currently logged into POE. PURPOSE This guide describes the processes used to perform the following tasks: · searching for a specific patient, · creating a patient list, and · deleting a patient list. SEARCHING FOR A PATIENT NOTE This procedure assumes that you are currently logged into POE. 1. Select the File Maintain List New... menu option. 2. Select the Location tab. 3. Click on the Include patients at selected locations only radio button. 4. Click on the + sign next to The Johns Hopkins Hospital option. 5. Click on the + sign next to the JHH INPATIENT option. NOTE You should generally limit your selections in the following step to one (1) unit as lists are limited to 150 patients. Deleting Undisplayed List(s) NOTE This procedure assumes that you are currently logged into POE. 1. Select the Edit Delete Patient List(s) menu option. 2. Select (highlight) the list to be deleted. NOTE If more than one list is to be deleted, hold down the CTRL key and repeat step 2 for each list you wish to delete before continuing on to step 3. Performance of the following step will result in the display of the default unit listing--the unit associated with the workstation being used to perform this task. 1. Click on the Find Patient icon. NOTE You may substitute the Identification tab in the following steps and enter information such as the MRN rather than patient name in the subsequent step. 6. Select (highlight) the units you wish to include on your list. 7. Click the OK command button. 8. Enter an appropriate name in the List Name data field. 9. Click the OK command button. NOTE The list created will be displayed and the name that was assigned will be displayed in the Current List field. This list is permanent and will remain available until you choose to delete it. 2. Click on the Name tab. 3. Enter appropriate patient information (Last and Given names, etc.). 4. Click on the Search command button. 5. Select (highlight) the patient of interest in the Search Results region of the dialog. 3. Click the OK command button. DELETING PATIENT LIST(S) Procedures used to delete the currently displayed list as well as one or more list that are not currently displayed are provided in this section of the guide. Provider Order Entry Quick Reference Guide­Patient Lists & Searches Revision­Version 3.5 XA 24 March 2005 ©2005 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[120]=new Array(0,4,"./Publications/QRG_Patient_List_Columns_(Add_Delete).pdf","2008-03-31","573K"," QRG - Lists, Add/Delete Columns "," 20071212 ","","Adding Columns NOTE The following description focuses upon the addition of the Assigned Nurses and Assigned Provider columns to the currently displayed list. This procedure could be used to add any other column option listed within the Available Columns drop-down list. Update Information in Assigned... Columns NOTE The information within the Assigned Nurse and Assigned Provider columns does not update automatically. For that reason, it is imperative that a unit clerk or other staff member enter/update this information for each patient at the beginning of every shift. 1. Select the Column Selection... option from the View menu. Provider Order Entry (POE) ­ Quick Reference Guide 1. Double-click in the Assigned Nurse field of the appropriate patient. PURPOSE This guide is intended for users of POE and describes the process employed for adding, deleting, and moving Patient List columns. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe 2. Highlight the Assigned Nurse option within the Available Column list. ASSUMPTIONS It is assumed that you: · · · are currently logged into POE, have attended appropriate POE training, and have the desired patient list displayed. NOTE The information within the Name Alert Choices field should generally be left as is whenever you update the Assigned Nurse and Provider information. PROCEDURE OVERVIEW Processes described include: · adding Assigned Nurse and Assigned Provider 2. Enter the name of the Assigned Nurse. 3. Enter the name of the Assigned Provider. 4. Click the OK button. 5. Repeat steps 1 through 4 for each occupied bed. 3. Click the Add button. 4. Click on the Move Up button repeatedly until the selected (new) column is at the top of the Displayed Columns list. 5. Repeat steps 2 through 4 for the Assigned Provider option. 6. Click the OK button. (continued on back) columns to a patient list, · updating the shift-based data contained within a lists Assigned Nurse and Assigned Provider columns, · re-positioning columns within a patient list, · deleting columns from a patient list, and · resizing columns. Provider Order Entry Quick Reference Guide­Patient List Columns, Add/Delete Initial Release, Version 4.5 XA 12 December 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Reposition Columns NOTE Repositioning of columns should generally be limited to your personal lists. System provided lists, such as the unit lists, which are used by a large number of staff members, should remain in their default configuration to minimize the potential for staff confusion. Remove Columns NOTE Removal of columns should generally be limited to your own lists. System provided lists, such as the unit lists, which are used by a large number of staff members, should remain in their default configuration to minimize the potential for staff confusion. Resize Columns 1. Position the cursor (pointer) over the right border of the column header for the column to be resized­the cursor symbol will change in appearance as illustrated below. 1. Click the and hold the left mouse-button over the column that you wish to move. NOTE In the following step, it is important that you keep the cursor (pointer) within the column header row as you reposition the selected column header; otherwise, the positioning arrow will not appear. 1. Select the Column Selection... option from the View menu. 2. Highlight the column to be removed within the Displayed Columns list. Resizing Cursor 2. Press and hold the left mouse-button down. NOTE Dragging the cursor to the right will increase the width of the affected column. Dragging the cursor to the left will decrease the width of the affected column. 2. Drag the column header horizontally to its new position. A red arrow will indicated the position that the column will occupy. 3. Drag the cursor in the appropriate direction until the desired column width is achieved. Red Arrow 3. Release the left mouse-button. 3. Click the Remove button. 4. Click the OK button. 4. Release the left mouse-button. "); array_files[121]=new Array(0,4,"./Publications/QRG_Ordering_Blood_Tests.pdf","2008-03-31","641K"," QRG - Blood Tests, Ordering "," 20070309 ","","REQUESTED TIME NOTE Refer to the following matrix to determine which draw times are appropriate for the Departments of Medicine, Surgery, and Pediatrics. COLLECTED BY Once you have specified a specimen collection time for a blood test order, you must then indicate who is to collect the specimen. As illustrated in the following figure and described in the Blood Test Collection Parameters matrix, the POE collection options are limited to the following selections. Pathology Phlebotomy Staff · Lab Collect Clinical Unit Staff · Unit Collect by Clinical Staff (default selection for Pediatrics) LAB DRAWS ALLOWED This field specifies how many times that the Phlebotomy Team can try to perform the draw before notifying the Provider that the test associated with this order will be canceled and that it will need to be reordered. Options available via the dialog are limited to the following values : · Not Applicable · Ordered Round--cancel after 1 round · Two Rounds (Default)--cancel after 2 rounds As illustrated in the following figure and described in the Blood Test Collection Parameters matrix (presented on the back of this sheet), the following specimen collection time options are available for selection. Phlebotomy Rounds (multiple): Provider Order Entry (POE) ­ Quick Reference Guide Non-Surgery 09:30 Round 12:30 Round Surgery Pediatrics OVERVIEW This guide explains how to order blood tests using the new Eclipsys-based Provider Order Entry System (POE). Please follow the instructions in this guide to ensure that specimens for the blood test you order are drawn by the appropriate staff member at the desired time. Blood tests are ordered in POE using most of the same functions and screens used to order medications, radiologic procedures, and other items. Refer to the User Guide--available both in print and online at http://www.jhmcis.jhmi.edu/poe--for general order-entry instructions. POE provides multiple options for indicating the time of blood specimen collection and who should collect the specimen or specimens. This side of the Quick Reference Guide describes the fields within the order form of particular interest to the clinician ordering a blood test. The back of this guide provides a matrix that guides the clinical user through the selection of appropriate dialog options as well as identifying the location where the associated label will be printed. Vascular Access Team · VAT ­ central line 15:30 Round 20:00 Round Early AM Lab AM Lab Routine Specified Time* STAT * for collection of time-critical specimens LABEL PRINTING Note also that the Requested Time and Collected By combination determines where the blood specimen labels will be printed. ACCURACY Placement of complete and accurate POE-generated blood test orders is a critical first step in ensuring that requested test results are available when required for appropriate patient management on POE-supported units. AN ADDITIONAL CONSIDERATION Not all of the possible Requested Time and Collected By combinations are permitted. For example: STAT specimen collection is not performed by the Vascular Access Team. Allowable Requested Time and Collected By combinations are summarized in the in the Blood Test Collection Parameters matrix located on the back of this sheet. Provider Order Entry Quick Reference Guide­Ordering Blood Tests Version 4.5 XA Revised 9 March 2007 This revision of the Ordering Blood Tests QRG supersedes all previous editions Those dated prior to 9 March 2007 should be destroyed. ©2004-2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Blood Test Collection Parameters If you want to place orders for: Choose Requested Time Option Early AM Lab Label Print Location (see NOTE) In Lab Collected By Option Lab Collect Comments Orders must be submitted by 1:00 AM. Blood will be drawn between 1:00 AM and 3:00 AM. Orders must be submitted by 2:30 AM. Blood will be drawn between 3:00 AM and 7:00 AM. Early AM Round (Surgery Only) Lab Collect (Normal) AM Phlebotomy Next Round Phlebotomy Round AM Lab Routine Desired Lab Round time-- 0930, 1230, 1530, and 2000. Specified Time--military time [24 hour clock] Cannot be a regularly scheduled round time. Lab Collect Lab Collect Lab Collect In Lab In Lab In Lab Lab Collect (Telephone Initiated) Specific Time Unit Collect by clinical staff On Unit Only allowed for coagulation tests and therapeutic drug monitoring. Place order, log in and place labels in the Phlebotomy Book, and call lab at 5-2648. Only between 11:00 PM and 6:00 AM; Place order, log in and place labels in the Phlebotomy Book, and call lab at 5-2648. STAT--overnight shift only STAT Unit Collect by clinical staff On Unit Unit Collect (Pediatric Default) Any Time Specific Time STAT Next Round VAT Round Specific Time Routine Specified Time--military time [24 hour clock] STAT Routine Desired Lab round time Specified Time--military time [24 hour clock] Unit Collect by clinical staff Unit Collect by clinical staff Uni "); array_files[122]=new Array(0,4,"./Publications/QRG_Orders_Sorting.pdf","2008-03-31","315K"," QRG - Orders, Sorting "," 20070315 ","","SORT PROCESS NOTE Provider Order Entry (POE) ­ Quick Reference Guide It is assumed that POE focus is already established on the patient of interest. 1 1. Click on the Orders tab. PURPOSE This guide is intended for use by members of the JHH Clinical Staff and describes the process used to arrange orders appearing within the POE Order Summary display in alphabetical order. The benefit derived from this capability focuses upon the recognition of: · · · 2. Click on the Standard filter tab (if it is not already selected). NOTE Selection of Active Only in the following step is intended to remove all discontinued, pending, and completed orders from the Order Summary display to aid in the recognition of duplicate or conflicting orders. duplicate orders, or order conflicts, and the resolution thereof. 3. Select Active Only as the Status/Priority option. 4. Select All as the Order Selection option. 5. Select By Department as the Display Format option. 6. Select Order Name, Date/Time as the Sort Sequence option. 7. Review the list of now sorted orders. NOTE See the back of this sheet for an illustration of a sorted Order Summary display. 2 3 4 5 6 Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. Provider Order Entry Quick Reference Guide­Sorting Orders Version 4.5 XA, 15 March 2007 . ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sorting displayed orders makes recognition of duplicate/conflicting orders less cumbersome. "); array_files[123]=new Array(0,4,"./Publications/QRG_Nurses.pdf","2008-03-31","130K"," QRG - Nurses "," 20041115 ","","2. 3. 4. 5. Type your current password into the Old Password field. Type your new password into the New Password field--it must contain at least six characters. Type your new password into the Confirm New Password field. Click OK. 3. 4. 5. Click Search. A list of patients found is displayed in the Search Results window. Double-click on patient name. The Show Visit dialog box opens, and displays a list of patients visits. Select desired visits and click Save Selected Patients. PATIENT LIST TAB: The patient list is the starting point for users of POE. It provides easy access to patient charts and notifies you about new information associated with patients within POE. Provider Order Entry (POE) ­ Quick Reference Guide LOG IN: 1. 2. 3. 4. Select POE command from the Start menu. Type your user name in the Name field. Type your password in the Password field. Click OK. If your username and password are correct, the system will log you on to POE. FLAG Flag Descriptions DESCRIPTION An alert that has not yet been acknowledged. Double-click this flag to view unacknowledged alerts. A new order (non-stat) Double-click this flag to view the new orders. A new stat order. Double-click this flag to view the new orders. A new normal result. Double-click this flag to view the new results. A new abnormal result. Double-click this flag to view the new results. An order needs to be verified Doubleclick this flag to verify these orders. An order which needs to be signed. Double-click this flag to sign these orders. An order was entered on behalf of the provider who is logged on. Doubleclick this flag to sign these orders. Unacknowledged..... Alert New Order ............... BUILD A SPECIAL LIST: You can quickly and easily create lists of patients by either searching for the patient(s) or selecting them within another list and then clicking the Save Selected Patients button. You can: o create new lists, o replace an existing list, or o add to an existing list. These special lists are not dynamically updated by the ADT system--whenever any of the patients in a special list are discharged or transferred, they remain on the special lists. Conversely, when new patients are admitted, they will not be added to these lists automatically. 1. Click on a patient in a list to select the patient. 2. Hold Ctrl button down and click another patient in the list. 3. Repeat step 2 until all desired patients are selected. 4. Click Save Selected Patients button. 5. Click the radio button next to either the: Add Patient to Selected List or Replace Patients on Selected List and click the list name, or New List Name and enter a new list name. 6. Click OK. NOTE If you are using POE for the first time, the Change Password dialog box opens for you to change your password. LOG OUT: 1. 2. Click the Log off toolbar button. Click Exit within the Logon dialog box to completely exit POE. New Result ............... To Verify ................... To Sign .................... SUSPEND: Click the Suspend Session button. RESUME: 1. 2. 3. Click on the suspended POE session on the task bar to maximize the Resume Login dialog box. Type your password in the Password field. Click OK. FIND A PATIENT NOT ON YOUR LIST: 1. 2. Click Find Patient toolbar button. In the Find Patient dialog box, enter either full or partial information to define search criteria. CHANGE PASSWORD: 1. Select the Change Password command from the Preferences menu. ©2004 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Nurses Revision­Version 3.5 XA 15 November 2004 ENTERING ORDERS­FOR YOURSELF: 1. 2. 3. Click order entry worksheet toolbar button. Check that Requested By field is set to Me for your own orders. Search for orders by category and department using Start of Browse... ORDERS TAB: The Orders tab displays all orders for the selected patient visit. You can use filters to limit what is displayed. The view control panel (occupying the left side of the display) provides access to the various filter options. The right side of the screen displays the list of orders. REORDERING: 1. 2. 3. 4. 5. 6. 7. Locate the order to reorder. Click the right mouse button over the order to be reordered. Point the mouse to ReOrder from the menu. Select Current to reorder with the current order details or select from the other order details for the same item. The new order item does not immediately display on the Order tab. The order is waiting for submission on the order entry worksheet. Open the order entry worksheet by clicking the button on the toolbar or in the patient header. Review the order and click Submit. RESULTS: DISCONTINUING ORDERS: or by typing 1st part of the order name using Manual Entry. 1. 2. 3. 4. 5. Double-click the order to select it. The order form displays when there are mandatory fields to complete as noted by the presence of blue stars. Complete the fields and click OK. Click Submit button. Locate the order to "); array_files[124]=new Array(0,4,"./Publications/QRG_Now-Routine-Orders.pdf","2008-03-31","138K"," QRG - Orders, Now-Then-Routine "," 20041115 ","","Step 1--Now Segment Refer To Figure 1 for additional insight into the following step 1 tasks. 1. Enter Once Into The Frequency data field to accommodate the initial (todays) dose. Step 2--Routine Segment Refer to Figure 2 for additional insight into the following step 2 tasks. NOTE In this step, you will create a routine order that begins tomorrow--allowing POE to reflect the medications routine time of administration on the MAR (worklist display) for the duration of the order. NOTE Time Critical is a good option for step 2, if the drug should be given at a particular time but is not considered STAT. Provider Order Entry (POE) ­ Quick Reference Guide 2. 3. Select either Time Critical or Stat as the Start Time Priority entry. If Time Critical is selected, enter the time (using the 24-hour/military clock) for the Now dose. 1. 2. 3. Enter daily into the Frequency data field. Select Routine as the Start Time Priority entry. Enter tomorrows date into the Start Date data field. OVERVIEW The POE system does not possess the logic necessary to support the issuance of a one-step Now-Then-Routine order set. WORK-AROUND A two-step approach must be used to generate two distinct (separate) orders to satisfy the requirements of a single Now-Then-Routine order. This quick reference guide addresses the timing of each of the orders (now and routine) only! It does not address the completion of the remaining order fields. daily Figure 1. Time Definition­Now Order Figure 2. Time Definition­Routine Order ©2004 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Now-Then-Routine Orders Revision­Version 3.5 XA 15 November 2004 "); array_files[125]=new Array(0,4,"./Publications/QRG_New_Rad_Forms_[Final].pdf","2008-03-31","1128K"," QRG - Ordering CTs & MRIs (New Forms) "," 20070912 ","","FEATURES OF THE NEW FORMS (continued) · Two Ordersets for MRIs & CTs As illustrated by Figure 1, there is now one order set · Synonyms Synonyms that may be used to locate these forms within the POE Order Entry Worksheet (see Figure 1) are identified below. Each occurrence of the character, within the following synonyms, indicates the insertion of a space ­ use of the spacebar. RAD CT Orders CT Orders CT Orders RAD RAD CT Quick Select CT Quick Select CT Quick Select Quick Select CT RAD RAD MRI Orders MRI Orders MRI Orders RAD RAD MRI Quick Select MRI Quick Select MRI Quick Select Quick Select MRI RAD The lower (grid) region of the form contains a listing of available (component) orders. Order selection Placement of a specific order requires the user to click within the checkbox displayed at the left side of the row that is associated with the order being placed ­ a check mark will appear within that check box. A specific order form may be opened (accessed) by double-clicking anywhere within the row associated with the order of interest or single-clicking within the appropriate order name cell. Mandatory data fields Mandatory fields within component orders will only display a red asterisk ( ) if the associated order has been selected for placement ­ a check mark will be visible within the associated checkbox. NOTE You may need to use the horizontal scroll bar (slider) in order to view/complete all of the data fields associated with a selected order! that contains all of the component orders for CTs and another for MRIs. These ordersets are titled: RAD CT Orders RAD MRI Orders Another orderset is available that contains only the most often used component orders for CTs and another for MRIs. These ordersets are titled: RAD CT Quick Select RAD MRI Quick Select Provider Order Entry (POE) ­ Quick Reference Guide See Synonyms topic for additional information. PURPOSE This guide describes the new POE radiology forms that may be used by JHH Providers to order CTs and MRIs. NOTE If preferred, Providers may continue to order CTs and MRIs as individual orders as they have in the past. Please note that additional information about other aspects of POE operation is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe · Logically Grouped Component Orders ­ Component orders are logically grouped in a head to toe (top-to-bottom) sequence and are alphabetically ordered. USAGE ­ CT & MRI FORMS Key points about usage of the new Radiology forms are summarized below while illustrations of the forms appropriate for ordering CTs (Figure 2) and MRIs (Figure 3) are presented on the back of this sheet. · Data Entered Only Once ­ There is no need to enter the same information more than once. Once entered, other fields containing the same information will be automatically populated (filled-in). Form Layout Forms are essentially divided into two regions ­ an upper region and a lower region. The upper region contains data fields used to record data common to most CT and MRI orders. Information entered into most of these fields will automatically populate other fields containing the same data, within the orders listed in the lower region of the form. These `source fields are recognizable by their titles, which appear as blue under-lined text. Priority data field Selection of the Emergent (now) option for this data field requires the user to click on the icon at the right side of the URL-Radiology Fellow On Call data field and to subsequently select the appropriate provider from the resultant display. Mandatory data fields Fields that must be filled-in are referred to as mandatory and contain a red asterisk ( ). METAL IN BODY ­ MRI FORMS ONLY The MRI forms contain a field titled History of Metal in Body within the common data region. Selection of the Yes (MUST specify at bottom) option will result in the display of an additional data region at the bottom of the form ­ immediately after the order grid. When these fields are displayed, the user must select at least one option from each of the following data fields. If the specified area of the body contains no metal, the user MUST select the Does Not Apply option. a) HEAD b) CHEST, HEART, or other CARDIOVASCULAR c) ABDOMEN, PELVIC, and SPINAL WHAT THIS GUIDE COVERS This guide summarizes the appearance and usage of the four new new MRI and CT orderset forms. It also provides graphic images of the new forms to facilitate user understanding. FEATURES OF THE NEW FORMS The features of the new radiology forms are summarized as follows: NOTE If metal does exist within the patients body but is not located in one of the defined regions identified above, the user MUST enter a text description of the metal location within the free-text field titled d) Specify Other Metal in Body! Completion of the History of Metal in Body form fields removes the obligation to complete the paper forms previously used to satisfy this reporting requirement. · Logical Form Layout ­ Fields for common information are located at the top of the new CT and MRI forms; while component orders are located at the bottom of the "); array_files[126]=new Array(0,4,"./Publications/QRG_Name_Alert.pdf","2008-03-31","552K"," QRG - Name Alert Feature "," 20050215 ","","NOTE This feature provides a visual cue to the existence of similar names only--there is no automated functionality associated with this feature. POE users are responsible for setting and clearing the Name Alert flags as patients are admitted to and discharged from their respective units. SET NAME ALERT FLAG: 1. Provider Order Entry (POE) ­ Quick Reference Guide REMOVE NAME ALERT FLAG: 1. 2. 3. 4. Double-click within the Name Alert cell in the same row as the patient whose flag is to be removed. Select the None option from the Name Alert Choices drop-down list. Click OK. Repeat steps 1 through 3 for each patient whose flag is being cleared. (continued on back) 2. 3. 4. OVERVIEW: The Name Alert feature is intended to provide a visual cue within the POE display, that will alert JHH staff members to the existence of patients--within a unit (on a list)--whose names are similar enough in either sound or spelling to create the potential for misidentification. One of two possible flags may appear within the MAR Name Alert cells associated with each of the patients whose names could be mistaken. These flags are described as follows: ....... presence of the red square flag indicates that the name of the associated patient is spelled the same as another patient. ....... presence of the green pennant indicates that the name of the associated patient sounds the same as another patient. Prescribers, nurses, clerical associates, and other unit staff members, who use POE, should be aware of the significance of these icons within the Name Alerts column. NOTE If the Name Alert column is not present on your display, see the Inserting Name Alert Column instructions on the back of this guide. Double-click within the Name Alert cell in the same row as the patient being flagged. Select the appropriate choice from the Name Alert Choices drop-down list. Click OK. Repeat steps 1 through 3 for each patient being flagged. Name Alert Column ©2005 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Name Alert Feature Revision­Version 3.5 XA 15 February 2005 INSERTING NAME ALERT COLUMN: Perform the following steps to insert and position a Name Alert column within your POE display. NOTE Users should remember that changes to POE display format and content are only applicable to the user who is currently logged into POE. 1. 2. 3. Select the View Column Selection menu option. Select Name Alert from the list of Available Columns. Click the Add command button. NOTE Performance of step 4 positions the Name Alert column at the extreme left side of the POE display. 4. 5. Repeatedly click the Move Up command button until Name Alert is at the top of the Displayed Columns list. Click OK. "); array_files[127]=new Array(0,4,"./Publications/QRG_Modify_PCA_&_Epi_Orders.pdf","2008-03-31","1460K"," QRG - Modify PCA_&_Epidural Orders "," 20070601 ","","MODIFYING ORDERS NOTE This procedure assumes that the appropriate patient has already been selected and that the Order Summary is displayed. 1. Right-click on the order that you are going to modify. 2. Select the Modify Order Requested by Me menu option. NOTE Modification of any or all of the following fields will result in a DOSE ADJUSTMENT label being displayed within the order description component for that order within the Order Summary display. Continuous Rate · Demand Dose · Demand Dose Lockout · Maximum Doses/Hour · DISCONTINUING ORDERS NOTE This procedure assumes that the appropriate patient has already been selected and that the Order Summary is displayed. 1. Right-click on the order that you are going to discontinue. NOTE Performance of the following step will result in the display of the Discontinue/Cancel Orders dialog box with all orders comprising the selected orderset preselected for cancellation. You may not deselect any individual component (order) comprising the orderset about to be discontinued. 2. Select the Discontinue/Cancel menu option. 3. Click on the OK command button. 4. Verify that the Order Summary reflects the orderset (and its components) as having been discontinued (see Figure 2). NOTE Be sure to contact and inform the assigned Nurse that you have discontinued this orderset! Provider Order Entry (POE) ­ Quick Reference Guide OVERVIEW This guide is intended to inform JHH Prescribers of the changes to the methodologies used to either modify or discontinue adult PCA / Epidural orders within POE. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. WHAT YOU NEED TO KNOW · · PCA can now only be ordered using a POE defined orderset. Component items comprising the PCA orderset are now linked. This means that discontinuance of any individual item within the associated orderset will cause all component items to be discontinued. It is no longer necessary to discontinue and reorder an existing PCA order in order to make a dose/rate change. 3. Make the desired modification(s) to the order. 4. Click on the OK command button. 5. Verify that the DOSE ADJUSTMENT label now appears within the Order Summary description for the modified order (see Figure 1). NOTE Be sure to contact and inform the assigned Nurse of the modifications you made to this order! · POE Quick Reference Guide Adult PCA & Epidural Order Modification by Prescribers 1 June 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 1 2 3 4 (Not Shown) 5 2 1 4 3 (Not Shown) "); array_files[128]=new Array(0,4,"./Publications/QRG_Managing_POE_Print-outs.pdf","2008-03-31","72K"," QRG - Managing POE Print-outs "," 20060523 ","","WHAT DO I DO WITH THE PRINT-OUTS? Throughout each day, order notices produced by the POE printer should be placed into the orders section of the patient chart--as soon as possible after having been printed. There are two essential reasons for this practice. · Provider Order Entry (POE) ­ Quick Guide NOTE The JHH Interim Medication Worklist may be discarded at midnight--in accordance with your unit procedures--once the JHH 24 Hour Summary and the JHH Scheduled MAR Report have been placed into the patient chart. PATIENT DISCHARGES When a patient is discharged, the responsible individual should perform the following tasks prior to discharging the patient (using Siemens ADT system). 1. Remove and discard the paper notices received during the immediately preceding 24 hours. 2. Remove and discard each JHH 24 Hour Summary accumulated during the patients stay on your unit. 3. Perform an on-demand print job for the JHH Cumulative Order Summary and place it in the orders section of the patient chart--this summary replaces all of the discarded 24 hour summaries discarded in step 2. 4. Perform an on-demand print job for the JHH Medication Administration Record, which is the eMAR for the day of discharge (spanning the period between 0001 and the time that the eMAR is printed­printing should be performed as close as possible to the actual time of discharge). 5. Place the printed record (eMAR) in the medications section of the patients chart. Non-POE providers/consultants will be able to review a collection of the days orders for the associated patient. Staff members in off-unit procedural areas will be able to access up-to-date patient information. · OVERVIEW During the course of a normal work day, many orders are entered into POE for each patient receiving care within your unit--medication orders, laboratory orders, nursing order review placeholders, etc. Each of these will appear as part of the patient record and are viewable via any POE workstation. All orders entered into POE will also be printed on your unit in the form of paper order notices-- produced by the units dedicated POE printer. This Quick Guide provides an overview for handling all of the paper order notices created during the course of a normal days activities. An online version of this guide and all other currently available POE documents is available at the POE website (the URL is provided below). http://www.jhmcis.jhmi.edu/poe. WHAT TRIGGERS THE PRINT-OUTS? At the end of an order session, prescribers select the Submit command button to generate the orders written during that session. As stated above, submission of these orders causes them to be routed to POE for viewing via an appropriately configured workstation and printing via the units designated POE printer. WHEN CAN I DISCARD THE PRINT-OUTS? Every evening--just after midnight--two POE reports will be printed for every patient within your unit. These reports are described below. · JHH 24 Hour Summary summarizes all orders written/discontinued during the immediately preceding 24 hours. JHH Scheduled MAR Report summarizes all medications submitted/administered during the immediately preceding 24 hours. · As soon as possible after these reports are printed, you should: 1. Remove and discard the paper order notices received during the immediately preceding 24 hours and replace them with the JHH 24 Hour Summary. 2. Insert the JHH Scheduled MAR Report into the MAR section of the patient chart. OFF UNIT PATIENT PROCEDURES If it is clinically necessary for a patient to go off unit for an extended period of time, the responsible individual should initiate an on-demand print request to obtain the JHH Interim Medication Worklist. Once obtained, the worklist should be placed into the patient chart to facilitate the administration of orders scheduled during the period the patient is off of your unit. Provider Order Entry Quick Guide­Managing POE Print-outs Version 4.0 XA Revised 23 May 2006 This revision of the Managing POE Print-outs QG supersedes all previous editions. Those dated prior to 23 May 2006 should be destroyed. ©2005-2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[129]=new Array(0,4,"./Publications/QRG_K_Bolus_Orders_PEDs.pdf","2008-03-31","895K"," QRG - Potassium Bolus Orders (Peds) "," 20070228 ","","BEFORE YOU BEGIN Please note that two Potassium Bolus orders are available for pediatric patients. When determining which order to select, the prescriber should consider the total dose that will be delivered­ Current infusions PLUS the bolus that will be ordered. · NOTE The prescriber will need to review the patients order summary to determine all current infusions containing KCL. Please note that the hourly mEq/kg rate is automatically populated once the required information has been entered. Provider Order Entry (POE) ­ Quick Reference Guide If the total potassium that will be delivered to this patient (including the bolus order) will be less than 0.3 mEq/kg/hour, select the order titled Potassium Bolus 0.3 mEq/kg/hr. If the total potassium that will be delivered to this patient (including the bolus order) will be equal to or greater than 0.3 mEq/kg/hour, select the order titled Potassium Bolus 0.3 mEq/kg/hr. NOTE 5. Enter the KCL mEq/Liter and the flow rate for each current infusion containing KCL. 6. Enter a value for KCL Bolus mEq/kg. NOTE This bolus order is placed after considering the patients current medical condition. Note that the prescriber specifies an absolute value for this order, which is to run over 2 hours ­the default value. PURPOSE This guide is intended for use by JHH Prescribers who need to place Potassium Bolus orders for a Pediatric patient within POE. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. · Total potassium in excess of 0.49 mEq/kg/hr is not allowed in any setting outside of ICUs. Orders 0.5 mEq/kg/hr or greater will not be processed by POE. 7. Change the length of time if necessary. 8. Select the desired Cardiorespiratory Monitoring Desired? option from the drop-down menu. 9. Click the OK command button. NOTE Selection of the OK command button in the previous step will result in POE attempting to process the order as you defined it. If POE determines that there appears to be a problem with the order, you will be presented with an alert dialog box explaining the nature of the discrepancy so that you may take the necessary corrective action(s). ASSUMPTIONS It is assumed that you: · · · · ENTER ORDER 1. Click on the Enter Order icon. 2. Enter potass into the field initially containing the following phrase. 3. Double-click on the desired bolus order­either Potassium Bolus 0.3 mEq/kg/hr or Potassium Bolus = or 0.3 mEq/kg/hr. NOTE Illustrations of the dialog boxes encountered in the following steps are provided on the back of this sheet. The POE order form used for Potassium Bolus reflects the paper order versions in use prior to the roll-out of POE. All data fields containing a red asterisk ( ) must be completed before the order will be processed. It may be necessary to use the scroll (slider) bar to access all mandatory fields. know your JHED ID, have received appropriate POE training, are currently logged into POE, and that POE focus is upon the appropriate patient. 10. Click on the Submit Order... command button. 4. Enter appropriate information (values) into all data fields containing a red asterisk. POE Quick Reference­Potassium Bolus Orders (Peds), Entering Version 4.5 XA 28 February 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 1 (Not Shown) 2 3 5 6 7 4 8 9 10 (Not Shown) "); array_files[130]=new Array(0,4,"./Publications/QRG_HLCC_PSC.pdf","2008-03-28","1120K"," QRG - Patient Services Coordinator (HLC) - Phase I "," 20060323 ","","About Individual Patient Data Display Information for each registered patient will occupy one row (horizontal division) of the status board. Rows associated with newly registered patients will display the name, sex, and age of the associated patient as well as an unassigned location, a waiting to be seen (WTBS) status, and a numeric indication (hh:mm) of the patients length of stay (LOS). NOTE You should also note that highlighting a patient within the status board will result in the display of the patients name and other information (MRN, visit number, age, sex, etc.) within the patient header. Remove Patient from Status Board NOTE This task is performed by the Checkout PSC once a follow-up appointment has been scheduled. 1. Right-click the patient. NOTE No confirmation dialog will be displayed when performing the following step. 2. Select the Remove Patient menu option. Restore Mistakenly Removed Patient 1. Select the Inactive Patients option from the View drop-down list. 2. Right-click on (highlight) the patient to be restored). 3. Select Return Patient menu option. NOTE Performance of the following step returns the patient to the previously occupied location. The length of stay (LOS) value will be correct value. HLC Application ­ Quick Reference Guide for the staff of the Harriet Lane Clinic This guide is intended for use by the Patient Services Coordinators assigned to the Harriet Lane Clinic. ASSUMPTIONS It is assumed that the HLC Status (Tracking) Board is displayed on your workstation. OVERVIEW All of the Patient Services Coordinator (PSC) tasks are generally performed after patient registration has been successfully performed by Admissions using the Epic System, and the associated patient has physically arrived at the Harriet Lane Clinic. The tasks performed by the PSC are identified as follows: · · · · · Enter Appointment Time 1. Double-click in the appointment time (Appt) cell associated with the patient--a flashing cursor should appear. 2. Enter the appointment time (24 hour clock) using the workstation keyboard. 3. Press Enter on the workstation keyboard. Enter Arrival Time 4. Double-click in the arrival time (Arr Tm) cell associated with the patient--a flashing cursor should appear. 5. Enter the arrival time (24 hour clock) using the workstation keyboard. 6. Press Enter on the workstation keyboard. Select Team 4. Select Yes button within the confirmation dialog. 5. Select the Active Patients option from the View drop-down list. SUPPLEMENTAL INFORMATION entry of appointment time, entry of patient arrival time, selection of an appropriate provider or team, designation of a patient location, and removal of patient from status board­performed by Checkout PSC. NOTE You may select the period (.) available at the top of the listed options to reset the Team listing. 7. Double click within the Team cell associated with this patient. Designate Location 8. Double-click within the Location cell associated with the patient. 9. Select either the general (General WR) or adolescent (Adolescent WR) waiting room. This revision of the Patient Services Coordinator­Phase I QRG supersedes all previous editions. Those dated prior to 27 March 2006 should be destroyed. Users of the HLC application may review changes made to status board information by right-clicking over the cell of interest and selecting the Show History option--see example menu below. NOTE Refer to the illustration on the back of this guide while performing the following tasks. Mary Small serves as an example of a newly admitted patient in this illustration. This capability is generally restricted to cells containing manually entered data. HLC Application Quick Reference Guide: Patient Services Coordinator­Phase I Version 4.0 XA 23 March 2006 ©2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Location Appointment Time Arrival Time Status Provider Team Team Drop-Down Provider Drop-Down Location Drop-Down "); array_files[131]=new Array(0,4,"./Publications/QRG_HLCC_Providers.pdf","2008-03-28","355K"," QRG - Providers (HLC) - Phase I "," 20060522 ","","WORKFLOW OVERVIEW Providers should monitor the status board continually in order to be aware of patient updates (changes in patient status). A patient is considered ready to be seen by the provider when the Acuity and Reason for Visit cells populate--information within these cells is retrieved from the nursing triage note). NOTE An acuity of 1 will cause the associated cell to display a red background. Discharging Patients NOTE If the PROV cell does not indicate a need for provider follow-up, all associated orders have been carried out, and documentation has been completed, the patient will be moved to the Inactive List (removed from the Active List) View prior to being discharged. The PSC (Patient Services Coordinator) will actually perform the patient discharge (manually). Printing a Triage Note NOTE The following description assume that focus is already on the appropriate patient. The requested print-out will be directed to the units network printer. 1. Click the Documents tab. 2. Select (highlight) the HLC Triage Note. 3. Click the Print Reports toolbar icon. 4. Select (highlight) the JHH Print Selected Documents option within the Reports Selection dialog box. 5. Click the Print button. 6. Click the Status Board tab--to return to the status board display. Changing Patient Information NOTE Providers will generally input/modify the following data prior to picking up the associated patient. ADDITIONAL TASK DESCRIPTIONS Viewing a Triage Note 1. Select (highlight) the patient of interest (on the status board). 2. Click the Documents tab. 3. Double-click the HLC Triage Note (title) that appears within the All Documentation list. 4. Click Close button--to return to the Documents display. 5. Click the Status Board tab--to return to the status board display. Copying Triage Info to EPR 1. Select (highlight) the patient of interest (on the status board). 2. Click the Documents tab. 3. Double-click the HLC Triage Note (title) that appears within the All Documentation list. 4. Highlight the desired text. 5. Right-click over the selected text and select Copy to Clipboard option. NOTE At this point you would access the EPR for this patient and paste the contents accordingly. Once pasted, return to the status board and proceed as directed below. Prior to Examining Patient HLC Application ­ Quick Guide for the staff of the Make the following changes. 1. Review the Triage Note. NOTE Make the following changes as necessary. Harriet Lane Clinic ASSUMPTIONS It is assumed that the HLC Status (Tracking) Board is displayed on your workstation. DISPLAY DESCRIPTION Information for each registered patient occupies one row (horizontal division) of the status board. Once registered, information reflective of that patient will populate the HLC Status Board (name, age, status, etc.) and you should notice the following: · · · 2. Change the content of the Provider field to display your name. 3. Change the Location field to indicate the appropriate examining room. 4. Change status (STS) to TIP (treatment in progress). After Examining Patient You will need to write paper orders and generate order notifications for the appropriate patient. NOTE Orders notifications provide visual indications­to members of the clinical staff­that written orders exist. Assigning Provider (Name in Drop-Down Menu) 1. Double-click within the appropriate Provider cell. 2. Select the appropriate provider name from the drop-down list. Assigning Provider (Name Not Displayed) 1. Double-click within the appropriate Provider cell. 2. Scroll to bottom of drop-down list and select the More Providers option. 3. Select the All providers of type `Physician option. 4. Select (click) the appropriate physicians name from the Provider Selection list. (continued on back) the Length of Stay (LOS) value automatically appears and updates, the associated Location field displays Unassigned, and the Status (STS) field will display WTBS (waiting to be seen). NOTE An illustration of the status board is provided on the back of this sheet. Status board column widths are somewhat narrow; however individual columns may be widened by dragging one side of a column in an appropriate direction. The narrow width of the Patient column affords a limited degree of confidentiality in that the entire patient name is not visible. Please note that acute rooms are identifiable by their red background color. 1. Double-click within the appropriate order cell--IMM, MEDS, etc. NOTE Performance of the following step will cause a cell background color to be applied. 2. Select ORD from the drop-down list of options. NOTE You may also select (highlight) the PROV (provider) cell to indicate a need for patient re-evaluation by the provider prior to discharge. HLC Application Quick Guide: Providers­Phase I Version 4.0 XA 22 May 2006 This version of the Providers­Phase I QG supersedes all previous editions. Versions of this document dated prior to 22 May 2006 should be destroyed. 6. Click Close button--to return to the Documents display. 7. Click the Status Board tab--to return to the status board display. ©2006 Information Tech "); array_files[132]=new Array(0,4,"./Publications/QRG_HLC_Nurses.pdf","2008-03-28","373K"," QRG - Nurses (HLC) - Phase I "," 20060525 ","","WORKFLOW OVERVIEW Nurses should monitor the status board continually in order to be aware of patient updates (changes in patient status). A patient is considered ready for triage after the Patient Services Coordinator (PSC) has entered appointment (Appt) and arrival times (Arr Tm) as well as having made Team and waiting room (Location) assignments. RESPONSIBILITIES­TRIAGE NURSE Triage Nurses are responsible for: · Documenting the Triage Note, and · Assigning a Nurse Clinician. Documenting the Triage Note 1. Select (highlight) the patient of interest (on the status board). 2. Click the Triage button (at the bottom of the status board display). 3. Click on the desired triage note section (see below). 5. Repeat steps 3 and 4 until Triage Note is completed. 6. Click Review button. 7. Examine the content of the Review/Preview display. 8. Click OK to return to the Triage Note. NOTE Do not continue to the next step until you are satisfied with the content of the Triage Note. Discharging Patients NOTE Once the PROV cell does not indicate the need for provider follow-up, and all of the associated orders and documentation have been completed, the patient will be moved to the Inactive List prior to being discharged by the PSC. 9. Click Submit button. 10. Click Refresh button. Making Nurse Assignments 1. Double-click within the NURSE cell associated with the patient of interest. NOTE If the name of the desired nurse is not listed, it will be necessary to access the More Providers option of the Provider Selection dialog. Once this dialog is displayed select the All providers of type `Nurse option to retrieve the names of all available nurses. ADDITIONAL TASK DESCRIPTIONS Viewing a Triage Note 1. Select (highlight) the patient of interest (on the status board). 2. Click the Documents tab. 3. Double-click the HLC Triage Note (title) that appears within the All Documentation list. 4. Click Close button--to return to the Documents display. 5. Click the Status Board tab--to return to the status board display. Printing a Triage Note NOTE The following description assume that focus is already on the appropriate patient. The requested print-out will be directed to the units network printer. HLC Application ­ Quick Guide for the staff of the Harriet Lane Clinic ASSUMPTIONS It is assumed that the HLC Status (Tracking) Board is displayed on your workstation. DISPLAY DESCRIPTION Information for each registered patient occupies one row (horizontal division) of the status board. Once registered, information reflective of that patient will populate the HLC Status Board (name, age, status, etc.) and you should notice the following: · · · 2. Click on the name of the nurse to be assigned. RESPONSIBILITIES­ALL NURSES · the Length of Stay (LOS) value automatically appears and updates, the associated Location field displays Unassigned, and NOTE The remainder of the Triage Note display (see figure on back of sheet) will reflect the content of the selection made in the previous step. In general: · Radio Buttons (circles) allow a single selection-- All nurses are responsible for addressing order notifications and documenting them on the status board. Addressing Order Notifications NOTE With the exception of the provider (PROV) cell, order cell background coloration is indicative of clinical responsibility. Green--Nurse Pink--Nursing Assistant Yellow--either Nurse or Nursing Assistant 1. Click the Documents tab. 2. Select (highlight) the HLC Triage Note. 3. Click the Print Reports toolbar icon. 4. Select (highlight) the JHH Print Selected Documents option within the Reports Selection dialog box. 5. Click the Print button. 6. Click the Status Board tab--to return to the status board display. (continued on back) ©2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. the Status (STS) field will display WTBS (waiting to be seen). NOTE An illustration of the status board is provided on the back of this sheet. Status board column widths are somewhat narrow; however individual columns may be widened by dragging one side of a column in an appropriate direction. The narrow width of the Patient column affords a limited degree of confidentiality in that the entire patient name is not visible. Please note that acute rooms are identifiable by their red background color. yes or no, true or false, etc. · Check Boxes (squares) allow multiple selections. · Data Fields (white rectangles) allow you to make 1. Double-click within the appropriate order cell-- IMM, MEDS, etc. NOTE Performance of the following step will cause the associated cells background color to revert to white. text entries. 4. Make appropriate entries into the selected section. This version of the Nurses­Phase I QG supersedes all previous editions Versions of this document dated prior to 25 May 2006 should be destroyed. HLC Application Quick Guide: Nurses­Phase I Version 4.0 XA 25 May 2006 2. Select either the in progress (IP), or completed (COMP) menu o "); array_files[133]=new Array(0,4,"./Publications/QRG_HLC_Acute_Care_Note.pdf","2008-03-28","645K"," QRG - MD Acute Care Note (HLC) "," 20061215 ","","3. Click on the Now (Authored) option--if it is not already selected. 4. Click on the Me (Authored by) option--if it is not already selected. 5. Click the Co-Signatures check box (a check mark should be visible). NOTE If the default listing does not display the name of the preferred Preceptor, click the Other radio button, enter the % character into the Care Provider data field, and click the Search command button before proceeding. 3 8 9 HLC Application ­ Quick Guide for the staff of the 4 Harriet Lane Clinic PURPOSE This quick reference is intended to provide the reader with an understanding of the content and use of the HLC MD Acute Care Note. AUDIENCE The primary audience consists of the residents, interns, and medical students who will be using ED Manager to create the HLC MD Acute Care Note. ASSUMPTIONS It is assumed that the user is logged on and that the HLC Status Board is displayed on your workstation. ACUTE CARE NOTE CREATION Individuals new to ED Manager are encouraged to perform each of the following steps in the order of their presentation when creating the HLC MD Acute Care Note. As experience is acquired, users may discover alternate approaches that are equally as successful. 1. Click on (highlight) the patient for whom the note is being created. 2. Click on the Enter Document icon. 6. Select (highlight) the Senior Resident (SAR) and Preceptor (Attending) that will need to cosign your note. 7. Click OK. 8. Enter (type) HLC into the Content of field­your entry replaces the Type here to enter document character string. 9. Double-click on the HLC MD Acute Care Note option. The HLC MD Acute Care Note - Structured Note display is presented. 10. Enter necessary information into the appropriate areas of the note. NOTE See reverse side for details on Copy Forward of vital signs and medications from the HLC Triage Note. 5 6 11. Once the note is complete, click on the Review button. 12. Click OK once you have finished examining the note. NOTE If review of the note revealed a need for either correction of existing information or the need for additional information, access the appropriate section (sub-section) of the note and correct (add) the appropriate information. See reverse side for figure associated with steps 10 through 13. 7 13. Click Submit to complete creation of the note (see reverse for additional submission information). HLC Quick Guide: MD Acute Care Note Version 4.5 XA 15 December 2006 ©2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Topic Header Region 10 Modify Templates Button 11 12 Not Shown 13 ADDITIONAL INFORMATION Staff members tasked with the creation of the MD Acute Care Note should review the following topics. Copy Forward This capability allows you to copy specific information from a previously created source (existing note) into the acute care note being created. The steps required to perform this function are summarized as follows: 1. Click the Copy Forward button. 2. Select (highlight) the appropriate HLC Triage Note. 3. Click the Vital Signs and Medications check boxes if those regions of the selected note contain appropriate (valued) information­check marks should be visible. 4. Click Copy Items into Current Note button. NOTE Two asterisks (**) will appear next to the immediate left of topic headers (sections/sub-sections) that contain the data that has been copied forward. Modify Template (continued) It is recommended that HLC residents, interns, and medical students remove the check mark from the Path Statement check box, as this note element is used by Preceptors (Attendings) only. Submission of Note Notes may be submitted as either complete (all relevant information has been input) or incomplete. · Complete--all relevant information has been input. The note will be made available to the Preceptor (Attending) and once co-signed may not be subsequently edited. Incomplete--additional information, which cannot be input during the current session, is required to complete the note. Create Note Dialog · The steps required to access an incomplete note are summarized below. 1. Click the Documents tab. 2. Select (highlight) the note of interest. 3. Right-click the selected note to access option menu. 4. Select the Edit Document option. 5. Complete data entry. 6. Click the Submit button once note is complete. 7. Click Submit as Complete (within resultant dialog). Modify Template This capability, which is initiated via the Modify Template button at the top of the display, allows you to tailor the note being created for a specific patient. This functionality allows you to delete and/or restore note components (sections and sub-sections). Two check boxes are available for how selected modifications will be applied. · Save template for me--all of your specified changes will be reflected in the acute care note structure each time you initiate creation of the acute care note. The structure of the note displayed to other residents, interns "); array_files[134]=new Array(0,4,"./Publications/QRG_Entering_Ht_&_Wt_Data.pdf","2008-03-28","298K"," QRG - Entering Height and Weight Data "," 20060111 ","","PROCEDURE 1 NOTE The following procedure assumes that you are logged into POE and that system focus is on the appropriate patient. Values may be entered in either metric or U.S. units of measure. POE will automatically covert these values and display them using both standards. Provider Order Entry (POE) ­ Quick Reference Guide NOTE Step 3 may be omitted as height information is not mandatory; however, it is preferable to include information when known. 3. 4. 5. Enter the value for Current Height. Enter the value for Current Weight. Click the OK command button. (continued on back) 1. 2. Click on the Patient Info tab. Double-click the Height/Weight option within the Data Entry filter region of the display. This guide is intended for use by JHH providers, nurses and pharmacists. OVERVIEW With the installation and employment of the bidirectional interface (connecting POE and BDM), patients weight and height data must be entered via POE. Corresponding values previously recorded within BDM will be overwritten by POE values. Entry of weight and height data into POE may be performed by providers, nurses or pharmacists. JHH policy states that weight information must be contained within an order before medications may be dispensed/administered. Entry of height information although preferred is not mandatory--unless required for proper dosing of the associated medication. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. Other publications of interest are also available at this web site. This guide describes two procedures that may be used for entering weight and height information. ©2005-2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Entering Height & Weight Data Revision­Version 4.0 XA 11 January 2006 PROCEDURE 2 NOTE The following procedure assumes that you are logged into POE and that system focus is on the appropriate patient. Values may be entered in either metric or U.S. units of measure. POE will automatically covert these values and display them using both standards. 1. 2. Click on arrow (icon) at right side of the Dose data field to access dose calculation dialog. Enter weight and/or height information, necessary to perform calculation, along with Requested amount per dose value. Click OK (within the Dose Calculation dialog). 3. NOTE Performance of the following step makes the data entered above available to BDM. 4. 5. Click OK (within the confirmation dialog). Click OK (within the order dialog). "); array_files[135]=new Array(0,4,"./Publications/QRG_Entering_Allery_Info.pdf","2008-03-28","855K"," QRG - Entering Allery Info "," 20080320 "," ","ALLERGIES IN POE... continued · Centricity allergy data is overwritten every time allergy NOTE If allergy data has been previously recorded for this patient (by selection of the New Allergy option), proceed directly to step 5. Otherwise, if either No Known Allergies or Allergy Status Unknown was previously selected (no specific allergy information recorded) perform both steps 3 and 4. updates are entered into POE. · Allergy reaction data entered in POE is not currently passed to Centricity. · Pharmacists wishing to enter allergy data for POE patients, MUST enter the data in POE. · Allergy data may be entered into POE by JHH providers, nurses, and pharmacists. Provider Order Entry (POE) ­ Quick Reference Guide ALLERGY ENTRY ­ POE NOTE The following procedure assumes that you are logged into POE and that system focus is on the appropriate patient--the one for whom allergy information is about to be entered. If focus is not on the preferred patient: · Click the Patient List tab, · Select the preferred unit from the Current List drop-down list, and · Select the patient of interest. This guide is intended for use by JHH providers, nurses and pharmacists. JHH has deemed that POE be main source of allergy information that will be made available to other clinical information systems. 3. Click the radio button on preferred Allergy Type. 4. Click the OK command button. 5. Select the appropriate allergy Type from the drop-down list. 6. Select the appropriate Allergen from the drop-down list. OVERVIEW This guide explains how to enter a patients allergy information into POE. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. 1. Click on the allergy (silhouette) toolbar. icon on the POE ALLERGIES IN POE & CENTRICITY All JHH staff members who interact with POE and/or Centricity should be aware of the following aspects of patient allergy database maintenance. · · 2. Click on the command button (within the Allergy Summary display). Allergy information is required by the Pharmacy before an order can be processed. Drug type allergens should be entered as single-ingredient items only--not as multiingredient allergens. · Allergy data displayed within Centricity originates in POE. (continued in next column) Provider Order Entry Quick Reference Guide­Entering Allergy Info Revision­Version 4.5 XA 20 March 2008 This revision of the Entering Allergy Info QRG supersedes all previous editions. Those dated prior to 20 March 2008 should be destroyed. (continued on back) ©2004­2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 7. Click the Add Reaction command button. 8. Select either the Unknown or Select all reactions that apply radio button. FOR CENTRICITY USERS ONLY As illustrated below, multi-ingredient allergens appear as italicized-blue-lowercase text entries. In the example below, acetaminophen-codeine has been entered as a multi-ingredient allergen. Automated checking WILL NOT be performed. VIEWING ALLERGEN INFO Additional information about allergens entered into Centricity may be viewed by performing the following tasks. 1. Select the Medical Allergies/Pharmacogenomics... menu option. 2. Select (highlight) the allergen of interest as listed under the Text Description column header. 9. Click the check box for each reaction that is appropriate for the allergy being described. 10. Click the OK command button within the Reaction Details dialog. 11. Click the OK command button within the Allergy (Adding New) dialog. 12. Click Close (within the Allergy Summaries display). As illustrated below, single-ingredient allergens appear as BLACK-UPPERCASE NON-ITALICIZED text entries. In the example below, ACETAMINOPHEN has been re-entered as a single-ingredient allergen. ALLERGY CHECKING The appearance of the information displayed within the allergy region is indicative of whether automated Ultimedex checking will be performed. · Checking Performed Allergens displayed with UPPERCASE BLACK LETTERING will undergo Ultimedex checking. · No Checking Performed Allergens displayed with italicized blue lettering will not be subjected to Ultimedex checking. MULTI-INGREDIENT ALLERGENS Multi-ingredient drug type allergens should NOT be entered into POE. There are two major reasons why only single-ingredient allergens should be entered into POE. · · No automated Centricity (Ultimedex) checking is performed on multi-ingredient allergens! Receipt of multi-ingredient allergens requires pharmacists to re-enter all multi-allergen components into POE as individual entries. 3. 4. Review the allergen information contained within the dialog. Click the OK command button. If an allergen is displayed with italicized blue lettering, the Pharmacist must discontinue that allergen in POE and re-enter it correctly. "); array_files[136]=new Array(0,4,"./Publications/QRG_Discharge_Summary_-_Worksheet_Integration_(Final).pdf","2008-03-28","359K"," QRG - EPR Discharge Summary & POE Worksheet Integration "," 20080318 ","","What happens if the EPR Discharge Summary is finalized (signed) prior to the receipt of a POE Discharge Worksheet? NOTE What happens if the Medications section of the POE Discharge Worksheet is empty? The content of the medications section of the POE Discharge Worksheet will always replace the corresponding section of the EPR Discharge Summary--even if the medications section of the POE Discharge Worksheet is blank and the corresponding section of the EPR Discharge Summary is not. How do providers document changes to the medications list--within the EPR Discharge Summary--after POE Discharge Worksheet medications have been inserted into the Discharge Summary preventing it from being edited? Any information reflecting changes made subsequent to patient discharge should be entered in the EPR Discharge Summarys Instructions section. How does use of the Document Wizard affect this new functionality? Currently, there are no POE Units within the Department of Medicine that use a document wizard to create a discharge summary. NOTE Documents described in the following statement do not meet the core measures requirement!. EPR will not replace the Discharge Medications section of a signed or finalized discharge summary. Does EPR know which units use the POE Discharge Worksheet? Quick Reference Guide No, EPR simply reacts to the discharge worksheets that it receives from POE. Is there a POE Discharge Worksheet for each patient visit? NOTE The purpose of this document... This document describes the Core Measures Enhancement that integrates the POE (Provider Order Entry) Discharge Worksheet with the EPR (Electronic Patient Record) Discharge Summary. What is the purpose of this enhancement? The Joint Commissions Core Measurement requirement, mandates that medications listed on both the POE Discharge Worksheet (given to the patient upon discharge) and the EPR Discharge Summary (sent to the patients referring physician) be identical. What effect does this enhancement have upon EPR? NOTE The following operation will not take place if the EPR Discharge Summary has already been signed, finalized or retired. Upon receipt of a finalized POE Discharge Worksheet, EPR will replace the text within its discharge medications list with that contained within the POE worksheet. POE and its discharge worksheet are not currently used at the Bayview Medical Center (BMC). No, because POE is not used in all JHH inpatient units and not all units using POE employ the discharge worksheet. For this reason, not all EPR Discharge Summaries will have the content of the Discharge Medications section replaced. Will I know if the Discharge Medications section of the EPR Discharge Summary has been replaced? Yes ­ the following message will be displayed within the EPR Discharge Summary. Should the status noted above change, use of the Document Wizard to generate discharge summaries would allow users to change the medication list. These documents would not meet the core measures requirement! Any other changes to the Management of EPR Discharge Summaries? See the back of this sheet for a larger version of the message pictured above. Yes, when you sign an EPR Discharge Summary, EPR will check to see if the Discharge Medications section is blank. If that section is blank, EPR will give you the option to either continue or go back and add medications. POE (EPR) Quick Guide ­EPR Disc. Summary & POE Disc. Wksht Integration Revision­Version 4.5XA 18 March 2008 This version of the EPR Discharge Summary & POE Discharge Worksheet Integration Quick Guide supersedes all previous versions. Versions of this document dated prior to 18 March 2008 should be destroyed. ©2008 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[137]=new Array(0,4,"./Publications/QRG_Creating-Modifying_Lists.pdf","2008-03-28","338K"," QRG - Creating (Modifying) Unit Lists "," 20050622 ","","Create A Single Unit List NOTE Performance of the following steps will create a single unit list that will be maintained until you choose to delete it. NOTE The name entered in the following step must match the name of the selected unit exactly as it appears within the Client Selection Criteria dialogs list of units. 1. Click the File menu option. 2. Select (highlight) the Maintain List option. 3. Select (highlight) the New option. 11. Type in the name that you wish to assign this list into the List Name data field. Provider Order Entry (POE) ­ Quick Reference Guide 12. Click the OK button. PURPOSE This guide is intended for use by all POE users and describes the process used to create/edit/delete a unit (personal) list. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe 4. Click the Locations tab. 5. Click on the Include patients at selected locations only radio button. 6. Double-click the option listed as The Johns Hopkins Hospital within the Available Locations window. 7. Double click the JHH-INPATIENT option. 8. Highlight the unit you want to add to your list. NOTE Performance of the following step will result in the selected unit being displayed with the Selected Locations window of the Client Selection Criteria dialog box. 13. Select the name that you entered from the drop-down of Current List options. Create A Multiple Unit List NOTE Performance of the following steps will create a list consisting of multiple units identified by a name that reflects the collection of units. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. OVERVIEW This process consists of the following subtasks: · · · · 1. Select the name of the list you wish to modify from the drop-down of Current List options. 2. Click the File menu option. 3. Select (highlight) the Maintain List option. 4. Select (highlight) the New option. creating a personal list consisting of a single unit, creating a personal list consisting of multiple units, deleting units from a personal list, and deleting a personal list 9. Click on the Add button. 10. Click on the OK button. (continued on back) ©2005 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Creating/Modifying Unit Lists Revision­Version 3.5 XA 22 June 2005 Create A Multiple Unit List--continued 5. Click the Locations tab. 6. Click on the Include patients at selected locations only radio button. 7. Double-click the option listed as The Johns Hopkins Hospital within the Available Locations window. 8. Double click the JHH-INPATIENT option. 9. Highlight the unit you want to add to your list-- within the Selected Locations window. NOTE Performance of the following step will result in the selected unit being added to the Selected Locations window of the Client Selection Criteria dialog box. Repeat steps 9 and 10 (before proceeding to step 11) for each unit you want to add to the list being modified. Delete Units From A List 1. Select the name of the list you wish to modify from the drop-down of Current List options. 2. Click the File menu option. 3. Select (highlight) the Maintain List option. 4. Select (highlight) the Modify option. Delete Units From A List--continued 10. Click the OK button. 11. Select the name of your list from the drop-down of Current List options. Delete A Personal List NOTE Failure to comply with the requirements of step one will result in the irreversible deletion of the list. Replacement of the list will only be possible through the creation of a new list and the assignment of an appropriate name. 5. Click the Locations tab. 6. Highlight the unit you want to delete from your list--within the Selected Locations window. NOTE Performance of the following step will result in the selected unit being removed from the Selected Locations window of the Client Selection Criteria dialog box. Repeat steps 6 and 7 (before proceeding to step 8) for each unit you want to remove from the list being modified. 1. Ensure that the name of the list that you wish to delete is displayed in the drop-down of Current List options. 2. Select the Delete Current List option from the Edit menu. 10. Click on the Add button. 11. Click on the OK button. 7. Click on the Remove button. 8. Click on the OK button. 12. Enter a name reflective of all the units contained within this list into the List Name data field. 9. If you wish to keep the current list name, skip this step and go directly to the next step. Otherwise, enter the new name that you wish to assign this list into the List Name data field. NOTE The currently selected list will be irretrievably deleted upon performance of the following step. No confirmation dialog will be displayed! 3. Click on the OK button 13. Click the OK button. 14. Select the name of your list from the drop-down of Current List options. "); array_files[138]=new Array(0,4,"./Publications/QRG_Creating_Service-Based_Lists.pdf","2008-03-28","326K"," QRG - Creating Service-Based Lists "," 20060624 ","","NOTE Performance of the following steps will create a service-based personal list that will be maintained until you choose to delete it. 6. Click on the The Johns Hopkins Hospital option to expand the listing displayed within the Available Locations window. 1. Click the File Maintain List New menu option. Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide is intended for use by all POE users and describes the process used to create a (personal) list of all inpatients being cared for by a particular JHH Service­for example, Urology. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe 2. Click the Service tab. 3. Select (highlight) the service of interest listed within the drop-down list ­ Urology in this example. 7. Select (highlight) the JHH INPATIENT option displayed within the Available Locations window. 8. Click the Add button. 9. Select the OK button. 10. Type an appropriate name into the List Name data field ­ such as My Urology List that is used in this example. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. 4. Click the Locations tab. 5. Click on the Include patients at selected locations only radio button. NOTE Performance of the following step will result in the My Urology List being displayed by POE. It is also assumed that all patients of interest are associated with the designated service. If a patient is missing from your service-based list (one that you know should be there), you should call Admissions and request that the service associated with the missing patient be corrected (updated). 11. Select the OK button. Provider Order Entry Quick Guide­Creating Service-Based Lists Version 4.0 XA 24 June 2006 This is the initial release of the Creating Service-Based Lists QG. ©2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. "); array_files[139]=new Array(0,4,"./Publications/QRG_Creating_Lists_-_Orders-Based.pdf","2008-03-28","755K"," QRG - Creating Orders-Based Lists "," 20070206 ","","OTHER QUICK REFERENCES Other POE Quick References that address the creation/use of lists include the following: · · · Patient Lists & Searches, Creating Service-Based Lists, and Creating/Modifying Unit Lists. PROCEDURE NOTE Provider Order Entry (POE) ­ Quick Reference Guide 13. Click on the Location tab. 14. Select the Include patients at selected locations only radio button. 15. Click on the plus sign (+) to the immediate left of THE JOHNS HOPKINS HOSPITAL option. 16. Select (highlight) the JHH-INPATIENT option. 17. Click the Add button. 18. Click the OK button. NOTE The name entered in the following step may be the same as the filter that you created to serve as criteria for this list or it may be something else­in either case it should be descriptive of the list that you are creating. An illustration of the steps comprising the following procedure is provided on the back of this sheet. PURPOSE This guide is intended for use by all POE users and describes the process used to create an orders-based list. The example used within this quick guide results in the construction of a list that is populated by any in-patient with at least one active PEDs Pain Service order. Your list could be made more specific by selecting one or more specific units rather than JHH INPATIENT; which is used within this example as the location that is to display patients who have at least one active order as specified within the PEDs Pain Service orders catalog. NOTE Remember only those patients that satisfy the criteria you specify will appear in the list created through the performance of this procedure. 1. Select the File Maintain List New menu option. 2. Click on the Orders tab. NOTE Selection of the checkbox in the following step will be visually affirmed by the display of a check mark. 19. Enter an appropriate title for your list within the List Name data field. 20. Click the OK button. IN SUMMARIZATION Please note that the list created by this procedure will contain only patients on the selected units that have at least one of the orders specified in your filter. This patient list will be available via the Current List drop-down menu each time you log into POE. This list will not require maintenance unless new units or new orders need to be accommodated. If patients requiring your services may be admitted to other units, you will need to modify your list to contain these units. If new orders (POE catalogue items) are added to your service, you will need to modify your order filter to contain these items. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe 3. Select the Check this box if you want to create a list of patients that only have orders as specified below checkbox. 4. Click on the Add New button located to the immediate right of the Order Selection Filter drop-down menu. 5. Enter an appropriate Filter Name­PEDs Pain Service Orders in this example. 6. Click in the Enter Order data field. 7. Enter the name of the POE catalog item (order) to be used as display criterion for this list into the Enter Order data field­epidural in this example. 8. Select (highlight) the desired medication--Epidural Peds in the example. 9. Click the Add button. NOTE Repeat steps 6 through 9 for each order that you wish to use as display criteria for this list. Proceed to the next step only when all of the desired orders have been entered. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. 10. Click the OK button. 11. Select (highlight) the filter that you created within the Order Selection Filter drop-down list. 12. Select Active Only as the Order Status Filter option. ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Creating Orders-Based Lists Version 4.5 XA 6 February 2007 1 2 5 6 7 8 9 10 3 4 11 12 13 19 14 15 16 17 18 20 "); array_files[140]=new Array(0,4,"./Publications/QRG_Create_Results_Filter.pdf","2008-03-28","634K"," QRG - Create Results Filter "," 20070316 ","","NOTE POE focus should be established on the patient of interest prior to performing any of the following procedures. CREATE A RESULTS FILTER The following procedure will create a results filter that will remain accessible via the Result Selection drop-down list until it is deleted. 1. 2. 3. 4. 5. Select the Results tab. Select the Preferences Results menu option. Click the Result Selection tab. Click the Add New command button. Enter a name in the Filter Name field. NOTE As an alternative method to that described by steps 6­9, you may select the Result Item radio button and then enter the name of a specific item (result). If you use this method, proceed directly to step 9 after an item has been selected. 13. Highlight the header and click either the Move Up or Move Down command button until the header is appropriately positioned. 14. If you wish to insert additional headers, repeat steps 11-13 for each additional header. 15. Click on the OK command button. 16. Click on the Close command button. MODIFY A RESULTS FILTER You should be aware of the following: changing the name of an existing filter, while in the act of modifying its content, will result in the original filter and its assigned name being preserved; and · the All filter cannot be modified. · CHANGE DEFAULT DESIGNATION 1. Select the Results tab. 2. Select the Preferences Results menu option. 3. Click the Result Selection tab. 4. Select (highlight) the name of the filter being designated as the default. 5. Click the Set as Default command button. 6. Click on the Close command button. USE PERSONAL RESULTS FILTER 1. Select the Results tab. 2. Click on the Results Selection drop-down arrow icon. 3. Click on the name of the desired filter (displayed in the resultant listing). USE TEMPORARY FILTERS The following procedure will create a results filter that will not be preserved for subsequent use. 1. Select the Results tab. 2. Click on the Results Selection drop-down arrow icon. 3. Click on the Temporary Selection... option. NOTE At this point, you may selectively use the appropriate steps (6­16) within the Create A Results Filter procedure to establish temporary filter criteria. Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide is intended for use by members of the JHH Clinical Staff and describes the processes used to create/modify user defined filters that control the content of the POE Results Summary display. These filters will only be available to the user who defines them and will have no impact upon the display of results to other users, who subsequently log into POE. This guide describes the processes used to: · · · · · · 6. Select the Result Browse radio button. NOTE It may be necessary to click on the icon in the following steps in order to view the desired results categories and subcategories. Select the Results tab. Select the Preferences Results menu option. Click the Result Selection tab. Select (highlight) the name of the filter being modified. 5. Click the Modify command button. NOTE At this point, you may selectively use the appropriate steps within the Create A Results Filter procedure to impart the desired modifications. 1. 2. 3. 4. create a results filter, modify a results filter, delete a results filter, change the default filter designation, use filter to view results, and use temporary filters. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. 7. If you wish to select an entire category (group of items) for display as part of this filter, highlight the category of interest and proceed directly to step 9. 8. If you wish to select a specific result Item, highlight that result. 9. Click the Add command button to make the selected item (category) part of the filter definition. 10. If you wish to include additional result categories/items, repeat previous steps for each additional item. NOTE If you wish to separate items into specific groups, perform steps 11­14; otherwise, skip to step 15. DELETE A RESULTS FILTER You should be aware of the fact that: · should you delete the currently designated default filter, the All filter becomes the default; and · the All filter cannot be deleted. Select the Results tab. Select the Preferences Results menu option. Click the Result Selection tab. Select (highlight) the name of the filter being deleted. 5. Click the Delete command button. 6. Click on the OK command button within the confirmation dialog. 7. Click on the Close command button. 1. 2. 3. 4. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. 11. Enter an appropriate label into the Header field. 12. Click the Insert command button. POE Quick Reference Guide­Results Filters, Creating Version 4.5 XA 16 March 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. 1 1 1 10 14 2 3 2 3 2 3 (Not Shown) 4 4 5 4 16 5 After completing steps "); array_files[141]=new Array(0,4,"./Publications/QRG_Create_Graph_Filter.pdf","2008-03-28","621K"," QRG - Create Graph Filters "," 20070316 ","","NOTE POE focus should be established on the patient of interest prior to performing any of the following procedures. NOTE If you wish to separate items into specific groups, perform steps 11­14; otherwise, skip to step 15. CREATE A GRAPH FILTER The following procedure will create a graph filter that will remain accessible via the Result Selection drop-down list until it is deleted. 1. 2. 3. 4. Select the Results tab. Select the Preferences Results menu option. Click the Graph Selection tab. Click the Add New command button. NOTE An asterisk will be appended to the name that you enter in the following step to indicate that the associated filter is applicable to graphs. Do not attempt to enter an asterisk as an initial character as it will not be accepted. Provider Order Entry (POE) ­ Quick Reference Guide 11. Enter an appropriate label into the Header field. 12. Click the Add Subgraph command button. 13. Highlight the header and click either the Move Up or Move Down command button until the header is appropriately positioned. 14. If you wish to insert additional headers, repeat steps 11-13 for each additional header. 15. Click on the OK command button. 16. Click on the Close command button. MODIFY A RESULTS FILTER You should be aware of the following: changing the name of an existing filter, while in the act of modifying its content, will result in the original filter and its assigned name being preserved; and · the All filter cannot be modified. · USE TEMPORARY FILTERS The following procedure will create a graph filter that will not be preserved for subsequent use. 1. Select the Results tab. 2. Click on the Results Selection drop-down arrow icon. 3. Click on the Temporary Graph... option. NOTE At this point, you may selectively use the appropriate steps (6­16) within the Create A Graph Filter procedure to establish temporary filter criteria. PURPOSE This guide is intended for use by members of the JHH Clinical Staff and describes the processes used to create/modify user defined filters that control the content of the POE graph displays. These filters will only be available to the user who defines them and will have no impact upon the display of results to other users, who subsequently log into POE. This guide describes the processes used to: · · · · · DELETE A GRAPH FILTER 1. Select the Results tab. 2. Select the Preferences Results menu option. 3. Click the Graph Selection tab. 4. Select (highlight) the name of the filter being deleted. 5. Click the Delete command button. 6. Click on the OK command button within the confirmation dialog. 7. Click on the Close command button. 5. Enter a name in the Filter Name field. NOTE As an alternative method to that described by steps 6­9, you may select the Result Item radio button and then enter the name of a specific item (result). If you use this method, proceed directly to step 9 after an item has been selected. create a graph filter, modify a graph filter, delete a graph filter, use filter to view results, and use temporary graph filters. 6. Select the Result Browse radio button. NOTE It may be necessary to click on the icon in the following steps in order to view the desired results categories and subcategories. 1. 2. 3. 4. Select the Results tab. Select the Preferences Results menu option. Click the Graph Selection tab. Select (highlight) the name of the filter being modified. 5. Click the Modify command button. NOTE At this point, you may selectively use the appropriate steps within the Create A Graph Filter procedure to impart the desired modifications. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe. ASSUMPTIONS It is assumed that you: · · · know your JHED ID, have attended appropriate POE training, and are currently logged into POE. 7. If you wish to select an entire category (group of items) for display as part of this filter, highlight the category of interest and proceed directly to step 9. 8. If you wish to select a specific result Item, highlight that result. 9. Click the Add command button to make the selected item (category) part of the filter definition. 10. If you wish to include additional result categories/items, repeat previous steps for each additional item. USE PERSONAL RESULTS FILTER 1. Select the Results tab. 2. Click on the Results Selection drop-down arrow icon. NOTE Remember that all graph filters have an asterisk appended as the first character of their names. 3. Click on the name of the desired filter (displayed in the resultant listing). ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. POE Quick Reference Guide­Graph Filters, Creating Version 4.5 XA 16 March 2007 1 1 10 14 2 3 2 3 (Not Shown) 1 4 4 16 5 2 3 5 4 6 7 6 11 12 5 7 8 13 15 After completing steps 1­5, perform appropriate steps of the Create Filter procedure to modify filter content. 1 3 9 2 To use a temporary filter, select Temporary Graph... in step 3 and perform app "); array_files[142]=new Array(0,4,"./Publications/QRG_Create_Dialysis_Lists.pdf","2008-03-28","1042K"," QRG - Create Dialysis Focused Lists "," 20071003 ","","3. Click on the Orders tab. NOTE In steps 9 and 10, your entries should be appropriate for the filter name previously specified in step 6. 15. Click on the Location tab. 9. Enter one of the following text options into the Enter Order field. Hemodialysis Peritoneal Dialysis CRRT Provider Order Entry (POE) ­ Quick Reference Guide 4. Click check box labeled Check this box if you want to create... 5. Click the Add New button within the Order Selection Filter region of the dialog. NOTE In step 6, enter a short name appropriate for the filter being defined. 10. Select the appropriate protocol from the list of Orders options. PURPOSE This guide describes the processes, which may be used by JHH physicians and nurses to create dialysisfocused lists for the following patient groupings. · HD Patients all active & pending verification orders · CRRT Patients all active & pending verification orders · PD Patients all active & pending verification orders · All Dialysis In-Patients all cancelled, completed, and discontinued orders Hemodialysis Protocol (Protocol Hemodialysis) Peritoneal Dialysis Protocol (Protocol, Peritoneal Dialysis) CRRT Protocol (Protocol, CRRT) 16. Select the Include patients at selected locations only radio button. 17. Click on the (+) next to The Johns Hopkins Hospital entry. 18. Select the JHH-INPATIENT option. 19. Click the Add button. 20. Click the OK button ­ the list now contains both in-patients & out-patients. 21. Enter Dialysis: Active HD as a list name. 11. Click the Add button. 12. Click the OK button. 13. Click the Order Selection Filter drop-down arrow and select the option appropriate for the filter being created ­ either HD, PD, or CRRT. 6. Enter one of the following options into the Filter Name field. HD (for hemodialysis) PD (for peritoneal dialysis) CRRT (for continuous renal replacement therapy) CREATE PATIENT LISTS ­ ACTIVE & PENDING VERIFICATION ORDERS 1. Click the Patient List tab. 14. Click the Order Status Filter drop-down arrow and select Active Only. This will limit the displayed list to those patients associated with either Active and/or Pending Verification orders. 2. Select the Maintain List New option from the File menu. 22. Click the OK button. 23. Repeat the above process for Dialysis: Active PD and Dialysis: Active CRRT lists, entering information appropriate for those lists. (continued on back) 7. Click the Order Item radio button. 8. Click within the Enter Order data field. POE Quick Reference Guide­Creating Dialysis Focused Lists Version 4.5 XA 3 October 2007 ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital.. CREATE PATIENT LIST ­ COMPLETED, CANCELLED & DISCONTINUED ORDERS 1. Click the Patient List tab. 2. Select the Maintain List New option from the File menu. 7. Click on Order Item. 8. Click within the Enter Order data field. 9. Type Hemodialysis within the Enter Order field. 10. Select Hemodialysis Protocol from the dropdown list. 11. Click the Add button. 12. Click within the Enter Order data field. 17. Type CRRT within the Enter Order field. 18. Select CRRT Protocol from the dropdown list. 19. Click the Add button. 20. Click the OK button. 21. Click the Order Selection Filter drop-down arrow and select HD, PD, CRRT as the Order Selection Filter. 25. Click on the Location tab. 22. Under Order Status Filter select Add New. 26. Select the Include patients at selected locations only radio button. 27. Click on the (+) next to The Johns Hopkins Hospital entry. 28. Select the JHH-INPATIENT option. 29. Click the Add button. 30. Click the OK button. 4. Click check box labeled Check this box if you want to create... 5. Click the Add New button within the Order Selection Filter region of the dialog. 6. Enter HD, PD, CRRT into the Filter Name field. 13. Type Peritoneal within the Enter Order field. 14. Select Peritoneal Dialysis Protocol from the dropdown list. 15. Click the Add button. 16. Click within the Enter Order data field. NOTE Outpatients are not being selected as their inclusion would result in an excessively long list. 3. Click on the Orders tab. 23. Type Canc, Comp, DC within the Enter the name of your new filter data field. 31. Enter Dialysis: Canc, Comp, DC as a list name. 24. Press and hold the Ctrl key down and select the following options from within the Select One or More Statuses list. 32. Click the OK button. Cancelled Completed (select both listed options) Discontinued "); array_files[143]=new Array(0,4,"./Publications/QRG_Corr_Insulin_Orders_PEDs.pdf","2008-03-28","1546K"," QRG - Correcting Insulin Orders (PEDs) "," 20070216 ","","Before beginning, please note that additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe NOTE You may also enter information into the non-mandatory fields within this dialog box as necessary. 7. Click on the icon at the right-end of the CoSignature data field. 8. Click on the Other radio button within the Co-Signature dialog box. 9. Click within the Occupation data field and select the appropriate option from the drop-down menu­RN in this example. 10. Click within the name (unlabeled) data field and begin entering the name of the nurse who will validate this order (last name then first name). VALIDATING RN NOTE As soon as possible after having validated the actions of the Administering RN, log into POE, and access the unit census display appropriate for this patient. 1. Double-click on the red flag icon located in the To Sign cell for this patient. 2. Locate the insulin order that you need to cosign. 3. Double-click on this order. 4. Review the information appearing within the dialog box to ensure that it is what you witnessed while watching the Administering RN perform the original calculation and syringe loading. 5. Once you verify that the information within the dialog box is correct, click the Close button. 6. Click on Sign to indicate that you have verified the dose calculation as well as the contents of the syringe. 7. Enter your Password into the Password Required dialog box to authenticate your identity. 8. Click the OK command button to complete the co-signature process. PRIOR TO BEGINNING You should: · · · Provider Order Entry (POE) ­ Quick Reference Guide know your JHED ID, have attended appropriate POE training, and log into POE. ADMINISTERING RN NOTE This process assumes that the eMAR (Kardex 12 Hr) for the appropriate patient is displayed on the portable workstation being used. 1. Right-click within the cell associated with the date/time that the insulin will be administered. 2. Select the Mark As Done... menu option. 3. Enter the appropriate value into the Point of Care Meter Number data field. 4. Enter the appropriate value into the Blood Glucose Result data field. NOTE An automatically calculated value will be displayed in the # Units to Give Per Glucose Result data field when you click within the field associated with the next step. 5. Enter the appropriate value into the # of Carbs in This Meal/Snack data field. NOTE An automatically calculated value will be displayed in the # Units to Give Per Gms Carbs Consumed and the TOTAL UNITS Insulin to Administer data fields when you click within the field associated with the next step. 6. Enter the appropriate information into the Carb Source data field. PURPOSE This guide is intended for use by JHH Nurses and describes the process used to administer and document insulin correction orders for pediatric patients. The steps are summarized below in the sequence that they are to be performed. · Administering RN calculates correct insulin dose based upon the pediatric patients current blood glucose reading and the number of carbohydrates consumed in the current meal (snack) and enters that information into the appropriate eMAR cell using the Mark as Done... menu option. The calculation dialog box will also be used to designate a Secondary RN who will validate the performance of the above tasks prior to the medication being administered. Validating RN will observe the activity of the Administering RN in order to validate that: the calculation is correct, the correct insulin is loaded into the syringe, and the syringe contains the correct volume based upon blood glucose and carbohydrate values entered into the POE dialog box. Administering RN rolls the portable POE workstation to patient bedside and marks the order as done after having administered the insulin. This will cause a To Sign flag to be displayed within the patient list of the Validating RNs unit census. Validating RN logs into POE and co-signs the order. 11. Select (click on) the name of the nurse who will be verifying this order from within the displayed list of nurses matching the characters entered in the previous step. 12. Click on the OK command button. NOTE At this time, have the Validating RN inspect the still open dialog box and verify that the calculation data is correct and ensure that the type and volume of the insulin being loaded into the syringe is also correct. Do not administer this medication (proceed to the next step) until after the Validating RN has inspected and approved of both the calculation data and the contents of the syringe! 13. Proceed to the patients bedside and administer the insulin using the syringe verified above. NOTE Clicking the OK command button in the following step will cause a To Sign flag to appear within the patient list of the Validating RN specified in step 11. 14. Click the OK command button to complete the Administering RNs portion of this task. · · · POE Quick Reference Guide­Corrective Insulin Orders, Administering Version 4.5 XA 16 February 2007 ©2007 Information Technology @ Johns Hopkins. All Rights "); array_files[144]=new Array(0,4,"./Publications/QRG_Attendings.pdf","2008-03-28","141K"," QRG - Attending Physicians "," 20041115 - distributed ","","NOTE If you are using POE for the first time, the Change Password dialog box opens for you to change your password. 2. 3. 4. 5. LOG OUT: 1. 2. Click the Log off toolbar button. Click Exit within the Logon dialog box to completely exit POE. Type your current password into the Old Password field. Type your new password into the New Password field­it must contain at least six characters. Type your new password into the Confirm New Password field. Click OK. SUSPEND: Click the Suspend Session button. Provider Order Entry (POE) ­ Quick Reference Guide CO-SIGNING DNR & CHEMOTHERAPY ORDERS: 1. 2. 3. 4. 5. Click Order Signature Manager toolbar button. Patients with DNR or Chemotherapy orders are displayed. Review the patients and orders. Double-click any order to see the associated order form. All orders are checked by default. Uncheck any orders that you DO NOT want to sign. Leave all orders you do want to sign checked. Click Sign button. RESUME: 1. 2. 3. Click on the suspended POE session on the task bar to maximize the Resume Login dialog box. Type your password in the Password field. Click OK. NOTE You will need to know your JHED ID in order to log into POE. The following procedure explains the process of obtaining your JHED ID. OBTAINING YOUR JHED ID: 1. 2. 3. 4. Log into the Johns Hopkins Enterprise Directory web site using Internet Explorer. http://jhed.jhu.edu/jhed/ Enter your Last Name, First Name into the Search for a person: data field. Click Go. Your JHED ID will be listed as Login Id. CHANGE PASSWORD: 1. Select the Change Password command from the Preferences menu. 6. NOTE If you need additional assistance or are having problems with your Password, call the POE Help Desk @ 5-HELP. LOG IN: 1. 2. 3. 4. Select POE command from the Start menu. Type your user name in the Name field. Type your password in the Password field. Click OK. If your username and password are correct, the system will log you on to POE. ©2004 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Provider Order Entry Quick Reference Guide­Attending Physicians Revision­Version 3.5 XA 15 November 2004 Start Date & Time Order Listing Stop Date & Time (if appropriate) · · Initials of person administering each dose are displayed in appropriate cells. Access additional information by either double-clicking the cell of interest or allowing the cursor (mouse pointer) to hover over it--a `balloon containing additional information will appear. NOTE - Order frequency designations were changed on September 28, 2004. Refer to any of the following documents for detailed information. Each of these documents is available via the POE web site o o o POE Upgrade Summary dated 15 November 2004 POE User Guide dated 1 December 2004 POE Bulletin 001 dated 24 September 2004 "); array_files[145]=new Array(0,4,"./Publications/QRG_Adv_As_Tol_Diets.pdf","2008-03-28","1075K"," QRG - Advance As Tolerated Diets "," 20060424 ","","NOTE The displayed conditional diets, which are selected by default within the Order Set Summary dialog, should generally remain selected. 4. Double-click the Goal Diet Generic Set option. NOTE The drop-down menu accessed in the following step consists of a list of all available diets. Provider Order Entry (POE) ­ Quick Reference Guide This Quick Reference Guide provides information for prescribers who will write advance as tolerated dietary orders and the nurses who will administer those orders. NOTE The following procedural descriptions assume that you are already logged into POE and that system focus is on the appropriate patient. 5. Click on the preferred generic diet option--Regular Diet in the example. 6. Click Add. 7. Click Close 8. Click OK. NOTE Should your patient have food allergies, you may need to make modifications to the selected diet. 9. Click Submit. PRESCRIBERS 1. Click the Enter Order icon. NOTE It may be necessary to close the Allergy Summary dialog box (by clicking the Close button) before proceeding to the next step. Make sure the Type here to enter order name field on the Order Entry Worksheet is highlighted before proceeding to the next step. If it is not, click within the field to highlight this phrase. 2 3 4 5 6 2. Type Advance using the workstation keyboard. 3. Double-click on the preferred diet option­Advance as Tolerated Diet--Adult in this example. 7 (Nurses information on the back of this guide) Provider Order Entry Quick Reference Guide­Advance As Tolerated Diets Version 4.0 XA 24 April 2006 This revision of the Advance As Tolerated Diets QRG supersedes all previous editions. Those dated prior to 24 April 2006 should be destroyed. ©2003­2006 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. NURSES NOTE The following procedural description is an example of a nurses action taken in in response to an Advance as Tolerated Diet order. The following procedure assumes that the nurse is logged into POE, and system focus is on the patient of interest. 1 2 1. Click the Orders tab. NOTE The nurse will determine which of the displayed diet orders is most appropriate for the patients current condition. 3 2. Right-click on the preferred dietary order and select the Activate option. NOTE It may be necessary to close the Allergy Summary dialog box (by clicking the Close button) before proceeding to the next step. 3. Click Submit. NOTE As the patients ability to digest food changes, the nurse will discontinue the current dietary order and activate the order which is now most appropriate for the patient. It is highly recommended that the current dietary order be discontinued before activating the new order! 4 5 4. Right-click on the active dietary order and select the Discontinue/Cancel option. 5. Select By... Other radio button. 6. Select appropriate Current Provider from list. 7. Select Discontinue-Condition Met option from list of sources. 8. Click OK. 9. Click OK. 10. To select a new diet option, perform steps 2 through 9 as needed. (Prescribers information on the front of this guide) 6 7 9 8 "); array_files[146]=new Array(0,4,"./Publications/QRG_ADT.pdf","2008-03-28","355K"," QRG - ADT Overview "," 20051030 ","","ADMISSION TO POE UNITS · All Units (except the Department of Psychiatry) 1. Admitting will register the patient using the SMS ADT system. 2. Patients registration information will be transmitted electronically to the POE system. 3. Orders may be entered for a patient only after the patient is in the POE system. 4. If the patient is not in the POE system, call Admitting to register the patient. Provider Order Entry (POE) ­ Quick Reference Guide TRANSFERS - continued · From a POE Unit to a Non-POE Unit Whenever a patient is transferred to a unit not equipped with POE, the clerical associate must complete four tasks. 1. Print the Transfer Order Summary and the MAR. 2. Contact nurse to discontinue/cancel all orders in POE-- except for pre-transfer orders. 3. Typically, the clerical associate on the unit receiving the patient should perform the transfer function using the EBB system. 4. Complete the transfer within POE. · From a Non-POE Unit to a POE Unit 1. Typically, the clerical associate on the POE unit will perform the transfer function using the EBB system. 2. In the absence of the clerical associate, the nurse will perform the transfer using the EBB system. 3. Once the patient transfer is completed, orders can be entered in POE. · To a Different Level of Care An automated POE mechanism does not currently exist to automatically discontinue orders when patients are transferred to a different level of care/service. Therefore, you will need to perform the following steps. 1. Provider orders the transfer 2. Contact nurse to discontinue/cancel all orders in POE-- except for pre-transfer orders. 3. Pre-transfer orders will be manually released by a physician when the patient arrives on the new unit. DISCHARGES 1. An active discharge order must be entered in POE. 2. Prior to discharging the patient (using the EBB), the clerical associate prints a MAR and a JHH Cumulative Order Summary. In the absence of the clerical associate, the nurse will print the MAR and the JHH Cumulative Order Summary. 3. Once the patient leaves the unit, the clerical associate will discharge the patient using the EBB. In the absence of the clerical associate, the nurse will discharge the patient using the EBB. NOTE Admissions originating from the Emergency Department or other sources are initially admitted to a hold unit (e.g., EDHD, CVDL). If the patient arrives on the unit but does not display on the POE unit census, the clerical associate (or designee), should transfer the patient into their unit/bed assignment using the EBB (see Figure 1 on the back of this sheet). · Department of Psychiatry Prior to 4:00 PM The Psychiatric Admitting Department will use the SMS ADT system to process planned admissions. Patient Data Coordinators (PDCs) will use the SMS ADT system to admit psychiatric patients from the Emergency Department. After 4:00 PM Patient Data Coordinators (PDCs) will use the SMS ADT system to admit psychiatric patients from all sources (e.g., ED, HAL, other JHH inpatient units). PURPOSE This guide serves as a concise summarization of the tasks that need to be performed in conjunction with the admission, transfer, and discharge of patients. ELECTRONIC BED BOARD Figure 1 on the back of this sheet illustrates the appearance of the EBB. NOTE Patients must be admitted via the SMS ADT system in order to exist in POE. Therefore, it is imperative that admissions, transfers, and discharges be performed expeditiously. If the patient does not display on the unit census, the clerical associate (or unit designee) should be asked to locate the patient in the Electronic Bed Board (EBB), and to transfer that patient to the unit. If unable to locate the patient using the EBB, the clerical associate (or unit designee) should contact admitting. In the absence of a trained-EBB person on the unit, contact Admitting. TRANSFERS Figure 2 (on the back of this sheet) illustrates the sequence of events associated with the transfer of patients to both POE and non-POE units from a POE equipped unit. · Between POE Units 1. Typically, the clerical associate on the unit receiving the patient should perform the transfer function using the EBB system. 2. In the absence of the clerical associate, the nurse will perform the transfer using the EBB system. (continued next column) DISCHARGES 1. An active discharge order must be entered in POE. 2. Prior to discharging the patient (using the EBB), the clerical associate prints a MAR and a JHH Cumulative Order Summary. In the absence of the clerical associate, the nurse will print the MAR and the JHH Cumulative Order Summary. 3. Once the patient leaves the unit, the clerical associate will discharge the patient using the EBB. In the absence of the clerical associate, the nurse will discharge the patient using the EBB. (continued next column) COVERAGE A high-level summary is provided for each of the following tasks: · · · · · · Admission to POE Units. Transfer between POE Units Transfer from a POE Unit to a non-POE Unit. Transfer from a non-POE Unit to a POE Unit. Transfer of Patient to a Different Level of Care Discharge of Patients ©2 "); array_files[147]=new Array(0,4,"./Publications/QRG_Actions_On_Alerts.pdf","2008-03-28","461K"," QRG - Actions On Alerts "," 20071017 ","","3. Prescribers may now take appropriate remedial action by selecting (clicking on) the View Actions... button. 4. Select the View Actions... button to take an appropriate action. THE AVAILABLE ACTIONS DIALOG The Available Actions dialog (see Figure 2) allows the prescriber to react to a medication order alert. Currently, the prescriber is encouraged to keep the new order and DC the existing order. NOTE Perform the following steps to keep the new order and DC/cancel the existing order. 1. Select the Keep This Order radio button. 2. Click on the red X icon to keep the new order and DC/Cancel the existing order. Provider Order Entry (POE) ­ Quick Reference Guide PURPOSE This guide is intended for use by JHH Prescribers and describes the new Actions-on-Alerts feature The Actions-On-Alerts feature provides an easier method of responding to order-alerts encountered during the placement of medication orders. It allows prescribers to take appropriate action without having to access and address each order ­ both new and existing ­ separately. Additional information about POE is available via the Internet URL noted below. http://www.jhmcis.jhmi.edu/poe 3. Click the OK button. 4. Submit the new order when the Order Entry Worksheet is displayed. NOTE Subsequent review of the Order Summary will reveal the presence of the new order and the discontinuance of the previous order. (continued on back) Figure 1. Alert Detail Dialog THE ALERT DETAILS DIALOG The Alert Details dialog will be encountered whenever a prescriber attempts to place an order via the POE Order Entry Worksheet that is at issue with an existing order. In this example, the issue is the possible duplication of an existing medication order. The Alert Details dialog (see Figure 1) provides you with a description of the alert. 1. The Alert field within the Alert Summary dialog summarizes the nature of the alert. In this case, Duplicate Medications. 2. The Message field restates the nature of the alert and summarizes the information associated with both the new and current medication orders. Figure 2. Available Actions Dialog ©2007 Information Technology @ Johns Hopkins. All Rights Reserved. No part of this guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. POE Quick Reference Guide­Actions-on-Alerts Version 4.5 XA 17 October 2007 KEEP THE EXISTING ORDER If you change your mind, you should click on the yellow arrow icon (see Figure 3) to restore the display to the previous state. Remember, once youve clicked the OK button, the existing order will be discontinued and irretrievable. Figure 3. Available Actions ­ Undo Arrow "); array_files[148]=new Array(0,4,"./Publications/Pharmacy_Intfc_Guide.pdf","2008-03-28","5558K"," POE Bidirectional Pharmacy Interface Guide "," 20080324 "," Rev A ","Provider Order Entry (includes appropriate CENTRICITY coverage as required) Version 4.5 XATM ­ March, 2008, Revision A Information Technology @ Johns Hopkins An online version of this publication is available for viewing at the following URL: http://www.jhmcis.jhmi.edu/poe/Publications/Pharmacy_Intfc_Guide.pdf POE Bidirectional Pharmacy Interface Guide ©2005-2008 Information Technology @ Johns Hopkins. All rights reserved. No part of this POE Bidirectional Pharmacy Interface Guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. SunriseTM Clinical Manager (SCM) is the property of the Eclipsys Corporation®. All other product and brand names are trademarks or registered trademarks of their respective companies. For Internal Use By JHH Pharmacy Personnel Only! Revision A Version 4.5 XATM March, 2008 POE Bidirectional Pharmacy Interface Guide Revision History The revision history page is a listing that allows the reader to quickly identify changes made to the pages contained with this publication. Change Listing Page(s) Description Revision [Date] All ............................................... updated content ............................................................................ Revision A, March 21, 2008 Initial Release ............................................................................... March 14, 2005 For Internal Use By JHH Pharmacy Personnel Only! Revision A A Version 4.5 XATM March, 2008 POE Bidirectional Pharmacy Interface Guide CONTENTS REVISION HISTORY................................................................................................................... A PREFACE................................................................................................................................... XI 1 1.1 1.2 1.3 1.4 1.4.1 1.4.2 2 3 USE OF THIS GUIDE ......................................................................................... XI Intended Audience.......................................................................................... xi Figures............................................................................................................ xi Tables............................................................................................................. xi Online Availability ........................................................................................... xi Links .........................................................................................................xii PDF Reader Navigation Devices ..............................................................xii POE GUIDANCE & INSTITUTIONAL POLICY ................................................. XIII CHANGES TO THIS GUIDE ............................................................................. XIII GLOSSARY............................................................................................................................... XV OVERVIEW...................................................................................................................................1 1 1.1 1.2 1.3 2 2.1 2.2 3 4 4.1 4.2 4.3 4.4 4.5 4.5.1 4.5.2 4.5.3 4.6 4.7 4.8 4.8.1 4.8.2 4.9 4.9.1 4.9.2 4.9.3 OVERVIEW OF THIS GUIDE................................................................................1 Purpose Of Document ..................................................................................... 1 Audience.......................................................................................................... 1 Content of Guide ............................................................................................. 2 OVERVIEW OF THE INTERFACE........................................................................2 What Does It Replace...................................................................................... 3 What Does It Do? ............................................................................................ 3 TERMINOLOGY .................................................................................................... 4 THINGS YOU NEED TO KNOW BEFORE USING THE INTERFACE ................. 5 Changing IV Diluents On Saved Orders.......................................................... 5 ADT (Admission, Discharge, & Transfer) Functions........................................ 5 Height & Weight............................................................................................... 6 Centricity & POE Use Different Knowledge Databases................................... 6 Not all Centricity Order Fields May Be Modified.............................................. 7 Centricity fields the pharmacist may change ............................................. 7 Centricity fields the pharmacist may NOT change..................................... 8 Addition of Information to Orders After Verification ................................... 9 Cloning of orders ............................................................................................. 9 Selected Day Orders ................................... "); array_files[149]=new Array(0,4,"./Publications/Order_Set_Survival_Guide_Part_II.pdf","2008-03-28","283K"," Order Set Survival Guide - Part II "," 20060216 ","","Guide to Building Order Sets in POE: Clinicians Order Set Survival Guide Part II rev. 02/16/06 Guide to Building Order Sets in POE: Clinicians Order Set Survival Guide Part II 1. Introduction 1.1. Purpose This document is intended to give clinicians an introduction to the development of order sets in the computerized Provider Order Entry (POE) system at Johns Hopkins Hospital. While the process and tools used for order set build in Sunrise Clinical Manager (SCM) change along with enhancements to the application, the basic requirements for POE order set review and design can be outlined in order to improve the quality of order set deliverables to Johns Hopkins Medicine Center for Information Services (JHMCIS) analysts. This will make the process more efficient and decrease the time required to build or revise order sets. Ultimately the objective is to enable providers to conveniently and accurately submit electronic orders. For more detailed information about using the POE application refer to the Clinicians Introduction to Order sets in Provider Order Entry, the POE User Guide, and the many Quick References available on the Johns Hopkins Medicine Center for Information Services JHMCIS POE website: http://jhmcis.jhmi.edu/poe/WP_Publications/Pubs.html 1.2. Overview Logical grouping of orders into order sets not only saves time and the effort of searching for individual orders, it also improves the quality of care and promotes best practices. When reviewing paper order sets or creating new ones for entry into POE it is important to consider the strengths and limitations of an electronic order entry application as well as the expected effect of each order included in the set. Entering orders directly into the computer streamlines the communication of orders to ancillary departments through direct interfaces to other software applications, significantly reducing the time it takes to act upon orders, cutting the cost of manual requisition and label generation, faxes, etc. However, this is a major process change that requires an understanding of how the system works and the information that is needed to successfully complete individual orders. Clarity and precision can be achieved by attention to detailed specifications that reflect the actual intent of orders within each set. This upfront planning will, in turn, generate effective order sets that are useful tools for providers. Initially, the implementation team responsible for rollout of the electronic order entry system will request submission of order sets that will need to be built in POE. These should include existing paper order sets that have already been approved by the Medical Record Forms Committee as well as new sets to be implemented only in electronic form. An internal review should be completed to ensure that the physician leader and any interested parties agree on the contents of each order set. Once updates have been made, a JHMCIS analyst will work with order set sponsors and clinician representatives to prepare all sets for entry in POE. Each order set is built by the analyst in a development environment of the system and reviewed by domain experts in areas where orders will be sent electronically (interfaced) to ancillary systems such as pharmacy, lab, radiology, and dietary, before a clinical review is scheduled with the physician sponsor. When all revisions have been made and the electronic order set is functioning as specified, it is presented to the Order Set Review Committee and then loaded into the Production database for use on clinical units that have implemented POE. N:POE_POCOrdersetsDocumentationPOE OS Build Clinician Guide 0206.doc Page 2 of 16 Guide to Building Order Sets in POE: Clinicians Order Set Survival Guide Part II 2. The POE Order Set Build Process 2.1. Adapting paper order sets for POE Translating paper orders for use in a computerized order entry system often points out changes in practice that have not been adequately captured in current order sets and reveals process issues that may need to be resolved before POE can be successfully implemented. Workflow is also a significant consideration. It is important to understand what happens when a provider enters an order into the computer. Unlike handwritten orders which may be interpreted, or acted upon by a nurse, therapist, or clinical associate, most orders entered into POE do not require human intervention to schedule tests, generate requisitions, prompt for the delivery and administration of medications, etc., so the orders that are included in sets must be complete and concise. To expedite order set design, clinicians who participate in the effort need to attend POE training before beginning this work. When sponsors are not educated upfront and develop an understanding of how the application works only after order sets have been submitted, the result is multiple revisions, increasing the project timeline. 2.2. Formatting order sets for electronic build Begin by reviewing each paper set for content, leaving as few blanks as possible. For example, the most frequently prescribed dose and "); array_files[150]=new Array(0,4,"./Publications/Order_Set_Survival_Guide_Part_I.pdf","2008-03-28","1163K"," Order Set Survival Guide - Part I "," 20060106 ","","Introduction to POE: Clinicians Order Set Survival Guide Part I rev. 01/06/06 Introduction to POE: Clinicians Order Set Survival Guide Part I 1. Introduction 1.1. Purpose This document is intended to serve as a general introduction to the use of order sets in the computerized Provider Order Entry (POE) system at Johns Hopkins Hospital. For more detailed information about the POE application refer to the POE User Guide and Quick References available on the Johns Hopkins Medicine Center for Information Services (JHMCIS) POE website: http://jhmcis.jhmi.edu/poe/WP_Publications/Pubs.html 1.2. Benefits of Using POE POE is a software tool that facilitates the automated entry, display, and retrieval of information by staff members within Johns Hopkins Hospital (JHH). The POE database maintains information on each person treated by a POE equipped unit at JHH, including orders, test results, and medication administration. A well designed and implemented POE program will reduce medication errors and adverse drug events, standardize patient care and improve the efficiency of patient care delivery. Transcription errors are eliminated when physicians enter orders directly into POE, and remote access to patient data enables the provider to review results, treatment plans, and respond to changes in a patients condition from any network computer with access to the application. Adding order sets to the POE process increases the speed of electronic order entry by eliminating the need to repeatedly search for individual orders. It also allows for the addition of department or service specific orders, standardizing physician prescribing practices, and decreasing order omission errors. Integrated clinical decision support functions such as allergy checking, duplicate order entry, dose range checking, dose calculators, and restricted routes of administration, are tools that can significantly reduce the incidence of sentinel events. 1.3. Impact on Clinical Practice The advantages of using an electronic order entry system also include access to the data collected for reporting and quality assessment purposes. The process of accumulating this information does necessitate some variation from existing paper ordering practice. Access to a computer workstation that has been configured for use with POE is needed, as are system training for all users, application ID, and passwords. The shift to electronic orders means that the paper versions no longer exist. All entry, review, and revisions to the treatment plan are done online, rather than from a portable hard-copy chart. Signatures and countersignatures are electronic as well, so that all members of the clinical team must monitor patients order summary displays for changes on a regular basis. For example, STAT orders may require face to face communication with nursing staff to ensure prompt action; verification of certain orders such as chemotherapy or DNR by the attending physician may be needed before the orders are activated and interfaced to ancillary systems. Designing order sets in a computer application so that the information is retrievable for reporting or able to be sent to another clinical application, such as radiology or pharmacy without additional human intervention, also requires considerable standardization and N:POE_POCOrdersetsDocumentationPOE OS Intro Clinician Guide0206.doc Page 2 of 15 Introduction to POE: Clinicians Order Set Survival Guide Part I codification of information that was previously left to interpretation. Orders must be complete at the time of entry so, for instance, every medication order must have dose, route, frequency, start date, etc., specified. Much of this information can be pre-valued through order sets using best practice standards. In most cases, where allowable by hospital and/or department policy, these preset parameters can be changed as each patient case demands. As previously mentioned, access to the network and the software application is needed to enter orders for a patient in POE. Downtime procedures have been outlined in the event of scheduled or unexpected disruptions to use of POE, however, a primary access consideration is that the patient must be registered in POE by Admitting before an active case is available for order entry. Pre-admission and pre-transfer orders can be entered for patients who appear in the system. These orders appear on the electronic record with a HOLD status until the patient arrives on the unit and the orders are activated by a clinician. Some orders and order sets are only available on select units. Restricted medications or procedures may be limited to intensive care areas, for instance. The ordering physician will not see these options when they enter searches for patients who are not admitted to these select locations. Pediatric medications will only be available in POE for patients who are admitted to units that have been set up as Pediatric POE locations. This prevents the selection of treatment options which cannot be completed based upon policy or procedural limitations. 2. Sunrise Clinical Manager Overview 2.1. "); array_files[151]=new Array(0,4,"./Publications/IS_Dose%20Hx.pdf","2008-03-28","758K"," Enhancing eMAR Dose History Display "," 20071217 ","","Enhancing Dose History Display on the eMAR C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History Nurses will Mark a Task as Done C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History Task Form (for Phase I) will contain a Dose Field (pre-populated based on the order) and a UOM Field (also pre-populated) C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History Dose Given can be seen by hovering over the cell: C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History History can be seen by expanding the dates/times displayed to the desired review period and selecting Task Details List for this order: C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History History is displayed: C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History If a nurse administers less than the ordered dose, the nurse can change the Dose Given field. In this example, the Tylox order is for 2 capsules, but the patient is only requesting 1 capsule at this time. The nurse will change the 2 to a 1 C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History A reason will be requested. C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History The eMAR will display a yellow down arrow to indicate a lower dose was given than ordered: C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History In the future... · Phase II will supply cumulative total for this order over the past 24 hours: o Total dose given prior to this task o Total dose given including this task · Phase III will supply cumulative total for this medication (all orders) over the past 24 hours o Total dose given prior to this task o Total dose given including this task C:Documents and Settingswmcneir1DesktopKT_DataSlide Show_Dose Hx.doc Dose History "); array_files[152]=new Array(0,4,"./Publications/FS_Peds_(Phase_I)_Go-Live.pdf","2008-03-28","144K"," Fact Sheet - Peds (Phase I) Go-Live "," 20070207 "," ","Effective February 18, 2007 OVERVIEW POE clinical users should be aware of a few changes in system functionality that will be apparent after POE is rolled out to Pediatrics on February 18, 2007. These changes are the result of the introduction of the Pediatric Medications Catalog and essentially consist of the following items. · Pre-Transfer (Preadmission) Orders o o Prescribers ­ Writing Pre-Transfer (Preadmission) Orders Nurses ­ Releasing Pre-Transfer (Preadmission) Orders Adult Forms Pediatric Forms · Medication Order Form Recognition o o PRE-TRANSFER (PREADMISSION) ORDERS & ORDER SETS The incorporation of a pediatric medications catalog has resulted in the following visual changes being imparted to the medication ordering process. Discussion of the changes that clinical users will encounter have been separated into two topics­one for Prescribers and one for Nurses. · Prescribers Prescribers should note that the POE order form will exhibit the following characteristics. On units serving but one patient age group­The POE order form will only display orders and order sets appropriate for that age group. On units serving both adult and pediatric patients­The POE order form will only display age appropriate orders for the patient; however, order sets from doth catalogs will be displayed. As indicated by the following illustration: age-appropriate order sets will appear against a white background; while, order sets that are not age-appropriate for the selected patient will appear against a gray background. Example Order Listing­Adult Patient Prescribers attempting to select an age-inappropriate order set will receive a confirmation message similar to the one shown below. In clinical situations where selection of a medication from what appears to be the inappropriate catalog is desirable, the Prescriber need only to select the OK command button to continue with order completion. However, if the medication was selected in error, the Prescriber should cancel the associated order and write an order for the correct medication. Order Desirability Confirmation Message · Nurses Nurses releasing Pre-Transfer (Pre-admission) orders for an age inappropriate patient should note that they will receive the informational message shown below. Although the associated orders will be released, Nurses should contact the Prescriber should there be any question about the suitability of the associated orders. Informational Message peds_go-live_fact_sheet_(final).doc 1 of 2 JS-MH-PZ/wm/20070207 Effective February 18, 2007 Order Form Recognition The format (appearance) and placement of items within a POE medication order form will be indicative of the catalog from which it was obtained. Adult Medication Order Forms Order forms associated with medications within the adult catalog will display two easily recognizable characteristics. Information, data fields and other components are displayed as a single-column and span the entire form width. Height and weight information is displayed in the lower regions of the form. Pediatric Medication Order Forms Order forms associated with medications within the pediatric catalog will display two easily recognizable characteristics. Information, data fields and other components are displayed in a multi-column. Height and weight information is displayed at the top of the form. Adult Order Form Height & Weight Data single-column Pediatric Order Form multi-column Height & Weight Data peds_go-live_fact_sheet_(final).doc 2 of 2 JS-MH-PZ/wm/20070207 "); array_files[153]=new Array(0,4,"./Publications/FF_VTE.pdf","2008-03-28","106K"," Fast Fact - VTE Prophylaxis Orderset "," 20071218 "," ","New VTE Prophylaxis Orderset December 2007 · The new VTE Prophylaxis Orderset was piloted on the Ortho-Spine service and is going into production for the rest of the hospital December 18, 2007 · It is a SMART orderset, meaning that it will guide prescribers in the ordering process by presenting options based on choices made · All prior versions of DVT/VTE ordersets will be replaced with the new one. If an existing orderset had a DVT prophylaxis section, this new orderset will takes its place. This new orderset has also been added to other selected existing ordersets where no VTE option existed before · Some parameters, such as patients age, relevant results, height, weight, and creatinine clearance will be defaulted in from the database. · Both Section A and B must be completed and more than one option can be selected in each section. · The Recommended Prophylaxis will be generated based on the selections made in Sections A and B · In the Prophylaxis Orders Grid: · A blue box preceding the medication choices indicate more information is needed ­ in this case the Start Time Priority is defined as Time Critical so a start time must be specified · Mechanical Prophylaxis will be pre-selected · If VTE prophylaxis was not ordered as recommended indicate why using the check box selections. · The last line item on the form, VTE Risk Assessment was Completed, must remain selected. Defaulted in from database Be sure to complete both sections A and B. Recommendations will be made based on the parameters selected "); array_files[154]=new Array(0,4,"./Publications/FF_Transfusions.pdf","2008-03-28","248K"," Fast Facts - Documenting Transfusions on eMAR "," 20060713-26 "," ","Why Transfusions Will Now Appear on the eMAR To minimize the potential for overlooking transfusion orders. To provide a standardized method for documenting the administration of blood products within POE. What Blood Products Can Be Documented on the eMAR? Red Blood Cells Autologous RBCs Platelets Fresh Frozen Plasma Cryoprecipitate Rhogam How Will Blood Products Be Displayed on the eMAR? Blood products will be displayed at the top of all applicable eMAR views. There is a new 12-hour transfusion view that will allow the user to only view blood products. Blood products with a Frequency of When available appear as a solid yellow trough on the eMAR. Once the 1st unit of blood is signed off, the system will calculate the date/time of the next unit due based on the frequency specified within the order. Orders with a specified frequency of either emergent or urgent appear as individual yellow cells. The initial cell, which corresponds to the time that the Prescriber places the order will also contain a red flag. The date/time of subsequent units will be automatically calculated and displayed as yellow cells based upon the time that the 1st unit was hung and information specified in the original order. When & How Documentation Should Be Done on the eMAR? When the blood product is hung, you document Mark as Done on the eMAR. Time actual will appear (vs. hourly time) as the default. You do not need to document the completion of the transfusion on the eMAR since that is reflected on the flowsheet. When multiple units are ordered, the schedule for administration of subsequent units will be calculated and displayed based upon information already contained within the order. Additional Information You Should Know: Overdue Transfusions--POE determines if a transfusion is overdue based upon the date/time that the initial bag was hung. You must therefore be aware of the following situations. Overdue indications will never appear for blood products requiring a single transfusion. Overdue indications will also never appear for blood products requiring multiple transfusions if the initial bag was never hung. Indications of an overdue transfusion will appear 4 hours after the transfusions scheduled time and result in the background color of the associated task description and date/time cells turning red. Remember to also document the transfusion(s) on the flowsheet. Platelets and Cryoprecipitate may have several units in one product bag. For these, you will be required to document the number of units in the product bag on the NUR Comment form. Transfusions may be ordered as Emergent, Urgent, or When Available. Emergent and Urgent orders will be marked as STAT on the order summary and eMAR. Transfusion orders auto complete after last unit is hung and signed off on the eMAR. DS/CM/DS/wm/20060713-26 "); array_files[155]=new Array(0,4,"./Publications/FF_No_Reason_DC_Orders.pdf","2008-03-28","131K"," Fast Facts - No Reason Required to DC/Cancel an Orders "," 20061005 "," ","Effective October 5, 2006 When discontinuing an order, a Discontinue/Cancel Orders dialog box is displayed. Previously, nurses were required to enter a Reason for discontinuing/canceling the associated order(s). The need to enter a Reason for discontinuing/canceling the order(s) within this dialog box is no longer required. Nurses are now encouraged to document the reason within the notes section of the patient flowsheet. An entry within this field is no longer required. ff_no_reason_dc_orders.doc DS/wm/20061005 "); array_files[156]=new Array(0,4,"./Publications/FF_Labs_Cannot_Be_Drawn.pdf","2008-03-28","145K"," Fast Facts - When Labs Cannot Be Performed "," 20070820 "," ","Effective September 25, 2007 There are many reasons why a lab test may be cancelled and consequently not be performed! Some of the potential reasons are listed below: Specimen dropped Specimen clotted Label not on specimen correctly Not enough blood in the sample Hemolized Specimen lost Before the introduction of POE, redrawing a Lab required performance of the following (or similar) steps: 1. The Lab informed the nurse that the lab order was cancelled and needed to be redrawn. 2. The nurse prepared another paper requisition and sent it to the appropriate phlebotomy service. 3. The lab specimen would be re-drawn by phlebotomy, VAT, or nursing without having to write another order. To ensure that a lab is redrawn, Nurses now re-order the lab test­using POE­without having to obtain a co-signature! The following steps should be performed whenever the Lab informs the nurse that a lab test cannot be performed. 1. Log into POE. 2. Select the correct patient. 3. Click on the lab test that needs to be redrawn. 4. Select Re-order. 5. Select Current. 6. Select Yes (in the resultant pop-up) to re-order the cancelled lab test on behalf of the original provider. 7. Select Unable to use prior specimen as the Source option. NOTE Selection of the above Source option does not Very Important Info! Scheduling Details STAT & Routine Orders If the lab was originally ordered as either STAT or Routine, the re-ordered lab will default to the next regularly scheduled draw time. Specific Times If the lab was originally ordered for a specific time-- such as 1530 or AM Labs--and that time has passed, the re-ordered lab will default to the same draw time on tomorrows schedule! If scheduling the redraw for tomorrow is inappropriate, make the provider aware of the fact that the lab needs to be re-ordered! In this situation, the provider must re-order the lab! require a doctors signature! 8. Click OK. 9. Click the Submit button on the order entry worksheet. NOTE The lab order now appears as re-ordered on the Order Summary, the associated label prints in the appropriate area, and the lab can now be redrawn! ff_labs_cannot_be_drawn_[final].doc DS/wm/20070820 "); array_files[157]=new Array(0,4,"./Publications/FF_Lab_Source.pdf","2008-03-28","113K"," Fast Facts - Discontinuing/Re-Ordering Labs "," 20061005 "," ","Effective October, 2006 Rationale for Change There are times when physicians place lab orders within POE and the specified lab collection source will have changed after those orders were placed. This generally occurs when VAT has been selected to perform the blood draw because the patient has a central line. A few days later, when the central line has been removed, VAT was still indicated as the collection source for future draws. This could also occur when the ordering physician was not aware that the patient had a central line and selected the lab as the collection source rather than VAT. Nature of Change A new procedure has been developed to: Accommodate a change in the lab collection source, and decrease the probability of the lab being cancelled. Procedural Steps 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Ensure that the correct patient is selected. Select the Orders tab. Right-click on the lab order that requires a lab collection source change. Select the Discontinue/Reorder Current menu option. Choose Other within the D/C cancel dialog box. Select Current Provider within the Requested By dialog box. Select the MD that placed the original order Select Lab Collection Source Change from the drop-down list of Source options. Click OK. Click OK within the D/C cancel dialog box. When the lab order form appears, select the appropriate source from the Collected by drop-down list of options. The listed sources are: Lab Collect, Unit Collect By Clinical Staff, or VAT-Central Line Select OK. Click the Submit button. Please Remember Please remember the following key points about this change in functionality. This new procedure allows nursing to discontinue/reorder a lab test when the lab collection source has changed! When discontinuing this lab, you must remember to choose Lab Collect Source Change as the Source option. Selection of the Lab Collect Source Change option does not require a doctors signature! fast_facts_lab_source.doc DS/wm/20061005 "); array_files[158]=new Array(0,4,"./Publications/FF_eMAR_Alpha-Sort.pdf","2008-03-28","120K"," Fast Facts - eMAR Alphabetical Sorting "," 20070813 "," ","Effective August13, 2007 Three new eMAR views will soon be available for viewing within POE. These views are identified below and will feature an alphabetically sorted orders listing. Med History Alpha Kardex 8 Hour Alpha Kardex 12 Hour All previous eMAR views remain available and are summarized in the following table. The default eMAR view remains the Kardex 12 Hour display. Current eMAR Views View Kardex Routine, One Time, Stats PRNs Meds Due Med History Time Frame 8 or 12 hour shifts 12 hour shift 8 or 12 hour shifts 2 hours only Starting with current day, looking back for 10 days Meds Included All current meds All but PRNs PRNs only Only meds due in the next 2 hrs. (except PRNs) All meds given, not given for a 10 day period Purpose Overall view for current shift Quick look at meds due for shift except PRNs Quick look at PRN meds Quick look at meds due within 2 hours Historical view of meds given for the past 10 days Current Medication History is NOW alphabetically sorted. Alpha Kardex 8 and 12 hour views are the same as the Kardex 8 and 12 hour views except for the fact that they are alphabetically sorted. All medications are sorted alphabetically so a PRN Tylenol will be next to a QID Tylenol. This new feature will make it easier to calculate the total dose of a medication given in a specified period of time. Actual sorting is based upon the content of the cells within the Task Description column. This new feature will be particularly helpful when a medication has multiple orders for different doses, routes, and/or frequencies. ff_emar_alpha-sort_[final].doc DS/wm/20070803 "); array_files[159]=new Array(0,4,"./Publications/FF_Down-time_Data_[20070211].pdf","2008-03-28","129K"," Fast Facts - Operational Changes (February 11, 2007) ",""," ","Effective February 11, 2007 OVERVIEW POE clinical users should be aware of a few changes in system functionality that will be apparent after POE is returned to service upon conclusion of the downtime period scheduled for February 11, 2007. In addition to the changes noted below, Prescribers should note that the dose ranges of many medications within the POE catalogs have been expanded. Please note that the changes to the Patient List functionality are not part of this downtime effort; however, they are being incorporated during the period leading up to the Pediatrics (Phase I) Roll-Out scheduled for February 18, 2007. · · PO Enteral Order forms will display a new route option Pediatric Medications Catalog o Will be made available to the Nursery o When Reordering medications, items within both the adult and pediatric patient catalogs will be available. Patient Lists o Unit Lists have been expanded to provide access to additional units o Personal Lists will need to be recreated · PO Enteral Orders A new route option­PO/Enteral Tube­will now be available to Prescribers placing PO Enteral orders. Selection of this route will result in the Pharmacy providing the associated medication in a liquid form. Pediatric Medications Catalog Prescribers assigned to the Nursery will now be able to access the full Pediatric Catalog when ordering medications. As illustrated in the example, pediatric medications are recognizable by the presence of two dashes separating the medications name and the associated dose. (over) down-time_data-sheet_[20070211_final_cor-01].doc 1 of 2 JS-MH-PZ/wm/20070207 Effective February 11, 2006 Reordering Medications When reordering medications--either by selection of a Discontinue or Reorder option, items from both the adult and pediatric catalogs will be displayed. Remember that pediatric medications are recognizable by the presence of two dashes separating the medication name from the associated dose information. Prescribers , who reorder a medication item from the wrong catalog (adult rather than pediatric or vise versa) will receive an alert in the form of a message similar to the one shown at the right of this paragraph. Upon receipt of a similar message, the Prescriber should complete the reorder process by selecting the medication from the appropriate catalog. Patient Lists To enable the display of new patient locations within the Current List drop-down menu, the POE data base will need to be updated. Unfortunately, this will cause you to lose any custom lists that you may have personally created. On the positive side, these enhancements should improve patient selection and eliminate unnecessary columns. The following enhancements essentially effect POE Prescribers are the result of user feedback from the POE Resident staff. · · · · Some units displayed within the Current List drop-down listing are better defined. An Age column has been added to Prescriber patient lists when the associated unit may care for both Adult and Pediatric patients. A new PREADMISSION location is now available for the display of pre-admitted patients who will be admitted either today or tomorrow. Columns are standardized across all of the units. down-time_data-sheet_[20070211_final_cor-01].doc 2 of 2 JS-MH-PZ/wm/20070207 "); array_files[160]=new Array(0,4,"./Publications/FF_Dose_Hx_Phase_I.pdf","2008-03-28","100K"," Fast Facts - Dose History, Phase I "," 20071218 ","","Dose History ­ Phase I December 2007 Summary Starting December 18, 2007 the first of three phases will be implemented to better enable end users to gather the history of medication dosing information from the eMAR: · Phase I: Will enable users to generate a medication history which shows the dose administered. This goes into effect December 18, 2007. · Phase II: will supply a cumulative total for the medication order over the past 24 hours. The information is specific to the one order. · Phase III: will supply a cumulative total for the medication over the past 24 hours. It is in this phase that you will be able to see a total cumulative dose of a medication which will include all of the different routes it was administered. · Implementation dates for Phases II & III have not been determined yet. To access the dose history: Steps to Access Dose History: · Go to the e-MAR · Select the date parameters · In the Task Description column, right click on the medication being queried · Select View and then Task Details List from the menus · A box titled Task Details List will appear on the screen with the information Two Additional Points: · To view an individual dose, using the mouse, users will now be able to hover over the administration cell and see the exact dose given. · In the event a lesser dose was administered, a small yellow down arrow will appear in the medication administration cell next the check mark & nurses initials. "); array_files[161]=new Array(0,4,"./Publications/FF_DC_Orders_Tfr.pdf","2008-03-28","209K"," Fast Facts - Discontinue/Cancel Orders Upon Patient Transfer "," 20061005 "," ","Effective October 5, 2006 When orders are being discontinued/canceled on behalf of a physician because of a patient transfer, a Requested By dialog box will appear as illustrated below. Nurses must select a Source option from the list appearing near the bottom of this dialog box. Previously, Verbal/Read Back/Confirmed was the default Source selection. This default selection created thousands of erroneously-generated unsigned physician orders within the POE system. As a result, this process has been changed. The Source no longer defaults to Verbal/Read Back/Confirmed. Nurses MUST now select the D/C Per Transfer Policy option, whenever patients are transferred because of either a change in service or level-of-care. D/C Per Transfer Policy ff_dc_orders_tfr.doc DS/wm/20061005 "); array_files[162]=new Array(0,4,"./Publications/Downtime_Procedures_Post.pdf","2008-03-28","156K"," Post-Downtime Procedures "," 20061021 ","","October 21, 2006 The tasks identified below are to be performed by Prescribers and Nurses for those inpatients received from either the PACU or the OR during the POE Downtime. Prescribers 1. Confirm accuracy of patient identification and post-surgical location (destination). 2. Enter the Downtime order prior to making any other entries into POE for the patient. 3. Enter all orders written during downtime into POE with the following exceptions! Laboratory and Radiology orders­these orders will be auto-entered as add-on orders from the lab and radiology. STAT or One-Time orders that have already been carried out­these will be maintained within the patient record as paper orders. 4. Orders discontinued on paper during downtime must be discontinued in POE! 5. When appropriate, enter a One-Time medication order for medications implemented after the scheduled dose. 6. Sign all verbal orders written on paper during downtime. If these orders require future activity, be sure to enter them in POE. Nurses 1. Confirm accuracy of patient identification and post-surgical location (destination). 2. Discontinue the PACU orderset­Select the D/C per transfer policy as the Source. 3. Implement preliminary orders­including pre-transfer/pre-admit, and post-operative orders­once POE system operation is restored. 4. Once the preliminary orders have been implemented, review the POE eMAR to insure that the scheduled medication administration times have populated the POE eMAR correctly. If the cells on the POE eMAR dont populate the correct administration times, the nurse should re-schedule the incorrect task to the correct scheduled time. 5. Medication orders implemented after the scheduled administration time will have a scheduled dose appearing on the POE eMAR for tomorrow. In these situations, have the prescriber verify whether the medication(s) needs to be given today. If the medication is to be given today, the prescriber will need to place a One-Time order in POE for that medication. 6. Review all orders written on paper during downtime and ensure that they have been entered into POE. 7. Make sure that the prescriber has discontinued all orders in POE that were discontinued on paper during the POE downtime. Post_Dn-time_Procedures_for_Prescribers_&_Nurses_Rev_A.doc 1 of 2 DS/wam/20061020 October 21, 2006 Nurses­continued 8. Make sure that the POE eMAR reflects that the medication has been discontinued. 9. If an overdue task appears on the POE eMAR for a discontinued medication, the nurse should select Mark as not done (within the overdue cell). Select Discontinued as the reason. 10. Review all orders placed in POE by the prescriber after the restoration of POE. Make sure that the scheduled medication administration times populate the POE eMAR correctly. If the cells on the POE eMAR dont populate the correct administration times, the nurse should re-schedule the incorrect task to the correct scheduled time. 11. All verbal orders taken during downtime should be co-signed by the prescriber, and entered into POE if future activity is required for that particular order. 12. Use the paper MAR to reconcile all overdue tasks generated on the POE eMAR that are the result of orders written during downtime. If these medications were administered and documented on the paper MAR during downtime, mark the appropriate POE eMAR overdue cell as Done. Enter Paper MAR used during downtime in the Comment section. 13. Mark the top of the Downtime MAR document with Downtime MAR used from __(Start Date/Time)__ to __(End Date/Time)__. 14. Make sure the Downtime MAR gets filed in the medication section of the blue chart. Post_Dn-time_Procedures_for_Prescribers_&_Nurses_Rev_A.doc 2 of 2 DS/wam/20061020 "); array_files[163]=new Array(0,4,"./Publications/Downtime_Procedures_NICU-Prescribers.pdf","2008-03-28","87K"," NICU Downtime Procedures - Prescribers "," 20080104 ","","Note ­During downtime periods, nurses will ensure that up-to-date versions of the Active Orders Report and Downtime MAR are placed in the appropriate patient chart. General Information Once downtime begins you will no longer be able to place orders within POE. Orders will need to be written on the Downtime/Crash Order Sheets. Note ­ The following downtime procedures apply to ALL Prescribers! While the POE System Is Down 1. Restrict the number of new handwritten orders to time-sensitive orders. 2. If new orders are needed, write orders on a yellow Downtime/Crash Order Sheet. 3. Place signed order sheets in the top and middle rings of the patients chart so that the top of the page sticks out of the binder. 4. Notify the Nurse that new paper orders have been written. 5. Radiology orders­fill out a paper requisition in addition to writing the order. 6. Laboratory orders­the Clerical Associate, Nurse, or Respiratory Therapist will fill out a paper requisition. 7. Laboratory results­may be viewed in both EPR and SCC, or obtained by calling 5-2648. After the POE System Comes Back UP The first POE entry made in each patient record after the system is restored must be the Downtime Order. Enter all orders written during downtime into the POE system EXCEPT the following: 1. Laboratory & Radiology Orders These will be auto-entered as add-on orders from the Lab and Radiology. 2. STAT or One-Time Orders that have already been carried out These will be maintained in the record as paper orders. Orders discontinued on paper during downtime must be discontinued in POE! For assistance during downtime, contact the HELP Desk. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ NICU_Dn-time_Procedures_Prescribers_20080104.doc DS/wam/20080104 "); array_files[164]=new Array(0,4,"./Publications/Downtime_Procedures_NICU-Nurses.pdf","2008-03-28","117K"," NICU Downtime Procedures - Nurses "," 20080104 ","","If Clerical Associate Is Unavailable In the absence of a Clerical Associate, ensure that the tasks identified on the document titled NICU POE Downtime Procedures ­ Clerical Associates are performed. Prior to POE Being Brought Down Complete a Nurse Order Review prior to the beginning of a scheduled downtime. Ensure that your patient charts contain at least two Downtime/Crash Order Sheets. Orders will need to be written on the Downtime/Crash Order Sheets for the duration of POE downtime. Obtaining Printed Reports During (when possible prior to) downtime, the RN will print the Downtime MAR and the JHH Adult & Pediatrics Transfer/Discharge/Active Orders Report performing the following steps on the designated POE downtime PC. 1. Click on the switch monitor button to connect to the designated downtime reporting workstation, which should always be powered on. 2. Click the Start button. 3. Click on the POE Downtime Reporting option. 4. Click Yes to access the Downtime Reporting System. 5. Enter your units passcode (located in the unit Pyxis machine) into the Enter Passcode field. 6. Click the Ok button. 7. Click the Print Current button. The Downtime MAR and the JHH Adult & Pediatrics Transfer/Discharge/Active Orders Report will be placed in the appropriate patients chart. While the POE System Is Down 1. STAT and One-Time medications that are ordered and administered during downtime are documented as given on the paper MAR. 2. During the downtime period, Nurses must transcribe medication orders from the order sheets onto the Downtime MAR. 3. Fax/scan all medication orders to the PEDs pharmacy (5-0283). Note ­ If a patient is admitted after downtime has started, the assigned nurse will need to transcribe medication orders for the new admission onto a paper MAR [form number ­ JHH 15-252120]. 4. Ensure that new diet orders are transcribed onto the Pediatric Diet Orders Sheet­Emergency. Completed sheets should be faxed to the Pediatric Dietary Office (4-8827). 5. Laboratory results­may be viewed in both EPR and SCC, or obtained by calling 5-2648. 6. Ensure that laboratory requisitions are completed for all labs written after downtime begins and are placed in the appropriate unit designated location. For labs written prior to downtime, labels will print in the appropriate location. This includes AM labs. 7. Ensure that all paper requisitions for x-rays, MRI, CT, etc. are stamped. NICU_Dn-time_Procedures_Nurses_20080104.doc DS/wam/20080104 After the POE System Comes Back UP 1. Reconcile all paper medication orders with the POE eMAR. Mark the appropriate cell(s) as Done for medications administered during downtime and enter administered during downtime in the Comment section. This will remove overdue tasks from the POE eMAR. Nurses should follow existing eMAR documentation procedures for omitted or rescheduled medications. 2. Orders discontinued on paper during downtime must be discontinued in POE! 3. Once all of the orders that were written during downtime have been entered into POE, the nurse must reconcile the paper MAR with the POE eMAR to ensure accurate time scheduling. For assistance during downtime, contact the HELP Desk. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ NICU_Dn-time_Procedures_Nurses_20080104.doc DS/wam/20080104 "); array_files[165]=new Array(0,4,"./Publications/Downtime_Procedures_NICU-CAs.pdf","2008-03-28","93K"," NICU Downtime Procedures - Clerical Associates "," 20080104 ","","Prior to POE Being Brought Down Ensure that an ample amount of paper is loaded into the designated POE downtime reporting printer. Ensure that you have an extra printer cartridge as well as enough Downtime/Crash Order Sheets--may be ordered from Standard Register-Order # U96-004 Place 2 Downtime/Crash Order Sheets behind the orders tab in all patient charts. While the POE System Is Down 1. During (when possible prior to) downtime, the RN will print the Downtime MAR and the JHH Adult & Pediatrics Transfer/Discharge/Active Orders Report using the designated POE downtime PC. The Downtime MAR and the JHH Adult & Pediatrics Transfer/Discharge/Active Orders Report will be placed in the appropriate patients chart. 2. Notify the nursing staff when paper orders are written. 3. Notify the Nurse immediately of any STAT orders. Note ­ If a patient is admitted after downtime has started, the assigned nurse will need to transcribe medication orders for the new admission onto a paper MAR [form number ­ JHH 15-252120]. 4. Fax/scan all medication orders to the PEDs pharmacy (5-0283). 5. Transcribe new diet orders onto the Pediatric Diet Orders Sheet­Emergency. Completed sheets should be faxed to the Pediatric Dietary Office (4-8827). 6. Complete laboratory requisitions for all labs written after downtime begins and place in the appropriate unit designated location. For labs written prior to downtime, labels will print in the appropriate location. This includes AM labs. 7. Notify Respiratory Therapist of any STAT respiratory orders. 8. Remember to stamp all paper requisitions for x-rays, MRI, CT, etc. 9. Call Radiology for STAT X-rays. 7:00 AM ­ 2:59 PM ........ call 3-7836 3:00 PM ­ 10:59 PM ...... call 3-2958 11:00 PM ­ 6:59 AM ...... call 3-2176 Remember to send a paper requisition for all patients traveling to radiology. After the POE System Comes Back Up Ensure that the Downtime MAR is placed within the medication section of the patient chart. For assistance during downtime, contact the HELP Desk. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ NICU_Dn-time_Procedures_CAs_20080104.doc DS/wam/20080104 "); array_files[166]=new Array(0,4,"./Publications/Downtime_Procedures_Prescribers.pdf","2008-03-28","66K"," Downtime Procedures - Prescribers "," 20070124 ","","General Information Note ­ all times stated below are approximations! Once downtime begins you will no longer be able to place orders within POE. Orders will need to be written on the Downtime/Crash Order Sheets. Nurses and prescribers will be able to view orders in the POE system until midnight. Note ­ The following Downtime Procedures apply to ALL Prescribers! While the POE System Is Down 1. Restrict the number of new handwritten orders to time-sensitive orders. 2. If new orders are needed, write orders on a yellow Downtime/Crash Order Sheet. 3. Place signed order sheets in the top and middle rings of the patients chart so that the bottom of the page sticks out of the binder. 4. 5. 6. 7. Notify either the Nurse or the Clerical Associate that new paper orders have been written. Radiology orders­fill out a paper requisition in addition to writing the order. Laboratory orders­the Clerical Associate or Nurse will fill out a paper requisition. Laboratory results­may be viewed in both EPR and SCC, or obtained by calling 5-2648. After the POE System Comes Back UP The first POE entry made in each patient record after the system is restored must be the Downtime Order. Enter all orders written during downtime into the POE system EXCEPT the following: 1. Laboratory & Radiology Orders These will be auto-entered as add-on orders from the Lab and Radiology. 2. STAT or One-Time Orders that have already been carried out These will be maintained in the record as paper orders. Orders discontinued on paper during downtime must be discontinued in POE! For assistance during downtime, contact the POE Command Center or the POE On-Call Representative. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ Dn-time_Procedures_Prescribers_20070124.doc DS/wam/2007-01-24 "); array_files[167]=new Array(0,4,"./Publications/Downtime_Procedures_PACU_Nurses.pdf","2008-03-28","107K"," PACU Downtime Procedures - Nurses "," 20070124 ","","Prior to POE Being Brought Down Note ­ all times are approximations! 1. Complete a Nurse Order Review prior to the beginning of downtime. 2. Since order notices will not be printed during downtime, you should check for new orders more frequently. Remember to check your patients orders upon accepting your patient assignment, at least every 4 hours during your shift, and at the end of your shift. 3. Once downtime begins you will no longer be able to place orders within POE. From then on, you will need to write orders on the Downtime/Crash Order Sheets. 4. Nurses and Prescribers will be able to view orders in the POE system until the beginning of downtime. 5. One hour prior to the beginning of downtime, the nurse should print the following reports in the PACU: PACU Cumulative Summary­place this report in the order section of the blue chart. Post-Op Orders Report­place this report in the order section of the blue chart. Printed Reports 6. The following documents will print automatically prior to POE becoming unavailable. 24 Hour Summary­place this report in the order section of the blue chart. Historical MAR­place this report in the medication section of the blue chart. Downtime MAR­kept by the nurse and used to sign-off medications administered during downtime. Place this report in the medication section of the blue chart upon patient transfer. 7. You may document on the POE eMAR until downtime begins. 8. Ensure that your patient charts contain at least two Downtime/Crash Order Sheets. While the POE System Is Down 9. Medication Orders must be faxed to your respective pharmacy during downtime. 10. Medication orders written during downtime will need to be transcribed onto the Downtime MAR. 11. Orders discontinued during downtime will need to be discontinued on the Downtime MAR. 12. All Lab and Radiology orders must be submitted using paper requisitions. Be sure to include the authorized prescribers name and prescriber number. Note ­ A nurse must verify transcriptions! 13. STAT and One-Time orders STAT and One-Time orders written and administered during downtime are documented on the Downtime MAR and paper orders sheet. Physicians should inform the nurse of all STAT orders. Dn-time_Procedures_for_PACU_Nurses_20070124.doc 1 of 2 DS/wam/2007-01-24 After the POE System Comes Back Up 14. STAT and One-Time orders will NOT be entered in POE when system operation is restored. 15. Reconcile all paper medication orders with the POE eMAR. Mark the appropriate cells as Done for medications administered during downtime. Change the time the drug was administered at the top of the Med Comment Form, and enter administered during downtime into the Comment section. This will remove overdue tasks from the POE eMAR. 16. Orders discontinued during downtime will need to be discontinued in POE. 17. Record the date and time that POE was restored at the top of the Downtime MAR and file it in the medication section of the patient chart. For assistance during downtime, contact the POE Command Center or the POE On-Call Representative. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ Dn-time_Procedures_for_PACU_Nurses_20070124.doc 2 of 2 DS/wam/2007-01-24 "); array_files[168]=new Array(0,4,"./Publications/Downtime_Procedures_Nurses.pdf","2008-03-28","73K"," Downtime Procedures - Nurses "," 20070124 ","","Prior to POE Being Brought Down Note ­ all times are approximations! 1. Complete a Nurse Order Review prior to the beginning of downtime. Since order notices will not be printed during downtime, you should check for new orders more frequently. Ensure that your patient charts contain at least two Downtime/Crash Order Sheets. need to write orders on the Downtime/Crash Order Sheets. Nurses and Prescribers will be able to view orders in the POE system until the beginning of downtime. 2. Once downtime begins you will no longer be able to place orders within POE. From then on, you will Printed Reports 3. The Downtime MAR will automatically start printing prior to the beginning of downtime 4. The 24-hour Order Summary will automatically start printing at midnight. 5. The Historical MAR will automatically start printing at midnight. Place this document in the Medication section of the blue chart. (typically 1-2 hours). Each functional unit is responsible for determining where these printed MARs will be placed--they can be placed in either the blue chart, bedside chart, or kept by the nurse. Make sure these summaries are placed behind the Orders tab in your patients chart. While the POE System Is Down 1. STAT and One-Time orders written and administered during downtime are documented as given on the paper MAR and the paper order sheet(s). 2. During downtime, orders which were transcribed must be verified by a nurse. 3. Medication Orders must be faxed to your respective pharmacy during downtime. Osler 2 Fax....................... 2-0606, Stat Fax ..................... 2-0618 Peds Fax .......................... 5-0283 Carnegie 6 Fax................. 5-4026 Weinberg Fax................... 5-6371 4. Medication administration is documented on the Downtime MAR if the POE eMAR is unavailable. Note ­ If a patient is admitted after downtime has started, the clerical associate or assigned nurse will need to transcribe medication orders for the new admission onto a paper MAR [form number ­ JHH 15-252120]. Transcribed orders will need to be verified by a second person (typically a nurse). After the POE System Comes Back UP 1. Reconcile all paper medication orders with the POE eMAR. Mark the appropriate cell(s) as Done for medications administered during downtime and enter administered during downtime in the Comment section. This will remove overdue tasks from the POE eMAR. 2. At the top of the Downtime MAR, document the date and time that POE was restored and file it in the medication section of the patient chart. 3. Orders discontinued on paper during downtime must be discontinued in POE! 4. Once all of the orders that were written during downtime have been entered into POE, the nurse must reconcile the paper MAR with the POE eMAR to ensure accurate time scheduling. For assistance during downtime, contact the POE Command Center or the POE On-Call Representative. Additional POE Information is available via the POE website http://www.jhmcis.jhmi.edu/poe/ Dn-time_Procedures_Nurses_20070124.doc DS/wam/2007-01-24 "); array_files[169]=new Array(0,4,"./Publications/Bulletin_016.pdf","2008-03-28","124K"," Bulletin 016, Change in Discharge Worksheet Functionality "," 20070525 "," ","WHO: Department of Medicine Units WHAT: New completion (finalization) process for DoM Discharge Worksheets WHEN: Immediately (May 25, 2007) WHY: To ensure that POE, EPR and the patient reflect the same information as contained on the POE Discharge Worksheet­to include an accurate list of discharge medications. Users Must Observe the Following Limitations · POE users will be prompted to either Submit as Complete or Submit as Incomplete when exiting the Discharge Worksheet. Discharge Worksheets printed before being finalized will have DRAFT displayed across the top of the page. Please note that Discharge Worksheets, which are a work in progress, should always be Submitted as Incomplete. POE users should only select Submit as Complete when they are sure that they have made the final edits/updates to the document and the patient is ready to go home. Completed (finalized) Discharge Worksheets will be automatically sent to EPR 60 minutes after the associated patient is discharged. Failure to submit a completed (finalized worksheet) will result in NO Discharge Worksheet being automatically transmitted to EPR for incorporation into the patient record once the patient discharge has been performed! Nurses should ensure that the printed Discharge Worksheet DOES NOT have the word DRAFT printed upon it. If it does, the appropriate prescriber should be contacted and asked to resubmit the document as completed. · · · · · "); array_files[170]=new Array(0,4,"./Publications/Bulletin_015.pdf","2008-03-28","360K"," Bulletin 015, New Discharge Worksheet "," 20060515 "," ","WHO: All Department of Medicine Units WHAT: New POE Discharge Worksheets are being placed into service When: 9:00 AM on May 15, 2006 Additional Information Call any of the following numbers from May 15th through midnight on May 17th 410-948-4229 / 410-948-47274 / 410-948-4290 After 12:00 midnight on May 17th, please call the Help Desk 410-955-HELP "); array_files[171]=new Array(0,4,"./Publications/Bulletin_014.pdf","2008-03-28","605K"," Bulletin 014, Changes Affecting Nurses "," 20060507 "," ","Change 1 -- Pharmacy Verification Process: The Pharmacy verification process is changing so that new medication orders will not appear on the eMAR until the pharmacy verification has occurred. This will reduce the clutter appearing on the eMAR making it easier to use. Change 2 -- eMAR Views: New eMAR views to enhance and support nursing workflow and patient care are being provided. Training: Be sure to complete the HealthStream course--titled POE QI Pack 1 Update--as soon as possible. This course describes the changes associated with this update in more detail and provides important information about implications of these changes for nurses. Information Sheet (Bulletin-014)--QI Pack 1 7 May 2006 CM/wam "); array_files[172]=new Array(0,4,"./Publications/Bulletin_013.pdf","2008-03-28","427K"," Bulletin 013, Q6H Orders "," 20060126 "," ","CRITICAL NEED: On Meyer 8 and Meyer 9, ordering labs to determine Sodium, Potassium, and Urine Specific Gravity levels on a Q6H schedule. SOLUTION: A Q6H Labs Orderset was created and made available to these units only-- Meyer 8 and Meyer 9. PROCESS: To place orders for any of these three items: 1. 2. Select the Q6H Labs Orderset by typing in the name. Once in the orderset: a. No Central Line--if collection is to be performed by the Lab, check the box next to Sodium and/or Potassium under the Lab Collect header. Central Line-- if collection is to be performed by the VAT, check the box next to Sodium and/or Potassium under the VAT Collect header. Check the box next to Urine Specific Gravity if desired. b. c. ADDITIONAL INFO: The times and number of repeats on these orders are preset and should not be changed! The times are configured to provide draw times as close as possible to 6:00 AM, 12:00 PM, 6:00 PM, and 12:00 AM using the existing Lab round times for these floors. They will repeat for three days--as agreed upon by the Laboratory and Neurosciences Departments. The POE and Pathology systems have been specially configured to make this orderset work. Ordering Q6H labs outside of this orderset may lead to failures and missed draws! Sodium, Potassium, and Urine Specific Gravity are the only tests currently approved for the Q6H lab draws as set up for Meyer 8 and Meyer 9. Information Sheet (Bulletin-013)--Q6H Orderset, Neurosciences 26 January 2006 PH/wam "); array_files[173]=new Array(0,4,"./Publications/Bulletin_012.pdf","2008-03-28","979K"," Bulletin 012, Medication Alert "," 20051122 "," ","Tuesday, November 22, 2005 The following three (3) issues have been reported since the installation of the POE Upgrade on 10/31/05 . We are actively working with the vendor to resolve these issues. Expected Behavior (Issues 1 and 2) After the last cell is documented on the eMAR, the order status should display as Completed on the Order Summary tab. However, the following issues have been noted. Issue #1 Orders may display a status of Active on the Order Summary tab after the last cell is documented on the eMAR. Recommended Action Verify all administrations using the eMAR NOT the Order Summary tab. Issue #2 Orders may display a status of Discontinue after the last cell is documented on the eMAR. Recommended Action Verify all administrations using the eMAR NOT the Order Summary tab. Expected Behavior (Issue 3) Only one line item should display on the eMAR for STAT orders. However, the following issue has been noted. Issue #3 STAT orders may display as 2 line items on the eMAR. One line item with cells and one line item without cells. Recommended Action Only administer the line item with cells! Do not administer the line item without cells. Bulletin 012 22 November 2005 PZ/JS/wam "); array_files[174]=new Array(0,4,"./Publications/Bulletin_011.pdf","2008-03-28","386K"," Bulletin 011, Shortened User Inactivity Period "," 20050913 "," ","Friday, September 16, 2005 @ 12:00 NOON Presently, POE goes into Suspend Mode (POE session closed down) after 10 minutes of inactivity. Users whose sessions have been suspended need only to re-enter their passwords to regain access to POE. Users are logged out of POE after 15 additional minutes of inactivity. POE will now enter Suspend Mode after 5 minutes of inactivity. All other facets of this functionality remain unchanged. This change in functionality was recommended and approved by the POE Steering Committee. The intent of this change is to improve authentication reliability (correctness) of the recorded user identity for a given data entry session. Bulletin 011 13 September 2005 MH/wam "); array_files[175]=new Array(0,4,"./Publications/Bulletin_010.pdf","2008-03-28","350K"," Bulletin 010, Order Display Functionality "," 20050721 "," ","Thursday July 21, 2005 @ 5:00 PM Until now, placing a repeating Lab test order caused the POE system to generates every occurrence of the order for the next seven days and displays them all on the review screen-- accessed via the Orders tab. As each day passed, another days worth of occurrences would be generated until all of the ordered occurrences are exhausted. As a result, an extremely large number of pending lab orders were populating the review display. To reduce the amount of pending lab orders appearing within the review display, the following functionality is being adopted. Beginning at 5:00 PM today, repeating Lab test order occurrences will only be generated for the current day and one day into the future. As each day passes another days worth of occurrences will be generated. The net result is that the review display will always show the current days occurrences plus the next days occurrences--until all of the ordered occurrences are exhausted. Bulletin 010 21 July 2005 PH/wam "); array_files[176]=new Array(0,4,"./Publications/Bulletin_009.pdf","2008-03-28","354K"," Bulletin 009, Revised Respiratory Services "," 20050707 "," ","Tuesday July 12, 2005 (between 6:00 and 8:00 AM) · · Incorporation of the following changes will result in functionality. no disruption of POE Revised Respiratory Therapy (Ventilation) orders will all be placed via order sets. The order sets--identified below--include all of the Laboratory, Radiology, and Nursing orders necessary to support ventilation therapy. Ventilation, Mechanical, Adult Order Set Ventilation, Non-Invasive, Adult Order Set Ventilation, High Frequency Oscillator · Type of Order A new field on the ventilation order forms used to indicate whether the order is an Initial Order or a Change Order. Change Orders The Discontinue/Reorder menu option--accessed by right-clicking on the existing vent order listing within the Order Review display--will allow you to initiate creation of a change order with all of the settings within the original order carried over. You must change the Type of Order selection to Change Order and make any desired changes to the carried over settings. New Logic The mechanical ventilation form presents only those settings fields that apply to the Mode which has been selected. These fields are required and must contain data! 7 July 2005 PH/wam · · Bulletin 009 "); array_files[177]=new Array(0,4,"./Publications/Bulletin_008.pdf","2008-03-28","369K"," Bulletin 008, Vascular Access Team Services (Orders) "," 20050706 "," ","Tuesday July 12, 2005 (between 6:00 and 8:00 AM) · · · There will be services. no disruption of POE functionality during the incorporation of these The Nursing orders identified below are being replaced by the VAT orders and will not be available after the indicated date. Saline and Heparin flushes for maintain orders must be documented using the POE MAR display. Discontinued Nursing Orders Catheter, Hemodialysis, Maintain - CC Catheter, Hemopheresis, Maintain - CC Catheter, Tunneled, Maintain Central Line, Flush Central Line, Multi-Lumen, Maintain Central Line, Peripheral, Insert Central Line, Peripheral, Maintain Central Line, Single Lumen, Maintain Convert IV to Saline Lock Implantable Port, Access Implantable Port, Flush IV, Cap IV, Flush 2nd IV w/Saline/VAD Protocol IV, Flush Infusion Port w/NS w/ VAD Prot IV, Flush with Saline IV, Insert and Maintain IV, Insert and Maintain 2nd Device Saline Lock, Insert VAT Orders and Ordersets Now Available within POE PICC VAT Order Set Implanted Port Access VAT Order Set Implanted Port Deaccess VAT Order Set Peripheral IV Catheter VAT Order Set Central Line, Maintain Order Set Peripheral IV Maintain Orderset VAT Bulletin 008 The following orders may be ordered individually. Declot Central Line Assessment VAT Peripheral IV Catheter, Insert 2nd VAT Peripheral IV Catheter Restart VAT (orderable by nurses if patient has an active IV) 6 July 2005 PA/wam "); array_files[178]=new Array(0,4,"./Publications/Bulletin_007.pdf","2008-03-28","364K"," Bulletin 007, Improved Radiology Form Functionality "," 20050622 "," ","On Sunday June 26, 2005 at 7:00 AM, the POE Staff and the Department of Radiology are implementing changes to radiology forms that have been designed to clarify request times, collect new data, and provide enhanced logic. New Request Time Clarification AM Radiology Rounds (ICU only) ........ SCHEDULED MORNING ROUNDS Day (Morning Preference) ........................ 7:00 AM TO 12:00 PM Day (Afternoon Preference) ................... 12:00 PM TO 5:00 AM Evening ................................................... 5:00 PM TO 12:00 AM Night ...................................................... 12:00 AM TO 7:00 AM New Data Collection Isolation Status Weight­Bearing Status Contrast Desired (for CTs & MRIs) Logic Enhancement 1. The pregnancy question will default to NO for males and females 10 & 70 years old. It will require an answer for all other patients 2. The weight bearing question will display and be required if you select wheelchair transport. 3. If the weight bearing question indicates the patient cannot bear their own weight, the transport method is changed to Stretcher. 4. The Suspected Diagnosis field will be required only if the user selects Other in the Diagnosis drop­down. 5. Portable method of transport will be defaulted and locked in for all portable exams. Bulletin 007 22 June 2005 PH/wam "); array_files[179]=new Array(0,4,"./Publications/Bulletin_006.pdf","2008-03-28","398K"," Bulletin 006, New Order Summary Departmental Header Sequence "," 20050601 "," ","Wednesday, June 15, 2005 @ 8:00 AM. Use of either the By Department or By Department/Status (Display Format) filters will reveal a new sequencing of departmental headers within the POE order summary display. Previous Header Sequence Resuscitation Status Transfuse Blood Products Cardiac Imaging Pharmacy Nursing VAT Physical Med & Rehab PT/OT/SLP Vascular Lab (VLAB) Radiology Neuro Testing Nutrition Respiratory Laboratory PFT Lab New Header Sequence Resuscitation Status Transfuse Blood Products Pharmacy Nursing VAT Respiratory Nutrition Laboratory Radiology Neuro Testing Cardiac Imaging PFT Lab VLAB Consults Social Work Physical Therapy Occupational Therapy Speech Therapy Physical Med & Rehab PT/OT/SLP Admission Orders Discharge Planning Consults Admission Orders Discharge Planning NOTE ....... Not all of the departmental headings are called out in the above table, although those headers will appear as part of a clinical grouping within the POE order summary display. Example--Neurology Services include Neuro Testing, Neuro Metrics, and EEG Lab. Bulletin 006 1 June 2005 JK/wam "); array_files[180]=new Array(0,4,"./Publications/Bulletin_005.pdf","2008-03-28","415K"," Bulletin 005, Vascular Lab Services (Orders) "," 20050527 "," ","When Wednesday, June 1, 2005 between 6:00 and 8:00 AM. Details Existing Vascular Lab (VLAB) Services will be made available within POE as of the indicated time period. There will be upgrade! no disruption of POE functionality during the incorporation of this VLAB service items (orders) may be accessed through the use of either the POE manual entry or Start of Browse methodologies. Existing VLAB services (orders) are listed within POE as individual orders rather than as a sub-component of a comprehensive service category. The names of these items (orders) reflect the names previously used in the non-POE environment. A listing of the actual order names may be obtained by accessing the POE web site (http://www.jhmcis.jhmi.edu/poe/) and reviewing the content of Bulletin 005--available through the selection of the Bulletins option of the Publications tab. See next page for listing of VLAB items (orders). VLAB Service Items (Orders) Ankle Brachial Index (ABI) VLAB Aortic Duplex VLAB Arterial Duplex LE Bilateral VLAB Arterial Duplex LE Left VLAB Arterial Duplex UE Bilateral VLAB Arterial Duplex UE Left VLAB Arterial Duplex UE Right VLAB Bypass Graft Duplex LE Left VLAB Bypass Graft Duplex LE Right VLAB Bypass Graft Duplex UE Left VLAB Bypass Graft Duplex UE Right VLAB Carotid Duplex VLAB Groin Duplex Left VLAB Groin Duplex Right VLAB Mesenteric Artery VLAB Radial Artery Map UE Bilat VLAB Renal Artery Duplex VLAB Segmental Doppler w Pressures Lower VLAB Segmental Doppler w Pressures Upper VLAB Toe Brachial Index VLAB Vein Mapping Study LE Bilat VLAB Vein Mapping Study LE Left VLAB Vein Mapping Study LE Right VLAB Vein Mapping Study UE Bilat VLAB Venous Duplex LE Right VLAB Venous Duplex UE Bilateral VLAB Venous Duplex UE Left VLAB Venous Duplex UE Right VLAB Arterial Duplex LE Right VLAB Radial Artery Map UE Right VLAB Vein Mapping Study UE Right VLAB Venous Duplex LE Left VLAB Radial Artery Map UE Left VLAB Vein Mapping Study UE Left VLAB Venous Duplex LE Bilateral VLAB Bulletin 005 27 May 2005 PA/wam "); array_files[181]=new Array(0,4,"./Publications/Bulletin_004.pdf","2008-03-28","414K"," Bulletin 004, Patient Discharge Order Procedure "," 20050331 "," ","Who Is Affected Department of Psychiatry Nurses, Social Workers, and Physicians. Patient Discharge is a Two­Step Process Step 1. Continue use of the Psychiatric Discharge Order Set (paper forms)! Step 2. Perform the following steps to submit a discharge order within POE to discharge the patient from the system and stop all inpatient orders. NOTE The following procedure assumes that you are currently logged into POE and that the system focus is on the patient about to be discharged. 1. Click on the (clipboard icon) to access the Order Entry Worksheet. 2. Type .Discharge (be sure to include the period that precedes the letter D) over the highlighted Type here to enter order name entry. 3. Double-click the highlighted .Discharge order which appears in the Order listing. 4. Fill-out the fields within the order form. 5. Click the OK command button. 6. Click the Submit command button. Bulletin 004 31 March 2005 DK/wam "); array_files[182]=new Array(0,4,"./Publications/Bulletin_003.pdf","2008-03-28","490K"," Bulletin 003, Patient List Functionality & More "," 20050318 "," ","Who Is Affected Nurses and Clerical Associates When At user logon anytime after 6:30 AM on March 24th (time approximate) Whats Happening Improved system functionality provides Nurses and Clerical Associates on JHH POE equipped units with the following operational enhancements. See new Patient Lists & Searches Quick Reference Guide for additional information. All POE toolbar icons will now be displayed--those not appropriate for the logged user will exhibit a grayed-out (faded) appearance. A reason for accessing patients outside of your unit (the unit associated with the workstation being used) is no longer required. The Current List drop-down listing (accessed via the Patient List tab) now displays the label Unit Census indicating the patient population associated with your unit--as determined by the location of the workstation. A listing of all DoM units will no longer be displayed. NEW Bulletin 003 OLD 18 March 2005 MH/JK/wam "); array_files[183]=new Array(0,4,"./Publications/Bulletin_002.pdf","2008-03-28","1012K"," Bulletin 002, Automated Med Order Checks "," 20041115 "," ","Whats Happening The installation of the SCM 3.5 XA upgrade will introduce a number of automated checks that will be performed as part of POE medication order writing. Effective Date Implementation of this change is scheduled to take place on November 21st and will cause POE to be unavailable between the hours of 12:01 AM and approximately 6:00 AM. Details The following table summarizes the new automated medication order checks. Consult the POE Upgrade Summary and updated POE User Guide for additional information. Order qam Evaluated Value Time of order placement Criteria 8:00 AM Action If placed after 8:00 AM, a message will be displayed stating that This order will not start until TOMORROW at 8:00 AM. If it is desired that the order also be administered today, an additional (second) order will need to be written with a frequency of once and a start time priority of Time Critical. If placed after 10:00 AM, a message will be displayed stating that This order will not start until TOMORROW at 10:00 AM. If it is desired that the order also be administered today, an additional (second) order will need to be written with a frequency of once and a start time priority of Time Critical. Enter an appropriate narrative (rationale). None--when order is saved (via the OK button), Once will automatically be inserted in place of the original entry and will not be modifiable. 15 November 2004 PZ/JS/wam daily Time of order placement 10:00 AM PRN STAT PRN Reason field entry Frequency field entry Must contain data Once Bulletin 002 "); array_files[184]=new Array(0,4,"./Publications/Bulletin_001.pdf","2008-03-28","1837K"," Bulletin 001, Order Frequency Designations "," 20040924 "," ","Whats Happening A number of previously defined order frequency designations used within POE are being changed to maintain compliance with JCAHO regulations. This change applies to new orders only--previously written orders will not be effected. Effective Date This change is scheduled for implementation at 12:00 noon on September 28th Details Old (Prohibited) Designations, which will no longer be used, are listed in the leftmost column of the following table. Corresponding New Designations, which will be used for all future orders, are listed in the rightmost column. Old (Prohibited) Designations qd qod qodbid qhs achs pchs qd-pantoprazole qd-warfarin Bulletin 001 New Designations daily every other day every other day twice daily at bed-time before meals and at bed-time after meals and at bed-time daily-pantoprazole daily-warfarin 24 September 2004 PZ/JS/wam "); array_files[185]=new Array(0,4,"./Publications/ADT_Dn_Admitting.pdf","2008-03-28","2459K"," ADT System Downtime Guide "," 20041124 "," ","Provider Order Entry for Admitting Department Personnel Version 3.5 XATM ­ November 24, 2004 Information Technology @ Johns Hopkins An online version of this publication is available for viewing at the following URL: http://www.jhmcis.jhmi.edu/poe/publications.html POE--ADT System Downtime Guide ©2004 Information Technology @ Johns Hopkins. All rights reserved. No part of this POE, ADT System Downtime Guide may be reproduced or circulated in any form or by any means without the prior written consent of the Johns Hopkins Hospital. Sunrise Clinical Manager (SCM) is the property of the Eclipsys Technology Corporation. All other product and brand names are trademarks or registered trademarks of their respective companies. Version 3.5 XATM November 24, 2004 POE, ADT System Downtime Guide Revision History The revision history page is a listing that allows the reader to quickly identify changes made to the pages contained with this publication. Change Listing Page(s) Description Revision [Date] All ...................................................... Initial Publication Release ............................................................. SCM 3.5XA [November 24, 2004] A Version 3.5 XATM November 24, 2004 POE, ADT System Downtime Guide CONTENTS REVISION HISTORY................................................................................................................... A PREFACE.................................................................................................................................... V 1 1.1 1.2 1.3 1.4 1.4.1 1.4.2 2 3 USE OF THE POE ADT SYSTEM DOWNTIME GUIDE ....................................... v Intended Audience........................................................................................... v Figures............................................................................................................. v Tables.............................................................................................................. v Online Availability ............................................................................................ v Links ......................................................................................................... vi PDF Reader Navigation Devices .............................................................. vi POE GUIDANCE & INSTITUTIONAL POLICY ................................................... vii CHANGES TO THIS GUIDE ............................................................................... vii GLOSSARY................................................................................................................................ IX OVERVIEW...................................................................................................................................1 1 2 2.1 2.2 3 4 POE AND ADT SYSTEM DOWNTIME ................................................................. 1 ADMITTING PATIENTS ........................................................................................ 1 Inpatient Admissions ....................................................................................... 1 Outpatient Registrations .................................................................................. 1 INFORMATION ACCURACY ................................................................................ 2 ADT DOWNTIME TASKS......................................................................................2 LOGGING ON TO POE ................................................................................................................ 3 1 2 3 4 5 LOG ON PROCEDURE ........................................................................................ 4 LOGGING OFF ..................................................................................................... 5 SUSPEND POE SESSION....................................................................................6 RESUME POE SESSION......................................................................................6 PASSWORD MAINTENANCE .............................................................................. 7 SEARCHING FOR PATIENTS ..................................................................................................... 9 1 2 3 MEDICAL RECORD NUMBER SEARCH ............................................................. 9 SOCIAL SECURITY NUMBER SEARCH............................................................10 PATIENT NAME SEARCH .................................................................................. 11 ADMITTING PATIENTS ............................................................................................................. 13 1 2 3 ADMIT PATIENTS--HAVING AN MRN IN POE ................................................. 13 ADMIT PATIENTS--NOT HAVING AN MRN IN POE ........................................ 18 VERIFY PATIENT REGISTRATION/VISIT INFORMATION ............................... 23 TRANSFERRING PATIENTS.....................................................................................................25 i Version 3.5 XATM November 24, 2004 "); 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