· Web viewScanner Reset is used for resetting med scanner Links: to additional resources such as Micromedex What’s New in HED Review tab for review of documentation Tabs: Training

5/6/2023/tt/file_convert/5abac4737f8b9a321b8c0ef4/document.doc 1

Training ID: TRAIWIW… NURSE

1. 4 hour classesa. July 16: 2 Adult Classes : Monday 0730-1130a 1010 OH and B319 b. July 17: 2 Adult Classes: Tuesday 0730-1130a 407 OH and B319c. July 13 Peds: Friday 8a-11:30a d. July 13: Peds: Friday 12:30-4:30p

Supplies Playback RN orders: TRAIAKO Before class Trainer’s Manuals: (2) in B319 (2) in 407 OH and (2) 1010 OH Wireless Scanner for Trainer (1)in each training room Rosters with column to check “Passed boards”

Handouts: Guided note-taking sheets Laminated POS and Lab Req - – can share Take Home Tip Sheet

Setup: 1. Amanita:

o Job Title: RN … Role: Nurseo Dept: Othero Lookup, change, acknowledgeo If boards not passed after class, change Amanita to MR, Other… use roster during

class to check who just passed board… then verify in database 2. Acudose – RN change to non-clinical if don’t pass boards3. Armband and PMM - given access to final unit at Match time

LCD Slides: (ALT/ESC to Toggle)1. Objectives HED2. Principles of Assessment3. Nurse Summary4. Objectives HEO/Wiz and StarPanel5. Admission History Sections 6. Flu Vaccine7. HEO/Wiz Legend8. Processing Orders 9. Steps to Acknowledge Orders

Access: RN but if have not passed boards change to Title: Nurse Residents, Role: MR/other. Acudose – Non Clinical, PMM as Float pool

Nurse Resident

2012

Before Class starts…1. Rosters: Ask question …” Have you passed boards” to the

people not listed on Roster as PASSED. Update roster and check data base to confirm did pass before changing amanita

2. Open PPT slide displaying Class Objectives

IntroductionTrainer: Welcome to Clinical Computer Class Training, taught by our department, Systems Support Services.

A. My name is ……….B. Restrooms are….C. Length of class is 4 hrs, with a break

Objectives for today are….( PPT Slide 1)

LCD Slide 1

Trainer: HED (Horizon Expert Documentation) is the nursing documentation system. There are 3 sections to HED that will be discussed: documentation of Interventions/ Assessments, Care Organizer, Admin-RX which is bar code scanning of med and Engage Learners and acknowledge past experiences: “Who has used an electronic nursing documentation? Anyone used HED? At


HEDCare Organizer, HED,

Admin-RX

OBJECTIVES: HED Nursing Documentation OBJECTIVES: HED Nursing Documentation

Document Interventions, Assessments Commit to use HED system safety checks

Set Preferences & Create Assignment

View Confirming Med Orders

Commit to use HED system safety checks

Vanderbilt or elsewhere? Who has done Bar-code Scanning of meds? Did you like it”?

This is a HIPAA-compliant screensaver view of the Inpatient WB that displays on CWS.

The columns are Bed, Patient Name displaying only initials, Age, LOS. The Status Column displays the admission type. IA is an Inpt

admission and OT is an Observation Admission. The PB column defines the patient's status for release of information. The Attending column displays the admitting attending. The Orders column displays with red and blue boxes alerting the nurse

that there are orders to be acknowledged. Red= STAT Blue= standard Links to flowsheet, MAR and labs The screen prompts the user to press the spacebar to log on

TRAINER: Sign-On. Note StarBrowser displays in lower tool bar ... this is StarPanel, the electronic med record system. We will cover this later in class when reviewing this application.

Click on the Go To Desktop Icon from StarBrowser Double-click on the HED TRAIN. Care Organizer – used to identify your patient assignment for

the day and what meds to give hour by hour. This will be covered in the scanning portion of the class.

Find the patient from the laminated sheet and click on it and Click HED


Brief overview of Screensaver

Main Screen Quick overview Pt name- click on down arrow to see full census Allergies are imported from HEO/Wiz Scanner Reset is used for resetting med scanner Links: to additional resources such as Micromedex What’s New in HED

Review tab for review of documentation Tabs: Training computers have all tabs for all units. You will only see the tabs for unit you are working on for current rotation

Additional Tabs: click the upside down triangle with double lines to see additional tabs

Left Menu Bar: use to navigate charting area VUH VS I&O tab always opens first

Click “Show ALL” – Jump to INTAKE section, then Jump to PAIN. Notice documentation area to the right jumps to that section.

Left bar: Note also under VS / I&O tab: Vents, Med Drips, CTs, Wound Vacs

Vertical Column and Previous Documentation Note DATE and TIME of column and white boxes to chart in Click Cancel at bottom Scroll bar on Right side for up and down Arrows for back & forward in time.


New Admission

HED Documentation

Scenario: Billy Bob’s O2 sats were 89 % on room air and O2 initiated at 2L. He arrives on your unit, complaining of nausea and pain. 2 IVs are infusing to CVC: Heparin drip and D5 ½ NS with 20KCL. He was given codeine for pain prior to transfer and vomits dark green emesis into a towel just as he arrives on the unit.

1. Click VS on left Bar2. Click Chart3. Click SHOWALL next to ADD to display all items in the VS category4. Change time to 30 min ago: Double click or use arrows5. Click Temp # 1 in F. Type 101.4 oral6. Click oral from the drop down box 7. Click exclamation point. Highlight value in red; significant finding 8. Click heart rate/DAS. Type 112 9. Click Apical from the drop down box10.O2 Sats: 93%....On Oxygen11.O2 Liter flow: 2L…Nasal Canula

12.Scroll to IV Site Check: add

How often are IV sites checked? Peds is every hour, Adult every 2h. Site assessment done every shift

1. From Left Bar, Click Pain 2. Click Show ALL next to ADD 3. Pain Site: chest4. Pain Description: Aching/constant5. Pain Scale: numbers


Vitals / I&O Tab

6. Pain Score: 87. Pain Goal: 38. Pain Intervention: see MAR and emotional support

When should pain be reassessed after an intervention…in this case medication and support? Within 2 hrs– Frequently missed and Vanderbilt is cited/ fined. Note “Response to Intervention” tab. Do not chart response and intervention at the same time.

Document 300ml D5 ½ NS with KCL, Emesis (O) with note of small green amount

1. Click Intake on left bar2. Click SHOWALL next to ADD. Note Oral is listed first3. Scroll to D5 ½ NS with KCL: 3004. Add Comment: Infused in ED5. Click Output on left bar6. Click SHOWALL in next to ADD 7. Scroll to find Emesis (O)8. Type (1) Occurrence, unable to measure9. Annotate with sticky note details, i.e. small amt green

Yellow check mark indicates unsaved data. Click Save10. Review data entered, time and date. 11. Click Confirm

Trainer: Note I&O summary in LEFT bar. HED displays shift and 24 hours.

Trainer: Monitored VS/DAS = Downloads VS from bedside monitors. You will learn how to on unit


Blood TransfusionDemo Only

Trainer: Click on the upside down triangle with double lines to add the Blood Transfusion tab to your viewReview only

Consent and Teaching section at the beginning Scroll to view various blood product categories, PRBC, platelets…

Unit # on TAR – Product verified with 2 licensed personnel – Trainer: checkmark

this Infusion status…. Started, etc Special Equipment

Trainer: Click save and point out that confirm screen is ideal way to cosign blood products. (But will practice how to cosign after the fact later in class with Insulin.)


Where are VS documented? VS or Blood Transfusion Tab. Documenting one place will display in the other

LCD Slide 2 Assessment Principles

Click on the dropdown triangle and add Med/Surg/Assessment Intervention Tab

Click SHOWALL on Left Bar Click CHART and Change time to 0730 Click Neuro, click show all: Document Standard Met Click Cardiovascular, click show all:

a. Standard Met Except b. Click drop down for Pulse: Standard display in ALL CAPS as

Regular & 60-100 BPM. Here’s where you find standards for each assessment


Assessments and

Interventions

Beginning of shift or change level of care Items in ALL CAPS on gray bar charted each shift Line Manage charted each shift Vanderbilt charts to Standards & only denotes

variances Systems

Assessments

c. Click Edema site #1d. Edema location: BLE – add comment “ankles”e. Edema scale 1 + pitting f. Scroll to Telemetry alarm settings – must enter / won’t download

Click Pulmonary/respiratory: click show alla. Click STANDARD MET EXCEPT. Standards in ALL CAPSb. Click RLL & select fine cracklesc. Click LLL & select fine crackles - If make a mistake, click

again to deselectd. Click cough e. Click productivef. Secretions: Make up some nasty secretions!g. Incent Spirometer: (600 X 5)

Scroll to Pulm Intervention: D B & Cough and NT suction Trainer: Most interventions at end of systems section

Renal/Urinary: Document Standard Met Skin: Review section only

Trainer: Note skin assessment done here, checkmark Braden score documented in WIZ/HEO. This will be reviewed later.

Falls risk: Review section only Everyone is at least STANDARD risk. “Any 1” or “Any 2” factors will designate HIGH risk; also

4 Meds Be sure to complete FALL RISK ASSESSMENT portion for

everyone

CVC: Scenario Dr. Golightly inserted the triple lumen in the ED. Document the CVC with information you know.


Line Management

a. Click CVC from Left barb. Click Start New CVC Sitec. Line Type: Central Lined. Site: Internal Jugulare. Side: Rightf. Lumen description: proximal, distal, middleg. Dressing: Chlorhex Drsg, Transparenth. Secured With: Suturesi.Type “T” in Date and Time to insert current date and time.

Can change j.Inserted by: Dr. Golightlyk. Location: VUMC EDl.Response: c/o pain on insertion, site comfortable after

procedurem.No commentsn. Click “Save”

Site Assessment: Note Boxes to document site after Line information…

a. Proximal Lumen Status: Intact, patent, flushed no resistance (address each lumen as appropriate for real pts)

b. Proximal Lumen Fluid/Med infusing: D5 ½ NS with KCLc. Site Appearance: Dry & warmd. Surrounding Skin: Dry & Intact e. Site Dressing: Dry & Intactf. Click Save and Confirm

Discontinue IV: Click on magnifying glass. Review section only. When ready to discontinue the CVC, just click on the ICON and complete lower section. PIV, wounds and urine catheters work in the same way.


1. Click Chart and Show All2. Activities of Daily Living: under Hygiene

a. Mouth careb. Bed Bath

3. Nutrition by Nursing – point out only4. Procedure on Unit:

a. Documentation of procedures on unit, such as chest tube placement

b. Codes are documented on resuscitation record on crash cart. Click box if code… “on resuscitation record”

5. Click Save and note option to change time here as well and buttons in lower right

Trainer: Notice different options: Save and Confirm = save data Save and Chart new = saves current data and opens chart to current

time Continue = returns to previous screen – can change current charting Discard All = exit without saving- ie wrong patient

ALL Click SAVE & CONFIRM

Is there a way to copy your previous documentation and change only what is different? Yes

1. Click Assessment/Intervention tab


COPY

Interventions

2. Chart must be CLOSED, Click in space between date a time 3. Click copy from the drop down box

Trainer: Data pre-fills new med time column. Change one thing about your assessment and save. Remember, the Entire column is copied so make changes to copied data based on reassessment. Change Pulmonary Assessment from fine crackles to coarse crackles. Save and Confirm.

What data can’t be copied? Numerical data Annotations/ comments Other people’s data Into the future After 30 hours… so it works for same assignment multiple days All or nothing, but remember you can edit what you copied.

Trainer: You documented the temp incorrectly. Change it to 102.4 and add a comment “MD notified”

1. Click VS Tab2. Click 101.43. Click blue boxes4. Type 102.4. Other fields can be modified from this window.5. Click on ! (Significant Data). 6. Change to yes.7. Click Save


Changes

What Changed? Parenthesis around the value means data has been changed.

Trainer: Time Limits on Making Changes 72 hours on admitted pts to correct mistakes 48 hours on discharged pts Information YOU enter Point out when hovering over a data field, click on hyperlink to

display trended data. This cuts down on scrolling.

1.Click on the upside down triangle with double lines to add the Plan of Care tab to your view. Click Chart and ShowAll in left gray bar.

2.Pathway Pneumonia 3.Phase Admission. This is going to match the pathway to be added in

EMR StarPanel.

Guided Discussion

As Billy Bob’s nurse, what problems will you focus on during your shift?

1. Pulmonary-Gas exchange2. Pain-Acute pain3. Physical Regulation-Infection


Plan of Care

Do you expect the problems to IMPROVE, STABILIZE, or DECLINE?1. Click Pulmonary on Left bar, middle way down2. Click Start Priority Problem3. Select Gas Exchange from dropdown

a. Maybe related to – shortness of breath b. Expected outcome- Improvec. Start time now…type T in box for current time

4. A short term goal of “Maintain O2 Sats > 94% on supplemental O2”, at the beginning of the shift and at the end of the shift, you would document whether goal was met or not.

5. Click Save and Confirm

LCD Slide 3

6. Type brief shift summary: temp controlled with Tylenol. No further nausea, oxygen saturations improved on NC

7. Plan Priorities, type PCV in a.m. at 05008. Goal Status, met 9. Save and Confirm


Nursing Summary for Next Shift

Nursing Summary - Click on Plan of Care from left gray barNursing Summary - Click on Plan of Care from left gray bar

Brief synopsis of your shift before Shift change

Include major clinical events & information

For oncoming RN..does not replace face-to-face report

Prints on OPC as reference for nurse during shift

Exiting out of HED Click file exit to close HED Click file exit to close Care Organizer

Guided Note Taking HED Nursing Documentation

Trainer: We will go into the medication scanning portion of the class that includes: Care Organizer, Admin Rx, and IV Manage. First we


1. The best way to edit a single item is to click on it.

2. To copy a column of information, click between the date and time.

3. Information that can NOT be copied: someone else’s charting, numbers, comments, older than 30 hrs

4. Capital letters in the gray bar tell the nurse to document every shift.

5. V/S will display in multiple tabs. List some: I&O, blood, quick assess for ICU.

6. It’s important to click “Show All” at least once a shift from the gray bar and when chart is open.

7. Documenting in a timely manner is important because providers view nursing data in StarPanel.

8. Plan of care includes documentation either at the beginning or end of shift.

a. Beginning of shift tasks short term goal, changes to pathway, phase of pathway.

b. End of shift tasks nursing summary, planned priorities, actual outcomes for goals.

Care Organizer, Admin Rx, IV

Manage

will need to set up your preferences in the live region when you start your first rotation.

Click File and Exit Click Exit and go to HED Production

Trainer: You will use CO to create patient assignments & view meds schedules

1. Click View on top left hand side2. Confirm that “Meds” & “IVs” checked3. Click “Configure”4. Click Default Care Relationship….Select Primary Nursing5. Click radial button Exclude in middle of box6. Scroll Available groups…select PHM. Hold CTR key down and

select RES7. Click ADD….OK


Set PreferencesIn Production and

Train

NR will set preferences in PRODUCTION and TRAIN.Preference Settings:

1. ROLE and SHIFT TIME (set to DAY/NIGHT shift)2. Department… their first rotation (will rotate for 6 weeks before final

placement)

Trainer: PHM and RES move to the R side, blocking ordered meds from displaying until checked by Pharmacy and schedules attached

1. Click Create Assignment button in upper tool bar. Pop-up box displays

2. Provider Type: click arrow- select RN 3. Care Relationship: Primary Nurse4. Shift: Select the shift you work first. Click OK5. Back time 15 min and up time 15 min.6. Patient Dept: Unit you will work on – NR set to first rotation but

must change each time they rotate to another location 7. File…Save Configuration8. Click EXIT9. Click “Create Assignment” again

Trainer: Does everyone have their preferences saved? 10. Click Search box11. Type your last name12. click FIND

Raise your hand if your name is NOT in the production data base13. click Cancel14. Click Exit out of assignment box DO NOT USE THE X TO CLOSE,

USE EXITTrainer: Will NOT create an assignment in the production region but will create an assignment in TRAIN.

15. Click Exit BOX… upper right corner16. Click on the X to close out login box


17. Click HED TRAIN to open training region 18. Click view to confirm meds, IV checked19. Repeat the configure, set preferences and create

assignment in Train (use laminated sheets for patient name and department).

20. Click Refresh to see assigned patient in Care Organizer.

Trainer: Locate the laminated sheets Physician Order sheet. On many units the nurses are transitioning

from using the POS to electronically acknowledging orders online. In StarPanel portion we will point where this is done but Please work with your preceptor on how to acknowledge orders.

Medications and your patient’s armband sheet 1. Locate the laminated POS. It contains detailed information about who

ordered med, the order #, description and date2. Make sure you are in Active view. Check overdues periodically.3. Click on patient name. Click view and confirm/unconfirm4. Expand Screen5. Locate PCM number and compare with Wiz number on POS on left

hand side6. Compare items on Med History Screen (Med name, dose, route,

frequency, start date/time, comments, status, and schedules) with order. Med schedules at the bottom of the screen


7. Clicks CONFIRM if order and schedule are correct 8. Click OK

Trainer: Famotidine displays to send message missing dose 1. Locate PCM number and compare with Wiz number on POS2. Send a message to PHM for next med “Dose missing, please

send”. Type unit’s phone number so PHM can call back if needed. 3. Click OK

Trainer: Confirm the rest of the meds on your own. Make sure schedules are present and accurate

4. Click Famotidine and notice that the confirm button to the right now says Details. All information about the order can be found here

5. Click Cancel to close History Box

a. What color displays in CO when order need confirming/verifying by RN? Yellow

b. What do you check on to confirm orders? View – Confirmc. What button displays contents of the order including schedules?

Historyd. What view should display when confirming orders? Activee. If a patient comes from surgery, CCL, or an unimplemented unit, will

old orders (not new) display and should you confirm them? Yes, yesf. Why is it important to stagger meds back on the standardized schedule

instead of sending Pharmacy a message to change the schedule when a pt meds get delayed? Drug Compatibilities and saves nursing time when meds can be given together. Also causes PHM delays in filling new meds if constantly changing schedules . Have one hr window to give med

g. If PHM touches the med order in their system, whether anything is changed or not, will it come across to be confirmed again? Yes


1. Click ACTIVE viewa. PRN meds display after scheduled meds. Click TO DO view.

Locate Acetaminophen 325mgb. Under STATUS column, note last time given

Trainer: H indicates IV hanging & moves along timeline. M indicates meds due

2. Click on the 5M due at 10AM-1200. Meds due display in the upper frame.

Trainer: Instruct learners to go to HED/ Admin-RXScenario: Billy Bob was off the unit for his CT and now has 2 meds

overdue . You take the meds to his room but he refuses the MOM.

1. Click Chart


PRNs &Timelines

RX-Scan

MOM refused, Potassium late

2. Click Admin (no scanning of med is needed for MOM since he refused)

3. Select “Not given, patient family refused” from the dropdown4. Scan Potassium: Note 2 warnings “Incorrect Amount” and

“Admin Too Late”5. Type 8 meq in dose field and Press ENTER. Incorrect Dose

warning is gone6. Scan Armband and ask for 2nd identifier 7. Override box comes up. Select “pt off unit” from the drop-down

box. Click “ok” 8. Check Admin Review Screen and Administer med. Then Save

and confirm.

a. Why did you learn about giving K+? Get warnings: “Too late” and “Incorrect amount”

b. How did you fix the incorrect amount warning? Type in correct amount and press Enter

c. How did you fix the too late warning? Forced to select a reason when scanning armband

Trainer: Give 2 meds…no issues Isopto Drops, Famotidine1. Review Care Organizer (from lower tool bar). View 5 meds on

timeline due at 1000. Insulin will be given next as a separate med2. Click “Horizon Expert Documentation” from lower toolbar to jump

back to Admin-RX3. Scan Isopto drops from vertical barcode4. Scan Famotidine (2 tabs, each barcode once). Press ENTER


Famotidine, Isopto Drops

5. Scan armband and ask for 2nd identifier 6. Administration Review Screen: make sure all meds scanned

display7. Give meds 8. Click CONFIRM

Trainer: Meal times vary up to 2hrs to provide better fresher food for our pts. Nursing judgment should be used to determine if Insulin is given early or late. Pharmacy adds two barcodes to insulin vials in the event the patient requires a scheduled and sliding scale dose.

1.Scan tadpole barcodeTrainer: Note Matched Med Box displaying both SS and Scheduled Insulin. Blue display is the dose selected. Blood Glucose is 240.

1.Select Sliding Scale dose 2.Hover over blue area or click on underline name to view scale. Note

4 units ordered3.Click OK4.Tadpole always scans 2units; change to 4 units 5.Warning-Site Field Required: Pick site field from small drop

down box next to the ! 6.Scan vial barcode7.Select scheduled dose 5U8.Click OK 9.Warning-Incorrect Amount: Dose displays 1unit. Type 5U. Press ENTER

10.Warning-Site Field Required: Pick same site field


Insulin SS & Scheduled

11.Scan Armband. 12.Point out cosign box for real-time cosigning.

Trainer: Note Co-Sign option if another nurse is in the room. Not commonly done.

Trainer: The norm is to find the patient via the census dropdown to document co-signature

13.COSIGN: Partner up… co-sign insulin by selecting partner’s pt from list of pts, then click documented insulin.

14.Click on the dose under co-sign select “click to co-sign” and Save.

Trainer: Nursing judgment should be used to determine if Insulin is

given early or late based on meal time. Note Co-Sign option by going to another patient, and click on

Administered Insulin… Click Co-Sign. No prompt at end of shift to remind you to CS. Your responsibility


WarningsMOM

Cosign Insulin

Scenario: Billy Bob changed his mind about the MOM. 1.Scan MOM, make sure you are back on your patient

Trainer: Note Warning. 1. Scan MOM : Note warning- “ No current schedule Found

– early for schedule…”

What schedule are you getting ready to take/steal? 12noon (Afternoon class 1600) In this case, do you think it’s OK to take the 12noon (afternoon class 1600) schedule of MOM? No. Pay attention to the time the med is due. If it’s not a good idea to take the next dose, document as an extra dose.

2.Click third button on popup – “Extra Dose”3.Click ok, change dose to 15 ml4.Scan Armand. Click Ok for Override Reason5.Save and Confirm

Can you think of a legitimate reason for overriding a warning? Too Early: might be legitimate if pt leaving unit and want to give

dose before procedure, etc. Too Late: pt returning from procedure Recently Given: Just FYI for nurse in case of duplicate

administration but same med in various forms (IV and PO, PRN and Scheduled, or meds with Q2hr frequency)

MEDICATION SCHEDULES FOR ADMIN-RX CLASSES 2012MED LABEL DOSE ROUTE FREQUENC AM PM TRAINING


Y SCHEDULE SCHEDULE

Potassium

Chloride oral sol

8 Meq PO BID BL 0700 –

1200 noon

Late

Famotidine 40 Mg PO TID cc 1000 1400 1700 On time

MOM 15 ml PO Q4H 0800

1200 noon

1600

2000

Pt refused

Isopto Drops 1 drop Each eye TID 1000 1400

1700

Insulin Regular

Human

5U Sub q TID cc 1000 1400 1800 On time

At end

Insulin Regular

Human

Sliding

Scale

Sub q TID cc 1000 1400 1800 On time

At end

D5 ½ NS + KCL 20

MEQ/L

125

ML/hr

IV

infusion

Now IV

1. Trainer: Over 95% of scanning issues can be resolved when the scanner is reset. Synthroid is a complex barcode that can be hard to scan so using the reset scanner link will resolve most issues. Ask preceptor how to do this on unit.

2. Occasionally, resetting the scanner will not correct the problem; label is damaged or med is new in Vanderbilt’s system. For meds that won’t scan after the scanner is reset, place in red bin on top of the Acudose cart and document the issue. Pharmacy will pick up and take corrective action to fix.

5/6/2023/tt/file_convert/5abac4737f8b9a321b8c0ef4/document.doc 25IV

Manage

Reset Scanner Link – Point Out

Trainer: IV maintenance fluids, PCAs and epdiurals are not scanned into Admin – Rx but are scanned into IV Manage

1. Go to Care Organizer2. Click on patient’s name from the bottom of the screen so

only your patient displays at the top of the screen.3. Look in Group column to note meds charted in IV manage

(Maintenance fluids, TPN/L, fluid boluses, Med drips PCA syringes, Epidural bags).

4. Scan Armband on laminated sheet 5. Click IV Manage6. Scan barcode of new bag of D5 ½ NS w 20KCL7. Dosing Wt = 08. Infusion Rate = 1 started9. Click SAVE. Note color change 10. End other bottle – checkmark end bottle and save11. Click Exit and refresh

Trainer: Mention in Vitals I&O a zero placer will display when a new bag is ended or Dc’d.

What are the steps involved with bar code scanning of meds? Scan Med, Scan armband and ask for 2nd ID, Give med, Confirm

If med will not scan, what should be done first? Reset Scanner Can the scanner be reset from the CWS? Scanner Reset from HED Most times meds will not be given at the exact time they are due.

What’s Vanderbilt’s standard for administering? 1 hour before and 1 hour after due


Guided Note Taking

Break 10 Min …Lock Screen …Click LOCK left lower tool bar

LCD Slide 4


OBJECTIVES: HEO and StarPanelOBJECTIVES: HEO and StarPanel

Explore StarPanel.. EMR

◦ Look up test results and documents

◦ Complete Admission History form

◦ Assign a Pathway (Plan of Care)

Enter orders in HEO/Wiz… CPOE

◦ Enter Nursing Orders for New Admission

TRAINER: Click on StarBrowser displays in lower tool bar ... this is StarPanel

Patient List: Census view Black bar: Many options including MR # or name search Go TO Icons: left of the black bar

Print Desktop Signoff the workstation Wiz Production HED Production …others Teletracking Veritas

Locate RED CARD on monitor. This is your patient. Navigating:

a. Single click to open documentsb. Frames: Adjust by double clicking in any white spot or

dragging frame with double arrow c. Yellow tabs: specific to the opened patient i.e., patient note d. White tabs: Generic, i.e., groups of patientse. Click “Pt List” to return to this view of pt’s

1. Click Blue ACTIONS text next to your patient’s name


StarPanel Inpatient

Whiteboard

2. Click My Actions – Change3. Select Inpatient Nurses from yellow box

4. Click FAST LABS (24 HR Labs will not display data) Drag frame up.

Displays in Reverse chronological order with Abnormal values display in reda. Hover over lab to display entire name and reference rangesb. Click on PCV to see TRENDSc. Click GRAPH

d. Close by clicking in Trends box and X out of Graph6. MAR : Click ACTIONS, MAR… ALL DAYS

Meds display from Admin-Rx and VPIMS, the OR system Open boxes mean “not given” or “given by another nurse” Closed “given”


Yellow “comments” note K, and blood glucose graph help track why med not given Click Levofloxacin 750 mg q24 Red Line indicates there was a Downtime and see paper

MAR Drug Reference: Hold CTRL and click on drug name in Blue

Trainer: Point out ED and OR documents can be accessed via the ACTIONS menu

7. Click ALL DOCS from ACTIONS menu: notes, communication, reports

Type in search field “Progress” and to view all progress notes Open a progress note & view in frame below

7. Click OPC from column

Overview of Patient Care Used to give and receive report… Handover tool Pulls in information from orders, test results, nursing & MD

documentationTrainer: Point out the following as learners locate Situation: SBAR format

Team Text Page can be done from here Blue text is a link to the document Admit History can see Contact info and present on Admission info Clinical Alerts: Code, Allergies, Isolation, Fall, Braden, Adv. Directives, No Information pt

Background: past medical/surgical historyAssessment:

Plan of Care includes Pathway, Nursing Summary and Plan Priorities, and goals


Assessments that have NOT met standards for a specific system/pain

Progress Notes/Consults/Rad/Rehab: replaced with new notes if documented.

24hr labs- Weight, V/S, I&O, pain Invasive line and vents info

Recommendations : 3. Current, Active orders from HEO Wiz

DEBRIEF: Can you see the overall benefit of using this tool?

Scenario: 57 year old Billy Bob is admitted to your unit after being seen in the ED with fever and cough. CXR revealed lower lobe pneumonia bilaterally.

When a new patient is admitted, how many hours to complete an Admission History? complete within 24h

LCD Slide 5Trainer: Admission History form is divided into 3 sections with specified times to collect information.

Section I: 1-2 hrs with critical information for safe patient care Section II: 6-8 hrs for planning care Section III: Collect 20-24 hrs for discharge plans and functional


Admission History

screens

What’s the quickest way to access an Admit History form on a patient? ACTIONS

1. Click Adult Admission History from ACTIONS menu. Trainer: Follow along to complete the form. Some data from previous admission might be pre-populated. Always confirm pre-populated data i accurate. Section I

a. Height: 5 ft 11 – stated and data collected today- use calendar to select

b. Weight: 189 lbs stated.. Peds 16kg measuredc. Admitted today @ 0850d. From EDe. No religious, cultural or ethical practices to consider. Confirm any

prepopulated data is accurate f. Patient has NOT been exposed to TB g. Reason for admission: Coughh. How Long: 1 weeki. How does patient care for problem: Robitussin

Legal Documents


j. Advanced directives/ Living will scanned in chartk. Family to bring in Durable Power of Attorney document

Communicationsl. Historian Family Member: m. Sally is patient’s sister and support person who is staying with

patientn. Her phone 333-3333o. Relationship: Siblingp. First Person: Same as designated support person q. Second Person: Information can be shared with Johnr. Instructions, Care For After Discharge, Transportation: same as

designated support personTrainer: There is a link to gather the Home Meds List (PAML). This will be demoed in HEO/Wiz.

s. Allergies: Verify with patient that all allergies are correct. Remove one allergy by clicking on the Red X.

t. Add allergy for Morphone by clicking New. Enter reactions, severity.

u. Save

Present on Admissionq. CPAP: used at home but the patient did not bring itr. Alcohol Screen: Denied intake…


v. If you are unable to complete section I then save as draft

Section IIPatient Summary: Receives all updated information from inpt and

outpt visits. Most accurate patient information source. Click to expand or collapse.

Tobacco Screen: Denies useImmunization Screen

1. Open Immunization Record: Click Blue link a. Barcode scan of immunization med will electronically update

recordb. Manual entry can be done if patient states given at earlier

date2. Stop Screening:a. If ICU, STAT name with incorrect birthday or patient unable to

provide historyb. Complete immunization screen when correct data is obtained

c. Stop Screen if pt <6 months old3. Flu immunizations Screening – will see this in Fall.


LCD Side #6

TRAINER: Nursing Protocol order electronically enteredd into HEO/Wiz 10 a.m. administration time scheduled for next day Better for our patients and Medicare/Medicaid requirement Pediatrics: Pharmacy will give all the flu immunizations, not

pt’s nurse

4. Pneumovax: Same type of screen as flu… do NOT complete 5. Scroll through Religions, Pain, Nutrition, Social Work, & Learning Readiness to end of section II. do NOT complete6. Verify Pre-pop data7. Save as DRAFT

Trainer save your form as FINAL and demo how to add amendment


Amend Admit History

Is it OK to complete all sections at the same time? Yes If all sections are not complete, what should you do? Save

as Draft What if someone changed the data you entered? tracked

electronically What’s the timeframe for completing section I? 2 hours of

admission

Trainer: a Plan of Care should be assigned to each patients medical record. Vanderbilt’s POC are called Pathways.

1. Click ACTIONS 2. Click E-Docs Pathway


Assign Pathway

3. Search for Pneumonia 4. Select 5. Click on ACTIONs menu next to patient’s name.6. Click AllDocuments to view E-Docs Pathway

Pathway is in AllDocuments and can be accessed easily by team. Also available as a hyperlink in Assessment section of OPC.

Guided Note Taking


1. Clicking on ACTIONS opens a menu for quick access to patient information & documentation.

2. OPC is an acronym for Overview of Patient Care & contains most recent documentation/tests.

3. The Admission History form is divided into 3 sections.

a. Section I: Critical information needed to deliver safe care, i.e., Allergies. Complete in 2 hrs

of admission

b. Section II: Positive screenings for Flu and Pneumovax generate Nursing Protocol order in

HEO/Wiz with a schedule time of tomorrow 1000. In Peds, Pharmacy administers .

Complete within 6 to 8 hours.

c. Section III. Functional screens for PT/OT/Speech/CM should be completed within 24 hrs of

admission and on short stay areas at least 8 hrs before discharge.

4. Existing data imported into the Admit History data base should always be Verified.

5. Meds documented in Admin-RX display in StarPanel in the Actions menu by clicking on MAR.

6. The Plan of Care (Pathway) is accessed from StarPanel by clicking on ACTIONS button & selecting e-

Docs Pathway

1. Click Desktop Icon2. Click Green Wizard (Wiz Train)

Trainer: Census derived from Medipac, application for Admit, Transfer and

Discharge Computers in this training rooms are set to display the census of

_____unit

Symbols LCD Slide 7

Security Indicators N: No information S: No information…Usually police involved G: Can give general information out according to policy

SearchA. Under Stations, click the unit you will work on. Note census change. B. Type (ZTEST) in search box and press ENTER. Displays pt’s from all units. C. Click Refresh button… don’t forget to refresh if pt not found on census. D. Click back on training census.


Paper Documents

Still a few

HEO/Wiz

V: training/nurse resident2011 3

HEO/Wiz Census LegendHEO/Wiz Census Legend

Computerized Physician Orders pages 1 and 2 Generally print to Medical Receptionist’s printer when orders entered

in HEO/WIZ Patient information and MD who authorized order at top Each order has a number STAT orders display bold … see page 2 Start & stop times (right side of page)

Open-ended orders (continuous) display start time. Remain until deleted or pt discharged – see #10 NHO

One-time orders - see #13 culture urine bacteria Timed orders – See #14 (pg 2) Percocet. 72 hrs stops

Far right column provides a place for MRs to note when dept called, etc MR & RN initials at the bottom when orders are processed and verified Computerized POS is not a permanent chart document

Requisitions: Lab pg 3 ► Reqs print on unit if procedure if test done on unit i.e. RT and EKG► Other Reqs print in performing department, i.e. Radiology, Nutrition Svc. ► Lab Reqs are bar coded:

2 barcode above double line are patient information Barcodes below line defines tests Lab scans Req when specimen is received

► Multiple tests print on same Req if tests can be run in same dept (CBC and PCV)

► Full signature, VUNet ID, dates & time from person collecting specimen. ► Text in center section gives directions on how to collect specimen, color of

tube


► If test ordered STAT, MR calls the performing department, except for Labs.

► Batch Reqs print after midnight if the test is to be done after MN, ie, next day’s labs

TRAINER: Demo how to reprint reqs1. Double click on patient’s name2. Click on Reprint Requisitions3. Select your test4. Click Reprint Checked Requisitions. (Note: If it is red with an accession number, it cannot be reused)

Scenario: Billy Bob arrives on your unit, now that a bed is available, after spending 8 hours as an admitted patient in the ED. The nurse in the ED completed the Admission History. It’s time for you to enter some orders in HEO/Wiz.

1. Double click name on red card or slips of paper on monitors on laptops2. Select Enter Orders 3. What order type? Protocol (Nurse to nurse order will pass along

information and doesn’t require Co-Signature from MD) 4. Physician? TEST5. Press Enter & Select Dr. Test from right upper window

Trainer: Screen is divided into left and right windows Top Left window: Name, rm. # MR #, Sex & UserID. Verify

correct pt Inside left window: Orders with numbers


Nursing Protocol Orders

New Admission

Organized by categoriesAlways review active orders before entering new ones

Right Window - Upper window displays common orders for that unit

Center window - colored text asks questions or gives instructions Bottom window - Flashing cursor. Type here. Toolbar @ Bottom of Screen: OOPS and DONE

Trainer: Instruct learners to NOT enter beds or pressure ulcers. Can demo on the screen but do NOT accept. Lots of cleanup involved.BRADEN:

6. Type Braden: (Braden Q for Peds) Pressure Ulcer Management- Braden Scale (Skin risk). Be creative. Skin Assessment is done in HED.

7. Demo adding a pressure ulcera. Click Add a Pressure Ulcerb. Location: Buttocksc. Side: Left, medial, superiord. Click Select Stage: 1.e. Pressure Redistribution Item: Chair Cushionf. Click Saveg. Click Done

SYMBOLS: Left Window Sun: new order Paragraph sign: order will drop off in 24 hrs… one time order Note order # assigned after order accepted

7. PAML- Pre-Admission Medication List (Home Medications) Includes: prescriptions, over the counter, herbal or vitamin

supplements


Complete within 2 hours of admission Providers reconcile PAML during patient’s admission and time of

discharge

Across top in gray area: patient’s information Top left is the Medication Search box Box underneath is the Patient Summary. This is the patient’s

current home med list from clinic. Ask the patient if she/he is still taking the medications. If yes, click on the yellow arrow to move med to right side of the screen under Pre-admit List. This box is where all home meds are updated.

8. Click DONE…Accept Trainer: Review orders. If Corrections? Return to order entry. Exit w/o accepting if wrong patient. Orders are correct. Click ACCEPT

Trainer: Billy Bob complains of pain and you page Dr. Test from the OPC pager link. (Starbrower open on lower tool bar) While on the phone, Dr. Tests gives you several verbal orders to enter.


More Orders

1. Double click name on red card2. Select Enter Orders

Trainer: What order type? Telephone 3. Type TEST, press Enter. Select Dr. Test from right upper window

Discontinue a. Click Guaiac from left windowb. Discontinuec. Reason (Dr. cancelled)

Modify: to 75ML: D5 1/2 NS with 20 KCL @ 125 ml/ha. Click current IV order in left windowb. Select Modify.

Trainer: Notice order in Upper R window. Identify parts: Name, Frequency, Priority, Duration, Comments

c. Click Rate to modify SYMBOL: Symbol for modify? Square

New: PCV in AM 0500 – “don’t draw L arm”a. Type PCV in the right bottom corner. Select from Listb. Select PCV blood –LABc. How Often: in AM- 0500d. When to Start? Routinee. Comments: Don’t draw from left armf. What Symbol displays before the new order? Sun

Switch: Change diet to Regular a. Click on NPO left windowb. Click Regular. Trainer: Treated as new orderc. No Comments: Press Enter

Medication Order: Morphine 30 mg PO q4h PRN


a. Type Morphineb. Select # 2: Morphine Immediate release tabc. Dose: 30mgd. Route: POe. How Often: q4h PRNf. When to Start: Routine…in greeng. How Long: 3 days or click ENTERh. Comments: for abdominal pain > 4 (required) NHO if

nauseated

Blood: Dr. Test ordered 2 U of blood to be transfused because your patient has a PCV of 21. This is not an urgent request and as a nurse you determine when it’s best to give to the patient, i.e, after a test, or bath. Type and Screen req will print if no results in StarPanel within the last 72 hrs when transfuse order is entered.

1. Click on Transfuse Order in left window2. Click Request Blood Product from Blood Bank3. Review information – confirm accurate4. Request 1 unit5. Click SEND, DONE, ACCEPT

LCD Slide 8

Emergency Departments: Orders do NOT print. Lab Requisitions generate to printer closest

to pt’s room

LCD Slide 9 Steps to Acknowledge Orders Electronically

TRAINER: Review slide steps


Processing of Orders Processing of Orders by Medical Receptionist

Orders & Reqs print to Medical Receptionist (MR) and placed in unit appropriate area

MR: Notifies RN of STAT Orders and Labs

MR: Notifies Department of Other Tests

RN: Acknowledges Orders online

Guided Note Taking

TRAINER: If time permits, have students complete Seek and Find

Trainer Responsibilities after class is overUpdate Amanita

1. Check sign-in roster where you noted that they said they passed boards

2. go to this web site: http://health.state.tn.us/Licensure/default.aspx - confirm they have passed boards

3. If passed, take training flag OFF 4. For those who have NOT passed boards

a. Change Role to Medical Receptionist – Other


1. To ENTER a new order without using an order set, just type it in.

2. To MODIFY or DELETE an order, just click on order in left window.

3. Identify the two places where Allergies alerts can be entered. Nursing Admission History Form and

HEO/Wiz.

4. Skin is assessed in HED and Braden Skin Risk is documented in HEO/Wiz.

5. When taking a verbal order from an MD, always verify who will Enter the order .

6. When requesting a unit of blood, click on order in left window and Request blood product.

7. PAML is an acronym for Pre-admit med list (home meds). Nurses review home med list with

patients when they arrive on the unit and as needed.

http://health.state.tn.us/Licensure/default.aspx

5. place in comments “Nurse Resident Training completed m/d/y

Discontinue all orders after each class-MD training ID TRAIAKO…
