HED and HEO/WIZ Downtime

1. HED and HEO/WIZ Downtime Be Prepared

2. HED and HEO/WIZ Downtime Saturday May 12, 2012 at 700pm Till approximately Sunday May 13, 2012 at 1200pm Downtime for: Order Entry (HEO/WIZ), Nursing Documentation (HED), Nursing Med Administration System(Admin_Rx)

3. PREPARING FOR DOWNTIME • Downtime Kits must be replenished, this kit includes: • A. Downtime Policies; • B. Laminated Downtime Checklist; • C. Physician Order Sheet (POS); E-Procurement: Order ASAP • D. Nursing Flowsheets; • E. Medication Administration Records (MARs); • F. Downtime Requisitions; • G. Other unit-specific documents. • H. NEW Documents to be added to the downtime kit: • VCH Patient Discharge Instructions (MC 4085); VUH Patient Discharge Instructions (MC 2418) COPY CENTER: ORDER ASAP • Policies: Insulin and Heparin Gtt Protocol, Restraints, Braden, Fall Risk, PCA, Epidural • Assessment Guidelines VUH and VCH

4. PREPARING FOR DOWNTIME • Order Copier Paper • Order Labels • Order Addressograph Labels • Order Black Pins • Increase Staffing • Replenish Downtime Kits

5. What to do whenMedical receptionist(cont) • Early Saturday Morning – For pts. not being discharged by 5p • Place Physician Order Sheets (POS) in blue charts TWO per chart, with patient labels attached on all three pages, DO NOT ADDRESSOGRAPH • Print 2 Downtime Flowsheets for each patient place labels, DO NOT ADDRESSOGRAPH • Print 2 Fall Risk Assessments for each patient place labels DO NOT ADDRESSOGRAPH • Print 30 labels for each patient • Pharmacy Fax Numbers posted near fax with time of day • VUH – 7a-7p 39879 • VUH – 7p-7a 31640 • VCH – anytime – 66402 • VPH – pharmacy rounds during day, • VPH – 7p-7a – 31630

6. What to do whenMedical receptionist(cont) • 5pm Saturday • Check printer for paper (Paper MAR’s will be coming) • PRINT OPC and any other routine shift change printing • Transfer Order Sheets on all patients. • Place TOS in patient’s chart • Pharmacy will generate MAR, place in blue chart • Print Assessment Guidelines, place in every blue chart • Charts to Bedside • During Downtime • Process Physician Orders – See algorithm • If electronic scanning, scan POS in EMR • MR will annotate “DT” on POS beside all non-medication orders to indicate to RN orders need to be entered into HEO/WIZ • Transcribe Medication orders to MAR • Complete requisitions (lab, radiology) and call ancillary departments PRN • Requisitions with serial times (i.e., Q6H), will be filled out through end of downtime on 5/13 at 1200p

7. What to do whenMedical receptionist(cont) • During Downtime Continued • Remind Physicians to give POS to the Medical Receptionist • Rounding on Blue Charts for Orders • Transfers: Physician will amend TOS, and transfer patient. Receiving unit will process TOS as if it were a Physician Order Sheet. • Scanning Units • After 7am Sunday Morning • Blue Chart Check to look for documents to be scanned • Nursing Flowsheet • POS’s missed • other

8. What to do whenRN’s • 5pm Saturday • Renew all restraint orders • Planned Priorities and Nursing Summary complete on all patients • Night Shift WILL NOT do Priority Problems or Nursing Summary • Nurses will need to transcribe cumulative Intake and Output for their shift on the 7p-7a downtime flowsheet • Ensure OPC and Transfer Order Sheet are printed (MR to Complete)

9. What to do whenRN’s(cont) • During Downtime • Helpful Information (Downtime Kit) • Assessment Guidelines will be in each chart • Policies for Restraints, Braden, Epidural, Fall Risk, Insulin gtt protocol and heparin gtt protocols • How to complete a MAR • How to complete a POS • Process and Verify Physician Order Sheet (POS) requires signature • Verify and Process Medication Administration Record (MAR) requires signature • Transfers: After MR processes Transfer Order Sheet (TOS), RN will verify and process orders as if it were a POS requires signature • Admission History: • VCH/VUH: Positive for CPAP, POS will need to be filled out and respiratory called. • Adults: If a positive screen for pneumovax, POS will need to be filled out and sent to pharmacy

10. What to do whenRN’s(cont) • During Downtime Continued • Discharge: Discharge will be written on POS and prescriptions printed through Rx_Star. Discharge Instruction Sheet completed and sent home with patient • MAR’S for Sunday will print after midnight Saturday. MR’s place in Blue Chart • RN’s will verify Sunday MAR with Saturday MAR, annotate changes and schedule changes and fax to pharmacy.

11. What to do WhenAfter Downtime(approximately Noon Sunday May 13) • RN’s • HEO/WIZ • From the POS and TOS, all non-medicated orders to be entered into HEO/WIZ, only exception completed one-time orders • NOTE: PHARMACY WILL ENTER ALL MEDICATION ORDERS • Admission History • Consult orders will need to be entered. • Care Organizer • Confirm Medication Orders with paper MAR. Send message to pharmacy via Care Organizer for corrections

12. What to do WhenAfter Downtime(approximately Noon Sunday May 13) • RN’s Continued • HED • Admin Rx, medications with outstanding schedule need to be addressed • Asmnt/Interventn Tab, document start of downtime and end of downtime. • RN Enters Cumulative Intake and Output for Saturday and Sunday • Example of Back time for Saturday’s Cumulative from paper flowsheet, (3/12/2012, 0645). • Will need to subtract what was charted from 7a-7p on 3/12 in HED from 24 hour cumulative from the paper flowsheet. • Sunday’s cumulative will be the current cumulative from the paper flowsheet. • Restraint Orders renewed • Priority Problems with goals back time to morning shift, and completed at end of shift Planned Priorities and Nursing Summary.

13. What to do WhenAfter Downtime(approximately Noon Sunday May 13) • MR’s • Scanning Units will scan documents in to EMR • Downtime flowsheets • Downtime POS (physician order sheets) that were missed • TOS (transfer order sheets) that were missed • Re-locate charts per unit protocol back to location for scanning • All units • Remove and Discard all unused downtime documents with patient labeled attached. • Remove and reuse any downtime documents that haven’t been labeled or used and place back in downtime kit. • Remove Transfer Order Sheets

14. POS Key

15. MAR MR Key

16. MAR RN Key

17. Lab Req Key

18. Critical CareRespiratory Care Lab Key