6.07 General Enhancements

1. 6.07 General Enhancements

2. Why are we upgrading the Meditech software? • Patient Quality and Safety • Meaningful Use Requirements • Health Care Reform Act • Reimbursement • Enhancements

3. Work-List • Larger checkboxes for inclusions • Larger box for look ahead hours • Larger icons • Associated Data • Protocol • Item Detail • Checkmarks • Target Symbol • New Outcome Icon • O instead of a target symbol • New Detail Button

4. Larger icons on Work-List

5. New Detail Button

6. Launches to Item Detail

7. Additional PCS Assessment Enhancements • Ability to display longer text within PCS assessments • Improved loading times when opening the assessments to document

8. Longer Display Text

9. 6.07 Immunization Enhancement

10. What changes have been implemented within the Immunization Enhancement? • New Electronic Order for Influenza and Pneumococcal • Previously a paper copy of the order printed to Pharmacy • New Immunization Screen in the MAR • New Immunization Section in the EMR Summary Panel • Similar to the Home Med and Allergy sections

11. Standardizing Administration Time for Immunizations • Unless contraindicated, administer vaccines when available • Do not wait until discharge to administer

12. Process for Pneumococcal and Influenza Vaccines • Document the Age 18+ Opt-Out Vaccine Assessment • All patients must be assessed for Influenza and Pneumococcal Eligibility upon Admission • Electronic Order files to Pharmacy • Information from the Nursing Assessment files with the order • Pharmacy reviews and processes the “Nsg Assessment ” Order (Completed Assessment) • Nursing Acknowledges • Canceled “Nsg Assessment ” Order • Vaccine med order entered for today and now • Administers the vaccine on the MAR • Documenting the revised MAR flow sheet • Documenting the new immunization screen • Vaccine information will flow to the EMR Summary panel once the vaccine is administered • Historical vaccine information is still available in the EMR • Summary panel • Legal/Indicators tab • Vaccine Information Clinical Panel

13. Vaccine Eligibility Documentation Process • Complete Age 18+ Opt-Out Vaccine Assessment • Save

14. Documenting the Vaccine Eligibility Assessment from the Work-List

15. Document the Vaccine Eligibility Assessment for Pneumococcal and Influenza Vaccines

16. Entering Electronic “Nsg Assessment” Orders • Vaccine Assessment Orders Triggered • The completed eligibility assessment will electronically file to Pharmacy • Pharmacy must review the assessment regardless of eligibility • Select Ok to file • Identify the Ordering Provider • Select Order Source “MEC Approved Protocol”

17. Triggering “Nsg Assessment” Orders Always click OK to file the orders

18. Entering “Nsg Assessment” Orders in OM Always click OK to file the orders • Choose Ordering Provider • Choose MEC Approved Protocol order source

19. IMPORTANT • Regardless of vaccine eligibility all vaccine assessment orders must be filed to Pharmacy • By following this process, you are not ordering a vaccine for a patient who is not eligible • The vaccine assessment order serves as an electronic notification to Pharmacy that the RN has completed the vaccination assessment • It is a requirement that Pharmacy review all inpatient vaccine eligibility assessments

20. Selecting the Orders • Place checkmark and select both orders • Will not file if not selected • Order detail will populate once selected • Save • Completed Nursing Assessments will electronically file to Pharmacy to be processed

21. Select both “Nsg Assessment” Orders • Pharmacy must review the assessment regardless of eligibility

22. Order Detail will populate once the orders are selected Must Checkmark Orders to File the Orders to Pharmacy Must Click Submit to File the Orders to Pharmacy

23. New Orders on Status Board • Once you have filed, you will notice the orders displaying on the Status Board as “Nsg Assessments” • These are the assessments which will electronically file to Pharmacy to review • Pharmacy will process and enter the order for vaccine if applicable

24. “Nsg Assessment” Orders Displaying on Status Board

25. Beware of Vaccine Assessment Order • Vaccine Assessment orders will queue for acknowledgement • RN is unable to acknowledge order until Pharmacy has processed the order • An error message will appear to alert Nurses that the orders are currently being reviewed by Pharmacy • When closing the error message, a visual indicator will display to indicate the order is unverified in Pharmacy

26. Error Message when Acknowledging Order The Nurse will not be able to acknowledge the order until the process is complete in Pharmacy

27. Pharmacy Order Status is Unverified

28. Vaccine Medication Order for Vaccine • Once an active Medication order has been entered by Pharmacy, the order will display in the orders column on the Status Board

29. Vaccine Medication Order on Status Board

30. Acknowledging Processed Pharmacy Orders • Once Pharmacy has processed the Vaccine Assessment Orders, the Vaccine Assessment Orders will display in the acknowledgement queue in a cancelled status • Nursing Tip: Cancelled status means that Pharmacy has completed their review of the vaccine assessment orders.

31. Processing Eligible Vaccine Orders • If Pharmacy determines the patient is eligible for immunization, a vaccine medication order is generated • RN will ack • Vaccine Medication Order • View Order Detail • “Cancelled” Vaccine Assessment Order • View Order Detail • Status of order is cancelled • Stop reason will default the user who cancelled the order

32. Acknowledging Medication Vaccine Order Review order detail for each order Acknowledge the vaccine first, then review cancelled “Nsg” Assessment” orders

33. View Order Detail Acknowledge Cancelled Vaccine Assessment Order

34. Processing Non-Eligible Vaccine Orders • If patient is not eligible for immunization, Pharmacy will cancel the Vaccine Assessment Order and enter a stop reason • RN will ACK • “Cancelled” Vaccine Assessment Order • View Order Detail • Status of order is cancelled • Stop reason will be entered as to why the patient is not eligible for vaccine • Pharmacy should be using the reason entered by Nursing on the Assessment

35. View Order Detail Stop Reason entered by Pharmacy

36. Vaccine on the MAR • New option to view vaccines only on the MAR • Active vaccines will display on the MAR as they do currently • MAR will display cancelled Vaccine Assessment Orders in yellow • Nursing will not have to document on the cancelled Vaccine Assessment Order

37. Viewing Vaccines on the MAR • New option to view only vaccine type orders on the MAR • Vaccine option only displays if there have been vaccines ordered for this patient during this visit • Cancelled “Nsg Assessment” orders will display in yellow • Active vaccines will display as they do currently

38. Administration Process • Scan the Patient’s Wristband • Scan the vaccine • Notice the Vaccine Assessment Order is linked to the Vaccine Med Order • Automatically defaults to the Protocol Tab • View the Eligibility queries associated as protocol to the order • Click Flow sheet • New queries • Error message if you do not go to the Admin Screen • Indicates the VIS publication date is required on the Admin Screen • Enter information into the New Immunization Medication Administration Screen • Ok to File

39. “Nsg Assessment” Linked to the Vaccine

40. Protocol will display Eligibility Queries from the Nursing Assessment

41. Updated MAR Flow sheet

42. VIS • Patients must be given a current Vaccine Information Statement (VIS) prior to receiving the vaccination • Documentation requirements are the date the VIS was given to the patient and the VIS Publication Date • VIS is available in multiple languages

43. VIS Publication Date Required Unable to file without entering required information on the Admin Tab

44. New Immunization Medication Administration Screen Required: • VIS Publication Date • Dose • Injection Site • Lot# • Expiration Date Defaults in: • Component • Used for vaccines with multiple components (MMR) • Eff Date • Whether the vaccine will count towards the schedule • Dose • Units • Manufacturer Optional: • Vaccination Reason • Variance Reason

45. New Immunization Medication Administration Screen

46. Admin Displays in Green

47. Session Summary of Medication Administration

48. Admin Displays in Black on the MAR

49. Viewing Immunizations in the EMR • Click on Summary Panel • Displays in the Clinical Tab • Similar to Home Medications and Allergies • Automatically updates when vaccine administered via the MAR

50. Immunization Routine