EPIC for Paramedics

1. EPIC for Paramedics Introduction to the EPIC EMR System at Salem Hospital

2. Logging Into Hyperspace • To log into Hyperspace • a User ID and password is required • Salem Hospital will issue a user ID and password to you • You will need to change your password at your first log in • Never share your password with anyone • It is your electronic signature

3. Hyperspace log in Screen

4. Epic Rules • A “Stop” sign indicates information must be entered • If “Accept” and “Cancel” are choices, you must choose one • An ellipsis requires an exact choice from a drop down list • Searching using the first 3 letters of key words will assist in finding information

5. Ellipsis Ellipsis A drop down menu will appear when the ellipsis is clicked

6. More Epic Rules • Work spaces are usually highlighted in dark blue • If there is an ellipsis for time and date you can use the following: • T= today (If you want to say 2 days ago use t-2) • W = week (If you want to say last week use w-1) • M = Month (If you want 3 months ago use m-3) • Y = Year (If you want 5 years ago use y-5) • N = Now (If you want a time 1 hour earlier use n-60)

7. Home Workspace • After login • Home workspace appears • Create a “My List” for your list of assigned patients • You only need to create your “My List” once • May add and remove patients on a daily basis to reflect your current patient list

8. Home Workspace

9. Creating a “My List” • With “My Patient’s List” highlighted in dark blue • Click on “Create” button • Enter your name in the stop sign row • Click “Copy” • Click “A Nurse List” • Click “Accept” in the small box • Click “Accept” in the big box

10. Create A “My List” 1. Give your “My List” a name 2. Click “Copy” 3. In “Available Columns” box, click on “A Nurses List” 4. Click “Accept”

11. Adding Patients to Your “My List” • There are two ways to add patients to your “My List” • Drag and drop unit home list into “My List” • Find unit list under expandable list - “System List” • Look under “Units” to find your nursing unit • Once you find your unit, drag it up to your “My List”

12. Adding Unit List to “My List” Click and hold your Unit - drag and drop in your “My List”

13. Add Patients to Your “My List” • To add specific patients to your “My List” (must know patient name or room number) • If using room number – drag and drop individual patient from your “Unit List” into your “My List” • If using patient name – highlight in blue - “My List” • Click on “Add Patient” • Use the “3,3” rule – first three letters of their last name and first three letters of their first name to search for patient

14. First 3 letters of last name, comma & first 3 letters of first name Add Patient Using “3,3” Rule

15. Add Patient Using “3,3” Rule Click “Add Patient” Use the “3,3 Rule” to find your patient Click “Accept”

16. How a “My List” Looks with Patients

17. Removing Patients from “My List” • Your patients (with black icons next to their name) will stay in your “My List” until you remove them • To remove a patient • Click on patients name • Click on “Remove” button • Your “My List” (with red and blue icons next to it) will be automatically updated as the unit census changes

18. Highlight the patient name & click “Remove” Removing a Patient from “My List”

19. Opening a Patient’s Chart & Getting Report • To open a patient’s chart from your “My List” • Highlight patient name & click “Open Chart” • Patient Summary Activity opens • Activities are gray tabs on left side of chart • To get report on a patient • Look at all reports under “Patient Summary Activity” – (more reports are available under double arrows on the right hand side of screen) • Receive verbal report from off-going nurse

20. Patient Summary Activity – Get Report Reports Activities

21. Chart Review Activity • Chart Review • Best for looking at old records on patients • Lab Results, Imaging Results, Past Medications are all located here

22. Lab results under this tab Chart Review Activity

23. Documenting Vital Signs - I&O - Lines & Drains • Found in Doc Flowsheet activity • Documentation of vital signs, I & O, Lines and Drains • Vital signs flowsheet is the default flowsheet • Automatically opens when clicked • To add columns • For current time, click “Add Column” button • For any time from the past, click “Insert Column” button - change time and date if necessary • Blank columns will disappear

24. Vital Signs – Doc Flowsheet To move up or down in flowsheet click on gray boxes above, or scroll on the right Notice a column is placed for the top of the hour

25. Documenting Vital Signs • Document vital signs, ADL’s & Intake & Output at time taken • Value documentation is done at time of care • Details box provides choices from a row with an “ellipsis” • May make multiple choices from “ellipsis” rows Example: • Documenting Oxygen source, charges the patient for the use of the O2 and th equipment for the day (only charges them once a day no matter how often you document source)

26. Documenting Vital Signs

27. Doc Flowsheet – Saving Information • Changing flowsheets, activities or closing the chart will automatically cause data to be saved • Note: Any information entered into a Doc Flowsheet will automatically be saved - whether you file the data or not!!

28. Doc Flowsheet – Saving Information • Editing data • Click on data to be changed • Type in new data • Click “File” • Note: This triggers the “Show Audit” alert to display on bottom of screen

29. See “Hide Audit” hyperlink on bottom of screen Initial data and changed data are shown Edited Data on Doc Flowsheet

30. Documenting On Intake Flowsheet Anything going into the patient is documented on the “Intake” flowsheet

31. Adding a Line to Intake Flowsheet • Adding a line (Peripheral IV line, PICC line, Central Line or Enteral Feeding line) - must be in “Intake Flowsheet” • Click “Add LDA” button • Choose line type for ellipsis • Click “Accept” • In “Properties” screen fill in the appropriate areas • Click “Accept” • A “line” on the Intake Flowsheet is added • Blue hyperlink describing a line is created

32. Properties Screen for Adding Line

33. Intake Flowsheet - Lines Added Note: line groups added to gray keys Note: blue Hyperlinks for each line within the flowsheet

34. Intake and Output Documentation • Documented in “real time” • Includes: PO intake, IVPB’s, IV boluses, bolus tube feedings, and water/saline flushes • Maintenance IV fluid volumes, continuous IV drips, continuous drips • Documented at end of each shift • Voided, straight cath, incontinent urine and all stools • Recorded as they are noted by the caregivers

35. Output Flowsheet Documentation • “Output Flowsheet” • Document all output’s • Adding a drain, chest tube, urinary catheter or ileal conduit • Click on “Add LDA” • Follow same steps as adding a line to “Intake Flowsheet”

36. Output Flowsheet with a JP Drain Note: document drain output in this row

37. Intake & Output Activity • “Intake & Output” activity • View only activity • Provides summary of I&O per shift • Viewed in • Table form • Graph form (note the 3 days graph and 7 day graph buttons) Note:Quickest way to see any shift’s total I&O

38. Intake and Output Activity

39. Notes Activity • Notes - written for significant events • Admission, transfer, discharge, patient fall, etc. • Nurses write “Progress Notes” • Click on “Notes” activity • Click “Progress Note” • Click “New Note” to create new note

40. Notes Activity Free type your note in this blank space Click “Accept” when completed

41. Results Review • Review new lab or imaging results • Go to “Results Review” activity • May be viewed by test, by all results, by date, by multiple dates, etc. • To change views click on “View” button • To change dates - click on “Hide Data Prior To” then change date • To mark you have seen results • Click on “Time Mark” button

42. Results Review Clicking on “Time Mark” will change results from italics to bold, and will cause them to not show as new results

43. Point of Care Tests • Three point of care tests that result into EMR • Capillary Blood Glucose • ABG’s • ACT • Example: CBG • Scan Namebadge • Scan patient’s armband • Scan glucostrip bottle • Perform test and read result • Dock glucometer in docking station (sends results to patient chart)

44. Medication Administration Record • The MAR Activity • Documentation of medications administered • Legend • Identifies meaning of specific colors, icons, and codes

45. MAR Legend

46. Tabs of the MAR • MAR tabs • All Tab – all medications alphabetically • Scheduled Tab – all scheduled medications alphabetically • PRN Tab – all prn medications alphabetically • Continuous Tab – all maintenance IV fluids and continuous IV drips alphabetically • Protocols Tab – all protocol medications • RN Verify Tab – a list of new medications that RN must verify against written order before administering first dose • RT tab – all RT administered medications alphabetically • Discontinue tab – list of discontinued medications

47. Tabs of the MAR Legend TABs

48. Administering Medications • Steps to medication administration • Always barcode patient’s armband first (this ensures you always have the right patient - also opens patient’s chart to the MAR) • Barcode each medication • Change any details for the medication – i.e. action of given, held, missed, due, the rate or dose • Type in any comments • Click “Accept” • Scan your name badge

49. Admission of a Medication Screen Medication information Medication Information Action types to choose from when documenting any action for a medication

50. Given Medications on MAR Given meds are green and underlined