Cerner Lab Upgrade with 2Hour Order Entry Downtime September 28 th 10-12noon

1. Cerner Lab Upgradewith 2Hour Order Entry DowntimeSeptember 28th 10-12noon Simultaneous implementation of two projects: Cerner Laboratory Information System (LIS) will replace the current GE (LIS) Abbott Diagnostics automated chemistry line will replace the current Beckman instruments

2. ACTIONS NURSING UNIT TO TAKE NOW TO PREPARE • Staff unit appropriately: (higher than a normal Saturday) • Schedule an MR and • Schedule one extra nurse • Make sure Downtime Kits are fully stocked for all types of Downtime documents before September 28th • physician order (POS) sheets (remove all triplicate forms you may still have) • lab requisitions • Look for emails, articles and Nurse Alerts with the latest details prior to the day

3. Order Ample Supply of DT Lab Requisitions and POS • E-docs link to order downtime requisitions: • https://edocsprod.mc.vanderbilt.edu/EDocsView.aspx?EDocsId=3363

4. PreDowntime – Day of • Providers encouraged to: • Order routine lab tests prior to 10am • Avoid ordering serial labs prior to 12N • Nurses to • Sort Batch print of requisitions to remove those dated and timed after 12 Noon 9/28/2013. Discard them • Dock Glucometers at midnight as usual then begin scanning account # on armband instead of MRN • Send specimens prior to 10 am whenever possible • MR • Print extra HEO lab labels, have POS ready to stamp for providers • Sort batch requisitions, shred those timed for after 12 noon • SSS to round on units to remind about the downtime processes

5. During Downtime-Provider and Nursing Instructions • DT Orders entered on STAMPED/LABELED downtime physician order sheet • New labs sent with STAMPED/LABELED DT paper requisitions • Labs ordered prior to DT will be sent with the HEO/Wiz requisition printed at order time UNTIL 12NOON • Medications ordered during DT will be faxed to pharmacy per normal HEO/WIZ DT procedures and will be entered by pharmacy then available in Admin-Rx • Labs will be resulted as usual though possibly slower • Systems Support onsite for inpatient areas to assist with questions related to downtime • Clinical Operations Engineers will be onsite to support outpatient areas using VOOM

6. During Downtime – MR • Be prepared to assist nurses and providers with stamped/labeled DT POS, and lab requisitions as needed • Fax medications orders to pharmacy so they can enter into HMM • Nurses will then be able to administer meds in Admin-Rx • Notify these services by phone of any new orders and a DT requisition: • Radiology • Respiratory Therapy or Rehab Services • Heart Diagnostic Test (Echo, EKG) • Lab:  • Labs will continue to be done during the downtime and results posted in StarPanel • Critical Labs will be communicated to provider/unit per protocol • Questions during the DT can be called to the lab hotline:

7. After Downtime- Nursing Nursing Instructions: • Charge RN will ensure that remaining HEO requisitions timed after 12 NOON are thrown away • SSS/DT Team -Active Lab orders in HEO will be dc’d and reentered starting at 12 noon • New HEO requisitions will be printed as the orders are re-entered in HEO/Wiz • Any lab that needs to be sent prior to receiving the new HEO/Wiz requisition should be sent with a DT requisition

8. After Downtime-Nursing, cont. Nurse Instructions: Verify labs carefully – the team dc’ing and re-entering the orders will not know what you sent, order changes etc. during the downtime Ask: • Was this lab sent during the downtime? • Do we still need this lab? Did it get dc’d on paper or verbally during the DT • Which requisition should be used? – if you have 2 HEO requisitions, use the requisition with the most recent “request date/time” on the requisition

9. After DT – MR and Pharmacists MRs (or designee): • Enter “ongoing non-pharmacy” written orders into HEO/Wiz • Written completed orders during Downtime will NOT be back-entered into HEO/Wiz Pharmacists: • enter “ongoing” written medication orders into HEO/Wiz • Once processed in HMM, medication orders display in Care Organizer to be verified

10. After Downtime-Providers Provider Instructions: • All lab orders in HEO/Wiz will be dc’d and reentered to allow HEO to communicate the order to Cerner lab • Lab orders will be reentered as “written” to avoid multiple co-signatures needed but be prepared as some may occur

11. After DT cont. Changes for Point of Care Blood Glucose, GEM, & Hemoglobin A1C Testing • Inpatient Nurses will now scan patient’s account number and not the MRN • Outpatient nurses will scan/enter the Epic account number on the label or encounter form

12. Reference Numbers & Resources for Lab Upgrade 9/28/13 • 3-HELP – HelpDesk will contact lab or support group to assist as needed • VUMC Lab to see new reference ranges • www.lab.vu.com or click on this StarPanel icon: • 5-LABS during the DT for lab questions • SSS website for DT Process questions: • SSS Downtime webpage • Link to order DT Forms from E-docs: • https://edocsprod.mc.vanderbilt.edu/EDocsView.aspx?EDocsId=3363