CPRS Training

1. CPRS Training June 2005

2. Patient Select Screen Patient name, SSN, Last 4 Setup Default lists Process Notifications

3. Patient Select Screen • You can use the full SSN, Patient’s first initial of last name and last 4, full last name etc. • To look for Team lists, Select Teams from the Patient Select box and type the name of the team. • To process Notifications, Highlight the notification that you want processed and hit the Process button. If you want to process all notifications, hit the Process All button. These notifications are usually unsigned notes, orders, etc.

4. Team Lists After selecting Team, type the name of the team. To save the list as your default, Press Save Patient List Settings. This can be done with any of the Patient List types.

5. CPRS Cover Page Menu Bar Cover Page Areas Tabs

6. CPRS Coversheet Overview • Menu options • There are Menu Options available for each Tab. • Left clicking File will let you pick a new patient or refresh patient information • Tools and Vista Apps have a number of links/programs that all areas may use. • Left click patient’s name to bring up Demographic information. • To find Next of Kin, Last admission, surgery dates, etc. • Left click Provider box to select the Visit and Provider. • Needed when entering orders or consults. This will be the provider that receives notification to sign an order or get results from a test. • Double left clicking any of the items on the cover sheet area will bring up more detailed information for that item. • Left clicking a tab will take you to that Page. • Remote data will be highlighted if there is information available at other VA’s

7. Medications Tab Medications Sections

8. Medications Section Continued • First section will be Patient’s current location Medications • If inpatient, there will also be listed Outpatient meds as well as non VA meds. • You can increase the viewable area of a section by left clicking and dragging a section. • To Do This: Hover the mouse pointer over the edge of the area until it changes to a sideways T with up and down arrows. Left click and hold the mouse down while increasing or decreasing the size of the area. • Double click a medication order for more detailed information about the order. • You can also increase the size of the columns. • To Do This: Hover mouse pointer over the line that divides two columns. It will change to two arrows with a horizontal line. Left click and hold the mouse down while changing the size of the column.

9. Orders Tab Types of orders that are viewed Write orders using these Orders written for this patient

10. To change what orders you see, Left Click View and then Custom Order View Once you’ve customized your view, you can left click on “Save as Default”

11. Highlight the Status and Service/Section If you want to only display orders for a specific time range, Select Only List Orders Placed… To create a more specific list, Left click the + in front of the name and then the detail you want

12. Orders are Separated by Service Order Start/Stop time and Status Who verified the order Nrs=Nurse Clk=Ward Clerk Chart=Chart Review

13. Life of an Order • Once an order is written, depending on the order type, it will have a Status (sts) of unreleased. • Releasing an order in CPRS is the same as signing an order on paper. For nurses taking verbal orders, it’s the same as writing an order and signing it as a verbal order. • Once the MD signs the order or the RN releases the order, the status will change. • Medication orders will have a status of Pending…until pharmacy verifies the order. After verification, the orders will be Active. They may also be Expired, DC’d etc. • Medication orders that are not verified by Pharmacy will not have a stop date. • Text (Nursing) and some other types of orders once signed (released) automatically are Active.

14. To take action on an order. Highlight the order and Left click Action • Nurse would also Complete an order or verify an order from this option. • Release without MD signature allows you to take a Verbal/Telephone order. It is recommended that you use this method when taking a verbal order. • Signature on Chart says that you are putting in an order that is written on paper some place. • Action also lets you Change an order or Discontinue/ Cancel an order • **Note** If you verify an order before it has been verified by pharmacy, you may need to reverify that order. • If you want to take action on multiple orders, hold the CTRL key down while left clicking the orders

15. Verifying an Order • Verifying an order means that it is Noted. You’ve seen the order and have made sure that the order is handled as it should be (when applicable). • If it’s a medication order, that its appropriate for the patient and that when the time comes to give it, there are no reservations as you see it. For ECU, this may also mean that you have ensured that the medication label or hand written entry is on the MAR and ready to be administered. • Verification can also be done by ward clerks designating that they’ve seen the order and if necessary, taken action on the order (printing lab requisition slips/labels)

16. Verify an Order continued Verification columns will be blank if the order is not verified.

17. Verify an Order continued To verify an order, left click to highlight then order Then select Action from the menu bar and then Verify

18. Verify an Order continued Nurse Ward Clerk Once the order has been verified, the verifier’s initials will appear on either the nurse column or Clerk column

19. Notes • The Notes Tab allow users to put in progress notes or other data that needs to be seen by other users. • Notes are assigned titles and are usually attached too tools that help format the note, called Templates • To write a New Note: • Click on Notes Tab • Left Click “New Note” • Select a Note Title (if there is a template attached, it will launch, otherwise you have a blank writing pad” • If you are using a template, once you are done, hit finish. • Sign the note using Action, “Sign Note Now” or Save the note to edit later with “Save without signature”

20. Notes Tab Note Titles Body of the Note Creating a New Note

21. Setting Up Note Titles • From the menu bar, Left click Tools and then Personal Preferences

22. Left Click Notes tab

23. Left Click Document Titles

24. Leave Document Class set to Progress Note • In the Document Titles box, Start typing the name of the note you wish to add to your default list. • Left click the title and then select Add. • The title will be displayed in “Your list of titles”. To remove it, highlight it and left click remove

25. Once the custom titles are setup and New Note is selected, the titles will appear in this list.

26. New Notes • Remember, when completing a note, all fields that have an * in front of them must be filled in. • When the note is completed, select finish. This places your note in the chart, Unsigned. • At this point you can either “Sign Note Now” or “Save Without Signature” • If you Sign the note, you will not be able to edit it…only add addendums to the note. • If you Save without signature, it saves the note so you can edit/add to it.

27. Save Without Signature • If you’re using “Save Without Signature” to continue using a template in the future, you must remember where you stopped on the template. It’s a good idea to stop end of a section so you can start at the beginning of the next selection. • You must use the “Edit Progress Note” from the Action option in the menu bar. You must also have the note you wish to edit highlighted • You’ll notice that your cursor will be placed at the bottom of the document that you are editing. This is so that if you reuse a template, it will insert the new data at the bottom of the note. You could move your cursor around and free type any text into the note if you wanted too. • When editing a progress note DO NOT use the New Note option. If you find that you have a blank page, its because you used New Note instead of Edit Progress Note. • If you signed the note, you will not be able to edit a note. • If you signed a note, you will not be able to delete a note.

28. Save Without Signature Continued After Finishing a note, hit Action And then Save Without Signature

29. Save Without Signature Continued • When you’re ready to edit the progress note • Highlight the Unsigned note • Select Action from the Menu bar • Select Edit Progress Note from the list of options. • Select Templates and then left click on the + in front of Shared Templates • Scroll down to the name of the template that you are using • Sometimes templates are located by department or division. • Left click on the + to get to the section/note that you are using • Double click the template • Scroll down to the area that you left off in. Sometimes you have to open up areas that will have *’s for required fields…such as the time of entry. • You can ignore the previous sections if you’ve filled them out already. The template is just a tool to help you touch all the areas that need to be addressed. • Once you are done, select finish. You can “Save Without Signature” as many times as you need too. Sign the note once it is complete.

30. Save Without Signature Continued Highlight the unsigned Note Left Click Templates

31. Save Without Signature Continued Left Click the + in front of Shared templates

32. Save Without Signature Continued Scroll down to your area and Expand the group by hitting the +

33. Save Without Signature Continued You’ll notice that the icon will change from just a folder to a file Folder combo

34. Lab Tab • The Lab Tab gives you access to lab results. It allows you to display the data in a variety of ways and is customizable to each user.

35. Lab Tab Continued Various ways to view results Results

36. Reports Tab • The Reports Tab displays certain data in a more viewable format. • Not all patient data will be in reports…Some of the things you can find there • Allergies (remote data) • Historical Medication Administration in the Inpatient side (BCMA reports) • Inpatient Flowsheets (Careplan, Coag, etc) • Inpatient Vitals • You may find the reports tab does not have data that every user needs, just realize that it is there. • This is where you’ll find remote data.

37. Reports Tab • When a user first clicks on the Reports tab, the only options that are visible are the reports and the data from the reports. When the user clicks on a report, CPRS uses the requesters default date range setting under personal preferences. This by default is set to the last 2 years worth of data • Once you run a report, CPRS will then ask for a data range to customize it. The problem is that you may have to wait for 10 minutes for the first report to run (set to the last 2 years) • In order to fix this, all users should change their default preferences. This is a one time preference change. • Once this default setting is changed (to a shorter period of time) you can then go back and select a date range that meets your needs.

38. Reports Tab Preferences • To change personal preferences for Reports • Select Tools • Select Personal Preferences • Click on Reports • Click on “Set all Reports” under All Reports • Change the start date to be within 14 days of today’s date • It may seem awkward at first, but when you run the report it doesn’t use those exact dates…it uses T (today) – the number of days you set. In this example T-14 • Hit OK on each screen to back out.

39. Report Tab Preferences Continued When you first click on Reports Tab, you’ll notice that you are not able to select a date range ???

40. Reports Tab Preferences Continued While on the reports tab, Left click Tools and then Personal Preferences

41. Reports Tab Preferences Continued Left Click Reports Left Click “Set All Reports”

42. Reports Tab Preferences Continued Change the Start Date to 14 days from today’s date Hit OK In this example, when the report is run, it will default to T-14

43. Reports Tab Preferences Continued Once you’ve actually ran a report, you can then customize the time range

44. Remote Data • If the Remote Data box is blue, there is remote data available. • Remote data is data that has been entered at another VA and that isn’t displayed until you request it. • Allergies are a good example of remote data that you may request. • To get remote data: • Left click the Remote Data box (if its not blue, there is no data available) • Select the sites you want data from. Usually you’d select all locations. A Check indicates that it is selected, unchecked box means its not selected. • Once you’ve identified the sites, left click on the report you want. Portland information will automatically be displayed and up to 30 seconds or so later, other sites data will appear (if there is information)

45. Remote Data Continued If a patient has Remote Data The Remote Data box will be blue

46. Remote Data Continued Left click the Remote Data box and Check All Available Sites

47. Remote Data Continued For Remote Allergy Data, Click the + next to Clinical Reports and double click Allergies.

48. Remote Data Continued When you first run the report, Portland data will automatically be displayed. Wait 15 or so seconds for other sites to load.