Emergency Care, Rx Writer, Exit Care - DeKalb Medical · ED Display Board Columns Display Board Column Description Room Displays the room/area where the patient is assigned Patient

Emergency Care,

Rx Writer, Exit Care

Sunrise Emergency Care

May 2013 v. 1.0

ED Display BoardLog into Emergency Care/SCM. The View dropdown box will be populated with the views appropriate for your role -- the table on the next page describes which views are available. If necessary, you may need to switch your view to the location that you will be working for that shift.

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ED Display Board (Cont)View Area

.ED All All North Decatur ED Areas

.WR ED Waiting Room

Admit View Patients assigned to temporary ED bed while waiting to be admitted

Behavioral Rooms ER 24-26

Inactive Patients Patients that have been removed from the board within the previous 72 hours.

Note: If the patient was removed from the board due to an inpatient transfer/admit, they

will NOT be displayed in the Inactive Patients view

Main 1 ER 3-10, HW 3-10, TR01

Main 2 ER 11-19, HW 11-19, TR02

Main 3 ER 27-32, HW 27-32, TR01, TR02

RTA RHW 01-04, RTA 01-03

Triage Patients waiting for Triage. All patients will default to this view upon presentation to ED.

Urgent Care ER 33-41, HW 33-35, HW A-E

WR Inner Urgent Care ED Inner Urgent Care Waiting Room

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ED Display Board (Cont)

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To switch to another view:

Steps Actions

1 From the Emergency Care main screen, click on the

View dropdown box

2 Select the view associated with your assigned location

ED Display BoardEmergency Care Views

The Patient Tracker Board may be viewed from a static ‘display board’ on large display monitors that will be strategically located in the ED.

Users may also access their own personal view of the Patient Tracking System (containing a subset of data from the display board) by logging onto Sunrise Emergency Care at a PC workstation.

Note that what you have access to view and change on the Patient Tracking System will be controlled by the security settings applied to your logon ID.

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ED Display Board

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Display Board Summary View

Time of Refresh – the display board is updated by information that is entered into Sunrise Emergency Care by various users on workstations throughout the hospital. The board view is configured to automatically refresh and show the latest data every 60 seconds. This area will display the actual time of the last refresh in the upper right side of the board.

Summary Information – This area will display a summary of information such as total number of patients on the unit, total number of patients in triage, etc. This summary data changes based upon the displayed Patient Tracking System view.

ED Display Board Columns

Display Board Column Description

Room Displays the room/area where the patient is assigned

Patient Displays the name of the patient (depends on the view you are in)

SBP/DBP/HR Displays the most recent vital signs

Age Displays patient’s age. Note: The system turns this cell pink if patient is a female and

blue if a male.

ESI The priority of the patient from the Nurse’s Triage Note.

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Display Board Columns (cont)


Chief Complaint From the Nurse’s Triage Note – patient’s stated complaint

Status (STS) Displays the status of the patient or the bed (status descriptions detailed later)

ED LOS Length of time patient has been in the ED location

Nurse Nurse assigned to this patient

MD ED provider assigned to this patient

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New Orders New physician orders have been placed in SCM

D/C Sts (discharge status) Paper icon will appear when the physician has entered a discharge order

Dispo Timer Triggered when the disposition order is placed. When timer is greater than 15 minutes

the cell background color starts blinking green. Timer stops when the patient is

removed from the board.

Inpt Timer Triggered when the status is RA (room assigned). When timer is greater than 30

minutes the cell background color starts blinking green. Timer stops when the patient

is removed from the board.

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Comments Any additional comments for communication

Consult Triggered when the physician enters a consult order. Shows complete when the OSA

completes the order (consulted MD has called back)

Lab/Urine/RAD/EKG/Meds/

Nursing

May show a ratio (0:3) - first number shows how many results are ready and the

second number displays the total number of orders placed. A single order will only

show the status of that order (performed, comp, ordered)

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Previous Visit Keeps a rolling count of the number of times the patient has been in the ED within the

previous 72 hours

Admitted fr ED to Rm Assigned inpatient room (by the Throughput Coordinator)

PADM Patient is waiting to be admitted

Patient is waiting for bed (Provider has checked Bed Req)

Admit order has been entered

BedReq Displays a checkmark if a Bed Req has been ordered by the physician

MD Timer The time that a patient has waited for a physician. This timer is triggered when the

patient has completed triage and the room status has been updated (WR, WRFC,

actual ED Room, etc.). The timer will stop ticking when the MD is assigned.

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Bed/Patient Status ColumnStatus Description Notes (Icons, Timers, etc)

Ready (BED) The bed has been cleaned and is READY for the

next patient

The line turns lavendar when the status is chosen signifying it is

ready for an admission.

Dirty (BED) This denotes a terminal clean room. The line turns brown.

OOS/Blocked (BED) Room is Out of Service or Blocked The line turns red.

Reserved (BED) Nursing has reserved the room for a patient after

receiving a call from ambulance stating that they are

on the way with a patient.

The line turns red.

Treatment in Progress (TIP) Provider is treating This status is automatically engaged when the provider assigns

him/herself to the patient. Sends notification that patient is ready

for full registration.

Consult Pending Consult ordered, has not been received

Pending Admission Bed Request has been received This status will be automatically engaged when the provider

checks the Bed Req column

Inpatient Admit Bed Request and Admission orders have been

received, but bed has not been assigned or is not

ready

This nurse will manually change to this status once Admission

orders and the Bed Req have been ordered by the provider

Remove From Board Removes patient from the board

Room Assigned Bed is assigned and ready for patient The 30 minute discharge timer begins ticking

Waiting to be Seen (WTBS) Waiting to be seen Triage Nurse will change to WTBS once the Triage Note is

completed.

Triage Patient is waiting for triage

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Provider ResponsibilitiesThe provider has the following responsibilities:

• Assign him/herself to the patient

• Computerized Physician Order Entry

– All orders will be done through the Electronic SCM systems including Discharge, Admit, Meds, Labs, RAD, etc..

• Order Bed Request for Inpatient Admits

• ED Disposition Orders for Patient Discharges from ED

• Create and Print Discharge Instructions using Exit Care

• Write electronic prescriptions using Rx Writer

• Sign off on electronic orders placed by Nursing

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Assign Provider to Patient

To assign yourself to a patient:

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Steps Actions

1 Select the desired patient

2 Double-click in the MD column for the desired patient and select your

name

The MD Timer will stop ticking and you will be assigned to the patient

Computerized Physician Order Entry

With Emergency Care system, ALL orders will now be placed electronically using Computerized Physician Order Entry (CPOE).

To assist you in this process, there are several Order Sets that have been built specifically for ED Providers.

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CPOE (Cont)

To place an order:

1. Select the desired patient

2. Click the Enter Order iconfrom the patient headersection

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CPOE (Cont)

To place an order (cont):

3. Select the appropriate order set or type in an individual order item name.

3. Double click on the order set/order item name to open.

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CPOE (Cont)


5. Select desired options

6. Click OK

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CPOE (Cont)


7. Review Order for Accuracy

8. Click Submit

Please see Module 3.4 in the ‘SCM

Acute Care Clinical System’ folder

“Order Entry” CBL.

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ED specific order sets have been built in Acute Care. While you can certainly search for them manually, it is often easier to set your default browse point to these particular order sets.

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Default Browse Point

CPOE (Cont)

Setting Default Browse

Point for Order Entry:

1. From the menu bar, select

Preferences/Order Entry.

2. The Order Entry Option

box will open.

3. From the Browse Start

Point tab click Add New.

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CPOE (Cont)


Point for Order Entry (cont):

• Select the browse option you

wish to display as the default.

This example displays Common

Order Sets By Unit/Common

Orders ED.

• Click OK.

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CPOE (Cont)


Point for Order Entry (cont):

Highlight the selection you

wish to set as the default.

Click on Set As Default,

then Click Close.

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Disposition Orders

When a patient is being admitted, transferred, or discharged, the

ED-Disposition Orderset should be used.

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Disposition Orders (Cont)

Disposition Orders

1. Select ED-Dispositions

2. Click Add

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Disposition Orders

3. Select desired options- You will need to double-click the order item to completethe required information- All orders with required information are preceded by

4. Click OKSlide 26


Disposition Orders

5. Click Submit

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Disposition Orders

Bed Request

(for Inpatient Admissions)

1. Using the ED-Dispositions orderset, double-click the ED-Bed Requestorder

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Disposition Orders

Bed Request


2. Complete all mandatory fields (fields with are required)

3. Click OK

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Disposition Orders

Bed Request


4. Click Submit

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Disposition Orders

Inpatient AdmissionsOnce the Bed Request Order has been submitted, the following will take place on the board:

• The Row will turn orange, signifying an inpatient admit

5. Click in the Bed Req checkbox to place a checkmark in the column

• A small bed icon will appear in the PADM column

• The Bed Req Timer begins ticking

• The STS column will change to PADM

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AlertsWhile using the system you may notice pop up alerts. These have been used to inform you that “ACTION” needs to occur. Some of the alerts you might see:

-admission orders while a patient is in the ED need to be entered in a “Hold” session type

-duplicate orders- users may not realize another practitioner has entered orders on the patient.

Please see Module 3.4 in the ‘SCM Acute Care

Clinical System’ folder for more details on how to find

patients and patient data.Slide 32

Exit CareExit Care is the application that is used to print Discharge Instructions and Work/School excuses.

To access Exit Care:

1. Select desired patient

2. Click on the Discharge Instructionsicon

ORRight-click the patient and select Discharge Instructions

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To access Exit Care (cont):

1. Click Login (the system recognizes your SCM log in)

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To select your document:

1. Select the desired document by clicking in the checkbox

2. Click Preview Highlighted Item if you would like to view the document

OR

Click Done to move to the next screen

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Alternatively, you can also use the Search feature to locate a document using free-text:

1. Free-text any part of the name of the document you are looking for

2. Select one of the following options:1. Title begins with

2. Title contains

3. Search within the text of ALL document

3. Click Find

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Note: The available translations pane will display the translations available for that document. As documents are chosen, the documents selected will display in the selected documents pane.

To edit your document:

1. Click the View Document tab

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2. Click the Edit button

Note: Edits are only available in English. The system is unable to convert English edits into other translations.

To edit and print your document:

1. Make any necessary edits

2. Click the Save button

3. Select Save for Current Patient Only

4. Click the Print/Fax/Email link to print the document

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Note: The language and size option allows the user to print documents in the desired translation (available translations will be available in bold. Unavailable translations will be grayed out). If another language is selected, there is an option to print an English copy. The font size of the document can also be changed to accommodate patient needs.

To add a work or school excuse:

1. Click the Add Excuse Formlink from the left panel

2. Complete necessary information

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To add an additional Care Provider:

1. Click the Add a Caregiverbutton

2. Select desired caregiver

3. Click OK

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To add a follow up Care Provider:

1. Click the Add a Follow-upbutton

2. Select follow-up number of days

3. Select follow-up provider

4. Click OKSlide 41

Additional notes provides an area to document meds given in the Ed and meds given to take home.

Adding Additional Notes:

1. Click the Lookup Notesbutton

2. Check the desired note

3. Click Add Selected

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Additional notes provides an area to document meds given in the Ed and meds given to take home.

Adding Additional Notes:

1. Click the Lookup Notesbutton

2. Check the desired note

3. Click Add Selected

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The notes will be pulled into the document and you can free text additional information in the space provided

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Rx Writer/ePrescribePrescription Writer is an application within Acute Care that

allows providers to do the following:

• Create and maintain a list of home medications

• Electronically transmit new prescriptions

• Convert listed home medications into prescription refills

• View a history of changes for prescriptions and home medications

• Before ePrescribing any medications, the provider must ensure the patient’s preferred pharmacy is entered in the system.

• To enter the patient’s preferred pharmacy

• Select your patient.

• Click the Rx Writer icon

• Click on the blue writing next to preferred pharmacy

• Click on the arrow. Enter the pharmacy name, state, and zip code. A list of pharmacies participating in ePrescribe will display

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• If the pharmacy name has this icon next to it, it is not a participating pharmacy in eSubscribe. FYI: DO NOT USE THE ADD NEW SIGN TO FIND OR ADD NEW PHARMACIES.

• Click on the patient’s preferred pharmacy from the list. If the patient’s pharmacy is not a participating pharmacy, the Provider should print all prescriptions.

• Click on the “add to preferred” icon

• Click on close

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To enter your user preferences

• Click on the Rx Writer icon

• Click on the user preferences icon

• Select the location you are practicing from.

• Select the phone number that a pharmacist can contact you with any questions.

• Click OK. Close out of Rx Writer application for the changes to take effect.

You only have to select the location and the phone number once. If the phone number listed in not correct or if you have a change in phone number/address please call 15757.

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• Select your patient from the patient list or PTS board

• Click the Rx Writer icon

• Once the Rx Writer dialogue box opens up, click on the enter prescription icon

• If your user preferences are set to favorites, you will see this list.

• Pick the category you would like to select your prescriptions from (full catalog, quick list, favorites).

• Failure to enter all required fields will result in an error for eSubmit. (Dose, Dosage Units, Route, Frequency, Days, Refills, Quantity, Dispensed Unit

NOTE: Medications on the favorites list have most of those fields pre-filled.

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Entering a Prescription

• If you need to add more medications, click add to list

•When you are finished adding all prescriptions, Click Review and Submit. The following screen will appear

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• If your user preference is defaulted to eSubmit, the prescriptions will default to eSubmit. Schedule II medications are not eligible for ePrescribe and orders will default to Print.

• If the patient does not want to participate in ePrescribe/eSubmit, the Provider can manually change the submit method to print.

• Once you have entered all Prescription(s), click Submit

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• There is a new “Notification” icon that displays to indicate pending e-prescribing refill requests, e-prescribing errors, unsubmitted prescriptions, and new medication dispense history.

• Medications listed in blue are unsubmitted prescriptions

• Medications listed in red have submission errors

• The errors that display are specific to the user that is logged in

• For example, in the screen shot below, the notification icon indicates there are 5 items that the logged in Provider needs to review. There are 3 unsubmitted orders, 1 submission error on levothroid, and 1 error that exists on another patient the logged in provider has cared for.

• Other providers will see the medications listed in blue or red and can address the errors.

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Managing Prescriptions

• To manage the errors, click on the “Notification error” icon, then

• Click on the item you would like to address.

• You will then receive a listing of the specific errors. Click on the plus sign to see more details

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• Right click on the medication with the error or in unsubmitted status

• A dialogue box with additional actions will pop up

• Select “View/Modify”

• When the prescription box pops up, make the changes to address the errors or review the medication, then

• Click “review and submit”

• Once all errors have been addressed, the writing of the medication will turn black and the number of errors on the “Notification” icon will decrease.

• Click “close” when finished.

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Signature ManagerThe following orders will need to be signed in signature

manager within Emergency Care, or in Sovera if the

patient's visit is no longer active:

- Verbal orders entered by nursing

- ED protocol orders

• To launch Signature Manager, click on the icon on

the toolbar.

• Click “Get List” button.

• Check the orders you wish to sign.

• Click “Sign”

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Congratulations!

You have completed the Emergency Care CBL

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Documents

Emergency Care, Rx Writer, Exit Care - DeKalb Medical · ED Display Board Columns Display Board Column Description Room Displays the room/area where the patient is assigned Patient