MICROMEDEX® 360 CARE INSIGHTS SUITE CAREFOCUS · micromedex® 360 care insights suite carefocus user guide may 2017

MICROMEDEX® 360 CARE INSIGHTS SUITE

CAREFOCUS

USER GUIDE May 2017

© 2017 Truven Health Analytics LLC

This manual, as well as the data and software implementation described in it, is furnished under license and may be used or copied only in accordance with the terms of such license. The content of this manual is furnished for informational use only, is subject to change without notice, and should not be construed as a commitment on the part of Truven Health Analytics.

Except as permitted by such license, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, recording, or otherwise, without the prior written permission of Truven Health Analytics.

The data and software implementation, as with all technical and computer-aided design software, is a tool intended to be used by trained professionals only. The data and the software implementation is not a substitute for the professional judgment of trained professionals. The software implementation is intended to assist with product design and is not a substitute for independent testing of product stress, safety and utility. Truven Health Analytics assumes no liability for any error or inaccuracies that may appear in this manual. Truven Health Analytics MAKES NO WARRANTIES WITH RESPECT TO THIS MANUAL AND DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.

Micromedex® is a trademark of Truven Health Analytics. All other trademarks are the property of their respective owners.

U.S. Government Customers:

The Products are provided to the Federal government and its agency with RESTRICTED RIGHTS. USE, DUPLICATION OR DISCLOSURE BY THE GOVERNMENT IS SUBJECT TO RESTRICTIONS SET FORTH IN SUB-PARAGRAPH (c)(1)(ii) OF THE RIGHTS IN TECHNICAL DATA AND COMPUTER SOFTWARE CLAUSE AT DFARS 252.227-7013 OR SUB-PARAGRAPHS (c)(1) O R (2) OF THE COMMERCIAL COMPUTER SOFTWARE-RESTRICTED RIGHTS AT 48 CFR 52.227-19, AS APPLICABLE. CONTRACTOR/MANUFACTURER IS Truven Health Analytics, 100 Phoenix Drive, Ann Arbor, Michigan 48108, USA.

TABLE OF CONTENTS

Contact Truven Health Analytics ..............................................................................................iCustomer Resource Center ......................................................................................................i

Technical & Customer Support ......................................................................................................... iTraining Center ....................................................................................................................... iii

Direct Access to Documentation..................................................................................................... iiiTotal Support Solutions .......................................................................................................... ivConventions Used in This Manual ...........................................................................................v

Chapter 1: Overview ...................................................................................................... 1CareFocus .............................................................................................................................. 1

How it Works....................................................................................................................................1Pre-Configured Profiles Powered by Micromedex® ........................................................................2Key Benefits.....................................................................................................................................2TRAINING CENTER........................................................................................................................3HOSPITAL LINKS............................................................................................................................3SWITCH TO.....................................................................................................................................3USER NAME ...................................................................................................................................3

Chapter 2: CareFocus Census...................................................................................... 5The Census .....................................................................................................................................6Patient Header - Demographics and Details ...................................................................................7Patient Medications .........................................................................................................................7Patient Labs & Reports....................................................................................................................8

The Census ............................................................................................................................ 9Viewing Patients on the Census List ...............................................................................................9View by List....................................................................................................................................10View by Patient ..............................................................................................................................13Census Icons .................................................................................................................................14

List/Patient Icons......................................................................................................................................14Viewing Patients on the Census ....................................................................................................16Status Icons & Alert Indicators on the Census ..............................................................................17

Labs, Reports, Isolation Status Icons ......................................................................................................17Form Status Icons....................................................................................................................................18Form Status Representation on the Census (Icon Hierarchy) .................................................................19

Forms: Filter by... ...........................................................................................................................20Filtering the Census Display: Lists and Units ................................................................................23

View Specific Lists or Units......................................................................................................................23Managing List Subscriptions .........................................................................................................24Searching for Patients ..................................................................................................................25Print the Census ...........................................................................................................................26Refresh .........................................................................................................................................27

Patient Header - Demographics and Details ........................................................................ 28Patient Demographics ...................................................................................................................28Patient Information.........................................................................................................................29Profiles Met....................................................................................................................................30

Profile Criteria Met ...................................................................................................................................31Viewing Completed Forms.............................................................................................................31Other Filters/Controls/Navigation Links in the Patient Header ......................................................32

Date Range..............................................................................................................................................32

Meds, Labs & Reports View Filter........................................................................................................... 32Notes....................................................................................................................................................... 40Orders ..................................................................................................................................................... 41Demographics ......................................................................................................................................... 42

Calculators.....................................................................................................................................43Calculators in the Patient Header ........................................................................................................... 43Calculator Descriptions ........................................................................................................................... 44

Patient Medications............................................................................................................... 47Filtering the Medications Display...................................................................................................47Meds, Labs & Reports View Filter .................................................................................................48Viewing Medications......................................................................................................................48IV Compatibility Results.................................................................................................................51

Common Solutions.................................................................................................................................. 53Y-Site ...................................................................................................................................................... 55Admixture ................................................................................................................................................ 56Syringe .................................................................................................................................................... 57TPN/TNA................................................................................................................................................. 58

Labs & Reports ..................................................................................................................... 59Viewing Labs & Reports ................................................................................................................59

Normal, Abnormal, and Critical Results .................................................................................................. 60View Details ............................................................................................................................................ 62Parking Pop-Up Windows ....................................................................................................................... 63View the Date the Lab was Last Performed............................................................................................ 64

Graphing Results...........................................................................................................................65Viewing a Graph...................................................................................................................................... 65

Graphing Multiple Results .............................................................................................................68

Chapter 3: Forms ......................................................................................................... 71Forms Overview.................................................................................................................... 71

Surveillance Profiles and Forms....................................................................................................71The Profile - Form Workflow ................................................................................................................... 71

Form Status ...................................................................................................................................72Form Status Representation on the Census (Icon Hierarchy) ................................................................ 73

Working with Forms .............................................................................................................. 76Required Form Fields.............................................................................................................................. 77Working in Forms .................................................................................................................................... 78Completing Forms................................................................................................................................... 80Manually Assigning a Form..................................................................................................................... 80Parking Pop-Up Windows ....................................................................................................................... 85

Flagging Forms for follow Up ................................................................................................ 87Viewing Forms With a Follow Up Set or Due ................................................................................90Change or Remove the Follow Up ................................................................................................91Ramifications of Changes to Forms Controls - Reporting and Data Export ..................................92

Chapter 4: Reports....................................................................................................... 95Antimicrobial Susceptibility Report ................................................................................................95Clinical Activity...............................................................................................................................98

Individual Strip Chart............................................................................................................................... 99Comparison Chart ................................................................................................................................. 100Aggregate Chart.................................................................................................................................... 100

Forms Data Export ......................................................................................................................103

Chapter 5: CareFocus on a Handheld Device ......................................................... 105Overview ............................................................................................................................. 105

Downloading 360 Care Insights .......................................................................................... 105Settings ............................................................................................................................... 105

Configuring a Site ........................................................................................................................106General Settings ................................................................................................................................... 108Info Button ............................................................................................................................................ 108

Beaming Site Settings .................................................................................................................110Sending (Beam) Settings ...................................................................................................................... 110Receiving Settings ................................................................................................................................ 110

Switching Sites ............................................................................................................................111Deleting a Site .............................................................................................................................111

Syncs (Synchronizing the Device) ...................................................................................... 112Starting a Sync ............................................................................................................................112

Message of the Sync (MOTS)............................................................................................................... 113Expired Data Syncs .....................................................................................................................113

Changing Your PIN ............................................................................................................. 113Logging Out ........................................................................................................................ 114General functionality ........................................................................................................... 115

The Patient Census ....................................................................................................................115Glinting .................................................................................................................................................. 115

The Patient List ................................................................................................................... 115Census Settings ..........................................................................................................................115Patient Information on the Patient List.........................................................................................116

New or Critical Results Indicators ......................................................................................................... 116Patient Name ........................................................................................................................................ 117Search for a Patient .............................................................................................................................. 117Add a Patient to your Census ............................................................................................................... 117Hide or Delete a Patient ........................................................................................................................ 119

Other Census Settings ................................................................................................................122Facility ................................................................................................................................................... 122Patient List ............................................................................................................................................ 123Census Modes ...................................................................................................................................... 126Census Retention.................................................................................................................................. 129Managing the Census ........................................................................................................................... 129Sort........................................................................................................................................................ 130Show Caregiver Roles .......................................................................................................................... 131

Patient Information Screen ................................................................................................. 132Patient Demographics........................................................................................................................... 132Diagnosis .............................................................................................................................................. 133Allergies ................................................................................................................................................ 133Note / Shared Note ............................................................................................................................... 133Caregivers............................................................................................................................................. 134Account ................................................................................................................................................. 134Contact.................................................................................................................................................. 134Insurance .............................................................................................................................................. 134Next of Kin............................................................................................................................................. 134Other ..................................................................................................................................................... 134Appt. / Procedure .................................................................................................................................. 134Follow After Discharge .......................................................................................................................... 135

MEDS.................................................................................................................................. 136Patient Allergy Data .............................................................................................................................. 136Additional Patient Data.......................................................................................................................... 136Medication Information Shown in 360 Care Insights............................................................................. 137

Medication Status ........................................................................................................................137Medication Details .......................................................................................................................138

IV Mixtures ............................................................................................................................................ 138Results - Reports and Labs ................................................................................................ 139

Data Retention ...................................................................................................................................... 139Sort ..............................................................................................................................................140

Changing the Sort ................................................................................................................................. 140Changing the Order of the Results........................................................................................................ 140

Fishbone Display .........................................................................................................................141Changing/Filtering Results Based on a Time Range...................................................................142Labs.............................................................................................................................................143

Common Labs....................................................................................................................................... 144Additional Information on Some of the Common Reports..................................................................... 147

Graphing......................................................................................................................................149Viewing a Graph.................................................................................................................................... 149

Orders ................................................................................................................................ 150Changing the Sort or Time Period......................................................................................................... 151

Forms and Profiles ............................................................................................................. 153Follow Up Status ................................................................................................................................... 153Viewing Profiles..................................................................................................................................... 154Viewing Forms ...................................................................................................................................... 155

Adding a Form to a Patient ..........................................................................................................156Entering Form Information .................................................................................................................... 158Required Fields ..................................................................................................................................... 159Calculators ............................................................................................................................................ 159

Follow Up.....................................................................................................................................164Adding a Follow Up Time to a Form...................................................................................................... 164Removing a Follow Up.......................................................................................................................... 165

Marking a Form Complete ...........................................................................................................166Removing a Form ........................................................................................................................166

Appendix A: Sample Exported Form ...................................................................... 167

Index ........................................................................................................................... 171

PREFACE

CONTACT TRUVEN HEALTH ANALYTICS

LocationsCorporate Office

100 Phoenix Drive Ann Arbor, MI 48108 USA

Colorado Office

6200 South Syracuse Way, Suite 300 Greenwood Village, CO 80111 USA

North Carolina Office

4819 Emperor Boulevard Durham, NC 27703 USA

CUSTOMER RESOURCE CENTER

Technical & Customer Support At Truven Health Analytics, our staff of technical and service experts has one goal - to quickly take care of your needs so that you are back to optimal performance with our solutions.

Our Customer Resource Center is available to all of our customers free of charge, and can be your single point of contact for the following services:

• Clinical Content Requests

• Technical Support Requests

• Product Use Support

• Product Enhancement Requests

© 2017 Truven Health Analytics LLC i

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MICROMEDEX® CAREFOCUS - USER GUIDE

24/7 Phone Support United States & Canada:

Phone: 1-800-525-9083

Select option 3 for the Support Services menu. For urgent technical inquiries select 3,3

Outside the United States & Canada:

Phone: 1-651-244-4000

Email Support (Business Hours Only) www.micromedex.com/request Email requests are answered during normal business hours. Requests received outside of normal business hours are answered the next business day.

Normal Business Hours

Monday through Thursday: 7:00 am through 5:00 pm (Mountain Time Zone). Friday: 7:00 am through 2:00 pm (Mountain Time Zone).

Outside of normal business hours, technical support calls will be managed according to the guidelines shown below:

For Knowledge Base Articles, FAQs, System Requirements, Technical Documentation, and other miscellaneous support information, please visit www.micromedex.com/support

For information on our products or services, visit our Web site at: www.micromedex.com or contact your local distributor.

General Guidelines Priority Maximum Initial Response and Assessment

After business hours:

Voice mail messages will be returned in the order they are received. Priority is assigned at that time.

Email requests received outside of busi-ness hours will be assigned a priority level the following business day.

Critical PriorityMultiple users cannot access or use major product functionality

Within 4 hours

High PriorityMissing or inaccurate data or functionality

Within 1 business day

Medium PriorityOne user cannot access or use major product function-ality

Within 2 business days

Low PriorityGeneral questions or enhancement requests

Within 5 business days


http://www.micromedex.com/request

http://www.micromedex.com/support

http://www.micromedex.com

PREFACE

TRAINING CENTER

Direct Access to Documentation

Navigate directly from any page in the CareFocus application to the Training Center to find User Guides, Release Notes, technical documents, and more. Click on an accordion bar to reveal the documentation available for download.

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TOTAL SUPPORT SOLUTIONSWe stand behind our products and our customers and believe that the total customer-experience is what differentiates us from the competition. Our solutions are the fastest, most reliable, accurate evidence-based clinical decision support solutions on the market. Our Total Support Solution offers top-notch service, training, and support to ensure you are able to realize all the benefits our products offer.

Our Total Support Solution includes dedicated personnel and robust tools and training to help you get the most from your investment in the Micromedex® 360 Care Insights solutions.

As part of our Total Support Solution we will:

• Provide flexible training opportunities, such as webinars, on-site classes, unit-to-unit specialized training, eLearning, and more, to help you and all users at your site stay current on Micromedex® 360 Care Insights solutions.

• Solve questions and issues promptly with our 24/7 technical support• Ask you for your input on how we can continue to improve our products and

services

• Make it easy to do business with us - on all fronts

Ask your Clinical Client Services Manager or Account Executive how we can help you with our Total Support Solution!


PREFACE

CONVENTIONS USED IN THIS MANUAL Certain standards and conventions have been employed in this user guide to communicate in the most effective manner possible. These standards have been used whenever possible.

Bold TextNormally, bolded text is used:

• to emphasize an important concept - or -

• to denote a clickable item on the user interface (for example, the directions may state: “Click the Button Name button...”) - or -

• to specify a menu item (for example, “...from the File > Print menu item...”)

• to identify another Truven Health Analytics product by name

Italicized TextGenerally, italics are used to denote:

• field names on the user interface (e.g., “Type ‘digoxin’ in the Field_Name field”)

• an “either-or” situation (denoted: - or -)

• window, dialog box, or page name (e.g., “the CareFocus Census page”) or a hypertext link (e.g., “the Switch to link”)

Examples, Scenarios, Screen CapturesAll examples described or shown in this guide are for training and illustration purposes only, are fully compliant with HIPAA regulations, and contain no valid patient information. Any resemblance to actual persons, patients, physicians or hospital information is purely coincidental.

Printing this GuideThis user guide has been designed in book layout, to print double-sided. If you print the guide single-sided, blank pages will print. These blank pages are intentional. You are not missing any information.

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CHAPTER 1: OVERVIEW

CAREFOCUSThe Micromedex® 360 Care Insights CareFocus patient management application identifies and manages specific patient populations, helping clinicians spend less time finding and screening patients, and more time providing care.

Using the intuitive CareFocus web-based interface (for Internet Explorer), you can specify any combination of five key data categories – account, medication, patient, order, and results – to generate a targeted list of all patients meeting the criteria. You can then assign the list to the care provider or clinical user who needs it.

The forms capture feature provides caregivers with the ability to document patient care.

How it WorksCareFocus employs a profiling engine that utilizes Boolean logic to identify patient populations with specific clinical conditions. CareFocus lets healthcare professionals spend their time delivering care instead of searching through clinical data for the relevant information. By facilitating immediate patient identification and clinical intervention, CareFocus maximizes clinician efficiency and improves overall clinical quality for any hospital.

CareFocus continuously applies clinical profiles against real-time patient data to identify those patients with Core Measure conditions, comorbidities, high-risk medication profiles, and other high-risk conditions — before their conditions become more serious. Patients who meet the hospital’s preset criteria are automatically segmented into lists that are immediately delivered directly to the desktop, smartphone, or other mobile device. Caregivers can also be notified or alerted of the new patients meeting the criteria via e-mail or text alert message.

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Pre-Configured Profiles Powered by Micromedex®CareFocus includes over 40 patient safety pre-built, evidence-based, clinical profiles developed by the same Truven Health Analytics editorial team that delivers the drug, disease, and toxicology referential content in Micromedex Solutions. The following is a sample:

• Never Events

• Early Warning/Rapid Response

• Surgery/Antibiotic Prophylaxis

• Early Sepsis

• Heart Failure

These profiles incorporate the most up-to-date protocols and guidelines to notify clinicians about patients that are at risk.

Key Benefits• Prevention of adverse drug events through targeted patient profiling and intelligent

alerting

• Provides hospitals with the ability to identify and manage specific patient populations faster and more efficiently

• Eliminates the need for clinicians to manually construct daily lists of patients who require more focused care – saving time and decreasing errors

• Enables clinicians to treat patients requiring unique care earlier – improving patient outcomes

• Reduces length of stay by facilitating the efficient identification and management of high-risk patients

• Helps hospitals comply with Centers for Medicare & Medicaid (CMS) and Joint Commission quality initiatives

• Directly impact compliance with quality measures that affect hospital reimbursement, such as “Present On Admission” and “Never Events,” by identifying patients based on targeted clinical criteria

• Enables clinicians to spend less time screening patients and more time providing care or other services

• Standardized documentation of care

The links described below are available at the top of every page in CareFocus.


CHAPTER 1: OVERVIEW

TRAINING CENTER

Direct Access to Documentation

Navigate directly from any page in the CareFocus application to the Training Center to find User Guides, Release Notes, technical documents, and more. Click on an accordion bar to reveal the documentation available for download.

HOSPITAL LINKSLinks to external Web sites and URLs can be created by your administrator and published from this drop-down list. Click the link to access the site listed.

SWITCH TOSwitch to other Micromedex 360 Care Insights products to which you subscribe.

USER NAMEThe user name of the person currently logged in is shown at the top right of the page. Hover over this area to view the available options.

My ProfileThis link presents the dialog box that allows you to alias your login, (if your administrator has chosen to enable this feature), or change your password and enter e-mail and phone information. See the Micromedex® Clinician Rounding User Guide for more information on this feature.

Log Out Logs you out of the current session.


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CHAPTER 2: CAREFOCUS CENSUS

CareFocus combines real-time patient data, clinical surveillance, and clinical decision support in one powerful interface, giving healthcare professionals unprecedented access to the answers they need to improve outcomes, reduce costs, and manage risk.

The CareFocus census page displays all of the pertinent information in a dashboard on one page.

Census information is organized into four major areas:

1. Census

2. Header

3. Medications

4. Labs & Reports


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The CensusThe census shows all patients that are currently on one of the current user’s lists, providing a quick and easy way to review the list of patients that need the user’s attention.

The census can be displayed sorted by list or by patient name. See “The Census” on page 9.



Patient Header - Demographics and DetailsA snapshot of the patient is available in this area. View the patient’s age, admitting diagnosis, any allergies, height, weight, and more from this area of the CareFocus page. See “Patient Header - Demographics and Details” on page 28.

Patient MedicationsView the patient’s drug orders or the medication administration record (if sent at your site) for this patient. See “Patient Medications” on page 47.


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Patient Labs & ReportsView the patient’s labs, tests, and reports and tell at a glance if values are High/Low or Critical. See “Labs & Reports” on page 59.



THE CENSUSAll relevant patient and clinical surveillance information can be viewed or accessed from the Census tab in CareFocus. Patients shown on the CareFocus patient list either currently meet (or previously met) the clinical criteria for inclusion on a list and/or profile, or were manually added by a user.

Users can display the census by “List” or by “Patient” sort. View the census by List to present the clinical surveillance lists to which the user is currently subscribed.

Clicking on a list name expands the list and shows all of the patients that currently meet (or

previously met ) the profile criteria for that list and their form(s) and/or labs/reports status.

Viewing Patients on the Census ListA vast amount of information is available directly from the census at a glance without having to open multiple windows or drill down for data.

When viewing the census “by List” the page displays all lists to which the user currently subscribes in alphabetical order in a collapsed layout. Clicking on the list row expands and displays the patients on the list.

When the list is expanded to show the patients on the list, the patient’s name is shown as last name, first name. Patient location, medical record number (MRN) and labs and forms status icon(s) are also shown.


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View by ListThe default census page view displays the patient census organized by list. This is denoted by the word List shown in blue font in View by in the Patient List area. Change the view to a strict patient sort by clicking on the Patient link (see “Changing the Sort Order of the Patients” on page 15).

The view you choose will persist from session to session, until you change to a different view by selection.

When the patient census is sorted by list, the page shows the user’s subscribed lists with patients who have met the list criteria.

• Lists are shown in alphabetical order in the gray expandable accordion bars and the number of patients meeting the list criteria is shown following the list name

• When the list is expanded (clicked/selected), the patient’s name is shown as last name, first name. In cases where the name is longer than the column, the name is truncated with an ellipsis (...). Hover over the name to view the name in its entirety. The patient’s location, MRN, lab and form status icons, if applicable, display to the right of their name.

Drill down one more level to see when and how the form was assigned (auto-assigned or manually assigned). Depending on the current Filter by selection, users may also see Follow Up status if it exists.



Patients with multiple forms (multiple instances of the same form) are displayed with the forms organized in chronological order, from oldest to newest.

Users are able to take action on a form (View, Complete/Uncomplete, Set/Edit Follow Up, Delete) without having to open the form.


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Expand the Patient to View Interventions

Click the patient name to view interventions (forms), meds, labs, and demographic information for this patient.

A patient can be shown in more than one list, if that patient meets the criteria for more than one list.



View by Patient

Change the patient census view to a patient sort by clicking on Patient in the View by: area. The sort you choose will persist from session to session, until you change to a different sort selection.

When the Patient view is selected, users see all of the lists the patient is on if the patient is visible on at least one List to which the user has subscribed. Whereas, in List View users see only the Lists to which they have subscribed.

Further, whether or not a patient is visible on the user’s census is determined by the List subscription AND the Filter selected.

Note: When viewing a patient in Patient View, all lists that a patient is currently on (meets profile criteria) are displayed as long as the user subscribes to at least one of the lists. For more information on how and when patients are displayed on the Census, see “Forms: Filter by...” on page 20.


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Census IconsCensus icons quickly depict the most critical status that exists for the patient (or list).

List/Patient IconsWhen the census is collapsed, the iconography still portrays important information to the clinician such as the list name, total number of patients on the list, and the most critical form status.

When in the List View:

When in the Patient View:

Additional status icons (e.g., or or or or etc.) signal to the user that an alert or form status exists. Hover over the icon to view a pop-up with a short description of what the icon signifies.

See “Labs, Reports, Isolation Status Icons” on page 17 and “Form Status Icons” on page 18 for a complete list of the icons and their meaning.

Icon Description

Unselected List

Lists are shown collapsed by default until selected, with light gray background row color and a black icon - until selected.

Selected List A List that has been selected (clicked) is shown with blue background row color and a white icon.

On ProfilePatient is currently meeting the profile criteria for this list.

Off Profile Patient met the profile criteria in the past, but no longer meets the criteria.

Icon Description

Unselected Patient

Patients currently on a list are shown with light gray back-ground row color and a black icon until selected.

Selected Patient

A patient that has been selected (clicked) is shown with dark gray background row color and a white icon.

On Profile Patient is currently meeting the profile criteria for this list.

Off Profile Patient met the profile criteria in the past, but no longer meets the criteria.



Changing the Sort Order of the PatientsThe sort order of the patients can be modified to sort by:

• Location• Name (default)• Medical Record Number (MRN)• Follow up Date

Find the Patient sort: in the Patient area and click on the desired sort. This selection is saved for future sessions and persists until you change the selection to something else.

Note: In some settings, a patient may appear more than once on a census. The most common scenario is when a patient is discharged/re-admitted within the census haircut time frame. For example, if a patient was seen in the emergency department on 12/1/2012 - then subsequently admitted as an inpatient on 12/2/2012, the patient may appear twice. Another, less common scenario: When internal departments (e.g., chemo, dialysis, etc.) treat an inpatient using a different outpatient account, they may appear once for each account number used.


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Viewing Patients on the CensusClick on a collapsed list name to expand the information and view the patients currently meeting the profile criteria for the list.

Viewing Forms, Labs, Medications, and ReportsClick the patient name to see the additional information available for that patient such as: forms, medications, labs, reports and demographic information.

Note: A patient can be shown in more than one list if that patient meets the criteria for more than one list.



Status Icons & Alert Indicators on the CensusIcons are used on the CareFocus user interface to denote an important alert or form status for the patient.

You can quickly understand the status of patients by scanning the icons associated or assigned to the patient.

Icons in CareFocus can depict both the current status of the patient’s form and alerts regarding their labs, reports, or isolation status.

* For details and step-by-step instructions regarding patient forms, see Chapter 3: Forms on page 71.

Labs, Reports, Isolation Status Icons

Icon Description

This patient has met the “Isolation” profile.

New results (Labs or Reports) are available for this patient.

Critical results (Labs or Reports) are available for this patient.


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Form Status Icons

When the census is collapsed, the most critical form status that exists for the List (when viewing by list; for patient when viewing by patient) is shown using the Hierarchy Icons. The following example shows the Census view by List:

Form Status Icon Forms Status (Hierarchy Level Icons)

New Form A new form has been assigned to the patient that has not been opened/saved.

At least one New Form has been assigned.

Follow Up Due The follow up time period set has elapsed and the patient is due for follow up.

At least one form in current sta-tus of Follow Up is Due exists.

In Progress The form has been opened and saved; form is considered to be "In Progress". No follow up has been set.

At least one form is In Progress.

Follow Up Set A follow up time period has been set.

At least one form in current status of Follow Up Set.

Completed Form The form has been completed.

All forms are Completed.



As the list or patient accordion is expanded, the specific form status icons are shown. When the list is expanded, then the most critical form status icon for the individual patient is shown.

Form Status Representation on the Census (Icon Hierarchy)When multiple forms exist, it is crucial that clinicians are able to see the status of the most critical forms so they know where to direct their attention first.

The Census Filter (Active Patients | Follow Up Forms | Incomplete Forms | Completed Forms | All) controls the census view and follows all rules for which patients to display. The Forms status is applied and the census displays the appropriate icon based on a prioritized hierarchy:

The icon shown is indicative of the 'rolled up' hierarchy of status and displays the most critical state of any form assigned.

In List View:

The roll-up (collapsed accordion view) of the form status hierarchy when viewing the census by List:

1. New = at least one patient on the list has a new (never saved) form.

2. Follow Up Due = there are no new forms, but at least one patient has a form where follow up is due.

3. In Progress = there are no patients with new forms or forms with follow up due, but at least one patient has an in progress form.

4. Completed = all patients on the list have completed forms (no new, due, in progress, or follow up set).

5. No icon = no patients on the list have forms assigned.

In Patient View:

The roll-up (collapsed accordion view) of the form status hierarchy when viewing the census by Patient:

1. New = the patient has at least one new (never saved) form.

2. Follow Up Due = there are no new forms, but the patient has at least one form where follow up is due.

3. In Progress = there are no new forms or forms with follow up due, but the patient has at least one form in progress.

4. Completed = all forms have been completed (no new, due, in progress, or follow up set).

5. No icon = no forms have been assigned to this patient.


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CareFocus determines the “most critical form status” according to the following hierarchy:

Forms: Filter by...The status of the profile and/or form also dictates when the patient appears on the census based on the Forms Filter selected:

Active Patients Filter (default)

A patient is considered an "Active Patient" if they are On Profile (even if they have no forms assigned) OR when they meet at least one of the following conditions:

• A new form

• A form with a Follow Up Due

• A form in progress

Note: Patients will be displayed in the "Active Patients" filter even if they have no forms assigned if they are currently meeting the Profile (ON Profile) >Deleted forms behave the same as no forms assigned >Users will not see a patient that no longer meets profile criteria (Off Profile) who never had a form assigned (or off profile and their forms were deleted)



The following table shows what patients will be visible on the census for each Filter based on the patient profile status (On or Off profile), and the forms assigned:

Viewing the Census View by List

The View by: and the Filter settings control which patients are displayed on the census page for the user. The table below describes the View by: List display.

Viewing the Census by Patient

The View by: and the Filter settings control which patients are displayed on the census page for the user.

If the patient is - On or Off Profile but On a Subscribed List: • If a patient is on at least one of the user's subscribed lists, they are visible based on

the filter selected. • When viewing a visible patient, the lists shown are based on the filter selected.

If the patient is - On Profile, but Off All Subscribed Lists: • If the patient is off all of the user's subscribed lists, they are not visible in the census.


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The following table below describes the View by: Patient display:

For example:

Patient “A” currently meets two profiles:

• Profile 1 (on List 11) and has a Form assigned with Follow up set.

• Profile 2 (on List 22)

User subscribes only to List 22 and is viewing the Census by Patient

With the Filter by: set to All - the user sees List 11 and List 22 for Patient “A”

With the Filter by: set to Incomplete Forms - the user does not see Patient “A” because the patient does not have an incomplete form on the user’s subscribed list (List 22).



Filtering the Census Display: Lists and UnitsBy default, the settings for the census display will show ALL of the user’s subscribed Lists for ALL Units. You can quickly change these settings (which will persist until changed again) to better reflect your current workflow or information needs.

View Specific Lists or UnitsThe Lists or Units shown on the census page can be quickly modified by clicking the list or unit drop-down and selecting the desired settings. To select a specific list click on the list name in the drop-down menu. To select multiple (but not all) units, simply click the appropriate unit checkboxes. The census immediately refreshes to reflect your filter choices.


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Managing List Subscriptions Patients displayed on a census are controlled by the user’s List subscription. Subscribing to specific lists ensures that clinicians are able to easily locate and work with the patients in their care. Each user is able to view and modify (if granted subscription permission by the administrator) their subscriptions.

1. View and/or modify the lists available on by clicking the Manage Lists icon at the top of the census page.

The Manage Lists window opens.• Filter the window to show only a specific list type (All, Physician, Physician Group,

Unit, Profile, or Service) by clicking the List Type drop-down• Search for a list by typing the name in the Search For field, then click Find

2. To add a list - click on the list in the Unsubscribed Lists box and click the arrow pointing to the right. To remove a list - click on the list in the Subscribed Lists box and click the arrow pointing to the left.

3. Click the Close button to save your changes.

Tip: View the users also subscribed to a list by clicking on the list name. Subscribed members are shown in the field on the bottom of the dialog box.



Searching for Patients

Find patients quickly by searching on their last name or their medical record number (MRN). Also use this feature to add a patient to a your list.

1. Click on the search icon.

2. Type the search criteria (at least three characters or numbers) in the Search field.

3. Click the Include Outpatient checkbox to change the search to include Outpatients if desired.

4. Press the Search key.• If only one match is found from within the subscribed list(s) - the patient is

automatically selected in the census; medication and lab details are shown with expanded patient census information.

• If multiple matches are found from within the subscribed list(s) - the left side of the page is shown with the patient matches in collapsed, gray accordion bars (no meds/labs details shown)

• If only one match is found from outside the subscribed list(s) - the patient is selected, medication and lab details are shown with the option to add the patient to one of the user’s subscribed lists.

• If multiple matches are found from outside the subscribed list(s) - the left side of the page is shown with the patient matches in collapsed state (no meds/labs or patient details shown). Clicking on a patient from the search results opens the patient details, meds, and labs, as well as the option to add the patient to your census.


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5. Click the Add to list drop-down and choose the list you want to add the selected patient to, then click OK.

Print the Census The census can be printed by the List View or the Patient View. Current selections for Lists, Sort, etc. are reflected in the printed report.

1. Click on the print icon .

2. Select the List View, the Patient View, or the MAR Report.

3. Click Print.

4. The report opens in Adobe Acrobat® PDF format in a new window.

5. Close the window to return to CareFocus.

MAR ReportThe printable MAR Report enables continuation of safe clinical care in the event of HIS downtime. This report provides clinicians with easy access to ordered, and already administered, medication information for their patient population.

The printable format supports the need to manage medication administration until access to the HIS is restored and documentation in patients' historical records can occur.

The report includes all active medication orders and administration records within last 24 hour window. Held and discontinued medications are not included in the MAR report.

Following the table of medications for each patient a signature section is available for clinicians to write their initials and signatures.



ention

Refresh

Refresh your page to display up to date results and information by clicking the icon.

Note: Census page filter selections (e.g., Lists, Units) are maintained in the report, but ALL intervform statuses are included regardless of current selection.


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PATIENT HEADER - DEMOGRAPHICS AND DETAILSA snapshot of the patient is available in the patient demographics and details area.

View the patient’s age, admitting diagnosis, any allergies, height, weight, and more from this area of the CareFocus page.

Patient DemographicsThe following information is displayed in the patient details area:

• Patient name - last name, first name

• Date of Birth, Age

• Date of Admission and length of stay (LOS)

Hover over the patient name to see Alternate ID (if applicable). Hover over the Age to view Race and Gender.

If the patient name is too long to display in full, it is denoted with the ellipses (...) as shown in the example.

Note: The amount of information for the areas described below at your facility will depend on the data that is available and sent from your HIS system.



Patient Information

• Allergies: Any allergies listed for the patient in the HIS system are displayed. If any of the information is truncated in the allergies field, hover your cursor over the area to view a pop-up with all allergies listed.

• Additional patient information is shown to the right:

• Dx - Admitting diagnosis (or top problem). If other diagnoses exist, they can be viewed by hovering your cursor over the Dx area and a pop-up box appears with the additional diagnoses.

• MD - The primary or attending physician is listed in this area, but other caregivers may be providing care. Hover your cursor over this area to view a pop-up listing any additional caregivers for this patient, such as consulting physician.

• Height - Values shown for height are those passed by the HIS. Hover your cursor over the field to view the value converted to US Units of inches for patients showing height in centimeters or meters. Patient height value is shown including decimals.

• Weight - Values shown for weight are those passed by the HIS. Hover your cursor over the field to view the value converted to US Units of pounds for patients showing weight in kilograms or grams. Patient weight value is shown including decimals.

• BSA - Body Surface Area is shown if it has been passed by the HIS. The units cannot be converted for this information.

• CrCl - Creatinine Clearance is shown if passed by the HIS or calculated based on patient values and Cockcroft-Gault and Schwartz formulas (adult and pediatric patients). The units cannot be converted for this information. Hover over the CrCl value to open a pop-up which provides the source of the CrCl value (HIS data feed or calculated). To view the formula used for the calculated value, click the "More detailed information can be viewed here" link.

• IBW - Ideal Body Weight is calculated and shown if the body surface area value is passed by the HIS. Hover your cursor over the field to view the value converted to US Units of pounds.


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Profiles Met

If the selected patient has met the criteria for one or more profiles, it is noted in this area of the patient header. The number of profiles met is shown in parentheses next to the Profiles met link.

The Profiles pop-up shows which profiles the patient currently meets, as well as profiles they met in the past. The green and gray patient icon reinforce the On or Off Profile status. In addition to the profile name, you can also see what List the patient is/was on as a result of meeting the profile criteria.

To view the profile elements and see exactly what criteria this patient met for this profile, click on the profile name.

Note: The system displays the Profiles Met and Historically Met Profiles for the account currently being viewed, but it is not a holistic view of all of the patient’s accounts.



Profile Criteria MetFull details of how this patient met the profile criteria are available by clicking on the profile name in the drop-down. The profile elements and whether or not the patient met the criteria are shown for each element.

In the example shown, the Profile Criteria window shows the element where the patient met the criteria by showing the . Likewise, elements that did not apply to the patient are represented by the icon.

Since the items in the example shown here are bound by the OR operator, the patient still meets the profile criteria even though he does not meet the results conditions shown.

Viewing Completed FormsQuickly view all Completed Forms for a patient from a link in the patient header.

When completed forms exist for a patient, they can be viewed in summary and in detail. Click the Completed Forms (#) link in the patient header area of the census page (shown to the right of the Profiles Met link). Click the form name link to view form details. The completed form can be uncompleted when viewing.

Completed forms are available until archived according to the setting established at your site (typically 60 to 90 days).


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Other Filters/Controls/Navigation Links in the Patient Header

Date RangeThe date range selection allows you to view a custom time-frame for medications, labs & reports.

Hover your cursor over the current date range field to open the available date range options. Select from:

• 24 hours

• 48 hours

• 5 days

• 7 days

Meds, Labs & Reports View FilterThis filter allows you to select a view for the medications, labs and reports customized for your patient’s condition or drug therapy. Select from one of the pre-defined views, or select to view all:

• (All) - displays all medications, all labs and all reports mapped from the HIS. The order of the items shown can be customized for your use. See “Changing Order Preferences for Labs and Reports” on page 33.

• Default - based on input from pharmacists, this view displays all medications, and the most commonly used/viewed labs and reports. For a complete list of the labs and reports included in the default view, see “Labs and Reports in the Labs & Reports View Filter” on page 35.

• The remaining view options: Aminoglycoside-Vancomycin, Digoxin, Theophylline, Anticonvulsant, and Anticoagulation are designed to show the pharmacist the most relevant information for their patient’s condition or medications.

Note: A complete list of the medications, labs and reports that are shown for the Aminoglycocide-Vancomycin, Theophylline, Anticonvulsant, or Anticoagulation view can be found in “Labs and Reports in the Labs & Reports View Filter” on page 35.



Changing Order Preferences for Labs and ReportsWhen the Meds, Labs & Reports View is set to (ALL), an (Edit) link is shown immediately to the right.

The Edit link allows you to customize the display order of labs and reports (by type) to accommodate your preferences.

1. Click the (Edit) link to open the lab and report type dialog.

2. Click and drag an item to the desired location.

3. Release the mouse button when the cursor is over the desired location.

4. Click Save to save your changes.

Changes to the order for Labs and Reports will remain in place from patient to patient, and session to session, until you change the view again.

Note: The order preferences established here is applied to all patients. If you are using CareFocus on your handheld device, the order preferences are synchronized to the device as well.


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Lab and Report GroupsThe items in the lab and report dialog are common lab and report groups. Some of the standard groups are:

Group Description

CBC Complete blood count

BMP Basic metabolic panel

COAG Coagulation panel

F.Y.I. Shows shared Scribble notes and Shared Messages from Micromedex® 360 Care Insights applications.

RADS Radiology reports

PATH Pathology reports

MICRO Microbiology reports

I/Os Trended by shift in descending chronological order

VITALS Trended by the time they were taken

HT/WT Height and weight

OTHER Discharge summaries, admission notes, history and physicals, reports, etc.

MISC Lab panels that do not fit into any of the displayed categories

NURS Nursing Observations

T

Note: The available labs and reports at your site may vary depending on the data available from your HIS.



Labs and Reports in the Labs & Reports View FilterDEFAULT VIEWGroup DescriptionMEDS AllMISC

Any of the following drug level results:

AcetaminophenAmikacinCarbamazepineCyclosporineDigoxinGentamicinLithiumPhenobarbital

PhenytoinSirolimusTacrolimusTheophyllineTobramycinValproic AcidVancomycin

BMP CR BUNK NA

CL CO2 GLU

CBC HGBHCT

WBCPLT

COAG INR PT PTT

HT/WT WT HT

VITALS SBP DBPTEMP

I/O(24) IN OUT NET

MICRO AllRADS AllPATH AllOTHER Progress Notes

Nursing NotesHistory and Physical

Operative ReportConsultation report

AMINOGLYCOCIDE-VANCOMYCIN VIEWGroup DescriptionMEDS Amikacin

GentamicinTobramycinVancomycin


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MISC Any of the following drug level results:Amikacin levelsGentamicin levelsTobramycin levels Vancomycin levels

BMP CR BUN

GI ALB AST ALKP ALP TBIL

MICRO culture and sensitivity tests CBC WBC

PLT HCT HGB

VITALS SBP DBP HR RESPTEMP

DIGOXIN VIEWGroup DescriptionMEDS DigoxinMISC Digoxin Level

TSHBMP CR

BUNK NA

LYTES MGCA

VITALS SBP DBPHRRESPTEMP

OTHER Echocardiogram report

AMINOGLYCOCIDE-VANCOMYCIN VIEWGroup Description



THEOPHYLLINE VIEWGroup DescriptionMEDS Theophylline

AminophyllineMISC Theophylline Level

PFTIRONFERRITIN

GI ALBASTALKPALPTBIL

VITALS SBP DBPHRRESPTEMP

OTHER Echocardiogram report

ANTICONVULSANT VIEWGroup DescriptionMEDS Carbamazepine

PhenobarbitalPhenytoinValproic Acid

MISC TSHCarbamazepine level Phenobarbital level Phenytoin level Valproic Acid level

CBC WBC PLT HCT HGB

GI ALB AST ALKP ALP TBIL Amylase


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BMP CR BUN K NA CL CO2

LYTES MG CA

VITALS SBP DBP HR RESP TEMP

OTHER EchocardiogramCOAG INR

PT APTT

ANTICOAGULATION VIEWGroup DescriptionMEDS Antithrombin

ArgatrobanAspirinBivalirudinClopidogrelDalteparinEnoxaparinFondaparinuxHeparinLepirudinProtamineTinzaparinVitamin K (or Phytonadione)Warfarin

CBC WBC PLT HCT HGB

GI ALB AST ALKP ALP TBIL

BMP CR BUN

ANTICONVULSANT VIEW



VITALS SBPDBP HR RESP TEMP

COAG INRPTAPTT

ANTICOAGULATION VIEW


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Notes

Notes, messages, and observations can be entered for a patient using the Notes link located in the patient header area.

A note added to a patient can be saved for viewing by other CareFocus users or shared across the entire 360 Care Insights Suite (Clinician Rounding, Pharmacy Intervention, Infection Prevention, etc.).

When viewing the notes for a patient, messages displayed in bold font were created outside of CareFocus.

1. Click the Notes link to open the Patient Notes dialog.

2. Type your note in the Add Message field.

3. To make this note visible to all caregivers who may have this patient on their list, click the Publish all message as an F.Y.I report checkbox. Publishing messages as an F.Y.I. shares the message to users even outside of CareFocus.

4. To keep this note private, leave the checkbox unselected.

5. Click Save and Close.

Note: A warning message displays if you type a note and then attempt to leave the Notes display by: selecting another patient on the census, switching to a different application, exiting the Notes display by using the ‘X’ in the top right of the dialog window, etc.



Orders

CareFocus users have access to all patient orders.

1. Click the Orders link located in the patient header area of the page.

2. Change the filter drop-down selection if you do not want to view all orders.

3. Change the order of the order types displayed if you wish to re-configure the ranking order shown. Once saved, your setting is saved indefinitely, or until you change the selections again.

4. View order details by clicking on the green triangle in line with the order.

5. Click Close to return to CareFocus.


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Demographics

Click the Demo button in the patient header area to view additional information for the patient such as: account information, contact names/numbers, insurance information, next of kin, or scheduled appointments.



Calculators

Calculators in the Patient Header All of the calculators in Micromedex® Solutions can be accessed from the Patient Header Demographics and Details area in CareFocus.

The calculators are grouped into logical areas to make it quick and easy to find the calculator you need. However, if you want to browse a full alphabetical list of all the calculators, click the View Alphabetical List link.

Note: Calculations performed by clicking this link do NOT become part of the form history.


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Calculator Descriptions

Antidote Dosing Calculators and Nomograms

Alcohols/Ethylene Glycol Blood Level

Provides levels for a single, acute ingestion.

Calculate the blood levels for: ethanol, methanol, ethylene glycol, or isopropyl alcohol.

Ethanol/IV Dosing for Methanol/Ethylene Glycol Overdose

Options are available to calculate for initiation of therapy, or to adjust a maintenance dose based on plasma level.

NAC Dosing for Acetaminophen Overdose

Calculates acetaminophen overdose treatment based on the patient’s weight, including the loading dose and maintenance dose.

Toxicity Nomogram

Calculates the toxicity risk of Acetaminophen. You provide the blood plasma level (and unit measurement: mcg/ml, mg/dcl or SI Units) as well as the time since ingestion of Acetaminophen.

Results can be displayed in graph or table format.

Laboratory Values

Anion Gap Calculator

Enter the sodium, chloride, bicarbonate, and potassium levels to calculate anion gap.

Creatinine Clearance Calculator

Enter the values, such as body weight, age, and gender, for on-demand creatinine clearance calculations.

Phenytoin Level Adjustment Calculator

Utilized by clinicians to adjust reported serum phenytoin levels in patients that have low serum albumin levels or renal impairment. Hypoalbuminemia and/or renal impairment changes the binding affinity of phenytoin, which results in a reported total phenytoin level that is of little value clinically. This calculator estimates what the total phenytoin level would be if the patient did not have these comorbid conditions.

Dosing Tools

ACLS/PALS Guidelines

Based on pediatric or adult weight, (in kilograms or pounds) this calculator displays the American Heart Association medication and recommendation guidelines for ACLS/PALS/neonatal resuscitation.



Dobutamine Dosing Calculator

It calculates based on weight (kg/lb) and the initial dose. Results are in mcg/kg/min with the selected solution.

Dopamine Dosing Calculator

It calculates based on weight (kg/lb) and the initial dose. Results are in mcg/kg/min with the selected solution.

Epinephrine Dosing Calculator - Adult or Pediatric

Epinephrine calculators are offered for Pediatric or Adult patients. The pediatric calculator factors in the weight (kg/lb) of the patient in the calculated dose.

Heparin Dosing Calculator

Formulates recommendations based on weight (kg/lb) and units/ml.

IV Rate Calculator

Enables clinicians to quickly and easily determine the infusion rate for medications that require complicated calculations. This flexible dosing tool is not specific to a particular drug, but calculates an infusion rate for a variety of medications, dosing options, and solution concentrations.

Nitroglycerin Dosing Calculator

Dosing calculations are for adults only (weight >= 40 kg). Calculations are not based on patient weight. Recommendations can be calculated based on concentration and mcg/min and whether or not the patient is on fluid restriction.

Nitroprusside Dosing Calculator

Calculations are based on patient weight (kg/lb) and mcg/kg/min and the concentration of the solution used.

Norepinephrine Dosing Calculator - Adult or Pediatric

Norepinephrine calculators are offered for Pediatric or Adult patients. The pediatric calculator factors in the weight (kg/lb) of the patient in the calculated dose.

Clinical Calculators

Alveolar-Arterial Oxygen Gradient

Allows you to calculate the alveolar oxygen concentration and gradient with notes related to the results obtained. You can also determine atmospheric pressure for a specific area or country.

Measurement Calculators

Body Mass Index Calculator

Body Mass Index (BMI) is a calculated value that shows body weight adjusted for height and indicates the weight status in adults. Calculates BMI based on weight (kg/lbs) and height (cm/in).


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BSA and Lean/Ideal Body Weight Calculator

Calculates body surface area and lean ideal body weight based on age, weight, height, and gender.

Metric Conversions Calculator

Provides conversions between Metric and English standard units for many common conversions utilized in clinical practice. The conversions include measurements of weight, length, volume, temperature, and parts per million.



rd

PATIENT MEDICATIONSThe Patient Medications area shows pharmacy orders (or medication administration records, depending on your configuration and HIS) for the patient. Results are shown in a trended, chronological order, with the most recent items shown first.

The default time range shown is to show the past seven (7) days. This value persists until changed by the user.

The default filter view is the default view. This filter selection persists until changed by the user.

IV Mixtures in the Medication Area

CareFocus limits the display of complicated IV mixtures to the first three components.

For example: Total parenteral nutrition (TPN) orders often have 15-20 ingredients that are itemized as medication components. CareFocus attempts to refer to the solution by its overall name, and then lists up to the first three components provided by the pharmacy system. These data are sufficient to communicate that the TPN order is active, but you may need to refer to the pharmacy system to confirm that, for example, Zantac is being added to the solution.

Filtering the Medications DisplayCareFocus users have the ability to show patient medication information in specified time frames of the past: 24 hours, 48 hours, 5 days or 7 days. The amount of information displayed can be affected by the date ranges selected.

Note: This page may also display Order information only, or the full Medication Administration Reco(MAR) if that information is configured to be sent from your HIS system.


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See “Date Range” on page 32 in the Other Filters/Controls/Navigation Links in the Patient Header section for more information on changing the date range shown.

Meds, Labs & Reports View Filter

The Meds, Labs, and Reports View filter allows you to select a custom view of the medications (and labs and reports) that focuses on a specific condition or therapy.

See “Meds, Labs & Reports View Filter” on page 32 in the Other Filters/Controls/Navigation Links in the Patient Header for a full description of each filter.

Viewing MedicationsThe medications area can relay a large amount of information to the CareFocus user without having to use a lot of space on the page.

Medications are shown in CareFocus grouped by:

• Active - if the medication was active during the time frame selected, it is shown in the Active medication group

• PRN - orders for PRN medications are shown if the order/administration was active during the time frame selected for view

• Held - shows medications that were active during the time frame, but have been put on hold

• Discontinued - shows medications that were active during the time frame, but have been discontinued

Clicking on a medication group accordion bar expands/collapses the detailed information about the medications included in that group.

CAUTION

! A filter can affect the list of medications displayed. To view all medications, change the filter to the (ALL) or Default selection.



Medications Shown Using REGULAR, ITALICIZED, or GRAY font • Medications shown in REGULAR font denote a medication that has been mapped to

the Micromedex drug name

• Medications shown in ITALICIZED font denote a drug that has not been mapped to a corresponding Micromedex drug name.

• Medications depicted with a GRAY font denote a drug that was active at some time during the currently selected time frame, but it has since been discontinued.

The Plus Sign (+)

When there are multiple entries for a single cell on the medication display, the most recent value is shown in the cell and a plus sign (+) and the number of additional values that are available for that day (cell) it is shown in a circle. For example: a +1 means that the displayed entry plus one more entry exists for that day. A +3 means that the displayed entry plus three more entries exist for that day.

Hovering over the circle opens a pop-up with the full MAR details and information.

Dashes on the Meds Display --

Two dashes (--) in a cell denote that no values or entries exist for that day. Hovering over that cell will cause a pop-up to display the message “No data available”.

Moving forward > or back < in the date range display

You can move the display to dates beyond the range you are currently viewing by clicking the arrows in the More meds and labs area. The right arrow (>) moves to dates that are older. The left arrow (<) moves the display to dates more recent.

If you are viewing a time frame other than that of seven days, you will receive confirmation that the time frame will be changed to seven days. Click OK to continue.


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Glinting

Cells shown with a yellow background and bold, red font denote that an administration was: missed, partial, refused, etc. Sites have the ability to configure the various medication administration statuses (MAR status). When configured, the glinting is enabled to show when an administration is considered incomplete.

View Order and Medication DetailsHover over or click on a drug. A pop-up opens, displaying the full drug name, route, strength order information and details and any note attached to the drug.

Single Drug IV Compatibility (including TPN/TNA & Solution compatibility)

Hovering over an intravenous drug may also include the IV icon in the pop-up. Clicking the IV icon will allow you to see Micromedex Solutions single drug IV compatibility information, including TPN/TNA and Solution compatibility with the drug. See “IV Compatibility Results” on page 51 for additional information on IV Compatibility.

When you hover over or click on an unmapped drug, a message stating which list the drug was not mapped to (drug or iv drug list or both) is displayed.

Drug Information in Micromedex Solutions

Click the FIND IN MICROMEDEX 2.0 button to go directly to the drug dashboard in Micromedex. From the dashboard you can choose the exact area you are interested in viewing (such as, Dosing, Contraindications, Adverse Effects, or to compare the drug side-by-side with another drug). See the online HELP or the User Guide available within the application for additional information.



IV Compatibility ResultsHovering over an intravenous drug name and clicking the IV icon in the pop-up displays the IV Compatibility Results in Micromedex Solutions.

Solution (compatibility in common solutions), Y-Site, Admixture, Syringe, and TPN/TNA (compatibility with TPN/TNA therapies) results are separated on five tabs, so you can quickly access the most applicable information.

Compatibility is denoted by an icon (on the right) and simple description/link (on the left). A legend at the bottom of the page lists all compatibility types, and hovering your mouse over the icon will open a pop-up with the full compatibility description. The full descriptions follow:

• Compatible - All studies showed these items as compatible

• Caution: Variable - Study results show IV compatibility is variable

• Incompatible - All studies showed these items as incompatible

• Uncertain - Study results were inconclusive, compatibility wasn’t determined

• Not Tested - IV compatibility has not been tested

The Compatibility: drop-down shows all compatibilities selected by default. Remove any compatibility indicator by de-selecting it and clicking the Update button.


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To modify the drug being checked, click the Modify Compatibility button.

View Drugs and Solutions Data Parenteral drugs and solutions are administered by injection, most often intravenously, but also commonly by intramuscular and subcutaneous injection. To prevent adverse effects, it is important to have access to relevant characteristics of parenteral products, such as pH, compatibility and stability, and proper rate of infusion. This information is critical in making decisions related to the preparation, storage, and administration of parenteral products.

Click on the icon next to the drug to view drugs and solutions data.

Tip: Online help is available for the IV Compatibility tool (and any other feature in Micromedex®) by clicking the HELP link located on the top right side of the page.



Common SolutionsSolution compatibility is provided for common and other standard IV fluids.

Common Solutions:• D5W - D5W-Dextrose 5%

• D10W - Dextrose 10%

• D5LR - Dextrose 5% in lactated Ringers

• D5NS - Dextrose 5% in sodium chloride 0.0%

• D5W - 1/2 NS - Dextrose 5% in sodium chloride 0.45%

• NS - Normal saline - sodium chloride 0.9%

• 1/2 NS - sodium chloride 0.45%

Where detailed results are available, the solution is shown as an active link. Click the solution link to view the additional information.

References for the information can be found by clicking the numbered link. Close the Compatibility Details by clicking the Close link.

Other Solutions can include Dextran, Dextrose, Fat emulsion, Fructose, Isolytes, Lactated Ringer’s, to name a few.


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Click on a tested solution link to view the compatibility details.

Solution compatibility details are shown in a five-column table:

• Drug 1 contains the drug name, the concentration, and the manufacturer's name

• Drug 2 shows the fluid and manufacturer's name

• Status column lists the compatibility result icon and description

• Information displays the physical compatibility, chemical stability (if applicable), and storage information

• Test Parameters contains a referenced link, the study period, the study methods, and the container information for this particular combination

• Notes for the test (if applicable) are shown in red text at the top of the detailed study information



Y-SiteClick on a drug name to see detailed Y-Site results for that drug in combination with the drug from the patient’s drug list.

Y-Site compatibility details are shown in a five-column table:

1. The the drug name, the concentration, and the manufacturer's name.

2. The secondary agent name, concentration, and manufacturer's name.

3. The the compatibility icon and description.

4. The the physical compatibility, chemical stability (if applicable), and storage information.

5. The link to the reference, the study period, the study methods, and the container information for this particular combination

Notes for the test (if applicable) are shown in red text at the top of the detailed study information


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AdmixtureFrom the Admixture tab click on a drug name to see detailed compatibility results for that drug in combination with the drug from the patient’s drug list.

Admixture compatibility details are shown in a five-column table:

1. The drug name, the concentration, and the manufacturer's name.


3. The compatibility icon and description.

4. The physical compatibility, chemical stability (if applicable), and storage information.

5. The link to the reference, the study period, the study methods, and the container information for this particular combination.




SyringeFrom the Syringe tab click on a drug name to see detailed compatibility results for that drug in combination with the drug from the patient’s drug list.

Syringe compatibility details are shown in a five-column table:

1. The drug name, the concentration, and the manufacturer's name.


3. The compatibility icon and description.

4. The physical compatibility, chemical stability (if applicable), and storage information.

5. The link to the reference, the study period, the study methods, and the container information for this particular combination


In cases where the drug was not tested with a listed drug, (Compatibility = Not Tested) there is no link to further information.


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TPN/TNA Overview information for the drug TPN (2-in-1) (total parenteral nutrition), followed by TNA (3-in-1) (total nutritive admixture) compatibility is displayed on the TPN/TPA tab.

Within each TPN/TNA grouping, the results are sorted alphabetically by TPN or TNA admixture name, with the associated compatibility icon and description, followed by high level notes, including composition of the TPN/TNA, on these tests.

Click the admixture name link to view the details of these tests.

Note: TPN and TNA results are not result type specific. They can be a Y-Site, solution, or admixture result. Results are comprised of all compatibility tests where the drug name searched is being included with a TPN or TNA solution.



LABS & REPORTSThe Labs & Reports area provides a comprehensive summary of all clinical results, including reports, lab results, and F.Y.I. (Scribble) data. The Labs & Reports area indicates how many total results are available, as well as how many results are available for each lab group or report type.

Viewing Labs & ReportsThe Labs & Reports area delivers a large amount of information to the CareFocus user without using a lot of space on the page.

Lab & Report names are abbreviated (i.e., WBC = white blood count) and are listed in the first column.

Note: The order that labs & reports are displayed can be modified. See “Changing Order Preferences for Labs and Reports” on page 33 for details and instructions.


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The type and amount of information shown will vary depending on the date range selected (24 hours, 48 hours, 5 days or 7 days), and the Meds, Labs & Reports View Filter. See “Date Range” on page 32 and “Meds, Labs & Reports View Filter” on page 32 for details on how these settings affect your Labs & Reports display.

Normal, Abnormal, and Critical ResultsThe value of the result is depicted using font weight and color.

• Lab values within the Normal range (within your facilities established reference range) are shown with REGULAR BLACK FONT. Hover your cursor over the result to view summarized result information.

• Results flagged as Abnormal (results that fall just outside [HIGH/LOW] the established reference range) are displayed using BOLD BLACK FONT. Hover your cursor over the result to view summarized result information. The pop-up indicates the Normal reference range as well as whether the result is considered high (*H*) or low (*L*).

• Lab values considered Critical (well outside the reference range) are depicted using BOLD RED FONT and the entire cell background is filled yellow. Hover your cursor over the result to view summarized result information. The pop-up indicates the result is either very high (*VH*) or very low (*VL*).



The Plus Sign (+)

When there are multiple entries for a single cell on the display, the most recent value is shown in the cell and a plus sign (+) and the number of additional values that are available for that day (cell) it is shown in a circle. For example: a +1 means that the displayed entry plus one more entry exists for that day. A +3 means that the displayed entry plus three more entries exist for that day.

Hovering over the circle opens a pop-up with summary results information.

Dashes --

Two dashes (--) in a cell denote that no values or entries exist for that day. Hovering over that cell will cause a pop-up to display the message “No data available”.

Moving forward > or back < in the date range display

You can move the display to dates beyond the range you are currently viewing by clicking the arrows in the More meds and labs area. The right arrow (>) moves to dates that are older. The left arrow (<) moves the display to dates more recent.

If you are viewing a time frame other than that of seven days, you will receive confirmation that the time frame will be changed to seven days. Click OK to continue.


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View DetailsClick on any result value to open the details of this result. The results for the full group (CBC in the example, even though HGB was clicked) opens. The most recent test date is displayed. Use the Next and Previous buttons to display results for other dates.

You can print just the selected result, or print the full group of results.



Parking Pop-Up WindowsLabs, results, and reports open as pop-up windows on the work space and can be moved or re-sized as needed. Multiple results can be opened at one time for a patient, thus allowing the clinician to reference all relevant information (interventions, labs, reports) for the patient.

To keep these windows organized, you may find the Park Up and Park Down functionality helpful. Pop-up windows can be “parked” to allow you to keep the window at your fingertips, but collapsed and moved out of the way.

With one or more pop-up windows open, hover over the “-” in the upper right corner. The hover text displays, “Park Up.”

For safe patient care practice, all open pop-up windows close automatically when switching to another patient or to a different application (e.g., Infection Prevention). This is a safeguard to ensure that only information about the current patient is being viewed.


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When the pop-up has been parked, hover over the “-” to re-open the window to show the pop-up details.

View the Date the Lab was Last Performed1. Hover or click on any lab or report abbreviation to open the pop-up with information on

when the lab was last performed.

2. Display the results for the group by clicking on the group name Details link (GI Details in the example above).

3. From the details page, view, print the group, or print the single result (see “View Details” on page 62).



Graphing ResultsGraphing enables you to quickly identify changes in a patient’s status that may not be as apparent when analyzing just the numeric values. Once a trend is identified, the clinician can take the appropriate action.

Lab results can be displayed in a trendable graph in CareFocus.

Viewing a Graph1. Hover or click on any lab or report abbreviation to open the pop-up with information on

when the lab was last performed.

2. Click the graphing icon or link.

3. The graph displays the single selected lab, showing all available time ranges.


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Normal vs. Abnormal Value Ranges on the GraphThe graph provides you with an indication of both how the lab value is trending and whether it is within normal range, above, or below the range. The established normal (or acceptable) range is shown in the background of the graph in white; values outside of the established normal (or acceptable) range are shown as red. The associated reference range is also shown on the graph. See (High: 1.27) and (Low: 0.64) in the following example.

Test value increments are shown on the vertical axis. The selected time period is displayed horizontally along the bottom of the page.

To view details of a specific data point, hover your mouse cursor over the data point until the pop-up window appears.

Note: A normal result plots within the white area on the graph. An abnormal (out of range) result plots in the red area.



The pop-up shows the panel:element abbreviated names (e.g., BMP:CR), the normal range, and the date and time the test was performed.

Selecting a Different Item to Graph1. Click the Result 1 drop-down menu

to view the list of available The menu is sorted by panel, then by the individual test elements.

2. Click on the desired individual test element to view the associated graph. You cannot choose the entire panel. For example, you cannot choose to view all values for the BMP at once. You can choose to view a maximum of two results at a time. For additional information and step-by-step instructions for graphing two results at a time, see “Graphing Multiple Results” on page 68.

Selecting a Different Time Period to ViewBy default, the graph is shown using all available results. The Time drop-down menu allows you to select other time periods for the graph. A menu item shown in gray text means values are not available for that time period and cannot be graphed.

Time periods for graphing are:

• All available

• 2 weeks

• 7 days

• 72 hours

• 48 hours

• 24 hours

The points on the bottom axis adjust according to the time range selected.


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The following shows an example of how the date and times are depicted for the same test, called for the various time periods:

Graphing Multiple ResultsYou can combine certain data elements on the same graph when their values require viewing in combination. Examples may include the following:

• temperature and white blood cell count

• mean blood pressure and drainage output

• creatinine and urine output

• platelet count (PLT) and bleeding times (PT or PTT)

Note: Test results depicted with text may not always produce relevant graphs. For example, a result of TRACE always graphs with a value of zero (0.0). A result of POSITIVE, NEGATIVE, LARGE, etc. may not produce datapoints on the graph. Results of ranges(e.g., 5-10), less than or greater than, or equal to (e.g., >=300) or approximate results (e.g., ~5.0) may not graph as expected.



To view a combination of values:

1. Open the patient’s lab or nursing observation graph that you want to view.

2. On the graph pane, modify any of the following drop-down menus: • The first element to graph (Result 1)• The time period (Time)• Select the second element from the Result 2 drop-down menu

Values for the second element are shown vertically on the right side of the page. The beginning point for high and low values are shown on the right side of the graph (see (High: 37.0) and (Low: 25.0) above).

The second element is depicted with a black dashed line with diamond-shaped datapoints. The abbreviated test element name is shown at the bottom, to the right of the first test element.

Note: To view details of a specific datapoint, hover your mouse cursor over the datapoint until the pop-up appears. The pop-up shows the panel:element abbreviated names (e.g., CBC:WBC), the normal range, and the date and time the test was performed.


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CHAPTER 3: FORMS

FORMS OVERVIEWForms in Micromedex® 360 Care Insights CareFocus provide the clinician with the means to track and report on patient care. Forms can be attached to a patient, automatically or manually, which enables users to capture their notes, observations, and care. This feature is available on both the desktop application and the mobile (handheld) version.

Surveillance Profiles and FormsCareFocus includes over 40 pre-built rules for identifying high-risk patients and intervention candidates. These rules, or profiles, are developed by the editorial team from Micromedex Solutions to monitor critical parameters across the patient population. These pre-built profiles include: Acute Myocardial Infarction, Chronic Kidney Disease, Earyl Sepsis, Early Warning/Rapid Response, Surgery/Antibiotic Prophylaxis, Never Events, Patient Fall, Pressure Ulcer.

The Profile - Form WorkflowPre-built profiles are available ‘out of the box’ with CareFocus, but administrators of CareFocus are also able to create their own unique profiles to identify patients in the hospital population. For more information on how profiles work and how to build your own, see the 360 Care Insights Administrator Guide.

The profiles run on a scheduled cadence and screen the patient population against specific clinical criteria. When a patient meets the criteria the patient is placed on a profile list.

By subscribing to the applicable List(s) in CareFocus, the census presents the clinician with the patients needing their attention.

When a patient meets the criteria for a profile they may also automatically have a form assigned for the clinician to document the patient’s care. The form assigned can be specific to the type of profile.

When a patient has met criteria (patient is ON a list) and has a form assigned, the census displays this information quickly through the extensive use of iconography.


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Form StatusThe current status of a patient’s form is represented by the use of the following form status icons:

The icons depicted on a rolled up (collapsed) census page depict the most critical form status that currently exists for the list or patient when multiple forms exist below the rolled up accordion. This allows the clinician to know at a glance where they need to direct their most immediate attention.

Form Status Icon

New Form A new form has been assigned to the patient that has not been opened/saved.

Follow Up Due The follow up time period set has elapsed and the patient is due for follow up.

In Progress The form has been opened and saved; form is considered to be "In Progress". No follow up has been set.

Follow Up Set A follow up time period has been set.

Completed Form The form has been completed.

Forms Status (Hierarchy Level Icons)

At least one New Form has been assigned.

At least one form in current status of Follow Up is Due exists.

At least one form is In Progress.

At least one form in current status of Follow Up Set.

All forms are Completed.


CHAPTER 3: FORMS

The following example shows the Census view by List:

As the list or patient accordion is expanded, the specific form status icons are shown. When the list is expanded, then the most critical form status icon for the individual patient is shown.

Form Status Representation on the Census (Icon Hierarchy)When multiple forms exist, it is crucial that clinicians are able to see the status of the most critical forms so they know where to direct their attention first.

The Census Filter (Active Patients | Follow Up Forms | Incomplete Forms | Completed Forms | All) controls the census view and follows all rules for which patients to display. The Forms status is applied and the census displays the appropriate icon based on a prioritized hierarchy:

The icon shown is indicative of the 'rolled up' hierarchy of status and displays the most critical state of any form assigned.

In List View:

The roll-up (collapsed accordion view) of the form status hierarchy when viewing the census by List:

1. New = at least one patient on the list has a new (never saved) form.

2. Follow Up Due = there are no new forms, but at least one patient has a form where follow up is due.

3. In Progress = there are no patients with new forms or forms with follow up due, but at least one patient has an in progress form.


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4. Completed = at least one patient on the list has a completed form, but none of the patients on this list have forms with a status of: new, due, in progress, or follow up set.

5. No icon = no patients on the list have forms assigned.In Patient View:

The roll-up (collapsed accordion view) of the form status hierarchy when viewing the census by Patient:

1. New = the patient has at least one new (never saved) form.

2. Follow Up Due = there are no new forms, but the patient has at least one form where follow up is due.

3. In Progress = there are no new forms or forms with follow up due, but the patient has at least one form in progress.

4. Completed = at least one form associated with the patient has been completed, and there are no forms with a status of: new, due, in progress, or follow up set.

5. No icon = no forms have been assigned to this patient.

The application determines the “most critical form status” according to the following hierarchy:

Date/Time and User That Assigned the FormDrill down to the Patient (when viewing by List) to see when the Patient met the profile/was added to the list.


CHAPTER 3: FORMS

Drill down to the List (when viewing by Patient) to see when the Patient met the profile/was added to the list.

Drill down one more level to see how the form was assigned (auto-assigned or manually assigned) and when the form was assigned. If a Follow Up has been set, the time the follow up comes due is shown.

You are able to take action on a form (Complete/Uncomplete, Set/Edit Follow Up, Delete) without having to open the form and directly from the census page when you have expanded the accordions to the form level.


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WORKING WITH FORMSForms provide clinicians with the ability to document patient care. Forms can be automatically assigned to a patient as a result of the patient meeting specific profile criteria - or - they can be manually assigned by a user.

Forms can be accessed directly from the Census page.

The actions available for a form are controlled by the current form state:

Form State Buttons Available

Assigned, but never saved Show | Complete | Set Follow Up | Delete

In Progress (assigned and saved at least once) Show | Complete | Set Follow Up | Delete

Incomplete and Set for Follow Up Show | Complete | Set Follow Up | Delete

Incomplete and Follow Up has elapsed (due) Show | Complete | Set Follow Up | Delete

Completed Show | Uncomplete


CHAPTER 3: FORMS

Required Form FieldsFields that require input before a form can be completed are depicted with the red asterisk * to the right of the field name.


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Working in Forms1. Open the form by clicking the Show button.

a. If you want to work in a form that has already been completed, click the Uncomplete button to gain access to the form fields.

b. Forms open as pop-up windows on the work space and can be moved or re-sized as needed. Multiple forms can be opened at one time for a patient, thus allowing the clinician to reference all relevant information (forms, labs, reports) for the patient while documenting their form details. For safe patient care practice however, all open pop-up windows close automatically when switching to another patient or to a different Micromedex 360 Care Insights application. This is a safeguard to ensure that only information about the current patient is being viewed. Patient information (such as height, weight, admit date, values, etc.) can automatically populate fields within the forms with information sent from your HIS.

c. Fields required in order to Complete the form are displayed with the red asterisk * (and are located/displayed between the label and the input field)

d. The current status of the form is shown as an icon - top left corner of the form.

Short cuts/icons available from the form (top right corner):• Save icon (floppy disk icon) - saves the form (without closing)• Print icon (printer icon) - prints the form• Audit Log icon (paper icon) shown top right - opens the audit log pop-up window

• Delete icon (trash can icon) - deletes the form• Parking windows (up or down) functions from the minimize/maximize controls (see “Parking Pop-Up Windows” on page 85)

• Closing the form with the 'x' prompts user there are unsaved changes that will be discarded (and form is closed) if they reply OK.

Note: Forms associated with Profiles configured as Join Across Patient appear with the message, "This patient form is shared across all accounts" to the right of the patient's name (see the Administrator Guide for more information on Profiles and Joins).


CHAPTER 3: FORMS

Forms With Follow Up

If a follow up has been assigned to the form, the time the follow up is due is shown in the bottom left corner area of the form. See “Viewing Forms With a Follow Up Set or Due” on page 90 for more information.

2. Enter the form information using the textbox, checkbox, calculator icon, radio buttons, drop-down lists, etc., as appropriate for the form.

3. To clear any entries and not save any changes, click the Close link located in the upper right corner of the form.

4. Save and Close | Complete | Uncomplete | Edit Follow up | Set Follow Up buttons:• Save and Close - saves any changes and closes the form (incomplete);

confirmation no longer appears• Complete - saves any changes and attempts to complete the form (as long as all

required fields have data); if successful, form window closes; confirmation no longer appears

• Uncomplete - only shown when viewing a completed form, the Uncomplete button reopens the completed form and returns the form status to In Progress

• Set Follow Up -saves any changes made to the form, then opens the Set Follow Up Reminder pop-up window where the user can set the reminder time/date and enter any follow up notes

• Edit Follow Up - saves any changes then opens the Set Follow Up Reminder pop-up window where the user can change the current follow up setting or notes

• To discard your work without saving, click the X link (located in the upper right corner of the window.

After saving (or discarding) your changes, all form windows are closed prior to changing to another patient or application. For patient safety practice, CareFocus will

Note: REQUIRED FIELDS Field names with an asterisk (*) denote a field that requires entry. You will be prompted to enter information into a required field before you are allowed to complete the form. See “Required Form Fields” on page 77 for selected Forms Examples and the required fields contained within.

Tip: An incomplete form can be saved during patient monitoring, but it cannot be completed until all required fields contain data.


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not allow the user to open forms for multiple patients simultaneously, or keep forms open when moving to other applications.

Completing FormsWith the form open, complete the form by clicking the Complete button.

Alternatively, forms can be marked complete without opening the form. To complete without opening simply select the patient and click the Complete button below the form name. In either case, to successfully complete a form, all required fields must contain data.

Manually Assigning a Form1. In the expanded patient row click Add Form... to add a form.

Tip: Parking Pop-Up Windows Multiple pop-up windows can be opened at one time for your convenience. You may find it easier to maneuver the census if you collapse and “park” windows when they are not needed at the moment. Pop-up windows can be “parked” to allow you to keep the window at your fingertips, but collapsed and moved out of the way. With one or more pop-up windows open, hover over the “-” in the upper right corner. The hover text displays, “Park Up”. When the pop-up has been parked, hover over the “-” to re-open the window to show the pop-up details.

Note: Patients with an open or incomplete form remain on the list even if they no longer meet profile criteria.


CHAPTER 3: FORMS

2. The Add Form diaglog opens. Click the appropriate form category (e.g., Infection Prevention) to expand the list. Drill down to the desired form.

3. The Generic Interventions list is selected and is the list this form will be added to by default. If the form should be added to a list other than Generic Interventions, click Select List and select the list to which you wish to assign to this form. The list the user was working in when they chose to add the form is populated by default, but any active (subscribed) list can be selected.

4. Click OK.


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Viewing a Completed FormCompleted patient forms can be viewed in summary and in detail. Click the Complete Forms (#) link in the patient header area of the Census page (shown to the right of the Profiles Met link).

Information displayed in the Completed Forms pop-up:

• The form name(s). Click the form name link to view form details. Note: the completed form can be uncompleted to allow for additional edits to the form.

• The date and time the form was assigned as well as who assigned the form is shown.

• The date and time the form was completed.

• The List to which the form was assigned.

Note: Completed forms are available until archived according to the setting established at your site (typically 60 to 90 days).


CHAPTER 3: FORMS

Removing (Deleting) FormsTo remove a form assigned to a patient click the button while viewing the patient in the census, or click the trash icon while viewing the form.

This removes the form from the patient; it does not mark it as complete.

WARNING

! Deleting a form removes the form and all audit log history.


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Printing Form Detail Report

When viewing a form click to print form details for the selected patient. The form Detail Report includes:

• Patient information including: demographics, admit date, admitting diagnosis (if available), attending and consulting physicians

• Current information on the form (the Intervention Details)

• Detailed audit information of form modifications, including date/time/user name

• Other interventions for the patient


CHAPTER 3: FORMS

Viewing Form Audit Log

When viewing a form click to view all changes to this form. The Forms Audit Log window opens and lists the: date, time, user id, and all changes made to the form.

Parking Pop-Up WindowsForm pop-up windows on the work space and can be moved or re-sized as needed. Multiple forms can be opened at one time for a patient, thus allowing the clinician to reference all relevant information.


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To keep these windows organized, you may find the Park Up and Park Down functionality helpful. Pop-up windows can be “parked” to allow you to keep the window at your fingertips, but collapsed and moved out of the way.

With one or more pop-up windows open, hover over the “-” in the upper right corner. The hover text displays, “Park Up.” When the pop-up has been parked, hover over the “-” to re-open the window to show the pop-up details.

For safe patient care practice, all open pop-up windows close automatically when switching to another patient or to a different application (e.g., Infection Prevention). This is a safeguard to ensure that only information about the current patient is being viewed.


CHAPTER 3: FORMS

FLAGGING FORMS FOR FOLLOW UPClinicians may have cases that need attention or follow up at a later time. The Follow Up feature flags the patient for attention when the follow up is due.

The Status filter can be used on the Census page to show patients whose follow up is due. See “List/Patient Icons” on page 14 for additional information.

A follow up reminder brings the clinicians’ attention to that form at a pre-determined time with the follow up due icon. When the follow up is set but not yet due, the form is not shown on the census (when View by: Active Patients is selected) thereby allowing the clinician to focus on the patients needing attention now.

Follow Up Status

Follow Up In Progress (Set but Not Due) - The form displays the Edit button with the clock. View the follow up time set for this form immediately below the form name and date/time/who assigned information. View the form (Show), complete the form (Complete), change follow up time (Edit Follow Up), or delete the form (Delete).

Follow Up is Due - The follow up time set for this form has elapsed and is now due. Text showing the date and time it was due is shown directly below the date/time/who assigned the form information. View the form (Show), complete the form (Complete), set a new follow up time (Set Follow Up), or delete the form (Delete).

Note: Forms in progress but not yet due are only visible on the census with the View by: Follow Up Forms- or - All setting. See “Forms: Filter by...” on page 20 for more details on how the View by setting controls the census display.


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Setting a Follow Up TimeUsers can access the follow up dialog from two separate areas in the application:

• From the Census with the patient accordion expanded

• From within the form

Set a Follow Up From the Census:With the census expanded to the patient, click the Set Follow Up button.

Set a Follow Up From the Form:With the patient form open, click the Set Follow Up button.


CHAPTER 3: FORMS

With the follow up dialog box open:

• Choose a follow up interval:

• The next occurrence of a time (e.g., 21:30)• After a specified lapse of time (minutes/hours/days)• At a specific date and time

You can also add a Note (maximum of 4,000 characters) to the follow up. Examples could include: the action to take when following up; why the follow up was added; etc.

Once the follow up is saved via the Set button, follow up details are visible on the census (with one of the following Filters selected: Follow Up Forms | Incomplete Forms | All). The follow up displays the time/date the follow up was set (or due), followed by the note.

If you were working on the census with View by: Active Patients selected, the form is considered to be in progress but not due and is removed from view as soon as the follow up is saved and the census is refreshed.

Note: Refresh the Census page display at any time by clicking the Refresh icon


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(See “Form Status Representation on the Census (Icon Hierarchy)” on page 19 for all scenarios and Filter by settings)

If the Note is longer than what can be displayed on the census, hover text shows the full note.

The next time you add a Follow Up for a patient on that same List, the increment setting used previously displays by default for the next Follow Up. Exception: If the last Follow Up option chosen by the user was the 'Specific date/time' option, the application does not populate that into the next follow up, but defaults back to 'The next occurrence of 06:00' option.

Viewing Forms With a Follow Up Set or DueOnce a Follow Up interval has been set/saved, but is not yet due, the census refreshes and the form no longer appears on the Active Patients Filter view.

Change the Forms Filter to: Follow Up Forms, Incomplete Forms, or All to see forms with a follow up set, but not yet due.

Follow Up Status and the Census Filter By Settings

Filter By Shows Forms in Follow Up Status

Active Patients Due

Follow Up Forms Set and Due

Incomplete Set and Due

Completed Forms N/A

All Set and Due


CHAPTER 3: FORMS

Change or Remove the Follow UpAfter a Follow Up has been Set, the follow up can be changed (edit) or removed (cleared) by selecting the Edit the Follow Up button which is available from the census (when expanded to show the form), or from within the form itself.

To Change the Follow UpEdit the follow up occurrence/interval/time and/or the note and save the change.

To Remove the Follow UpSelect the Clear button. If the form is still incomplete, it will once again be visible on the Incomplete Forms Filter view of the census visible on the Incomplete Forms Filter view of the Census.


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Ramifications of Changes to Forms Controls - Reporting and Data Export

Forms administrators have the ability to modify forms and their associated costs and controls at any time. However, changes to these properties, after they have been made available, can affect reporting and data export information. See the table and WARNING (following the table) for details. See your Forms Administrator if you have questions.

CAUTION

! Changes to Form controls can have an impact on Reporting and Data Export! See the 360 Care Insights Suite - Administrator Guide and the following table for details.

Description of the Change to the Form

Ramification to Clinical Activity (Form Details)

Ramification to the Data Export

Control ADDED

Only the controls that were available to the form at the time it was completed are shown. In other words, if the control was available to the form when the user completed it, it will be shown in the Form Details.

The added control(s) will result in additional columns in the data export. The current order of controls are reflected in the col-umn order.Data is populated in the additional column if it was pro-vided by the user when the form was completed.If the control did not exist at the time of completion (control was added after the user completed) then data displays as “Control Did Not Exist”.

Control DELETED

Only the controls that were available in the form at the time it was completed are shown. In other words, if the control was not avail-able in the form when the user completed it, it will not be shown in the Form Details.

If a user calls for a data export covering a time-frame during which the control existed, it will be included in the export.If the control was deleted during or after the export time-frame, it will appear in a column at the end of the report rather than in the order of the controls.If the control did not exist at the time of completion (control was deleted before the user completed the form) then data displays as “Control Did Not Exist”

Control TYPE changed (e.g., a radio button is changed to a drop-down)

The data shown for the control in Form Details will reflect the control type at the time the form was completed.

The control will continue to be included in the data export. However, clinical context may have been affected. Contact your Forms administrator if you question the data included in the export.

Control COST changed

No affect; control costs are not available to Form Details.

If a user calls for a data export covering a time-frame where the control had an associated (non-zero) cost, the cost data that existed at the time of form comple-tion will appear in the export in the column to the right of the associated control. The column heading for the control cost is the same as the control name label.

FORM COST is changed

No affect; form costs are not available to Form Details.

The cost associated with the form at time of comple-tion is shown in the data export

Control LABEL changed

The label shown is based on the label as it existed at the time of form completion.

If you change the label of a control you will see the most recent label in the export.

Control ORDER changed

The order of the controls shown in From Details is the order that existed at the time of form completion.

The current order of the controls is shown in the data export.


CHAPTER 3: FORMS

WARNING

!If there is no change in clinical context, there are no serious ramifications to the type of change described. However, if the change also modifies the clinical context of what is being documented, then, reporting is affected. See your Forms administrator if you have questions or for assistance.


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CHAPTER 4: REPORTS

Antimicrobial Susceptibility Report Also known as an antibiogram, this report lists the sensitivity of an isolated organism to different antibiotics. This information can help clinicians with their decision for the most effective treatment for an identified bacteria based on past results.

To access the report click the Reporting tab and then select Antimicrobial Susceptibility.

The following filters are available:

• Period - Display data for either the concurrent year (the immediate past 12 months), or for the previous full calendar year.

• Facility - Select one or more facilities.

• Patient class group - Select one or more patient classes, such as: Inpatient or Outpatient. Depending on the data received through the HL7 messages, you may also have the ability to select patients by groupings such as: Recurring Appointments or Scheduled Appointments.

• Unit - Select one or more units.

• Click Update View to display the report.

Note: The previous year time period shows data through the end of the last calendar year. The concurrent period shows data for the immediate past 12 full months.

Note: To select multiple items a drop-down list hold down the Ctrl key.


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CHAPTER 4: REPORTS

Each cell in the column represents the sensitivity to the organism for the listed drug. The example above shows that the ampicillin/sulbactam regimen was effective in inhibiting the Enterococcus organism 25% of the time. In this case, there were four incidences (denominator: 4.0) and the ampicillin/sulbactam was effective in inhibiting the Enterococus organism three times (numerator: 1.0).

The total number of times the organism has been tested (with a drug) is depicted immediately below the organism name at the top of the page. See the example above, showing that Acinetobacter has been tested 180 times, Candida 596 times, etc.

Drug CodesDrugs tested and included in the report are depicted by an abbreviated code. For the full drug name, hover over the code in the column to view a pop-up containing the full drug name, or see the bottom of the page for the listing of drugs and their associated codes.


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Clinical ActivityClinical Activity Reports cover a number of key performance indicators around completed intervention forms.

The report types include:Count of Occurrence by Type

Occurrence by type reports on the number of a specific type of occurrence.Cost of Occurrence by Type

Occurrence by type reports the cost in dollars that have been associated to a specific type of occurrence. Provides the ability to report on the total cost of the reported occurrences, represented as the sum total of occurrences multiplied by the designated dollar cost for the specified time period.

Three Elapsed Time Reports

Time-based reports allow you to view occurrences for a specified time period, designated with a start and end date. or view specific occurrences grouped as a unit of time (e.g., day, week, month, quarter, year).

Measure Efficiency/Staff Management:

1. Report the average time elapsed from when the form is associated to a list (whether manually or automatically) to completion.

2. Report the average time elapsed from when a user first opens a form, to when it is completed.

3. Report the average time elapsed from when the form is associated to a list to when it is first opened. Average time to complete a specific form by user.

For reporting purposes, the term ‘occurrence’ is assumed to be represented by the concept of the form. This can apply whether you are documenting an intervention or an outcome.

Note: Only completed forms (desktop and a current mobile sync) are considered for these reports. Incomplete forms of clinical information ingested into the platform are not included.


CHAPTER 4: REPORTS

graphics

Other important definitions are:

• Intervention - an activity that produces an effect, or is intended to alter the course of a disease or process in a patient or population

• Outcome - a measure of the quality of medical care, the standard against which the end result of the intervention is assessed

• Outcome Measure - determination and evaluation of the results of an activity, plan, process, or program and their comparison with the intended or projected results

Report Filters Offer You FlexibilityThe various filter selection drop-down boxes allow you to narrow in on the specific data desired by filtering on the date range, interval, form type(s), user(s), unit(s), facilities and/or attending physician(s).

Group your data selection by form type, user, unit, facility or attending physician.

Filter options can be the default (All), one item, or multiple items selected from the drop-down. To select more than one item, simply click each item until all items you wish to select have been clicked.

Upon generating a report you are shown three different visualizations for the data:

Individual Strip ChartThis visualization displays individual line graphs of the key performance indicator selected. These data are organized based on the criteria selected in the “group Y axis by” setting.

Note: A minimum setting of 1024 x 768 Display Screen Resolution is required to render reporting appropriately.


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Comparison ChartThis visualization layers the individual data points from the strip chart to provide the ability to compare trends. The data in the filter drives the data shown in the comparison chart. So for example, if you are grouped by form type and have selected 10 forms in your filter you will have 10 strip charts and 10 lines on the comparison chart. Each line represents a form type.

Aggregate ChartThis visualization displays the aggregated data across all form types, users, facilities, units and attending physicians selected in the reporting criteria.

Note: Data for Clinical Activity reporting began aggregating with Version 28 Service Pack 23

and will accumulate up to a maximum of seven years of data. Your system configuration for data archive and haircut (purge) may differ. See your HIS administrator to confirm your settings.


CHAPTER 4: REPORTS

Download ReportsReport/Chart information can be exported as a Microsoft® Excel .csv (CSV) file, PDF, or Image (PNG) file. After creating the report, select the appropriate icon and answer any prompts in the File Download dialog.

View Occurrence Date and CountIndividual form occurrences (documented events and interventions) can be viewed within the Clinical Activity Report. Basic information related to the occurrences (e.g., date and count) is viewable by hovering over the data point.


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View Occurrence DetailsClick on any data point in the Strip Chart to view the Form Detail Results for each occurrence. The following system-generated data is displayed: the patient name, medical record number, account number, open and close (completion) dates, and the last user to complete the form.

Click on an individual occurrence to view the clinical intervention data documented by the user for that occurrence. If there is a label with no data in the Form Details it means the end user chose not to complete that control.

Users can also print the form selected for viewing by clicking the Print button.

CAUTION

! Changes to Form controls can have impact on Reporting and Data Export! See the 360 Care Insights Administrator Guide and “Ramifications of Changes to Forms Controls - Reporting and Data Export” on page 92 for details.


CHAPTER 4: REPORTS

te forms

Forms Data ExportThe Forms Data Export feature provides users with the ability to export form data to Microsoft® Excel Version 2007 and above as an .xls (or .xlsx) file and includes all data captured in the completed form. The exported data can be sorted, manipulated, and maximized to develop the graphs and spreadsheets that meet the needs and requirements of your facility.

1. Click the Forms Data Export link on the Reporting page

2. Select from the filters (dates, facility, unit, forms, users, attending) as appropriate. Use Ctrl + click or click + Shift click to select multiples from the drop-down filters.

3. Select the Export button to open the File Download dialog.

If there are blank cells in the export, it denotes that (1.) it is an optional field, and (2.) the user chose not to complete that control.

Forms Data Export vs. Outbound Forms ExchangeThe Forms Data Export function is not the same function as the Outbound Forms Exchange. The Outbound Forms Exchange feature provides hospitals with the ability to export forms in HL7 Clinical Document Architecture format, (CDA®), for use in other Healthcare Information Systems. As forms are completed they are automatically exported from 360 Care Insights carrying clinician documentation including their patient care, observations and interventions.

Note: Only completed forms (desktop and a current mobile sync) are eligible for export. Incompleare not included.


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For more information on the Outbound Forms Exchange feature, see the sample exported form in Appendix A: “Sample Exported Form” on page 167 “and the Forms” chapter in the Micromedex® 360 Care Insights Suite - Administrator Guide.


CHAPTER 5: CAREFOCUS ON A HANDHELD DEVICE

OVERVIEWCareFocus users have the ability to attach forms to a patient so they can capture their notes, observations, and care. This feature is available on both the desktop application and the mobile (handheld) version.

Forms can be accessed, assigned, and maintained on the handheld device from the census.

Mobile apps are available for Apple and Android devices.

DOWNLOADING 360 CARE INSIGHTS 1. Visit the iTunes® App Store (Apple devices) or Google Play® (Android devices) and

search for "Micromedex"

2. From the Micromedex app results, select Micromedex 360 Care Insights

3. The app will download directly to your device.

SETTINGSThe first time you open 360 Care Insights on your device you will be prompted to configure at least one site. Tap the Settings button to continue to the 360 CI Sites screen.


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Configuring a SiteIt is not necessary to configure multiple sites within the same healthcare system. The Site Selector allows 360 Care Insights users to view patient data across multiple healthcare systems.

1. Tap the Add site ... row. You are presented with the New screen. The Site Name NEW is replaced with the actual site code name upon completion of the first sync.

Only one active data set may be viewed at a time.

Switching to an alternate site is accomplished from the PIN screen. See “Switching Sites” on page 111 for more information.

2. Complete the following fields:• User Name

Note: If you are not opening 360 Care Insights for the first time, you can access the 360 CI Sites screen by tapping the Settings button on the PIN screen.

Note: Site settings can also be beamed from device to device. See “Sending (Beam) Settings” on page 110 for more information.



• Password• Public Key

• Server URL Settings:• Outside (if applicable)• Inside Server (internal to your firewall)

3. Tap the Sync Site button to synchronize the new settings.

4. You will return to the PIN screen. Once you have entered your PIN the sync begins downloading the site configuration information to your device. For additional information on synchronizing, see “Syncs (Synchronizing the Device)” on page 112.

After the sync you are able to view the General, User Settings, Server URL Settings, and Beaming settings. All of these settings are site specific.

Note: Contact your 360 Care Insights administrator if you are not sure of the settings or configuration which should be used at your site.


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General SettingsThe About information and the Info Button toggle are not available until after the first sync.

Info Button Available to customers as an add-on to 360 Care Insights, the Info Button feature offers access to drug, disease, and lab information from the Micromedex® Solutions clinical information application.

With the Info Button setting toggled to the “ON” state, you are able to access the information via the Info Button Access icon.

Info Button LinksInfo Button Access allows you to reference clinical drug, disease, and lab information from the Drug Information, Disease Information, and Lab Recommendations databases. You must have a subscription to Info Button to enable this feature.

Drug Information

Summary drug documents (with links to the more detailed DRUGDEX® database if subscribed) can be accessed from an InfoButton icon that is placed next to the drug name in the Medications screen. You may be required to choose a specific drug name before the actual reference is opened.

Example: More than one title was a possible match for the medication Coreg, so all candidates are shown as hyperlinks. Once the specific drug is selected, the summary drug information is shown.

Disease Information

Detailed disease documents (General or Emergency Medicine) can be accessed from an Info Button icon that is placed next to the patient’s diagnosis. You may be required to specify a disease state (such as, chronic or acute) or choose a more specific diagnosis (such as Community Acquired Pneumonia, or Aspiration Pneumonia) before the actual reference is opened.

Example: Once the specific disease and disease state is selected, the clinical disease information is shown.



Lab Information

Detailed lab test documents can be accessed from an InfoButton icon that is placed next to the lab in the Labs & Reports screen. You may be required to choose a specific test name before the actual reference is opened.

Example: More than one title was a possible match for the CBC lab, so all candidates are shown as hyperlinks. Once the specific lab is selected, the clinical lab information is shown.


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Beaming Site SettingsIn the busy clinical setting you may find it more convenient to simply “receive” the site settings from a device that has already been configured by having the device user “beam” the settings.

Using the Bluetooth® technology resident on the device, you can send and receive site settings between devices. User name, password, and patient data is not transmitted during the send or receive beam function.

Senders/Receivers should be in close proximity for either Sending or Receiving settings.

Sending (Beam) Settings1. From the PIN screen, tap the Settings button.

2. Tap the name of the site you want to send to another device.

3. Tap the Send button in the Beaming area of the screen.

4. A pop-up displays stating you are “Sending site settings...”.

5. Tap Cancel if you wish to stop the transmission of settings to a nearby device.

Receiving Settings1. From the PIN screen, tap the Settings button.

2. From the 360 CI Sites screen, tap the Receive button.

3. Select the Nearby option from the pop-up. Tap Cancel if you wish to stop and exit the Receive Settings function. You may see a screen stating that it is looking for other devices.

4. You will receive confirmation the Beam was successful.

5. Sync your device with the settings just received.

Note: BlueTooth must be enabled on the sending and receiving devices.



Switching SitesIf you have configured more than one site on your device, you can switch to an alternate site at any time.

1. From the PIN screen, tap the Site field.

Sites that have been configured are shown on the Site screen.

2. Tap the desired site name, and then tap the Done button to confirm the change and return to the PIN screen.

3. The site selected in the previous step is shown in the Site field on the PIN screen.

Deleting a Site1. From the PIN screen, tap the Settings button.

2. From the 360 CI Sites screen, tap the site you wish to delete.

3. Flick to the bottom of the screen and tap the Delete Site button.

4. Tap Delete Site again to confirm you wish to delete this site from your device. Click Cancel to ignore the request to delete and return to the Settings screen.

Note: Sites must be on V27 SP2 or later to use (and switch to) the SmartPhone (mobile platform) version of 360 Care Insights.


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SYNCS (SYNCHRONIZING THE DEVICE)Synchronizing retrieves new and changed data from the Hospital Information System (HIS) and places it on your device. Communication between 360 Care Insights and the server occurs via a secure connection using industry standard encryption protocols.

A normal sync pulls down just new or changed (delta) data since the last sync to the device.

When a sync attempt is interrupted or fails, simply re-launch the sync. No data is lost if the sync is not completed. Examples of an interruption can be:

• The phone receives a phone call (rings)

• The application is quit (the Home button is pushed)

• The wireless/cellular connection is lost

Starting a SyncTo initiate a sync:

1. Tap the update icon.

2. The update icon changes to a cancel sync (X) icon and the status text reflects that the update is in progress. You can continue using the application while the update process continues in the background.

3. When the sync has finished checking for updates, you receive notification that the data is ready for download. Tap the Continue button.



4. When the download completes, the status text displays the date and time the last sync completed.

Message of the Sync (MOTS)Your 360 Care Insights administrator may have configured a Message of the Sync (also known as the MOTS) that is also displayed at the end of the notification message.

You can access the Message of the Sync at any time by tapping the status text on the last updated date/time.

Expired Data SyncsData on the device expires a site-specific number of days after the last sync.

If you have not performed a sync in the set number of days, you will see an error screen indicating the data has expired, and you are required to perform a sync.

Performing a sync after a data expiration may take as long as a first-time setup sync.

CHANGING YOUR PINYou can modify your PIN at any time.

1. From the Enter PIN screen, tap the Settings button.

2. On the 360 CI Sites screen, tap in the name of the Site you are using.

3. Scroll down to the User Settings area of the screen and tap in the Change PIN field.


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4. The Set PIN screen prompts you to tap your old (current) PIN.

5. Once you have entered the current PIN, the screen prompt changes to “Enter a new PIN.” Tap your new PIN. You will be prompted to enter the new PIN again for verification. Tap the new PIN.

6. You are returned to the Setting screen.

LOGGING OUTWhen you exit 360 Care Insights all data is saved, and all current selections (sorts, filters, lists, etc.) remain the same when you re-enter the application at a later time.

Logging out of the application is available from the Patient List screen. Tapping the Logout button returns you to the Enter PIN screen.

When the 360 Care Insights application remains idle on your device for a set amount of time, the application closes, requiring the entry of a valid PIN to re-open the application.

Note: If you enter the wrong PIN code in excess of the number of times an invalid code is allowed, you will be locked out of your device and all data will be purged from the device as a security measure. You will have to contact your 360 Care Insights Administrator to unlock / enable your account.



GENERAL FUNCTIONALITY

The Patient CensusThe census shown upon entry to 360 Care Insights displays the patient list. A plethora of information can be gleaned with just a glance at this screen. An overview of the information, icons, and colors follow.

GlintingThe patient row appears with yellow glinting (highlighted with a yellow background to the row) when the patient has newly met the criteria for a profile associated with a list to which the user subscribes.

The glinting is removed after the patient’s form or profile has been viewed. See “Forms and Profiles” on page 153 for complete information on working with forms on your device.

THE PATIENT LISTClinicians are able to view their patient lists with all relevant information at a glance.

The initial screen shown is the Patient List.

Census SettingsThe top of the screen shows a summary of the current Census Settings (or view selections) such as:

• Site

• Facility

• Subscribed List(s)

• Patient Mode (Rounding, Critical, Outpatient, Schedule, or All patients).

To modify any of these settings, tap the Edit button. See “Other Census Settings” on page 122 for additional information.


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The sort order of the patient list is also customizable. To change the sort order, tap the Edit button. The list can be shown sorted by Name, Room, or Date, but not all patient modes support all three sort selections. See “Other Census Settings” on page 122 for additional information.

Patient Information on the Patient List

New or Critical Results Indicators

New

Any patient with New results not yet viewed by the user is shown by placing the green star to the left of the patient’s name.



This indicator appears only when a new lab or report is available, and remains until the results have been viewed on the device.

Critical

Patients with Critical results not yet viewed by the user are shown by placing the red circle and

an exclamation point to the left of the patient’s name.

This indicator remains until the results have been viewed on the device.

Patient NameTapping anywhere in the patient name row takes you to patient level information (Patient Info, Meds or Results) for the patient.

Search for a PatientTo look for a patient on your census, tap the looking glass icon located near the bottom, right side of the screen.

An alphabetical list of patients is shown. You can flick/scroll to any patient in the list. Tap on the patient name row to view patient information.

If it would be faster to search for this patient by name:

• Tap in the Search field to open the keyboard

• Tap a few letters of the patient’s first or last name; keep adding letters until you see the patient

• Tap on the row to view the patient information screen for the selected patient

Add a Patient to your CensusPatients can be manually added to your census list by following these steps:

Note: New and Critical indicators are specific to the user. For example, if one user views a new report for patient Smith, the indicator will continue to display for other users.


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1. Tap the Edit button on the Patient List screen

2. Tap the Add Patient row

3. A three-tabbed screen is shown.

Adding a Patient by Namea. Tap the Add by Name buttonb. Flick or scroll to any patient in the list, or tap in the search field and begin typing the name. The list

populates based on the characters entered for the search.c. Tap on the patient name row when the appropriate match is found.

Note: Adding patients to your list is controlled by the configuration at your site. If your device varies from the examples shown, you may not be allowed to add; or, you may be required to add a patient by medical record number (MRNUM) rather than by name. Check with your 360 Care Insights administrator.



d. When presented with the Add Patient confirmation, tap the Add Patient button

e. From the Choose List screen, tap on the list you wish to attach to the selected patient

- OR -

Adding a Patient by MRNa. Tap the MRN buttonb. Tap in the search field and type the MRN.c. When presented with the Add Patient confirmation, tap the Add

Patient button

4. From the Choose List screen, tap on the list you wish to attach to the selected patient

Hide or Delete a PatientTo hide or delete a patient, complete the following steps:

Note: A manually added patient is not visible to other list subscribers until after a sync of the device.

Note: Pharmacy Intervention and Infection Prevention users: A patient cannot be manually added to a profile list.

Note: Manually Added patients stay on the list until they are deleted by a user, or 60 days after the last activity on the account, which ever comes first.


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1. Tap the Edit button on the Patient List screen

2. Tap the Remove or Hide Patients row

3. Patients and their status (shown to the right of their name) are displayed. Examples of status are:

• Manually Added• Follow• [blank] - patient added by the 360 Care Insights application

4. To Hide Patients:



• Tap the circle icon next to the patient(s) you want to hide; the circle changes to a check mark with a red background

• Tap the Hide button

5. To Remove Patients:• Tap the circle to the left of the patient(s) you want to remove; the circle changes to a

check mark with a red background• Tap the Remove button

6. To quickly select ALL patients manually added by the user, tap the Select Added button. Quickly de-select (after all have been selected) by tapping the Clear Added button.

Note: Only patients that were added manually can be removed from a list. All others must be Hidden.

Note: Manually added patients removed from the list are removed after the next sync. Until the patient has been removed AND the device has been synched, the patient is visible on the list to other list subscribers.


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Other Census SettingsThe top of the Patient List shows the current site code, facility, mode, and patient list selected.

To change the view selections for facility, mode, rounding, or patient list, follow the steps below.

Tap the Edit button to view the Patient List Settings screen.

FacilityYou have the ability to view all facilities in a combined census, or to specify one specific facility.

1. Tap the Facility row shown below the Settings heading.

2. Select the facility from the list by tapping on the row. The screen returns to the Patient List Settings screen.

3. The census is updated to reflect the selected facility when you tap the Done button to return to the Patient List.

Note: When changing to a different facility, the patient list also changes to either the default list fofacility, or the list selected by the user the last time they selected that facility.



Patient List360 Care Insights users subscribe to the patient lists they need to view. For additional information on the various types of lists and how to gain access to lists, see the 360 Care Insights Suite Manager Guide.

Patient Lists can be based on: physician names, units, service types, physician groups or profiles. Profiles are available if your site has purchased Micromedex® CareFocus, Micromedex® Pharmacy Intervention, or Micromedex® Infection Prevention.

• Physician List is a list made of patients associated to a physician. For example, Dr. Jones.

• Physician Group List is a list comprised of multiple physicians who practice together such as Bay Area Cardiology.

• Ward (Unit) List associates patients by location (also called nursing station). For example, 3 Main.

• Service List associates patients by hospital service code, such as Bone Marrow Transplant.

• Surveillance List (Micromedex® CareFocus, Pharmacy Intervention, or Infection Prevention customers) associates patients by a set of rules (profiles) and acts as an alert for caregiver or clinician intervention.

The census display can show all lists, a selected single list, or a combination of lists.

Note: This is further controlled by the selection of which physician roles (attending, admitting, consulting, primary care provider, referring, and other) are used to put patients on physician lists. See the System Parameters Worksheet to learn about these options.


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Switching ListsFrom the Patient List Settings screen:

1. Tap the Patient List row shown directly below the Settings heading. All lists that are currently subscribed are shown on the Patient List screen.

2. Switch to any of the lists shown by tapping on the row. The screen returns to the Patient List Settings screen.

3. The census is updated to reflect the selected list when you tap the Done button to return to the Patient List.

Adding ListsFrom the Patient List screen:

1. Tap the Add List button. All lists that are currently available for subscription are shown on the Available Lists screen.

2. To add a list:

• Tap the green icon next to the list you want to add - or -

• Tap the Search field and begin typing the list name. Tap the green icon to add it.

3. Repeat previous step until all desired lists have been added.

4. Tap the Patient List button to return and view the updated screen of all lists currently subscribed by the current user.

5. Tap Done to return to the Patient List Settings.



Removing ListsFrom the Patient List screen:

1. Tap the Remove List button. All lists that are currently subscribed are shown on the Lists screen.

2. Tap the circle icon next to the list(s) you want to remove.

3. The number on the Remove button updates with the number of lists selected in the previous step.

4. Tap Remove.

5. Tap Done to return to the Patient List.


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Census Modes Mode selections allow a focused list of patients based on their status. Available modes are:

• Rounding

• Critical

• Outpatient (if applicable)

• ALL

• Schedule (if applicable)

To change the Mode:

1. From the Patient List screen, tap the Edit button.

2. From the Patient List Settings screen, tap the Mode row.

3. Tap the desired mode.

4. Tap Done to return to the Settings screen.


Rounding ModePatients appear in the Rounding mode if the following rules are met:

• There is a date of admission.

• There is no date of discharge, or the discharge date falls within the Default Number of Days After Inpatient Discharge system parameter. This configuration can be overridden on a user account basis. See the 360 Care Insights Suite Manager Guide for more details.

In Rounding mode, the first column of data in the census list contains any indicators (new, critical), followed by the patient’s last name, first name and (optional) initial. The patient room number and (optional) bed.

If the patient has been discharged, but remains on the census (a patient can remain on a rounding census until the site configured number of days past discharge have elapsed), “D/C” is shown in place of a room/bed location.

If no room/location is available, “N/A” is displayed in the location column.

The Rounding mode census can be sorted by patient name or by room. Room is the default sort for Rounding mode. See “Sort” on page 130 for additional information on sorting the census.



n the

Outpatient ModePatients appear in the Outpatient mode if the following rules are met (if the patient type is configured to display under Outpatient):

• There is a date of admission or encounter date - and -

• it falls within the allowable range as set in the system parameters (Default Number of Days Before Arrival and Default Number of Days After Arrival).

These rules can be overridden on a user account basis. See the 360 Care Insights Suite Manager Guide for more details.

Outpatient mode can be disabled if needed. In this mode, the Room column is replaced with the patients’ appointment dates. Removing a patient from an Outpatient list is driven by the date of admission or encounter date.

N/A appears in place of room/location for patients on the Outpatient census whose encounter date is in the past

The Outpatient mode census can be sorted by patient name or by procedure date. See “Sort” on page 130 for additional information on sorting the census.

Critical ModeAccounts that display in Critical mode include patients from both Rounding and Outpatient modes that have labs with critical results that have not been viewed by the user. After a user views the lab results the patients will no longer display in Critical mode for that particular user but will still display in Critical mode for other users.

The Critical mode census can be sorted by patient name only. See “Sort” on page 130 for additional information on sorting the census.

ALL ModeThe All mode shows the Rounding and Outpatient (including Critical and Schedule) modes in one view.

The ALL mode census can be sorted by patient name only. See “Sort” on page 130 for additional information on sorting the census.

Note: ED/ER patients may appear on the Rounding census or the Outpatient census depending oconfiguration at your site. Check with your 360 Care Insights administrator.

Note: Patients fall off the Critical census once the result has been viewed.


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after the

Schedule Mode The Schedule mode shows schedule patients in one view. Information shown in Schedule mode includes:

• appointment date and time

• patient name (last, first, middle initial if available)

The Schedule mode census can be sorted by date and time only. See “Sort” on page 130 for additional information on sorting the census.

Patient shows on list when: Patient is removed from list when:

Rounding

Patient is admitted.

Patient is discharged. (An Administrator can increase or decrease the number of days after the discharge to keep Rounding patients on the census.)

Outpatient Patient is assigned an admis-sion or encounter date. (An Administrator can increase or decrease the number of days before the encounter to add Outpatients to the census.)

The date of the encounter is in the past. (An Administrator can increase or decrease the number of days after the encounter to keep Outpatients on the census.)

Critical Any patient that has a critical result that the user has not yet viewed.

Result has been viewed.

All Both rounding patients and outpatients.

See rules for Rounding and Outpatient modes above.

Note: “Manually added” patients are removed from the census 60 days after discharge or 60 dayslast account activity, whichever is later. “Follow Me” patients remain on the census until manually removed by the user.



Census RetentionA summary of the system parameters that control the retention of patients on census lists follows:

• Outpatient Days Before Arrival—number of days before registration or encounter date an outpatient displays on lists. The default value is seven days, but it is configurable. This may also be controlled on an individual list.

• Outpatient Days After Arrival—number of days after registration or encounter date an outpatient displays on lists. The default value is seven days, but it is configurable. This may also be controlled on an individual list.

• Inpatient Census Discharge Retention—default number of days after discharge an inpatient remains on Rounding lists. A default for this value is set, and it can also be controlled at the list level.

These parameters can be controlled at the individual list level (see the 360 Care Insights Suite Manager Guide for more information).

Managing the CensusA user’s personal list contains all patients assigned through HL7 messages from the HIS. Specifics on how patients are assigned to physicians vary by site. The following are census questions users might bring to your attention and steps that might resolve them.

Question: What if a patient is missing from my census?

• Verify that the patient in question is officially assigned to the user for the current account (this information is available via standard hospital information system (HIS) channels).

• Confirm that the user has performed a recent sync (i.e., since the patient in question has been admitted to the hospital).

• Confirm that the user has not hidden the patient on the device.

• Confirm the user is looking at the correct Census mode.

Question: I want to delete a patient from my list, but I am only allowed to hide the patient. Why?

There is a difference in how patients are treated if they are manually added versus when they are automatically added by an HL7 message.

• Confirm whether the patient in question was manually added to a user’s list, or they automatically appeared on their list. Manually added patients may be deleted at the user’s discretion, but only from within the list that they were added to. Manually added patients cannot be deleted from the ALL list.


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SortThe options shown for the census Sort feature will vary according to the census mode selected.

To change the Sort:


2. From the Patient List Settings screen, tap the Sort row.

3. Tap the desired sort.


Mode Available Sort

Rounding Name, Room*

Outpatient Name, Date*

Critical Name

All Name

Schedule Name, Appointment Date/Time*

* Default



Show Caregiver RolesA caregiver role is the caregiver's association to the patient as listed in the HIS.

Show Caregiver Roles enables the display of the caregiver’s associated roles with the patient on the Patient List census screen. The role for each patient associated with the currently logged in caregiver is shown below the patient name when this parameter is toggled to ON.

To toggle Show Caregiver Roles ON/OFF:


2. From the Patient List Settings screen, tap ON (or OFF) in the Show Caregiver Roles row.



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PATIENT INFORMATION SCREENThe Patient Information screen is the main access for a specific patient’s data. Access this data by tapping the row of the patient on the Patient List screen. The Patient Information screen for the selected patient displays.

When viewing the Patient Info screen, you can move easily to the selected patient’s medications, lab results, or Orders by tapping the Meds, Results, or Orders tabs at the bottom of the screen.

The full patient name is displayed at the top of the Patient Info screen, as well as the Room/Bed (or D/C, N/A, or Appointment Date/Time).

If the full patient name is too long to display (shown truncated with ellipses), tap and hold on the name to open a pop-up with the full patient name.

Patient DemographicsGeneral demographic patient information is shown below the patient name/room and include:

• Age

• Race/ethnicity

• Gender

• Date of birth

• Medical Record Number (MRN)

• Alternate ID

• Admit Date and Length of Stay



DiagnosisThis area shows the patient’s admit diagnosis (some customers might show Chief Compliant).

If Info Button has been enabled, you may see the Info Button icon. Tap the icon to see detailed information on the patient’s condition. An Internet connection is required.

AllergiesIf the HIS sends allergy information for the selected patient, it is shown in the allergies section on the Patient Info screen.

Note / Shared NoteThis area can be used to key in To Do lists, charge codes, and clinician observations and notes. Notes can remain private (viewable only by the author) or can be shared with other clinicians who have the selected patient on their list.

To create a Note:

1. Tap on the Note row on the Patient Info screen of the selected patient. This opens the Edit Note screen.

2. Tap in the (note) field to open the keyboard.

3. Type your notes and tap Return.

4. To share the note with other clinicians who have this patient on their list, tap the ON toggle button in the Shared Note row.

5. Tap Save. Tap Cancel if you change your mind and don’t want to save the note.

6. Sync the device to share the Shared Note.

Note: A maximum of one message per patient per day is allowed for each user.


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ages can

and are

CaregiversInformation shown for the caregiver role to the patient depends upon the selection made for Show Caregiver Roles. See “Show Caregiver Roles” on page 131 for information on showing/not showing caregiver roles on this screen.

AccountThis area shows the patient account summary, including admission source, type, and discharge disposition.

Tap on the Account row to display the account details.

ContactTap on the Contact row to display patient address(es) and phone number(s).

InsurancePrimary and secondary (if available) insurer contact information, group, policy number, and other miscellaneous insurance information is shown when the Insurance row is tapped.

Next of KinTap on this row to display the name(s), relationship, address(es) and phone number(s) for patient next of kin.

OtherThis area contains patient citizenship, nationality, language, and religion.

Appt. / ProcedureThis area shows any appointment information with the month and day, status, and ID.

Note: Each user can share one message per patient per calendar day. Once shared, these messbe seen on Reports > F.Y.I. A message can be unshared and edited during the same day it was created. Shared Messages are stored in the 360 Care Insights Suite mobile database for 30 days not pushed back to the source HIS. A Note can accommodate 4,294,967,296 characters.



Follow After DischargeWhen Follow After Discharge is set to ON, this feature allows the caregiver to track the patient and to view lab results or reports that come in after the patient has been discharged.

To follow a patient after discharge, complete these steps: • Ensure that you are currently viewing only the list on which you want the patient to

remain after discharge. If you are viewing ALL lists on your device, the patient may be added to more than one list.

• With the appropriate list and patient in view, tap the toggle to ON in the Follow After Discharge row at the bottom of the Patient Info screen

• Once the patient is discharged, the room number displays as N/A. The patient remains on the list as a manually added patient until the user manually deletes the patient.

Note: After discharge, Follow Me patients do not have medications because medications only show for active accounts.


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MEDSPharmacy (medication) orders are available via the Meds button after a patient has been selected from a list.

The patient name and location are displayed at the top of the screen.

Patient Allergy Data Allergies can be configured to show in the Meds screen if the information is sent by your HIS.

If allergies have been configured and allergies are known for the patient, they are displayed. However, if allergies have been configured, but the patient’s records indicate no known allergies, a message such as the following will be displayed: “Allergies: None,” “NKDA,” “No Known Drug Allergies.” If configured but there is no allergy data available for the patient, the message, “Allergies: Not Available” is displayed

Additional Patient Data Additional patient data elements can be displayed on the medications screen if available from your HIS system and if they have been configured to display. These can include:

• Height

• Weight

• Creatinine clearance



ders only

that filter

Medication Information Shown in 360 Care InsightsThe Meds screen can display pharmacy order information or medication administration records.

Micromedex 360 Care Insights can display medication administration records if the information is sent by the HIS and configured for your site.

If administration records are not available, the Meds screen displays only the:

• Drug

• Dose

• Route

• Frequency

• Note

Medication StatusBy default, the Meds screen shows all medications (the ALL button is selected) for the patient. All medications are shown alphabetically within their respective status. Active medications are shown first, followed by active PRN, followed by Held, and then Discontinued.

Discontinued medications remain on the patient’s Meds display for a configurable length of time or until the next sync, whichever is greater. The default time is two days.

To filter for a specific medication status, tap the appropriate button (Active, PRN, Hold, DC) and the screen changes to show just the medications for the selected status.

Note: Pharmacy orders are not a substitute for the medication administration record. Pharmacy orlets the user know which medications are ordered, held, or discontinued.

Note: Once a filter (Active, PRN, Hold, or DC) has been selected, the Meds display will default to until a different medication status filter is selected.


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Medication DetailsTap on a medication to view the details for this medication.

If medication administration is configured, the screen defaults to the Administration screen, but both order and administration information is available. The Administration screen displays the date and time the drug was administered as well as the dose and by whom the medication was administered, and any note that was entered.

If medication administration is not configured, only the orders information is shown. This includes: drug, dose, route, frequency, and any notes for the medication.

If Info Button is configured, tap the icon to view detailed drug information from DRUGDEX®.

Return to the Meds screen by tapping the Meds back button.

IV MixturesThe display of complicated IV mixtures is limited to the first three (3) components. For example: Total Parenteral Nutrition (TPN) orders often have 15–20 ingredients that are itemized as medication components. 360 Care Insights attempts to refer to the solution by its overall name, and then list up to the first three (3) components provided by the pharmacy system. These data are sufficient to communicate that the TPN order is active, but the user may need to refer to the pharmacy system to confirm that, for example, Zantac is being added to the solution.



ults tab.

RESULTS - REPORTS AND LABSLabs and Reports (results) are available via the Lab & Reports button after a patient has been selected from a list.

Laboratory results are maintained for the set (configured) number of days after the result is reported or updated (as opposed to when the test was performed).

Data RetentionThe amount of reports and lab data displayed for patients is highly customizable. Administrators can set the default number of days to show for reports, labs, and nursing observations. 360 Care Insights administrators use the Manager application to define these settings at the individual user level. The system default is to have seven (7) days of reports, labs, and nursing observations with 30 days of micro results.

Some specific report types, such as Histories and Physicals, and Discharge Summaries, can be flagged to be permanently retained in the database. These reports are permanently warehoused and associated with the patient’s record in future visits.

Note: Unviewed Critical results exist for the patient when the critical icon is shown on the ResThis icon disappears after the result has been viewed.


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SortResults can be shown sorted in one of four ways:

• Summary shows the number of results for each type of lab or report. The results can be viewed in table format by tapping on the lab or report row.

• Chrono (chronologically) shows individual results in reverse chronological order (most recent first, oldest last)

• Critical shows all critical results (in reverse chronological order) followed by all other results (in reverse chronological order)

• Detailed shows the detailed results of each individual test.

Changing the Sort1. Tap the Sort field to open the Sort settings screen.

2. Tap the desired sort (Summary, Chrono, Critical, or Detailed).

Changing the Order of the ResultsWhen viewing results sorted by Critical or Detailed, each user has the ability to customize the order of the display of the groups.

1. Tap the Edit button on the Results screen.

2. To move a group up, tap the button; to move a group down, tap the button.

3. Tap Done to return to the Results screen. The new order is reflected when viewing results sorted by Type.

4. The screen returns to the results screen with the new sort selection.

Note: Results in the Fishbone layout are not available when sorting by Type. See “Fishbone Display” on page 141.



Fishbone DisplaySome clinicians prefer to see their results in the “fishbone” layout. This display is only available when the selected sort is either chronological, critical, or detailed results.

Once modified, the fishbone display preference remains until changed again.

To view results in the fishbone layout:

1. With a patient selected, navigate to the Results tab.

2. Tap the Edit button.

3. Toggle the Display Fishbone parameter to ON or OFF.

4. Tap Done to return to the Results page.


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Changing/Filtering Results Based on a Time RangeThe time period displayed can be filtered to show:

• the last 24 hours



• ALL available results *

* Administrators can set the default number of days to show for reports, labs, and nursing observations. See “Data Retention” on page 139 for more information.

Laboratory results are maintained for the set (configured) number of days after the result is reported or updated (as opposed to when the test was performed). Each user has the ability to set the time period they wish to view.

To change or filter the time period:

1. From a Result screen, tap the Period field

2. Tap the desired time range to view.

3. Tap Done to return to the Results screen. The results update with the time period selected.



LabsTap the Lab & Reports tab to view clinical results.

Results are always listed based on the time the test was performed (not based on when the result was reported). Each result is shown individually, with the most recent result listed first.

New / Critical Result IndicatorsWhen a new result that has not been viewed is found for the patient it is indicated by the green

star icon next to the type or result. Once the result has been viewed, the indicator disappears on the Results screen.

When a critical result that has not been viewed is found for the patient it is indicated by the red exclamation point icon next to the type or result. Once the result has been viewed, the indicator disappears on the Results screen.

Trended LabsThe screen shown to the right is an example of trended labs.

The result type name (CBC) is followed by the number of results available (7).

Results are presented from left to right, with the most recent result shown on the left. If more than one screen of results are available, move to older results by flicking or dragging the table. Normal, abnormal, and critical values are visually differentiated by use of regular font (normal), bold font (abnormal) and red font with a yellow background (critical).

If your facility has the proper subscription and if configured, tap the Info Button for information on the laboratory test from Micromedex Lab Recommendations.

Tap the date/time column header to display the details of the panel, including any additional information, and the normal result ranges as specified by your facility.

Tapping on an individual lab panel name (e.g., HGB) opens the result in graph view. See “Graphing” on page 149 for more information.


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Abnormal ValuesAbnormal values (values that are flagged as HIGH or LOW for the range) are displayed in black, bold font.

Critical ValuesAny lab panels with critical values have a yellow shaded background.

Common LabsThe following table lists the common lab types and the typical tests included in each.

Note: The mapping of tests to lab group is done during implementation and may vary slightly from this example.

Lab Test (Type) Results Included

Description

ABG (Arterial Blood Gas) PH Blood pHPCO2 Partial pressure of CO2PO2 Partial pressure of O2HC03 Bicarbonate concentrationSAT Oxygen saturation FI02 Fraction of inhaled oxygenBEX Base Excess

CBC (Complete Blood Count) HGB Hemoglobin concentrationHCT Hematocrit concentrationWBC White Blood Cell CountPLT Platelet count



MCV Mean red cell volumeNEUT Neutrophil percentageBAND Band percentage

CHEM7 (basic serum electrolytes) NA Sodium concentrationK Potassium concentrationCL Chloride concentration C02 CO2/HCO3 concentrationBUN Blood urea nitrogenCR Creatinine concentrationGLU Glucose concentration

COAG (Coagulation Studies) PT Prothrombin timeINR International normalized ratioPTT Partial thromboplastin time

GI (Liver and Pancreas Labs) AST Aspartate aminotransferaseALT Alanine aminotransferaseALKP Alkaline phosphataseTBILI Total bilirubinAMY AmylaseLIP LipaseALB Albumin

HEART (Cardiac Labs) TROP Troponin I/Troponin TCK Creatine kinaseCKMB Creatine kinase, MB fractionCHOL CholesterolLDL Low density lipidsHDL High density lipidsTG Triglycerides

LYTES (Additional Serum Electrolytes) CA Calcium concentration

ICA Ionized calciumMG MagnesiumPHOS Phosphate


Description


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UA (Urinalysis) NIT NitritesLE Leukocyte esteraseBACT BacteriaWBC White blood cellsRBC Red blood cellsSQM Epithelias/Squamous cellsPROT Protein

MISC (Any labs not reported in the above categories)

Any lab panel that does not have results that fit into the above categories


Description



Additional Information on Some of the Common Reports

VitalsVitals are trended by the time they are taken and the active column is shaded gray.

Results are presented from left to right, with the most recent result shown on the left. If more than one screen of results are available, move to older results by flicking or dragging the table. Normal, abnormal, and critical values are visually differentiated by use of regular font (normal), bold font (abnormal) and red font with a yellow background (critical).

For additional information from Micromedex®, tap the Info Button icon, if configured.

Tap the date/time column header to display the details, including any additional information, and the normal result ranges as specified by your facility.

Tap an individual lab panel name (e.g., SBP) to open the result in graph view. See “Graphing” on page 149 for more information.


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me e labels the

Inputs or OutputsI/Os are trended by shift in reverse chronological order. The active column is shaded gray.

The following is a list of symbols you might encounter in the I/Os at the report level:

• + (Preceding NET)—the measured input amount has exceeded the output

• - (Preceding NET)—the measured output amount has exceeded the input

• + (Following a value)—the total is comprised of measured volume plus a counted item

• ~ (Preceding a total)—it is taking into account the measurable plus the counted

• ? (Too large)—data is too large for the column width; tap the date/time column header to display the details

There is also a system parameter to enable an additional pop-up that displays I/Os summarized by 24-hour periods.

Tap an individual lab panel name (e.g., PO) to open the result in graph view. See “Graphing” on page 149 for more information.

Note: There may be additional information in the Details screen (accessed by tapping the date/ticolumn header) that is not on the main I/Os screen. Trended values are the ones that havthat appear on the left side of the main I/Os screen. Additional information only appears inDetails screen.



Graphing360 Care Insights products can display lab results and nursing observations in a trendable graph layout. The graph allows the clinician to quickly identify trends in patient labs or notes that may not be as apparent when analyzing only the numeric values.

Viewing a GraphYou can graph any individual lab or nursing observation by tapping the link on the name of the label for that lab.

The graph provides you with an indication of both how the value is trending and whether it is abnormal or normal. These values are depicted in red and white on the graph with white indicating a normal range, and red indicating an abnormal range.

The vertical axis on the graph is the reference range and contains the high and low values.

The horizontal axis is reflective of the time period selected for the graph.

Data points are shown as the blue dots and depict a data collection point.

Other results are available via the use of the Type button. Tapping the Type button opens a list of all results available in that particular category or lab panel.

Tap on the Period button to change the time period used for the graph. Valid options are:

• ALL

• 24 hours

• 48 hours

• 72 hours


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ORDERS Orders transmitted by your HIS are available in 360 Care Insights products for the mobile platform. To view Orders the Orders Role must be turned on for the user. See 360 Care Insights Suite Manager Guide for more information on user roles.

To access a patient’s orders, tap on the Orders button.

All orders for this patient are shown, grouped by order type such as: LAB (lab orders), DOC (documentation), DIAG (diagnostic), DIET (dietary), and so on.

View all orders for a specific type by tapping on the appropriate row. The examples below show the screens after tapping the LAB type or DOC type.

Note: Order types are configured at the site level (not at the user level).



View the details of a specific order by tapping on the specific row of the order. The examples below show a sample order detail for the first LAB order and the first DOC order from the previous example.

Return to the full list of orders by tapping on the List button.

Changing the Sort or Time Period

Orders can be shown sorted chronologically (most recent to oldest) or Summary.

To change the sort order:

1. Tap on the Sort button.

2. Tap on the sort desired (Summary or Chrono).

3. Tap on the Done button.


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The time period shown can be modified:

1. Tap on the Period button.

2. Tap on the time period desired (All, 24 hours, 48 hours, or 72 hours).

3. Tap on the Done button.



FORMS AND PROFILES Forms (interventions) can be automatically assigned to patients that meet the criteria of specific profiles. This occurs when the Forms Administrator has assigned an intervention form to a profile and the patient meets that profile criteria. See the 360 Care Insights Administrator Guide for CareFocus, Infection Prevention & Pharmacy Intervention for full details on assigning a template to one or more profiles.

Interventions can also be manually attached to a patient by a user by associating the intervention with the patient and list.

The forms icon next to a patient on the Patient List screen denotes that one or more forms are associated with the patient.

Follow Up StatusPatients with forms assigned that have been flagged for follow up are shown using:

• Follow Up = has been set (Active) or

• Follow Up = Due

If a follow up status has been assigned and is now due, the icon is shown on the census. If a follow up has been assigned, but is not yet due, the forms icon is shown on the census.

Both follow up statuses (due and active) are shown when viewing the Forms tab with the patient selected.


154


Viewing ProfilesTo view the profiles associated with a patient: Tap on the patient in the census, then tap on the Forms button.

The list(s) causing the glinting are shown glinted (highlighted yellow).

Note: Profiles are glinted only if both of the following conditions are met: 1. The user has not viewed the patient since the patient met the profile criteria. -and- 2. The user is currently subscribed to that List.

Note: The mobile platform displays all Lists that: - the user is authorized to view, and - are associated with the patient ...regardless of the user’s current List selection setting.



Viewing FormsTap on the patient in the census, then tap on the Forms button.

Tap on the form row to open and view or modify the form. See “Entering Form Information” on page 158 for additional information on adding information to a form.

Follow Up on Forms

Forms marked with a follow up that is now due are shown with the icon and the date and time the follow up was due.

Forms marked as follow up is required but not yet due, are shown with the icon and the date and time the follow up will be due.

Note: When tapping the form to open it, do not accidentally tap the checkbox, or form Complete button, to the left of the form name, as this may complete the form.


156


Adding a Form to a Patient1. Select the patient from the Census, then tap the Forms button.

2. Tap the + Form button.

Available forms are shown, grouped by Category (e.g., Patient Safety, Anticoagulation Monitoring, etc.) or by Name. Tap the Name or Category button to change the grouping of the forms.

3. Tap on the row of the form you want to add. The form is added to the Generic

Interventions list. If the form was added in error, tap the Delete button to remove it.



4. To associate the form with a different list, tap the List row to open the Select List screen and attach the form to the desired list.

5. Fill out the Form fields. See “Entering Form Information” on page 158 for explanations of the controls available in form fields.

6. Sync your device to make your changes available to other users who have the patient on their census.

Note: The List can be changed prior to a sync, but cannot be changed after a sync.


158


Entering Form InformationForms can include any of the following control types of input fields:

• Pick List - tap to select from the list• Radio buttons - tap the appropriate option (circle) to select• Toggle switches (e.g., YES | NO or ON | OFF) - tap to toggle between the two values• Short and Long Text fields - tap the field, then type using the keyboard• Date - press in the field to open the calendar and navigate to the date using the

arrows and calendar days• Drop-down - tap to open the selector wheel and flick up or down then tap on the

desired item• Calculators - tap the calculator name row. Values passed from your HIS (e.g., weight,

lab values) will be populated in the appropriate fields. Enter any additional values and tap Submit to view the calculation.



Required FieldsFields that require a value to complete the form are noted with glinting. If you attempt to mark the form as complete without entering data into a required field, you are prompted to enter all required information before you are allowed to complete the form. This occurs when the administrator has placed a requirement on one or more fields stating that information is required on the field before it can be considered complete.

CalculatorsCalculators may be embedded into forms. The available Calculators include:

• BSA and Lean/Ideal Body Weight

• Creatinine Clearance

• Dobutamine Dosing

• Dopamine Dosing

• Epinephrine Calculator (Pediatric and Adult*)

• Heparin Dosing


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• Nitroglycerin Dosing

• Nitroprusside Dosing

• Norepinephrine Calculator (Pediatric and Adult*)

• Phenytoin Level Adjustment

* EPINEPRINE and NOREPINEPHRINE Calculators: When calculating dosage for patients >17 years of age, the adult version of the calculator is used. When calculating for patients < 18 years of age, you have the option to select to use the Pediatric or the Adult version of the calculator.

Entering Information in CalculatorsWhen a calculator has been embedded into a form, tap on the calculator row in the form to open it.

The Creatinine Clearance Calculator (shown at right) is an example of a calculator.

The user must provide the information before the calculation can be performed.

To enter values into the calculator, tap anywhere on the screen.

The screen zooms in on the first field for entry and displays the keyboard.

Enter the value for the first field. If there are additional fields for entry, you will see the Next button.

Tap the Next button to be positioned in the second field. Continue this until all fields have been entered. Tap the Done button to close the keyboard.



Drop-down Controls in CalculatorsSome calculators require the user to choose from a list of pre-populated values. Tap on the drop-down field to open the list of available values. Flick up or down and tap to select. Tap Next to continue to the next calculator field, or tap Done.

Tap the Submit button to start the calculation. Tap Clear if the values entered need to be modified and/or re-entered.


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Results are displayed below the input fields.

From the calculator results screen, you can clear the input values and start over, or tap Resubmit to return to the entry screen to modify one or more fields.



Add Calculations to the Patient FormTo add a calculation to the patient’s form, tap in the Stored Value field. Doing so opens the keyboard and you can then enter the value for the patient. Tap return to close the Stored Value field. Tap the Form button to return to the Form. Sync to make this information available to other users.


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Follow Up

Adding a Follow Up Time to a FormIf the patient should be followed at a specific time interval, you may add a follow up time to the form.

1. With the patient selected and the form open, tap the Set F/U button.

2. Set the desired follow up time. Select from: Midnight tonight, 4, 8, 12, or 24 hours, or enter a custom date and time. To enter a custom date and time, flick to the desired date and time, then tap the Done button to return to the Set Follow Up screen. Tap the Form button to exit the follow up selection screen.

3. When you return to the selected patient, you see the form with the follow up time/date assigned.



Removing a Follow Up 1. With the patient selected and the form open, tap the Set F/U button.

2. Tap the Remove Follow up button.


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Marking a Form CompleteWith the patient selected and the form open, tap the Complete button. The screen returns to the patient and shows the form in completed status (visible if the ALL forms filter is selected).

A completed form cannot be edited, but the status of a completed form can be changed back to incomplete by unchecking the complete. You can view the details of a completed form by tapping on the form name.

Removing a FormWith the patient selected and the form open, tap the Delete button. Tap OK to confirm that you want to delete the form.

The screen returns to the patient forms and the form is no longer associated/attached to the patient.

Note: Forms with Required Fields (see “Required Fields” on page 159) cannot be marked as complete until all required fields contain information.


APPENDIX: A SAMPLE EXPORTED FORM360 Care Insights supports the exchange of clinical intervention data. The Outbound Forms Exchange feature provides the ability to export forms in HL7 Clinical Document Architecture format, CDA®, for use in other Healthcare Information Systems.

A sample printout of an exported form follows:


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APPENDIX A: SAMPLE EXPORTED FORM


170



INDEX

AAlert Indicators 17antibiogram 95

CCalculators

ACLS/PALS Guidelines 44Alcohols/Ethylene Glycol Blood Level 44Alveolar-Arterial Oxygen Gradient 45Anion Gap 44Antidote Dosing and Nomograms 44BMI 45Clinical Calculators 45Dobutamine Dosing 45Dopamine Dosing 45Dosing Tools 44Epinephrine Dosing (Adult & Pediatric) 45Ethanol/IV Dosing for Methanol/Ethylene Glycol

Overdose 44Heparin Dosing 45iPhone and Android 159IV Rate 45Laboratory Values 44Measurement Calculators 45Metric Conversions 46NAC Dosing for Acetaminophen Overdose 44Nitroglycerin Dosing 45Nitroprusside 45Norepinephrine (Adult & Pediatric) 45Toxicity Nomograms 44

Ffollow up

adding (mobile) 164removing (desktop) 90removing (mobile) 165

formsadding (mobile) 115, 156adding a follow up (mobile) 164required fields (handheld) 159required fields (mobile) 159

GGlinting 115

IIcons 17

Critical results 17Isolation 17New results 17

Infection Control Bulletin 95Interventions

Audit log 85Completing 79Follow up

Status 87Printing 84Removing 83

Isolation 17IV Compatibility

1/2 NS 53Caution - Variable 51Compatible 51D10W 53D5LR 53D5NS 53D5W 53Incompatible 51Not Tested 51NS 53Syringe 57TPN/TNA 58Uncertain 51

Pprofile

criteria met - viewing 31

RReports

Antibiotics and Organism Susceptibility 95Clinical Activity 98Pharmacy Intervention Detail 84

SSolution 50

TTPN/TNA 50


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MICROMEDEX® INFECTION PREVENTION - USER GUIDE


Documents

MICROMEDEX® 360 CARE INSIGHTS SUITE CAREFOCUS · micromedex® 360 care insights suite carefocus user guide may 2017