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6.07 General Enhancements Why are we upgrading the Meditech software? • • • • • Patient Quality and Safety Meaningful Use Requirements Health Care Reform Act Reimbursement Enhancements Work-List • Larger checkboxes for inclusions • Larger box for look ahead hours • Larger icons – – – – – Associated Data Protocol Item Detail Checkmarks Target Symbol • New Outcome Icon – O instead of a target symbol • New Detail Button Larger icons on Work-List New Detail Button Launches to Item Detail Additional PCS Assessment Enhancements • Ability to display longer text within PCS assessments • Improved loading times when opening the assessments to document Longer Display Text 6.07 Immunization Enhancement What changes have been implemented within the Immunization Enhancement? • New Electronic Order for Influenza and Pneumococcal – Previously a paper copy of the order printed to Pharmacy • New Immunization Screen in the MAR • New Immunization Section in the EMR Summary Panel – Similar to the Home Med and Allergy sections Standardizing Administration Time for Immunizations • Unless contraindicated, administer vaccines when available • Do not wait until discharge to administer Process for Pneumococcal and Influenza Vaccines • • • • • • • Document the Age 18+ Opt-Out Vaccine Assessment – All patients must be assessed for Influenza and Pneumococcal Eligibility upon Admission Electronic Order files to Pharmacy – Information from the Nursing Assessment files with the order Pharmacy reviews and processes the “Nsg Assessment ” Order (Completed Assessment) Nursing Acknowledges – Canceled “Nsg Assessment ” Order – Vaccine med order entered for today and now Administers the vaccine on the MAR – Documenting the revised MAR flow sheet – Documenting the new immunization screen Vaccine information will flow to the EMR Summary panel once the vaccine is administered Historical vaccine information is still available in the EMR – Summary panel • Legal/Indicators tab – Vaccine Information Clinical Panel Vaccine Eligibility Documentation Process • Complete Age 18+ Opt-Out Vaccine Assessment • Save Documenting the Vaccine Eligibility Assessment from the Work-List Document the Vaccine Eligibility Assessment for Pneumococcal and Influenza Vaccines Entering Electronic “Nsg Assessment” Orders • Vaccine Assessment Orders Triggered – The completed eligibility assessment will electronically file to Pharmacy – Pharmacy must review the assessment regardless of eligibility • Select Ok to file • Identify the Ordering Provider • Select Order Source “MEC Approved Protocol” Triggering “Nsg Assessment” Orders Always click OK to file the orders Entering “Nsg Assessment” Orders in OM Always click OK to file the orders •Choose Ordering Provider •Choose MEC Approved Protocol order source IMPORTANT • Regardless of vaccine eligibility all vaccine assessment orders must be filed to Pharmacy • By following this process, you are not ordering a vaccine for a patient who is not eligible • The vaccine assessment order serves as an electronic notification to Pharmacy that the RN has completed the vaccination assessment • It is a requirement that Pharmacy review all inpatient vaccine eligibility assessments Selecting the Orders • Place checkmark and select both orders – Will not file if not selected • Order detail will populate once selected • Save • Completed Nursing Assessments will electronically file to Pharmacy to be processed • Select both “Nsg Assessment” Orders • Pharmacy must review the assessment regardless of eligibility Order Detail will populate once the orders are selected Must Checkmark Orders to File the Orders to Pharmacy Must Click Submit to File the Orders to Pharmacy New Orders on Status Board • Once you have filed, you will notice the orders displaying on the Status Board as “Nsg Assessments” • These are the assessments which will electronically file to Pharmacy to review • Pharmacy will process and enter the order for vaccine if applicable “Nsg Assessment” Orders Displaying on Status Board Beware of Vaccine Assessment Order • Vaccine Assessment orders will queue for acknowledgement • RN is unable to acknowledge order until Pharmacy has processed the order • An error message will appear to alert Nurses that the orders are currently being reviewed by Pharmacy • When closing the error message, a visual indicator will display to indicate the order is unverified in Pharmacy Error Message when Acknowledging Order The Nurse will not be able to acknowledge the order until the process is complete in Pharmacy Pharmacy Order Status is Unverified Vaccine Medication Order for Vaccine • Once an active Medication order has been entered by Pharmacy, the order will display in the orders column on the Status Board Vaccine Medication Order on Status Board Acknowledging Processed Pharmacy Orders • Once Pharmacy has processed the Vaccine Assessment Orders, the Vaccine Assessment Orders will display in the acknowledgement queue in a cancelled status • Nursing Tip: Cancelled status means that Pharmacy has completed their review of the vaccine assessment orders. Processing Eligible Vaccine Orders • If Pharmacy determines the patient is eligible for immunization, a vaccine medication order is generated • RN will ack – Vaccine Medication Order • View Order Detail – “Cancelled” Vaccine Assessment Order • View Order Detail – Status of order is cancelled – Stop reason will default the user who cancelled the order Acknowledging Medication Vaccine Order Review order detail for each order Acknowledge the vaccine first, then review cancelled “Nsg” Assessment” orders View Order Detail Acknowledge Cancelled Vaccine Assessment Order Processing Non-Eligible Vaccine Orders • If patient is not eligible for immunization, Pharmacy will cancel the Vaccine Assessment Order and enter a stop reason • RN will ACK – “Cancelled” Vaccine Assessment Order • View Order Detail – Status of order is cancelled – Stop reason will be entered as to why the patient is not eligible for vaccine – Pharmacy should be using the reason entered by Nursing on the Assessment View Order Detail Stop Reason entered by Pharmacy Vaccine on the MAR • New option to view vaccines only on the MAR • Active vaccines will display on the MAR as they do currently • MAR will display cancelled Vaccine Assessment Orders in yellow • Nursing will not have to document on the cancelled Vaccine Assessment Order Viewing Vaccines on the MAR • New option to view only vaccine type orders on the MAR • Vaccine option only displays if there have been vaccines ordered for this patient during this visit • Cancelled “Nsg Assessment” orders will display in yellow • Active vaccines will display as they do currently Administration Process • Scan the Patient’s Wristband • Scan the vaccine • Notice the Vaccine Assessment Order is linked to the Vaccine Med Order • Automatically defaults to the Protocol Tab – View the Eligibility queries associated as protocol to the order • Click Flow sheet – New queries • Error message if you do not go to the Admin Screen – Indicates the VIS publication date is required on the Admin Screen • Enter information into the New Immunization Medication Administration Screen • Ok to File “Nsg Assessment” Linked to the Vaccine Protocol will display Eligibility Queries from the Nursing Assessment Updated MAR Flow sheet VIS • Patients must be given a current Vaccine Information Statement (VIS) prior to receiving the vaccination • Documentation requirements are the date the VIS was given to the patient and the VIS Publication Date • VIS is available in multiple languages VIS Publication Date Required Unable to file without entering required information on the Admin Tab New Immunization Medication Administration Screen Required: • VIS Publication Date • Dose • Injection Site • Lot# • Expiration Date Defaults in: • Component – Used for vaccines with multiple components (MMR) – Eff Date • Whether the vaccine will count towards the schedule • Dose • Units • Manufacturer Optional: • Vaccination Reason • Variance Reason New Immunization Medication Administration Screen Admin Displays in Green Session Summary of Medication Administration Admin Displays in Black on the MAR Viewing Immunizations in the EMR • Click on Summary Panel • Displays in the Clinical Tab – Similar to Home Medications and Allergies • Automatically updates when vaccine administered via the MAR Immunization Routine View Immunization Administrations in the EMR • Click on the vaccine or Click on the “i” • View the following: – Vaccines – Components – Antigens • View information entered via MAR • View Audit Trail – Click on History Report footer button – Include Audit Trail Yes • View Immunization Summary – Click on Immunization Summary footer button View Additional Information • Click on the “i” or • Click directly on the vaccine View MAR Administration Information View History and Summary History Report View and Print History of all Immunizations with audit trail Immunization Summary Report Print a summary of all the vaccines administered at your hospital Historical Vaccines • Summary Button in the EMR – Legal/Indicators Tab • Clinical Panels – Vaccine Information Viewing Historical Vaccines •Click on the Summary Tab •Click on the Legal/Indicators Tab Viewing Historical Vaccines •Scroll down within the Legal/Indicators Tab •Historical Vaccine Data will display the same View Historical Vaccines in the EMR Clinical Panel •Click on Clinical Panel •Click on Vaccine Panel EMR Vaccine Panel 6.07 Discharge Enhancement Streamlined Discharge Process • Nursing and Physician Documentation are available within the Discharge Routine • All Discharge Documentation printed via the Discharge Panel • Nursing Discharge Canned Text note will no longer be applicable for the discharge process • Nursing Discharge Documentation will automatically populate the new discharge panel Discharge Process • • • • Discharge Order queues for acknowledgement Acknowledge order Complete Discharge Documentation Print Discharge paperwork via the New Discharge routine Discharge Order entered via Physician Discharge Routine • Discharge order displays on Status Board indicating Physician has begun Discharge Documentation Acknowledge Discharge Order Review Order Detail Discharge Documentation Process Review • Nursing Discharge Documentation • Discharge Page Two if applicable • Teaching (Health Medication Education – Teach Record) • Complete Outcomes Nursing Discharge Documentation Important • Do not edit Physician Documentation • If there is a discrepancy, you will need to contact the Physician to update the documentation within the discharge routine Enhanced Discharge Process • Click on the Discharge Button • Notice the Physician Discharge Referral Information will default into the Discharge Routine – Prescriptions • Paper prescriptions will still need to be written – – – – Referrals/Follow up Appointments Care Plan Goals Activity Restrictions Reference Links Discharge Button Click on the Discharge Button Physician Discharge Referral • Physician Discharge Referral will populate the discharge routine once the Physician has completed their documentation in the Discharge Routine •If the fields are all blank, this indicates the Physician has NOT completed their portion of the discharge process Instructions, Stand Alone Forms and Forms • Instructions, Stand Alone Forms and Forms will not be used at this time Prescriptions • Medications which will be continued at home will display within the Prescriptions section •Written prescriptions will still need to be provided to the patient Referrals • Physicians will add Referrals within the Discharge Routine • When a referral is entered within the Discharge Routine, the Physician will receive a copy of the Patient Health Summary • Physicians can indicate how long after discharge to follow up with the referring Physician Enter Referral Notes • Scroll over to the right •Click on the Notepad Icon Enter Follow up Text and/or Dates and Times • If your hospital schedules the patient’s appointments upon discharge, you can enter the date and time of the appointment here • The referral text and follow up dates will print on the Patient Visit Report Care Plan Goals and Activity Restrictions Additional Reference Links and Reference Text Print Language • English will default in as the print language • Currently the discharge packet is only set up to print in English Printing the Nursing Documentation • • • • Click Reports on the bottom of the screen Choose Nursing Discharge Instructions Choose Discharge Page Two (if applicable) Click ok Printing Nursing Reports Print Nursing Discharge Instructions Patient Health Summary will print with the Discharge Packet • Print Nursing Discharge Instructions, Discharge Page Two, Discharge Page Three Print to printer Print Discharge Packet • Click Print Packet • Packet Includes the Following – Patient Health Summary – Patient Visit Information – Face to Face Certification – Discharge Medication List Print Packet Choose Printer Discharging out of Meditech • • • • Click the Discharge Data Tab Enter Discharge Date and Time Click now for the current date and time If patient was discharged previously, then you can select a time in the past – Discharge date and time should be when patient actually left the hospital • Click Save Discharge Date/Time Now for Current Date and Time Entering a Time in the Past Discharge Disposition • Discharge Disposition will populate from Physician Documentation • Save Discharge Disposition Important • Once the Discharge Data is saved, the patient will be discharged out of Meditech