be prepared hed and heo/wiz downtime. saturday may 12, 2012 at 700pm till approximately sunday may...

Be PreparedHED AND HEO/WIZ

DOWNTIME

Saturday May 12, 2012 at 700pmTill approximately

Sunday May 13, 2012 at 1200pm

Downtime for: Order Entry (HEO/WIZ), Nursing Documentation (HED),

Nursing Med Administration System(Admin_Rx)

HED AND HEO/WIZ DOWNTIME

Downtime Kits must be replenished, this kit includes: A. Downtime Policies; B. Laminated Downtime Checklist; C. Physician Order Sheet (POS); E-Procurement: Order

ASAP D. Nursing Flowsheets; E. Medication Administration Records (MARs); F. Downtime Requisitions; G. Other unit-specific documents. H. NEW Documents to be added to the downtime kit:

VCH Patient Discharge Instructions (MC 4085); VUH Patient Discharge Instructions (MC 2418) COPY CENTER: ORDER ASAP

Policies: Insulin and Heparin Gtt Protocol, Restraints, Braden, Fall Risk, PCA, Epidural

Assessment Guidelines VUH and VCH

PREPARING FOR DOWNTIME

Order Copier PaperOrder LabelsOrder Addressograph LabelsOrder Black Pins Increase Staffi ngReplenish Downtime Kits

PREPARING FOR DOWNTIME

Early Saturday Morning – For pts. not being discharged by 5p Place Physician Order Sheets (POS) in blue charts TWO per

chart, with patient labels attached on all three pages, DO NOT ADDRESSOGRAPH

Print 2 Downtime Flowsheets for each patient place labels, DO NOT ADDRESSOGRAPH

Print 2 Fall Risk Assessments for each patient place labels DO NOT ADDRESSOGRAPH

Print 30 labels for each patient Pharmacy Fax Numbers posted near fax with time of day

VUH – 7a-7p 39879 VUH – 7p-7a 31640 VCH – anytime – 66402 VPH – pharmacy rounds during day, VPH – 7p-7a – 31630

WHAT TO DO WHENMEDICAL RECEPTIONIST (CONT)

5pm Saturday Check printer for paper (Paper MAR’s will be coming) PRINT OPC and any other routine shift change printing Transfer Order Sheets on all patients.

Place TOS in patient’s chart Pharmacy will generate MAR, place in blue chart Print Assessment Guidelines, place in every blue chart Charts to Bedside

During Downtime Process Physician Orders – See algorithm

If electronic scanning, scan POS in EMR MR will annotate “DT” on POS beside all non-medication orders to

indicate to RN orders need to be entered into HEO/WIZ Transcribe Medication orders to MAR Complete requisitions (lab, radiology) and call ancillary departments

PRN Requisitions with serial times (i.e., Q6H), will be filled out through

end of downtime on 5/13 at 1200p


During Downtime Continued Remind Physicians to give POS to the Medical Receptionist Rounding on Blue Charts for Orders Transfers: Physician will amend TOS, and transfer patient.

Receiving unit will process TOS as if it were a Physician Order Sheet.

Scanning Units After 7am Sunday Morning

Blue Chart Check to look for documents to be scanned Nursing Flowsheet POS’s missed other


5pm Saturday Renew all restraint orders Planned Priorities and Nursing Summary complete on all

patients Night Shift WILL NOT do Priority Problems or Nursing Summary

Nurses will need to transcribe cumulative Intake and Output for their shift on the 7p-7a downtime flowsheet

Ensure OPC and Transfer Order Sheet are printed (MR to Complete)

WHAT TO DO WHENRN’S

During Downtime Helpful Information (Downtime Kit)

Assessment Guidelines will be in each chart Policies for Restraints, Braden, Epidural, Fall Risk, Insulin gtt protocol and

heparin gtt protocols How to complete a MAR How to complete a POS

Process and Verify Physician Order Sheet (POS) requires signature

Verify and Process Medication Administration Record (MAR) requires signature

Transfers: After MR processes Transfer Order Sheet (TOS), RN will verify and process orders as if it were a POS requires signature

Admission History: VCH/VUH: Positive for CPAP, POS will need to be filled out and respiratory called. Adults: If a positive screen for pneumovax, POS will need to be filled out and sent to

pharmacy

WHAT TO DO WHENRN’S (CONT)

During Downtime Continued Discharge: Discharge will be written on POS and prescriptions

printed through Rx_Star. Discharge Instruction Sheet completed and sent home with patient

MAR’S for Sunday will print after midnight Saturday. MR’s place in Blue Chart RN’s will verify Sunday MAR with Saturday MAR, annotate

changes and schedule changes and fax to pharmacy.

WHAT TO DO WHENRN’S (CONT)

RN’s HEO/WIZ

From the POS and TOS, all non-medicated orders to be entered into HEO/WIZ, only exception completed one-time orders NOTE: PHARMACY WILL ENTER ALL MEDICATION ORDERS

Admission History Consult orders will need to be entered.

Care Organizer Confirm Medication Orders with paper MAR. Send message to

pharmacy via Care Organizer for corrections

WHAT TO DO WHENAFTER DOWNTIME

(APPROXIMATELY NOON SUNDAY MAY 13)

RN’s Continued HED

Admin Rx, medications with outstanding schedule need to be addressed

Asmnt/Interventn Tab, document start of downtime and end of downtime.

RN Enters Cumulative Intake and Output for Saturday and Sunday Example of Back time for Saturday’s Cumulative from paper flowsheet,

(3/12/2012, 0645). Will need to subtract what was charted from 7a-7p on 3/12 in HED from 24

hour cumulative from the paper flowsheet. Sunday’s cumulative will be the current cumulative from the paper flowsheet.

Restraint Orders renewed Priority Problems with goals back time to morning shift, and

completed at end of shift Planned Priorities and Nursing Summary.



MR’s Scanning Units will scan documents in to EMR

Downtime flowsheets Downtime POS (physician order sheets) that were missed TOS (transfer order sheets) that were missed Re-locate charts per unit protocol back to location for scanning

All units Remove and Discard all unused downtime documents with

patient labeled attached. Remove and reuse any downtime documents that haven’t been

labeled or used and place back in downtime kit. Remove Transfer Order Sheets



POS KEY

MAR MR KEY

MAR RN KEY

LAB REQ KEY

CRITICAL CARERESPIRATORY CARE LAB KEY