EPIC for Paramedics

Introduction to the EPIC EMR System at Salem Hospital

Logging Into Hyperspace

To log into Hyperspace a User ID and password is required

Salem Hospital will issue a user ID and password to you You will need to change your password at your

first log in Never share your password with anyone

It is your electronic signature

Hyperspace log in Screen

Epic Rules

A “Stop” sign indicates information must be entered

If “Accept” and “Cancel” are choices, you must choose one

An ellipsis requires an exact choice from a drop down list

Searching using the first 3 letters of key words will assist in finding information

Ellipsis

Ellipsis

A drop down menu will

appear when the ellipsis is

clicked

More Epic Rules

Work spaces are usually highlighted in dark blue

If there is an ellipsis for time and date you can use the following:

T= today (If you want to say 2 days ago use t-2) W = week (If you want to say last week use w-1) M = Month (If you want 3 months ago use m-3) Y = Year (If you want 5 years ago use y-5) N = Now (If you want a time 1 hour earlier use n-60)

Home Workspace After login

Home workspace appears Create a “My List” for your list of assigned

patientsYou only need to create your “My List” onceMay add and remove patients on a daily basis

to reflect your current patient list

Home Workspace

Creating a “My List”

With “My Patient’s List” highlighted in dark blue Click on “Create” button

Enter your name in the stop sign row Click “Copy” Click “A Nurse List” Click “Accept” in the small box Click “Accept” in the big box

Create A “My List”

1. Give your “My List” a

name

2. Click “Copy”

3. In “Available Columns” box,

click on “A Nurses List”

4. Click “Accept”

Adding Patients to Your “My List”

There are two ways to add patients to your “My List”Drag and drop unit home list into “My List”

Find unit list under expandable list - “System List” Look under “Units” to find your nursing unit

Once you find your unit, drag it up to your “My List”

Adding Unit List to “My List”

Click and hold your Unit - drag and drop in your “My List”

Add Patients to Your “My List” To add specific patients to your “My List”

(must know patient name or room number) If using room number – drag and drop

individual patient from your “Unit List” into your “My List”

If using patient name – highlight in blue - “My List”

Click on “Add Patient”Use the “3,3” rule – first three letters of their

last name and first three letters of their first name to search for patient

Add Patient Using “3,3” RuleFirst 3 letters of last name, comma & first 3 letters of first name

Add Patient Using “3,3” RuleClick “Add Patient”

Use the “3,3 Rule” to find your patient

Click “Accept”

How a “My List” Looks with Patients

Removing Patients from “My List”

Your patients (with black icons next to their name) will stay in your “My List” until you remove them

To remove a patient Click on patients nameClick on “Remove” button

Your “My List” (with red and blue icons next to it) will be automatically updated as the unit census changes

Removing a Patient from “My List”

Highlight the patient name & click “Remove”

Opening a Patient’s Chart & Getting Report

To open a patient’s chart from your “My List” Highlight patient name & click “Open Chart”

Patient Summary Activity opens Activities are gray tabs on left side of chart

To get report on a patient Look at all reports under “Patient Summary

Activity” – (more reports are available under double arrows on the right hand side of screen)

Receive verbal report from off-going nurse

Patient Summary Activity – Get Report

Activities

Reports

Chart Review Activity

Chart Review Best for looking at old records on patients

Lab Results, Imaging Results, Past Medications are all located here

Chart Review Activity

Lab results under this tab

Documenting Vital Signs - I&O - Lines & Drains Found in Doc Flowsheet activity

Documentation of vital signs, I & O, Lines and Drains Vital signs flowsheet is the default flowsheet

Automatically opens when clicked To add columns

For current time, click “Add Column” button For any time from the past, click “Insert Column” button

- change time and date if necessary Blank columns will disappear

Vital Signs – Doc Flowsheet

To move up or down in flowsheetclick on grayboxes above, orscroll on the right

Notice a column is placed for the topof the hour

Documenting Vital Signs Document vital signs, ADL’s & Intake & Output

at time taken Value documentation is done at time of care Details box provides choices from a row with an

“ellipsis” May make multiple choices from “ellipsis” rows

Example: Documenting Oxygen source, charges the patient

for the use of the O2 and th equipment for the day (only charges them once a day no matter how often you document source)

Documenting Vital Signs

Doc Flowsheet – Saving Information

Changing flowsheets, activities or closing the chart will automatically cause data to be saved

Note: Any information entered into a Doc Flowsheet will automatically be saved - whether you file the data or not!!

Doc Flowsheet – Saving Information

Editing dataClick on data to be changedType in new data Click “File”

Note: This triggers the “Show Audit” alert to display on bottom of screen

Edited Data on Doc Flowsheet

See “Hide Audit”hyperlink on bottom

of screen

Initial data andchanged data are shown

Documenting On Intake Flowsheet

Anything going intothe patient is

documented onthe “Intake” flowsheet

Adding a Line to Intake Flowsheet

Adding a line (Peripheral IV line, PICC line, Central Line or Enteral Feeding line) - must be in “Intake Flowsheet” Click “Add LDA” button Choose line type for ellipsis Click “Accept”

In “Properties” screen fill in the appropriate areas Click “Accept”

A “line” on the Intake Flowsheet is added Blue hyperlink describing a line is created

Properties Screen for Adding Line

Intake Flowsheet - Lines Added

Note: line groups added to gray keys

Note: blue Hyperlinks for

each line within the flowsheet

Intake and Output Documentation

Documented in “real time” Includes: PO intake, IVPB’s, IV boluses, bolus tube

feedings, and water/saline flushes

Maintenance IV fluid volumes, continuous IV drips, continuous drips Documented at end of each shift

Voided, straight cath, incontinent urine and all stools Recorded as they are noted by the caregivers

Output Flowsheet Documentation

“Output Flowsheet” Document all output’s

Adding a drain, chest tube, urinary catheter or ileal conduitClick on “Add LDA” Follow same steps as adding a line to “Intake

Flowsheet”

Output Flowsheet with a JP Drain

Note: documentdrain outputin this row

Intake & Output Activity

“Intake & Output” activity View only activity Provides summary of I&O per shift

Viewed in Table form Graph form (note the 3 days graph and 7 day graph buttons)

Note: Quickest way to see any shift’s total I&O

Intake and Output Activity

Notes Activity

Notes - written for significant events Admission, transfer, discharge, patient fall,

etc. Nurses write “Progress Notes” Click on “Notes” activity

Click “Progress Note”Click “New Note” to create new note

Notes Activity

Free type your note in this blank spaceClick “Accept” when completed

Results Review

Review new lab or imaging results Go to “Results Review” activityMay be viewed by test, by all results, by date, by multiple

dates, etc.To change views click on “View” buttonTo change dates - click on “Hide Data Prior To” then

change date To mark you have seen results

Click on “Time Mark” button

Results Review

Clicking on “Time Mark”will change results fromitalics to bold, and will

cause them to not showas new results

Point of Care Tests Three point of care tests that result into EMR

Capillary Blood Glucose ABG’s ACT

Example: CBG Scan Namebadge Scan patient’s armband Scan glucostrip bottle Perform test and read result Dock glucometer in docking station (sends results

to patient chart)

Medication Administration Record

The MAR Activity Documentation of medications administered

Legend Identifies meaning of specific colors, icons,

and codes

MAR Legend

Tabs of the MAR MAR tabs

All Tab – all medications alphabetically Scheduled Tab – all scheduled medications

alphabetically PRN Tab – all prn medications alphabetically Continuous Tab – all maintenance IV fluids and

continuous IV drips alphabetically Protocols Tab – all protocol medications RN Verify Tab – a list of new medications that RN must

verify against written order before administering first dose

RT tab – all RT administered medications alphabetically Discontinue tab – list of discontinued medications

Tabs of the MAR

Legend

TABs

Administering Medications

Steps to medication administration Always barcode patient’s armband first (this ensures you

always have the right patient - also opens patient’s chart to the MAR)

Barcode each medication Change any details for the medication – i.e. action of

given, held, missed, due, the rate or dose Type in any comments Click “Accept” Scan your name badge

Admission of a Medication Screen

Medication information

MedicationInformation

Action typesto choose from

when documentingany action for a

medication

Given Medications on MAR

Given medsare green and

underlined

IV Piggybacks

Administering IVPBMark action as “Given” on MARNote amount of fluid to be infused

Open “Doc Flowsheet” activity Open “Intake Flowsheet”

Document amount of volume

Documenting IV Fluids on the MAR

Documentation of maintenance IV fluids Navigate to “Continuous” tab of MARLocate IV fluid to be administeredClick on “white” space time frame Choose “New Bag” action

Ensure correct rate Click “Accept”

Documenting IV Fluids on the MAR

Note action of new bag

Changing IV Fluid Rate on MAR

Changing IV fluid rate Change rate on IVClick “Continuous” tab of MARClick on the “white” space for IV fluids Administration screen opens

Change the action to “Rate Change” Change the rate Click “Accept”

Changing Rate of IV Fluids on MAR

Note: Action of rate changeand rate changed to 150

A warning of the pink “i” in a circle alerting change in rate from ordered rate

IV Bolus on the MAR Open MAR Administering bolus from a current IV fluid bag

Click “white” space for time to begin bolus Choose action of “Bolus” Change rate Click “Accept”

Administering bolus from different IV fluid Locate bolus under te “prn” tab of MAR Click on “white” space for time Choose action of “Bolus” Click “Accept”

IV Bolus on MAR

Action is “Bolus”

Documenting IV Volumes on Doc Flowsheet

Document Maintenance IV volumes Open Doc Flowsheet Intake flowsheet

At end of shift or at transfer Document IV volume infused during shift (Note: You can chart left to count fluid in the left to count row -

it is an information only row)

Document IV Bolus volumes Open Doc Flowsheet Intake flowsheet In IV volume row

Document bolus volume as bolus begins

Titratable Medications on MAR

Titratable medications Located in “Continuous” tab of MAR Also on “Intake” flowsheet

Administering new titratable drip medication Open MAR Locate medication Click on “white” space for time Enter action of new bag Ensure correct rate/dose Click “Accept”

Titratable Medication on MAR

Ensure rate is correctfor patient weight

Titrating Medications Titrating medications after adjusting rate on pump

Open “Intake” Flowsheet Locate correct medication group

Add column for real time Click on dose or rate row Click on syringe icon MAR opens Choose action of “Rate Change” - change rate Click “Accept” “Intake” flowsheet opens - shows changed dose

and rate

Titrating Drips on MAR

Calculating Titratable Medication Volumes

On “Intake” flowsheet Volume row is seen for each titratable medication

Calculating volume and clearing row for next shift Add column Click on volume row for drip Click on calculator in that row (this brings up

calculated volume) Verify volume matches volume on pump (if not use

the pump volume if it was cleared by last shift)

Calculating Volumes on Intake Flowsheet

Calculator

Calculatoropened

Closing a Patient Chart

To close a patient chart, click on the “x”

Logging Out of the System

Click on “Log Out”