Adding a FAVORITES Powerplan
The attached shows how to add a Favorites Powerplan in Cerner. Most of you may have done this already, but it's a good refresher. And, although it implies that all useful Powerplans begin with ANES, five don't:
- Hypoventilation Risk and Obstructive Sleep Apnea
- Low Dose Ketamine Analgesia Post-Op Orders
- Paravertebral Catheter
- Peripheral Nerve Catheter
- Spinal Narcotic Post-Op
HELP DESK and IN-Hospital Support
SENT ON BEHALF OF CHRIS HALL, MD, CHIEF MEDICAL INFORMATION OFFICER:
Thursday, November 13, 2014
Hello Medical Staff.
We’d like to thank you for your efforts, dedication and patience over the past 6 weeks. Though we acknowledge a lot of issues and bumps in the road, patient care was largely successful on the backs of our providers, nurses and staff. We still have a lot of work to do and appreciate those that are putting in additional tickets through the EMHS IS HelpDesk:http://intranet.emhs.org/EMHS/Portals/Information-Systems-(IS)/IS-Customer-Support-Services.aspx
The HelpDesk process can be annoying but it is an incredibly useful tool for us to advocate on your behalf as well track resolution of issues. We are working with EMHS to right-staff Mercy for permanent support. In the meantime they recognize there is a gap just using the HelpDesk (879-3475). We will be working with EMSH to actively tune the process and staff over the next few weeks. Given the gaps, we have extended some outside resources for a bit more.
Perry Cannon (cell 816-803-1932) will be supporting at the Fore River Hospital Monday – Friday 0700 – 1500, stationed in the 2nd floor physicians lounge. On Wednesday – Friday she will support rounding from 0700 – 0800 or so on FRH 4th floor. She is available both on the fly and by appointment for assistance during these hours with the helpdesk providing support outside those hours. She will be here through 11/21.
Darren Woodard (cell 919-631-5946) at the State Street hospital. He rounds much of the day and is also available as issues arise or by appointment. Please reach out to him as needed. He will be here through the end of November.
October 12, 2014:
I will send these out as I learn them, but, unless it is an urgent update, I'll wait till I can send several at once.
-Once a patient enters the hospital (as an inpatient or outpatient), there are **no paper orders** for anesthesiologists. All of our orders (including, e.g., preop DuoNebs) must be in Cerner. The only exception are orders from the CSS, which can be on paper, since they are faxed to the Pharmacy before the day of surgery. If you sent each order as a favorite the first time that you add it, every subsequent order is easy.
-Please remember to add haloperidol to your postop orders. Use "Add to Phase" on the Postop Order Set, and set up a 0.5 mg IV prn dose with a repeat x 1 to 3 doses (your preference). Add it to your Favorites. It will unfortunately trigger a warning that your dose is too low, and I suggest "disagree with recommendation". I will try to get it added system-wide in the future.
-Be careful on the postop orders to check the bolus and not infusion orders for fentanyl. There is a fentanyl infusion order in there - again, this is a system-wide set.
-If you wish to add something to the postop orders once you (or someone before you) has initiated them, use this method: **It is very important that all of your postop orders, even additions, be within the order set.** Otherwise, they do not appear on the same section of the PACU RN's screen; so they might be missed or not discontinued when an inpatient goes to the ward. Click on the Orders tab in the Menu. Click on the Anesthesia Postop Orders in the list on the left. The initiated orders will appear. If you want to add something like haloperidol, Ofirmev, DuoNeb, et al., click "Add to Phase". (Put them in your Favorites if you plan to order them frequently.) If you want to add something that is *already* on the order set but was not checked by you or someone before you, click on the two light bulbs next to "Add to Phase". This will bring up all orders in the set that have not yet been checked. You can now check whatever you want to add. For example, there are a full set of opioid orders for additional dosing under "Analgesia Reassessment". (Use this when your initial max has been exceeded.)
-Old anesthesia records (at least after October 1) can be found in the Clinical Notes tab on the Menu. They are under Anesthesia/Recovery. Each scanned preop and record is listed a M_Anes Record.
-When you pull an APMS epidural or take a labor epidural patient to C/S, please discontinue the epidural orders. Right click on the orders and click discontinue. The orders will appear. You only need to check orders that you want to **keep**.
If you need screen shots of any of these or have questions, please let me know.
Thanks for a pretty smooth first 12 days.
October 8, 2014
As of now you can use SurgiNet to access your patients for writing orders. This is done through the tracking boards in SurgiNet. If you right-click on a patient you will be able to confirm their name and enter directly into the patient's chart. Your favorites will be there, however you will have to do a one time configuration of any customizations on items like the MP page summary again.
October 5, 2014
First, thanks for a successful launch. To be honest, things went far smoother than I had anticipated they would, especially given how busy it was. And, especially, thanks for tolerating some long (and early) days with grace.
Here are some notes and tips (in no particular order) based on week one (Janell and Vance, please forward this to the nurse anesthetists - thanks):
You've probably noticed that the surgeon's name is no longer on the label. Please don't check the "as listed" box on the anesthesia record; please write in the surgeon's name.
Labor epidural orders: This will be more awkward than before. There are two options now, and there will be a third soon. First, you (the doc) can wait until you arrive to put in the orders before you see the patient. Second, you can dictate the orders to the nurse over the phone before you get to FR. She will need to log on to Cerner with you on the phone and go through the orders with you. Third, soon you can do it over the VPN before you leave home. All take time and the first delays release of the infusion. I know that none are optimal, but that is one of the realities of the new record. The obstetrician or nurse midwife cannot order them anymore, because one must complete the entire order set, including details of the PCEA. They do not have privileges to make such orders, and the physician completing the order set is logistically and medically responsible for them.
Please initiate orders as soon as you write them (despite what we were told in training). I have this straight from the EMHS/Cerner Coach in the PACU.
ACU orders done before the day of surgery (in the CSS, for example) can be done on paper. On the day of surgery, they should be in Cerner. Otherwise, the RN will have to make it a verbal order from you, which takes even longer. Put DuoNeb, scopolamine patches, etc. in your Favorites.
Transfusion order clarification will be coming this week.
On the ultrasound, the Worklist for block patients is now called MANESTH US GUIDED NERVE BLOCK.
Despite the nice cards that we were given, DO NOT DICTATE procedures for now. Use our paper forms. There is no billing link for dictation.
Please put the mobile computers back in the FR Office or SS ACU when you are done. I'm working on labels for them.
Thanks, and share your tips with the group.
October 5, 2014
The procedure is for the nurse to take it as a verbal order from you. The obstetrician or nurse midwife should not order the labor epidural, since they actually don't have privileges to do it. Thanks
On Oct 5, 2014, at 10:50, Theresa Kudlak <email@example.com> wrote:
Having done labor epidurals this weekend, and needing to order the drugs on Cerner after arriving at the hospital and thus delaying the actual placing of the epidural, the OB and I agreed that there should be some means to get the epidural drug ordered when the decision has been made to do an epidural so that the drug is ready to go. just like, in the past, the OB would order the drug on paper before we get there. Perhaps the OB order set could include an order for epidural meds? Sorry to add another burden on you to get this done. Can anyone think of an alternative?
Sent: Thursday, October 02, 2014 1:05 PM
Here are some tips from the first two days:
This lists the 11 order sets that you should place among your favorites. (You can ignore the haloperidol - that is a favorite I set up for myself with PONV dosing.)
2. Patient lists
The coaches have not been able to show us yet how to set up truly tailored lists. However, I have found the ones listed here as helpful. (Ignore MSCUOF - that was somehow added automatically). You can sort them by patient name, date, or surgeon to make it easier to find your patient (as opposed to searching the global list). They are added by using the Wrench icon in the Patient Lists tab. Search by location, and within Mercy, go to outpatient to get all except the Birthplace, which is inpatient. There are mulitple steps, so it is easier to have someone show you how to add the locations.
3. MPage Summaries
TVL noticed just how much information is on this page. I have found that I can do most of the preop from here without opening the paper chart. (It has the problem list, the home med list, the vital signs, the CSS nursing assessment is in the Documents tab, and many other things.) You can customize this in many ways - you should have been shown it in the Cerner class. I now wheel one of the anesthesiologist computers (stored in the ASC at SS, and in the Office at FR) up to the patient's bay, and use it during the preop.
Sept 29, 2014
The EMHS policy on specimen labelling includes use of one’s network user ID – the “mp” pneumonic with initials. This process allows for ease of tracking/follow up within Cerner if there are questions. So, simple initials is no longer enough.
Thanks for your help, Lucy