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WELCOME
2/8/12
Soarian Clinical Team (eDocumentation) June 2008 Soarian Financials June 2009
EHR SOARIAN
Soarian Common Clinicals (Orders) June 2008
Computer Provider Order Entry August 30, 2011 Memorial Forms Catalogue 2007
CPOE Chartin g
ALL
22 MP PHS S Psy ch 24
2/1
Class Content
Computer Provider Order Entry (CPOE)
Physicians and other providers will place orders on all their patients In house and remote access
IVs
Medications
Free Text
Orders to be Signed Orders Reaching Expiration Revising/Discontinuing Medications
Learn the differences between a physician's account and Nurse or Unit Secretary account
Group Individual
Unit Secretary M onitors orders and com municates imm ediate needs to appropriate staff
Nurse signs into Soarian and reviews worklist for new orders
Verifies Med O rders in M AK (with Order as W ritten and ) acknowledges all orders in Soarian
STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary
CPOE
Hard Copy
ALL Orders only found in Soarian. Clinicians must be aware whether a CPOE physician or Paper Order Physician, emphasize emphasize emphasize
Patient Admitted to YVMH Physician Signs into Soarian to review ALL orders Physician Enters orders in Computer Unit Secretary Monitors orders and communicates immediate needs to appropriate staff Places orders into eKardex
CO P E
P y ic nO e h s ia rd r Tp ye
Nurse signs into Soarian and reviews worklist for new orders
Verifies Med Orders in MAK (with Order as Written) and acknowledges all orders in Soarian
STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary
H rdC p a oy
CPOE
Hard Copy
P y ic nS n in h s ia ig s to S a ntore ie A L o ria v w L o e rd rs
Unit Secretary Monitors orders and communicates immediate needs to appropriate staff
Nurse signs into Soarian and reviews worklist for new orders
Verifies Med Orders in MAK (with Order as Written) and acknowledges all orders in Soarian
STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary
CPOE
Hard Copy
Unit Secretary will set up Personal Census to cover ALL patients on unit(s) of responsibility .
Setting Personal Census for 3W Icon, Change time, assign all patients,
Setting Personal Census for 3W Icon, Change time, assign all patients,
Setting Personal Census for 3W Icon, Change time, assign all patients,
Move to 3E
Click Personal Census icon, make sure time is right, move all 3E patients
Now ALERTS are based on Personal Census. Work list is now functioning for both units Illustration Test 2 Validation has no alerts
ALERT shows on census view and Worklist Unit Secretary notifies appropriate staff
Nurse needs to go into Soarian to view exact order. Once the nurse starts acting on order, should be in MAK by the time of Administration. Can chart it through Pharmacy Pending Review). Workflow - Physician places order STAT Order goes directly into Pharmacy System. At the same time ALERT to Soarian notifying Nurse and Unit Secretary. STAT order goes to top of Pharmacists screen Pharmacy validates Viewable in MAK for nurse to verify and administer
The Nurse MUST clear ALL STAT Medications ALERTS in Soarian manually The ALERT for STAT Diagnostics or Patient Care Orders, are cleared by acknowledging the order The Unit Secretary at NO time should clear the ALERTS, EXCEPT for the STAT Med ALERT. It is role based. It will not remove the ALERT from the Nurses account The Unit Secretaries responsibility is to notify the appropriate staff member of the ALERT There will be times the Nurse notices the ALERT before the Unit Secretary. The Nurse can go ahead and follow the process and remove the ALERT
Ordering Physician is a physician caring for patient Time appropriate (i.e. Change dressing timed appropriate) Look at mode of transport on radiology. Is it appropriate?
Compare with the eKardex and update the eKardex as needed Verify Medication Orders in MAK using Order as Written (OAW)
Orders in Soarian
Must Refresh screen every 15 minutes Communicate to Appropriate Staff Member Physician Ordering Remote should call all STATS to Unit
Keep track of Physicians on Unit Monitor Patients for new orders Check with Physician before physician leaves unit Physician should update secretary on any patient that has new orders
Compare with the eKardex and update the eKardex as needed Updated CPOE Physician List Will be Provided
Nurse signs into Soarian and reviews worklist for new orders
Unit Secretary Monitors orders and communicates immediate needs to appropriate staff
Nurse signs into Soarian and reviews worklist for new orders
Verifies Med Orders in MAK (with Order as Written) and acknowledges all orders in Soarian
STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary
CPOE
Nurse Only
Hard Copy
Titrate parameters show up blank. Titration will be listed under DIRECTIONS Medication will be verified with Order as Written (OAW) NEW ICON DR in front of medication indicates the
Order as Written is exactly how the physician wrote the Order. If Pharmacist uses substitute or alters order in any way, the alteration will show up in OAW. I.e., Nexium for Protonix. Substitution will be listed.
Unit Secretary Monitors orders and communicates immediate needs to appropriate staff
Nurse signs into Soarian and reviews worklist for new orders
Verifies Med Orders in MAK (with O rder as W ritten and ) acknowledges all orders in Soarian
STAT orders will be called to unit by the Physician AN D an alert is sent in S oarian to N urse and Unit Secretary
CPOE
STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary
Hard Copy
Unit Secreta ry M onitors orders and com m unicates im m ediate needs to appropriate staff
Nurse sig ns into Soarian and reviews w orklist for new orders
Verifies M ed Orders in M AK (w ith Order as W ritten an d ) acknow ledges all orders in Soa rian
STAT orders w ill be called to unit by the Ph ysician AN D an alert is sent in Soarian to Nurse and Unit Secretary
CPO E
Hard C opy
Unit Secretary M onitors orders and comm unicates imm ed iate needs to appropriate sta ff
Nurse signs into Soarian and reviews worklist for new orders
Verifies Med Orders in MAK (with Order as W ritten and ) acknowledges all orders in Soarian
STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary
CPO E
Hard Copy
Picklists for Physicians are different then Nursing and Unit Secretary screens
Picklist
Picklist
Labs in AM Picklist
Picklist
When starting an admission Med/Surg will routinely go to Adult General Admission Orders
When placing an order(s) make sure to fill out Session Detail Do not fill in priority when using the Order Sets. It will change the Pre-set priority on all orders within the order set. Only use priority when entering single orders or several orders with the same priority.
Admit to/Transfer to
The Order Detail will open on the Admit To screen. Service is where the patient is being admitted to Patient Status (In patient or Outpatient) Condition Critical, Stable, Guarded, Unstable, etc. Code Status Primary/Secondary Diagnosis (Editable Fields)
Click to edit Master text styles Second level Third level Fourth level Fifth level Information from Registration
Placing Orders Using CPOE Alerts for conflicting Orders will Click to edit Master appear before the physician signs text styles Second level and activates the order. Third level level There is a Model issue with some FourthFifth level ALERTS repeating IGNORE IT
Click on Meds if looking for a Medication, Labs, if looking for Lab, or All if looking for a
Two types of Orders - Pre-Defined, specific, fully automated - Packaged, Order Detail screen must be filled out Dose, Frequency, priority,
Example of Packaged Medication Order detail and all the fields that must be filled in
Communication Order
Click to edit Master text styles Second level Third level Fourth level An order the physician Fifth level can use to communicate tasks to the nursing staff is a Patient Care Order called Communication. Once found through the Search, click on the name of the order which will bring up the
Communication Order
Click to edit Master text styles Second level By going into the Order Third level Detail and putting in the Fourth level specific instructions under Fifth level Order Comment
Communication Order
Click to edit Master text styles Second level Third level Fourth level Fifth level It will show up as a Patient Care Oder with the information typed into the Comment Field
How the weight based medication displays before signing. Note the mg/kg/dose in the order.
The physician prints it out from here and places on the chart.
Medication Bolus
Click to edit Master text styles Second level Third level Fourth level Fifth level
Medication Bolus
With Weight Base Dosing, Calculation is done for you ( MUST HAVE A
Medication Bolus
Click to edit Master text styles Second level Third level Fourth level Fifth level
Remember, this will place an ALERT on the Secretarys and Nurses Worklist. Follow that procedure The icon Mortar and Pestle indicates the order originated in Pharmacy. The Rx icon indicates validation by Pharmacy. The ^ symbol means there was an EDIT.
If medication is one that is used frequently by the physician Before Activating an order or signing
Once the physician starts a list of Personal Favorites This new tab shows on the Order
Any instructions the physician has added to the order will stay within the Favorites
Type in WILD and click LAB if sending an order to lab. Above method goes to Pharmacy.
ALERT will display. Pharmacy cannot Clinically check because of the Free Text.
When Revising an Order, revise liquids, IVF, etc. Tabs must be handled differently.
It works off the Tablet. Be certain this is what is needed. Otherwise, Discontinue the order and place a new order for the dose.
Parenterals, Elixirs, and IVFs can be revised. Emphasize when revising a tablet its working on the tablet, not the strength.
Discontinuing an Order
Click to edit Master text styles Second level Third level Fourth level Fifth level
To Discontinue an order simply check the box next to it and click discontinue.
Discontinuing an Order
A reason does not need to be inputted at this time. That might change in the near future do to regulations. Click OK to bypass this field
Discontinuing an Order
When placing a STAT order make sure Priority is set on Order Detail
Once signed, it sends the ALERT to both the Unit Secretary and Nurses Worklists
Orders to be Signed by Physician will show up on the Worklist. Simply check the box and Click
Click to edit Master text styles Second level Third level Fourth level Fifth level
The Physicians Account Displayed next to the physicians name is YVMH. This is because Soarian is an Enterprise Program. If there were multiple Hospital in the enterprise, they would ALL be listed. Clicking on YVMH allows the physician to view the census in that Hospital.
The main Browser to the physicians account is found in the middle of the screen
My Patients Only
Displays patients in the census that are either registered to the physician Or Manually added by the physician
Displays patients in the census that are either registered to the physician or a physician in a particular coverage group Or Registered to a specific list of physicians
Lists patients registered to a particular service Or Lists several services and the patients registered under the services
Outpatients
Displays patients in the census that are either registered to the physician And Manually added by the physician Or Displays patients in the census that are registered to physicians in a particular coverage group Or Registered to a specific list of physicians Or Lists patients registered to a particular service Or Lists several services and the patients registered under the services
The Search menu is the set up for each filter type. Searching by Unit is the best way if looking for an inpatient. It is making sure the user is on the right encounter
Three Ways Physician can add patient to census OR Notify Registration to add Physician as a Once the Patient is found and the record is entered, an icon appears on the left upper corner of the screen. This allows the physician to addrelationship with the patient to the census view. Make certain this is what is needed. If added and then account stays on the census, the patient moves to the outpatient environment on discharge. This can bog down the patient Outpatient view and if the amount exceeds 500 patients, the outpatient view will not display.
Adding Patients to My Patients Only as Consult or other physician places physicians name on account
Click to edit Master text styles Second level Third level Fourth level Fifth level
Adding Patients to My Patients Only as Consult or other physician places physicians name on account. Physicians name can be viewed through Demographic hyperlink.
If the Physician added the patient using the CONSULT or OTHER CAREGIVER This icon appears.
The Physicians name stays on the Demographics, BUT displays the Stop Date
My Coverage Group
Click to edit Master text styles Second level Third level Fourth level Fifth level
Go to the Search window and click on the Coverage tab. When the Physician first sets up the Coverage group their group should be already in the left-hand part of the window. The user simply checks the box, clicks the arrow in
My Coverage Group
Click to edit Master text styles Second level Third level Fourth level Fifth level
If the user wants the Coverage to be specific to certain members, CLICK the (+) next to the coverage group. ALL the members names will appear. Click the box(es) next to the name and move them over to the right side. Click Save
My Coverage Group
Click to edit Master text styles Second level Third level Fourth level Fifth level
The user can SEARCH for any group. Click the radio button next to All Coverage
My Coverage Group
Click to edit Master text styles Second level Third level Fourth level Fifth level
The user can SEARCH for any user. Click the radio button next to All Users, type in a search, click search.
My Coverage Group
Click to edit Master text styles Second level Third level Fourth level Fifth level
Nurses Station View Go to Search screen. Click on Location and Service Tab. (CLICK) Click on plus next to Nurse Station.
Click on YVMH.
Check Boxes next to units listed with number and letter only.
Once the unit appears in the window under nurse station click Save and Close
Patient Service is done exactly the same way. CLICK the (+) next to Patient Services.
Once the Service appears in the window, click Save and Close.
COMBINED Specialty Click on Service, then desired Nurse Station Click on the Arrow in the middle of the Screen, Once it appears on the right, Click SAVE AND CLOSE.
Outpatient Census
Click to edit Master text styles Second level Third level Fourth level Fifth level
Setting up Outpatient View. Once the other views are set up, Outpatients can be viewed by the above dropdown. Make sure they set it up for days before and days after.
Discharged Patients
Click to edit Master text styles Second level Third level Fourth level Fifth level
Discharged Patients are the same way. Use the dropdown for desired view, can either use number of days or the calendar setting. Click SAVE and CLOSE.
Discharged Patients
Click to edit Master text styles Second level Third level Fourth level Fifth level
Summary
Reviewed the Impact on the Workflow of the Nurse and Unit Secretary Reviewed placing different Medication Orders Reviewed the Differences Between the Nurse/Unit Secretary Account and the Physician Account