w elcome 1.this class follows a standardized structure. the learner is expected to: listen and watch...

WELCOME

1. This class follows a standardized structure. The learner is expected to:

• Listen and watch the instructor demonstrate and explain at the beginning of each lesson with HANDS OFF THE WORKSTATION

• Practice individual exercises

• Participate in knowledge check activities

• Practice working through group activities

2. The material presented in this class is a foundational overview of the Clinical Systems. Unit specific information and practice will be covered when you are active on your unit.

CLINICAL SYSTEMS

STARBROWSER/STARPANEL

ACTIONS MENU

STARBROWSER/STARPANELACTIONS MENU

LEARNING OBJECTIVES

1. Locate and define the purpose of primary menus and icons in StarBrowser/StarPanel

2. Define the purpose of the StarBrowser/StarPanel systems

3. Demonstrate accessing the Actions Menu

4. Identify links located on the Actions Menu and their use

VIDEO INTRODUCTION: STARBROWSER/STARPANEL

1. Click here to load video

STARBROWSER/STARPANELLOGGING ONTO THE SYSTEM

INDIVIDUAL ACTIVITY

1. Log onto the system using the training ID

ACTIONS MENUQUIZ SHOW

ACTIONS MENUKNOWLEDGE CHECK

1. The link in the Actions Menu that is a record of any document that pertains to a patient’s medical history at Vanderbilt University Medical Center.

ACTIONS MENUKNOWLEDGE CHECK

All Documents

ACTIONS MENUKNOWLEDGE CHECK

2. The link in the Actions Menu that displays medications, dosages and time administered for a specific patient.

ACTIONS MENUKNOWLEDGE CHECK

MAR

ACTIONS MENUKNOWLEDGE CHECK

3. The link in the Actions Menu that allows you to request assistance from the IV team.

ACTIONS MENUKNOWLEDGE CHECK

IVT Request Form

ACTIONS MENUKNOWLEDGE CHECK

4. The link in the Actions Menu that provides a snap shot of important information charted for a patient using the SBAR format

ACTIONS MENUKNOWLEDGE CHECK

OPC

ACTIONS MENUKNOWLEDGE CHECK – TIE BREAKER!

5. The link in the Actions Menu that provides an overview of lab results from a patient’s hospital stay.

ACTIONS MENUKNOWLEDGE CHECK

Fast Labs

CHARTING A NEW PATIENT’S ADMISSION HISTORY

CHARTING A NEW PATIENT’S ADMISSION HISTORYLEARNING OBJECTIVES

1. Locate required sections of the Admission History and define the completion deadlines for those sections

2. Demonstrate the ability to complete a patient admission history

ADMISSION HISTORY FORM ACTIVITY

With a partner, please complete an admission history form Make sure to include information in each section and do not skip

sections After the allergies section, please save the form as a draft and

switch roles with a partner Take turns being the nurse and the patient, providing information for

completion of the form

Each partner should have an opportunity to practice!

CLINICAL SYSTEMS

ORDER ENTRY – HEO/WIZ

VIDEO INTRODUCTION: HEO/WIZ

1. Click here to load the video

ORDER ENTRY – HEO/WIZLEARNING OBJECTIVES

1. Define the purpose of the HEO/Wiz system.

2. Demonstrate searching for and locating active orders.

3. Demonstrate entering orders.

ORDER ENTRY – HEO/WIZLOCATING ACTIVE ORDERS

INDIVIDUAL ACTIVITY

Use patient name on the patient card.

1. Practice selecting a patient and locating a diet order for the patient on your patient card.

2. Practice locating the transfuse PRBCs order.

ORDER ENTRY – HEO/WIZENTERING ORDERS

INDIVIDUAL ACTIVITY

1. Practice entering a telephone order from Dr. Physician Test for a routine, one-time CBC w/platelets for 5 a.m. tomorrow.

2. Click done and Accept Orders.

ORDER ENTRY – HEO/WIZREQUESTING A BLOOD PRODUCT

INDIVIDUAL ACTIVITY

1. Practice requesting your remaining blood product from the blood bank for your training patient.

ORDER ENTRY ACTIVITY

Enter the following order:• Protocol order• Test, Physician• Diabetic diet consistent cho• Daily• NXT meal• Until discontinued

IT’S LUNCH TIME! PLEASE LOG OFF OF YOUR WORKSTATIONS BEFORE EXITING THE ROOM!

CLINICAL SYSTEMS

CHARTING HED

CHARTING HEDLEARNING OBJECTIVES

1. Define the purpose of the HED system.

2. Demonstrate the method for reviewing and completing labs in Care Organizer

3. Demonstrate confirming a medication in Care Organizer.

4. Locate and define the purpose of primary menus in HED.

MEDICATION ADMINISTRATIONCONFIRMING A MEDICATION ORDER

1. Practice verifying that you are in “Active view” prior to confirming medication.

2. Practice selecting your patient from laminated sheet and confirming Haldol using the confirm button.

3. Confirm the remaining medications using the view, confirm/unconfirmed menu.

4. Using any medication, demonstrate sending a message to the pharmacy.

5. Click the refresh button.

CHARTING NAVIGATION AND PROCESSESCHARTING A NEW PATIENT’S VITALS IN HED

INDIVIDUAL ACTIVITY

1. Open HED Train.

2. Click “Show All”

3. Practice entering the following in the Vital Sign section of the chart:

Change time to 30 minutes ago. Enter temp of 102.4 Oral. Click exclamation point to make significant finding. Enter heart rate/DAS of 116 apical. Enter O2 Sats of 95% on Oxygen Enter O2 Liter Flow of 2L, Nasal Cannula

4. Click “Save and Confirm” after vitals have been entered.

CHARTING THE PHYSICAL ASSESSMENT AND CARE PLAN IN HED

1. Click HED train and the “ICU/SD Asmt/Interventn” tab.

2. Click “Show All” Demonstrate entering the following in the Pulmonary section of the chart:

• Select Respiratory ASMT (Problems) and select Gas Exchange• Chart abnormal breath sounds using the following:

• Click Chart then SHOW ALL• Click RLL and fine crackles

• Click LLL and fine crackles

• Click cough

• Click productive

• Make up nasty secretions

• Incentive Spirometer: 600X5

• Scroll to Pulmonary intervention: D B and Cough and Suction• Chart a Braden skin assessment and a Falls Risk Assessment

4. Click “save and confirm”.

CHARTING NAVIGATION AND PROCESSESBEGINNING AND DISCONTINUING A LINE IN HED

1. Start a new CVC line using the following information:

• Line Type: Central Line, Site: Internal Jugular

• Side: Right, Number of Lumens: Double, Lumen Description: Proximal, Distal

• Dressing: Chlorhex Drsg, Transparent, Secured with: Suture

• Type “T” in date/time, Inserted by: Dr. Golightly, Location: VUMC ED

• Response: c/o pain on insertion, site comfortable after procedure

2. Click “Save”.

3. Chart an assessment of an existing line.

4. Type the letter “T” in line removal to automatically enter the correct time and date.

5. End your existing line.

6. Save the line removal information so that *Ended* is displayed next to each piece of charted information.

CHARTING PRIORITY PROBLEMS, NURSING SUMMARY, PLAN PRIORITIES, ADDRESSING GOALS AND DISCHARGE PLANNING

Use the “Start Priority” hyperlink to start a new pulmonary problem and enter the

following: • Click Gas Exchange• May be related to - Secretions• Expected Outcome – Improve• Start Time “T”

• Document a short term shift goal using the following:• Maintain O2 Sats>94% on supplemental O2

1. Click the “Care Plan” tab in HED and enter phase.

2. Enter the following free text in the “Nursing Summary” field:

• Temp 102.4 with Tylenol Q4h. 02 Sats 94% with 2L.

3. Enter the following Plan Priority:

• Continue to wean 02 as ordered, encourage PO intake, encourage ambulation, and draw trough after 1800 dose of Vancomycin.

4. Chart short term goal status was met.

5. Save the “Nursing Summary” and “Plan Priorities”.

6. Hover over the yellow note in the middle column to display text that has been entered.

7. From the magnifying glass, end the priority problem.

8. Click “Show All” to find the “Discharge Plan” section of the tab. Chart the review of d/c plan.

WORKFLOW OF CHARTING

Review Nursing Summary and Plan Priorities of previous shift from OPC.

Complete physical assessment, charted in HED.

Select 2-3 problems identified on assessment to create Priority Problems with Short Term Goals.

Assess the phase of Plan of Care for appropriateness, found in StarPanel.

Chart Nursing Summary and Plan Priorities, charted in HED.

Chart “Met/Not Met/Improving” after revaluating Short Term Goals, Charted in HED.

BEGINNING OF YOUR SHIFT TASKS END OF YOUR SHIFT TASKS

CHARTING NAVIGATION AND PROCESSESCHARTING PATIENT EDUCATION

INDIVIDUAL ACTIVITY

1. Click the “Education Record” tab in HED.

2. Click “Show All” to find the “Care Contact” section of the chart.

3. Document one care contact.

4. Click “Show All” to find the “Pulmonary Education”.

5. Chart the following information:

• Pulmonary->pulmonary care education->teachback/verbalize understanding-> patient and care contact #1

CHARTING IN HED ACTIVITY

Chart the following sections:

Chart the following sections:• Vitals • Physical Assessment• Plan of Care• Education

MEDICATION ADMINISTRATIONLEARNING OBJECTIVES

1. Demonstrate the use a barcode scanner and explain the 5 rights.

2. Demonstrate administering a matched medication.

3. Demonstrate the cosigning of a high alert medication.

MEDICATION ADMINISTRATIONADMINISTERING MEDICATION

INDIVIDUAL ACTIVITY

1. Locate the “To Do” view in Care Organizer and showing your worklist.

2. Click HED and locate and click the Admin Rx tab.

3. Administer using the barcode scanner

Ondansetron (Zofran)

Milk of Magnesia

4. Address warnings if necessary.

MEDICATION ADMINISTRATIONMATCHED MEDICATION

1. Administer scheduled insulin.

2. Administer sliding scale insulin. Blood sugar 255mg/dL.

3. Chart the sliding scale accordingly using hover feature to determine amount of insulin needed to treat this blood sugar.

4. Practice cosigning a partner’s for the High Alert Medication insulin.

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

Coin toss to see which team goes 1st.

MEDICATION ADMINISTRATION

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

1. Calling the pharmacy via telephone is the best method of communication about a medication.

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

Clicking “Send Rx a message” is the best method for communicating

with the pharmacy.

Myth

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

2. IV fluids are scanned into Admin Rx. Nurse will select “extra dose” and scan the patient armband. Then the nurse will choose “protocol.” This will chart the fluid and account for the missing schedule and is expected behavior.

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

Hit

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

3. Medications are confirmed in Care Organizer.

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

Hit

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

4. Warnings from the system will only occur when no medication order is found.

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

Warnings from the system will occur when an incorrect dose is selected, medications is administered too late or too early, or when no

medication order is found.

Myth

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

5. Multiple orders can be confirmed for the same patient in Care Organizer.

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

Hit

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

6. The Five Rights are:

• The right dose

• The right medication

• The right patient

• The right route

• The right unit

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

The five Rights are: The right dose, the right medication, the right patient, the right route and the right time.

Myth

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH” TIE

BREAKER

7. To confirm medications you should be in Active View in Care Organizer.

MYTHHIT or

MEDICATION ADMINISTRATIONKNOWLEDGE CHECK – “HIT” OR “MYTH”

TIE BREAKERTo confirm medications you do have to be in Active View in Care Organizer and will be confirming ALL doses.

HIT

FINAL KNOWLEDGE CHECK