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
WHAT TO DO WHENMEDICAL RECEPTIONIST (CONT)
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
WHAT TO DO WHENMEDICAL RECEPTIONIST (CONT)
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.
WHAT TO DO WHENAFTER DOWNTIME
(APPROXIMATELY NOON SUNDAY MAY 13)
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
WHAT TO DO WHENAFTER DOWNTIME
(APPROXIMATELY NOON SUNDAY MAY 13)