Emergency Care,
Rx Writer, Exit Care
Sunrise Emergency Care
May 2013 v. 1.0
ED Display BoardLog into Emergency Care/SCM. The View dropdown box will be populated with the views appropriate for your role -- the table on the next page describes which views are available. If necessary, you may need to switch your view to the location that you will be working for that shift.
Slide 2
ED Display Board (Cont)View Area
.ED All All North Decatur ED Areas
.WR ED Waiting Room
Admit View Patients assigned to temporary ED bed while waiting to be admitted
Behavioral Rooms ER 24-26
Inactive Patients Patients that have been removed from the board within the previous 72 hours.
Note: If the patient was removed from the board due to an inpatient transfer/admit, they
will NOT be displayed in the Inactive Patients view
Main 1 ER 3-10, HW 3-10, TR01
Main 2 ER 11-19, HW 11-19, TR02
Main 3 ER 27-32, HW 27-32, TR01, TR02
RTA RHW 01-04, RTA 01-03
Triage Patients waiting for Triage. All patients will default to this view upon presentation to ED.
Urgent Care ER 33-41, HW 33-35, HW A-E
WR Inner Urgent Care ED Inner Urgent Care Waiting Room
Slide 3
ED Display Board (Cont)
Slide 4
To switch to another view:
Steps Actions
1 From the Emergency Care main screen, click on the
View dropdown box
2 Select the view associated with your assigned location
ED Display BoardEmergency Care Views
The Patient Tracker Board may be viewed from a static ‘display board’ on large display monitors that will be strategically located in the ED.
Users may also access their own personal view of the Patient Tracking System (containing a subset of data from the display board) by logging onto Sunrise Emergency Care at a PC workstation.
Note that what you have access to view and change on the Patient Tracking System will be controlled by the security settings applied to your logon ID.
Slide 5
ED Display Board
Slide 6
Display Board Summary View
Time of Refresh – the display board is updated by information that is entered into Sunrise Emergency Care by various users on workstations throughout the hospital. The board view is configured to automatically refresh and show the latest data every 60 seconds. This area will display the actual time of the last refresh in the upper right side of the board.
Summary Information – This area will display a summary of information such as total number of patients on the unit, total number of patients in triage, etc. This summary data changes based upon the displayed Patient Tracking System view.
ED Display Board Columns
Display Board Column Description
Room Displays the room/area where the patient is assigned
Patient Displays the name of the patient (depends on the view you are in)
SBP/DBP/HR Displays the most recent vital signs
Age Displays patient’s age. Note: The system turns this cell pink if patient is a female and
blue if a male.
ESI The priority of the patient from the Nurse’s Triage Note.
Slide 7
ED Display Board Columns
Display Board Columns (cont)
Display Board Column Description
Chief Complaint From the Nurse’s Triage Note – patient’s stated complaint
Status (STS) Displays the status of the patient or the bed (status descriptions detailed later)
ED LOS Length of time patient has been in the ED location
Nurse Nurse assigned to this patient
MD ED provider assigned to this patient
Slide 8
ED Display Board Columns
Display Board Columns (cont)
Display Board Column Description
New Orders New physician orders have been placed in SCM
D/C Sts (discharge status) Paper icon will appear when the physician has entered a discharge order
Dispo Timer Triggered when the disposition order is placed. When timer is greater than 15 minutes
the cell background color starts blinking green. Timer stops when the patient is
removed from the board.
Inpt Timer Triggered when the status is RA (room assigned). When timer is greater than 30
minutes the cell background color starts blinking green. Timer stops when the patient
is removed from the board.
Slide 9
ED Display Board Columns
Display Board Columns (cont)
Display Board Column Description
Comments Any additional comments for communication
Consult Triggered when the physician enters a consult order. Shows complete when the OSA
completes the order (consulted MD has called back)
Lab/Urine/RAD/EKG/Meds/
Nursing
May show a ratio (0:3) - first number shows how many results are ready and the
second number displays the total number of orders placed. A single order will only
show the status of that order (performed, comp, ordered)
Slide 10
ED Display Board Columns
Display Board Columns (cont)
Display Board Column Description
Previous Visit Keeps a rolling count of the number of times the patient has been in the ED within the
previous 72 hours
Admitted fr ED to Rm Assigned inpatient room (by the Throughput Coordinator)
PADM Patient is waiting to be admitted
Patient is waiting for bed (Provider has checked Bed Req)
Admit order has been entered
BedReq Displays a checkmark if a Bed Req has been ordered by the physician
MD Timer The time that a patient has waited for a physician. This timer is triggered when the
patient has completed triage and the room status has been updated (WR, WRFC,
actual ED Room, etc.). The timer will stop ticking when the MD is assigned.
Slide 11
Bed/Patient Status ColumnStatus Description Notes (Icons, Timers, etc)
Ready (BED) The bed has been cleaned and is READY for the
next patient
The line turns lavendar when the status is chosen signifying it is
ready for an admission.
Dirty (BED) This denotes a terminal clean room. The line turns brown.
OOS/Blocked (BED) Room is Out of Service or Blocked The line turns red.
Reserved (BED) Nursing has reserved the room for a patient after
receiving a call from ambulance stating that they are
on the way with a patient.
The line turns red.
Treatment in Progress (TIP) Provider is treating This status is automatically engaged when the provider assigns
him/herself to the patient. Sends notification that patient is ready
for full registration.
Consult Pending Consult ordered, has not been received
Pending Admission Bed Request has been received This status will be automatically engaged when the provider
checks the Bed Req column
Inpatient Admit Bed Request and Admission orders have been
received, but bed has not been assigned or is not
ready
This nurse will manually change to this status once Admission
orders and the Bed Req have been ordered by the provider
Remove From Board Removes patient from the board
Room Assigned Bed is assigned and ready for patient The 30 minute discharge timer begins ticking
Waiting to be Seen (WTBS) Waiting to be seen Triage Nurse will change to WTBS once the Triage Note is
completed.
Triage Patient is waiting for triage
Slide 12
Provider ResponsibilitiesThe provider has the following responsibilities:
• Assign him/herself to the patient
• Computerized Physician Order Entry
– All orders will be done through the Electronic SCM systems including Discharge, Admit, Meds, Labs, RAD, etc..
• Order Bed Request for Inpatient Admits
• ED Disposition Orders for Patient Discharges from ED
• Create and Print Discharge Instructions using Exit Care
• Write electronic prescriptions using Rx Writer
• Sign off on electronic orders placed by Nursing
Slide 13
Assign Provider to Patient
To assign yourself to a patient:
Slide 14
Steps Actions
1 Select the desired patient
2 Double-click in the MD column for the desired patient and select your
name
The MD Timer will stop ticking and you will be assigned to the patient
Computerized Physician Order Entry
With Emergency Care system, ALL orders will now be placed electronically using Computerized Physician Order Entry (CPOE).
To assist you in this process, there are several Order Sets that have been built specifically for ED Providers.
Slide 15
CPOE (Cont)
To place an order:
1. Select the desired patient
2. Click the Enter Order iconfrom the patient headersection
Slide 16
CPOE (Cont)
To place an order (cont):
3. Select the appropriate order set or type in an individual order item name.
3. Double click on the order set/order item name to open.
Slide 17
CPOE (Cont)
To place an order (cont):
5. Select desired options
6. Click OK
Slide 18
CPOE (Cont)
To place an order (cont):
7. Review Order for Accuracy
8. Click Submit
Please see Module 3.4 in the ‘SCM
Acute Care Clinical System’ folder
“Order Entry” CBL.
Slide 19
To place an order (cont):
ED specific order sets have been built in Acute Care. While you can certainly search for them manually, it is often easier to set your default browse point to these particular order sets.
Slide 20
Default Browse Point
CPOE (Cont)
Setting Default Browse
Point for Order Entry:
1. From the menu bar, select
Preferences/Order Entry.
2. The Order Entry Option
box will open.
3. From the Browse Start
Point tab click Add New.
Slide 21
CPOE (Cont)
Setting Default Browse
Point for Order Entry (cont):
• Select the browse option you
wish to display as the default.
This example displays Common
Order Sets By Unit/Common
Orders ED.
• Click OK.
Slide 22
CPOE (Cont)
Setting Default Browse
Point for Order Entry (cont):
Highlight the selection you
wish to set as the default.
Click on Set As Default,
then Click Close.
Slide 23
Disposition Orders
When a patient is being admitted, transferred, or discharged, the
ED-Disposition Orderset should be used.
Slide 24
Disposition Orders (Cont)
Disposition Orders
1. Select ED-Dispositions
2. Click Add
Slide 25
Disposition Orders (Cont)
Disposition Orders
3. Select desired options- You will need to double-click the order item to completethe required information- All orders with required information are preceded by
4. Click OKSlide 26
Disposition Orders (Cont)
Disposition Orders
5. Click Submit
Slide 27
Disposition Orders
Bed Request
(for Inpatient Admissions)
1. Using the ED-Dispositions orderset, double-click the ED-Bed Requestorder
Slide 28
Disposition Orders
Bed Request
(for Inpatient Admissions)
2. Complete all mandatory fields (fields with are required)
3. Click OK
Slide 29
Disposition Orders
Bed Request
(for Inpatient Admissions)
4. Click Submit
Slide 30
Disposition Orders
Inpatient AdmissionsOnce the Bed Request Order has been submitted, the following will take place on the board:
• The Row will turn orange, signifying an inpatient admit
5. Click in the Bed Req checkbox to place a checkmark in the column
• A small bed icon will appear in the PADM column
• The Bed Req Timer begins ticking
• The STS column will change to PADM
Slide 31
AlertsWhile using the system you may notice pop up alerts. These have been used to inform you that “ACTION” needs to occur. Some of the alerts you might see:
-admission orders while a patient is in the ED need to be entered in a “Hold” session type
-duplicate orders- users may not realize another practitioner has entered orders on the patient.
Please see Module 3.4 in the ‘SCM Acute Care
Clinical System’ folder for more details on how to find
patients and patient data.Slide 32
Exit CareExit Care is the application that is used to print Discharge Instructions and Work/School excuses.
To access Exit Care:
1. Select desired patient
2. Click on the Discharge Instructionsicon
ORRight-click the patient and select Discharge Instructions
Slide 33
To access Exit Care (cont):
1. Click Login (the system recognizes your SCM log in)
Slide 34
To select your document:
1. Select the desired document by clicking in the checkbox
2. Click Preview Highlighted Item if you would like to view the document
OR
Click Done to move to the next screen
Slide 35
Alternatively, you can also use the Search feature to locate a document using free-text:
1. Free-text any part of the name of the document you are looking for
2. Select one of the following options:1. Title begins with
2. Title contains
3. Search within the text of ALL document
3. Click Find
Slide 36
Note: The available translations pane will display the translations available for that document. As documents are chosen, the documents selected will display in the selected documents pane.
To edit your document:
1. Click the View Document tab
Slide 37
2. Click the Edit button
Note: Edits are only available in English. The system is unable to convert English edits into other translations.
To edit and print your document:
1. Make any necessary edits
2. Click the Save button
3. Select Save for Current Patient Only
4. Click the Print/Fax/Email link to print the document
Slide 38
Note: The language and size option allows the user to print documents in the desired translation (available translations will be available in bold. Unavailable translations will be grayed out). If another language is selected, there is an option to print an English copy. The font size of the document can also be changed to accommodate patient needs.
To add a work or school excuse:
1. Click the Add Excuse Formlink from the left panel
2. Complete necessary information
Slide 39
To add an additional Care Provider:
1. Click the Add a Caregiverbutton
2. Select desired caregiver
3. Click OK
Slide 40
To add a follow up Care Provider:
1. Click the Add a Follow-upbutton
2. Select follow-up number of days
3. Select follow-up provider
4. Click OKSlide 41
Additional notes provides an area to document meds given in the Ed and meds given to take home.
Adding Additional Notes:
1. Click the Lookup Notesbutton
2. Check the desired note
3. Click Add Selected
Slide 42
Additional notes provides an area to document meds given in the Ed and meds given to take home.
Adding Additional Notes:
1. Click the Lookup Notesbutton
2. Check the desired note
3. Click Add Selected
Slide 43
The notes will be pulled into the document and you can free text additional information in the space provided
Slide 44
Rx Writer/ePrescribePrescription Writer is an application within Acute Care that
allows providers to do the following:
• Create and maintain a list of home medications
• Electronically transmit new prescriptions
• Convert listed home medications into prescription refills
• View a history of changes for prescriptions and home medications
• Before ePrescribing any medications, the provider must ensure the patient’s preferred pharmacy is entered in the system.
• To enter the patient’s preferred pharmacy
• Select your patient.
• Click the Rx Writer icon
• Click on the blue writing next to preferred pharmacy
• Click on the arrow. Enter the pharmacy name, state, and zip code. A list of pharmacies participating in ePrescribe will display
Slide 45
• If the pharmacy name has this icon next to it, it is not a participating pharmacy in eSubscribe. FYI: DO NOT USE THE ADD NEW SIGN TO FIND OR ADD NEW PHARMACIES.
• Click on the patient’s preferred pharmacy from the list. If the patient’s pharmacy is not a participating pharmacy, the Provider should print all prescriptions.
• Click on the “add to preferred” icon
• Click on close
Slide 46
To enter your user preferences
• Click on the Rx Writer icon
• Click on the user preferences icon
• Select the location you are practicing from.
• Select the phone number that a pharmacist can contact you with any questions.
• Click OK. Close out of Rx Writer application for the changes to take effect.
You only have to select the location and the phone number once. If the phone number listed in not correct or if you have a change in phone number/address please call 15757.
Slide 47
• Select your patient from the patient list or PTS board
• Click the Rx Writer icon
• Once the Rx Writer dialogue box opens up, click on the enter prescription icon
• If your user preferences are set to favorites, you will see this list.
• Pick the category you would like to select your prescriptions from (full catalog, quick list, favorites).
• Failure to enter all required fields will result in an error for eSubmit. (Dose, Dosage Units, Route, Frequency, Days, Refills, Quantity, Dispensed Unit
NOTE: Medications on the favorites list have most of those fields pre-filled.
Slide 48
Entering a Prescription
• If you need to add more medications, click add to list
•When you are finished adding all prescriptions, Click Review and Submit. The following screen will appear
Slide 49
• If your user preference is defaulted to eSubmit, the prescriptions will default to eSubmit. Schedule II medications are not eligible for ePrescribe and orders will default to Print.
• If the patient does not want to participate in ePrescribe/eSubmit, the Provider can manually change the submit method to print.
• Once you have entered all Prescription(s), click Submit
Slide 50
• There is a new “Notification” icon that displays to indicate pending e-prescribing refill requests, e-prescribing errors, unsubmitted prescriptions, and new medication dispense history.
• Medications listed in blue are unsubmitted prescriptions
• Medications listed in red have submission errors
• The errors that display are specific to the user that is logged in
• For example, in the screen shot below, the notification icon indicates there are 5 items that the logged in Provider needs to review. There are 3 unsubmitted orders, 1 submission error on levothroid, and 1 error that exists on another patient the logged in provider has cared for.
• Other providers will see the medications listed in blue or red and can address the errors.
Slide 51
Managing Prescriptions
• To manage the errors, click on the “Notification error” icon, then
• Click on the item you would like to address.
• You will then receive a listing of the specific errors. Click on the plus sign to see more details
Slide 52
• Right click on the medication with the error or in unsubmitted status
• A dialogue box with additional actions will pop up
• Select “View/Modify”
• When the prescription box pops up, make the changes to address the errors or review the medication, then
• Click “review and submit”
• Once all errors have been addressed, the writing of the medication will turn black and the number of errors on the “Notification” icon will decrease.
• Click “close” when finished.
Slide 53
Signature ManagerThe following orders will need to be signed in signature
manager within Emergency Care, or in Sovera if the
patient's visit is no longer active:
- Verbal orders entered by nursing
- ED protocol orders
• To launch Signature Manager, click on the icon on
the toolbar.
• Click “Get List” button.
• Check the orders you wish to sign.
• Click “Sign”
Slide 54
Congratulations!
You have completed the Emergency Care CBL
Slide 55