Epic in Action at SutterKim Windsor, RN, MSNICU Clinical EducatorEden Medical Center

History and Challenges

Epic in place for 2 years: Limited functionality in the beginning. First 6-12 months was learning the system. After 18-24 months, we realized a lot of things were missing.

Understanding the difference between a donor patient and a regular patient, caring for them clinically and how that translates into EHR

Access for new CTDN members and training

Navigating same system/different hospital EHR system and keeping up to date with existing systems

SolutionsFind your EHR “Go-to” person and a super user on the floor

Utilize EHR to make your life easier – use smart phrases, order sets and a set process

Know your report/summary sheets to find information easily

Initial Access/Maintaining Access to EHR

Communicate with the Manager/Director of the unit

Keep an up-to-date list of staff

Keep staff updated of changes in the system

ReferralsHave reference materials for the bedside nurses to use when talking with the donor network

Utilize the smart phase with the referral number, the donor phone number and the plan

CTDN staff charts where the patient is in the process of donation using smart phrases

Easy for any health care provider to find

Progress NoteUtilize smart phrases

Have a systematic way of utilizing the phrases – fill out at the end of shift or with changes.

This allows the health care team to know where the patient is in the process of donation

Adding a Note

Type donor or CTDN to pull up the smart phrase

Smart Phrases

We created 4 smart phrases – 2 for our bedside nurses 2 for the CTDN nurses

Smart Phrases for Bedside RN

CTDN Asystolic Organ Donor Referral Note: Use within one hour of asystolic death

CTDN Imminent Death Organ Donor Referral Use within one hour of the following – Vented and brain injured patient (bleed, anoxic, trauma), GCS of 5 or less, one or more absent stem reflexes, anticipated discussions end of life (before brain death declarations and before poor prognosis meetings)

Bedside RN Smart Phrase

Bedside RN Smart Phrase

Smart Phrase for CTDN Staff

CTDN Onsite Evaluation Note: For chart/review evaluation on site

CTDN Progress Note: A progress note is written at end of shift, or upon leaving the unit to ensure health care team and CTDN are on the same page..

CTDN Smart Phrase

CTDN Smart Phrase

CTDN Smart Phrase

CTDN Smart Phrase

Order Set

Create an order set in the EHR

Be sure all staff have access to the order set

Keep it up to date and make changes as needed

Use the hospital process as much as possible to make it easier for the bedside nurse to manage the patient – fewer mistakes

Onsite Evaluation

Order Set

Future StepsRemote Access

Enhance Smart Phrases

Keep order sets up to date

Flowsheet for Donor Patients

Plan of Care for Donor Patient with references so that the bedside nurse can be knowledgeable about the process (more buy-in)

Utilize system to keep health care team on top of recent referral process (smart phrase/notes/references)

Future StepsHave all of our systems “talk!!”

Create a job aid to walk all health care workers through the process from start to finish

Have a place dedicated in the hospital for donor information and updates

Always improve your existing system!