Paragon Training Nursing Students

Logging In At Seton Medical Center we have Single Sign On which allows you to swipe your badge for login. Swipe your badge over the reader The Unlock Workstation Window Opens; enter your password And click OK

Double Click on the Paragon Shortcut on the computer’s Desktop Logging In (cont) Double Click on the Paragon Shortcut on the computer’s Desktop The Paragon Applications will open. Double click on the Clinical Carestation

Clinical Care Station (CCS) When you log into CCS the Splash Screen Opens. To access your patients click on the icon in the center of the screen. In CareGlance look to ensure you defaulted to the correct Nursing Station. If not, click on the drop down arrow for the Nursing Station and pick the correct Unit you are working on.

CCS (cont) Assigning your patients Click in the “Assign” Box next to your 1st “assigned” Patient The “Self Assignment – Shift Selection” Box will open Choose your shift from the drop down arrow Click the “Assign…” box so that when you click the other patient’s assigned to you, you don’t have to complete this box again Then Click the OK button and finish assigning the rest of your patients to yourself.

CCS (cont) Assigning your patients After assigning yourself your patients click the “Assigned Patients” box (next to the Nursing Station Field. Click the “Retrieve” Button (think of this as your “refresh” button)

“Bubbles” All patients have “bubbles” to the right of their names w/ initials above them. Here are a few you will be ac AA – Admission Assessment (this one is done by the staff RN, but if it is GREEN then it is clear that an Admission Assessment has been completed by an the staff RN) FS – Flow Sheet RX – Medication Administration NR – New Results Doc – Physician Progress Notes (if they do electronically) There is a “legend” icon located in the Secondary Tool Bar that can be used to assist you w/ what the color scheme in the bubbles indicate.

CCS (cont) Patient Profile The Patient Profile supplies information on patient’s Home Medications, Allergies, Admission Height & Weight, etc. To Access Highlight the patient you wish to view and click the Patient Profile Icon in the Primary Tool Bar .

CCS (cont) Patient Profile To see the Admission Height & Weight (and some additional information) Click on the down arrow in the Patient Banner To close this screen simply click the up arrow at the bottom of the screen

CCS (cont) Patient Profile Another important icon located in the Patient Profile is the Patient History Icon. Single Click the icon for the Visit History Window to Open When the Visit History window opens Single click on a visit(at the top of the screen) To review diagnostic tests for that visit on bottom half of screen. Double Click on a visit (at the top of the screen) To Open the Patient’s Medical Record to view H&Ps, and other documentation

HPF (Horizon Patient Folder) (The patient’s legal record) When HPF Opens there is a one time set-up that will have to be completed before any documentation can be seen. Click: File  Preferences  Personal Record View Personal Record View: Click the Add All button to move all “Documents Not in View to the right “Documents in View” then Click OK Exit HPF through the Door

Daily Assessments This Assessment Type is where you document your shift baseline head to toe assessment, your hourly rounding (on the Peep Tab), your pain assessments, IV assessments, etc. Your instructor will let you know how often she expects documentation in these areas.

Daily Assessment (con’t.) Click on the “Change Unit Type” Icon in the primary tool bar. Select the Unit Type of LHP-MedSurg Click on the “Perform Assessment” Icon and choose the “Daily” Assessment The Daily Assessment will open to reveal these categories (Tabs)

Components of the Daily Assessment Daily Assessment (con’t.) Components of the Daily Assessment The Assessment is made up of “Tabs” or “Categories”. Within those Tabs are Group Boxes Within the Group Boxes are Finding Codes Together these components make up your documentation. A Head-to-Toe Assessment is completed on the tabs that are all upper-case:

Daily Assessment (con’t.) In the Daily Assessment you do have a way to add extra information during your assessment. This can be done 2 ways 1st Way: Create a “Group Note” which allows 255 characters. Simply right click in the group boxes header and click on “Group note” The blank Group Note Screen will open and you can type up to 255 characters. The little yellow piece of paper will show in the Group Notes Header

Daily Assessment (con’t.) In the Daily Assessment you do have a way to add extra information during your assessment. This can be done 2 ways 2nd way: Create a “Category Note” which allows 255 characters. Simply right click anywhere in the Gray portion of the screen click on “Category Note” The blank Category Note Screen will open and you can type up to 255 characters. The little yellow piece of paper will show on the Category Tab

Daily Assessment (con’t.) System Assessments are all designed in the same format. All “normal” findings are at the top of the page w/ all “abnormal” findings below (see SKIN tab) Normal Abnormal

Hendrich II Fall Risk Model Daily Assessment (con’t.) Hendrich II Fall Risk Model SMCHH uses the Hendrich II Fall Risk Model. This model has 2 components (Risk Factor & Get-up-and-Go Test) that are added together for a score. If the score is equal to or greater than 5 the patient is considered High Risk for Falls and Fall Precaution Bundle is put in place.

McKesson Pain Assessment Daily Assessment (con’t.) McKesson Pain Assessment SMCHH uses the McKesson Defined Pain Assessment Screen. This is embedded into the Daily Assessment Click on the Pain Assessment button Click on the New button at the bottom of the window to open a “New” Pain Assessment Click within the fields for the drop down choices. If this is a pre-intervention assessment click the pre-intervention assessment option and be sure to re-evaluate your patient after intervention. Upon re-eval, click the post-intervention assessment option.

“Rounding” at SMCHH is done on the Peep and/or Intervention tabs Daily Assessment (con’t.) “Rounding” at SMCHH is done on the Peep and/or Intervention tabs You only document on the tabs that you need. To close an assessment ALWAYS “yellow arrow” out. You will be asked “do you wish to close this assessment? Click YES if you have completed the assessment of NO if you wish to come back and finish the assessment later

Follow-UP Assessment Type = TEACHING ALL Teaching documentation is completed under the “Follow-Up” Assessment Type Click on the “Perform Assessment” Icon Select the Follow-Up Assessment The Follow-Up Assessment will open. There are 3 tabs:

Follow-UP Assessment Type = TEACHING Admit/Assess Educ

Follow-UP Assessment Type = TEACHING Ongoing Education

Follow-UP Assessment Type = TEACHING Medication Education

Wound Assessment Type Assessments of Wounds are done in the Wound Assessment Type. Click on the “Perform Assessment” Icon Select the Wound Assessment The Wound Management Window will open. If this wound has been documented and this is the wound you are assessing simply double click on that site. If it is a “NEW” wound, click on the scroll in the secondary toolbar.

Wound Assessment Type If documenting on an existing wound when the assessment opens, the top half reveals the baseline Wound Info (it is not editable). The Site Assessment is on the lower half and reveals the last assessment completed. To start a new site assessment click on the Insert button. To view assessments prior click on the arrows at the bottom of the screen. The new Site Assessment will open to allow for documentation. When completed, click OK and the assessment will close

Wound Assessment Type If documenting a “NEW” wound, click on the scroll in the secondary toolbar. The top half of the screen “Wound Info” is the baseline wound information and once saved this cannot be changed. The bottom half, “Site Assessment” is the nurses assessment of that wound. Once completed click OK to close the assessment.

Flow Sheet (Vital Signs, I/O’s, Measurements, and IV insertions) In the CareGlance screen double click on the FS bubble When the Flow Sheet screen opens right click in the “white” space to select what you need to do.

Vital Signs: Flow Sheet (con’t.) Enter your vital signs and then click “OK” at the bottom of the screen

I/O’s: Flow Sheet (con’t.) Enter your I/Os and then click “OK” at the bottom of the screen

IV Management Flow Sheet (con’t.) IV Site List Screen will open. Click on New IV Site and then OK

IV Management Flow Sheet (con’t.) The IV Site Screen will open and the Started By Field will default to you. Click the drop down arrow to choose the IV Site Click the drop down arrow to choose the IV Type Enter Catheter size Enter Site Started Date and Time Areas in Bold must have entries

IV Management Flow Sheet (con’t.) Click the OK at the bottom of the screen IV Entry: Do you want to save your changes? Click Yes

IV Management Flow Sheet (con’t.) The Fluid Screen will be available to add Fluids if you are hanging a bag at the time of IV Insertion. Enter Fluid Type (i.e. NS) Fluid Started By defaults to the user Enter Starting Volume Enter Rate Then Click OK and Save your changes.

IV Management Assessment of IV’s is in the Daily Assessment under the Intravenous Tab The IV Assessment looks like this. Click on the IV Site you are assessing and complete the fields.

Order Management Application There are two tabs in Order Management (OM) that we will cover. One is the “DIET” Tab and the other is the “Inquiry” Tab. To access OM highlight your patient in Clinical CareStation (CCS). Click on the OM Icon (aka “Pizza Hut”)  in the Primary Tool Bar. This will open the OM Application and the Order Entry Tab is defaulted.

Order Management Application Click on the Diet Order Tab to view your patient’s diet order.

Order Management Application Click on the Order Inquiry Tab to view ALL orders that have been placed on your patient as well as see results. To view results, highlight the order you wish to review and click the “Results” button to the right of the screen. Normal Abnormal (out of range) Resulted (no ranges) Critical Result

ADMINISTERING MEDICATION(S)

The Most Common way is through the Rx Bubble on CareGlance Screen Administering Medication(s) The Medication Administration Application can be accessed two different ways. The Most Common way is through the Rx Bubble on CareGlance Screen The other option is to click on the Medication Administration Icon in the Primary Tool Bar

Scan the Medication(s) you wish to administer to the patient Administering Medication(s) 1 Identify your patient w/ two identifiers – Once the MAR is loaded – Scan your patients armband. Scan the Medication(s) you wish to administer to the patient 2

Administering Medication(s) A Lock will appear on the Admin. column. Medication(s) are now “PENDING”

Administering Medication(s) 1 Go to “Pending” Folder to verify that medication(s) were scanned. Look for a green checkmark to the left of medication(s) scanned. Click “Confirm” after reviewing that Total Scan matches Ordered Dose (The example here is different as patient only wanted 1 Tylenol). Complete Administration Screen to include any edit boxes that are required (i.e. Early/Late Doses) 2

Administering Medication(s) Once you click “confirm” the Administration Window will open (5 rights, PRN Reasons, Late Dose Code, etc.) Areas that must be completed will be BOLD.

You are Ready to Administer Your Patient’s Medications Administering Medication(s) You are Ready to Administer Your Patient’s Medications After Administering your Patient’s Medication Click the CHART Button! If you don’t, the medications will go back into the eMAR like they were never given. Don’t Forget…