6.07 General Enhancements

Why are we upgrading the Meditech software? Patient Quality and Safety Meaningful Use Requirements Health Care Reform Act Reimbursement Enhancements

Work-List Larger checkboxes for inclusions Larger box for look ahead hours Larger icons – Associated Data – Protocol – Item Detail – Checkmarks – Target Symbol New Outcome Icon – O instead of a target symbol New Detail Button

Larger icons on Work-List

New Detail Button

Launches to Item Detail

Additional PCS Assessment Enhancements Ability to display longer text within PCS assessments Improved loading times when opening the assessments to document

Longer Display Text

6.07 Immunization Enhancement

What changes have been implemented within the Immunization Enhancement? New Electronic Order for Influenza and Pneumococcal – Previously a paper copy of the order printed to Pharmacy New Immunization Screen in the MAR New Immunization Section in the EMR Summary Panel – Similar to the Home Med and Allergy sections

Standardizing Administration Time for Immunizations Unless contraindicated, administer vaccines when available Do not wait until discharge to administer

Process for Pneumococcal and Influenza Vaccines Document the Age 18+ Opt-Out Vaccine Assessment – All patients must be assessed for Influenza and Pneumococcal Eligibility upon Admission Electronic Order files to Pharmacy – Information from the Nursing Assessment files with the order Pharmacy reviews and processes the “Nsg Assessment ” Order (Completed Assessment) Nursing Acknowledges – Canceled “Nsg Assessment ” Order – Vaccine med order entered for today and now Administers the vaccine on the MAR – Documenting the revised MAR flow sheet – Documenting the new immunization screen Vaccine information will flow to the EMR Summary panel once the vaccine is administered Historical vaccine information is still available in the EMR – Summary panel Legal/Indicators tab – Vaccine Information Clinical Panel

Vaccine Eligibility Documentation Process Complete Age 18+ Opt-Out Vaccine Assessment Save

Documenting the Vaccine Eligibility Assessment from the Work-List

Document the Vaccine Eligibility Assessment for Pneumococcal and Influenza Vaccines

Entering Electronic “Nsg Assessment” Orders Vaccine Assessment Orders Triggered – The completed eligibility assessment will electronically file to Pharmacy – Pharmacy must review the assessment regardless of eligibility Select Ok to file Identify the Ordering Provider Select Order Source “MEC Approved Protocol”

Triggering “Nsg Assessment” Orders Always click OK to file the orders

Entering “Nsg Assessment” Orders in OM Always click OK to file the orders Choose Ordering Provider Choose MEC Approved Protocol order source

IMPORTANT Regardless of vaccine eligibility all vaccine assessment orders must be filed to Pharmacy By following this process, you are not ordering a vaccine for a patient who is not eligible The vaccine assessment order serves as an electronic notification to Pharmacy that the RN has completed the vaccination assessment It is a requirement that Pharmacy review all inpatient vaccine eligibility assessments

Selecting the Orders Place checkmark and select both orders – Will not file if not selected Order detail will populate once selected Save Completed Nursing Assessments will electronically file to Pharmacy to be processed

Select both “Nsg Assessment” Orders Pharmacy must review the assessment regardless of eligibility

Order Detail will populate once the orders are selected Must Checkmark Orders to File the Orders to Pharmacy Must Click Submit to File the Orders to Pharmacy

New Orders on Status Board Once you have filed, you will notice the orders displaying on the Status Board as “Nsg Assessments” These are the assessments which will electronically file to Pharmacy to review Pharmacy will process and enter the order for vaccine if applicable

“Nsg Assessment” Orders Displaying on Status Board

Beware of Vaccine Assessment Order Vaccine Assessment orders will queue for acknowledgement RN is unable to acknowledge order until Pharmacy has processed the order An error message will appear to alert Nurses that the orders are currently being reviewed by Pharmacy When closing the error message, a visual indicator will display to indicate the order is unverified in Pharmacy

Error Message when Acknowledging Order The Nurse will not be able to acknowledge the order until the process is complete in Pharmacy

Pharmacy Order Status is Unverified

Vaccine Medication Order for Vaccine Once an active Medication order has been entered by Pharmacy, the order will display in the orders column on the Status Board

Vaccine Medication Order on Status Board

Acknowledging Processed Pharmacy Orders Once Pharmacy has processed the Vaccine Assessment Orders, the Vaccine Assessment Orders will display in the acknowledgement queue in a cancelled status Nursing Tip: Cancelled status means that Pharmacy has completed their review of the vaccine assessment orders.

Processing Eligible Vaccine Orders If Pharmacy determines the patient is eligible for immunization, a vaccine medication order is generated RN will ack – Vaccine Medication Order View Order Detail – “Cancelled” Vaccine Assessment Order View Order Detail – Status of order is cancelled – Stop reason will default the user who cancelled the order

Acknowledging Medication Vaccine Order Review order detail for each order Acknowledge the vaccine first, then review cancelled “Nsg” Assessment” orders

View Order Detail Acknowledge Cancelled Vaccine Assessment Order

Processing Non-Eligible Vaccine Orders If patient is not eligible for immunization, Pharmacy will cancel the Vaccine Assessment Order and enter a stop reason RN will ACK – “Cancelled” Vaccine Assessment Order View Order Detail – Status of order is cancelled – Stop reason will be entered as to why the patient is not eligible for vaccine – Pharmacy should be using the reason entered by Nursing on the Assessment

View Order Detail Stop Reason entered by Pharmacy

Vaccine on the MAR New option to view vaccines only on the MAR Active vaccines will display on the MAR as they do currently MAR will display cancelled Vaccine Assessment Orders in yellow Nursing will not have to document on the cancelled Vaccine Assessment Order

Viewing Vaccines on the MAR New option to view only vaccine type orders on the MAR Vaccine option only displays if there have been vaccines ordered for this patient during this visit Cancelled “Nsg Assessment” orders will display in yellow Active vaccines will display as they do currently

Administration Process Scan the Patient’s Wristband Scan the vaccine Notice the Vaccine Assessment Order is linked to the Vaccine Med Order Automatically defaults to the Protocol Tab – View the Eligibility queries associated as protocol to the order Click Flow sheet – New queries Error message if you do not go to the Admin Screen – Indicates the VIS publication date is required on the Admin Screen Enter information into the New Immunization Medication Administration Screen Ok to File

“Nsg Assessment” Linked to the Vaccine

Protocol will display Eligibility Queries from the Nursing Assessment

Updated MAR Flow sheet

VIS Patients must be given a current Vaccine Information Statement (VIS) prior to receiving the vaccination Documentation requirements are the date the VIS was given to the patient and the VIS Publication Date VIS is available in multiple languages

VIS Publication Date Required Unable to file without entering required information on the Admin Tab

New Immunization Medication Administration Screen Required: VIS Publication Date Dose Injection Site Lot# Expiration Date Defaults in: Component – Used for vaccines with multiple components (MMR) – Eff Date Whether the vaccine will count towards the schedule Dose Units Manufacturer Optional: Vaccination Reason Variance Reason

New Immunization Medication Administration Screen

Admin Displays in Green

Session Summary of Medication Administration

Admin Displays in Black on the MAR

Viewing Immunizations in the EMR Click on Summary Panel Displays in the Clinical Tab – Similar to Home Medications and Allergies Automatically updates when vaccine administered via the MAR

Immunization Routine

View Immunization Administrations in the EMR Click on the vaccine or Click on the “i” View the following: – Vaccines – Components – Antigens View information entered via MAR View Audit Trail – Click on History Report footer button – Include Audit Trail Yes View Immunization Summary – Click on Immunization Summary footer button

View Additional Information Click on the “i” or Click directly on the vaccine

View MAR Administration Information

View History and Summary

History Report View and Print History of all Immunizations with audit trail

Immunization Summary Report Print a summary of all the vaccines administered at your hospital

Historical Vaccines Summary Button in the EMR – Legal/Indicators Tab Clinical Panels – Vaccine Information

Viewing Historical Vaccines Click on the Summary Tab Click on the Legal/Indicators Tab

Viewing Historical Vaccines Scroll down within the Legal/Indicators Tab Historical Vaccine Data will display the same

View Historical Vaccines in the EMR Clinical Panel Click on Clinical Panel Click on Vaccine Panel

EMR Vaccine Panel

6.07 Discharge Enhancement

Streamlined Discharge Process Nursing and Physician Documentation are available within the Discharge Routine All Discharge Documentation printed via the Discharge Panel Nursing Discharge Canned Text note will no longer be applicable for the discharge process Nursing Discharge Documentation will automatically populate the new discharge panel

Discharge Process Discharge Order queues for acknowledgement Acknowledge order Complete Discharge Documentation Print Discharge paperwork via the New Discharge routine

Discharge Order entered via Physician Discharge Routine Discharge order displays on Status Board indicating Physician has begun Discharge Documentation

Acknowledge Discharge Order

Review Order Detail

Discharge Documentation Process Review Nursing Discharge Documentation Discharge Page Two if applicable Teaching (Health Medication Education – Teach Record) Complete Outcomes

Nursing Discharge Documentation

Important Do not edit Physician Documentation If there is a discrepancy, you will need to contact the Physician to update the documentation within the discharge routine

Enhanced Discharge Process Click on the Discharge Button Notice the Physician Discharge Referral Information will default into the Discharge Routine – Prescriptions Paper prescriptions will still need to be written – Referrals/Follow up Appointments – Care Plan Goals – Activity Restrictions – Reference Links

Discharge Button Click on the Discharge Button

Physician Discharge Referral Physician Discharge Referral will populate the discharge routine once the Physician has completed their documentation in the Discharge Routine If the fields are all blank, this indicates the Physician has NOT completed their portion of the discharge process

Instructions, Stand Alone Forms and Forms Instructions, Stand Alone Forms and Forms will not be used at this time

Prescriptions Medications which will be continued at home will display within the Prescriptions section Written prescriptions will still need to be provided to the patient

Referrals Physicians will add Referrals within the Discharge Routine When a referral is entered within the Discharge Routine, the Physician will receive a copy of the Patient Health Summary Physicians can indicate how long after discharge to follow up with the referring Physician

Enter Referral Notes Scroll over to the right Click on the Notepad Icon

Enter Follow up Text and/or Dates and Times If your hospital schedules the patient’s appointments upon discharge, you can enter the date and time of the appointment here The referral text and follow up dates will print on the Patient Visit Report

Care Plan Goals and Activity Restrictions

Additional Reference Links and Reference Text

Print Language English will default in as the print language Currently the discharge packet is only set up to print in English

Printing the Nursing Documentation Click Reports on the bottom of the screen Choose Nursing Discharge Instructions Choose Discharge Page Two (if applicable) Click ok

Printing Nursing Reports

Print Nursing Discharge Instructions Print Nursing Discharge Instructions, Discharge Page Two, Discharge Page Three Patient Health Summary will print with the Discharge Packet

Print to printer

Print Discharge Packet Click Print Packet Packet Includes the Following – Patient Health Summary – Patient Visit Information – Face to Face Certification – Discharge Medication List

Print Packet

Choose Printer

Discharging out of Meditech Click the Discharge Data Tab Enter Discharge Date and Time Click now for the current date and time If patient was discharged previously, then you can select a time in the past – Discharge date and time should be when patient actually left the hospital Click Save

Discharge Date/Time

Now for Current Date and Time

Entering a Time in the Past

Discharge Disposition Discharge Disposition will populate from Physician Documentation Save

Discharge Disposition

Important Once the Discharge Data is saved, the patient will be discharged out of Meditech