W ELCOME 1.This class follows a standardized structure. The learner is expected to: Listen and watch the instructor demonstrate and explain at the beginning of each lesson with HANDS OFF THE WORKSTATION. Practice individual exercises Participate in knowledge check activities Practice working through group activities. 2.The material presented in this class is a foundational overview of the Clinical Systems. Unit specific information and practice will be covered when you are active on your unit.

C LINICAL S YSTEMS S TAR B ROWSER /S TAR P ANEL

V IDEO I NTRODUCTION : S TAR B ROWSER /S TAR P ANEL 1.Click here to load videohere

S TAR B ROWSER /S TAR P ANEL L OGGING O NTO THE S YSTEM INDIVIDUAL ACTIVITY 1.Log onto the system using the training ID.

C LINICAL S YSTEMS T HE A CTIONS M ENU

V IDEO I NTRODUCTION : A CTIONS M ENU 1.Click here to load Videohere

A CTIONS M ENU Q UIZ S HOW

A CTIONS M ENU K NOWLEDGE C HECK 1.The link in the Actions Menu that is a record of any document that pertains to a patient’s medical history at Vanderbilt University Medical Center.

A CTIONS M ENU K NOWLEDGE C HECK All Documents

A CTIONS M ENU K NOWLEDGE C HECK 2.The link in the Actions Menu that displays medications, dosages and time administered for a specific patient.

A CTIONS M ENU K NOWLEDGE C HECK MAR

A CTIONS M ENU K NOWLEDGE C HECK 3.The link in the Actions Menu that allows you to assign or view a pathway.

A CTIONS M ENU K NOWLEDGE C HECK E-Docs Pathway

A CTIONS M ENU K NOWLEDGE C HECK 4.The link in the Actions Menu that provides a snap shot of important information charted for a patient using the SBAR format

A CTIONS M ENU K NOWLEDGE C HECK OPC

A CTIONS M ENU K NOWLEDGE C HECK – T IE B REAKER ! 5.The link in the Actions Menu that provides an overview of lab results from a patient’s hospital stay.

A CTIONS M ENU K NOWLEDGE C HECK Fast Labs

C HARTING A N EW P ATIENT ’ S A DMISSION H ISTORY

C HARTING A N EW P ATIENT ’ S A DMISSION H ISTORY L EARNING O BJECTIVES 1.Locate required sections of the Admission History and define the completion deadlines for those sections. 2.Demonstrate the ability to complete a patient admission history.

A DMISSION H ISTORY F ORM A CTIVITY  With a partner, please complete an admission history form.  Make sure to include information in each section and do not skip sections.  After the allergies section, please save the form as a draft and switch roles with a partner.  Take turns being the nurse and the patient, providing information for completion of the form.  Each partner should have an opportunity to practice!

C LINICAL S YSTEMS O RDER E NTRY – HEO/W IZ

V IDEO I NTRODUCTION : HEO/W IZ 1.Click here to load the videohere

O RDER E NTRY – HEO/W IZ L EARNING O BJECTIVES 1.Define the purpose of the HEO/Wiz system. 2.Demonstrate searching for and locating active orders. 3.Demonstrate entering orders.

O RDER E NTRY – HEO/W IZ L OCATING A CTIVE O RDERS INDIVIDUAL ACTIVITY Use patient name on the patient card. 1.Practice selecting a patient and locating a diet order for the patient on your patient card. 2.Practice locating the tranfuse PRBCs order.

O RDER E NTRY – HEO/W IZ E NTERING O RDERS INDIVIDUAL ACTIVITY 1.Practice entering a telephone order from Dr. Physician Test for a routine, one-time CBC w/platelets for 5 a.m. tomorrow. 2.Click done and Accept Orders.

O RDER E NTRY – HEO/W IZ R EQUESTING A B LOOD P RODUCT INDIVIDUAL ACTIVITY 1.Practice requesting your remaining blood product from the blood bank for your training patient.

O RDER E NTRY A CTIVITY Enter the following order: Protocol order Test, Physician Diabetic diet consistent cho Daily NXT meal Until discontinued IT’S LUNCH TIME! PLEASE LOG OFF OF YOUR WORKSTATIONS BEFORE EXITING THE ROOM!

C LINICAL S YSTEMS C HARTING HED

V IDEO I NTRODUCTION : HED 1.Click here to load the videohere

C HARTING HED L EARNING O BJECTIVES 1.Define the purpose of the HED system. 2.Demonstrate the method for assigning patients in Care Organizer. 3.Demonstrate the method for reviewing and completing labs in Care Organizer 4.Demonstrate confirming a medication in Care Organizer. 5.Locate and define the purpose of primary menus in HED.

N OTIFICATION AND C OMPLETING L ABS IN C ARE O RGANIZER 1.Demonstrate cicking the to-do radial button 2.Demonstrate clicking the Complete button 3.Demonstrate completing the Urinalysis lab order 4.Demonstrate closing the box

M EDICATION A DMINISTRATION C ONFIRMING A M EDICATION O RDER 1.Practice verifying that you are in “Active view” prior to confirming medication. 2.Practice selecting your patient from laminated sheet and confirming Haldol using the confirm button. 3.Confirm the remaining medications using the view confirm/unconfirmed menu. 4.Using any medication, demonstrate sending a message to the pharmacy. 5.Click the refresh button.

C HARTING N AVIGATION AND P ROCESSES C HARTING A N EW P ATIENT ’ S V ITALS IN HED INDIVIDUAL ACTIVITY 1.Open HED Train. 2.Click “Show All” 3.Practice entering the following in the Vital Sign section of the chart:  Change time to 30 minutes ago.  Enter temp of Oral.  Click exclamation point to make significant finding.  Enter heart rate/DAS of 116 apical.  Enter O2 Sats of 95% on Oxygen  Enter O2 Liter Flow of 2L, Nasal Cannula 4.Click “Save and Confirm” after vitals have been entered.

C HARTING THE P HYSICAL A SSESSMENT AND C ARE P LAN IN HED 1.Click HED train and the “ICU/SD Asmt/Interventn” tab. 2.Click “Show All” Demonstrate entering the following in the Pulmonary section of the chart: Select Respiratory ASMT (Problems) and select Gas Exchange Chart abnormal breath sounds using the following: Click Chart then SHOW ALL Click RLL and fine crackles Click LLL and fine crackles Click cough Click productive Make up nasty secretions Incentive Spirometer: 600X5 Scroll to Pulmonary intervention: D B and Cough and Suction Chart a Braden skin assessment and a Falls Risk Assessment 4. Click “save and confirm”.

C HARTING N AVIGATION AND P ROCESSES B EGINNING AND D ISCONTINUING A L INE IN HED 1.Start a new CVC line using the following information: Line Type: Central Line, Site: Internal Jugular Side: Right, Number of Lumens: Double, Lumen Description: Proximal, Distal Dressing: Chlorhex Drsg, Transparent, Secured with: Suture Type “T” in date/time, Inserted by: Dr. Golightly, Location: VUMC ED Response: c/o pain on insertion, site comfortable after procedure 2.Click “Save”. 3.Chart an assessment of an existing line. 4.Type the letter “T” in line removal to automatically enter the correct time and date. 5.End your existing line. 6.Save the line removal information so that *Ended* is displayed next to each piece of charted information.

C HARTING P RIORITY P ROBLEMS, N URSING S UMMARY, P LAN P RIORITIES, A DDRESSING G OALS AND D ISCHARGE P LANNING Use the “Start Priority” hyperlink to start a new pulmonary problem and enter the following: Click Gas Exchange May be related to - Secretions Expected Outcome – Improve Start Time “T” Document a short term shift goal using the following: Maintain O2 Sats>94% on supplemental O2 1.Click the “Care Plan” tab in HED and enter phase. 2.Enter the following free text in the “Nursing Summary” field: Temp with Tylenol Q4h. 02 Sats 94% with 2L. 3.Enter the following Plan Priority: Continue to wean 02 as ordered, encourage PO intake, encourage ambulation, and draw trough after 1800 dose of Vancomycin. 4.Chart short term goal status was met. 5.Save the “Nursing Summary” and “Plan Priorities”. 6.Hover over the yellow note in the middle column to display text that has been entered. 7.From the magnifying glass, end the priority problem. 8.Click “Show All” to find the “Discharge Plan” section of the tab. Chart the review of d/c plan.

W ORKFLOW OF C HARTING  Review Nursing Summary and Plan Priorities of previous shift from OPC.  Complete physical assessment, charted in HED.  Select 2-3 problems identified on assessment to create Priority Problems with Short Term Goals.  Assess the phase of Plan of Care for appropriateness, found in StarPanel.  Chart Nursing Summary and Plan Priorities, charted in HED.  Chart “Met/Not Met/Improving” after revaluating Short Term Goals, Charted in HED. B EGINNING OF Y OUR S HIFT T ASKS E ND OF Y OUR S HIFT T ASKS

C HARTING N AVIGATION AND P ROCESSES C HARTING P ATIENT E DUCATION INDIVIDUAL ACTIVITY 1.Click the “Education Record” tab in HED. 2.Click “Show All” to find the “Care Contact” section of the chart. 3.Document one care contact. 4.Click “Show All” to find the “Pulmonary Education”. 5.Chart the following information: Pulmonary->pulmonary care education->teachback/verbalize understanding-> patient and care contact #1

C HARTING IN HED A CTIVITY Chart the following sections: Vitals Physical Assessment Plan of Care Education

M EDICATION A DMINISTRATION L EARNING O BJECTIVES 1.Demonstrate the use a barcode scanner and explain the 5 rights. 2.Demonstrate administering a matched medication. 3.Demonstrate the cosigning of a high alert medication.

M EDICATION A DMINISTRATION A DMINISTERING M EDICATION INDIVIDUAL ACTIVITY 1.Locate the “To Do” view in Care Organizer and showing your worklist. 2.Click HED and locate and click the Admin Rx tab. 3.Administer using the barcode scanner  Haldol,  hydralazine  Milk of Magnesia 4.Address warnings if necessary.

M EDICATION A DMINISTRATION M ATCHED M EDICATION 1.Administer scheduled insulin. 2.Administer sliding scale insulin. Blood sugar 255mg/dL. 3.Chart the sliding scale accordingly using hover feature to determine amount of insulin needed to treat this blood sugar. 4.Practice cosigning a partner’s for the High Alert Medication insulin.

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” Coin toss to see which team goes 1 st.

M EDICATION A DMINISTRATION

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” 1.Calling the pharmacy via telephone is the best method of communication about a medication. MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” Clicking “Send Rx a message” is the best method for communicating with the pharmacy. Myth

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” 2.IV manage in Care Organizer is for continuous medication drips and the Admin Rx tab in HED is for scheduled medications. MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” Hit

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” 3.Medications are confirmed in Care Organizer. MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” Hit

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” 4.Warnings from the system will only occur when no medication order is found. MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” Warnings from the system will occur when an incorrect dose is selected, medications is administered too late or too early, or when no medication order is found. Myth

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” 5.Multiple orders can be confirmed for the same patient in Care Organizer. MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” Hit

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” 6.The Five Rights are: The right dose The right medication The right patient The right route The right unit MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” The five Rights are: The right dose, the right medication, the right patient, the right route and the right time. Myth

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” T IE B REAKER 7.To confirm medications you do not have to be in Active View in Care Organizer. MYTH HIT or

M EDICATION A DMINISTRATION K NOWLEDGE C HECK – “H IT ” OR “M YTH ” TIE BREAKER To confirm medications you do have to be in Active View in Care Organizer Myth

M EDICATION A DMINISTRATION G ROUP A CTIVITY With a partner, administer the following medications: Milk of Magnesia Ondansetron (Zofran) Hydralazine Partners can provide patient information as needed. Each partner should have an opportunity to practice!

F INAL K NOWLEDGE C HECK

S URVEY AND A SSESSMENT Rules