1. Epic in Action at Sutter Kim Windsor, RN, MSN ICU Clinical Educator Eden Medical Center

2. 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

3. Solutions Find 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

4. 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

5. Referrals Have 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

6. Progress Note Utilize 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

7. Adding a Note Type donor or CTDN to pull up the smart phrase

8. Smart Phrases We created 4 smart phrases – 2 for our bedside nurses 2 for the CTDN nurses

9. 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)

10. Bedside RN Smart Phrase

12. 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..

13. CTDN Smart Phrase

17. 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

18. Onsite Evaluation

19. Order Set

20. Future Steps Remote 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)

21. Future Steps Have 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!