Know and Go PowerChart Tips Jan 2008
Transcription
Know and Go PowerChart Tips Jan 2008
Know and Go PowerChart Tips Jan 2008 Table of Contents Advanced Directives__________________________________ 5 Finding a previous Advanced Directive_____________________ 5 Citrix Server_________________________________________ 6 Finding your Citrix Server Number ______________________ 6 ACIS/PowerChart Citrix Session TimeOut _________________ 7 Documents___________________________________________ 8 Document Report Dual Page __________________________ 8 ED Triage Form as a Text Document_______________________ 9 Document Search __________________________________ 10 Dual Page View ____________________________________ 11 Opening Multiple Documents _________________________ 12 Resizing and/or moving a document window_______________ 14 Save Work during Inbox Document Modification ______________ 15 Encounters_________________________________________ 16 Selecting a patient previous encounter _________________ 16 Login_______________________________________________ 17 Login and Password for ACIS_ __________________________ 17 Quick and Easy Login_ ________________________________ 18 Log out with Exit and Ready____________________________ 19 Patient Lists ________________________________________ 20 Creating a Location List: _________________________________ 20 Creating a Visit Relationship List: __________________________ 22 Customizing Columns _______________________________ 25 Options for printing a List______________________________ 26 Proxy your Patient List ______________________________ 30 Privacy Status ____________________________________ 32 PowerChart Tabs_ ___________________________________ 33 Discharge Document Tab ____________________________ 33 Navigating the Document/Reports Tab____________________ 34 Results Viewing_____________________________________ 39 Blood Bank Results___________________________________ 39 Customizing the Search Criteria Default _ _______________ 40 Setting your Default Flowsheet View ___________________ 41 What does the MORE Button do_ ________________________ 42 Printing Lab Results with Reference Ranges _____________ 43 Tools_______________________________________________ 44 Clinical Calculators _________________________________ 44 Launching other Applications through PowerChart!_ _________ 45 What is contained within the TABS of PowerChart? ________ 46 Reduce Number of Click to Search Policies_________________ 47 APPENDIX____________________________________________ 49 Cerner Learning Manager: Web Based Training (WBT)_ ______ 50 Hybrid Medical Records________________________________ 52 Documents - PowerChart Document Categories_____________ 53 Categories of Documents Types Standardized Full ______________ 54 PowerChart Document Categories Chart Order______________ 56 PowerChart Document Categories Alphabetical_ ____________ 58 test your powerchart knowledge_ ___________________ 61 PowerChart Quiz #1_ _________________________________ 62 PowerChart Quiz #2_ _________________________________ 63 ACIS PowerChart Crossword (Quiz #3)____________________ 64 Competency Test_____________________________________ 65 PowerChart Quiz #1 Answers___________________________ 69 PowerChart Quiz #2 Answers___________________________ 70 Crossword Answer____________________________________ 71 The symbol at the end of the title signals content for Physicians page 2 page 3 •Advanced Directives Finding a previous Advanced Directive basic Concept of Locating a Previous document ; The search criteria must include the date of service – the date the test was performed or the date the old chart was scanned. A discharged chart is scanned to the date of dc. ; The Ad can be found under the All results Tab or the documents-reports Tab. Locating a Previous Ad in PowerChart scenario – Ad has been copied during a previous admission – unknown date. ; you must check across ALL admissions [a.k.a. encounters] Open the Patient chart and click on the Location to see the visiT LisT double click on the earliest encounter. click yes, then close the window [Ok or exit]. There may be a hesitation in loading the information if the patient has many inpatient admissions. From any Flowsheet Tab, select the ellipse button. [This is a search feature] your view might be better with the grOuP view if there are many Ad entries. note – this search will only return documents within the search criteria dates listed in the green bar [default is 24 hr. PreAdmission to current]. Type in “Adv” and enTer: select either option by double clicking or highlight and click Ok. you will only see Ad related forms – summary and scanned Advanced directives. page 4 page 5 •Citrix Server Finding your Citrix Server Number ACIS/PowerChart Citrix Session TimeOut To maintain the ACis/Cerner Application response Times, the Applications will CLOse after 60 minutes of nO ACTiviTy. it should not log you out while using any Cerner ACis program. Continue to leave the Log-in screen up and ready for the next user – do not cancel out of the login screen, unless you intend to close the program completely. remember, when you exit PowerChart from the Organizer using the “x” in the upper right corner, the screen will be ready for the next user. The Log On box will automatically appear. Login time is as quick as you can type your login username and password. Reminder – close all patient charts before exiting if you select “CAnCeL” when this log on box appears, the PowerChart connection is closed and the next login will take much longer. If you experience any slow responsiveness or if you are kicked out of Cerner ACIS applications while being used, Please notify the IT HelpDesk, 2249. ACis Cerner Applications include: PowerChart [Core Chart] Firstnet [ed] Profile / Provision / mrP [him / medical records] page 6 page 7 •Documents Document Report Dual Page ED Triage Form as a Text Document go to document/reports Tab click on icOn at bottom of window select enable dual Page view select or de-select any other options desired. On the FLOWsheeT view, if you double click on ed nursing record you will see the text document and can print from there. Also available On the dOCumenTs/rePOrTs tab in the documents-reports Tab, i have opened a group of scanned Orders. it has 129 pages. i have enabled duAL PAge vieWer to more quickly page through the group of documents. i have checked all boxes. i can use the small teal arrows below to move through 2 pages at a time. i can zoom the pages if desired, using the magnifying glass + or -. To reverse – i just uncheck the first item “enable dual page view”. The other items can remain checked to make it a quicker selection next time. Printing Tip: you must use the Print icon at the bottom window – be sure to select page(s) and not print ALL! WhAT This meAns TO yOu: • you can now view the form as it looks printed. • you can tell who modified what and when. • you can print the text document without going to form browser! Additional report eFFecTive 5/3/06 page 8 page 9 Dual Page View Document Search page 10 page 11 Opening Multiple Documents Opening Multiple Documents in a Patient’s Chart Opening Multiple Documents at one time in a patient’s chart There is new functionality after the ACIS Upgrade that allows you to open more than one document in a patient’s chart from the Documents/Reports tab. You can either open additional documents one at a time or open multiple documents at once. 1. Open a patient’s chart to the Documents/Reports tab. 2. Navigate to the first document you would like to open and single click to select the document. 3. Navigate to the additional document you would like to open, hold down the Ctrl key on your keyboard and single click to select the document. Continue to select documents in this manner until all the documents you would like to open are selected (highlighted blue). 4. Right click on any one of the selected documents and choose Open Multiple Documents. “Open Additional Document” – Opens the document in a separate window for easier viewing. If you keep selecting this option with other documents, you will have more than 1 document opened at the same time. 1. Open a patient’s chart to the Documents/Reports tab. Reminder: Make sure your search criteria is set to include the documents you are looking for. To change your search criteria, right click on the green bar and select Change Search Criteria. 2. Navigate to the document you would like to open and single click to select/highlight that document in your list. You can expand document folders by single clicking on the plus sign next to the folder. 3. Right click on the selected document and choose Open Additional Document. This will open each selected document in a separate window. Once the documents are open, you can resize or move the windows around for easier viewing. This will open the selected document in a separate window. Once the document is open, you can resize or move the window around for easier viewing. 4. Continue to open additional documents in this manner one at a time until all the desired documents are open. To open more than one document at once, see the next page. IMPORTANT: Once a document is open on the right hand pane of the Documents/Reports tab (if you double click on the document instead of right click), it cannot be opened in a separate window at the same time. You would need to navigate to a different document, and then go back to the document you would like to view, right click and select Open Additional Document. For best results, do not double click on any documents! Page 1 of 3 Page 2 of 3 page 12 page 13 Once a document is open in a separate window, you can move, resize, minimize, maximize or close that window. each of the following steps corresponds to the numbered boxes on the image below. 1. restore maximize Close 2. To move a window, click and hold on the blue title bar at the top of the window then drag to move to the desired location. 3. The document window for scanned documents has 2 panes (transcribed documents only have one), the document viewer (upper pane) and the document information (lower pane). To resize the panes to allow for better viewing of the document, hover your mouse pointer over the line separating the panes, click and hold with the left mouse button, then drag up or down to resize the panes. 4. Save Work during Inbox Document Modification The blue title bar at the top of the document window allows you to do the following actions: minimize Resizing and/or moving a document window To resize a window, hover your mouse curser over any one of the 4 corners of the window. your curser will change to a 2-headed arrow. Once this happens, click and hold with the left mouse button then drag to resize the window. 1. To minimize, maximize or close the window, use the corresponding buttons on the blue title bar. 2. To move the window, click and hold on the blue title bar with the left mouse button, then drag the window to the desired location. 3. To resize the document pane: hover your mouse pointer over the line between the two panes of the window. Then click and hold with the left mouse button and drag to resize the pane. 4. To resize the window: hover your mouse pointer over the corner of the window. Then click and hold with the left mouse button and drag to resize the window. Page 1 of 1 page 14 page 15 •Encounters Selecting a patient previous encounter 1. click on the LOCation in the banner bar 2. double click on the encounter you want to open. click 3. yes and 4. Ok to close the windows. •Login Login and Password for ACIS For first time log in, first login after a password reset and expired password notification. First Time Password – 1. might be reset to the same as your user name [ex. “greenejs”] 2. –or as instructed, ex. Password1 how selecting a past encounter affects what is seen in the tabs default search Criteria = All documents from selected encounter [only shows documents from the encounter you select] document/reports Tab discharge documents default search Criteria = 24 hour Prior to Admission to Current – will show all documents from the past encounter admission to today’s date [includes all encounters in between the admission date of the selected encounter to present date] Quick view Lab rad All results page 16 yOu create your password – At least 2 numbers and 4 letters. [ex. 12remember] The password you just used to login. retype the password you just created to validate – make sure you didn’t have a typing error. when prompted to change your password, you must change the password to something that you have not previously used. you are no longer able to reuse passwords in Powerchart. if you need to change your password for security reasons at a time between scheduled changes (every 180 days) – go to Task menu > Change Password. page 17 Quick and Easy Login Log out with Exit and Ready FACT: initial login into Powerchart may take up to 20 – 30 seconds as it establishes a ciTrix connection to denver, cO [national Offices]. FACT: you do not have to wait that long every time! when you exit Powerchart, the login screen pops back up, making it reAdy FOr The nexT user. Please dO nOT CAnCeL and close Powerchart completely. Logging in at this point is immediATe upon typing in your name and password. if you want it to be out of your way…place cursor on the screen, hold the left mouse button and drag the screen off to the corner of your desktop display. sTOP WAiTing and Access Patient information immediATeLy! LimiTATiOn: The citrix session expires after 60 minutes of inACTiviTy. This means, if this sits untouched for 60 minutes – it closes. page 18 unit secretaries – yOu CAn heLP Take a few minutes before high volume times to make sure all of your nursing station and Physician Area Computers are powered on, open the desktop ACis iCOn and then the PowerChart iCOn so it will be up and running and ready for access. exit Functionality set to decrease Login Times when you exit PowerChart from the Organizer using the “x” in the upper right corner, the screen will be ready for the next user. The Login screen will automatically appear. Login time is as quick as you can type your login username and password. All shared, general use workstations [ex. those in the nurses station] will be set to exit in this manner when exiting using the upper left “X” in the Organizer. Reminder – close all patient charts before exiting if you select “cAnceL” when this log on box appears, the Powerchart connection [citrix] is closed and login will take longer. The citrix connection will time out after 60 minutes or inactivity [no user activity] and close the PowerChart connection. Only for private, single user computers: you need to change the default setting if you do not want the Powerchart Login screen to appear each time you exit. Please go to TAsk menu > select exiT and this dialog box will appear. chose your default setting and select yes. exit and shut down the application – closes it out completely check “save as the default choice” check “don’t ask me this again” OTher OPTiOn meAnings: Exit application, with screen ready for next user = the way all shared, general use computers will exit. Have a new user take over application in its current state = same as change user – will be useful in Phase ii with co-signing functions. page 19 •Patient Lists Location – Follow Steps in Screenshot Below Creating a Location List: Select List Maintenance from Patient List menu or Use ICON Select NEW Select Location type of list Refresh the organizer to see New Location List Call Paula @ 4776 or Eula @1863 with issues with Artromick Cart Please give us objective feedback on carts, things that would help you etc. as we do this evalution. Clean these carts with the Antimicrobial wipes frequently!! page 20 page 21 Creating a Visit Relationship List: select List maintenance from Patient List menu or select visit relationship type of list use icOn select neW visit relationship – based on yOur Powerchart position/relationship select yOur relationship change the Title of the List, if desired click Finish make the list ACTive Patient charts you have viewed will post to the list refresh the organizer to see patients of newly opened charts select yOur relationship – your position in POWerChArT Check yOur relationship you can change the name to whatever you like. page 22 page 23 Customizing Columns select nexT – Filters if you do not want to see discharged patients, select nOT disChArged. select nexT - PrOxy you can set PrOxy if desired – see other tip sheet for instructions Otherwise, select Finish. you will need to move it from Available Lists to Active List to view in the Organizer. Active: List that you see in the organizer. Available: “Waiting in the Wings” - List that are made, but not viewed in the organizer. You can change the order – highlight and use the arrows to the right to move up or down in the order. From the PowerChart Organizer – select the patient list you want to customize. go to Patient List in Task bar and select Customize Columns. Columns Available: *Admitted Admitting Physician *Age *Attending Physician consulting Physician *dOb *discharged expiration date *Fin Leave status^ Length of stay *Location *mrn medical service *name *new results note^ Primary care Physician Priority^ Privacy status [Opt Out] sec^ *sex Temp Location^ viP code visit reason visitor status^ 4. sAve when completed – and close out using 3. sort use this arrow to move the selected column to the position you desire *default 1. Available Columns highlight the column you want to add from the Available column box on the left 2. existing Columns use the teal arrow to move it to the existing columns box on the right ^ disclaimer: not all column data may be sent at this time. A visit relationship List has a few more options. page 24 if you want to delete a column – highlight the selected column name and click here The new column should appear once you close the customize columns window. use the “As Of” button to refresh data is needed. page 25 Options for printing a List start the explorer menu from the Powerchart Organizer by clicking on the icOn Patient List Click on “Patient List” to show options in the box to the right. Select the list you want to print from the drop-down box. Select your Sort Priority Click Execute double-click to Open “main menu” Types of Lists are Available: click the “+” to Open the Powerchart Audits menu [or double-click] Select the list you want to print from the drop-down menu Patient List This provides a different print layout of yOur Patient Lists [Only lists yOu have created under your login] if you print the Patient List from the Powerchart Organizer – it prints exactly like it appears on the screen. if you select one of your patient lists from the explorer menu, it will be formatted on two rows with space in between each patient name row. The Patient List report Contains: Patient name, Privacy status, Location, Age/sex, dOb, mrn, Fin, Admit, dc, Attending md and Patient Type. station Census The station census provides a printed list based on a patient care location. The list can be printed non-spaced [single spaced] or spaced [a few rows in-between each patient name, separated by a line] The station Census report Contains: room-bed, Patient Type, Account, Privacy status, Patient name, service, Age, sex, and Attending Privacy status is abbreviated – only “do no” is seen for “do not Publish” = no information Patient You have the option to sort by Name or by Location. Then click EXECUTE. It will not take long for your list to appear in a new window. 2 page 26 page 27 Station Census Select MBO – LEX, only choice Select Facility Select Unit [you can select more than 1, and they will page break between units] This report takes longer to execute than the Patient List – may take 20-30 seconds – or more if multiple units have been selected. Select MBO – only 1 choice - LEX Check Facility Once you have opened the report, it will be listed in this “recent Programs” folder Check Unit Choose Spacing The report appears in a new window. Use the print ICON to start printing. NOTE: The Thebefore report appears in a new window. Use thechoice printof ICON to start printing. asterix the patient name signifies an OPT OUT privacy – do not give out any information on location or condition – treat as if this person is not on the list. 4 page 28 page 29 Proxy your Patient List Proxy Your Patient List Proxy Your Patient List Select the list you want to proxy to another provider: Select a stop date and time if desired. This will automatically remove the Patient List from the Proxy. Click APPLY. The Proxy name must be in the left box. Select PROPERTIES from Patient List Menu or ICON : The Provider must activate the Patient List through list maintenance to see the tab in their Patient List. IT will stay in the Available lists column until needed or until it expires. Select PROXY Tab. Select NEW. Select PROVIDER. Enter a provider name – it will auto-search for matches. For multiple matches – click the address book ICON Select LIST MAINTENANCE. Move the list from AVAILABLE LISTS to ACTIVE LIST using the arrow. Click OK. Select ACCESS – Important! READ is best. Full Access would allow the proxy to DELETE your list! page 30 page 31 •PowerChart Tabs Sept. 7 2006 •Privacy Status Discharge Document Tab th Clicking into Safety PowerChart can now be the Privacy Source of Truth In STAR, when patients are registered, they are asked if they want to Opt Out of the Census. It is entered in STAR if they say YES, I want to Opt Out or NO, I don’t want to Opt Out. If they choose to OPT OUT – this means they want they stay to be private and NO INFORMATION should be given out… even their presence in the hospital should not be revealed. If you receive and inquiry, you should say “They do not appear on our hospital census.” You should not have the computer screen where others can see it. A new Powerchart Tab for Physicians, nurses and him staff. PurPOse: To assist with discharge summaries and for quick past visit in the same layout as documents/reports Tab Filter shows All documents from the selected encounter includes limited categories defaults to show documents “by encounter” hover above categories to see details of document name In the STAR station census, it is designated by an * before their name. In PowerChart, it is designated by “Do Not Publish” if they chose to OPT OUT – or- “na” if it is Not Applicable and they chose No, they are OK with the standard level of HIPAA privacy. You will see this in a NEW Column in the Patient List – “Privacy Status”. It also appears on the Visit History Tab [Under the Patient Information Tab] and the Face Sheet. hover shows document name If you have used the “Customize Column” feature to add/delete columns, you will need to add this column manually since your personal settings have priority over global settings. review. Content Categories: Face sheet h&P consult Orders Progress note Operative report Procedure record heart cath report cardiac Procedure ekg echo stress dc Plan PFT cardiac Other doubleclick to see document Positions with the new Tab: move page to page Arrows expand folder and select next document page 32 settings – look here to set dual Page view seen in this example dbA mbO core Analyst Pathnet: Pathologist Physician e-signature Physician no e-signature Physician Assistant esignature Physician Assistant no e- sig nurse Practitioner e-sig nurse Practitioner no e-sig nurse rn Physician office staff Provider co-signature him:Analyst him:coders him:emPi him:managers page 33 Navigating the Document/Reports Tab navigating the documents and reports Tab categories to their maximum, showing the document in the window. if you hover your mouse pointer over the form category name – you see the entire entry – showing the “name of the document” Current search Criteria is set to All documents from selected encounter. To change search criteria - right mouse click on the green search range bar. you may prefer “by encounter” to see 1 list of ALL document types. you can use the green arrows at the lower left to easily expand the 2 page 34 page 35 navigating the documents and reports Tab navigating the documents and reports Tab To access the Progress notes/Orders, click the documents and reports category and expand to see all categories within. select / go to Physician Orders. [you can double click on a category or form to expand or you can use the green arrows] ideally, ALL orders / progress notes are under one heading of “Orders”. some orders are scanned in separate if the paper chart is not complete when sent to medical records. making the view larger: move window border – hover over border until -||- appears, hold down mouse button and drag. you can expand your view somewhat by going to view and deselecting (clicking each one) demographic bar, Toolbar and status bar to help minimize your up and down scrolling to view the entire document. use the small green arrows in the lower portion of the document window to move through the pages from admission to discharge. 3 page 36 4 page 37 •Results Viewing Blood Bank Results navigating the documents and reports Tab holding your place while you double check a result if you come across a Progress note that makes you want to check a Lab result or an OP note, use the tabs of the chart to navigate to those documents (like the All results tab) and you will not lose your place in the Progress notes when you navigate back to the documents/reports tab. blood bank results in PowerChart new result navigator Panes may be seen in PowerChart: [category types are only seen if your patient has results posted to the chart for the category] 1. 2. 3. 4. 5. 6. 7. 8. blood group and Type Antibody screens hemolytic investigation Antigen information Crossmatch results Therapeutic Phlebotomy rh immune globulin investigation Transfusion reaction results example: Crossmatch results - for each blood product prepared for transfusion, up to 6 fields will be sent to Powerchart 1. Product id – Type of product [ex. Platelets, cryoprecipitate, red blood cells, etc.] 2. unit number – assigned by the collecting / processing facility 3. Crossmatch result – if applicable 4. status info – ready, issued, Transfused, canceled 5. Product Code – corresponds to the product barcode on the blood product label 6. unit Type – the blood type of the product [ex. O Pos, A Pos, etc. each “set” of result codes will be prefaced by a numerical identifier, e.g. 01, 02, 03, etc. where the 01 is the first unit, 02 the second unit, etc. status info messages for crossmatched products will be sent to Powerchart immediately at the completion of the crossmatch. status messages for FFP, Platelets, and cryoprecipitate will not be sent until the product is ready to release, i.e. thawed, pooled, etc. 1. you may want to change the view on this screen and can easily do that by selecting the grOuP radio button to group items by date and make your scrolling up and down only. This view is a nice way to see Trending. each product is designated by 01, 02, etc. example: All information for the first unit is designated by “01” 2. you can use the navigator bars to quickly pull the category to the top of the window – click once on the navigator bar category [example coagulation]. 3. you may want to change the seArCh CriTeriA to view more results [right click green bar – select a date range or admission to current] 4. you can then view labs or other transcribed reports, radiology results, etc… and still return to the documents/reports tab and not lose your place. The crossmatch specimen expires in 3 days. until expired as shown here, it will show a date in this format: yyyymmddhhmm [year, month, day, hour, minute] status: ready, issued, Transfused, cancelled 5 page 38 page 39 Customizing the Search Criteria Default Setting your Default Flowsheet View Setting your favorite Flowsheet View as the Default View This will set your personal default properties for the Flowsheet you have selected [ex. Quick view, Lab, rad, All results]. As a default setting, you will see your search criteria every time you open a chart. each Flowsheet Tab default is set individually. Open a patient chart. select the Flowsheet Tab on which to set defaults. go to OPTiOns in menu and select PrOePrTies. setting your Favorite Flowsheet vieW as the default view example: you want to always see your Powerchart Quick view flowsheet in grOuP view 1. Open a patient chart Quick view flowsheet and set it to grOuP view select defaults Tab choose your defaults and select sAve*. “yes” to are you sure? And Ok to exit the window. This sets criteria for the arrows on each end of the search criteria bar – how many days it skips forwards and backwards. days for “clinical/Posting range” Or results for “result count” your default view will be set. you must close the chart and reopen to see your changes. *if you are setting your flowsheet view to Table, group or List, select the desired view, and go to the default tab and select sAve. There is not an item on the defaults tab window to select. similar settings for other tabs can be found: documents/reports Tab: go to “document” > “Options” > select “index defaults” Forms browser Tab: go to “Options” > “Properties” page 40 2. go to OPTiOns in the menu bar – select PrOPerTies a. select the deFAuLTs tab b. click sAve c. click yes This is set per flowsheet. page 41 What does the MORE Button do Printing Lab Results with Reference Ranges A cap to the number of results that are returned in Powerchart has been set to help maintain system performance. This is set to 1000 results per cerner’s recommendation. Only the first 1000 will be returned regardless of what the search criteria is set to. if you want to see all of the results, you have to click on the mOre button. clicking the mOre button will return all results for that patient (nOTe: you could experience a slight delay if a patient has a lot of results). you will encounter this using the Flowsheet Tabs [Quick view, Lab results, and All results, which contain large amounts of information]. For these tabs, the default search range is set to 24 hours Preadmit to current date. if you select a previous encounter this search range might span several month to years of encounters. it is easier to click mOre than to alter the search criteria. If you see the MORE button active [bold, not grayed out]; click it before looking through the chart. grayed out = all results are showing bold = results are capped to show only 1000 – click to see ALL resuLTs page 42 page 43 •Tools Clinical Calculators Select the ICON to launch the Clinical Calculator functions. Select the desired calculation from the drop down menu. Enter the data and the result will automatically calculate. There is a basic calculator that can be accessed in the lower left of the window if desired. Below are the available calculations: Calculation Formula Body mass Index English Body mass Index Metric BSA Cardiac Index Cardiac Output [(weight)/(height*height)]*703 [(weight)/(height*height)]*1000 sqr [(ht x wt)/3600] Mostellar formula CO/BSA HR x SV (stroke volume) ml per hr (mcg desired x wt x 60)/(concentration of drip) Celsius to Fahrenheit Centimeters to inches 32 + [(9/5) x c] Cm/2.54 Diastolic BP – PWP (Pulmonary Wedge Pressure) (0.48 x ht x BSA)/(S.Cr. x 1.73) (140 – age) x wt / (72 – S.Cr.) Crockcoft-Gault formula (140 – age) x wt / (72 – S.Cr.) x 0.85 [Crockcoft-Gault] (F-32) x (5/9) (ht^2) x 1.65/1000 Coronary Perfusion Pressure Estimated Creatinine Clearance < 17 yo Estimated Creatinine Clearance Men Estimated Creatinine Clearance Women Fahrenheit to Celsius Ideal Body Weight (IBW) < 60” Child Ideal Body Weight (IBW) > 60” Female Child Ideal Body Weight (IBW) > 60” Male Child Ideal Body Weight (IBW) Male Ideal Body Weight (IBW) Female Inches to Centimeters IVF rate Kg to Lb Lean Body Weight (LBW) Male in Acis/Powerchart, click on the WhiTe iCOn in the toolbar – you can select Lex intranet or Chi micromedex. From the intranet – you can connect to UpToDate and search for the latest ebP information on diagnosis, Treatments and drugs! 42.2 +2.27 x (ht – 60) 39 + 2.27 x (ht – 60) 50 + 2.3 x (ht – 60) Devine 1974 45.5 + 2.3 x (ht – 60) Devine 1974 Inch x 2.54 (ml x drop factor) / time Kg x 2.2 1.10 x wt – [128 x{(wt^2 / (100 x ht)^2}] Lean Body Weight (LBW) Female 1.07 x wt – [148 x{(wt^2 / (100 x ht)^2}] mcg / kg / min mcg / min Lb to Kg Pulmonary Vascular Resistance Stroke Volume System Vascular Resistance Total Pulmonary Resistance Total Systemic Resistance (ml x concentration of drip) / (60 x wt) (ml x concentration of drip) / 60 Lbs / 2.2 [9mean PAP – PWP) / 60] x 80 CO / HR [(MAP – mean RAP) / CO] x 80 mean PAP / CO MAP / CO page 44 Launching other Applications through PowerChart! All clinicians have access to this new resource from any sJhc/chi computer. For more information on upTodate – click on the FAQ link in the “what’s new” section on the sJhc intranet. page 45 Quick View TAB Only Lab Results Lab TAB Only Rad Results Rad TAB Everything under Documents/ Reports Tab Lab and Radiology Results All Results Transcribed Documents – ex. H&P, Consults, Op records, Procedure Records, DC summary etc. Transcribed Radiology Reports Documents/ Reports Orders Progress Notes H&P Consults Facesheet Discharge Documents Will contain Clinical Documentation directly in to PowerChart/ FirstNet ED Triage Forms Browser TAB Visit List – current and prior visit dates [Double-Click to go to another encounter] Patient Demographics Patient Information TAB – contains other tabs: FaceSheet FaceSheet We are NOT using this funcation at this time PowerOrders PPR Summary [List of providers associated with the chart] All Scanned Documents – posted to DC date, including OR documentation from the HSM system Intellistrip [quick view of activity more later] Operative Report Procedure Report Visit History locations the patient has been during an encounter All ED Records, including Patient ED Discharge Education ED Triage Heart Cath Report Cardiac Procedure EKG Echo Stress Cardiac Other DC Plan PFT What is contained within the TABS of PowerChart? Lab and Radiology Results Discharge Summary H and P Consults Operative Record Procedure Record ED Physician Record page 46 Reduce Number of Click to Search Policies page 47 •APPENDIX page 48 page 49 Cerner Learning Manager: Web Based Training (WBT) The Cerner Learning Manager home replaces Mymeded. Several Cerner WBTs are available to CHI employees. You may complete as many as you would like but Cerner does not keep a record or provide documentation of completion. 3. Click My Learning in the upper left corner. All Cerner WBTs available to CHI display on your My Learning Plan tab. You may also see the status of your progress for each WBT ( Enrolled, In progress, Completed). Steps to Access Cerner WBTs: 1. Click here to log into Cerner Learning Manager. The Welcome to Cerner Learning Manager login window displays. My Learning Plan tab displays all available WBTs. 2. Register in Cerner Learning Manager. Even if you have a Cerner.com account, you must create a new account to access the WBTs that can be accessed by CHI. a. Click the phrase Click Here to Register. The Self Registration window displays. b. In the Registration Key field, type CHI011808. You must enter this key to access the CHI WBTs. c. Complete all required fields (*). If you already have a Cerner.com account, you must choose a different username. d. Click Submit. e. Click Login. The Welcome to Cerner Learning Manager! window displays. Note: You will use your username and password when you log into Cerner Learning Manager in the future. page 50 4. To begin or resume a WBT, locate the WBT name. 5. Scroll to the right and click Begin or Resume on the line with the appropriate WBT name. A window displays with the name of the WBT or the components WBT. 6. Click the name of the WBT or a component to launch it. If you need assistance or have problems with your account, please contact: Kristi Blazek Catholic Health Initiatives ∞ ITS-Denver ACIS Cerner Training Coordinator [email protected] (720)874-1195 – office page 51 Hybrid Medical Records Documents - PowerChart Document Categories CATEGORIES We are living in a hybrid world – How do paper and electronic mix? Electronic During admission – does not contain progress notes, orders, MARs, nursing notes, ancillary evaluations and progress notes. Dictated reports – viewable immediately upon transcription Dictated reports – viewable immediately upon completion of dictation when physicians use PowerScribe and self-edit. Lab results – viewable immediately upon completion Paper During admission may contain most all records – but may not, it depends on printing and associate management of the chart. Dictated reports - print out upon completion of transcription, but must be physically retrieved by an associate, chart located and placed [ranges from a few minutes to never making it to the chart] Lab results - print out upon completion, but must be physically retrieved by an associate, chart located and placed [ranges from a few minutes to never making it to the chart]. Final lab summary not in the paper chart. DOCUMENT TYPES DISCHARGE-FACE SHEET ADVANCED DIRECTIVE Face Sheet Discharge Summary Coding Summary Cancer Staging Forms Problem List Advanced Directive-Living Will HISTORY and PHYSICAL-CONSULTATION H and P Prenatal Record Consults EMERGENCY PHYSICIAN ORDERS ED Record ED Physician Record ED Nursing Record Orders Restraints PROGRESS NOTES OPERATIVE PROCEDURE REPORTS Progress Note Photos Operative Report Procedure Record Anesthesia Operative Documentation LABORATORY REPORTS Blood Administration Laboratory Document Pathology Referral Lab PKU DIAGNOSTIC IMAGING Radiology Nuclear Med Vascular Diagnostics CT Artery CARDIAC Cardiac Procedure EKG Echo-Stress Cardiac Other MONITORING STRIPS Monitoring Forms TECH SERVICES Tech Service Reports GRAPHICS Graphic Viewable from any computer – unit, hospital, office, home. Viewable only in the nursing unit MEDICATION RECORDS MAR MAR-Diabetic MAR-Anti-Coagulant MAR-Other Viewable by many clinicians at the same time Viewable by 1 clinician at a time Record complete with paper records scanned 24-48 hours post DC Record never complete NURSES NOTES Assessment Flowsheets Nursing Notes Plan of Care Pathways Care Record Updates continue post DC [physician signatures, etc] Is never updated post DC PSYCH ASSESSMENT TX PLAN DISCHARGE PLANNING PATIENT EDUCATION PSYCH Assessment PSYCH Treatment Plan PSYCH Therapist Notes Transfer Form Discharge Plan Instructions Patient Education Forms During admission - Legal Medical Record [hybrid during admission] During admission - Legal Medical Record [hybrid during admission] Post DC – Legal Medical Record Post DC, NOT the legal record – interfaced documents removed and destroyed, other documents moved off site immediately CLINICAL ANCILLARY CONSENTS OTHER-MISCELLANEOUS CARE CENTER Respiratory Pulmonary Function Test PT-OT-Speech Nutrition Other Ancillary Consent Forms Special Consents Legal Documents Patient Rights Miscellaneous ROI Other Facility Care Center Records page 52 page 53 page 54 N N Y N N N Transfer Form Discharge Plan Instructions Patient Education Forms Respiratory Pulmonary Function Test PT-OT-Speech Nutrition Other Ancillary DISCHARGE PLANNING PATIENT EDUCATION CLINICAL ANCILLARY N Other Facility N N ROI Care Center Records N Miscellaneous CARE CENTER N N Legal Documents Patient Rights OTHER-MISCELLANEOUS N Y Consent Forms Special Consents CONSENTS Y Y N Y Y Y PSYCH Assessment PSYCH Treatment Plan PSYCH Therapist Notes PSYCH ASSESSMENT TX PLAN N N N N MAR MAR-Diabetic MAR-Anti-Coagulant MAR-Other N N N N N N Y N N N Cardiac Other Monitoring Forms Tech Service Reports Graphic Assessment Flowsheets Nursing Notes Plan of Care Pathways Care Record Y Y Y Y N N Y Y Y Y Y Y Y Y Y N Y Y Y N N N Y N Y Y Y Y Y Y Y Y Face Sheet Discharge Summary Coding Summary Cancer Staging Forms Problem List Advanced Directive-Living Will H and P Prenatal Record Consults ED Record ED Physician Record ED Nursing Record Orders Restraints Progress Note Photos Operative Report Procedure Record Anesthesia Operative Documentation Blood Administration Laboratory Document Pathology Referral Lab PKU Radiology Nuclear Med Vascular Diagnostics CT Artery Cardiac Procedure EKG Echo-Stress DOCUMENT TYPES DEFICIENCY ANALYSIS NURSES NOTES MONITORING STRIPS TECH SERVICES GRAPHICS MEDICATION RECORDS CARDIAC DIAGNOSTIC IMAGING LABORATORY REPORTS OPERATIVE - PROCEDURE REPORTS PROGRESS NOTES PHYSICIAN ORDERS EMERGENCY ADVANCED DIRECTIVE HISTORY and PHYSICAL-CONSULTATION DISCHARGE-FACE SHEET CATEGORIES Signature Required N N N N N N N Y N N Y N N Y Y Y Y Y N N N Y N N N Y Y Y N Y Y Y Y Y Y Y Y Y N Y Y Y N N N Y N Y Y Y Y Y Co-signature Required N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N Allow multiple anticipated documents Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N Match anticipated documents with physician HIM EVENT EXTENSION TOOL QUESTIONS Document Delinquent and suspension times will be dithered since we are using visit aging only. Categories of Documents Types Standardized Full page 55 page 56 Ch EMERGENCY DOCUMENTATION DEPART SUMMARY [1st Level] ANATOMIC PATHOLOGY PATHOLOGY REPORTS [1st Level] LABORATORY DOCUMENTS LABORATORY REPORTS [1st Level] NUCLEAR MED SP SCANNED DIAG IMAGES XRAY CT SURGERY DOCUMENTS PHOTO SENSITIVE CARE CENTER OTHER-MISCELLANEOUS CONSENTS CLINICAL ANCILLARY TREATMENT RECORDS PATIENT EDUCATION DISCHARGE PLANNING PSYCH ASSESSMENT TX PLAN NURSES NOTES MEDICATION RECORDS GRAPHICS TECH SERVICES MONITORING STRIPS CARDIAC OPERATIVE PROCEDURE REPORTS PROGRESS NOTES PHYSICIAN ORDERS EMERGENCY DIAGNOSTIC IMAGING [1st Level] In r tO ar de r HISTORY and PHYSICAL-CONSULTATION ADVANCED DIRECTIVE CATEGORIES – [Navigator Bar and in Doc/ Reports - 2nd level of “by TYPE”] DOCUMENT AND REPORTS [1st Level] DISCHARGE-FACE SHEET Depart Summary Blood Administration [Blood Txn Report] Laboratory Document [POC, Outside Labs, Blood Txn – moved to above May 2007] Pathology Referral Lab – Results from PKU CT [Test Name] XRAY [Test Name] Radiology Vascular Diagnostics Special Procedures [Test Name] NM [Test Name] PSYCH Assessment PSYCH Treatment Plan PSYCH Therapist Notes Recurring Psych Transfer Form Discharge Plan [DC Medications. CareNotes Summary] Instructions Patient Education Forms Patient Questionnaire Treatment Records Respiratory Pulmonary Function Test PT-OT-Speech [Evals and Progress Notes] Nutrition Other Ancillary Consent Forms Special Consents Legal Documents Patient Rights Miscellaneous [License, Insurance Card] Other Facility [Summary from LC system] ROI [Release of Info] Care Center Records Photo Sensitive Surgery Documents Face Sheet Discharge Summary Coding Summary Cancer Staging Forms Problem List Advanced Directive-Living Will [Summary and Actual AD] H and P Prenatal Record Consults Psych Eval ED Record ED Physician Record ED Nursing Record [Triage] Orders [Orders/Progress Notes – all pages together] *NOTE – Med Reconciliation and Pneumo/Flu Vaccin will be the last 2 pages. Restraints Progress Note [Only Progress Notes, not Orders/Progress Note Combo] Photos Operative Report [OP Report, Sedation and Analgesia Procedure Flowsheet] Procedure Record Anesthesia Operative Documentation [McKesson HSM Printout, PeriOP Flowsheet] Cardiac Procedure EKG Echo-Stress Cardiac Other [Rhythm Strips] Monitoring Forms Tech Service Reports Graphic [VS, Glucose, Nutritional Assessment] MAR [All in order Admit to DC] MAR-Diabetic MAR-Anti-Coagulant MAR-Other Assessment Flowsheets [Scanned Daily Flow sheets – 1 day per entry] Nursing Notes [all other nursing forms, like ADMISSION HISTORY, restraint documentation, care plans, wound photos, etc.] Plan of Care Pathways Care Records [shows in Doc/Reports 3rd level “by Type” and only level in other views] DOCUMENT TYPES – PowerChart Document Categories Chart Order electronic and scanned documents are placed under category headings. These are shown in the Navigator bars in the flow sheets [ex. Quick View] and in a folder “tree” format under the Documents/Reports Tab – “Tree” branches=levels 1, 2 and 3. page 57 CATEGORIES – page 58 MONITORING STRIPS MEDICATION RECORDS GRAPHICS HISTORY and PHYSICAL-CONSULTATION EMERGENCY DISCHARGE PLANNING DISCHARGE-FACE SHEET CONSENTS CARE CENTER CLINICAL ANCILLARY PATHOLOGY REPORTS [1st Level] ANATOMIC PATHOLOGY DEPART SUMMARY [1st Level] EMERGENCY DOCUMENTATION SP XRAY NUCLEAR MED LABORATORY REPORTS [1st Level] LABORATORY DOCUMENTS PROGRESS NOTES TECH SERVICES DIAGNOSTIC IMAGING [1st Level] CT SCANNED DIAG IMAGES NURSES NOTES OPERATIVE PROCEDURE REPORTS OTHER-MISCELLANEOUS PATIENT EDUCATION PSYCH ASSESSMENT TX PLAN PHYSICIAN ORDERS ha r Alp rde n O I DOCUMENT AND REPORTS [1st Level] ADVANCED DIRECTIVE CARDIAC l ca i t be [Shown in Navigator Bar and in Doc/ Reports - 2nd level of “by TYPE”] Depart Summary Blood Administration Laboratory Document Pathology Referral Lab – Results from CT [Test Name] Radiology Vascular Diagnostics Special Procedures [Test Name] XRAY [Test Name] NM [Test Name] PSYCH Assessment PSYCH Treatment Plan PSYCH Therapist Notes Orders [Orders/Progress Notes – all pages together] *NOTE – Med Reconciliation and Pneumo/Flu Vaccin will be the last 2 items. Restraints Progress Note [Only Progress Notes, not Orders/Progress Note Combo] Photos Tech Service Reports Legal Documents Patient Rights Miscellaneous Other Facility Patient Education Forms Operative Report Procedure Record Anesthesia Operative Documentation [McKesson HSM Printout] Assessment Flowsheets [Scanned Daily Flow sheets – 1 day per entry] Nursing Notes [all other nursing forms, like ADMISSION HISTORY, restraint documentation, care plans, etc.] Plan of Care Pathways Advanced Directive-Living Will Cardiac Procedure EKG Echo-Stress Cardiac Other Care Center Records Respiratory Pulmonary Function Test PT-OT-Speech Nutrition Other Ancillary Consent Forms Special Consents Face Sheet Discharge Summary Coding Summary Cancer Staging Forms Problem List Transfer Form Discharge Plan [DC Medications] Instructions ED Record ED Physician Record ED Nursing Record [Triage] Graphic H and P Prenatal Record Consults MAR MAR-Diabetic MAR-Anti-Coagulant MAR-Other Monitoring Forms [shows in Doc/Reports 3rd level “by Type” and only level in other views] DOCUMENT TYPES – PowerChart Document Categories Alphabetical electronic and scanned documents are placed under category headings. These are shown in the Navigator bars in the flow sheets [ex. Quick View] and in a folder “tree” format under the Documents/Reports Tab – “Tree” branches- levels 1, 2 and 3. page 59 •test your powerchart knowledge page 60 page 61 PowerChart Quiz #1 Answers may be found on page 64! True/False: 1. True or False: The following picture depicts the desktop icon i need to click on to access Power chart. PowerChart Quiz #2 Answers may be found on page 65! using the picture below, answer the following question: Print Icon #1 Print Icon #3 2. True or False. i have successfully logged on to Power chart at least once in the last week, and have been able to access a patient chart. i am using my own user id and password to get into Power chart. Mystery Area Fill in the blanks: 3. List at least 2 super users in your department: __________________________________________ __________________________________________ 4. List two (2) ways you can locate a patient, to gain access to a patient’s electronic chart in Power chart. What does the X indicate? Question #4 ___________________________________________ ___________________________________________ Print Icon #2 referring to the picture of the “tabs” available in Power Chart, answer the following questions: 5. under which “tab” will you find the scanned paper charts (old charts)? _______________________________________ 6. under which “tab” will you find a patient’s encounters? ________________________________________ referring to the picture of the “icons” available in Power Chart, answer the following question: 7. scenario: i’ve been logged into Power chart for 20 minutes. i’m looking for a radiology result that i know was “resulted” within the last 10 minutes, but i can’t find the result in Power chart. i should click on which icon to “refresh” my view in Power chart and obtain the most recent results since i logged in. ___________________________________________ 1. To print a copy of this scanned document, which print icon should be used (Print icon #1, #2, or #3)? Print icon #_____ 2. what is the “official” name of the mystery area?? _____________________ 3. what action do i take to change the range described in this mystery area? ___________________________________________________________ 4. what does the “x” in the red square indicate? This document is ______________. what is one reason for this document being assigned this indicator? ____________________________________________________________ 5. what “domain” was accessed in the picture above? buiLd, PrOd or TrAin?? ___________ 6. how do you know this? ________________________________________________________ page 62 page 63 ACIS PowerChart Crossword (Quiz #3) Name: _________________________ Competency Test Department: _______________ Directions: Please complete this crossword puzzle and return to the designated Super User in your department. This person is _________________________________. Answers may be found on last page! 1. The AS OF Icon on the toolbar is used for: a. A. Searching for a patient b. Refreshing the screen and showing changes in the chart c. Reviewing old records d. Exiting the system Crossword Puzzle: 1. When logging out of PowerChart, you can: a. Use the Exit Icon b. Use the Change User Icon c. Use the “X” in the upper right hand corner d. 2. The All Results tab is: a. b. c. d. 3. ACROSS 1. ___ Bar - contains basic demographic information. 3. Each nursing unit has a default ___ patient list. 6. Marks new results as “viewed.” 7. Function used to create “drawing” of discreet results. 9. Critical results display in ___. 10. ___ List - patients in a physician group. 11. New results display in ___. 14. ___ Bar - shows every result category. 15. System prompts you to change this every 180 days. 16. ___ List - can include any patient, and is built by the user. DOWN 2. “Refresh” information. 4. Initial screen obtained when logging into Power Chart. 5. Name of “live” domain. 8. ___ Summary - names of anyone who has accessed a patient’s chart. 12. Relationship not being used. 13. Patient information organized in ___. page 64 or use All of the Above Best overall view Contains every result Lab, Radiology, Documents/Reports All of the above The Orders Tab is non-functional in this phase: a. True b. False 6. It is ok to look up any patient records, including your own, a family member or friend: a. True b. False 8. By right clicking on the Green Search Bar, you can change the search criteria: a. True b. False page 65 9. It is not recommended to print results or old charts? 12. If a document is multiple pages, to view the other pages, you can: a. True b. False 10. a. use the scroll bar b. Use the arrows c. Enter the page # d. a & c e. b & c You will need to double-click on a Lab Result to display the normal ranges and view any comments that may be present: a. True b. False 13. To print this document, which printer icon will you use: A. TOP B. MIDDLE C. BOTTOM 11. A Final Report is: 1. A Discharge Summary 2. A transcribed document that has been electronically signed by a physician 3. The final results of a lab test 14. Under the Patient Information Tab, which tab will show you the movement of a patient from unit to unit (per Bed Control) for the current visit or most recent visit? a. Patient Demographics b. Visit List page 66 c. PPR Summary d. Visit History page 67 page 68 page 69 Answers: Form Browser Tab is used to find: Patient meds Emergency Dept visits. Patient Demographics Patient diagnosis 1. True or False: The following picture is the desktop icon i click on to access Power chart. The a. b. c. d. Answer: FALse – the Acis icon looks like this. it should be found on each Pc and/or wyse/winterm terminal in your department. 20. if you find a Pc or wyse/winterm terminal that is missing this icon, please call the heLP desk at 3132249. The Visit Reason lists the diagnosis of the patient: a. True b. False The Navigator Panel shows: 2. True or False. i have successfully accessed Power chart at least once in the last week. i am using my own user id and password to get into Power chart 19. c. Everything that has been done and completed in Patient’s chart. a. The items that have been ordered only b. A list of only the important items on a patient 18. Answer: hopefully, True! if you have not, please work with your super user to practice logging on to Power chart at least once a week! if your login and password don’t work, please call the heLP desk at 313-2249! 3. List at least 2 super users in your department: if you could do this, great! if not, please speak to a member of your management team. They should be able to direct to a list of super users in your area! 4. List two (2) ways you can locate a patient, to gain access to a patient’s electronic chart in Power chart. • you should be able to find a patient on a patient list – nursing units should have a “default” patient list that should be specific to that nursing unit, and have a list of that unit’s patients on it. if you double click on a patient name on that list, the electronic chart should open up for you! drawn resulted ordered received in In PowerChart, Lab Results are displayed: • use the Find Patient icon a. When they are b. When they are the Lab c. When they are d. When they are or completed 17. or select Task – Find Patient from the menu bar. 5. under which “tab” will you find the scanned paper charts (old charts)? documents/reports 6. under which “tab” will you find a patient’s encounters? Patient information Under the Patient Information Tab, under which tab will you locate the patient’s previous visit information? 7. i should click on which icon to “refresh” my view in Power chart and obtain the most recent results since i logged in. The “As Of” button! a. Patient Demographics b. Visit List c. PPR Summary d. Visit History 16. a. Patient Demographics b. Visit List c. PPR Summary d. Visit History 15. Under the Patient Information Tab, under which tab will you locate insurance information? PowerChart Quiz #1 Answers page 70 page 71 Answers: 1. if you’re in the document/reports tab, you need to print using Print icon #2 at the bottom of the screen. in this tab, if you print using the icons on the top of the screen (Print icons #1 or #3), you will just get a blank page! scanned document pages are the only pages with 3 print icons! On non-scanned document pages (i.e. transcribed reports – h&P) in the document/reports tab, there are 2 print icons (1 and 3) at the top of the screen. both of these will print the document! 2. search range bar 3. using your mouse, you need to point to the search range bar, and perform a righT CLiCk. A little box will display that says “change search criteria.” After clicking on this box, another window will display with the options available in that tab to change search criteria ranges. 4. This “x” indicates that this box is in errOr. various reason for this exist: a. This document may have come down with the paper chart and had the incorrect patient’s name addressographed on the paper form 5. The domain used was the TrAin domain. 6. you know this because the screen tells you (refer to the area circled in red at the lower right corner of the screen). nOTe: you should glance at this area after you sign into Power chart, just to make sure you are in the domain that you intended to access!! Crossword Answer PowerChart Quiz #2 Answers