Charting a New Course for Nursing Documentation
Nov. 2, 2015 Update
Rollout Schedule:
Already live: Pediatric Acute Care Units; Adult Acute Care Units in MCN and 8N/S, 7N/S, 6S, 5S
11-2-15: Adult Acute Care Units Group 3: 9N & S, 6N, 11N
11-11-15: ICUs Group 1 – PCICU, PICU, VCH; 10N, 11S, VUH (NOTE -- this is a Wed.)
11-17-15: ICUs Group 2 – 10T3, 9T3, 8T3
Thanksgiving Week Break
12-1-15: ICUs Group 3 – 5N, 5T3 COBS, 6T3, 7T3, S54 Palliative Care
12-8-15: EDs – Pediatric and Adult Inpatients boarding in the EDs (does NOT include documentation on Treat and Release patients)
Focus Topic for this Week:
Internal Application Errors – what are they are how do I prevent them?
Known Admin-Rx IAE:
Internal Application Errors (IAEs) are not unique to HED. Anytime a computer application cannot reconcile a command,
an IAE can occur. Until we began with this most recent round of Nursing Documentation Revisions, our most common
IAEs occurred in Admin-Rx when a pain score was documented and while the cursor was still in that field, the nurse
scanned a patient arm band # or medication bar code. The account # and medication barcode# are longer than the 2
digits allowed in the pain score field.
To PREVENT the Admin-Rx IAE: Move the cursor out of the pain score box before scanning the armband/account
barcode or medication barcode.
New HED IAE:
The new default tab is the PLAN tab and should open in Display Mode, and it is supposed to display in 12 hr. shift
columns. When you click on Chart, the screen usually expands to show all documentation in real time. What we are
seeing is that in some instances the Plan Tab opens to Charting mode instead of Display mode, and does NOT expand to
show real times but remains in 12hr. shift columns as though it were in Display Mode. If you click on Cancel, it goes to
Display mode but in real time. In short, the rules get reversed from what they should be. When attempting to chart and
save documentation (usually Goals), when the application is in the “confused” state, you will get an IAE.
To PREVENT the HED IAE in Plan tab:
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Look at the view and make sure you are in chart mode with exact hours displaying. The 1st screen shot on the
next page shows what the tab SHOULD look like in Chart mode
Do not chart on the PLAN tab if the display is in chart mode but columns display 12 hr. times (see 2nd example).
Go back to Care Organizer and select the patient again
Verify the PLAN tab display is correct on the 2nd attempt. If not, select another patient.
Assuming the second patient’s PLAN tab opens correctly, then switch back to the patient whose display was NOT
working correctly and in most cases, we are seeing the PLAN tab open correctly.
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This is just a work around until we can identify exactly what interaction is causing this to happen. If you try this and still
are seeing the PLAN tab open already in Chart Mode but 12 hr. Shift Display mode, please report this to the Help Desk so
we can investigate immediately.
Correct display of Plan tab to allow charting without fear of an IAE. Note: real times are displaying in Chart mode.
Plan tab display that will cause an IAE: Note: PLAN tab is in Chart mode but is still displaying data by 12 hr. shifts – which is wrong
and which will result in an IAE if you try to document when the tab is in this state.
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For access to FAQs, Training Information, and other Resources:
http://www.mc.vanderbilt.edu/root/vumc.php?site=sss2&doc=47409
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Summary of Issues Resolved since last week (see screenshots below):
Issue
1. Definitions in hover for PAIN SCORE/SCALE incorrect
2. Neurological definition has been changed
3-8. Categories with required assessment only on
Admission or if patient has issues did not have definitions
for WNL in hover
9. Peritoneal Dialysis catheter not present for assessment
10. Need faster way to document very frequent
assessments (neurovascular checks, pulses, GCS, etc.)
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Resolution
Revised
Revised
Definitions added for all categories
Added back
See new Focused Reassessment section on Vitals/I&O
Tab.
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10. Time Saver! Focused Reassessment on Vitals/I&O Tab:
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