MEDICAL RECEPTIONIST New Employee Orientation 2016 Setup PRIOR to Class: Enter pre-orders for number of students in the class for 7N census or census for the room the class is being held. Training room Census: B319: 7N, 1010: 6N, 407: 5N Enter Pre-Orders on training pts for # of learners expected plus 2 (for late arrivals, etc.) 1. How to Enter Pre–orders a. Sign on with provider ID: TRAIAKO, password: variable ck with Blair or Julie (look on website at Training ID Information for current passwords) b. Go to the clinical desktop c. Click on Wiz Train d. Double click on patient name then Click Manage Pre-Orders e. Open dropdown box and Select Surgery/Procedure f. Click Create g. Click on patient name top of left frame h. Click on Manage Personal Orders i. Click CP/MR Class j. Click on Playback k. Click Done l. Type pre-op, Click Max, Click Today, Click Save Signed pre-Orders 2. Turn on LCD, set up Microphone, check CWS 3. Place laminated sheets on ring clip, colored laminated training ID sheets, printouts #1-4, and MR Additional Activities on each desk 4. Write names/unit of students on half sheets of colored paper and tape to back of the monitors in assigned seats, considering breaking up those who are going to the same unit. This diminishes the amount of chatting that goes on in class. 5. Instructor signs-on with MR TRAINING ID. B319: TRAI1VN, 1010: TRAIZOZ, 407: TRAIVVN 6. SUPPLIES a. Trainer’s Manual and Roster b. Laminated Documents: POS, Lab & RT requisition e. Downtime Kit stocked Page d. Print MR Handouts for class and staple together 1 Gettingc. Print Started: 5 min Patient List for appropriate unit for training room for each student Welcome: Trainer show slide #1 Introductions with explanation of CAPs role Restrooms Length of class is 4 hours with 1 break. Explain handouts – o Class Handouts 1. Computerized POS (laminated on ring clip) 2. Computerized Requisition (laminated on ring clip) 3. Patient list o Unit handout (paper copies to take and use in class and on unit) 1. MR HANDOUT #1: Notes page. If users learn best by taking notes, this page was made for them! 2. MR HANDOUT #2: One Time Set Ups (in case not able to do at end of class) 3. MR HANDOUT #3: Systems Access Checklist Refer users to partner with their Security Manager to get racfid issued and setup. Will prevent access to Medipac if not issued. 4. 3 blank lab requisitions for practice activity 5. MR additional activities handouts Trainer: Your job as a Medical Receptionist will vary based on your specific unit. Today you will learn about patient care applications as they related to your job. For class today, everyone will be using a Training ID. Your permanent ID and systems access will be set up by your security manager (on most units, the AA). A checklist is provided for things that Page 2 need to be done to complete your systems access and set up your Virtual Clinical Workstation. StarPanel: (30 min) Driver: Show slide #2 OBJECTIVES Explain StarPanel is the full electronic medical record. Inpatient Whiteboard: Trainer: 1. Until you sign on you have a non-secure view of the patient list, and indicators for orders, labs, etc. 2. Nurses ONLY acknowledge orders here . Sign on: Trainer/Driver: 1. Press Spacebar…sign-on **Unclick Virtual to sign in 2. Uncheck the bottom box to get the racfid login box a. VCWS vs non virtual b. Explain VCWS: i. Tap in or Sign on to virtual and open all your applications. ii. Don’t close applications, use Red X to sign off or tap out. iii. As you move from one computer to another you will go right into where you left off. iv. Always check patient name in new room to avoid documenting on wrong patient! You will only do it once! 3. Explain how and why to logout completely and the two icons that perform this function. 4. Discuss the need to logout each time a user leaves a CWS related to HIPPA laws and unprotected Page 3 access to our clinical systems. StarPanel practice: Trainer: 1. HANDOUT #2: Refer user to one-time setups for inpatient whiteboard & frame sub tabs 2. Explain the 3 ways to size frames but explain only tabs will be taught 3. Navigating in StarPanel: Numbered tabs at top =Frame number, or resize a frame by double click in a white spot or drag lines between up and down 4. Hover over column headers will reveal additional information about the functionality. 5. Explain that StarPanel is a ONE CLICK application. 6. Click on column headers in the patient list and show sorting function 7. Explain anything blue in StarPanel either performs a function, like sorting, or navigates you to somewhere, like to a document. 8. Describe the function and use of some of the headers like Publicity. Discuss the need to honor HIPPA laws. a. Publicity is a way of ensuring a patient’s identity is protected. b. Patients may be at Vanderbilt and request anonymity for a variety of reason including security. This may be related to violence, for example, a gang shooting or domestic dispute. c. Also, a patient may request to be anonymous because they are famous or simply have not shared their admission with family and friends. d. No matter the reason, we must relentlessly protect a patient’s identity. e. The federal gov’t levies fines back to the individual, not the institution-Vanderbilt, when HIPPA laws are violated. Page 4 f. These fines are upwards of $10,000. Driver: 1. Click inpatient census in black bar 2. Locate patient’s name on Patient List and find patient on census list…may need to scroll or resize to locate 3. Click MR# to load patient’s entire chart 4. Click Pt List to view full census for unit 5. Click ACTIONS to the right of your patient’s name 6. Click CHANGE 7. Select Medical Receptionist’s Menu Actions Menu: Trainer: Review most frequently used functions by MR from Actions menu. Instruct how to change the view to Medical Receptionist view by using the change button and choosing the appropriate actions menu view. Remind to click on Actions from the patient list in top frame. Driver: 1. Click AllDocuments (will open in frame 2) Trainer: this contains a record of any document that pertains to a patient’s medical history at Vanderbilt University Medical Center. Frame below census opens with all of the documents in the pt’s chart a. Type “Property” in the Title search field b. Press ENTER c. Click on one of the Property Records 3. Click on the red X at the top R to close the popup Page property the pt had with them at admission. 5 2. Property documents opens in a new popup window. Review the scanned document of the 4. Click frame 1 tab to return to patient list 5. Click Actions menu next to your patient’s name 6. Click e-Docs (will open in frame 2) a. Opens in a new popup window b. Click Downtime tab. 2nd document listed Downtime and Code Req (bottom of list) c. Trainer: Explain broken up into Acute Care, Specialty, and ICU areas. When HEO/Wiz, the order entry system goes down, this document used to order labs, blood products and other tests d. Note the location of this link. We will discuss Downtime in depth later today 7. Click on the red X at the top R to close the popup 8. Click on Actions menu next to your patient’s name 9. Click OPC (will open in frame 2) a. Overview of Patient Care b. Printed by MR for nurses prior to shift change c. Nurses use to give and receive report… Handover tool d. Pt information from orders, test results, nursing & MD Trainer: Point out the following as learners locate on OPC Situation: Team Page can be done from here Explain teaching hospital framework for those who have never worked in a teaching hospital; including the levels of residents, who are attendings, why we use the term providers and not doctors Synopsis: Provider note detailing events that led to patient’s hospitalization Alerts: Allergies, Isolation, Fall, Advance Directive: end of life document Background: past medical/surgical history Assessment: Nursing and Care Partner documentation Recommendations: Orders from HEO/Wiz Explain OPCs are printed for nurses prior to shift change a. Click Actions b. Click OPC 11. Point out Care partner and Charge nurse snapshot Page 10. Click frame 1 tab 6 c. Note Print button - DO NOT click 12. Explain CarePartner Snapshot printed prior to shift change…same steps as OPC 13. Explain Charge Nurse Snapshot printed prior to shift change a. One document prints with all patients listed 14. Click IVT Request Form. (learner will just watch as you will show live patients) Trainer: MR, CP or RN completes this form to request IVT services. It displays on their dashboard so they are not interrupted by calls and pages. See Handout #2 for instructions on setting up the IVT dashboard in your favorites. MR Dashboard: (15 min) Students watch only-no training form Trainer: MR Dashboard is what you should see when you first sign on to the computer as an MR (once set-up). It was designed for MR’s to promote efficiency and facilitate notification of orders once requisitions no longer print– see HANDOUT #2: One Time Set ups handout for instructions to set this up on your own ID. Demonstration of the MR dashboard can only be done showing live patients. Instruct users to WATCH and NOT click. 1. Access MR dashboard from Black menu bar 2. The MR dashboard is located under the Dashboards list, however, it is also in the favorites Page 7 already saved to your training ID a. On your own ID you will save the Inpatient Whiteboard and the MR ancillary Dashboard to your favorites as you see here so you can easily toggle back and forth if change roles i. MR dashboard – use as MR ii. Inpatient WB – use as CP Driver: 1. Show the dashboard by clicking on MR Ancillary from the favorites in the black menu bar 2. Check the unit census – choose a random unit 3. Click on Change Panel if you need to change 4. Trainer selects ___(census of training room) (this will take you into the live region). 5. Show them how to select single and multiple units. 6. Click OK 7. The dashboard is a view of the unit census with columns to show: a. Patient MRN, age, location and including publicity codes b. Action link (OPC is here) c. Team Pager – Click to text the provider (x out -don’t click send) d. NURSING Orders - shows new orders, red for STAT orders, P for Preorders you need to playback at appropriate time (more on this later) e. Ancillary Orders – RT and EKG i. RT – green is a routine order and red is for STAT. From the MR Dashboard, click on the order indicator. Review the order and click “Acknowledge orders” to acknowledge you have seen the order. A hollow box indicates the order has been acknowledged. By acknowledging, you are showing you saw the order and it is the electronic equivalent of picking the paper requisition up off of the printer. STAT orders are called to the RT team. Routine orders will be seen Page 8 by RT on their dashboard. ii. EKG – the indicator colors are the same as RT’s but the process for notifying EKG will be specific for each unit. There is no automatic notification for EKG orders. f. Currently there are indicators for Orders/preorders, RT orders, EKG orders, code status, Discharge Appointments and Discharge orders. g. In the notes column, click in the blank space to make notes for MR or Charge RN. For example, this is a way to track Consents, pt specific data from shift to shift and contact precautions, etc. h. Discharge Appointment indicator provides notification of any follow-up appointments made since admission. If the indicator is white, no appointments have been scheduled and follow up is needed with the patient’s RN. i. D/C indicator shows if there has been a HEO/Wiz order placed to discharge the patient. HEO/Wiz: (30 min) Driver: show slide #3 OBJECTIVES Driver: 1. Double click on Green Wizard hat to open HEO/ Wiz Training region Trainer: Explain this is another way to see the patient’s publicity status Confidential Status N= pt requested no info be given out G= general info such as room number can be given out U = unknown NS = No info and Security Risk, i.e. Victim of violent crime and should be treated the same as no info patient Search for patient. Type Ztest Printouts button Refresh(refreshes the census after a Medipac transfer/discharge) Page 9 Other Things from Census View Printouts Button: Trainer: 1. Printouts button used for printing most important list of day…The patient list used for tracking patient movements throughout the shift. 2. May print patient list with 30 names on a page (see laminated patient list on ring holder) or may print with maximize spacing for room to write details about patient movement 3. Also printed on most units for dayshift are the diet list and the rehab list Driver: Click on Printouts; demonstrate printing a patient list from Printouts button 1. Click printouts 2. Click for a given unit 3. Click unit 4. Click maximize spacing 5. Click cancel to exit out-NOT the X 6. Don’t print Diet List is printed (for Adult Units) prior to the arrival of the food cart Pre-Orders Playback: Trainer: What does the purple P indicate to the left of a pt’s name? Preorders are entered by a provider and stored prior to the patient being placed in a Medipac bed. A purple “p” alerts medical receptionist to activate the orders. Driver: 1. Double click on your same patient 2. Click Manage PreOrder (list of preorders with today as playback date will be displayed) 3. Verify the correct preorder set is selected Trainer: Do NOT Attempt to playback Unsigned orders-check with Charge Nurse for date to Page 10 playback. Driver: 4. Click Playback. Preorders load 5. Scroll to bottom and click next. The orders will load & flash across the screen 6. Click Next. The preorders report will be displayed. This document is also sent to StarPanel and if Wiz were down during the time you needed to playback the orders you could access this document in StarPanel, print it and use for downtime orders. 7. Scroll to bottom of the View/ Playback orders screen 8. Click Playback Orders 9. Click Yes to “Are You Sure?” HEO closes once orders are played back. POS and Reqs print 1. Click REFRESH - Purple P goes away Some units get more preorders than others. Dialysis orders are only played back by Dialysis Staff Reprint Requisition: Driver: 1. Click on Patient’s name 2. Select Reprint Req…Reqs can be printed for yesterday, today, tomorrow 3. Reprint “cbc/plt/diff in 0500 – prints to closest printer on unit Page 11 Trainer: Why would you reprint a req? Lost, damaged, need early Processing Orders: Trainer: When orders are entered directly by a provider or nurse or playback by the MR, a hard copy of the orders print on the inpt units. CLASS HANDOUTS (laminated): have class get out the packet to use for this section Computerized Physician Orders o Print to Medical Receptionist’s critical printer when orders entered in HEO/WIZ and the MR’s either distribute them per unit protocol. o RN’s will acknowledge orders online o Patient information and MD who authorized order is at top - show on handout # 1 o Each order has a number o STAT orders display bold … see page 2 o Start & stop times (right side of page) o Open-ended orders (continuous) display start time. Remain until deleted or pt discharged – see #10 NHO o One-time orders - see #13 culture urine bacteria o Timed orders – See #23 (pg 2) Morphine. 72 hrs stops o Computerized POS is not a permanent chart document o Shredded after replaced – see unit protocol for details o Requisitions: Lab (class handout #2) o Reqs print on unit if procedure or test done on unit. The MR distributes the reqs per unit protocol. You will learn what your unit does from your preceptor. o Other Reqs print in performing department, i.e. Radiology o Multiple tests print on same Req if tests can be run in same dept (CBC and PCV) o Full signature, VUNet ID, dates & time from person collecting specimen. o Text in center section gives directions on how to collect specimen, color of tube o If RT or EKG test ordered STAT, MR calls the performing department, except for Labs. o Batch Reqs print after midnight if the test is to be done after MN, ie, next day’s labs Page 12 Break Time (10min) Medipac: (45 min) Driver: show slide #4 OBJECTIVES Refer to MR HANDOUT#4 Medipac tips Trainer: Whiteboard unit’s census is managed in 3 ways via the Medipac system: a. Admitting department admits a new patient into Medipac b. Unit staff discharge patients in Medipac when they leave VUMC c. Unit staff transfers patients in Medipac to a different location When a change is made in the Medipac system, the census is changed in StarPanel and in other applications. Maintaining an accurate unit census is one of the most important aspects of the Medical Receptionist’s job. Trainer: Find your patient on the patient list Review Patient List from laminated packet Snapshot of current census at the time it is printed Headers across top: unit, bed, pt’s name, age, sex, admission status (all here are inpts (IA), MR#, Case #, date admitted and Attending At the Beginning of shift, print a Patient List. Will Use this list to practice transfer and discharge 0+Case # = Account # - always use this account #, not blue card Driver: Show slide #5 (Medipac keyboard tips) and #6 (Pavilions) Trainer: What unit is your patient on? 7N (or census for the room training is being held) What Pavilion is 7N in? Heart and Vascular institute – pavilion 4 Driver: 1. Click Go to Desktop… 2nd icon from black bar 2. Double click Medipac Icon 5. Press ENTER. Patient management menu displays Page 4. Type A where cursor is blinking 13 3. Tab to MEDP3M Transfers: Trainer: From your training card, practice transferring a patient from current unit (ie 7N) to the unit and bed listed on the card Unique location noted for each patient on your colored laminated card What Pavilion displays? Pavilion 4 Trainer: If you need to transfer a patient to a different pavilion or from a different pavilion you will have to change the pavilion. Driver: 1. Tab to Nurse unit Transfer (NXFE) 2. Type A & press Enter 3. Press TAB key until the flashing cursor stops to the right of the Account # 4. Type the number zero; the leading zero will be necessary even in the live environment 5. Locate your pt’s case # on the laminated sheet 6. Type the 12 digit case # 7. Press Enter Trainer: Always confirm that the name in the top left corner matches the name on the Patient List. Transfer Date and time defaults to current time. Never transfer or discharge till you see the patient actually leaving the floor! Page 14 The patient is transferred within Pavilion so no Pavilion change is needed Driver: 8. Tab to LOC 9. Type ?? 10. Press Enter 11. Review the list of locations patient can be transferred to 12. Look to see what unit your patient is being transferred to and find it on the list and type in the appropriate line number 13. Press ENTER Trainer: A list of available beds display, have students assign their patient to bed on the back of their patient card. No two people should select the same bed. Driver: 14. Locate line number and bed on the Patient List 15. Type LINE # …be careful to select correct bed for your pt 16. Press Enter 17. Confirm Medipac bed matches what’s on the Patient List 18. Note Message …Transfer complete Transfer Back to Home Unit: Trainer: When the patient returned to the unit from surgery or other areas, the MR should transfer the patient immediately to their unit’s census. Driver: 1. Tab to Account # 2. Type zero 3. Type the 12 digit account number 4. Press Enter 5. Tab to LOC 6. Delete Red text by pressing spacebar and shift+tab back to beginning of the line 7. Type ?? 8. Select 7N… the pt’s home unit 9. Type line number for the original bed, based on the patient list Trainer: Additional Transfer Information: Page 15 10. Press Enter. Transfer complete displays at bottom left screen Transfer Notice will print When transferring to the OR, CCL or other procedure areas, select any available bed. When transferring to unit, select actual room patient is going in to Discharge for IA: Trainer: Practice discharging your SAME patient. All patients should be moved back to their original bed. Where can you find their original bed placement? (The Patient List) Driver: 1. Press Pause/Break to get out of transfer function 2. Tab to NDSC “Nurse Unit Discharge” 3. type A 4. Press Enter 5. Tab to Account # 6. Type zero 7. Type account # 8. Press Enter 9. Type over date /time if not time patient leaves unit 10. Tab to disposition code 11. Type E 12. Press Enter 13. Press Enter again after message -Warning, pt in house on this day 14. message at bottom left Additional Discharge Information: Never perform the Medipac discharge or transfer function until the patient physically Page Transfer complete displays at bottom left screen 16 leaves the unit Admitting department must cancel all discharges… i.e., patient is leaving unit but collapses at elevators and MD decides not to discharge Trainer: REVIEW questions… What admissions types are discharged, IA or OT? IA…on Patient list Is there urgency in getting a discharge cancelled if patient didn’t leave? Yes, orders are lost in 4 hours and no new orders can be entered until patient is back in Medipac. What happens if disposition code 7 is selected instead of E? Pt will not have MR # to schedule clinic visits/hospital readmits. If you correctly typed in the acct #, but get message “Pt not in this Pavilion”, what’s the problem? Change pavilion Hardware Checks: (15 min) Driver: Show slide #7 OBJECTIVES 1. What printer is termed “Critical? Order printer 2. Do critical printers look any different than demand printers? No, but they are monitored by the HD and unit will be notified if a problem. However, they are labeled with a critical sticker 3. Electronic Script Printer, locked and has special prescription paper which is kept in a secure loaction 4. Is it your job to make sure all printer on your unit function properly at all times? Yes 5. What should you do if you find a printer or a CWS that isn’t working? Troubleshoot & report to helpdesk if unable to resolve the problem Jam - Off line Out of paper – Unplugged -Out of toner 7. If unable to solve the problem what should you do? Turn off and back on Page 17 6. What kind of problems can happen to a printer that you can solve? Notify the HD: by phone for Critical printers, Prescription printers and Zebra printers. The HD should replace the printer very quickly. Paper Documents are being scanned into the medical record and your unit also has a Scanner, copier, and fax all in one. Issues with the scanning equipment should be called into the vendor. Check with your AA for your unit’s process. Open HELP Desk Ticket: Trainer: When you find CWS or a demand printer that doesn’t work, it’s your responsibility to get it fixed. First reboot the CWS and do routine printers checks. If that doesn’t work, notify the HD by placing a self-service ticket – faster than a phone call! Driver: 1. Go to desktop 2. Click on the helpdesk icon 3. Click Here to open Pegasus 4. Enter VUNET ID and Password 7. Type Title and Description and add any attachments 8 Click ADD Scanning Documents: (15 min) Driver: Show slide #8 workflow for scanning Trainer: Explain there needs to be a current patient label affixed to each side of the document. 1. Explain documents are scanned in batches of 10 pages. Patients may not be mixed and twosided and one-sided documents may not be mixed. Each batch can be 5 two-sided documents or 10 one-sided documents. Page sticker to indicate completion. 18 2. After the scanning process is complete, put a yellow highlight check mark on the patient 3. The type of documents needing to be scanned varies by unit. Please ask your preceptor or CAPS person for further information. Driver: show slide #9 case study for scanning Then discuss Patient A will need 25 stickers and will have 3 batches to scan (2 two sided batches and 1 one sided batch). Patient B will need 22 stickers and will have 3 batches to scan (1 two sided batch and 2 two sided batches). TOTAL OF 6 batches!! It may be easy, seeing these rules for scanning to think of reasons to delay scanning as it can be time consuming. Remember that clinical decisions can not be made wfrom information that has not yet been loaded into StarPanel through scanning. Downtime: 35 min MR is gatekeeper and tone setter for downtime! The role of the MR is to assess what systems are down and assist the team in transitioning from computer based applications to paper. This process includes keeping the downtime kit stocked. Driver: show slide #10 OBJECTIVES Downtime can occur with any of the systems we have learned about. Generally speaking: StarPanel: seldom goes down Medipac: has scheduled DT for Maintenance and Upgrades HEO/ Wiz and HED: scheduled DT for Maintenance and upgrades and sometimes unscheduled DT. 1. Email announcements are posted around unit ahead of time if DT is scheduled 2. StarPanel banner with DT info is entered 3. AOC texts the CSL’s – especially for unplanned DT 4. Overhead announcements are made prior to DT(if scheduled), start of DT and at end of DT 5. Downtime Kit for ALL types of Downtimes: MR’s job to keep stocked. E-docs is the electronic warehouse where documents can be found for the downtime kit. Use the Downtime tab (SSS website is a good resource for information.) a. Black accordion folder on each unit & some units have multiple kits Page DEMO Downtime kit: 19 6. Each patient room must have a blue chart for downtime documents as needed. b. Point out “Quick Reference” laminated sheet describing what EVERYONE on unit should do during DT and everything that should be stocked in the kit (30 rooms = 30 MARS, etc.) c. Mention Policies c. Refer to example of completed POS (for HEO/Wiz DT) for Providers to hand-write orders and manually process (unit has supply). Fax Pharmacy a copy to enter meds when system back up d. Mention Peds / adult packets (critical & general care) to their specific area -Flowsheet (for HED DT)- for nurses and CP to document patient care (from e-docs) e. MAR: (for Admin-RX DT) –Pharmacy will print computer generated MARs for scheduled and unscheduled DT for nurses to document medications on during the DT. If Pharmacy can’t print and admin-Rx is down, a paper MAR can be printed from e-docs. Trainer: tell learners to check with their preceptors to find out where their unit DT computer generated MARs print. A Closer Look at Downtime when HEO/Wiz is down: Driver: Show slide #11 POS for requisition exercise DT Handwritten POS (see in e-docs) Which orders are ongoing… that means not a one-time order Locate the code column… what code is in this column for on-going orders? DT – these orders must go in computer after DT is over: Bedrest, full liquid diet Which orders need to go to someone other than the nurse? Full Liquid diet (nutrition svc), PRBC (BB), Aspirin and Metoprolol to (Phm) What code is placed next to these types of orders? Req except for Medications. Phm will receive a faxed copy of the entire order Signoff on POS –Some providers have never written orders on paper. Example sheet is in kit to share Mark large X through any unused area on sheet Fax sheet to Pharmacy Scan in after DT is over Flag orders for nurse. Inform of STATs RN should verify orders were processed accurately and signs full name, date/time at Trainer: Review DT Req’s 3 sections are completed. Send a req for each dept Page DT Requisitions (SEE IN E-DOCS) 20 bottom. Section I - Lab: MR completes this portion and gives to phlebotomist to finish Section II- Lab: Based on orders from Order sheet, STAT CBC req is sent to lab Section III -Ancillary Depts: Nutrition and other ancillary depts. need a req to know of the change.. “Full liquid diet” note other departments on form and each dept will receive their own req Section IV -Blood Bank: 2 Units PRBC… symptomatic anemia Medicine Administration Record (MAR) –(SEE IN EDOCS) MR prepares an MAR for each patient and puts at bedside per unit protocol End of DT: Follow laminated sheet in kit for instructions on DT recovery Show slide #s 12, 13, 14 (Completed Requisitions) to check their work on activity Have students complete the additional activities packet. Be availabale for questions. Trainer: SHOW slide #15 End of Class Duties (15 min) 1. Update Amanita (if student is in there): a. Remove Training Flag b. Comments: Trained MR Class (date/yr) 2. Add New MR to SSS distribution list in the correct location (VCH or VUH) – Julie to do 3. Verify all patients are back in the correct beds – cancel any discharges if you need to now! Page 21 4. Discontinue all orders and delete those pre-orders that were not played back.