CERNER DOWNTIME JANUARY 28, 2012
In the days before downtime:
1. All department managers alert employees of scheduled downtime and
review downtime procedures/responsibilities. In ancillary departments,
make sure employee’s codes are current for order entry.
2. Make sure all patients have an adequate supply of labels and face sheets.
3. All areas make sure fax machines are in working order (including toner
and paper) and will be manned during downtime. In the event there is a
problem with a fax machine, notify the “HELP” desk at 4357.
4. Ensure there is an additional cartridge for the unit printer(s) and
adequate paper as multiple large print jobs will occur the afternoon of
the downtime.
5. Stock sufficient Miscellaneous Order forms NS-205 (item # 5456).
6. Ensure adequate floor stock of the appropriate manual documentation
forms:
 Nursing Notes NS 372 (item # 87901) for VS and narrative charting
 Charting By Exception Daily Assessment Form" for ROS, IV
noting, ADL’s and equipment documentation:
a. Adult NS 298 (item # 60674)
b. Pediatric NS 299
c. Mental Health NS 300 (item # 72187)
 Nursing Activity Documentation” for interventions NS-383 (item #
95566)
 ICU’s Critical Care Flow Sheet Adult (item # 5203) Peds (item #
5204)
 Admission Profile for new admissions (Adult: NS 240 and NS 312;
Peds: NS 314; Mental Health: NS 240 and NS- 343 and MH 155 and
156). Also for new admissions: Medication Administration Record
(NS 306 item # 63361) and Home Medication Order Sheet (NS 359
item # 63587)
 Worksheets for downtime: Downtime Diet List, Pharmacy ADT
notification, Initiate Plan of Care worksheet (sent via email)
01/2012
N Luttrell
1
On January 28:
1. Specific documents will be printed on the unit printers prior to the
downtime. Make sure there is an additional cartridge for the printer
and adequate paper. Documents will be printed before the downtime to
provide relevant clinical information for reference during the downtime.
These include:
 Beginning around 0600, final radiology reports will print to the
nursing units. Place on the patient chart under Tab 11.
 The remainder of the reports will begin printing between 1800 and
1900:
 Cumulative Lab Report for each patient. Place in the chart
under the Tab 12.
 Paper MAR (midnight to midnight 1/28) will print in
pharmacy and pharmacy will distribute to nursing units.
This will be used as a worksheet during the downtime.
 1 copy of a Physician Progress Note for each patient. Place
in the chart under the Tab 9.
 The “Home Medication Report” will print for each patient.
Place in the chart under Tab 13.
 Medication Summary for each patient. Place in the chart
under Tab 13.
 Diet list for each unit. Maintain at the nurses stations.
 Caredex for each patient. This will have the most current
orders as of the print time. Nurses will use this document to
provide care, note new orders and communicate with other
disciplines.
Managing orders/processes during downtime and recovery
Use the miscellaneous order form for new orders. Fax to the appropriate
department. Call or page the appropriate department for stats or timed
orders. They will pick up the miscellaneous order form when they come to the
unit
 Lab – The cumulative lab report will print. Lab results that
become available between the cumulative lab report print and
2200 on 01/28 will print on the nursing unit. Nursing will place
these sheets on the patient chart. New orders received after 2200
01/2012
N Luttrell
2
must be faxed to 765-3019. Remember to clearly record the
ordering physician on the miscellaneous order form so the results
will go to the correct physician. When the system comes back on
line, lab will enter and result these items.
Note: For new lab orders that have duration (i.e. x 3 days) and the
first one is to be done on the day of downtime, request one on a
miscellaneous order form and fax. When the system comes up,
nursing will need to enter the order for additional tests with the
appropriate duration, less the one already ordered on the
miscellaneous form (i.e. x 2 days).
Lab will draw previously ordered am labs as usual. Assuming that
the system is back on line by 0700, these results are expected to be
available by approximately 0900 on Sunday, January 29.
 Radiology – Beginning with orders received after 2200 on 01/28,
complete a miscellaneous order form. If a test needs to be
performed before the system comes back up, call ER radiology at
5-8524; for CT, call 5-8644.
Note: For new radiology orders that have duration (i.e. x 3 days)
and the first one is to be done on the day of downtime, request one
on a miscellaneous order form and fax. When the system comes
up, nursing will need to enter the order for additional tests with
the appropriate duration, less the one already ordered on the
miscellaneous form (i.e. x 2 days).
 Meals: A diet list will print before the downtime. Use this list for
communicating changes during the downtime. Keep the diet list
updated with diet changes, including discharges, admits and
transfers. For breakfast, fax (765-1139) the updated diet list by
0500. Any breakfast orders received after the list is faxed will
need to be ordered on a miscellaneous form.
Upon system recovery, nursing will enter any new diet orders
received during the downtime. “At Your Request” will not be
impacted by the downtime.
01/2012
N Luttrell
3
 Respiratory therapy orders – Contact Respiratory care for new
orders received after 2200 on 01/28:
For blood gases, contact the department and complete the
miscellaneous order form. Upon system recovery, respiratory care
will enter and result the blood gases.
For nebulizations/respiratory medications, scan the order to
pharmacy and contact respiratory therapy.
 Medication Charting: A paper MAW will be printed by
Pharmacy and delivered to the nursing units. The pharmacy also
has a copy of each MAW. This should be used as a worksheet with
meds being charted on line when the system comes back up; in the
event that the system does not come up before the night shift
nurses have finished their shift, the paper MAW will serve as
documentation. This information will need to be entered when the
system comes back on line (the nurse charting for another will do
this on the electronic MAR).
 During the downtime, all meds in Pyxis will be on override.
Pharmacists will be located centrally in the Pharmacy. Keep a
manual list of all discharges, transfers and expirations as they
occur. Notify pharmacy of these by scanning the “Pharmacy
Downtime ADT Notification” sheet. If unable to scan, fax to 7653280.
 If a Physician Power plan is needed during the downtime, it will be
available from “LakeLink”.
Nursing Documentation
1. Nurses should make every effort to plan care and complete their
documentation prior to 2200. This will make the recovery process much
easier when the system comes back on line. Remember to make sure the
correct time is recorded on all interventions performed during the
downtime. The interventions/tasks that were generated before the
system goes down and after will display on the PAL/task list upon
recovery. Remember to chart medication follow up at the appropriate
time; when the medication is charted in the system for specified prn
meds, a task is generated for medication follow up. Because medications
will be charted after the downtime, the follow up intervention time will
01/2012
N Luttrell
4
not be accurate. Be sure to change the time on the medication follow up
form.
2. Nursing documentation that must be entered into the system upon
recovery: Admission Profile, Admission Assessment, Initiate Plan of
Care and home medications on new admissions and Intake and Output
on all patients.
In the event that it is necessary to chart by proxy for another nurse, the
process is outlined below:
 Change the date and time on the form to reflect the date and time
the action was performed.
 Select the Results Info icon located on the Tool Bar.
 In the "performed by" box, click to the far right of your name and
backspace to erase your entire name.
 Type the last name of the user you are charting for in the
"performed by" box. If there are multiple matches, select the
binoculars to reveal a list of users. Select the appropriate user's
name and select OK.
 Note: When charting values for another nurse on the I and O tab,
the nurse must validate that the data is appropriate but does not
need to chart by whom the data was gathered. (However, any
questions about values should be clarified with the person that
recorded the data manually before entering in the system.)
Patient Wristbands
New admissions during the downtime will have a “downtime” wristband which
uses a patient label. Admissions will place a label on the wristband. Upon
system recovery, Bed control will notify admissions of the location of all
patients admitted during the downtime. Admissions will print Cerner
wristbands and tube to the appropriate nursing unit. NOTE: nursing will not
be able to use the handheld devices and scan patient wristbands for medication
administration until Cerner wristbands have been created and applied to the
patients.
Bedside glucose
Results of bedside glucose testing performed during the downtime will cross to
Cerner when the system comes back up. Remember to follow the
01/2012
N Luttrell
5
hypoglycemia protocol and notify the physician as appropriate for results less
than 60; and to notify the physician for a result of 400 or greater. Remember
that a task will be generated when the system comes back on line for the nurse
to chart the interventions for these abnormal results; the time of the task to
chart interventions will be a function of when the system came back up rather
than the time the intervention should have been performed. Remember to
change the time of that task.
Order entry on recovery:
Any order that was requested via a miscellaneous form and performed during
the downtime will be entered and resulted by the department performing the
action (lab, radiology, etc). Nursing will enter all other orders except
medications.
Pharmacy will enter medications orders with the date and time that the
pharmacist enters the order, not when the order was written. Please make
sure any duration orders are correct. Verify correct order entry using the
written order and orders for review. Review carefully. Omissions in order
entry by pharmacy will not be caught unless the written order and orders for
review are compared with diligence.
01/2012
N Luttrell
6