Template:Downtime - Revision history

Bchap23: /* Downtime */

2017-10-03T21:17:18Z

Downtime

Rossf: /* Downtime */

2016-12-02T20:28:22Z

Downtime

← Older revision		Revision as of 20:28, 2 December 2016
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	'''AED, PEDS, RME and Psych ED patient tracking'''		'''AED, PEDS, RME and Psych ED patient tracking'''
	*Assigned staff member: Area charge RNs		*Assigned staff member: Area charge RNs
			*The charts of new patients waiting to be seen will be placed in a basket in the physician workroom.
	*Write patients on the white boards. In the AED, color code green and purple team patients.		*Write patients on the white boards. In the AED, color code green and purple team patients.
	*Continue documentation on the HH107 (adult) HH868 (peds) and Addendum HH107A		*Continue documentation on the HH107 (adult) HH868 (peds) and Addendum HH107A

Rossf: /* Downtime */

2016-09-12T21:58:29Z

Downtime

← Older revision		Revision as of 21:58, 12 September 2016
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	*Continue documentation on the HH107 (adult) HH868 (peds) and Addendum HH107A		*Continue documentation on the HH107 (adult) HH868 (peds) and Addendum HH107A
	*The ED clerk will keep a set of logs of patient departure times and dispositions.		*The ED clerk will keep a set of logs of patient departure times and dispositions.
			<br />
			'''Order Managements'''
			*Move each pod's chart rack to the front counter.
			*After the clerk has transcribed orders from the order sheet to the lab and radiology requisition forms, he will place them standing up in the chart rack, signifying there are orders to be done.
			*When the orders have been completed, the nurse will place the chart down on its side in the folder.
	<br />		<br />
	'''Lab Ordering'''		'''Lab Ordering'''
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	'''Nursing documentation'''		'''Nursing documentation'''
	*Nurses will document on the nursing note/MAR form. There is an addendum page that can be added if necessary.		*Nurses will document on the nursing note/MAR form. There is an addendum page that can be added if necessary.
			*The nurse will keep her documentation in the chart rack that will be placed on the counter.
	<br />		<br />
	'''Physician documentation'''		'''Physician documentation'''

Rossf: /* Downtime */

2016-08-29T18:42:50Z

Downtime

← Older revision		Revision as of 18:42, 29 August 2016
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	*Clerk will transcribe to a radiology requisition form.		*Clerk will transcribe to a radiology requisition form.
	*Clerk will notify nurse that there is a new order		*Clerk will notify nurse that there is a new order
	*Nurse will be responsible for communicating with technician and getting patient to study or portable tech to patient.		*Nurse will be responsible for communicating with technician and getting them the requisition form and getting the patient to the study or the portable tech to the patient.
	<br />		<br />
	'''Radiology Results'''		'''Radiology Results'''

Rossf: /* Downtime */

2016-08-29T18:25:43Z

Downtime

← Older revision		Revision as of 18:25, 29 August 2016
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	*Write prescriptions on paper with the patient’s MRN and note them on the 253		*Write prescriptions on paper with the patient’s MRN and note them on the 253
	*Discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. Print it. There are no custom DHS instructions. There is no record kept of what was written or printed.		*Discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. Print it. There are no custom DHS instructions. There is no record kept of what was written or printed.
			*Nurses will depart discharged patients from the board when they have departed from the ED. Lab and radiology will ensure that the necessary orders are in on the back end as part of their recovery process.
	<br />		<br />
	'''Follow Up'''		'''Follow Up'''

Rossf: Updated after 7/2016 upgrade downtime.

2016-08-29T18:16:18Z

Updated after 7/2016 upgrade downtime.

← Older revision		Revision as of 18:16, 29 August 2016
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	'''Gather your forms'''		'''Gather your forms'''
	*There is a cabinet in each of the four pod nursing stations and the triage hallway labeled “Downtime Forms” stocked with forms for about 200 patients. There is a list of the contents and number of each form on the door. There is one extra set in the “Pediatric Nursing Office” SE1E41, across from the large supply room between peds and RME.		*There is a cabinet in each of the four pod nursing stations and the triage hallway labeled “Downtime Forms” stocked with forms for about 200 patients. There is a list of the contents and number of each form on the door. There is one extra set in the “Pediatric Nursing Office” SE1E41, across from the large supply room between peds and RME.
			*Labs and radiology orders will be transcribed onto the one page radiology and lab requisition forms. The triplicate forms for the individual lab areas are no longer in use.
	*[Prior to a planned downtime, forms will be set out in each area. Packets will be prepared in advance for newly arriving patients containing a physician documentation form (253), nursing note/MAR (or PEDS version), MSE form, and order sheet].		*[Prior to a planned downtime, forms will be set out in each area. Packets will be prepared in advance for newly arriving patients containing a physician documentation form (253), nursing note/MAR (or PEDS version), MSE form, and order sheet].

	<br />		<br />
	'''Waiting room and triage'''		'''Waiting room and triage'''
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	*Call the laboratory supervisor to notify him or her of the problem.		*Call the laboratory supervisor to notify him or her of the problem.
	*Providers will write all orders on generic order sheets.		*Providers will write all orders on generic order sheets.
	*Clerk will transcribe to ~~forms based on the~~ lab ~~area~~. Clerk will notify nurse that there are new orders.		*Clerk will transcribe to a one-page lab requisition form. Clerk will notify nurse that there are new orders.
	*Nurse will draw (or call phlebotomy), label with timed patient stickers, and place in tube with requisitions and tube to lab.		*Nurse will draw (or call phlebotomy), label with timed patient stickers, and place in tube with requisitions and tube to lab.
	<br />		<br />
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	'''Radiology ordering'''		'''Radiology ordering'''
	*Provider will order on order sheet.		*Provider will order on order sheet.
	*Clerk will transcribe to radiology requisition		*Clerk will transcribe to a radiology requisition form.
	*Clerk will notify nurse that there is a new order		*Clerk will notify nurse that there is a new order
	*Nurse will be responsible for communicating with technician and getting patient to study or portable tech to patient.		*Nurse will be responsible for communicating with technician and getting patient to study or portable tech to patient.
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	<br />		<br />
	'''Admissions'''		'''Admissions'''
	*Providers will write the Request for Admit order on an order sheet.		*Providers will write the Request for Admit order on an order sheet, including service, attending, diagnosis, and level of care.
	*Registration will perform hourly rounds to identify patients needing admission.		*Registration will perform hourly rounds to identify patients needing admission.
	*The clerk will call bed control with each admission so they can search for a bed.		*The clerk will call bed control with each admission so they can search for a bed.
			*Bed control will call the clerk when a bed has been found.
	<br />		<br />
	'''Discharges'''		'''Discharges'''
	*~~Write~~ discharge instructions ~~on paper and summarize on~~ the ~~253~~.		*The nurse will check with registration that they have completed full registration prior to discharging patients.
			*''The 253 form has a section for your handwritten discharge instructions. Give the carbon copy to the patient.''
	*Write prescriptions on paper with the patient’s MRN and note them on the 253		*Write prescriptions on paper with the patient’s MRN and note them on the 253
	*Discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. Print it. There are no custom DHS instructions. There is no record kept of what was written or printed.		*Discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. Print it. There are no custom DHS instructions. There is no record kept of what was written or printed.
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	'''After recovery'''		'''After recovery'''
	*[For a long, planned downtime, a team may be allowed back into the system prior to the system being release for everyone. Their priorities will be: 1. Entering patients into ORCHID that arrived during downtime. 2. Moving patients to their correct rooms in ORCHID. 3. Removing patients who were discharged during the downtime and entering: arrival time, diagnosis [Best ICD10 guess], disposition, providers, last room (or just AOF or POF for adult vs peds), and time left ED entered in ORCHID].		*[For a long, planned downtime, a team may be allowed back into the system prior to the system being release for everyone. Their priorities will be: 1. Entering patients into ORCHID that arrived during downtime. 2. Moving patients to their correct rooms in ORCHID. 3. Removing patients who were discharged during the downtime and entering: arrival time, diagnosis [Best ICD10 guess], disposition, providers, last room (or just AOF or POF for adult vs peds), and time left ED entered in ORCHID].
	*~~Patients~~ who arrived during ~~the~~ downtime ~~but remain in the ED at recovery should be placed~~ into ORCHID ~~by the nurse caring for the patient~~. There is a “downtime registration” box on the quick registration page that allows using the MRN that was assigned during downtime. ~~[For the planned downtime on 7/10/2016, this will be done by the team given early access].~~ Registration will register the patients who are on boarding status or already admitted. Bed control will change the encounter status to inpatient for the admitted patients.		*For a short or unplanned downtime, registration will enter patients who arrived during downtime into ORCHID. There is a “downtime registration” box on the quick registration page that allows using the MRN that was assigned during downtime. Registration will register the patients who are on boarding status or already admitted. Bed control will change the encounter status to inpatient for the admitted patients.
	*When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.		*When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.
	*Providers will enter all ongoing orders except medications for patients still in the ED at recovery. This will include entering the Request for Admit and diagnoses.		*Providers will enter all ongoing orders except medications for patients still in the ED at recovery. This will include entering the Request for Admit and diagnoses.

Rossf: /* Downtime */

2016-07-19T17:22:45Z

Downtime

← Older revision		Revision as of 17:22, 19 July 2016
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	****RME Nursing Station 200HUMDSK45527		****RME Nursing Station 200HUMDSK45527
	****ED Registration Office 200HUMDSK45588		****ED Registration Office 200HUMDSK45588
	****Acute Adult Front Nursing Station ~~200HUMDSK45596~~		****Acute Adult Front Nursing Station HARSE1J2572401
	****Gold Unit 200HUMDSK45604		****Gold Unit 200HUMDSK45604
	****Psych ED Station #1 200HUMDSK42257		****Psych ED Station #1 200HUMDSK42257
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	*Write discharge instructions on paper and summarize on the 253.		*Write discharge instructions on paper and summarize on the 253.
	*Write prescriptions on paper with the patient’s MRN and note them on the 253		*Write prescriptions on paper with the patient’s MRN and note them on the 253
			*Discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. Print it. There are no custom DHS instructions. There is no record kept of what was written or printed.
	<br />		<br />
	'''Follow Up'''		'''Follow Up'''

Rossdonaldson1 at 22:25, 1 July 2016

2016-07-01T22:25:05Z

← Older revision		Revision as of 22:25, 1 July 2016
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	'''Preparation Checklist for Planned Long Downtime'''<br />		'''Preparation Checklist for Planned Long Downtime'''<br />
	'''T-2 Weeks:'''<br />		'''T-2 Weeks:'''<br />
	~~□Check~~ with Elaine and Mario that forms are stocked		*Check with Elaine and Mario that forms are stocked
	~~□Assemble~~ 100 packets of MD 253, nursing note/MAR page 1 (20 with peds nursing note for PED), MSE, and order form		*Assemble 100 packets of MD 253, nursing note/MAR page 1 (20 with peds nursing note for PED), MSE, and order form
	~~□Registration~~ checks stocks of downtime forms, labels, wristbands		*Registration checks stocks of downtime forms, labels, wristbands
	<br />		<br />
	'''T-2 Days:'''<br />		'''T-2 Days:'''<br />
	~~□Registration~~ sets up files to be moved to Router counter for quick registration		*Registration sets up files to be moved to Router counter for quick registration
	<br />		<br />
	'''T-2 hours:'''<br />		'''T-2 hours:'''<br />
	~~□Check~~ that 724 Level 2 computers are running		*Check that 724 Level 2 computers are running
	~~□Put~~ out forms		*Put out forms
	<br />		<br />
	'''T-1 hour:'''<br />		'''T-1 hour:'''<br />
	~~□Go~~ on ED Saturation to EMS. Remain open to STEMI and trauma		*Go on ED Saturation to EMS. Remain open to STEMI and trauma
	~~□Registration~~ will take over quick reg, but will continue entering patients in ORCHID up until T-0.		*Registration will take over quick reg, but will continue entering patients in ORCHID up until T-0.
	~~□Pharmacy~~ will print the MAR on boarding patients		*Pharmacy will print the MAR on boarding patients
	<br />		<br />
	'''T-30 minutes:'''<br />		'''T-30 minutes:'''<br />
	~~□Patient~~ arriving at this point will still be registered into ORCHID, but will have clinical documentation started on paper.		*Patient arriving at this point will still be registered into ORCHID, but will have clinical documentation started on paper.
	~~□Write~~ patients on white boards		*Write patients on white boards
	~~□Print~~ charts from level 2 724		*Print charts from level 2 724
	<br />		<br />
	'''Day after recovery:'''<br />		'''Day after recovery:'''<br />
	~~□Email~~ Elaine and Mario that there was a downtime so they can check the levels of forms.		*Email Elaine and Mario that there was a downtime so they can check the levels of forms.

Rossf: Major revisions for planned downtime 7/2016

2016-07-01T21:28:35Z

Major revisions for planned downtime 7/2016

Show changes

Rossf: Added line breaks to sections that were running together

2016-03-25T20:36:37Z

Added line breaks to sections that were running together

← Older revision		Revision as of 20:36, 25 March 2016
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	***Urgent Care 200HUMDSK43298		***Urgent Care 200HUMDSK43298

	*Open the “724AccessViewer” from the desktop.		*Open the “724AccessViewer” from the desktop.<br />
	Login using the ID and Password that will be distributed at the downtime via DHS email.		**Login using the ID and Password that will be distributed at the downtime via DHS email.<br />
	Click on the “Firstnet Search” tab		**Click on the “Firstnet Search” tab<br />
	Choose the Tracking Group “HAR ED”		**Choose the Tracking Group “HAR ED”<br />
	Click the “Tracking Location” column to sort by that. You could also sort by DOB to bring the pediatric patients to the top.		**Click the “Tracking Location” column to sort by that. You could also sort by DOB to bring the pediatric patients to the top.<br />
	Click “Print List”		**Click “Print List”<br />
	Choose “Landscape” orientation and only the essential columns. If you choose them all, they will not fit on the page.		**Choose “Landscape” orientation and only the essential columns. If you choose them all, they will not fit on the page.<br />
	Print a copy for each pod and distribute them.		**Print a copy for each pod and distribute them.<br />

	*To read a patient’s chart, double click on it. There is a button at the top left to print the chart.		*To read a patient’s chart, double click on it. There is a button at the top left to print the chart.
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	-Print the 724 charts of patients in the waiting room.		-Print the 724 charts of patients in the waiting room.

	-Registration will enter patients who arrive during downtime on a log with name, mode of arrival, DOB, arrival time, and chief complaint.		-Registration will enter patients who arrive during downtime on a log with name, mode of arrival, DOB, arrival time, and chief complaint.<br />
	-The Router will starts a nursing triage note on each patient with name, sex, chief complaint, arrival time and triage priority. These forms will be taken to the triage nurse.		-The Router will starts a nursing triage note on each patient with name, sex, chief complaint, arrival time and triage priority. These forms will be taken to the triage nurse.<br />
	-If stable, the patient will go to the registration window for registration.		-If stable, the patient will go to the registration window for registration.<br />
	-Registration will place an armband on the patient when quick registration is done. (In ORCHID this will have a FIN generated by the registration machine which generates downtime FINs. An MRN will not be assigned).		-Registration will place an armband on the patient when quick registration is done. (In ORCHID this will have a FIN generated by the registration machine which generates downtime FINs. An MRN will not be assigned).<br />
	-The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.		-The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.<br />
	-If the patient is sent to a room for RME or treatment, their completed triage form will accompany them.		-If the patient is sent to a room for RME or treatment, their completed triage form will accompany them.<br />
	-If the patient is sent back to the waiting room, the triage form will be sorted by ESI score and arrival time and kept on the triage counter.		-If the patient is sent back to the waiting room, the triage form will be sorted by ESI score and arrival time and kept on the triage counter.<br />
	-Sort the 724 printouts in with the forms of newly triaged patients.		-Sort the 724 printouts in with the forms of newly triaged patients.<br />
	-A nurse will visit each patient in the waiting room to create a list of all patients. This list will be compared to the piles of charts in waiting for room and waiting for triage stacks to ensure that no body has been missed.		-A nurse will visit each patient in the waiting room to create a list of all patients. This list will be compared to the piles of charts in waiting for room and waiting for triage stacks to ensure that no body has been missed.<br />
	-Consider calling the sheriff for assistance with crowd control if needed to separate patients from family members if needed to determine who has been accounted for.		-Consider calling the sheriff for assistance with crowd control if needed to separate patients from family members if needed to determine who has been accounted for.<br />

	*AED, PEDS, RME and Psych ED patient tracking		*AED, PEDS, RME and Psych ED patient tracking<br />
	Assigned staff member: Area charge RNs		Assigned staff member: Area charge RNs<br />
	Write patients on the white boards. In the AED, color code green and purple team patients.		Write patients on the white boards. In the AED, color code green and purple team patients. <br />
	Continue documentation on the HH107 (adult) HH868 (peds) and Addendum HH107A		Continue documentation on the HH107 (adult) HH868 (peds) and Addendum HH107A<br />
	-The ED clerk will keep a set of logs of patient departure times and dispositions.		-The ED clerk will keep a set of logs of patient departure times and dispositions.<br />

	*Lab Ordering		*Lab Ordering
	-Call the laboratory supervisor to notify him or her of the problem. Ask whether the ORCHID Lab Information System.		-Call the laboratory supervisor to notify him or her of the problem. Ask whether the ORCHID Lab Information System. <br />
	-Lab and radiology orders should be written on the appropriate forms from downtime box C (eg, x-ray, hematology, chemistry, etc). If a particular form is out, use the miscellaneous lab form.		-Lab and radiology orders should be written on the appropriate forms from downtime box C (eg, x-ray, hematology, chemistry, etc). If a particular form is out, use the miscellaneous lab form. <br />

	*Lab Results		*Lab Results
	-The lab will print lab results and fax or tube them to the ED.		-The lab will print lab results and fax or tube them to the ED.<br />
	-Distribute lab results to the providers as they arrive.		-Distribute lab results to the providers as they arrive. <br />

	*Radiology Results		*Radiology Results
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	*Divert patients and notify necessary stakeholders		*Divert patients and notify necessary stakeholders
	-Assigned staff: Attending MD		-Assigned staff: Attending MD<br />
	-The extent of the closure should be determined by the attending, charge nurse, and administrator on duty. For example, a crash of FirstNet only may allow us to remain open to trauma, while failure of all network systems would require diversion of all ambulance traffic.		-The extent of the closure should be determined by the attending, charge nurse, and administrator on duty. For example, a crash of FirstNet only may allow us to remain open to trauma, while failure of all network systems would require diversion of all ambulance traffic.<br />
	-“ED Saturation” is a closure to Advanced Life Support ambulances, remaining open to trauma, STEMI, and BLS ambulances.		-“ED Saturation” is a closure to Advanced Life Support ambulances, remaining open to trauma, STEMI, and BLS ambulances.<br />
	-“Internal Disaster” closes to ALL ambulances, including trauma and STEMI. Consider involving the trauma and cardiology attending in the decision to go on internal disaster.		-“Internal Disaster” closes to ALL ambulances, including trauma and STEMI. Consider involving the trauma and cardiology attending in the decision to go on internal disaster.<br />
	-Notify the nursing supervisor, who will call the administrator on duty. Discuss whether to open the hospital emergency operations center to provide additional planning resources.		-Notify the nursing supervisor, who will call the administrator on duty. Discuss whether to open the hospital emergency operations center to provide additional planning resources.<br />
	-Notify the MICN to place us on the appropriate level of diversion to ambulance traffic.		-Notify the MICN to place us on the appropriate level of diversion to ambulance traffic.<br />
	-If access to Redinet is down, the MICN should call the MAC, who can update Redinet		-If access to Redinet is down, the MICN should call the MAC, who can update Redinet<br />
	-If needed, the nursing supervisor can call MLK and ask them to stop sending patients.		-If needed, the nursing supervisor can call MLK and ask them to stop sending patients.<br />
	-Email (and call during daytime hours hours) and Director of Emergency Informatics Ross Fleischman (rossf@emedharbor.edu ~~310-683-0312~~).		-Email (and call during daytime hours hours) and Director of Emergency Informatics Ross Fleischman (rossf@emedharbor.edu).<br />
	*Admissions		*Admissions
	-Call bed control with each admission so they can search for a bed		-Call bed control with each admission so they can search for a bed
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	*After recovery		*After recovery
	-When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.		-When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.<br />
	-Patients who were in ORCHID prior to the downtime but discharged during the downtime will need their chief complaint, arrival time, diagnosis, disposition, providers, last room, and time left ED entered in ORCHID by the charge nurse.		-Patients who were in ORCHID prior to the downtime but discharged during the downtime will need their chief complaint, arrival time, diagnosis, disposition, providers, last room, and time left ED entered in ORCHID by the charge nurse.<br />
	-Patients who arrived during the downtime but remain in the ED after recovery should be placed into ORCHID by the nurse caring for the patient.		-Patients who arrived during the downtime but remain in the ED after recovery should be placed into ORCHID by the nurse caring for the patient.<br />

	*Post-recovery registration		*Post-recovery registration
	-See registration downtime instructions		-See registration downtime instructions<br />
	-Email Elaine Perez and Mario Trejos there was a downtime so they can check the levels of forms.		-Email Elaine Perez and Mario Trejos there was a downtime so they can check the levels of forms.<br />