|
|
| (14 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| ED Computer Downtime Emergency Instructions
| |
|
| |
|
| 1. Identify affected systems and request a fix
| |
| Assigned Staff: Any tech savvy staff member.
| |
| Check which of the following systems are affected:
| |
| ORCHID
| |
| Computer network
| |
| Landline phones
| |
| Spectralink Phones
| |
| Paging system
| |
| Synapse
| |
|
| |
| Assign someone to see if any of the affected systems can be used from nearby locations outside the SE building, such as the psych ED, D-9, or the nursing administration office in the hallway leading to the cafeteria.
| |
| First call the IT Help Desk at x5059 or 323-409-8000.
| |
|
| |
| 2. View the ORCHID 724 Backup
| |
| Assigned Staff: Any tech savvy staff member.
| |
| The 724 Backup computers can be used to print lists of patients in the department at the time of the downtime and to view their charts going back ten days.
| |
| Locations of the 724 backup computers:
| |
| ED Pediatric Nursing Office SE141.
| |
| -Charge nurses have a key to this office
| |
| -This computer can be connected directly to the printer in case of a complete network outage
| |
| Peds Nursing Station 200HUMDSK45054
| |
| Trauma Nursing Station 200HUMDSK45265
| |
| RME Nursing Station 200HUMDSK45527
| |
| ED Registration Office 200HUMDSK45588
| |
| Acute Adult Front Nursing Station 200HUMDSK45596
| |
| Gold Unit 200HUMDSK45604
| |
| Psych ED Station #1 200HUMDSK42257
| |
| Psych ED Station #2 200HUMDSK42668
| |
| Urgent Care 200HUMDSK43298
| |
|
| |
| Open the “724AccessViewer” from the desktop.
| |
| Login using the ID and Password that will be distributed at the downtime.
| |
| Click on the “Firstnet Search” tab
| |
| Choose the Tracking Group “HAR ED”
| |
| Click the “Tracking Location” column to sort by that. You could also sort by DOB to bring the pediatric patients to the top.
| |
| Click “Print List”
| |
| Choose “Landscape” orientation and only the essential columns. If you choose them all, they will not fit on the page.
| |
| Print a copy for each pod and distribute them.
| |
|
| |
| To read a patient’s chart, double click on it. There is a button at the top left to print the chart.
| |
|
| |
| A job aid for the 724 is attached and is online on the Harbor home page.
| |
| In the event of a network failure, the computer in SE1E41 can be connected to the printer with a long USB cable.
| |
|
| |
| Assign someone to staple them, sort by pod, and distribute to each pod and triage.
| |
|
| |
| 3. 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.
| |
|
| |
| 4. Triage and waiting area patient tracking
| |
| -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.
| |
| -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.
| |
| -If stable, the patient will go to the registration window for registration.
| |
| -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).
| |
| -The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.
| |
| -If the patient is sent to a room for RME or treatment, their completed triage form will accompany them.
| |
| -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.
| |
| -Sort the 724 printouts in with the forms of newly triaged patients.
| |
| -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.
| |
| -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.
| |
|
| |
| 5. AED, PEDS, RME and Psych ED patient tracking
| |
| Assigned staff member: Area charge RNs
| |
| 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
| |
| -The ED clerk will keep a set of logs of patient departure times and dispositions.
| |
|
| |
| 6. Lab Ordering
| |
| -Call the laboratory supervisor to notify him or her of the problem. Ask whether the ORCHID Lab Information System.
| |
| -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.
| |
|
| |
| 7. Lab Results
| |
| -The lab will print lab results and fax or tube them to the ED.
| |
| -Distribute lab results to the providers as they arrive.
| |
|
| |
| 8. Radiology Results
| |
| If Synapse is down, you will need to view images on the machine on which they were shot (eg, CT scanner, X-ray machine, or portable x-ray machine). For CT reads, call the reading room x7295 (daytime). At night page the radiology resident at 5814 to come down and make preliminary reads on the scanner. Ask if radiology can dedicate a staff member to the ED.
| |
|
| |
| 9. Medication ordering
| |
| -Medication orders are written on an HH929 Supplemental Prescriber’s Orders and given to the patient’s nurse.
| |
|
| |
| 10. Physician documentation
| |
| -Physicians should document on the 253 forms.
| |
|
| |
| 11. Divert patients and notify necessary stakeholders
| |
| -Assigned staff: Attending MD
| |
| -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.
| |
| -“ED Saturation” is a closure to Advanced Life Support ambulances, remaining open to trauma, STEMI, and BLS ambulances.
| |
| -“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.
| |
| -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 MICN to place us on the appropriate level of diversion to ambulance traffic.
| |
| -If access to Redinet is down, the MICN should call the MAC, who can update Redinet
| |
| -If needed, the nursing supervisor can call MLK and ask them to stop sending patients.
| |
| -Email (and call during daytime hours hours) and Director of Emergency Informatics Ross Fleischman (rossf@emedharbor.edu 310-683-0312).
| |
|
| |
| 12. Admissions
| |
| -Call bed control with each admission so they can search for a bed
| |
|
| |
| 13. Discharges
| |
| -Write discharge instructions on paper and summarize on the 253.
| |
| -Write prescriptions on paper and note them on the 253
| |
|
| |
| 14. Orders for admitted patients
| |
| -Write on paper. Fax medications to pharmacy.
| |
|
| |
| 15. After recovery
| |
| -When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.
| |
| -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 arrived during the downtime but remain in the ED after recovery should be placed into ORCHID by the nurse caring for the patient.
| |
|
| |
| 16. Post-recovery registration
| |
| -See registration downtime instructions
| |
| -Email Elaine Perez and Mario Trejos there was a downtime so they can check the levels of forms.
| |
