From: Sobala, Stephanie J on behalf of PIVOT powered by EpicTo: Sobala, Stephanie JSubject: PIVOT Pulse - Accessing Epic during Downtime and eRx of Controlled SubstancesDate: Monday, October 22, 2018 3:37:44 PMAttachments: image005.emz

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October 22, 2018

Nursing: What You Need to KnowDid YouKnow?

· During downtime you can access a “read only” version of Epic.

· MLH’s Business Continuity Access (BCA) Shadow Read Only (SRO) environment provides access to a read onlyversion of Epic just before the downtime. This allows patient care to continue using the same workstationswithout printing numerous reports. This should be your first resource during a downtime before proceeding toBCA Web or the BCA Workstation.

FYI –BestPracticeAdvisories

(BPA) ReviewEvery Shift

· There are BPAs that can found for your patient in the BestPractice Advisories section in the Overview report inthe Summary activity. It is important to review these BPAs at least once a shift, or more frequently, to ensurethat that proper alerts are being addressed during the patient’s encounter in a timely manner. Examples of BPAscan alert you to complete certain documentation or place orders for consults.

Auto HeldWorkflow -

Coming 10/30

· Newly improved build for Auto Held medications for patients that have been on MAR Hold/MAR Unhold fromprocedural areas or leave of absence. MAR Hold tip sheet will be available on Learning Home Dashboard withthe updated process.

· If a medication has been auto held in the last 4 hours, you will see an “Auto Held Medications” banner in theOverview summary report, Due Meds and Profile patient list reports, and Current Meds sidebar report.

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BCA SRO Tip.pdf

· In MAR, there is AutoHeld Meds tab that will display the autoheld meds for the past 4 hours.

· You will need to document on ALL the autoheld doses by clicking on the “autoheld” bubble in the MAR. Followthese steps:

o After MAR Unhold, the system does not assume any medications before that time should be given or notgiven.

o Nurses should use clinical judgment to proceed with giving medications that had been held and to give the"Auto Held" dose if clinically appropriate.

· For the medication above, the 5pm due time was changed to “Dose Auto Held” because the MAR Hold was ineffect when the due time occurred.

· Following return from procedure, the nurse should review any meds with “Dose Auto Held” status to determine ifthat medication needs to be administered. If a dose was not administered, you must document “not given”. This issimilar to what you had to do in MAK in legacy system.

· The nurse should reconciling all the doses that were autoheld in the MAR. Once all the autoheld doses havebeen documented, the autoheld banners will be removed from the summary and side bar reports.

· You MUST update the date/time of when you are administering the medication, as the system will notautomatically update this field with the current date/time. The system will also make you complete the offschedule reason.

· If there are questions regarding which medications should be given, check with the provider.

Central LineRequired -

MARBestPracticeAdvisory –

Coming 10/30

· There are medications with certain concentrations that require administration through a central line. A BPA willalert you on these medications (listed below) that a central line is required.

· If your patient has a central line, then click Accept to continue with medication administration. If your patient doesNOT have a central line, then click Cancel before proceeding with administration and contact pharmacyand/provider for clarification.

· Concentrations include but not limited to:

· Dextrose >15% infusion (adults)

· Dextrose >12.5% infusion (peds)

· Esmolol 2000 mg/100 mL

· KCL 40 mEq/100 mL

· TPN

· Phenylephrine 100 mg/250 mL

· Nicardipine 50 mg/100 mL

· Dopamine 800 mg/250 mL & 1600 mg/250 mL

· Dobutamine 1000 mg/250 mL & 2000 mg/250 mL

· Norepinephrine 8 mg/250 mL & 16 mg/250 mL

· Epinephrine 8 mg/250 mL & 16 mg/250 mL

· Sodium Chloride 23.4%

Providers: What You Need to KnowWhere to getinformation

duringdowntime:

Epic ShadowRead Only

· The Shadow Read Only (SRO) environment provides access to a read only version of Epic just before thedowntime. This allows patient care to continue using the same workstations without printing numerous reports.

· This should be your first resource during a downtime before proceeding to BCA Web or the BCA Workstation.

· The icon will only appear on the desktop during a downtime.

· HOW IT WILL WORK:

1.

During a downtime go to the MLH intranet and open the Clinical Applications subheader. Click on Epic andthen Epic Portal.

2. Click on SRO icon and login using your MLH credentials

3. Upon login, the environment will display “Read-Only Mode”.

4. View the reports and print if necessary.

5. If SRO isn’t functional, use BCA reports through a BCA PC or BCA Web on the MLH Intranet.

Please note:

· Similar to other environments, access to the SRO environment is available through Citrix.

· The SRO environment will only be available during a downtime.

· You cannot input data in an SRO environment.

Summary ofCare

Documents - Specialtyfollow up

from the ED

· Summary of care documents will no longer go to specialists whom the patient is told to follow up with from theEmergency Department even though the patient may not yet have a relationship with that provider.

· Summary of care documents will continue to go the Primary Care Provider of record when a patient isdischarged from the Emergency Department.

Drug-InducedQT

Prolongation- QTc

Information inEpic

· Prolongation of the QT interval can lead to a life threatening ventricular arrhythmia such as Torsades de Pointeswhich can potentially result in sudden cardiac death. There are a number of commonly used drugs known tocause QT- prolongation.

· The risk of prolonged QT is dependent on patient factors and medication history. The risks and benefits mustbe determined on a case-by-case basis. Consider a baseline ECG prior to starting a new QT prolonging drug,correct modifiable risk factors such as electrolyte disturbance and avoid QT prolonging drugs in patients withnon-modifiable risk factors.

· The Epic team has built a tab with recent QTc results to be displayed when ordering drugs commonlyassociated with QT- prolongation.

eRx ofControlled

Substances -Register with

PDMP

· The Epic team has begun work with the Commonwealth of Pennsylvania to integrate the Prescription DrugMonitoring Program (PDMP) directly into Epic.

· Instead of having to go to the PDMP website - the lookup will happen automatically in Epic and the results willbe displayed while prescribing medications.

· In order for this functionality to work properly, folks need to have an account with the PDMP.· If you do not have an account, please sign up for one at: https://pennsylvania.pmpaware.net/login.

PrescribingOpiods to

Minors 

· To comply with Pennsylvania Opioid Prescribing Laws and MLH policy, on 10/24/18, PIVOT will introduce a BPAto help prescribers of opioids to minors comply with the law and policy.

· Before issuing a prescription to a minor-patient for a controlled substance containing an opioid, the Prescribermust complete all of the following:

1. Assess whether the minor-patient has taken or is currently taking prescription drugs for treatment of asubstance use disorder, and

2. Discuss with the minor-patient and their parent, guardian or Authorized Adult:

a. The risks of addiction and overdose associated with the controlled substance containing an opioid,

b. The increased risk of addiction to controlled substances to individuals suffering from mental orsubstance use disorders,

c. The dangers of taking a controlled substance containing an opioid with benzodiazepines, alcohol orother central nervous system depressants, and

d. Any other information in the patient counseling information section of the labeling for controlledsubstances containing an opioid that the Prescriber deems necessary.

3. Obtain the written consent of the minor-patient’s parent, guardian or Authorized Adult on the state-prescribed form, which is attached as Exhibit “A” (the “Consent Form”). The form must be maintained in theminor-patient’s medical record.

· This policy and BPA will only apply to minors in ambulatory offices, being discharged from the ED or hospital. This BPA will not affect patients who are admitted to the floor.

Process Within Epic:

https://pennsylvania.pmpaware.net/login

· The BPA appears for the prescriber when they attempt to sign the medication order.

· The BPA reminds the prescriber of the law and procedure.

· The consent form can easily be printed from a hyperlink within the BPA.

· Once consent has been obtained, the prescriber can note within the BPA that they have obtained consent andwill scan the consent form back into the chart. If the patient meets any of the exceptions to the law, which aredelineated in the BPA, the prescriber can also document those reasons within the BPA.

· Please remember that before prescribing any new opioid medication, the prescriber or their delegate mustsearch the Pennsylvania PDMP.

It’s Possible:Borrowing

SmartPhrases

· Watch this week’s video via the Epic UserWeb (must sign up for a free UserWeb account if you don’t haveone).

Main Line Health | Well ahead

https://welearning.epic.com/Details.aspx?csn=208244https://welearning.epic.com/Details.aspx?csn=208244