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Hi,
I am attaching our training packet for when we went to 5.4 and began using
the status board and flow sheet. Please feel free to adapt as needed.
Carol Petrusky
Carol Petrusky RN, BSN, BC
Patient Care Informatics Analyst
Parma Community General Hospital
Phone: 440-743-2334
Fax: 440-743-4047
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Monday, August 21, 2006 10:22 AM
To: [EMAIL PROTECTED]
Subject: [MEDITECH-L] status board training
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Good Morning
We are in the process of upgrading to 5.5 and I am wondering if
anyone has a training package for the status board and flow sheet functions
that they would be willing to share.
Normy Frazer RegN BScN
Clinical Applications Analyst
Norfolk General Hospital
Simcoe, ON
[EMAIL PROTECTED]
519-426-0130 x 1456
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RN/LPN
GENERAL TRAINING ISSUES-November 2004 - Instructor to use OETRAIN with
password TRAIN
Introduction:
Welcome to this training session. Today we will be covering the improvements
and updated documentation processes in the 5.4 version of Meditech. We will
be going live with the upgrade on December 4th. We want to let you know that
most of the pathways you now use to document remain the same - you still have
Process Interventions, Assessment routine, Plan of Care, and Patient Notes.
We will be covering new ways to document using the Integrated Desktop with the
Status Board and Flowsheets. We will be showing you a new way to access all
this information. Please do not click onto or go into any routine until you
are instructed to do so.
To begin the training session please click on the Meditech icon that says HCIS
and has a blue background. Select #3 Test Application 5.4. Sign in with your
assigned user ID and password, TRAIN.
Before when you went into the red screen you may have had several different
numbered choices but now, most people will only have 2 choices, MIS and PCI
databases. This is an example of a Numeric Menu.
Select #1 MIS to reach the next type of menu which is a Desktop that has
multiple icons
o The icons you see here are based on your job description and access.
To move around the screen:
- Move from icon to icon using the up and down and right and
left arrow keys or single left click on the icons using the mouse
- The text will be highlighted in blue as you move either by
using the arrows or clicking on the icon with the mouse. To
go further into the routines, either single click on the icon or
when the text is highlighted in blue press Enter. You will then
either move into a routine or a Cascade menu will drop down
with multiple function choices for you.
Please click on Magic Office. This shows you the third type of menu, the
Cascade menu a drop down box with Icons and routines. A routine with an arrow
on the right indicates there is a sub- routine for that selection
In a Cascade you can make a selection several ways:
o Using a Mouse - move the mouse to highlight the desired selection and
click on it to enter the routine or sub-routine
o Using the Arrows - use the up and down arrows to highlight the desired
selection then, press enter to display the additional routines or use the
right arrow to move into the additional routines. Press enter to go into
the routine.
o Using a Shortcut - press the underlined letter in the word and either
Enter or left click onto the selection.
There are a few common icons used in Cascades:
Printer - indicates a Print routine
Pencil - indicates an Enter/Edit routine
Monitor - indicates sub-routines are attached
Magnifying Glass - indicates it is a View routine
X in a red circle - indicates a Delete routine
There are several ways to exit from a menu:
o Esc--Escape will get you out of most screens as well as clicking on the
small X in the upper right hand corner of screen or click on the button
marked Exit on some screens or type in the underlined letter X. When a
Cascading menu is in use, clicking anywhere outside of the menu will also
exit you from the routine.
Navigation Bar on the far right hand side of the screen - (Hold mouse over
icon and description will appear just like windows)
Explanation of symbols on Navigation bar - Please don't click on anything
unless we instruct you to.
o Green checkmark - same as Magic OK key or F12
o Red X - same as Exit or F11
o Blue question mark - same as Help key or Shift +F8 documentation lookup
o Binoculars in Process Interventions - same as Lookup F9
o Colored Screen - same as Magic Key or Split Screen (Shift + F12) with
the addition of Session Management. Session Management suspends the
session you are working in thereby locking the terminal/PC you are using
the time out rules however, still apply. You will have to re-enter your
password to return to the session you were working in. Demo this
o Hammer and Screwdriver Tools - will bring up the calculator when you
click on it while you are in the MIS Desktop
>From the Blue Asterisk on down the keys are better utilized in Process
Interventions.
o Blue Asterisk - when used in Process Interventions allows you to
checkmark a single intervention same as the Right Control key(can toggle
between check and uncheck) toggle - go back and forth between 2 items
o Green Checkmark with All - when used in Process Interventions places a
checkmark in front of each intervention same as Shift+ Right Control key
(can toggle between checked and unchecked)
o Blue Arrows move up, down, right and left just like arrow keys on
keyboard
o Green Up/Down arrows - same as Page up and Page down on keyboard
Click on the Patient Care Module to access the Integrated Desktop. Once we
are inside explain that the whole screen is the Integrated Desktop and the
smaller white screen where the patients are listed is the Status Board. From
this point forward, please do not go into or click on things we have not shown
you specifically, the ACK (acknowledge) and Results because once you click on
these flags and viewed them they are removed from your Status Board and we
need them for the next classes.
Just to remind you:
o Keyboard shortcuts (Underlined letters) - found in menus and on buttons
on Integrated Desktop, anywhere you see an underlined letter that's a
shortcut.
o The Function Keys (F keys) as well as the usual keys will still work
when you are working in Process Interventions or the Integrated Desktop.
o Explain headers at top of status board
Room/Bed-Pt's admitted/assigned location
Location is where the patient is temporarily located like dialysis, OR,
etc.. The temporary location must still be entered in the Administrative
Data screen.
Name - Patient's name
RN/LPN - clicking on the name brings up the admission data screen AKA
patient snapshot
Color behind names most will be blue unless the patient has a same last
name in the same area. It will then turn yellow. This is a flag for
you to make sure you are selecting the right patient.
Black highlight bar on a patient name shows where your cursor currently
is. When you click on the buttons to the right, you will go to that
module and the patient's name in black will be the one that defaults
in.
Caregiver - Staff members who are caring for the patient. A plus
indicates that more than one caregiver is assigned to this patient. You
can click on the plus sign to see all the caregivers who are caring for
the patient. This may be a long list because it contains all the
caregivers from all the shifts.
Age/Sex - Age/Sex of Pt
Diet - Patient's current diet - Click on diet gives you full diet name
Attending - Name of attending physician. You can click on the physicians
name to display his address and phone number from the Provider
dictionary. The information you have in your floor physician book or
rolladex will not be contained here like, if a doctor wants you to page
him first or always call the answering service.
Other Dr(s) - Other providers on patient case. If only one will only
have one name. If more than 1, + sign appears. To view the additional
providers click on the plus sign and a screen will show you their names.
Click on individual names on the list to see the physician information
from the Provider dictionary.
Next Int - Time of Next Scheduled Intervention - click on a patient to
display the interventions for that patient and then discuss the color
differences.
Black - coming up or still within the current time frame
Red - overdue and needs attention
No time - If an intervention has no directions attached to it
then no times will be generated and nothing will show here to
let you know that an intervention is due. It may also indicate
that the admission process has not been completed and the
interventions have not been added yet.
Document on an intervention and discuss the screen buttons:
Process Int - takes you to Process Interventions
Document - click on this button after you have highlighted the
intervention you wish to document on.
Time Period - skip this
t
falls off the screen and it doesn't matter who documents it.. It can
be an RN , LPN, or PCA.
Next Med - Time of Next Scheduled Medication
o Will become important with EMAR(electronic medication
administration record)/BMV(bedside medication verification or
barcoding) which will be coming in the 2nd quarter of 2005.
Orders
o Lets you know there are new orders entered on your patient.
Will learn to acknowledge them the 1st quarter of 2005.
Results
o Lets you know there are new results on your patient By clicking on
the results, it will take you to PCI to view the new results but,
once the results have been viewed they drop off the Status Board.
The Green boxes with the white arrow at the bottom right of the last column
indicate that there are more Headers to view. You can view them by clicking
on the green box with your mouse or by clicking on the Blue Arrows in
the Navigation Bar
DOB
One of the patient second identifiers is the patient DOB
T/P/R/BP
Most recent set of documented vital signs
If there are Green boxes in the bottom left of the Status Board, this means
you have more than 11 patients on your list and you can view them by clicking
on the down arrow box.
Some of the information that is shown here on the Status Board will be used as
a reference for shift to shift report. As time goes on, we may modify/add to
the headers to meet the needs of the individual units.
Buttons - Located at the bottom and side of the status board
o Underlined letter on button is a keyboard shortcut
o Clicking on button takes you to item listed on button
Buttons at the bottom of the Status Board show you how to manage your list of
patients.
o Location - Allows the caregiver to see all the patients for a specific
location. This will be dependent upon whether you are restricted by
location or not but, most people are restricted by location. This
feature can be used to temporarily cover patients from another district
but , most of the time you will be working from your own list of
patients. Demo toggling to My List and back to Location
o Find Patient - Allows the caregiver to locate a patient not currently
on the status board. (This too, is dependent upon whether you are
restricted by location or not.) This feature is just a temporary
addition to the list. The patient will not stay on your list once you
exit out and come back in.
o Manage List- RN/LPN's can adjust their own list. It's a way to do an
on-line assignment. To manage your list type in your mnemonic. We don't
need to worry about the HH or handheld Format because we don't use any
handheld devices. Don't use the first section, Patient, because if one
of your patients leaves and you get another patient in the same room they
will not automatically be added to your list. Instead, add patients to
your list by using the room numbers but, please include the empty rooms
as well so that no matter what patients are admitted they will
automatically show up on your list .
o Options - Allows the user to adjust the timeframe of the interventions
on their screen or the number of hours before and after current time.
The default is 4 hours before and 4 hours after the time the intervention
is due. Explain that: if you have an intervention due at 0800 then, you
will see it on your Status board starting at 0400 and remaining there
through 1200. At 1201, the intervention falls off your display so, it is
even more imperative that we document in a timely fashion. To see the
big picture, at the end of the shift you can adjust the times to look
back and see if all the interventions were completed for the past 4, 8,
or 12 hrs. This time adjustment will only be for this one time just like
it is when you go into Select Interventions to see interventions that
have been completed. When you go out and come back in the default time
of 4hrs will return.
Status board format space - Shows the default status board for user
by caregiver type. Will later have additional types that can be
accessed via this space.
Buttons down the side of the Status Board - Depends on caregiver type and
job responsibilities. Please make sure your assigned patient is highlighted.
o Allergies - shows patient allergies. Click on the button to see the
full screen. Click on Detail to see additional information. This is the
allergy information that is entered on the Nursing Admission screen,
Administrative Data screen, in Order Entry, Dietary or in Pharmacy and is
shared by all. Exit - will take you out of this screen
o Administrative Data - Formerly #8 on the Order Entry screen - Takes you
to the patient administrative data screen. Become familiar with this
screen as it will become the online kardex in the months to come. Exit
returns you to the Status Board.
o Archive - Takes the user to the patient care archived reports
o Flowsheet - Takes the user to the Process Flowsheet - one shown is the
Med/Surg but, there will be a Critical Care flowsheet as well.
Items with (+) mean there is more information under this section.
Items marked with (-) mean there is no information currently on the
flowsheet for this section.
Sections is greyed out and it is a function we are not using at this time
Document - Allows you to document information into the flowsheet by
clicking on the document button. When you click on the word Document a
listing of the interventions attached to the flowsheet will appear.
Click on the intervention(s) you wish to document on. (Please note that
you can document multiple interventions in this way but, only for a
single time using this method). We are going to practice this by
selecting Weight, Monitor and then click on OK. When you are finished
documenting file the document. Now there is a plus sign beside Weight
which shows that there is information under this section.
Graph -- The graph button at the bottom defaults to a Vital Signs graph.
To see a graph for another intervention, you click on the specific
intervention value. This brings up a screen with multiple button
choices:
All Values - Shows all values for the intervention and to bring up a
graph first click on this to pull in all values
Edit - allows you to change the intervention values
Document - allows you to document another one of the same
intervention
View CDS - shows you the completed intervention screen
Graph - shows you the graphed values - this can be of great value
when we start documenting our meds online because we can correlate a
med with the statistics you are seeing.
o Time Period - Allows the user the ability to see the current flowsheet
that you are displaying as well as change the display date and time.
o Click on the date field and a calendar will appear so you can
choose a different date
o Click on the time field and a pop-up number pad will appear so you
can click in the time.
o My List - When you click on My List it displays your list of patients
on the Status Board. You may document from this area by highlighting the
patient you want to chart on. Click on the intervention listed in the
Next Int column. A list of interventions will appear with assigned times
and directions. Highlight the desired intervention and click on the
Document button at the bottom of the screen. Adjust the time of
occurrence if needed, and proceed to document in the usual manner.
o Worklist - This takes the user to the list of their patients where they
can select one, several or all patients on the list by clicking on the
patient name to highlight them. The listing of intervention(s) to be
done for the patient(s) sorted by time in ascending order (oldest to most
recent and beyond. Remember that you can only define one time for all
the interventions.
When you move around in the following routines, you can still use all the
usual keys and functions but, you can save time and use the mouse to click on
the selections as well.
o Assessment-Takes you to the Assessment routine in the Patient Care
Module - talk about Set Stamp(changing the time) vs real time. If you
need to change the time of an intervention then, you must first set the
stamp then go ahead and document on the intervention.
o Process Intervention-Takes you to the Process Intervention Routine in
the Patient Care Module where you can document in the same manner you
always have. The patient you have the black highlight bar on in the
Status Board will default into Process Interventions for you. Go to
Process and talk about using the mouse to click on the verb strip and
individual interventions.
o Plan of Care-Takes you to the Plan of Care routine in the Patient Care
Module. Go to the Plan of Care and discuss the importance of not
entering the name of the care plan in the Plan of care space and demo how
to add a care plan under the Diagnosis section using the / and doing a
lookup into the Plan of Care dictionary. Explain that the reason we
need to do it this way is because if the patient has multiple problems
with multiple care plans only the care plan that was entered last would
show as the care plan and not present an accurate picture of the patient.
JACHO questioned why only one care plan was listed for people with
multiple problems.
o Pt Notes-Takes you to the Patient Notes routine of the Patient Care
Module. Go to patient notes and discuss using the mouse to click on the
selections and how to move into the notes.
o Print Report-This routine takes you to a listing of other options that
you may need to access right from this screen without exiting the screen.
It includes the following submenus and their routines per role based
access rules: See Handout.
RN/LPN Departmental Reports-101
Enter Department Reports-10
Enter Department Orders-11
Process Department Orders-12
Process Department Reports-13
Audit Trail-18
Enter Department Charges-41
Enter Batch Department Charges-42
RN/LPN Medication Reports-704
Enter Stock Orders-2
Print MAR's-20
Hospital Formulary-30
Print Profiles-53
Discharge Medications-80
Drug Monographs-91
Daily IVPB Count Report-100
Daily IVPB Count Detail Report -101
Nursing Station Worksheet-102
RN/LPN Miscellaneous Reports-707
Height/Weight Census-10
Height/Weight Exception-20
Height/Weight Exception (Outpatient)- 21
Worklist by Location-30
Worklist by Category-40
Dailys Worklist-41
Nursing Procedures Log-50
View Work Requisitions-60
Floor Drug Stock Location-70
Dietary Rescreening Worklist-91
EKG Worklist by Location-100
RN/LPN Patient Care Reports-709
Process Interventions by Location-7
Patient Profile-11
Patient Flowsheet-14
Audit-17
Print Multiple Pt Chart Reports-19
Print Census with Note area-12
Print Census -13
Print Bed Roster- 14
Print Worklist- 16
Print Condition/Special Considerations-15 from OE
Rounds Report (without PCI) - 103 #31
Rounds Report by Doctor (without PCI) - 103 #32
RN/LPN Order Entry Reports from OE
List Patient Orders-5
List Incomplete Orders by Patient-4
List Unverified Orders-3
Review orders by Order Date-2
Review orders by Service Date-6
Enter Requisitions-11
List Current Diets-16
Order Audit Trail-10
RN/LPN Scheduling Reports-708
Scheduled Patients by Location-20
Inpatient List Appointment for the One Pt-40
o Orders-Takes you to Order Entry - Initially, Review Orders by order
date with the ability to Enter Orders, Print Orders, etc.
o PCI - Takes you to PCI
o E-Mail - Takes you to Meditech Email
o More- Will not be using this until later
Additional information - Directions
o All interventions for NUR or orders need to have directions, even if
they are .prn type directions to appear on the patient caregiver
worklist. Interventions MUST have timed directions on them just like all
the Respiratory Therapy interventions do now or they will not appear on
the Status Board and unless you check either the Worklist or Process
Interventions, you won't know what interventions are to be done for the
patient!
Default directions for some interventions by location can be changed at the
time of ordering if the physician changes the standard times. Demo this: Click
on Process interventions, type in EO which will take you to Order Entry.
Enter a NUR order for Vital Signs. Use Shift and Right arrow at the order
line to get to the directions screen and change the directions to Q4H
Stress the need to change the time to correspond with the usual times we
perform interventions - on the hour instead of leaving times at 1352 for
instance. Please do not file this order.
Ways to include directions
Shift + Right arrow at the order line will get you to the directions screen
in order entry.
CD - Change Directions from Process interventions will change directions on
existing interventions.
Can use look up, or other conventions (see directions sheet handout)
Text/directions needs to be updated on the intervention itself and not a new
intervention added. While we are in Process Interventions, we are going to
change the directions on the intervention Intake and Output to every 4 hrs by
using [EMAIL PROTECTED],04,08,12,16,20. Highlight Intake and Output and enter
CD
for Change Directions or click on it. Change to [EMAIL
PROTECTED],04,08,12,16,20
and file.
We have touched on a few new things as we covered the update today and
these are our plans for the future:
On January 5th or 6th, we will activate the new and revised list of
interventions, screens, and streamlined Care Plans.
In the first quarter of 2005, we will introduce the On-line Kardex and train
you how to acknowledge your orders on-line and to use the kardex.
In the second quarter of 2005, we will be bringing RN/LPN's back for training
with EMAR ( Electronic Medication Administration Record) and BMV(Bedside
Medication Verification or Barcoding).
Sometime within the next 2 years, we will be training for CPOE or
Computerized Physician Order Entry!
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