1. Be Prepared HED AND HEO/WIZ DOWNTIME

2. Saturday May 12, 2012 at 700pm Till approximately Sunday May 13, 2012 at 1200pm Downtime for: Order Entry (HEO/WIZ), Nursing Documentation (HED), Nursing Med Administration System(Admin_Rx) HED AND HEO/WIZ DOWNTIME

3.  Downtime Kits must be replenished, this kit includes:  A. Downtime Policies;  B. Laminated Downtime Checklist;  C. Physician Order Sheet (POS); E-Procurement: Order ASAP  D. Nursing Flowsheets;  E. Medication Administration Records (MARs);  F. Downtime Requisitions;  G. Other unit-specific documents.  H. NEW Documents to be added to the downtime kit:  VCH Patient Discharge Instructions (MC 4085); VUH Patient Discharge Instructions (MC 2418) COPY CENTER: ORDER ASAP  Policies: Insulin and Heparin Gtt Protocol, Restraints, Braden, Fall Risk, PCA, Epidural  Assessment Guidelines VUH and VCH PREPARING FOR DOWNTIME

4.  Order Copier Paper  Order Labels  Order Addressograph Labels  Order Black Pins  Increase Staffing  Replenish Downtime Kits PREPARING FOR DOWNTIME

5.  Early Saturday Morning – For pts. not being discharged by 5p  Place Physician Order Sheets (POS) in blue charts TWO per chart, with patient labels attached on all three pages, DO NOT ADDRESSOGRAPH  Print 2 Downtime Flowsheets for each patient place labels, DO NOT ADDRESSOGRAPH  Print 2 Fall Risk Assessments for each patient place labels DO NOT ADDRESSOGRAPH  Print 30 labels for each patient  Pharmacy Fax Numbers posted near fax with time of day  VUH – 7a-7p 39879  VUH – 7p-7a 31640  VCH – anytime – 66402  VPH – pharmacy rounds during day,  VPH – 7p-7a – 31630 WHAT TO DO WHEN MEDICAL RECEPTIONIST (CONT)

6.  5pm Saturday  Check printer for paper (Paper MAR’s will be coming)  PRINT OPC and any other routine shift change printing  Transfer Order Sheets on all patients.  Place TOS in patient’s chart  Pharmacy will generate MAR, place in blue chart  Print Assessment Guidelines, place in every blue chart  Charts to Bedside  During Downtime  Process Physician Orders – See algorithm  If electronic scanning, scan POS in EMR  MR will annotate “DT” on POS beside all non-medication orders to indicate to RN orders need to be entered into HEO/WIZ  Transcribe Medication orders to MAR  Complete requisitions (lab, radiology) and call ancillary departments PRN  Requisitions with serial times (i.e., Q6H), will be filled out through end of downtime on 5/13 at 1200p WHAT TO DO WHEN MEDICAL RECEPTIONIST (CONT)

7.  During Downtime Continued  Remind Physicians to give POS to the Medical Receptionist  Rounding on Blue Charts for Orders  Transfers: Physician will amend TOS, and transfer patient. Receiving unit will process TOS as if it were a Physician Order Sheet.  Scanning Units  After 7am Sunday Morning  Blue Chart Check to look for documents to be scanned  Nursing Flowsheet  POS’s missed  other WHAT TO DO WHEN MEDICAL RECEPTIONIST (CONT)

8.  5pm Saturday  Renew all restraint orders  Planned Priorities and Nursing Summary complete on all patients  Night Shift WILL NOT do Priority Problems or Nursing Summary  Nurses will need to transcribe cumulative Intake and Output for their shift on the 7p-7a downtime flowsheet  Ensure OPC and Transfer Order Sheet are printed (MR to Complete) WHAT TO DO WHEN RN’S

9.  During Downtime  Helpful Information (Downtime Kit )  Assessment Guidelines will be in each chart  Policies for Restraints, Braden, Epidural, Fall Risk, Insulin gtt protocol and heparin gtt protocols  How to complete a MAR  How to complete a POS  Process and Verify Physician Order Sheet (POS) requires signature  Verify and Process Medication Administration Record (MAR) requires signature  Transfers: After MR processes Transfer Order Sheet (TOS), RN will verify and process orders as if it were a POS requires signature  Admission History:  VCH/VUH: Positive for CPAP, POS will need to be filled out and respiratory called.  Adults: If a positive screen for pneumovax, POS will need to be filled out and sent to pharmacy WHAT TO DO WHEN RN’S (CONT)

10.  During Downtime Continued  Discharge: Discharge will be written on POS and prescriptions printed through Rx_Star. Discharge Instruction Sheet completed and sent home with patient  MAR’S for Sunday will print after midnight Saturday. MR’s place in Blue Chart  RN’s will verify Sunday MAR with Saturday MAR, annotate changes and schedule changes and fax to pharmacy. WHAT TO DO WHEN RN’S (CONT)

11.  RN’s  HEO/WIZ  From the POS and TOS, all non-medicated orders to be entered into HEO/WIZ, only exception completed one-time orders  NOTE: PHARMACY WILL ENTER ALL MEDICATION ORDERS  Admission History  Consult orders will need to be entered.  Care Organizer  Confirm Medication Orders with paper MAR. Send message to pharmacy via Care Organizer for corrections WHAT TO DO WHEN AFTER DOWNTIME (APPROXIMATELY NOON SUNDAY MAY 13)

12.  RN’s Continued  HED  Admin Rx, medications with outstanding schedule need to be addressed  Asmnt/Interventn Tab, document start of downtime and end of downtime.  RN Enters Cumulative Intake and Output for Saturday and Sunday  Example of Back time for Saturday’s Cumulative from paper flowsheet, (3/12/2012, 0645).  Will need to subtract what was charted from 7a-7p on 3/12 in HED from 24 hour cumulative from the paper flowsheet.  Sunday’s cumulative will be the current cumulative from the paper flowsheet.  Restraint Orders renewed  Priority Problems with goals back time to morning shift, and completed at end of shift Planned Priorities and Nursing Summary. WHAT TO DO WHEN AFTER DOWNTIME (APPROXIMATELY NOON SUNDAY MAY 13)

13.  MR’s  Scanning Units will scan documents in to EMR  Downtime flowsheets  Downtime POS (physician order sheets) that were missed  TOS (transfer order sheets) that were missed  Re-locate charts per unit protocol back to location for scanning  All units  Remove and Discard all unused downtime documents with patient labeled attached.  Remove and reuse any downtime documents that haven’t been labeled or used and place back in downtime kit.  Remove Transfer Order Sheets WHAT TO DO WHEN AFTER DOWNTIME (APPROXIMATELY NOON SUNDAY MAY 13)

14. POS KEY

15. MAR MR KEY

16. MAR RN KEY

17. LAB REQ KEY

18. CRITICAL CARE RESPIRATORY CARE LAB KEY