Clinical Guide July 2019

Table of Contents Intervention Overview 3 Intervention Types 4-7 Custom Interventions 8-10 DME Cleaning Interventions 11 Intervention State: New & Active 12-13 Intervention: Discontinue/ Discontinue & Clone 14-15 Medications Overview 16-17 Order Overview 18 How Orders Get Created 19 Order Types 20-22 Processing Orders: New 23-25

Intervention Overview Order Type: Standard & Custom Standard: pre-loaded into the system & attached to standard goal Standard: may include brackets [ ] for patient specific parameters Standard: may have mobile app functionality built in Custom: allows user to create all custom text Custom: allows user to indicate additional mobile app functionality Start Date Defaults to todays date SOC date should be used for initial assess New/Changes Order dates used after initial End Date Should not be used pre-emptively i.e. if cert period ends 3/31 do NOT enter end date of 3/31 End date should be left blank until an order is discontinued Goals Standard Interventions all mapped to a standard goal Standard goals may be used multiple times in single assessment When custom intervention created user may create custom goal

Intervention Type: PRN Will be listed in the PRN tab of the mobile app Any intervention with a type other than PRN can still be prompted to be in PRN section of mobile app if the order states ‘& PRN’ All orders which are only for the 485 should be marked as PRN Any orders which will be addressed in the mobile app in tandem to another order or medication should be marked as PRN Examples include: CPT with each albuterol treatment; flushes after feeds & meds

Intervention Type: By Times May be prompted at specific times in the mobile app Intervals of 15 minutes Commonly used for continuous feeds If a visit starts at 0700 and an intervention has a suggested time of 0700, 0715, 0745 it will appear in the 0700-0800 suggested time block in mobile app If a visit ends at 0700 and an intervention had a suggested time of 0700 it will not show in that visit in mobile app

Intervention Type: Daily, Weekly & Per Shift Will appear in the ‘daily tasks’ group in mobile app Daily: will appear in both day and night shift if both exist Weekly will prompt what day of the week to be addressed Per Shift will appear in all shifts for patient w/i 24 hours

Intervention Type: Frequency Sets the intervention to be prompted at frequency per # of hour(s) Frequency clock starts at the scheduled start time of mobile app visit Many standard interventions include [ ] to indicate # to appear in order on the 485 and matching frequency # must be selected from drop down to prompt intervention in the mobile app Examples include: repositioning patient; suctioning; feeds that are not continuous

Custom Interventions Allows for completely custom text for interventions Intervention Type & Dates function the same as they do for standard interventions Highlighting Additional Detail Required forces mobile app user to enter additional details for this intervention in the mobile app Includes 6 special function options (standard interventions already include appropriate options) Marking an intervention with more than one special function is only appropriate for tube feeds (see special functions)

Custom Interventions VENT: Shows mobile app user vent settings and prompts user to record vent readings. Vent log can be created on the web with this data SEIZURE: Asks mobile app user ‘Did a seizure occur?’ which defaults to no, if changed to yet prompts answers for all seizure activity . Seizure log can be created on the web with this data VITALS: Will prompt mobile app user to record patient vitals TUBE FEED: Will prompt mobile app user to record volume of feed, volume of flush, tolerance & residual. **If this is marked Input/ Output should be marked as well**

Custom Interventions INPUT/OUTPUT: interventions marked as this type prompt mobile all user to record values for the input & output record Input Types: Flush, Input other, IV, Oral Feed, Tube Feed **if Tube feed is selected the Tube Feed special function also needs to be applied (see previous page)** Output Types: Emesis, Output Other, Stool/BM, Stool/Urine Mix, Suction, Urine Output type suction: will prompt mobile app user to indicate suctioning route; tracheal, orally, nasal Measured by: indicated how mobile app user will be recording value of the I/O intervention; amount, count, or not measured

DME Cleaning Interventions DME: This is only used if your company required a formal DME Cleaning Log If adding any standard interventions from the DME section of the assessment only mark as PRN as all standard DME cleaning interventions are marked as DME in the background If DME is checked for a custom intervention, the intervention must be marked as PRN regardless of actual frequency as the DME Cleaning section in the mobile is fixed and never drops off the visit to allow for mobile app users to address DME cleaning at any time during their visit If your company does not use a DME cleaning log (PDF) do not use the DME special function on custom interventions

Intervention State: New NEW (not yet charted against via the mobile app) Once an intervention has been added to a patient assessment/ LPR it cannot be deleted Prior to any electronic charting being completed it can be edited and saved Example: User adds an intervention with a frequency of every 2 hours and realizes it should be every 3. If it has not been charted against via the mobile app, user can edit the frequency and save

Intervention State: Active ACTIVE (has been charted against via the mobile app) Once an intervention has activity & has been charted against via the Mobile App it is no longer editable and all fields are greyed out except end date User has two options: discontinue and clone or discontinue now Discontinue & Clone: as of end date discontinues current order while creating a copy to be edited & saved for order changes Discontinue Now: as of end date discontinues order without copying forward

Intervention: Discontinue and Clone Purpose: An active patient order is being changed Step 1: Enter end date of the current order; i.e. 3/31/19 Step 2: Click Discontinue and Clone and accept acknowledgment Step 4: select start date of new order; i.e 4/1/19 *will default to end date of the discontinued order but should be changed unless both should be active on the end date Step 3: make appropriate changes that reflect the new order i.e. original order was Daily, new order is PRN Step 4: Save Discontinued order will drop below red (discontinued) line & new order is active

Intervention: Discontinue Purpose: An active patient order is being discontinued Step 1: Enter end date of the current order; i.e. 3/31/19 Step 2: Click Discontinue & accept acknowledgment Step 3: Save Discontinued order will drop below red (discontinued) line and no longer be visible in the mobile app after end date.

Medications Overview

Medications: Adding/Updating Standard: pulls rxcui data including standard strength options; allows for interactions to be run against other meds; automatically pulls drug class based on rxcui once saved Custom: medication has no direct link to drug database; all fields, including strength & drug class are custom; interaction cannot be run against other meds Suggested Times: required for Routine Meds; indicates when mobile app user will be prompted to admin med Connected Intervention: if a med is to be proceeded by or followed up with another order this should be connected here; allows mobile app user to indicate med admin and intervention were completed together; i.e. flushes; CPT with neb treatments Order date: Effective date of the medication End Date: Discontinue date of medication *may be set ahead of time if known Controlled Substance: prompts count prior to admin in mobile app Track for Scoring: records frequency med is admin for reporting Is Liquid: prompts mobile app user to record volume for input record Is Antibiotic: prompt reason for & triggers infection logs record

Orders Overview Order states: new; pending MD signature & completed Order types: New, Clarification, Discontinue & Non-Med ID: Every order is assigned a unique order number Patient Name is linked directly to patient’s LPR Last Note can be hovered to view most recent note user saved Attachment: Ability to mark as completed w/ MD Signature PDF of Order Add/ view order attachments

How Orders Get Created Orders are created from patient LPR; Patient Orders & The Mobile App LPR: when a med is edited & saved user is asked if they want to create a new order Patient Orders: Clicking New Order will start process to add order Orders taken directly from the LPR or patient Orders tab default to verbal order: yes and update patient record immediately Mobile App: Clinicians charting in the mobile app may create orders which will submit when they submit their visit Orders taken in the Mobile App default to verbal order: no; if user selects yes medication will be available to admin immediately & impact LPR when visit submitted Orders taken in the Mobile App left at default of verbal order: no; medication will not be available for admin and will not impact LPR until approved in orders. When an order is taken via the Mobile App the next clinician will receive a notice when they clock in ‘Patient Has A New Order Since Your Last Visit’

Order Type: NEW & DISCONTINUE NEW: To be used when a new medication is ordered Non-required fields are Indication, Instruction, connected intervention Physician drop down will show all physicians attached to patient & Unattached Physician to allow for typing a name when an MD is not yet attached to patient profile Suggested times will be grayed out if med is PRN DISCONTINUE: to be used when a medication is being discontinued & not clarified Physician drop down will show all physicians attached to patient & Unattached Physician to allow for typing a name when an MD is not yet attached to patient profile User will have option to select from current list of patient’s active Routine & PRN medications

Order Type: CLARIFICATION CLARIFICATION: To be used when a Routine or PRN med has changed Non-required fields are Indication, Instruction, connected intervention Physician drop down will show all physicians attached to patient & Unattached Physician to allow for typing a name when an MD is not yet attached to patient profile Suggested times will be grayed out if med is PRN User will have option to select from current list of patient’s active Routine & PRN medications Once med being clarified is selected all current fields for the medication will populate & user may make changes Saving order will automatically discontinue to medication that was clarified and create the new medication The PDF of clarification order will show the original and new details

Order Type: NON-MED/COMMUNICATION NON-MED/COMMUNICATION: To be used for orders that are not medications or to record communication notes for medical record. Physician drop down will show all physicians attached to patient & Unattached Physician to allow for typing a name when an MD is not yet attached to patient profile Non-Med/Communication Order get added to the LPR via Ops-Clinical- Orders when they are processed to send to the MD for signature Examples: changes to feeds, flushes; communication notes regarding patient

Processing Orders (New) When an order is created it is sent to Ops – Clinical – Orders: New to be processed By checking the box on the left user may ‘send to MD’ which moves order to Pending MD Signature Status; Delete order if it was created in error; or Complete w/o MD Signature which moved order to a status of completed bypassing Pending MD Signature If an order needs to be edited, user may click on the line to make changes before processing Orders taken by an LVN/LPN will be e-signed by the RN who processed the order Non-Med/Comm order must be processed one at a time to indicate which section of patient LPR they are assigned to

Processing Orders (Non-Med/Communication) From the Order Managers page (New) check the box Click Send to MD The create intervention box will appear If this order does not need to go in the LPR, click skip If an intervention is being added to the LPR select group Create intervention (see slides 2-10) Click Save Intervention The order will be moved to Pending MD Signature The new intervention will be active in the LPR

Processing Orders (Pending MD Signature) Once an order has been sent to MD it is moved to Pending MD Signature By checking the box on the left user may delete order; re-send to MD which updates the ; Delete order if it was sent in error; or Complete w/o MD Signature which moves order to a status of completed Re-send to MD will update ‘Date sent to MD’ Adding an attachment will prompt user ‘Mark as completed with Signature?’ If yes completes order Once an order is completed drops off list and is marked as completed in patient chart Adding an attachment functionality also works directly from individual patient chart – orders tab

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