1. Clinical Guide
July 2019

2. Table of Contents Intervention Overview 3 Intervention Types 4-7
Custom Interventions
DME Cleaning Interventions
Intervention State: New & Active
Intervention: Discontinue/ Discontinue & Clone
Medications Overview
Order Overview
How Orders Get Created
Order Types
Processing Orders: New

3. 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

4. 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

5. 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 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

6. 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

7. 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

8. 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)

9. 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**

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. Medications Overview

17. 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

18. 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

19. 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’

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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