1. Introduction to the EPIC EMR System at Salem Hospital
EPIC for Paramedics
Introduction to the EPIC
EMR System at
Salem Hospital

2. Logging Into Hyperspace
To log into Hyperspace
a User ID and password is required
Salem Hospital will issue a user ID and password to you
You will need to change your password at your first log in
Never share your password with anyone
It is your electronic signature

3. Hyperspace log in Screen

4. Epic Rules A “Stop” sign indicates information must be entered
If “Accept” and “Cancel” are choices, you must choose one
An ellipsis requires an exact choice from a drop down list
Searching using the first 3 letters of key words will assist in finding information

5. A drop down menu will appear when the ellipsis is clicked

6. More Epic Rules Work spaces are usually highlighted in dark blue
If there is an ellipsis for time and date you can use the following:
T= today (If you want to say 2 days ago use t-2)
W = week (If you want to say last week use w-1)
M = Month (If you want 3 months ago use m-3)
Y = Year (If you want 5 years ago use y-5)
N = Now (If you want a time 1 hour earlier use n-60)

7. Home Workspace After login
Home workspace appears
Create a “My List” for your list of assigned patients
You only need to create your “My List” once
May add and remove patients on a daily basis to reflect your current patient list

8. Home Workspace

9. Creating a “My List” With “My Patient’s List” highlighted in dark blue
Click on “Create” button
Enter your name in the stop sign row
Click “Copy”
Click “A Nurse List”
Click “Accept” in the small box
Click “Accept” in the big box

10. Create A “My List” 1. Give your “My List” a name 2. Click “Copy”
3. In “Available Columns” box, click on “A Nurses List”
4. Click “Accept”

11. Adding Patients to Your “My List”
There are two ways to add patients to your “My List”
Drag and drop unit home list into “My List”
Find unit list under expandable list - “System List”
Look under “Units” to find your nursing unit
Once you find your unit, drag it up to your “My List”

12. Adding Unit List to “My List”
Click and hold your Unit - drag and drop in your “My List”

13. Add Patients to Your “My List”
To add specific patients to your “My List” (must know patient name or room number)
If using room number – drag and drop individual patient from your “Unit List” into your “My List”
If using patient name – highlight in blue - “My List”
Click on “Add Patient”
Use the “3,3” rule – first three letters of their last name and first three letters of their first name to search for patient

14. Add Patient Using “3,3” Rule
First 3 letters of last name, comma & first 3 letters of first name

15. Add Patient Using “3,3” Rule
Click “Add Patient”
Use the “3,3 Rule” to find your patient
Click “Accept”

16. How a “My List” Looks with Patients

17. Removing Patients from “My List”
Your patients (with black icons next to their name) will stay in your “My List” until you remove them
To remove a patient
Click on patients name
Click on “Remove” button
Your “My List” (with red and blue icons next to it) will be automatically updated as the unit census changes

18. Removing a Patient from “My List”
Highlight the patient name & click “Remove”

19. Opening a Patient’s Chart & Getting Report
To open a patient’s chart from your “My List”
Highlight patient name & click “Open Chart”
Patient Summary Activity opens
Activities are gray tabs on left side of chart
To get report on a patient
Look at all reports under “Patient Summary Activity” – (more reports are available under double arrows on the right hand side of screen)
Receive verbal report from off-going nurse

20. Patient Summary Activity – Get Report
Reports
Activities

21. Chart Review Activity Chart Review
Best for looking at old records on patients
Lab Results, Imaging Results, Past Medications are all located here

22. Chart Review Activity
Lab results under this tab

23. Documenting Vital Signs - I&O - Lines & Drains
Found in Doc Flowsheet activity
Documentation of vital signs, I & O, Lines and Drains
Vital signs flowsheet is the default flowsheet
Automatically opens when clicked
To add columns
For current time, click “Add Column” button
For any time from the past, click “Insert Column” button - change time and date if necessary
Blank columns will disappear

24. Vital Signs – Doc Flowsheet
To move up or
down in flowsheet
click on gray
boxes above, or
scroll on the right
Notice a column is
placed for the top
of the hour

25. Documenting Vital Signs
Document vital signs, ADL’s & Intake & Output at time taken
Value documentation is done at time of care
Details box provides choices from a row with an “ellipsis”
May make multiple choices from “ellipsis” rows
Example:
Documenting Oxygen source, charges the patient for the use of the O2 and th equipment for the day (only charges them once a day no matter how often you document source)

26. Documenting Vital Signs

27. Doc Flowsheet – Saving Information
Changing flowsheets, activities or closing the chart will automatically cause data to be saved
Note: Any information entered into a Doc Flowsheet will automatically be saved - whether you file the data or not!!

28. Doc Flowsheet – Saving Information
Editing data
Click on data to be changed
Type in new data
Click “File”
Note: This triggers the “Show Audit” alert to display on bottom of screen

29. Edited Data on Doc Flowsheet
See “Hide Audit”
hyperlink on bottom
of screen
Initial data and
changed data are shown

30. Documenting On Intake Flowsheet
Anything going into
the patient is
documented on
the “Intake” flowsheet

31. Adding a Line to Intake Flowsheet
Adding a line (Peripheral IV line, PICC line, Central Line or Enteral Feeding line) - must be in “Intake Flowsheet”
Click “Add LDA” button
Choose line type for ellipsis
Click “Accept”
In “Properties” screen fill in the appropriate areas
A “line” on the Intake Flowsheet is added
Blue hyperlink describing a line is created

32. Properties Screen for Adding Line

33. Intake Flowsheet - Lines Added
Note: line groups added to gray keys
Note: blue
Hyperlinks for
each line within
the flowsheet

34. Intake and Output Documentation
Documented in “real time”
Includes: PO intake, IVPB’s, IV boluses, bolus tube feedings, and water/saline flushes
Maintenance IV fluid volumes, continuous IV drips, continuous drips
Documented at end of each shift
Voided, straight cath, incontinent urine and all stools
Recorded as they are noted by the caregivers

35. Output Flowsheet Documentation
Document all output’s
Adding a drain, chest tube, urinary catheter or ileal conduit
Click on “Add LDA”
Follow same steps as adding a line to “Intake Flowsheet”

36. Output Flowsheet with a JP Drain
Note: document
drain output
in this row

37. Intake & Output Activity
View only activity
Provides summary of I&O per shift
Viewed in
Table form
Graph form (note the 3 days graph and 7 day graph buttons)
Note: Quickest way to see any shift’s total I&O

38. Intake and Output Activity

39. Notes Activity Notes - written for significant events
Admission, transfer, discharge, patient fall, etc.
Nurses write “Progress Notes”
Click on “Notes” activity
Click “Progress Note”
Click “New Note” to create new note

40. Notes Activity Free type your note in this blank space
Click “Accept” when completed

41. Results Review Review new lab or imaging results
Go to “Results Review” activity
May be viewed by test, by all results, by date, by multiple dates, etc.
To change views click on “View” button
To change dates - click on “Hide Data Prior To” then change date
To mark you have seen results
Click on “Time Mark” button

42. Results Review Clicking on “Time Mark” will change results from
italics to bold, and will
cause them to not show
as new results

43. Point of Care Tests Three point of care tests that result into EMR
Capillary Blood Glucose
ABG’s
ACT
Example: CBG
Scan Namebadge
Scan patient’s armband
Scan glucostrip bottle
Perform test and read result
Dock glucometer in docking station (sends results to patient chart)

44. Medication Administration Record
The MAR Activity
Documentation of medications administered
Legend
Identifies meaning of specific colors, icons, and codes

45. MAR Legend

46. Tabs of the MAR MAR tabs All Tab – all medications alphabetically
Scheduled Tab – all scheduled medications alphabetically
PRN Tab – all prn medications alphabetically
Continuous Tab – all maintenance IV fluids and continuous IV drips alphabetically
Protocols Tab – all protocol medications
RN Verify Tab – a list of new medications that RN must verify against written order before administering first dose
RT tab – all RT administered medications alphabetically
Discontinue tab – list of discontinued medications

47. Tabs of the MAR
Legend
TABs

48. Administering Medications
Steps to medication administration
Always barcode patient’s armband first (this ensures you always have the right patient - also opens patient’s chart to the MAR)
Barcode each medication
Change any details for the medication – i.e. action of given, held, missed, due, the rate or dose
Type in any comments
Click “Accept”
Scan your name badge

49. Admission of a Medication Screen
information
Medication
Information
Action types
to choose from
when documenting
any action for a
medication

50. Given Medications on MAR
Given meds
are green and
underlined

51. IV Piggybacks Administering IVPB Open “Doc Flowsheet” activity
Mark action as “Given” on MAR
Note amount of fluid to be infused
Open “Doc Flowsheet” activity
Open “Intake Flowsheet”
Document amount of volume

52. Documenting IV Fluids on the MAR
Documentation of maintenance IV fluids
Navigate to “Continuous” tab of MAR
Locate IV fluid to be administered
Click on “white” space time frame
Choose “New Bag” action
Ensure correct rate
Click “Accept”

53. Documenting IV Fluids on the MAR
Note action of new bag

54. Changing IV Fluid Rate on MAR
Change rate on IV
Click “Continuous” tab of MAR
Click on the “white” space for IV fluids
Administration screen opens
Change the action to “Rate Change”
Change the rate
Click “Accept”

55. Changing Rate of IV Fluids on MAR
Note: Action of rate change
and rate changed to 150
A warning of the pink “i” in a circle alerting change in rate from ordered rate

56. IV Bolus on the MAR Open MAR
Administering bolus from a current IV fluid bag
Click “white” space for time to begin bolus
Choose action of “Bolus”
Change rate
Click “Accept”
Administering bolus from different IV fluid
Locate bolus under te “prn” tab of MAR
Click on “white” space for time

57. IV Bolus on MAR
Action is “Bolus”

58. Documenting IV Volumes on Doc Flowsheet
Document Maintenance IV volumes
Open Doc Flowsheet Intake flowsheet
At end of shift or at transfer
Document IV volume infused during shift
(Note: You can chart left to count fluid in the left to count row - it is an information only row)
Document IV Bolus volumes
In IV volume row
Document bolus volume as bolus begins

59. Titratable Medications on MAR
Located in “Continuous” tab of MAR
Also on “Intake” flowsheet
Administering new titratable drip medication
Open MAR
Locate medication
Click on “white” space for time
Enter action of new bag
Ensure correct rate/dose
Click “Accept”

60. Titratable Medication on MAR
Ensure rate is correct
for patient weight

61. Titrating Medications
Titrating medications after adjusting rate on pump
Open “Intake” Flowsheet
Locate correct medication group
Add column for real time
Click on dose or rate row
Click on syringe icon
MAR opens
Choose action of “Rate Change” - change rate
Click “Accept”
“Intake” flowsheet opens - shows changed dose and rate

62. Titrating Drips on MAR

63. Calculating Titratable Medication Volumes
On “Intake” flowsheet
Volume row is seen for each titratable medication
Calculating volume and clearing row for next shift
Add column
Click on volume row for drip
Click on calculator in that row (this brings up calculated volume)
Verify volume matches volume on pump (if not use the pump volume if it was cleared by last shift)

64. Calculating Volumes on Intake Flowsheet
Calculator
opened
Calculator

65. Closing a Patient Chart
To close a patient chart, click on the “x”

66. Logging Out of the System
Click on “Log Out”