Continue the great work! Updates from today:

• For ED Boarders:
  • If you need to add additional orders outside of Gen Med Admit, make sure the patient’s status is “ED Boarder” and not ED. Otherwise all orders will get routed to the ED pharmacy and lab.
  • Make sure to specify first dose timing for all meds. If medications are needed STAT for ED boarders, verbally communicate this to ED nurses.
  • Night hospitalist residents should list themselves as primary contact for all overnight admits.  Teams assuming care in the morning should sign up as primary contact during sign-out
• Use “Slides Wright Giemsa Wright Stain” for peripheral smears
• Adding favorite folders to quick orders tabs
  

• Specimens from procedures: once the specimen is collected and labeled, please update the status of any specimen in ORCHID to “Collected” BEFORE it arrives in laboratory, by:

  a.       Having the nurse scan the patient’s wristband AND specimen label.

  …OR…
  

  b.      Updating the specimen status manually under Specimen Collection in the menu bar.

  
  

  Select “Unable to scan barcode?”

  
  

  Hover over the lab specimen order and click on the menu icon on the right.

  
  

  Change status to “Collected.”

Do the above before the specimen goes to Laboratory.  You can still bring the specimen to Laboratory yourself (especially those critical ones), but Lab cannot process the order until it is “collected” in ORCHID.

Please continue to check here for daily updates!

• If you receive an alert on powerchart titled “Merge Alert,” then the chart is corrupted. This is what you need to do immediately.
  • STOP using the chart and immediately call registration at x5228 to initiate creating a new MRN for the patient
• Cardiology orders:
  • All cardiology orders start with “CV” prefix
  • Use “CV Exercise Treadmill Test.” This test also occurs under other multiple names, which may be discontinued soon.
  • If ordering an Echo with Definity or bubbles, state what is needed in the “Order Comments” section.
  • Place EKG order prior to having nurse/tech completion of EKG. This will allow EKG to be uploaded to EMR immediately after completion.  In emergent situations, have another MD place this order for you.
  • Bedside EKGs done in ICU/ER via bedside monitors do not currently go to the EMR. These must be signed by ordering MD and sent to medical records for scanning.
  • Call Department of Cardiology with questions instead of the Cardiology Fellow on Call
• Clinic A Updates:

1. Prevnar is listed as PCV 13 vaccine
2. Use “special instructions” text for ordering complicated Rx sigs (eg. Lispro 18/14/14 QAC dosing). Do not use comments as these are not seen by the Pharmacist.
3. Zostavax is stocked in the pharmacy so you must order as “In office med from pharmacy” not as Zoster vaccine live. Enter 0.5cc, Zostavax SQ, shingles vaccine in details. Please look at the all the patients you will be seeing in that session and decide in the beginning of your session if Zostavax or Meningococcal vaccine will be needed.
   Place these orders at the BEGINNING of clinic as there can be up to a 30 minute delay getting them from the pharmacy.
4. For Meningococcal vaccine, the Polysaccchride vaccine is for one time dosing only . Conjugate vaccine is for patients who will need repeat dosing( ie: post splenectomy patients who will need q 5year vaccines)
5. Order FIT for CRC screening (future order yes, nurse collect no) rather than FOBT.
6. Bone Density testing: search BD Bone Density–> you must order BOTH App and Axial for Hip and LS spine testing!
7. Mammograms ordered for women <50 OrderRight will try to block you. You can override and order digital screening mammo if you feel appropriate, eg. for women ages 40-50. Please do not order the Ultrasound option for basic screening- only if there is a breast specific issue you are trying to address
8. Please make sure to order consults in ORCHID and Econsult so that the consult shows on the patient’s end of visit summary!!!
9. Cardiology orders are set up: can order TTE and stress tests specifying a time window and Cards will schedule. EKGs you can follow previous workflow–order, send pt there and they will come back with copy of EKG.
10. Make sure to check and CLEAR your box daily!!! If there are labs sent to you in error, please refuse them and forward the results to the correct provider. Once you acknowledge the labs you are responsible for them!!!
11. Be very careful which printer you select–prescriptions must be sent to printers with suffix “RX” to be printed on secure paper. Please do not switch the paper. Instead go under the button with three dots, pick ” OTHER OUTPUT DEVICES ” and search for the printer. Add this to your Favorites
12. Visit summary–Once any edits are made, this must be published/printed, ie. if PCP touches the visit summary and later MA publishes, TWO copies of visit summary are generated. MA’S WILL BE IN CHARGE OF EDITING AND PUBLISHING THE VISIT SUMMARY (this is a change from our initial workflow). Send Amb Comm order to MAs detailing what you would like unchecked and what you would like included in the last text box.
13. The last thing you should do prior to sending the patient out to the waiting room to wait for dispo is to put inthe E/M visit charge. This will signal to the MA that the patient is ready for them to vaccines etc….
14. FACULTY- when cosigning clinic notes- if you want your thoughts to be seen on the residents note, you must MODIFY the note and add an ADDENDUM. If you are only signing the note, then you can just hit REVIEW . Anything you put in comments will not show up in the note.
15. Look up historical OVMC CWS/Affinity MRN under Patient Information (on the left dark gray menu).
16. PFTs –order in ORCHID and recommend calling to confirm they received/will process your ORCHID order.
17. If you have any questions please feel free to ask Dr. Suthar and Dr. Kim!

Please check back for more useful updates!

• Home Health no longer requires a VNA or DME form. Instead, place a “Home Health” order and fill out the appropriate details for Wound Care, Visiting Nurse, etc. BE SPECIFIC!
• Home Hospice has it’s own order. Again, be specific.
• Home Antibiotics orders should be entered by the consulting ID team.
• To order AFB smear for TB rule out, write an “Acid Fast Bacilli Culture-INT” order. Choose “Micro Specimen” for specimen type, then add a comment reading “Sputum Induced” . You also need a separate order for RT to induce sputum by ordering “Sputum Induction” and writing “AFB x3” in the special instructions section. Results for will NOT be posted, so you have to call everyday to follow up on AFB results. (This should be fixed soon)
• To order studies from cardiology, ensure you pick studies starting with “CV” (not the 5 number prefix).
• Coumadin Clinic Referrals: Continue to use the previous Coumadin Clinic Referral form and fax to x4747.
• Details regarding hemodialysis can still be found in the hard chart.

Great job with the Orchid roll-out!  Here are a few updates/reminders:

• Dynamic documentation is required.
• Make sure to complete “Required Provider Note Information” daily.
• Refresh often!
• Reconcile meds and orders on a daily basis.
• Convey all STAT orders with nursing verbally.
• For portable CXR, specify “portable” under transport mode.
• To hold medication, you must discontinue and then reorder at later time.
• Forward all notes using the “SIGN” button instead of “REVIEW.”
• In Urgent Care, housestaff may complete Econsults up until 11/13 instead of the Urgent Care attendings.
• Notes need to be forwarded to attendings, but orders do n0t require co-signature by attending (unless written by medical students or IMGs, who should forward to the intern or resident)
• When admitting patients via the GEN MED ADMIT power plan, UNcheck the MRSA screen since nursing are already doing this if indicated