Cerner | CPOE Significant cultural shifts for review

We needed an EHR system that would drive change as well as organizational redesign. We needed a system that plays a critical role in safety initiatives that were found in CPOE – Cerner. Cerner Millennium architecture provided a comprehensive EMR that was connected bringing up decreased times from medication order to meds cabinet access, significantly. Transformation grew out of that adhesiveness thus driving safety and efficiency with significant improvements. I no longer have to wait for someone else and now have more control. 

The wielding benefit of order entry is found in integrated care where nurses, physicians and pharmacists all see the same information. If you do not have that, that is where the risk comes in and patient safety fails. You see this more in Hybrids than in software like what Cerner offers.

Reliability is another plus I’ve experienced with CPOE – Cerner. When an order is placed for a Chest XR, I can trust that it will be received and completed by radiology. Through transformed workflows and these new tools, we have found improvement. We have seen efficiency in our workflows presently taking on these changes, then how we used to do things. With the staffing, we were able to reduce our HUCs by half and then the remaining HUCs the focus is now more customer-centric.  Nurses used to complete charts at the end of the shift, and now it is mostly being done closer to the actual delivery of care. We found a reduction in elapsed time between dictation and physician signatures as well as a reduction from code to bill time.

Within CPOE, the order sets have improved patient safety. With real time documentation, you cannot help improvements with JCHO standards and advanced directives.  In the ED so many times, the allergies were never documented and now with hard stops, it is always being completed. Patients were getting missed for isolation sometimes for almost a week, and now the required patients are placed in isolation immediately. CPOE presents the right information at the right time for patient care and safety. More times than I’d like to admit CXRs were ordered with no reason. Now we place the orders and document at the same time thus increasing insurance collection with less time in research by support staff or denial. Advance directives compliance has improved with the entering of height, weight and allergy documentation. This just gives everyone the needed information for the most effective decisions and care available.

In the ED, we are totally CPOE, and we were able to replace the old grease board with large plasma monitors that give you an instant integrated view of the ED. If you see Child Life signed in with a suture nurse you know that support is taking place and Child Life will be tied up for the awhile. Lobby management is no longer a guess; you will know what it out there. Triage can see what beds are open. If a patient is in radiology and no longer in their room, we do not spend time looking and asking where the patient is. We can see at a glance if labs are back or how many are still out. We found communication of bed availability saved valuable time, enabling continuity of care from the ED to inpatient. CPOE effectively reduces drug-related injuries and adverse drug events, as well. We saw a reduction in preventable ADEs after the implementation of CPOE.

In summary, we have seen almost a 100% change in compliance driving safety and efficiency with significant improvements all the way around our health system. Cerner CPOE was the best investment.

Cerner | Maternity

Cerner –  Maternity & CPOE for OB Triage/L&D/Postpartum/Newborn

Under the Cerner EHR umbrella, you will find many products. The process of vetting the right EHR can be grueling and cost thousands into millions of dollars. Many providers feel they are actually stepping backwards in functionality when siding with enterprise solutions. The amount of clicks and the effort put into the simplest of tasks to the most critical have been the biggest areas of contention with providers as well as sluggishness.

When looking at EHRs a few questions to consider:

• You need to consider the Company as well as the technology, so look at both

• What will be my implementation experience

• What will be my ongoing support experience be like

• Will the Vendor lead and support us to meet the Meaningful Use deadlines

• Clinical workflow should increase productivity

• Will this EHR help us maintain or improve patient care

• Where to store EHRs? In house or with Cerner in Kansas City

• One house vendor or many – will they play well with each other?

A comprehensive set of capabilities in an integrated database is the sum of the Cerner electronic health record. PowerChart Maternity Ambulatory provides real-time access to gynecologic and maternity information. All labs, fetal tests, hospitalizations and history are displayed for real time viewing from the expectant mother and baby during pregnancy.

This EHR surrounds the entire pregnancy journey. Real-time display, recording, storage and retrieval or data. The clinical information obtained about the mother and baby live in one location and is available at the point of care when you need it.

PowerChart Maternity Basics

• CPOE

• Meds Rec

• PowerNotes

• FetaLink

• Tracking Shell

 

History and Physical of L&D  

 

Tracking 

 

FetaLink+: Mobile Fetal Monitoring for iOS

 

 

 

 

 

 

 

 

 

Critical in the maternal care setting is your ability to manage risk thus giving a high level of care. Cerner FetaLink+ displays the relationship of fetal, and maternal waveforms, allowing clinicians the ability to assess the status of patients. This gives them the ability, to examine changes in waveform patterns over time. Clinicians are able to temporarily, permanently hide or display any waveforms. Waveforms can be analyzed independently or in conjunction with waveforms of choice.

Annotation Summaries on the fetal strip can be quickly viewed by Clinicians providing quick views. The Summary serves as a navigation tool, giving a view of a historical waveform at the correlating time of entry.

This product claims the following benefits for Clinicians and their patients by:

• Critical information regarding a woman’s pregnancy and the health of her baby is accessible

• Patient safety is improved and helping clinicians make informed decisions

• Providing mobile access to fetal and maternal waveform data, key pregnancy related data, EDD, EGA, cervical exam status, and gravida para

• Comparisons of historical pregnancy data can be used to evaluate the health of subsequent pregnancies

• Reducing medical errors

 

Delivery Summary Report                                                                 

 

Overview

PowerChart Maternity is the pregnancy band available for use in the PowerChart solution family. What I liked was that it provided me with a single point of entry in my documentation of an active pregnancy starting from the initial prenatal visit through postpartum follow ups. Additional tools include the EDD/EGA calculator, height/weight and labor graphing, the result copy tool, related records (mother/baby toggle), and the birth log book. PowerChart Maternity also gives users the ability to view all of the documented details of a closed pregnancy from within the OB/GYN tab of the History band.

Three licensed options are available for implementing PowerChart Maternity that I found helpful.

• Ambulatory

• Acute RN

• Acute Provider

Outcomes of PowerChart Maternity that I wanted to note.

• Decreased the number of orders to sign

• Increased visibility of orders

• Improved Provider workflow

• Increased Provider satisfaction

Key Benefits of Cerner Women’s Health Solutions that I found.

• Spans the entire pregnancy process

• Improve patient care, clinicians can focus on the patient’s overall health and not just a visit

• Real-time efficiency, allowing fast and efficient critical decisions

• Increase access to information

• One stop location for all clinical data

• Increases staff efficiency and ability to staff patient care by giving immediate access to the clinical

• Newborn care is improved by looking at current, historical and archived fetal monitoring tracings, by integrating fetal monitoring data into the EHR in one location.
Advanced Nurse Review Notes & Comments (PowerChart Maternity & CPOE) that I have.

Weight based Medications: Weight based medication infusions display the calculation information within the order details both in the Orders view and on the MAR

Titratable Drips: Titratable infusions ordered via CPOE require the physician to enter the titratable medication and then enter the parameters in the order comments section before signing the order. If details are not entered, you will see an incomplete order which requires follow-up with the physician.

Medications with a Tapering Dose: The pharmacy continues to have an active role in entering medications with a Tapering Dose. With tapered dosing, the provider enters an initial order, and then the pharmacy will enter the individual orders required for the taper. With CPOE, the provider’s order will show up automatically in the scheduled medication section of the MAR, but the icon indicating pharmacy verification is required will appear, and there will be no associated task on the MAR. Wait to nurse review the provider’s original order until pharmacy has entered the individual dose orders and all orders appear on the nurse review screen. Use the order comments in the physician’s order to verify correct order entry by the pharmacy.

Total Parenteral Nutrition (TPN): TPN orders appear in the Nurse Review section and on the MAR as usual. All TPN orders are entered online via a PowerForm. To verify the ingredients in your patient’s TPN reflect the entered orders, you should compare the bag to the PowerForm or TPN Therapy Analysis tab. While not new with CPOE the TPN Therapy Analysis band, is a new feature to most, so something to note in your review.

 Pharmacy Verification (Notes that I considered important)

Pharmacy Review: Let’s take a moment to look at the Orders band, the eMAR and review how CPOE will impact Order Review, Pharmacy Verification and Medication Administration. The time it takes for medication orders to be verified by the pharmacy may vary depending on the time of day, patient census, or issues related to a specific order. Unlike medication, orders written on a physician’s order sheet and scanned to pharmacy for order entry, CPOE orders appear on the patient’s eMAR before the pharmacy has verified the medication. The Mortar & Pestle icon indicates the order has not been verified by the pharmacist. Only emergent meds should be given prior to pharmacy verification. Routine medications should not be administered before a pharmacist has verified the order, and Rejected Meds should not be given! You will find the Mortar & Pestle icon (if selected by your facility to represent Pharmacy) viewable on the Orders Band, Nurse Review, and the eMAR.

In urgent or emergent situations, you may need to administer medication before a pharmacist verifies the order. When scanning an unverified medication, the MAR will display a pharmacy verification warning pop up. You may continue to chart. However, be certain it is appropriate to administer the medication per protocols. Be sure to determine whether any follow-up actions are required.

Rejected Medications: Medication orders rejected by the pharmacy appear on the eMAR and the Orders Band with the Pharmacy Mortar & Pestle Rejection icon. A similar Pharmacy Mortar & Pestle Rejection icon appears next to the order on the Medication List tab in the patient’s order profile. Never administer a medication rejected by the pharmacist. The pharmacist will contact the provider to clarify the order. Then the pharmacist will take the appropriate action as an RVVO/RVTO then Pharmacy will discontinue or verify the original order. Based on the discussion between the pharmacist and the provider, a new RVVO/RVTO Pharmacy order may also be entered into Cerner by the Pharmacist. Verbal or telephone orders entered by the Pharmacist appear for the nurse review, as usual.