metro south health iemr business continuity plan · 2018-07-19 · page 3 of 58 supporting...

Metro South Health ieMR Business Continuity Plan

Logan Beaudesert Hospitals Digital Hospital Program, Metro South Health

November 2017, Version 1

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Document details

Document version history

The table below shows the high level changes that have been made to each version of this document,

who made them and when:

Version Issued Sections Pages Author Comments

0.1 09/2017 All All Samantha Boustead, Noelene Herbert

Initial Draft

0.2 10/2017 All All Various members of the Digital Hospital Implementation Committee (DHIC)

Feedback received from committee members and incorporated into the document.

1 11/2017 All All Samantha Boustead, Noelene Herbert

Submitted to the Disaster Preparedness committee for endorsement

The Metro South Health ieMR Business Continuity Plan is subject to change and will be updated in

response to lessons learned from activation of the Plan and emerging information from Queensland

Health.

Copyright © the State of Queensland, Metro South Health 2015

Copyright protects this publication. Except for purposes permitted by the Copyright Act, reproduction by whatever means is prohibited without the prior written permission of Queensland Health. Inquiries should be addresses to the Manager, Clinical Informatics (Clinical Informatics Quality Manager).

Commercial-in-confidence This document may contain commercial-in-confidence information. This document has been produced for the sole use of Metro South Health, and should not be provided to external organisations without the written approval of the Chief Information Officer, Metro South Health.

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Supporting Documentation

The Metro South Health ieMR Business Continuity Plan is a sub-plan to the Logan Hospital Contingency Plan 2015 and the Beaudesert Hospital Contingency Plan 2016

The Plan has been developed in alignment to Standards Australia, AS/NZS 5050: 2010, Business

continuity – Managing disruption-related risk.

In addition, the following publications and documents have been used or referenced throughout this

document.

The Logan Hospital Contingency Plan

The Beaudesert Hospital Contingency Plan

The Logan Hospital Emergency Response Manual

The Beaudesert Hospital Emergency Response Manual

Logan and Beaudesert Digital Hospitals Business Rules

DAS- ieMR Support Model and System Management Guide

The Viewer Downtime Plan

HBCIS Downtime Plan

AUSLAB Downtime Plan

Karisma Downtime Plan

Business Continuity during 1.Pharmacy Downtime Procedure: HSSA

The Logan Hospital Pyxis Downtime Plan

The 724Acccess Downtime Viewer Quick Reference Guide

Information Standard 18 – Information Security

Standards Australia, AS/NZS 5050: 2010, Business continuity – Managing disruption-related risk.

Standard Australia AS/NZS 31000: 2009 Risk Management Principles and Guidelines.

AS/NZ 5050:2010 – Business Continuity – Managing disruption related risk

ISO 22301:2012 – Societal security – Business continuity management systems – Requirements

ISO 22300:2012 – Societal security – Terminology

Relevant Legislation

The following legislation and regulations are relevant to this Plan:

Disaster Management Act 2003

National Health Security Act (2007)

Hospital and Health Boards Act 2011

Hospital and Health Boards Regulation 2012

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Planning Responsibility

It is the responsibility of Logan & Beaudesert Emergency Preparedness Committee and Metro South Adoption Services to periodically review this plan.

Testing and Review

Testing

This Plan should be tested:

Following the initial completion of the plan

Following any major revisions of the plan

Annually

Review

Review of this plan is to be conducted annually or subsequent to:

Exercises designed to practice or test aspects of the plan

Following activation of the plan in response to an event

On the introduction of any major structural, organisational or legislative changes that affect

Queensland Health/IT operations.

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Contents

1. Introduction ...................................................................................................................................... 8

1.1 Background ............................................................................................................................... 8

1.2 Purpose ..................................................................................................................................... 8

1.3 Objectives ................................................................................................................................. 8

2. Scope ............................................................................................................................................... 9

2.1 Inclusions .................................................................................................................................. 9

2.2 Exclusions ................................................................................................................................. 9

2.3 Assumptions .............................................................................................................................. 9

3. Activation ......................................................................................................................................... 10

4. Authority .......................................................................................................................................... 10

5. Notification Process ......................................................................................................................... 10

5.1 External Notification ................................................................................................................. 10

5.1.1 SIM Notification ..................................................................................................................... 10

5.1.2 Cerner AMS Notification ....................................................................................................... 11

5.2 Internal Notification ................................................................................................................... 11

5.2.1 Logan Beaudesert Hospitals Notification Process ................................................................. 11

6. Business Continuity Plan Activation ................................................................................................ 11

6.1 Process of activation ................................................................................................................ 11

6.2 Command, Control and Coordination Arrangements ................................................................ 11

6.3 Roles and Responsibilities ....................................................................................................... 11

6.3.1 Roles .................................................................................................................................... 12

6.4 Logan and Beaudesert Hospitals Emergency Operations Centre ............................................. 12

6.5 Incident Levels ......................................................................................................................... 13

6.6 Activation Phases ..................................................................................................................... 14

6.7 Operational Debriefing.............................................................................................................. 16

7. Risk Mitigation Strategies ................................................................................................................ 16

7.1 General risk mitigation strategies .............................................................................................. 16

7.1.1 Hosted Solution .................................................................................................................... 16

7.1.2 Cerner 724Access Downtime Viewer .................................................................................... 16

7.1.3. Emergency Power ................................................................................................................ 17

7.1.4 Local storage ........................................................................................................................ 17

7.2 Clinical risk mitigation strategies ............................................................................................... 18

7.2.1 Planned downtime ................................................................................................................ 18

7.2.2 Unplanned Downtime ............................................................................................................ 20

8. Routine Management ...................................................................................................................... 22

8.1 Proactive Prevention Activities ................................................................................................ 22

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8.1.1 System Management Activities ............................................................................................. 22

8.2 Preparedness Activities ............................................................................................................ 22

8.2.1 Keeping Plans and Procedures Current ................................................................................ 22

8.2.2 Checking Resource Availability ............................................................................................. 22

8.2.3 Testing .................................................................................................................................. 23

8.2.4 Training ................................................................................................................................ 23

9. Continuity Procedures ..................................................................................................................... 24

9.1 Paper based functions .............................................................................................................. 24

9.2 ieMR Downtime ........................................................................................................................ 24

9.2.1 General continuity procedures .............................................................................................. 24

9.2.2 Area specific continuity procedures ....................................................................................... 40

9.2.3 Scanning (Kofax) continuity procedures ................................................................................ 45

9.3 Power failure ............................................................................................................................ 46

9.4 Loss of Network....................................................................................................................... 46

9.5 Device Failure .......................................................................................................................... 46

10. Recovery Plan ............................................................................................................................. 47

Glossary of Terms .................................................................................................................................. 51

Appendix A: Business Impact Assessment - Overview ........................................................................... 52

Appendix B: Action Cards ....................................................................................................................... 53

Action Card: Unit Downtime Coordinator ............................................................................................. 53

Action Card: Chief Informatics Officer (CIO) ........................................................................................ 54

Appendix C: Location of Hospital Downtime 724 Viewers ....................................................................... 55

Appendix D: Downtime Kit Contents Checklist ........................................................................................ 56

Appendix E: Monthly Checklist – Unit Downtime Coordinator ................................................................ 57

Appendix F: Communication Plan ........................................................................................................... 58

1. Introduction

1.1 Background

The Metro South Health Digital Hospital Program is a program of work focused on the transformation of paper medical records and forms to an integrated digital system across the Logan and Beaudesert Hospitals (LBH)

An integrated electronic Medical Record (ieMR) will increase the reliance on

technology, so it is therefore imperative that adequate procedures are in place to

effectively manage planned and unplanned loss of access to key information, to

ensure that staff can continue to care for patients with minimal disruption.

1.2 Purpose

The purpose of the Metro South Health ieMR Business Continuity Plan (BCP) is to clearly outline the procedures that need to be undertaken in the lead up to, during and after the loss of access to the ieMR, including supporting systems and medical devices as they directly impact the ieMR.

This plan will include:

Authority to activate the BCP, including triggers leading to this decision

Notification processes

Roles and responsibilities

Communication channels to be utilised

Procedures to be undertaken at the unit level to ensure business continuity

Post recovery responsibilities

Procedures to be undertaken at the unit level during recovery

1.3 Objectives

The continuation of safe patient care in such circumstances is paramount and, as such, the overriding purpose of the ieMR BCP is to ensure that staff can continue to care for patients with minimal disruption and no impact on outcomes during any downtime event.

This document provides an overarching plan and links to supporting, detailed processes, to ensure that:

All staff know what to do during a downtime event, who to contact, who is responsible for what, and what they, personally, are responsible for

The chain of command and responsibilities for decisions and communication during downtime events are clearly documented and understood

All staff have been adequately trained to ensure that their expertise is current and sufficient for them to be effective during a downtime event

The downtime solution and processes are regularly tested and updated

Communication during downtime events is provided in a clear and timely manner

Staff have access to the necessary resources to operate effectively during a downtime

The impact on systems and devices that feed information into and receive information from the ieMR is understood and managed throughout downtime and as part of the return to normal operations. The return to normal operations occurs with minimal impact on staff time and with the highest level of data quality to support continuity of patient care.

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2. Scope

2.1 Inclusions

This plan will include scenarios where information within the ieMR is not available to staff at the LBH due to full or partial unavailability of:

The ieMR and the individual modules and components that make up the ieMR

Supporting systems where the ieMR is affected, including HBCIS, AUSLAB, Pyxis, iPharmacy, Karisma and their interfaces

The Queensland Health Network (Wi-Fi and Ethernet) and the Local Area Networks where the ieMR is affected

Power to LBH where the ieMR is affected.

This plan will cover both planned (scheduled) and unplanned instances of unavailability.

2.2 Exclusions

This plan will exclude the following:

Technical disaster management planning and procedures undertaken by technical specialists to prepare and recover the system before, during and after planned or unplanned system downtime

Disaster management planning and procedures implemented at the LBH in the event of a disaster, including internal disasters (Code Yellow). This is covered by Facility Continuity and Disaster Management Plans.

‘Roll back’ planning and procedures undertaken if the decision is made to ‘roll back’ the system and revert to a paper-based system

General and ongoing support and maintenance of the ieMR, supporting interfaces and systems and medical devices

Business continuity planning for supporting systems and devices where the ieMR is not affected

2.3 Assumptions

During the development of this document the following assumptions were made.

Loss of access to the ieMR can be caused by an internal or external factor

Maintenance of critical services at each site is priority

Safety and security of patients, staff, visitors and volunteers is the top priority

When the BCP is activated, it is assumed that there will be enough resources available to successfully complete the required activities, including during recovery

Logan and Beaudesert Hospitals have fully operational BCP and emergency procedures that cover all relevant scenarios for the hospital, and which are regularly updated and tested

The plan is only valid for sites using the ieMR LBH and external clinics acting as part of LBH services.

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3. Activation

Activation of this plan will be at the discretion of those that have the appropriate authority (shown below) and will be based on the scope and magnitude of the incident and the impact on the business.

Activation of this plan by the LBH Executive Team is based on the escalation of information received from the following sources:

DAS-ieMR

CIO Metro South

Digital Response Committee

Cerner

Members of the Executive Team Activation of this plan will trigger the local unit procedures detailed within this document.

4. Authority

Members of the LBH Executive Team have the authority to activate this plan under delegation from the Executive Director Logan Bayside Health Network acting as the LBH Hospital Emergency Controller.

5. Notification Process

5.1 External Notification

5.1.1 DAS- ieMR Notification to Logan and Beaudesert Hospitals

DAS-ieMR are the Service Owners and are responsible for the end to end service of the system. They are responsible for providing technical support for the ieMR solution and manage the relationship with the system and support vendor, Cerner.

Timely notification of the downtime will be received from DAS-ieMR to LBH, Notification of planned downtime will occur a minimum of two weeks prior to the date and time of the downtime. This notification will be conducted via email to key representatives within the business including, but not limited to:

Clinical Informatics notification team

Health Information Management System LBH Site Director

LBH Executive

DAS-ieMR will be responsible for monitoring the system and in the event of an unplanned downtime, notification and communication will commence as soon as possible to relevant LBH stakeholders including email to:

Clinical Informatics

Health Information Management System LBH Site Director

LBH Executive

After hours i.e. Monday to Friday 1700-0700, Weekends and public holidays notification is to be provided to the Logan Hospital After Hours Nurse Manager and Beaudesert Hospital Emergency Team Leader by email AND follow up telephone call.

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5.1.2 Other external sources notification to Logan and Beaudesert Hospitals:

Managers of other systems affecting the ieMR have the responsibility of notifying LBH as above External

Notification

5.2 Unplanned Outages

5.1.3 Unplanned outages

In the instance of any reduced functionality in the system that is impacting clinical care staff should call the Metro South Adoption Services on ext 8800. After hours ie. Monday to Friday 1700-0700, Weekends and public holidays staff should contact the After Hours Nurse Manager at Logan Hospital and Emergency Team Leader at Beaudesert Hospital. Standard internal escalation to line management should also be followed.

6. Business Continuity Plan Activation

Any unplanned downtime will be managed as a Code Yellow – Internal Emergency as per each facility’s Code Procedures.

6.1 Process of activation

The Logan and Beaudesert Hospitals Emergency Management Teams (EMT) notification will be on the direction of the Executive or delegate and coordinated through the Switchboard.

If the team is needed Switchboard will contact each person by phone and inform; Emergency Management Team is required, with a brief situation report and instruct to urgently present to the Emergency Operations Centre (EOC)

The Executive Director or delegate will brief the EMT upon arrival to the EOC.

6.2 Command, Control and Coordination Arrangements

It is important to note that formal organisational accountabilities and reporting lines are maintained during the event of an unplanned downtime.

Action Cards have been developed to support the positions when a Code Yellow/Metro South Health ieMR Business Continuity Plan and sub plans are activated.

6.3 Roles and Responsibilities

The Logan and Beaudesert Hospitals will conduct the response to a disaster according to the principles of the Australasian Inter- sectoral Incident Management System (AIIMS). This will include the establishment of a Logan Emergency Operations Centre and Beaudesert Emergency Operations Centre with clear lines of reporting and accountability to the Metro South Health Chief Executive and/or the State Health Emergency Coordination Centre (SHECC).

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The Logan and Beaudesert EOCs will coordinate the emergency response through an established framework of facility or Unit Site Commanders and a formal method of conducting, monitoring and evaluating Operations, Planning and Logistic functions. This will include Communications aspects (internal and external).

6.3.1 Roles

There are a number of key roles which will be essential for the success of the ieMR Downtime BCP and its use during downtimes. The roles are:

Emergency Controller – as per Code Yellow Procedures

Clinical Informatics Officer – part of Clinical Informatics Team and Incident Management Team

Emergency Management Team – a multi-disciplinary team from across the hospital plus relevant external parties (e.g. DAS-ieMR representative, Cerner representative), and

Logan/Redland Network Adoption Lead – Manages the Digital Hospital Response and Support Teams, DH Support Centre and provides recommendations and updates to the EMT.

Digital Hospital Support Centre – as required, is stood up - provides phone and at the elbow support to ieMR users.

Unit Downtime Coordinator – located in each clinical/operational unit which has a 724Access Downtime Viewer. In the event of an after-hours downtime this role will revert to the most senior staff member in the unit.

6.4 Logan and Beaudesert Hospitals Emergency Operations Centre

The LBH Hospital Emergency Management Controller shall assemble an Emergency Management Team as required. The EMT members will be notified via Switchboard as per the EMT Phased Call in System.

In the event that a LBH Emergency Operations Centre needs to be activated the primary location shall be:

Logan EOC Command Room Security Services Training Room, Building 1

Beaudesert EOC Command Room Executive Boardroom

In the event that an alternate Command Room is required, this will be located at the following site: Logan EOC Alternate Command Room Meeting Room, Level 2, Building 2

Beaudesert EOC Alternate Command Room Conference Room

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6.5 Digital Hospital Support Centre

Digital Hospital Support Centre is stood up to support and coordinate activities during a planned

downtime exercises. This group reports to LBH executive and/or the EMT during this time.

Provide a link to operational staff

The Digital Hospital Command Centre can be stood up as required.

6.6 Incident Levels

Level 1 Incident Able to be resolved through the use of local or initial response resources only

Managed locally through the Executive on Call and current staffing and resources

Level 2 Incident More complex either in size, resources or risk, requiring additional support

Managed through the EMT (Phase 1 call in list)

Level 3 Incident Characterised by degrees of complexity that may require the establishment of divisions and units for effective management of the situation.

Managed through the EMT (Phase 1 and 2 call in list)

6.7 Activation Phases

Emergency management in Queensland utilises four phases of emergency response; Alert, Lean Forward, Stand up and Stand down. In many situations, theses stages may be condensed with stages being activated concurrently:

Level of Activation Actions Required Downtime (Scheduled & Unscheduled) Activities

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When advice of an impending of potential disaster or emergency is received or following an occurrence, it is unclear if a Department of Health response is required.

Notification of potential incident or response required to Clinical Informatics and LBH Executive. Metro South Adoption Services Leads assess and provide recommendations to the LBH Executive LBH Executive to determine if activation of the disaster plan is required or ongoing monitoring of incident.

Alert: Notification to Staff (if required) Switch or DAS > Executive Manager > Executive on call (code Yellow) > EMT > Notification to Staff (Overhead, emails, meetings/briefings, EMT Line management governance.

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When information available indicates necessity to instigate preparatory activities in readiness for the response phase. Disaster coordination centres are on stand-by; prepared but not activated.

Monitor the threat and track/plot/record all information

As requested by the Executive Director in the role of the Emergency Management Controller, the Emergency Management Team is formed and meeting held

Emergency Operation Centre (EOC) readied and manned for further action

Prepare for Step Up of DH Support Centre including allocation and standby of additional staff resources

Support units placed on standby to attend EOC / identified functional areas to commence department control

Liaison Officers dispatched as necessary

Advise relevant staff of incident alert

Additional resources sourced if required (e.g. stock, supplies, staffing, hospital capacity)

Confirm emergency response arrangements with nearby hospitals and other health facilities public and private

Incident briefing communicated to Metro South Chief Executive Officer and Executive team

Personnel placed on standby and given instructions

Scheduled Downtime: 1. Implement Risk Identification & Mitigation Strategies including Digital Hospital

Communication Plan 2. Ensure adequate staffing, skill mix and resources available to assist with preparation for

scheduled downtime and recovery activities 3. Ensure notification of key stakeholders, staff and patients as required

Unscheduled Downtime: Treated as Code Yellow. Activation Phase = Stand Up

Preparations:

Locate Downtime Kit and ensure adequate resources Print a copy of the patients most recent ECG and store in the patient end of bed chart Ensure each patients have an end of bed chart available

Sta

nd

Up

When a disaster or emergency incident occurs and a Department of Health response is required and resources are deployed. Disaster coordination centres are activated.

Emergency Management Controller implements Disaster Management Plan

EOC and support units raised to operational status with desired staffing levels and briefings

Step up DH Support Centre Liaison Officers notified of upgrade of status – communications maintained

Carry out respective emergency plan

Communications to hospital departments, staging areas and nearby hospitals and health services

Coordinate and manage all activities as they occur

Provide status report to Metro South Chief Executive, SHECC and other coordination groups

Centre to remain operational until all tasks are completed and hospital recovery phase is well underway

Consider operational debriefing sessions to be convened at the end of each shift if required

Handovers to be staged to maintain information integrity

Activate ieMR Business Continuity Plan

Ensure notification of activation of plan to all affected units.

Activate Unit Downtime Coordinator (UDC) Role in each affected unit

UDC to notify staff in each unit of Stand Up phase

UDC to access Downtime 724 Viewer using provided password

UDC to ensure relevant clinical information and printing is accessed from the Downtime 724 Viewer

Print the following for ALL patients in the relevant ward from the Downtime Viewer: o Active Orders: a list of outstanding/ active orders for all patients. If patient has

a blood order ensure this active order is printed from this tab in the downtime viewer.

o Current Medication Orders: Medications report from “Medication Administration (Current)” tab

Print the following for acute or unwell patients (24-48 hrs) in the relevant ward from the Downtime Viewer:

o Documents o Intake & Output o Discontinued Medications o Patient Care result o Vital Signs

All printed notes should be stored in the patient end of bed chart.

UDC to access Downtime Kit and ensure staff have adequate resources for paper-based clinical documentation and placed in the patient end of bed chart

UDC to access Downtime Kit and ensure staff have signage ‘patient on paper’ to place with each patient

Ensure all Pathology and Radiology orders are written on the relevant paper orders

UDC to escalate any concerns and issues to normal line management up through to the Emergency Management Team

DH Support Centre provide technical support, attends Rapid Response Calls, assists with communication and provides regular updates to the EMT

Pyxis Machines turned to ‘non profile mode’ – manual entry of details required for access to medications

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nd

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When an organisations site and immediate emergency response is no longer required. Acute care for victims can continue but Department of Health can return to business as usual.

Operations in EOC suspended – stand down order given

Emergency Management Controller advises coordination control centre and DH Support Centre of stand down and advises Liaison Officer(s).

Emergency Management Controller advises nearby hospitals and health facilities of stand down and checks status of facilities/services

NOTE: Some services may still need to operate at an accelerated pace. Backfill arrangements should be in place. All personnel to be made aware of ongoing mental health/crisis support available

Recovery Activities:

Resources – support for recovery activities will be required

Documentation of the event for all patients treated during downtime (OPD or inpatient) stating “ieMR downtime from (x) hours to (y) hours, please refer to paper documentation”

Retrospective documentation is required for Medication Management including:

o RN caring for patient to reconcile medications given and ordered for patients during downtime

o MO to prioritise reconciling medications written during the downtime for new admissions, ICU transfers and acute or deteriorating patients.

o MO to ensure order verification from their message centre o Once transcribed all paper forms must be marked ‘transcribed’, a line placed

through the order, date, time, initial

Medical Registrar notes including to be reconciled from USB to ieMR

o Assessment of acute or deteriorating patients o Admission notes o ED Notes o Code Blue notes

Remove patient identification (‘patient on paper’) as patients medications are reconciled in to the MAR

Ensure all written paperwork is stored in the end of bed chart for 24hours post downtime then filed in the patient’s Clinical Encounter Chart (CEC).

Unit level and Executive Debriefing

Replenish stock in Downtime Kit

Lessons learnt

Recommendations

Procedure review

Pyxis Machines turned to ‘profile mode’ – manual entry of details no longer required

6.8 Operational Debriefing

Recovery helps to bring closure to an event and includes debriefing of personnel involved to ensure learning can be captured and processes refined to improve the health response to disaster events. It is the responsibility of the Emergency Management Controller to ensure a timely debriefing of all involved staff in the LBH response. Outcomes from the debrief will be used to inform further revisions to the plan. Key staff from LBH may participate in other debriefings as required.

7. Risk Mitigation Strategies

A number of risk mitigation strategies have been put in place as part of the Digital Hospital Program and ieMR implementation.

7.1 General risk mitigation strategies

7.1.1 Hosted Solution

Cerner is contracted to provide hosting services covering three aspects of system management:

Hosting Management Services

Operational Management Services, and

Application Management Services.

Having the hosted solution means that the data and system configuration is held at the Cerner data centre. Therefore, any incident which impacts the LBH data centre or the LBH site should not result in the ieMR data or configuration being compromised.

Cerner operates a highly secure and fully redundant environment and has contractual commitments regarding service levels. This means that there is full failover of hardware and full replication of the solution to an alternate location in real time to cover any failure in their environment. Cerner is also responsible for ensuring standard operational processes such as backup, system management and monitoring and security are of the highest standard.

7.1.2 Cerner 724Access Downtime Viewer

The LBH will be using Cerner’s 724Access Downtime Viewer which provides 7x24 hour access to clinical data currently available in the ieMR when access is not available.

The 724Access Downtime Viewer provides access to 7 days of historical clinical documentation and 30 days of orders up until the point of loss of access to the ieMR and/or network. Summary patient information can be viewed and/or printed allowing clinical staff to continue to provide care.

The 724Access Downtime Viewer application runs on secure, dedicated PCs on emergency power that are connected locally to a printer. These PCs are strategically located in 75 locations across the hospital, providing easy access for clinical areas. They are not to be used for any purpose other than to view medical information during system downtime.

The use of 724Access is a critical component of the ieMR BCP as described below in the contingency procedures.

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7.1.3 Medication Transfer Report and Medications Management

Where a medication order cannot be verified from the Medication Downtime report, a secondary application i.e. ‘Medication Transfer Report’ can be accessed by staff 7x24 hours. Staff can utilise this to validate any orders including the order itself or special instructions to ensure safe medication administration. The Medication Transfer Reports can be accessed for each ward from their local downtime viewer PC desktop via a desktop icon. These reports can only be access when using the generic downtime log on. Updated patient medication information is pulled hourly from the ieMR into this report with the exception of the Emergency Department, Maternity, Coronary Care Unit, Endoscopy and Theatres that receive up to date information 10 minutely to the application.

It is not recommended that the Medication Transfer form is printed unless required. It is to be used

ONLY as a contingency to validate orders from the downtime report.

7.1.4 Emergency Power

Uninterrupted Power Supplies (UPS) and generators are used to provide emergency power at the LBH, across a wide range of relevant functions/equipment. This includes the 724Access Downtime Viewer PCs, the wireless network, bedside medical devices (battery operated and can be recharged at emergency power points), workstations on wheels (battery operated and can be recharged at emergency power points) and the telephone/PA systems.

7.1.4 Local storage on devices

Medical devices that are integrated with the ieMR system have two forms of storage should the ieMR become unavailable or in the event that the connection between the two is severed.

The first is that each of the medical devices can store a set number of pieces of data. The second is that the integration tool itself (iBus) can store data for a period of time.

Both local storage locations can be accessed if required.

7.1.5 Local Area Downtime Kits

Each Unit has the responsibility to maintain local area downtime kits. These kits contain paper based forms and essential items for use only during an ieMR downtime and can be customised to each unit’s unique service requirements.

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7.2 Clinical risk mitigation strategies

7.2.1 Planned downtime

Risk Mitigation Activity Responsibility

Notification of Staff (via email, memorandums, meetings)

Cause of downtime

Time of downtime

Length of downtime

Potential Impacts and affected areas

Instructions for contingency plans

Recovery processes

Metro South Adoption Services

Staff Preparation

Ensure Downtime 724 Viewer access, password

Ensure Downtime 724 Viewer is on

Ensure adequate supplies in Downtime Kit

Re-familiarise staff with Downtime procedures and quick reference guides

Implement local unit plans for downtime as required

Ensure Medical Registrars and ICU Registrar are informed of the clinical documentation processes for medication management, patient assessments, admissions and Code Blue calls during downtime

Unit Downtime Coordinator

Patient Preparation

Ensure each patient during a downtime has signage above the bed to indicate “Patient on Paper”


Clinical Documentation Preparation

Ensure adequate end of bed charts are available

Ensure adequate forms available in Downtime Kit

Ensure any Advanced Resuscitation Plans (ARP) and Advanced Health Directives are printed and available in the CEC

o Pre-printing of relevant documentation prior to planned Downtime: Using HBCIS and/or ESM

Patient Tracking list Clinic List (OPDs) Patient labels

o Using the ieMR print: Recent ECG (mark as ‘copy’) List of Orders – completed, pending Patient labels

Ensure relevant paper medication charts are available for each patient in the end of bed chart.

If patient is receiving blood or blood products – ensure Crossmatch report is available at the end of bed chart.

Printing of relevant documentation upon commencement of Downtime, using Downtime Viewer.


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Notification of Staff (via email, memorandums, meetings)

Print the following for ALL patients in the relevant ward from the Downtime Viewer:

1) Current Medication Orders: Medications report from “Medication Administration (Current)” tab

2) Active Orders: a list of outstanding/ active orders for all patients including the following tabs in the downtime viewer:

o “Orders (current)”

o “Completed orders”


o Documents o Intake & Output o Discontinued Medications o Patient Care Results

o Vital Signs

Other relevant clinical documentation can be accessed as clinically indicated

**Monitor all reprinting in a downtime to ensure Medication related orders are not reprinted Reprinting of Medication Chart for patients is a risk in a downtime. The responsibility of printing and monitoring this activity is with the Unit Downtime Coordinator who will manage access to the downtime viewers during a downtime.

Pre-printing preparation will depend on the predicted length of time of the Downtime and clinical need. For prolonged Downtime periods, units may consider printing the entire ieMR form the downtime viewers


Device Integration

Continue to use devices during downtime (e.g. Welch Allen portable vital signs machines, Phillips ECG machines)

Ensure all previous ECGs in the machines are matched to the patient prior to downtime.

Stocks of ECG Thermal paper should be checked and provided to each machine as per current procedures.


Additional Staffing and Resource Requirements

Additional staffing of the recovery activity for medication reconciliation should be considered in the recovery phase post downtime

Additional staffing may be required in areas with high patient flow numbers and documentation requirements; e.g. ED, and Theatre during the Downtime, as well as in the Recovery phase after the Downtime period.

Divisional Executive Team

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Risk Mitigation Activity Responsibility Additional Staffing and Resource Requirements continued

The need for additional staffing and resources will be made by the clinical units prior to the proposed planned downtime, and will be dependent on the time of the downtime, length of the downtime, impact of the downtime, and clinical requirements. DH Support Centre

Additional staffing will be required in the DH Support Centre to provide phone and at the elbow support.

In planned scenario Digital Support Centre team will capture a report of upcoming appointments (7 days in to future). This report is to be collated the evening prior to planned downtime

Adoption Service/ Clinical Informatics

7.2.2 Unplanned Downtime

All Unplanned Downtime will be treated as a Code Yellow (Internal Emergency) to ensure an adequate organisational response. Risks identified during unplanned downtime are shown below.


Limited or no information available within the 724Access Downtime Viewer for Outpatient Departments

Although scheduled appointments will be visible in the Downtime 724 Viewer, there may be limited access to previous patient clinical documentation and medical history as the Downtime 724 Viewer will only store historical clinical documentation for the 7 days and 30 days of orders up until the point of loss of access to the ieMR and/or network

In planned scenario Digital Support Centre team will capture a report of upcoming appointments (7 days in to future). This report is to be collated the evening prior to planned downtime

Consider cancellation/rescheduling of Outpatient appointments

Emergency Management Controller / LBH Executive / Digital Support Team

Limited or no information available with the 724Access Downtime Viewer for Elective Surgery

Although scheduled appointments will be visible in the Downtime 724 Viewer, there may be limited access to previous patient clinical documentation and medical history as the Downtime 724 Viewer will only store patient information for the past 30 days.

In planned scenario Theatre list report produced for 7 days. This report is to be run as close as possible to the scheduled downtime.

Consider cancellation/rescheduling of Elective Surgery Procedures

Emergency Management Controller / LBH Executive/ Digital Hospital Support Team

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Insufficient resources available during and after downtime Depending on the time and length of an unplanned downtime, high patient flow areas and some specific roles will require support during a downtime, as well as in the Recovery Phase for retrospective required documentation (e.g. Patient Registrations, Triage, Patient flow tracking, clinical documentation, and medication reconciliation).

Consider additional staffing and resources to be deployed to areas with high patient flow or increased workload in recovery phase (e.g. the Emergency Department, Theatres)

Emergency Management Controller / LBH Executive


Consider additional support for recovery activity for reconciliation of medications post downtime – prioritising nursing workload and medical officer transcription of admissions, ICU transfers and deteriorated patients and admissions

Emergency Management Controller / LBH Executive

Consider additional support to ensure recovery activity to upload clinical notes for registrars post downtime from USB. Clinical notes for RRTs, admissions and consults during a downtime

Digital Support Centre

DH Support Centre

Additional staffing will be required in the DH Support Centre to provide phone and at the elbow support.

Metro South Adoption Services

External small clinics will not have access to 724Access Downtime Viewers on site.

Alternate communication methods to be used in regards to the electronic medical records and appointments during a downtime. Information to be provided over the phone, or via fax.

Emergency Management Controller

Identification of research patient on a Powertrial:

More difficult to identify research patient if on a Power trial as unable to see this on the Banner Bar

No workaround. Limitation in Downtime Viewer functionality n/a

OPD PowerPlans:

Unable to access orders (including medications) unless initiated prior to appointment in the OPD.


Access to patient information

If they have not presented within 30 days. Unable to see active orders or patient information if they have not presented within 30 days


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8. Routine Management

The primary components of routine management of the BCP and associated procedures are shown below.

8.1 Proactive Prevention Activities

8.1.1 System Management Activities

Each element of the ieMR system, supporting physical and technical infrastructure, local network and feeding/receiving systems will be managed according to the industry standard (ITIL). This includes monitoring, maintenance, management and upgrading with a focus on areas such as security and access, system performance and capacity, installing of patches, performance to SLAs and rigorous testing regimes.

8.2 Preparedness Activities

8.2.1 DH Support Structure

The Digital Hospital Team provides ongoing support across the LBH. Clinical Informatics and the Digital Hospital Team can respond rapidly to provide incident assessment, recommendations, and support to manage incidents.

8.2.2 Keeping Plans and Procedures Current

Consideration of the ieMR BCP and supporting documentation will be included within each project undertaken with Metro South Health. As part of the planning of each project, an assessment of the impact on the ieMR, the ieMR BCP, the downtime procedures and other supporting documentation will be completed.

Following any downtime test or actual downtime, the learnings from the downtime review process will be incorporated into the BCP and supporting documentation as required. Alternatively the ieMR BCP and supporting documentation will be reviewed annually to ensure it remains valid to the business activities currently undertaken at the sites.

Each time the ieMR BCP or supporting documentation is updated, it will be provided to the Executive Director Logan Bayside Health Network for final approval by the Chief Executive Metro South Health. Once approved all changes should be incorporated into downtime packs and training and testing materials.

8.2.3 Checking Resource Availability

An important part of preparedness is making sure that the required resources are available during downtime. Each week the Unit Downtime Coordinator in each unit should sign a log and check the following:

The downtime kit is accessible and the seal has not been tampered with. In the instance where the seal has been broken the unit should review the contents against the checklist and ensure the downtime kit contains the correct and a sufficient amount of forms, up-to-date instructions and pens.

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The downtime computer can be accessed via the key and the login username and password is functional. “Log off” after. DO NOT SHUTDOWN on the 724 downtime viewers

The Medication Transfer Report can be accessed on the desktop of the Downtime viewers with accurate information displayed for current patient cohort.

Technical monitoring of the 724 downtime viewers

Clinical Informatics to monitor the functionality and connectivity of the downtime 724 viewer devices using monitoring tools. Any issues to be managed and reported through clinical informatics for prompt resolution.

It is the responsibility of the local downtime coordinators and Unit managers to replenish resources in the Downtime kits and report any issues with the 724 downtime viewers. Technical issues should be reported to the InfoService Centre on 1800 198 175.

A checklist for the Downtime Kit and 724Access Downtime Viewer in each unit has been provided in Appendix D. These lists are the baseline requirements. They can be tailored to suit the unit’s speciality needs.

8.2.4 Testing

The ieMR BCP and supporting documentation will be tested annually, at a minimum.

Planned downtime provides an opportunity, in a relatively controlled and low risk environment, to ensure that staff is aware of what to do and that systems and processes work effectively. However planned downtimes usually occur when volumes and staffing are low in order to ensure minimum disruption, therefore testing will occur outside of these times.

8.2.5 Training

Training in the ieMR BCP and supporting procedures will occur in a number of contexts:

As part of the testing processes described above, and

As part of Disaster Management training and exercises.

Local training in units for new downtime coordinators.

To assist with staff knowledge of the downtime systems/processes and ease of use during downtimes, quick reference guides are included in the downtime pack and on the intranet.

9. Continuity Procedures

9.1 Paper based functions

A number of functions will still be managed using paper forms. These include (but are not limited to):

Acute Resuscitation Plan (ARP)

Advanced Health Directives

Consent Forms

These functions are not included in the continuity procedures below and these forms will not be included within the Downtime Kits.

9.2 ieMR Downtime

9.2.1 General continuity procedures

During the event of an unplanned downtime a number of continuity procedures will need to be completed to ensure that patient care and safety is maintained for the duration of the event. These procedures are shown below. In a planned downtime situation, for example an extended planned downtime, activation and use of these procedures will be approved and communicated by the Emergency Management Team.

Please note these procedures do not include supporting system downtime except where the downtime directly impacts the ieMR. These procedures are focussed on access to and the recording of information within a patient’s chart – patient safety and care should take priority.

All paper forms completed during downtime are to be stored with the patient’s end of bed chart.

Function Potential impact Description Contingency Task Responsibility

Medication History

Discontinued medications prior to downtime

A patient’s discontinued medications are stored in the ieMR and will not be available

Accessible from the Downtime Viewer and printable as required

Access the 724 Downtime Viewer using the Quick Reference Guide within the downtime kit.

Search for a patient and access ‘discontinued medications’ tab for information

This information can be either viewed or printed if required.

Unit Downtime Coordinators

Unable to view Home Medications

A patient’s home medications are stored in the ieMR and will not be available

Accessible from the Downtime Viewer and printable as required


Search for a patient and access ‘home medications’ tab for information

This information can be either viewed or printed if required.


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Medication History continued..

Unable to document medication history

ieMR not accessible during downtime to document this information

Document on paper The downtime kits will contain both clinical notes forms (progress notes).

Medical staff and Pharmacy

Unable to view Pharmacy Admission Note

Pharmacy Admission note truncates in the 724 downtime viewer. If printed the whole progress note can be seen.


Search for a patient and printed print required document/s. Do not use the ‘Print Document’ as note may be truncated.

Medication Allergies

Unable to view medication allergies

Allergies are viewable in the ieMR

Accessible from the Downtime Viewer and printed in the Downtime Medication report

This information will be printed as part of the Medication Downtime Report and will be visible on the front page with patient demographics.

Allergy stickers can be accessed form the downtime kit to highlight allergy history


Unable to document Medication Allergies

ieMR not accessible during downtime to document this information

Document on paper The downtime kits will paper forms to be utilised during downtime.

All clinical staff

Medication Orders

Unable to document new medication orders

If the ieMR is not available new medication orders will not be able available to be documented in the MAR.

All new medication orders should be prescribed on the relevant paper medication order form

The downtime kits will contain relevant medication ordering related forms

These forms are to be utilised during downtime.

All prescribers

Unable to access decision support

If ordering without the MAR the prescriber or pharmacists will not be able to access decision support tools

Availability of prescriber decision support tools via the intranet

Where decision support is required a prescriber or pharmacist can access the appropriate decision support guidelines on any PC

Prescribers and Pharmacists

Unable to view a patients Medication Orders (including special instructions) form the Medication Downtime Report

The Medication Downtime Report at times (especially with infusions) can be unreadable or appear incomplete

Where the clinician reads the Medication Downtime Report and identified an unreadable or incomplete order the can access the Medication Transfer Report

The Medication Transfer report can be accessed when an order is incomplete or unreadable directly from the desktop of any downtime viewer. This information can be viewed however it is not recommended to print. If unable to determine order accurately, the order is to be re-prescribed on the relevant paper form


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Medication Administration

Unable to sign for administration of medications ordered in the MAR

The administration of medication orders cannot be documented in the MAR during a downtime

Document administration on the Medication Downtime Report or on relevant paper forms as required. Downtime Medication Report can only be used for 24 hours. Downtimes longer than 24 hours the medication will need to be ordered on the relevant paper form

Ensure all medication administered during downtime are recorded on the printed Medication Downtime Report unless

Changes

New order

Inadequate space In these instances orders can be transcribed on to relevant paper based medication order form for ongoing administration.

Staff who administer medications to patients (including nursing, medical, allied health)

Medications and Patient Transfers within the Hospital

Transferring ward unable to access most up to date medications information from the ieMR

In a downtime staff will not be able to access the MAR in the ieMR

Downtime Medication Report and Paper documentation to remain with the patient at all times.

The Downtime Report and any paper documentation are to remain in the end of bed chart for transfer.

It is the task of the transferring RN to ensure all orders are legible and handed over to the transferring ward

Pharmacists, Nurses and Medical Officers

Medications and Inter hospital Transfers

Unable to access up to date Medication Transfer Reports for transfers to other facilities

In a downtime staff will not be able to access the most up to date Medication Transfer information from the ieMR

The Downtime Medication Report and any paper documentation to be photocopied and to be transferred with the patient.

The Medication Downtime

Report and any paper

documentation to be

photocopied for transfer.

It is the task of the transferring

RN to ensure all orders are

legible and handed over

It is recommended that an

escort for all patients

transferred during a downtime

be considered.to ensure safe

transfer of information

Pharmacists, Nurses and Medical Officers

Blood or blood product orders and administration

Unable to review existing blood and blood product orders and past products administered

Blood & Blood product orders are documented in iView in the ieMR. In an ieMR downtime this will not be available

This information can be either viewed or printed from the active order section of the Downtime viewer

Access the 724 Downtime Viewers using the Quick Reference Guide within the downtime kit.

Search for a patient using the steps shown within the guide. Print from the active order section of the Downtime viewer


Unable to order or administer new blood or blood products

If the iView is not available new blood and blood product orders will not be able to be prescribed or administered in iView

Continue to order using paper based form. Document blood product administration on Fresh Blood Component Transfusion Prescription and Administration Record or other appropriate paper form

Required paper forms are located in the Downtime Kits

Prescribers and Nursing

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Patient Admission

Unable to complete patient admission/registration

Patient admissions are conducted in HBCIS and if the ieMR is not available this function can continue to occur. If HBCIS is unavailable, HBCIS downtime procedures should be followed. (For ED information please see below under Area specific procedures - Emergency Department)

N/A N/A Administration staff

Unable to create an ieMR patient encounter

Renal Chronic, Pre-Arrival and Outpatient encounters are created within Power Chart and ESM

Encounters will be unable to be created during downtime. (For ED information please see below under Area specific procedures - Emergency Department)

Encounters needed to be created in the ieMR will need to be manually tracked.

When the ieMR is available, patient encounters will need to be created.

(For label, wristband printing and clinical documentation see the sections below)

Wait until the ieMR is active and create encounters.

Complete the required administration activities (print labels etc.)

Administration staff

Unable to generate or locate an existing patient ID

URNs are generated in HBCIS and if the ieMR is not available this function can continue to occur.

If HBCIS is unavailable, HBCIS downtime procedures should be followed.

(For ED information please see below under Area specific procedures - Emergency Department)

N/A N/A Administration staff

Unable to generate patient ID labels

Patient ID labels are printed directly from the ieMR.

Existing, spare patient labels located within the CEC and End of Bed Chart should be used on paper forms during downtime.

If ieMR labels are not available,

1) HBCIS labels can be used

2) Patient details can be handwritten

When the ieMR is available, patient labels will need to be printed from Power Chart and added to the form.

Use the existing, spare from the patient’s CEC or End of Bed Chart to labels forms.

Where ieMR labels are not available print HBCIS labels or use the spare, blank labels to manually write a patient’s details on the label.

Administration staff/Nursing staff/Allied Health staff/Medical staff

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Patient Admission continued..

Unable to generate patient ID wristbands

Patient ID wristbands are printed directly from the ieMR (using a wristband printer).

Patient ID wristbands are available within the Downtime Kits. Patient ID wristbands will be manually created during downtime.

Using the patient ID wristbands found within the downtime kit, manually write a patient’s details on the band and attach to the patient.

Ensure that all alerts and allergies are recorded on the wristband.

Nursing staff /Allied Health staff/Medical staff/Admin Staff

Unable to review and update patient information – Clerical Details and Next of Kin

Patient Information is stored within HBCIS and if the ieMR is not available this function can continue to occur.

If HBCIS is unavailable this information can be viewed with the 724 Access Downtime Viewer.

Use HBCIS to validate patient information, including next of kin.

If HBCIS is unavailable use the 724Access Downtime Viewer to view and validate this information.

(Changes can be made when HBCIS is available).


Search for a patient using the steps shown within the guide.

This information can be printed if required.

Administration staff/Nursing staff

Unable to identify patient as ‘on study’ (currently participating in a research study/trial)

If a patient is enrolled on a PowerTrials study/trial the Banner Bar within the patient’s chart (PowerChart) will show ‘Clinical Research: On Study’. This information is not available within the 724Access Downtime Viewer.

Patients should present to the hospital with a study/trial information card with receiving treatment on a research study/trial.

Treating clinicians should also be able to ascertain this when requesting information around medical history.

If a patient is identified as currently participating in a research study this information should be recorded in a progress note and communicated to the relevant staff in the area and at handover.

The downtime kits will contain clinical note forms (progress notes).

These forms should be utilised to record this information during a downtime and facilitate handover.

All staff

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Patient tracking

Unable to track patient locations and bed status

Patient tracking information is available within HBCIS and Patient Flow Manager (PFM).

Alternatively the 724Access Downtime Viewer will show a list of patients in a defined location.

Use HBCIS and/or PFM to view the location of a specific patient or list of patients admitted to a specific location within the hospital.

Patient lists are also available within the 724Access Downtime Viewer.


Search for a patient list using a HBCIS location. A list of locations is contained within the downtime kit.

This list can be printed if required.

Local tracking/bed allocation procedures should be used to manage patient tracking within a specific area (e.g. manual planning using a whiteboard).

Patient Flow across the hospital should be managed using manual procedures. Information should be provided to the unit by faxing all locally created patient registers and tracking sheets to the Patient Flow Unit (during hours) or After Hours Nurse Managers (after hours) for Logan.

These areas will also be able to access patient lists shown in the 724Access downtime Viewer.

Nursing staff

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Clinical assessment

Unable to view a patient’s medical record

A patient’s medical record is stored within the ieMR. If the ieMR is not available, patient chart information can be accessed using the 724Access Downtime Viewer.

Use the 724Access downtime viewer to view and/or print information from a patient’s ieMR.


Search for a patient using known information (First Name, Last Name, URN).

Information can be viewed by selecting options from the left hand side menu.

Step-by-step instructions are shown in the 724Access Downtime Viewer Quick Reference Guide located within the downtime kit.

Nursing staff/Medical staff/Allied Health staff

Unable to access ECGs ECGs are stored electronically within the ieMR. If it is not available, ECGs are not able to be viewed within the 724Access Downtime Viewer.

Printed ECGs for high risk patients will be held within the Current Encounter Chart (CEC).

All admissions ECGs undertaken within ED, Theatres, ICU and Cardiology will be printed and stored within the CEC. This also applied to any other high risk patients across other areas of the hospital. Subsequent ECG completed for a change in the patients cardiac rhythm and for any new episode of chest pain are also printed and stored in the CEC

This will allow these ECGs to be accessible during the event of an unplanned downtime.

During downtime, any new ECGs will need to be printed and later sent for scanning. This will ensure that these ECGs are scanned into the system and available within the ieMR post downtime.

Access the CEC to view ECGs during downtime.

If previous ECGs are not available, another ECG may need to be conducted, printed and placed in the end of bed chart prior or during a downtime

All new ECGs are to be printed and stored within the patient’s end of bed chart. These will be scanned into the ieMR during normal scanning activities or upon discharge.

Nursing staff/Medical staff

Unable to record patient assessment information –

including clinical handover notes, primary assessment information, vital signs and cannulation

The 724Access Downtime Viewer is read-only and no

information can be entered into the system.

All observations, assessments and notations will need to be

recorded on the relevant paper forms contained within the downtime kits.

The downtime kits will contain assessment forms (observation

forms) and clinical notes forms (progress notes).


All Medical admission assessments to be completed in the electronic format provided by


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Clinical Assessment continued

the Digital Support team in a downtime.

Information on how these forms are managed and processed when the system is available can be found within the Recovery Procedures below.

Unable to record alerts and allergies

Alerts and allergies are viewed and recorded within the ieMR.

The 724Access Downtime Viewer is read-only and no information can be entered into the system.

Alerts and allergies are viewed using the 724Access Downtime Viewer.

All new alerts and allergies must be recorded on the relevant paper forms.

Record all alerts and allergies in the appropriate area of the forms used to record patient information during downtime.

The paper forms will be contained within the downtime kits.


Unable to record progress notes The 724Access Downtime Viewer is read-only and no information can be entered into the system.

All progress notes will need to be recorded using paper forms contained within the downtime kits.

The downtime kits will contain assessment forms (observation forms) and clinical notes forms (progress notes).




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Radiology

Unable to view previously ordered Radiology tests and/or procedures

If the ieMR is not available, active and past radiology tests and procedures are able to be viewed within the 724Access Downtime Viewer.

Refer to PACS system

Use the 724Access downtime viewer to view and/or print radiology tests and/or procedures that have been ordered for a patient (including orders that were active and not yet completed at the time of downtime).



Access the required information from the Orders option on the left hand side menu.


To review radiological procedure refer to PACS system if available

Nursing staff/Medical Staff/Allied Health Staff

Unable to order a Radiology test and/or procedure

If the ieMR is not available, radiology tests and procedures are unable to be electronically requested.

The 724Access Downtime viewer is read-only.

Radiology requests will need to be made using paper forms that are available in the downtime kits.

(For Outpatient information please see below under Area specific procedures – Outpatient areas)

The downtime kits will contain radiology request forms.

Critical areas (including ED, Theatres, ICU and Cardiac Surgery) should immediately use these forms.

All other areas should assess the expected duration of downtime (this will be regularly communicated during unplanned downtime) and determine if the test/procedure can wait until the system is available or if the request is urgent and a paper request is required.

All requests are to be faxed to the radiology department (with a follow-up phone call if required).

(For Outpatient information please see below under Area specific procedures – Outpatient areas)

Medical staff

Unable to view results from previously conducted radiology tests and/or procedures (procedure conducted prior to downtime)

If the ieMR is not available, past radiology results are able to be viewed within the 724Access Downtime Viewer.

If available, images are able to be viewed in Synapse.

Previous Images and reports can be viewed in Synapse or the Viewer.


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Radiology continued…

Unable to receive results (reports) from recently conducted radiology procedures (procedure conducted during downtime)

If the ieMR is not available, reports from radiology procedures performed during downtime are not able to be viewed within the 724Access Downtime Viewer.

Radiology reports will still be available in Synapse if ieMR is unavailable. If Synapse is unavailable, radiology will fax the report.

The report will also be visible within the ieMR when active.


Pathology

Unable to view previously ordered Pathology tests

If the ieMR is not available, active and past pathology tests are able to be viewed within the 724Access Downtime Viewer.

Use the 724Access downtime viewer to view and/or print pathology tests that have been ordered for a patient (including orders that were active and not yet completed at the time of downtime).

Refer to AUSLAB



Access the required information from the Orders option on the left hand side menu.


Refer to AUSLAB


Unable to order a Pathology test If the ieMR is not available, pathology requests will need to be completed using current AUSLAB procedures.

During downtime specimen label printers are not able to be used. All labels need to be manually created during downtime.

Pathology requests will need to be made using paper forms that are available in the downtime kits.

Affix the label to the specimen collection container and place specimen collection container and form in a specimen collection bag and send to pathology.

The downtime kits will contain pathology request forms.

Critical areas (including ED, Theatres, ICU and Cardiac Surgery) should immediately use these forms.

Outpatient areas should also utilise these forms to ensure that the patient leaves their appointment with the necessary pathology requisition.

All other areas should assess the expected duration of downtime (this will be regularly communicated during unplanned downtime) and determine if the test can wait until the system is available or if the request is urgent and a paper request is required.

Nursing staff/Medical Staff

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Pathology continued…

Using the spare labels found within the downtime kit, manually write a patient’s details on the label.

Affix the label to the specimen collection container and place specimen collection container and form in a specimen collection bag and send to pathology.

Unable to view results from previously conducted Pathology tests (tests conducted prior to downtime)

If the ieMR is not available, Pathology results received prior to downtime are able to be viewed within the 724Access Downtime Viewer.

If available, results can also be viewed within AUSLAB, AusCare and The Viewer.

Use the 724Access downtime viewer to view and/or print pathology results.


Step-by-step instructions are shown in the 724Access Downtime Viewer Quick Reference Guide located within the downtime kit. Refer to AUSLAB. Pathology to fax results to wards as per AUSLAB downtime procedures or call through urgent or abnormal results


Unable to receive results from recently conducted Pathology test (test conducted during downtime)

If the ieMR is not available, reports from pathology test performed during downtime are not able to be viewed within the 724Access Downtime Viewer.

If available, results can be viewed within AUSLAB, AusCare and The Viewer.

If there systems are not available contact Pathology Queensland and results can be provided over the phone.

These results are manually recorded on a form available within the Downtime Kits.

If results are provided over the phone a Pathology Report (verbal) form should be used to record the results provided.

The downtime kits will contain Pathology Report (verbal) forms.

Use this form to record pathology results. Refer to AUSLAB


Unable to mark patients who were bled during downtime as no longer requiring pathology tests

Patients who have existing orders in the system before the downtime, who are bled during the downtime are at risk of being unnecessarily bled again.

Pathology can produce reports of patients who had tests during the outage.

After downtime, Request report from pathology of patients bled during outage window.

Cancel all existing orders that are duplicates of orders that were taken during the outage

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Patient Transfer

Unable to track the transfer patient from one area of the hospital to another (e.g. ED to ward, ward to ward or theatre to ward)

Patient transfers are conducted in HBCIS and if the ieMR is not available this function can continue to occur.


N/A N/A Administration staff/Nursing staff

Unable to access patient clinical information relevant for transfers

Clinical handover will utilise the information available within the 724Access Downtime Viewer, including clinical notes, vital signs, etc. and information contained within the CEC.






Transferring ward unable to access most up to date medications information from the ieMR

In a downtime staff will not be able to access the MAR in the ieMR

Downtime Medication Report and Paper documentation

The Downtime Medication Report and any paper documentation are to remain in the end of bed chart for transfer. It is the task of the transferring RN to ensure all orders are legible and handed over to the transferring ward

Pharmacists, Nurse and Medical Officers

Unable to access relevant clinical information to complete inter-hospital patient transfer

Information required for Inter- hospital patient transfers are not available as the ieMR is not available.

A record of the transfer is not able to be completed within the ieMR.


Copy all clinical notes made using paper forms during downtime.

Store all information gathered in the patient’s CEC.

Provide a copy of the documentation (via phone, email and/or fax) to destination hospital or facility.


Follow the step-by-step instructions shown in the 724Access Downtime Viewer Quick Reference Guide located within the downtime kit to view and print patient information.

Provide a copy of all information found within the patient’s CEC (and other relevant information accessible in the Downtime Viewer) to the destination hospital/facility via fax.

Administration Staff / Nursing Staff / Medical Staff

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Patient Discharge

Unable to discharge patient from the hospital

Patient discharges are conducted in HBCIS and if the ieMR is not available this function can continue to occur.


N/A N/A Administration staff/Nursing staff/Medical staff

Unable to complete patient discharge forms and information

Patient Discharge Summaries are created using the Enterprise Discharge System (EDS).

If EDS is not available, EDS downtime procedures should be utilised.

N/A N/A Nursing staff/Medical staff

Unable to print PBS scripts form the ieMR for discharged patients

Prescribers will be unable to print PBS scripts from the MAR as the ieMR will be unavailable

Paper PBS script pads available Access paper PBS script pads form the downtime kits and complete for discharges.

Pharmacy to dispense from paper scripts

Prescribers/Pharmacists

Scheduling (This section applied to OPD and Elective Surgery scheduling)

Unable to access daily appointment list

If ESM is not available a daily appointment list is not able to be viewed or printed.

Appointments (past and future) can be viewed within the 724Access Downtime Viewer.

Use the 724Access downtime viewer to view and/or print a daily appointment list.


Search for an appointment list using an outpatient location. A list of locations is contained within the downtime kit.

This appointment list can be printed if required.



Unable to note patient attendance (check in and check out)

If ESM is not available patient attendance is unable to be recorded.

Appointment (past and future) can be viewed within the 724Access Downtime Viewer.

Attendance (status) will need to manually tracked using the ESM Downtime Forms.

Use the 724Access downtime viewer to view and/or print appointment information.

Manually track attendance using the ESM Downtime Forms.


Search for an appointment list using an outpatient location. A list of locations is contained within the downtime kit.

This appointment list can be printed if required. Use the ESM Downtime Forms to note attendance (status) of patients.


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Scheduling (This section applied to Radiology, OPD and Elective Surgery scheduling

Unable to reschedule a patient’s appointment

If ESM is not available patient appointment rescheduling is not available.

Use the ESM Downtime Forms to record rescheduling requests.

When ESM is active reschedule the patient’s appointment and complete the required administration activities.

Wait until ESM is active and reschedule appointments.

Complete the required administration activities (appointment confirmation letter etc.)


Unable to cancel a patient’s appointment

If ESM is not available patient appointment cancellation is not available.

Use the ESM Downtime Forms to record cancellations.

When ESM is active cancel the patient’s appointment and complete the required administration activities.

Wait until ESM is active and record the appointment cancellation.

Complete the required administration activities (inclusion of cancellation reason, etc.)


Appointments

Unable to schedule appointments

If ESM is not available patient appointment scheduling, either booking off the wait list or a follow up, is not available.

Use the ESM Downtime Forms to record scheduling requests.

When ESM is active schedule the patient’s appointment and complete the required administration activities.

Wait until ESM is active and schedule appointments.

Complete the required administration activities (appointment confirmation letter etc.)


Referrals

Unable to process referrals (entry or updates)

If ESM is not available patient referral management, including entry or updates, is not available.

Referrals for entry will need to be kept locally. Use the ESM Downtime Forms to record referral updates.

When ESM is active enter or update the patient’s referral and complete the required administration activities.

Wait until ESM is active and enter or update referrals.

Complete the required administration activities (appointment confirmation slips, etc.)


Research

Unable to view research treatment plan

Research PowerPlans outlining a patient’s treatment plan for a particular study/trial (and relevant Visit/Phase/Cycle) will not be available during a downtime.

The 724Downtime Viewer does not show all the information within a PowerPlan or PowerPlan phase.

Researchers should refer to study/trial documentation, specifically the schedule of events, within the research protocol, to view treatment information during a downtime.

Access documentation from a secondary storage location during a downtime, e.g. Network drive folders, paper copies.

This information will not be stored within the Downtime Kits.

Research staff

Unable to print and dispense trial medication using PBS scripts from the ieMR

Prescribers will be unable to print trial medication PBS scripts

Complete the relevant Trial Medication Ordering template

This template is stored by the prescriber/s involved with the particular trial and/or the clinical trial pharmacist, and will not be available within the downtime kits. If the template is not available paper PBS script can be completed

Principal investigators, Associate Investigators, Researchers with pre-scribing rights and Trial Pharmacist/s.

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Research continued..

Unable to place orders If the ieMR is not available orders will not be able to be placed electronically.

Orders should be placed using the standard downtime procedures described above for radiology, clinical assessment and medication orders.

There is no change to the pathology ordering process – this remains on paper using the pre-printed forms provided by Pathology Queensland.

Order forms contained within the Downtime Kits should be utilised for radiology ordering.

Medication orders should be completed using the Research Medication Ordering Template provided by the Clinical Trial Pharmacist as stated above – this template will not be available within the Downtime Kits.

If required, paper PBS scripts can also be utilised.

Research staff

Unable to view results If the ieMR is not available, results received prior to the downtime are able to be viewed within the 724Access Downtime Viewer.

Please refer to the specific sections above for more information.

Results should be viewed within the 724Access Downtime Viewer if received prior to the downtime.


If required, specific forms are contained within the Downtime Kits for recording results – e.g. Pathology Verbal Results Form, Progress Notes, Observation Forms, etc.


Research staff

Unable to record information relating to the treatment of the patient

The 724Access Downtime Viewer is read-only and no information can be entered into the system.

All progress notes and observations will need to be recorded using paper forms contained within the Downtime Kits.

The downtime kits will contain assessment forms (observation forms), acute observation forms and clinical notes forms (progress notes).



Research Staff

Unable to access enrolled patient list

The 724Access Downtime Viewer does not contain any PowerTrials specific information, including the list of patients enrolled on a specific study.

All information will need to be accessed from an alternative source, e.g. Network drive folder, paper copy.



Research Staff

Unable to access and print study/trial documentation

The 724Access Downtime Viewer does not store any PowerTrials specific documentation, for example a copy of the study/trial consent form.

All information will need to be accessed from an alternative source, e.g. Network drive folder, paper copy.



Research Staff

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Research continued..

Unable to recruit for studies The 724 Access Downtime Viewer does not provide access to pre-screening rules – meaning that electronically screening the ieMR for eligible patients is not available.

It is recommended that all recruit cease during a downtime, however if urgently required all recruitment will need to be completed manually.

Cease recruitment during a downtime, however if urgently required all recruitment will need to be completed manually.

Research Staff

Unable to ensure eligibility for study/trial

A patient’s medical record is stored within the ieMR. If the ieMR is not available, patient chart information can be accessed using the 724Access Downtime Viewer.

If HBCIS is available, Alerts and Allergies can also be viewed.


Use this information to manually determine eligibility.



Information can be viewed by selecting options from the left hand side menu. Step-by-step instructions are shown in the 724Access Downtime Viewer Quick Reference Guide located within the downtime kit.

Research staff

Unable to record a patient’s enrolment or treatment status

PowerTrials is used to record and manage the status of patient’s on a particular study, for example, recording a patient as ‘off treatment’.

PowerTrials will not be available during a downtime.

This information will need to be recorded using paper forms contained within the Downtime Kits.

The downtime kits will contain assessment forms (observation forms), acute observation forms and clinical notes forms (progress notes).



Research staff

Unable to create or edit a PowerTrial

Research Studies/Trials are created electronically within PowerTrials. Once created, the status of these trials/studies is managed electronically within the system (e.g. Suspension of a study).

During a downtime this function will not be available.

Information specific to patients will need to be recorded using paper forms contained within the Downtime Kits.

Information relating to the study itself should be recorded in an alternative electronic system or on paper. Specific forms have not been developed for this purpose.

Record all relevant information in an alternative electronic system or on paper.

There is no specific form for this.

Research staff

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9.2.2 Area specific continuity procedures

Emergency Department

The procedures shown below relate to the specific functions undertaken by the Emergency Departments at Logan and Beaudesert Hospitals. Where procedures are not noted below, Emergency Department staff should refer to the general continuity procedures shown above.


Patient registration/admission

Unable to record triage information

As FirstNet is not available triage information can’t be electronically recorded for a patient.

Triage information should be captured within the Triage Downtime Form.

The downtime kits will contain Triage Downtime Forms. Use this form to record triage information. Store this form in a patient’s CEC to ensure that information travels with the patient.

Nursing staff

Unable to generate or locate an existing patient ID

If the patient has previously been to the hospital their URN can be found using HBCIS. If HBCIS is not available, or the patient has not been to the hospital FirstNet Downtime URNs are to be used.

If available, search for the patient’s URN in HBCIS. If a URN can’t be located or HBCIS is not available, assign a FirstNet Downtime URN to the patient. Note this URN on the Triage Downtime Form captured by the Triage Nurse.

Search HBCIS for the patient’s URN. If found, note this URN on the Triage Downtime Form. If the URN is not found or HBCIS is unavailable assign the patient a FirstNet Downtime URN. These URNs are supplied by HIMS – contact the NUM or shift team leader for information on where these are located within your area. Note the URN on the patient’s Triage Downtime Form.


Unable to complete ‘Quick Registration’ of patients presenting to ED

As FirstNet is not available quick registration of patients can’t occur.

Record registration information on a FirstNet Registration Downtime Form. If available, patient information (name, DOB, contact details and next of kin) should be confirmed in HBCIS. If HBCIS is not available, confirm patient details with the patient or family/friend with the patient. Note the patient’s URN (either existing HBCIS URN or FirstNet Downtime URN) on the registration form.

The downtime kits will contain FirstNet Registration Downtime forms. Use this form to register a patient. If available, confirm patient information (name, DOB, contact details and next of kin) using HBCIS. If HBCIS is not available confirm the patient’s details with the patient or family/friend Note the patient’s URN on the registration form. Store this form in a patient’s CEC to ensure that information travels with the patient.


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Patient registration/admission

Unable to create an Emergency Encounter Emergency encounters are usually created within FirstNet. Encounters will be unable to be created during downtime.

Retrospectively add Encounters Using the Downtime quick registration and Triage assessment Forms found in the Downtime pack and HBCIS registration

Administration staff/Nursing Staff

Unable to admit patient to ED Short Stay or CDU

Admit the patient using HBCIS. If HBCIS is not available, HBCIS downtime procedures should be followed.

N/A N/A N/A

Unable to admit patient to inpatient units Admit the patient using HBCIS. If HBCIS is not available, HBCIS downtime procedures should be followed.

N/A N/A N/A

Theatres

The procedures shown below relate to the specific functions undertaken by theatre at Logan and Beaudesert Hospitals. Where procedures are not noted below, Theatre staff should refer to the general continuity procedures shown above.


Elective Scheduling

Unable to identify theatre schedules If ESM is not available a daily/session list is not able to be viewed or printed.

Appointments (past and future) can be viewed within the 724Access Downtime Viewer.

Use the 724Access downtime viewer to view and/or print a daily appointment list.


Search for an appointment list using a HBCIS location. A list of locations is contained within the downtime kit.

This list can be printed if required. Step-by-step instructions are shown in the 724Access Downtime Viewer Quick Reference Guide located within the downtime kit.

Administration staff/Medical/Nursing Staff

Unable to reschedule a patient’s surgery If ESM is not available patient surgery rescheduling is not available.

Use the Surgery Downtime Forms to record rescheduling requests.

When ESM is active reschedule the patient’s surgery and complete the required administration activities.

Wait until ESM is active and reschedule surgery.



Unable to cancel a patient’s surgery If ESM is not available patient surgery cancellation is not available.

Use the Surgery Downtime Forms to record cancellations.

When ESM is active cancel the patient’s surgery and complete the required administration activities.

Wait until ESM is active and record the surgery cancellation.

Complete the required administration activities (inclusion of cancellation reason, etc.)


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Elective Scheduling

Unable to schedule a patient’s surgery

If ESM is not available patient surgery scheduling is not available.

Elective Patients: schedule the patient using HBCIS for he elective admission.

If HBCIS is not available, HBCIS downtime procedures should be followed.

Use the Surgery Downtime Forms to record surgery bookings.

When ESM is active schedule the patient’s surgery and complete the required administration activities.

Wait until ESM is active and schedule surgery.



Emergency Scheduling

Unable to schedule a patient’s surgery

If ESM is not available patient surgery scheduling is not available.

Information from paper emergency Booking form written on White Board.

When ESM is active schedule the patient’s surgery and complete the required administration activities.

Wait until ESM is active and schedule surgery.


Unable to reschedule a patient’s surgery

If ESM is not available patient surgery rescheduling is not available.

Use the Emergency Booking Form to record rescheduling requests.

Wait until ESM is active and reschedule surgery


Medical History

Unable to view a patient’s ieMR and medical history (Emergency cases)

If the ieMR is unavailable a patient’s ieMR and medical history is not able to be viewed within the system, including assessments and information gathered while the patient was in ED.

Emergency Surgery should continue as per current processes.

All relevant information recorded while the patient was in ED will be contained within the patient’s CEC.

Emergency Surgery should continue as per current processes.

Access relevant information from the patient’s CEC. Information will also be provided verbally via clinical handover.


Unable to view a patient’s ieMR and medical history (Category 1)

If the ieMR is unavailable a patient’s ieMR and medical history is not able to be viewed within the system.

The 724Access Downtime Viewer will show information from the past 30 days.

The Viewer will also show any historical information.

Where available, information should be accessed from the 724Access Downtime Viewer.

Please note the Downtime Viewer will provide information for the past 30 days – information relating to Category 1 patients should be visible within the system.

Access this information with the 724Access Downtime Viewer.

If no information is available within The Viewer or The Viewer is not available, a decision should be made to either: reschedule surgery or to continue should be made.



Completion of paper forms (including ARPs and Consent Forms) should continue as per current procedures and will be found within the patient’s CEC.


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Medical history

Unable to view a patient’s ieMR and medical history (Category 2 & 3)





Please note the Downtime Viewer will provide information for the past 30 days.

If information is not available within the 724Access Downtime Viewer, The Viewer should be utilised.

If no information is available within The Viewer or The Viewer is not available, a decision should be made to either reschedule surgery or to continue should be made.





If information is not available check for information with The Viewer.

If information is not available within The Viewer or The Viewer is not available, a decision to postpone or reschedule surgery or continue with the procedure/surgery should be made.

Completion of paper forms (including ARPs and Consent Forms) should continue as per current procedures and will be found within the patient’s CEC.


Inter-operative Information

Unable to check in a patient for surgery

As SurgiNet is not available, patients cannot be checked in for surgery

Use the Surgery Downtime Forms to record surgery check in’s.

When SurgiNet is active complete the check in process.

Wait until SurgiNet is active and check in surgery.


Unable to complete inter- operation notations (all cases)

As SurgiNet is not available, inter-operative notes are not able to be completed electronically.

All inter-operative notes and observations will need to be completed on an Inter-operation SurgiNet downtime form.

This form will be stored within the patient’s CEC for use during recovery and clinical handover to a ward.

The downtime kits will contain Inter-Operation Forms for recording clinical notes and observations.

Use this form to record information during downtime. Store this form in a patient’s CEC to ensure that information travels with the patient and can be used during clinical handover. Wait until Surginet is active and complete the Intraoperative documentation with the retrospective data requirements as per QRG


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Anaesthetic Notes and Medications

Unable to complete or access inter-operation notations (all cases)

If ieMR downtime the SAA Anaesthetic module is not available

Print notes prior to downtime (planned).During downtime document on relevant paper based form

In a planned downtime (mid case) print notes prior to downtime.

In unplanned retrospective documentation form the devices prior to completion of case is recommended. All anaesthetic notes and orders during downtime should be documented on the relevant paper form located in the local downtime kits.

Medical Staff

Pre-operative Information

Unable to complete pre- operative checklist

As the ieMR is not available the pre-operative checklist can’t be completed electronically.

All pre-operative checklists must be completed on a paper form.

This form will be stored within the patient’s CEC.

The downtime kits will contain Pre-operative checklists for recording pre-operative information.

Use this form to record information during downtime.

Store this form in a patient’s CEC to ensure that information travels with the patient and can be used in preparation for surgery and during clinical handover.

Nursing staff

Outpatient Departments

The procedures shown below relate to the specific functions undertaken by Outpatient Departments at Logan and Beaudesert Hospitals. Where procedures are not noted below, staff should refer to the general continuity procedures shown above.


Outpatient Appointments

Unable to view a patient’s ieMR and medical history





Please note the Downtime Viewer will provide information for the past 30 days.

If information is not available within the 724Access Downtime Viewer, The Viewer should be utilised.

ARMS can also be accessed to view referral information.

If information is not available within either system, a decision should be made to either reschedule the appointment or to continue with the appointment.

Access the 724 Downtime Viewer using the Quick Reference Guide within the downtime kit. Search for a patient. Information can be viewed by selecting options from the left hand side menu.

Step-by-step instructions are shown in the 724Access Downtime Viewer Quick Reference Guide located within the downtime kit. If information is not available check for information with The Viewer. Check for referral information within ARMS. If information is not available within either system, a decision to reschedule the appointment or continue should be made.


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Maternity Services The procedures shown below relate to the specific functions undertaken by Maternity Services at Logan and Beaudesert Hospitals. Where procedures are not noted below, staff should refer to the general continuity procedures shown above.


Antenatal Care

Unable to view a patient’s ieMR. If the ieMR is unavailable a patient’s ieMR and medical history is not able to be viewed within the system. The 724 Access Downtime Viewer will show information from the past 30 days.

The patient will have available a print out of the Patient Hand Held Record that they also carry.

Antenatal Care should be documented on the Patient Hand Held Record – a determination should be made if the information needs to retrospectively be entered in ieMR.


Labour and Delivery

Unable to complete Partogram and Intrapartum documentation

At the first notification of Downtime the Intrapartum paper record should be commenced and CTG tracings converted to paper.

The Partogram can be populated with data prior to down time. The 724 Access Downtime Viewer will enable viewing of data prior to down time.

NA


FetaLink – Unable to view electronic CTG trace

If ieMR is not available CTGs will not be visible on screen

Revert to CTG paper trace

See Appendix G for Work steps in the event of ieMR (Millennium) downtime or FetaLink downtime occurs

Nursing Staff

Post-Natal Care

Unable to complete documentation.

As the ieMR is not available to document post-natal care

The Post-natal Pathway either Vaginal Delivery or Caesarean Delivery are commenced as part of preparation for downtime and data entered to reflect where care is up to on the pathway. The 724 Downtime Viewer will enable viewing of care prior to downtime.

The Post-natal pathways will be available from HIS

Nursing staff

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9.2.3 Scanning (Kofax) continuity procedures

The procedures shown below relate to unplanned downtime of the Kofax system and the procedures that need to be implemented within the departments/wards/area in terms of accessing scanned documentation and preparing and sending documentation for scanning.


Scanning

Unable to view scanned documentation

If the ieMR is available, previously scanned documentation can be viewed within the system.

If the ieMR is not available scanned document are not visible within the 724Access Downtime Viewer.

If available, other systems can also be used to access information, for example The Viewer.

Where available, scanned documentation should be viewed directly from the ieMR.

If available, other systems can also be used to access information, for example The Viewer.

Access the ieMR as per current procedures and view scanned documentation.

Access other systems to view additional information, for example, The Viewer.


Unable to scan paper forms and other patient documentation

If Kofax is not available new paper forms and documentation will not be able to be scanned.

No scanning can occur if Kofax is not available.

Preparation activities can continue to occur to prepare for when the system is back online.

Continue to prepare documentation for scanning.

Wait for notification that the system has been restored before sending documentation for scanning.

Current scanning business rules apply – for example, some areas work under the ’30 days or upon discharge’ business rule.

Administration Staff/Nursing Staff

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9.3 Power failure

The Logan and Beaudesert Hospital have back-up generators to ensure that areas are able to continue to function in the event of power loss. Procedures around this are documented within the Facility Continuity Plans.

The 724Access Downtime Viewer is connected to Uninterruptable Power Supplies (UPS) and will therefore utilise these back-up generators.

It is important to note that during a power failure scanning is unable to continue. For information on what to do when the Kofax (scanning) system is not available see section 9.2.3 above.

The 724Access Downtime Viewer and supporting medical devices have their own local back-up batteries. Information relating to this is shown below.

Device Approximate battery back-up duration

724Access Downtime Viewer – a standard Windows 7 MOE laptop is used to access the 724Access Downtime Viewer application. This laptop will show the battery power available before a recharge is required.

4-8 hours

Welch Allyn Connex Vital Sign Monitors (CVSM) – the battery power indicator will indicate time remaining on each charge

At least 90 minutes

Bedside Vital Sign Monitors – the battery power indicator will indicate time remaining on each charge 4-5 hours

Phillips ECG Carts – the battery power indicator will indicate time remaining on each charge At least 45 minutes of continuous Rhythm printing

9.4 Loss of Network

The contingency procedures documented above include loss of network causing loss of connection to the ieMR.

9.5 Device Failure

All faults and issues with medical devices should be managed using the Digital Hospital Support Model.

10. Recovery Plan

This Recovery Plan is intended as a guide only. Patient safety principles take precedence. The decision to enter clinical information into the ieMR manually, or have the information scanned and reconciled upon discharge post a downtime period will be at the discretion of the Local Line Reporting Manager in consultation with the Divisional Executive Team.

0 – 8 Hour Downtime > 8 Hour Downtime

Admission

History

(Admission

clinical

assessment)

Initial manual process using electronic template, printed copy to be placed in end of bed chart and signed by the admitting medical officer. Medical officer to reconcile in to the ieMR post downtime. Paper documentation reconciled upon discharge through normal business scanning practices.

Patient

Registration,

Admissions,

Discharges

and Transfers

No retrospective input should be required for patient movements. Post downtime, units should validate the HBCIS patient list with the ieMR.

Allergies &

Alerts

Retrospective documentation by medical/ nursing/ pharmacy staff during Recovery Phase for all new allergies and alerts

Problem List

Refer to admission notes. Retrospective documentation considered by medical team during post downtime assessment

Discharge

Summaries

Continue to use discharge summaries from EDS where applicable. ED Discharges- Patient ‘Statement of Attendance’ record to be mailed to patient’s address

Height and

Weight

Retrospective documentation by nursing staff.

I & O Fluid

Balance

Retrospective documentation by nursing staff.

Plan of Care

Documented on Progress Notes, and placed in the CEC.

Reconciled at discharge or in routine scanning practices.

Medication

History

Retrospective documentation should be considered by medical staff in recovery phase

Medication History (home medications) to reconcile in to the patients ieMR by discharge as per standard practise

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Medications

Retrospective documentation of orders

and administration of medications by both

nursing and medical staff.

In prolonged downtime the omission of retrospective entry could be considered Reconciliation of current orders required. Consider ‘purging’ tasks associated with when the ieMR was unavailable. Medication reconciliation should be avoided at night where possible

OPD

Scheduling

Retrospective input and correction of data will be required during Recovery Phase

Pre-existing

Paper-Based

Documents

No change. Reconciled at scanning upon discharge or normal unit scanning processes. During downtime clinical notes to be kept in the CEC, and patient care documentation to be stored in the end of bed chart. 24 hours following a downtime period all downtime documentation should be stored in the CEC.

Pathology Orders

After downtime, request report from pathology of patients bled during outage window.

Electronic orders that have been completed during downtime will need to be reconciled and

. cancelled Refer to AUSLAB Downtime Plan

Pathology

Results

Results received during the downtime will be available in the ieMR

Patient

Identification

Wristbands

New ieMR armbands to be printed post downtime to replace the existing handwritten . armbands

Patient Labels

Any HBCIS labels printed during the downtime are to be destroyed and replaced with ieMR . encounter labels Forms which were labelled with HBCIS labels or had patient details hand written in the label

section during the downtime are not to be re-labelled by ward staff under any circumstances

These forms are to be prepped within the scanning batch upon discharge with the . correct encounter label attached to the batch cover sheet

Progress Notes

All other general progress notes Summary documentation is recommended post downtime for critical elements entered into

ieMR, e.g. including Code Blue activations, clinical deterioration All progress notes to remain in end of bed chart for 24 hours and then moved to CEC.

Paper progress notes are to be prepped within the scanning batch upon discharge with the correct encounter label attached to the batch cover sheet

Pyxis

Pyxis machines to be manually returned to ‘profile mode’ by Unit Downtime Coordinator

http://qis.health.qld.gov.au/DocumentManagement/Default.aspx?DocumentID=33959&DocumentInstanceID=107201

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Radiology

Orders

Electronic orders that have been completed during downtime will need to be reconciled and

cancelled

Radiology

Results

Results received during the downtime will be available in the ieMR

Risk

Assessments

Admission Nursing Risk Assessments should be retrospectively entered into the ieMR

Theatre

Operations

Initial manual process on Progress Note. To be stored in patient CEC. Reconciled at discharge or in routine scanning practices.

Retrospective documentation of key statutory data will be required during Recovery Phase. Consider extended downtimes the delay or reschedule of theatre cases could be considered.

Theatre

Scheduling

Retrospective input and correction of data will be required during Recovery Phase.

Triage

Retrospective documentation into the ieMR will be required during the Recovery Phase.

Vital Signs

Retrospectively enter the most recent set of vital signs Clinical judgement should determine whether additional retrospective vital signs are required to be entered A summary of clinical deterioration should be documented into the ieMR as clinically indicated

Research

See above for specific information relating to treatment during downtime, including Height & Weight, I & O Fluid Balance, Medication History, Medications, OPD Scheduling, Pre-existing paper-based documents, Pathology Orders & Results, Progress Notes, Radiology Orders & Results, Risk Assessments, Vital Signs.

Retrospective recording of patient enrolment.

Retrospective recording of study information/status, e.g. study suspension

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Glossary of Terms

AIIMS Australasian Inter-sectoral Incident Management System AO Administration Officer AUSLAB Pathology Information System ARP Acute Resuscitation Plan BCP Business Continuity Plan CEC Current Encounter Chart CVSM Welch Allyn Connex Vital Sign Monitors DAS Digital Application Services DIG Digital Implementation Group ECG Electrocardiogram ED Emergency Department EDS Enterprise Discharge Summary EIC Executive Implementation Committee EMT Emergency Management Team EOC Emergency Operation Centre ESM Enterprise Scheduling Management System HBCIS Hospital Based Computer Information System HSIA Health Services Information Agency ICU Intensive Care Unit ieMR Integrated Electronic Medical Record IT Information Technology ITIL Information Technology Infrastructure Library LBH Logan Beaudesert Hospitals LBHEOC Logan Beaudesert Hospitals Emergency Operations Centre OERR Orders Entry and Results Reporting OPD Outpatients Department MDT Multi-disciplinary Team MSHHS EOC Metro South Hospital and Health Services Emergency Operations Centre QH Queensland Health RRT Rapid Response Team SDCC State Disaster Coordination Centre SHECC State Health Emergency Coordination Centre SLA Service Level Agreement UDC Unit Downtime Coordinator UPS Uninterrupted Power Supply

Appendix A: Business Impact Assessment - Overview

Systems ED Outpatient Inpatient Peri- Operative Services

ICU Patient Flow

Radiology Mental Health

Pathology Admin Switch

Community Services

AUSLAB

(Pathology) X X X

CIMHA

(Mental Health)

X

X

X

X

X

X

X

ESM

(Scheduling)

X

X

X

X

X

FirstNet

X

X

X

X

X

HBCIS

Karisma

X

X

X

X

X

PasLink

(FirstNet to HBCIS)

X

X

X

X

X

X

X

PowerChart

(ieMR)

X

Pyxis X X X X X X X X X

SAA Anaesthetic

X

X

X

X

X

X

X

X

SurgiNet

(Surgery)

X

X

X

X

X

X

X

PowerTrials – POM and PPM

X

X

Appendix B: Action Cards

Action Card: Unit Downtime Coordinator

Level 3 Incident


SCHEDULED DOWNTIME OR CODE YELLOW – Local Manager (NUM or delegate)

Purpose:

The Local Manager (NUM or delegate)/Nurse in charge of each Unit/service will be advised that a Scheduled or Unplanned Downtime (Code Yellow) is planned or has occurred. Upon direction from the Emergency Management Team, the Local Manager will implement the Downtime Plan immediately as requested. This role will only be activated depending on the scope of the response.

Key Responsibilities:

Communications – local briefing of staff pre, during and post downtime.

Safety aspects – regular patient rounding during the downtime and recovery phase

Coordination of event at local area

Escalation of concerns – reporting through normal line management

Recovery activities – debrief and feedback, reports, documentation responsibilities, replenishment of stock in the Viewer kit.

Key tasks:

Local team briefing: notification of staff of event and information known.

Proceed to the 724 Viewer: access the Viewer with the key and password provided

Downtime kit: ensure distribution of contents, refer Quick Reference guides as required

Ensure clinical care documentation is stored in the end of bed charts

Ensure each patient (as required) has appropriate signage “refer to patient paper record”

Print a tracking list of current patients in the unit from HBCIS or Patient Flow Manager

Print the following for ALL patients in the relevant ward from the Downtime Viewer:

1. Current Medication Orders: Medications report from “Medication Administration (Current)” tab 2. Active Orders: a list of outstanding/active orders for all patients including the following tabs in the downtime

viewer:

o “Orders (current)” o “Completed orders”


o Documents o Intake & Output o Discontinued Medications o Patient Care Results o Vital Signs

Other relevant clinical documentation can be accessed as clinically indicated **Monitor all reprinting in a downtime to ensure Medication related orders are not reprinted

Downtime Documentation: Ensure staff are attending to appropriate clinical documentation during the Downtime and in the Recovery phase

Local team briefing: following notification of completion of downtime and informing staff to commence recovery activities.

Recovery activities: Ensure recovery activities are attended to by the staff as outlined in the ieMR Downtime Plan

Escalation of concerns is to follow normal processes of governance, reported to line manager for escalation to the Incident Management Team.

Reports to: Manager, e.g. ADON

Delegates to: reporting staff

Key contacts: Manager/ADON, reporting staff, patients, family members, MDT local team.

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Action Card: Chief Informatics Officer (CIO)

Level 2/3 Incident Chief Informatics Officer

CODE YELLOW - Clinical Informatics Director

Purpose:

The Clinical Informatics Officer supports and works closely with the Emergency Management Controller. This role is vital to ensuring both timely actioning of Business Continuity Management (BCM) of an Electronic Medical Record (EMR) downtime and potential impacts of interdependencies:

Manage the immediate impacts of a ICT business interruption (crisis management),

Manage the re-establishment of core services or outputs as soon as possible following a business interruption (business recovery), and

Manage the longer-term recovery issues to enable the resumption of business to pre-incident capacity where possible (business restoration).

This role will only be activated depending on the scope of the response.

Key Responsibilities:

Assists the Emergencyt Management Controller in the ICT leadership of the EOC; coordinates the management of ICT functions and BCM response and recovery activities.

Liaises with ICT and Digital Hospital Support structure – i.e. Digital Hospital Response Committee, Digital Hospital Support Team, Cerner and systems support roles.

Key Questions:

Criteria Example and Matters to Consider

Cause of Downtime Cerner outage, feeder system, receiving system, network outage, LBH wide issue (e.g. electricity outage)

Breath of Downtime How many clinical areas are impacted, what can’t they do (breadth in terms of units impacted and functions impacted)

What is still available and working that can be used

Impact of Downtime Are all clinical areas impacted or only some

Is it a busy period clinically

Are functions that impact patient safety compromised

Potential length of Downtime

Is the potential length known (if not, it will be assumed it will take some time to resolve)

Contingency Plans What contingency plans exist

What tasks and activities need to be implemented for risk mitigation and prevention

Recovery Plan What activities need to be implemented for the recovery phase

Are additional staff and recourses required for successful recovery

Key tasks:

• Obtain briefing from Incident Management Controller (EMC);

Identify local, Branch and functional plans for activation and notify plan owner(s)

Determine the level of seriousness of the problem and the likely impact, determine the required response and recovery strategies

• Advise the EMT on continuity practices

• Complete Incident Log sheets for recovery steps and actions taken. • Provide regular updates and other communication as directed by the HIC

• Be the point of contact for Clinical Informatics-related support mechanisms and response activities.

• On stand down participate in debriefing activities

Reports to: Emergency Management Controller (EMC)

Delegates to: Clinical Informatics Team

Key contacts: Emergency Management Team, Clinical Informatics Team, External Stakeholders

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Appendix C: Location of Hospital Downtime 724 Viewers

Facility Area/Location Number of

viewers

Logan Allied Health 1

Logan LPOS 1

Logan Recovery 1

Logan Day Procedure Unit 1

Logan Theatres 2

Logan Patient Flow Program 1

Logan Ward 2A 1

Logan Ward 2B 1

Logan Ward 2C 1

Logan Ward 2D 1

Logan Ward 2E Obstetrics 1

Logan Ward 2E Special Care Nursery 1

Logan Birth Suite 1

Logan Ward 2G 1

Logan Ward 2H 1

Logan Ward 2I 1

Logan Ward 2J 1

Logan Ward 2K 1

Logan Ears, Nose & Throat 1

Logan Intensive Care Unit 1

Logan Medical Outpatients 1

Logan Outpatients Building 1 1

Logan Paediatrics Outpatients 1

Logan Pharmacy 1

Logan Transit Care Hub 1

Logan Ward 3A 1

Logan Ward 3B 1

Logan Ward 3C 1

Logan Outpatients Building 2 1

Logan Renal Dialysis 1

Logan Endoscopy 1

Logan Supportive Care 1

Logan Emergency Adult/Paeds 8

Logan Paediatrics 3

Logan Rehabilitation 1

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Facility Area/Location Number of

viewers

Beaudesert General Ward 1

Beaudesert Emergency 1

Beaudesert Theatres 1

Beaudesert Maternity 1

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Appendix D: Downtime Kit Contents Checklist This is the baseline/ minimal requirements for each downtime kit. Units can add to this in accordance with their own clinical requirements.

Clinical Forms and Resources

Quantity Item

24 hour stock Patient ID wristbands : red and white coloured

1 pack per bed (inpatient areas)

Key clinical forms required:

1 x “Patient on Paper” Sign

1 x National Inpatient Medication Form (NIMC)

1 x Intravenous & Subcutaneous Fluid Order Form

1 x Patient Observation Forms (Q-ADDs/CEWT/MEWT)

2 x Progress Notes

1 (packet) Patient Observation Forms (Q-ADDs/CEWT/MEWT)

2 (packet) Progress Notes

2 (pads) Pathology Order forms

1 (packets) Medical Imaging Request

1 (packet) Pre-operative Theatre Checklist

2 (packets) National Inpatient Medication Form (NIMC)

2 (packets) Intravenous & Subcutaneous Fluid Order Form

1 (packet) Insulin Intravenous Infusion Order and Blood Glucose Record Adult

1 (packet) Insulin Subcutaneous Order and Blood Glucose Record

1 (packet) Fresh Blood and Component Transfusion Prescription and Administration Record

1 (packet) Heparin Intravenous Infusion Order and Administration

Additional resources

2 Pens (Box)

1 roll Allergy Stickers

Zip Ties

.

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Appendix E: Weekly Checklist – Unit Downtime Coordinator

Weekly Downtime Checklist

Unit Ward:

Date Check Completed:

/ /

Completed By:

Name:

Signature:

Task Variance – Action Required

Action Completed (Initial and Date)

Downtime Kit

1 Downtime kit is easily accessible

2 Downtime Kit is sealed and has not been tampered with

If Downtime Kit has been opened the following is checked:

3 Check contents against the Unit checklist; restock contents (if required) and kit resealed.

724 Downtime Viewer

4 Key to access the secure cabinet can be located and works

5 The Downtime 724 Viewer computer is turned on (it should be left on at all times) and plugged into emergency power

6 TEST- The Username and Password for the Downtime 724 system can be located and works as a login DO NOT ‘SHUT DOWN’ POST TEST (use ‘logoff’ Function)

7 TEST- Locate the tracking list in the Downtime 724 system (tracking list)

8 TEST- Printing functionality by printing the tracking

list from the Downtime 724 system

Medications Transfer Report

9 TEST – locate unit Medication Transfer Report and search current patient

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Appendix F: Communication Plan

Audience Communication

Methods

Key messages

Minister / Director General

Ministerial/DG briefing Event Implications and risks Management plan

Chief Executive

Phone briefing Event Implications and risks Management plan

Staff Staff email crisis Staff bulk text message Overhead

Event Implications Instructions Next message due

MSHHS Executive Team

Email Teleconference

Event Implications Instructions

Suppliers/ contractors/ service providers

Phone Email


General public

Press release Overhead Health Clinicians face to face


State Disaster Coordination Centre (SDCC) OR

State Health Emergency Control Centre (SHECC)

Situation Report Event Time and date Officer in charge of IMT Situation as at time of report Media & PR info Management plan activation status Planned actions