overview: step-by-step processes for clinical staff · 2019. 5. 2. · capacity management...

Capacity Management Step-by-Step Processes for Clinical Staff

1 Updated May 2019

Questions? Call Children’s IT Service Desk 24/7 952-992-5000 (4-5000 internal)

Overview: Step-By-Step Processes for Clinical Staff

ED Admission .................................................................................................................................................. 2 ED-IP ............................................................................................................................................................... 3 ED Patient Moved to Receiving Unit in Error .................................................................................................. 4

First, Cancel Transfer: ................................................................................................................................ 4 Second, manually add the patient back to the Transfer List in Capacity Management: ............................ 5

ED to OR ......................................................................................................................................................... 6 In FirstNet .................................................................................................................................................... 6 In Capacity Management ............................................................................................................................ 6

ED to ED.......................................................................................................................................................... 7 Unit-to-Unit Transfer ........................................................................................................................................ 8

Other Transfer Actions ................................................................................................................................ 8 Transfer Patient Within a Unit ......................................................................................................................... 9 How to Correct an Inpatient Transfer Completed in Error ............................................................................. 10 How to Correct a Cleaning Job Placed in Error ............................................................................................ 11 Discharge Process ........................................................................................................................................ 12 Direct Admits ................................................................................................................................................. 13 PACU Process for Expected Admissions ...................................................................................................... 14 Holding a Room ............................................................................................................................................. 15 Ad Hoc Clean Requests ................................................................................................................................ 17

Lead Requests .......................................................................................................................................... 17 Linen Request ........................................................................................................................................... 18 Parent Requests a Routine Room Clean .................................................................................................. 18 Prioritize Next Discharge Room to be Cleaned ........................................................................................ 19

Changing Room/Bed Statuses ...................................................................................................................... 20 Status Definitions ...................................................................................................................................... 20 How to Change the Status of a Room ...................................................................................................... 21

Cross Campus Transfer ................................................................................................................................ 22 ED to ED ................................................................................................................................................... 22 ED to Inpatient .......................................................................................................................................... 22 Inpatient to Inpatient ................................................................................................................................. 22 ED-IP to inpatient ...................................................................................................................................... 22 Mercy Mother Baby ................................................................................................................................... 22

Capacity Management Downtime ................................................................................................................. 23 During downtime – all Capacity Management Downtimes ....................................................................... 23 During downtime – if all of the EMR is down ............................................................................................ 23 During downtime – if PowerChart etc is working ...................................................................................... 23 After Downtime ......................................................................................................................................... 23

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2 Updated May 2019


ED Admission 1 ED Physician places Admit from ED order.

2 The patient name appears on the Transfer List, with the Comments from the Admit order.

Note: The ED PAS can click the Comment field to add other useful information to the Task List comments.

3 HNS negotiates a bed with receiving Charge Nurse.

4 HNS plans the bed in Capacity Management by dragging and dropping the patient name to the selected room. It is possible in Capacity Management to plan to an available, dirty or occupied bed.

5 ED Charge/RN views bed assignment on FirstNet tracking board, along with bed status, and

negotiates transfer time.

Note: Available status means that the room is ready, not that the floor is ready to accept the patient.

6 Case Management (days) or HNS (night) enters Patient Status Recommendation order.

7 ED Provider signs Admit to Inpatient or Observation order (putting the patient in an ED Pending bed location).

Note: The order is required to complete the transfer in Capacity Management. If no order is entered, use the Location Check-In PM conversation.

8 At time of transfer, ED PAS completes the transfer, which removes the patient from the Transfer List, places the patient in the Receiving unit and removes them from the FirstNet Tracking Board.

Action - Open Capacity Management, click in leftmost column next to patient name to select patient, select Transfer, then select Complete Transfer.


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ED-IP The ED patient who will become an admission, but is not leaving the ED, will have the following process:

1 ED Provider signs Admit to Inpatient or Observation order, putting the patient in an ED Pending bed location on the Transfer List.

2 At time of transition to Inpatient Providers, ED PAS to transition into ED-IP status using link shown below (Location Check-In.)

Note: Acuity color on tracking board will not be lost.

Patient remains on the ED tracking board, is in the ED-S location in Capacity Management, in the ED bed assigned, and is on the Transfer List.

Because they are in need of an inpatient bed, the patient will remain on the Transfer List until an inpatient bed placement is found or discharge occurs.

3 If the ED-IP patient moves to a different room within the ED, do the following to ensure that the patient remains on the tracking board and on the appropriate patient list for the provider:

• Move the patient to the new room in FirstNet using location. This will change the patient location in the banner bar back to ED-M.

• Go back to the Location Check-in conversation (compass icon on the FirstNet toolbar) and update the patient to the new ED-IP room/bed.

It is important to follow these steps in this sequence.

4 Admission - If patient eventually gets an inpatient bed, patient is already on the Transfer List, HNS will plan the bed. ED PAS will complete the transfer as usual when the patient leaves the department.

Completion of the transfer will not remove the patient from the ED tracking board. ED PAS will move patient to Checkout location in FirstNet. The name will appear in Checkout only briefly (no action is required).

5 Discharge - If the patient is discharged, use the Depart on the toolbar, NOT the

quicklink on the Tracking Board to discharge the patient. They will need to be removed from the tracking board by placing into Checkout when the patient leaves. The name will appear in Checkout only briefly (no action is required).

6 In Capacity Management, switch the ED-IP room from dirty to available.


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ED Patient Moved to Receiving Unit in Error If a Capacity Management patient transfer from ED Pending Bed to the Unit was completed too early, the PM conversation Cancel Transfer will put the patient back to the ED Pending Bed location.

Note: No additional Capacity Management cleanup is needed. When a Cancel Transfer is used, the bed status will flip back to Available and no clean job is generated.

First, Cancel Transfer:

• Within Capacity Management on the Bed Board view, dropdown the options from the PM conversation launcher and select Cancel Transfer.

• Search for and select the encounter you need to return to the ED Pending Bed location.

• Complete the conversation (this should put the patient back into ED Pending Bed)

• Confirm the patient is back in the ED Pending Bed location

Note: On the Tracking Board, the Rm will now show the unit room they are returning from and the FN room due to the cancel transfer


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Second, manually add the patient back to the Transfer List in Capacity Management:

• On the Patient List, search for the Patient/Encounter.

• Highlight the patient row, click the dropdown arrow in the leftmost column to expand

options.

• Highlight/select Transfer > Transfer Patient.

• Work with the CTCC group to ensure the patient is planned back to the appropriate

unit/room/bed within Capacity Management.


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ED to OR

In FirstNet

1 Go to Depart icon.

2 Select ED to OR.

3 Under Service area, select Support Depts.

4 Select Surgery-S or Surgery-M for Clinic/Department/Unit and Day Surgery or Inpatient for the

patient type. (If uncertain whether the child will be Inpatient patient type, select Day Surgery.)

5 Fill in required fields, and then click on Complete.

In Capacity Management

6 ED PAS - From the Capacity Management Patient List, use to find patient. When patient has appeared on the Patient List, click on the left-most column beside the name, and select Transfer, then Transfer Patient. Patient now appears on the Transfer List.

7 HNS will plan a bed by dragging name to chosen bed.

8 PACU RN will find the targeted room on the Transfer List and call receiving unit.

9 Receiving unit UOC completes the transfer when the patient arrives.

Action - Receiving unit UOC opens Capacity Management, click in leftmost column next to patient name to select patient, select Transfer, then select Complete Transfer.


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ED to ED 1 Open Conversation Launcher and select the Cross Campus Outpatient Transfer

conversation. Search for the correct patient encounter. 2 Fill in the required fields, and then click Complete. 3 The patient will appear on the receiving tracking board, but the previously assigned room

must be unassigned.

4 Right-click on the patient’s name, navigate to the Base Location menu and select Unassign.

5 Move the patient into the TFR location until they present to the unit.

ED Pending Bed to ED Pending Bed

1. ED Provider needs to Void the Patient Status Order (Admit to Inpatient or Place in Observation)

2. Open Conversation Launcher and select the Cross Campus Outpatient Transfer conversation. Search for the correct patient encounter.

3. Fill in the required fields, and then click Complete. 4. The patient will appear on the receiving tracking board, but the previously assigned room

must be unassigned.

5. Right-click on the patient’s name, navigate to the Base Location menu and select Unassign.

6. Move the patient into the TFR location until they present to the unit. 7. Receiving ED Provider signs new Patient Status Order (Admit to Inpatient or Place in

Observation)


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Unit-to-Unit Transfer 1 Sending Unit Charge or UOC locates patient on the Bed Board and places the patient on the

Transfer List.

Action – Click on the patient to select, will see name of patient appear in Actions Toolbar. Click on the transfer icon (arrows). Then click Transfer Patient.

2 Complete pop-up window details as appropriate.

3 Patient name is now on the Transfer List. Sending Charge or UOC will click on the Comment

field to add any instructions relating to transfer – special needs, time, etc.

4 HNS will negotiate a bed with receiving unit. HNS will plan the bed by dragging the patient name to the chosen bed, complete pop up window details as appropriate.

5 Receiving Charge nurse or UOC will complete the transfer.

Action – In the Transfer List, click on the left-most column to select the patient. Select Transfer, then select Complete transfer.

Other Transfer Actions

Cancel Transfer - Use this if you decide not to transfer - select Cancel transfer.

Modify Transfer - Use this to change patient attributes or attending and patient type - select Modify Patient Attributes, then Modify Transfer.

Unreserve Destination - Use this if the HNS has planned the patient to your unit, you may plan the room. If a room has been planned, and you wish to select a different room, select Unreserve Destination, then plan to a different bed. This will not generate a clean job for the room.


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Transfer Patient Within a Unit 1 Unit Charge or UOC selects a new room.

Action - On Bed Board, expand your unit view by clicking on the arrow at the corner of the unit.

Locate the patient on the Bed Board, then drag the name to the new bed location. You must be able to see both the current bed location and the destination bed on the Bed Board. Complete popup window.

Patient name appears on the Transfer List, and the new room appears on the bed board with hash marks.

Note: It is possible in Capacity Management to plan to an available, dirty or occupied bed.

2 Patient physically moves to new room.

Action – From the Transfer List, click on the left-most column beside the patient name, click on Transfer, then Complete Transfer.

3 The patient no longer appears on the Transfer List, and the original bed is marked as dirty and a

cleaning job is sent to EVS.


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How to Correct an Inpatient Transfer Completed in Error If a patient on the Transfer List erroneously has been completed, the patient is placed in the destination bed, and is removed from the Transfer List. There are two ways this could be corrected. Only one of the two options listed below needs to be completed. Please note, previously saved comments and the bed they were planned to will be lost upon transfer completion. In either option, prior to correcting, make note of the unit and bed they were transferred to so you can plan them back to the same spot.

If you do not know what patient you accidentally completed, it is possible to find the patient through the Explorer menu:

1 Go to Explorer menu on toolbar

2 Select Main Menu.

3 Select Census/ADT

4 Select Inpatient Transfer Report

5 Set filters to today

6 Find patient and room based on time of transfer

To correct the erroneous transfer, use one of these two options:

Option #1:

1 Write down the unit/room the patient was transferred to.

2 Transfer the patient back to the original bed per normal transfer process.

3 Clean up steps post transfer back into correct unit/bed: • Cancel EVS clean job for original room the patient was transferred from. • Cancel the EVS clean job for the room the patient was transferred to. • Change bed status from Dirty to Available for the room the patient was transferred to

erroneously. • Add the patient back to the Transfer List and plan the patient back to the unit/room they

were originally planned to (this will be the unit/room you just removed them from).

Option #2:

1 Open the PM Cancel Transfer Conversation

2 Find the patient on the Bed Board or the Patient list and click on the patient. (Note the unit/room they were erroneously transferred to)

3 Click on the PM conversation icon and select Cancel Transfer.

4 Enter the patient name into the search window and select the active encounter. Complete to place the patient into the original unit/room.

5 Cancel the EVS clean job that was erroneously generated for the original room, which the patient never physically left.

6 Add the patient back onto the Transfer List and plan the patient to the unit and bed.


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How to Correct a Cleaning Job Placed in Error

1 From the Custodial Services List, click on the column to the far left of the cleaning job that

needs to be removed from this list.

2 Then hover on the arrow next to “clean” to get the action list to appear.

3 Select Cancel Clean

4 Then select the cancel clean reason and click OK.

1 2 3

4


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Discharge Process 1 Unit Charge or UOC places anticipated discharges on the discharge list.

Action – from the Bed Board, select the patient by clicking on the room. In the Actions Toolbar, click on the house icon, then select Discharge Patient.

2 Patient will display on the Discharge list with a status of Requested. Once the Discharge orders

are written by the provider. A green dot is added to the house icon and the status changes to Started.

3 Unit UOC discharges the patient from Powerchart when the patient leaves. Discharges must occur at the time the patient actually leaves and not be delayed for the completion of charting.

4 Upon completion of the discharge in Powerchart, the patient disappears from the Discharge list and from their assigned bed on the Bed Board. The bed displays as Dirty on the Bed Board and an EVS clean job is generated.

5 If it is decided that the patient will not be discharged, remove them from the Discharge List by clicking on the left column beside the patient name, then selecting Discharge, then Cancel Discharge.

6 Even if the patient was not placed on the Discharge List in anticipation of discharge, the

discharge order from the provider will place them on the Discharge List.

Action - The discharge from Cerner will create the cleaning job for the room, there is no need to enter an Ad Hoc request for a discharge clean. If you want that bed cleaned before others in your department, use the Custodial Services List to set the priority to ”next” in the Priority column.


13 Updated May 2019


Direct Admits There are a variety of ways that patients get directly admitted into a bed in the hospital.

Unit UOC – Continue to utilize the paper process currently in use to communicate anticipated admits.

1 First, check the Transfer List. If you see your patient with a bed planned, complete the transfer in Capacity Management when patient arrives. No need to do location check in, admitting can complete the registration if needed. If the patient is on the Transfer List, and is registered or has a location check-in before completing the transfer, they will appear in the Bed Board as the patient in the room and the patient planned to the room, and they will be on the Transfer List as well. To fix this: Follow the steps for cancelling a transfer request.

2 If the patient is not on the Transfer List, go to the Pre-Admit List. Find the patient:

• Be sure that you are set for “Today”.

• Look for the patient under the Current Location (where they are coming from) Destination (your unit) or Planned Admits.

• If you do not find them, try alphabetizing the patient name list by clicking on the header for that column selecting descending, then looking for the patient name.

Once you find the patient on the pre-admit list, do a location check-in or have admitting complete the registration. This will put them in the bed on your unit in Capacity Management.

3 If you still cannot find the patient, try the following:

• Check your filters – you may have filtered out their location or are on the wrong day.

• Check the Bed Board for your unit – they may have been to registration and are already placed in the bed.

• Go to the Patient List, and do a Global Search. This method will only find active encounters – i.e. patients coming from PACU or a clinic and are checked-in. If they are in clinic with an active encounter see #4.

• Call the HNS for assistance.

4 If the patient has a clinic visit, followed by a planned admission, complete location check-in while the encounter is in the clinic location. This places the patient in the bed on the Bed Board.

Note: IC quick reg patients will be placed directly in the room and will not have steps in Capacity, but NICU is cautioned to check for a pre-reg under the mother’s name to avoid duplicate patients.


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PACU Process for Expected Admissions Note: HNS to continue current paper process of planning for expected surgical admissions.

1 Patient appears on the PreAdmit List as a result of pre-registration.

2 Filter PreAdmit list for Today and Location if desired.

3 When patient arrives, the OR UOC will check in the appointment and activate the encounter. This can be done in Capacity Management by selecting the patient then clicking on

.

When the check-in is completed, the patient falls off the PreAdmit List.

4 As soon as the child is checked in, UOC will place all AM admit and Obs patients on the Transfer List.

Action -

• From the Patient List, use to find patient. When patient has appeared on the Patient List, click on the left-most column beside the name, and select Transfer, then Transfer Patient. Patient now appears on the Transfer List.

• HNS will plan a bed by dragging name to chosen bed.

• PACU RN will find the targeted room on the Transfer List and call receiving unit.

• Receiving unit UOC completes the transfer when the patient arrives. Open Capacity management, click in leftmost column next to patient name to select patient, select Transfer, then select Complete Transfer.

• For unexpected admissions, the UOC places patient on the Transfer List using this process, then calls the HNS. If there is no Capacity Management-trained UOC or Charge in the OR on off hours, the HNS will assist.


15 Updated May 2019


Holding a Room Patient needs to leave unit for a procedure, but will be returning to their room. For example, a patient is going to SPS for a sedated spinal tap, or a patient going to PICU for a chest tube, then will return to the original room.

Note: if an inpatient is going to OR and returning to the same room, there are no actions in Capacity Management.

1 Sending Unit Charge or UOC will use transfer process for placing patient on the Transfer List and planning to a bed.

Action – Open Capacity Management, open Transfer List, from Bed Board, select patient and click on the transfer icon in the Actions toolbar. This places the patient on the Transfer List. Important: Sending Unit will enter comment on the Transfer List describing the reason for transfer; for example: Sedated LP in SSU at 1030.

2 The Procedure unit UOC will plan the bed by dragging and dropping the name from the Transfer List to the chosen bed on their unit. When planning to the bed, you will get this pop up:

3 Check the box Patient will return to current location.

When the patient arrives on the receiving unit, the Procedure unit UOC will complete the transfer (Transfer/complete transfer)

The original bed appears on the bed board as Held, and does not generate a discharge room clean. The Bed Board looks like this:


16 Updated May 2019


4 When the procedure is complete and the patient is returning, the Procedure unit UOC will select the patient, then click on transfer icon on the Actions Toolbar and select Return Patient to Held Location.

5 Patient is now on the Transfer List. When the patient leaves the receiving unit, the Procedure

unit UOC will complete the transfer by selecting transfer, then complete transfer. The current bed displays occupied and the procedure bed is marked as dirty, with a clean job generated for EVS.


17 Updated May 2019


Ad Hoc Clean Requests

Lead Requests

This process is used for:

• Public space cleans, like a spill in a hallway, or a public restroom in a unit needing cleaning • Bed/Crib requests

Note: Not used for routine discharge bed cleans – when the patient is discharged the cleaning job is automatically generated.

Public Space Clean/Bed or Crib Request

Unit Charge or UOC will:

1 On the Bed Board, click on the broom icon in the Actions Toolbar.

2 Select . Window will open.

3 Click on the ellipsis . Scroll down to select . (Note – the circle displayed does not select, clicking anywhere on the words will highlight the line and select.)

4 Enter the details of your request. Include location, type of spill, contact person and contact

phone number under AdHoc Job Details.

5 If desired, dropdown the priority and select “next”. The job will display on the Custodial Services list.

6 Click OK.

Bed/Crib Request - To request that a bed or bubble top crib be delivered to your unit, use the same process, entering bed type, location to be delivered to and callback name and number in the details.


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Linen Request


1 On the Bed Board, click on the broom icon in the Actions Toolbar and select

.

2 Click on the ellipsis, then select . (Note – the circle displayed does not select, clicking anywhere on the words will highlight the line and select.)

3 Enter details

4 Click OK.

The job displays on the Custodial Services List.

Parent Requests a Routine Room Clean


1 On the Bed Board, Charge or UOC requests an Ad Hoc room clean by selecting the patient room, then clicking on the broom icon in the Actions toolbar.


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2 In the window that opens, enter details, including location, name and callback number,

3 Select priority of next if desired.

4 Click OK.

The job will display on the Custodial Services List.

Prioritize Next Discharge Room to be Cleaned

The Charge or UOC may select the next room to be cleaned on their unit. This could be in preparation for an expected admission. Normally, dirty rooms will flow to the EVS associate in the order that they were vacated. To change that order, go to the Custodial Services List, find the room to prioritize, right-click on the priority of Routine and select Next.

Note: There can only be one Next at a time per unit

This action will allow the EVS associate to finish the job they are currently working on, but will be the next job that appears on their device.

If you need a room cleaned emergently, the Charge Nurse must call the HNS. Only the HNS can prioritize a STAT clean. Typically, a STAT clean is only for an unstable patient urgently needing a bed.


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Changing Room/Bed Statuses Bed status can be corrected by the unit UOC or Charge Nurse in Capacity Management.

Status Definitions

Occupied - The room/bed currently has a patient assigned to it

• Blue or pink on the bedboard based on patient gender • Automatically set based on when a patient is placed into the room and bed. • This status can’t be manually updated; a transfer or discharge is required • Patients can’t be admitted into rooms in this status.

Available – Room/bed is clean and available for a patient

• Green on the bedboard • Allows patients to be admitted or transferred into the bed

Cleaning - EVS is in the process of cleaning the room/bed

• Yellow on the bedboard • Automatically set when a job is marked started by an EVS Associate • Automatically updated to Available when marked complete by an EVS Associate • Can be set manually, but will not trigger a new housekeeping job • Allows patients to be admitted or transferred into the bed if needed

Dirty – Room/Bed needs to be cleaned

• Brown on the bedboard • Automatically set when patient is transferred to or discharged from the bed • Broom icon indicates cleaning job is on the Custodial Services List • Can be set manually, this WILL trigger a new custodial services job • Changing from Dirty to another status WILL NOT cancel a custodial services job (cancel it

from the Custodial Services List) • Allows patients to be admitted or transferred into the bed if needed

Blocked – Room/Bed is temporarily unavailable

• Black on the bedboard. • Manually set • Used for rooms that are having short duration work done such as mechanical work or floor

waxing


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Out of Service – Room/Bed is closed for an extended time or not included in bed counts

• Gray on the bedboard • Manually set • Used for units that are closed for a season and the extra beds in PI and NI units built to

support rare or sporadic double occupancy

Held Status - Can only be set within the transfer process.

How to Change the Status of a Room

On room on Bed Board, click the down arrow next to the letter on the left side of the box and select a room status

Available: when selecting available, be aware of any cleaning job that might be displaying on this room (denoted by a broom) and cancel this cleaning job as appropriate.

Cleaning: This status is automatically generated when an EVS associate has accepted and started the job. There should not be any reason to select this status.

Dirty: This status is automatically generated through a transfer or discharge from the room, and if the room is changed to a status of dirty. There will also be a broom icon located on the room if there is a cleaning job displaying on the custodial services list for this location.

Out of Service: When selecting this status, a pop up will display requiring a reason for choosing this status. Select a reason and click ok. To remove the “Out of Service” reason, just click on the drop down and choose another status.

Blocked: When selecting this status, a pop up will display requiring a reason for choosing this status. Select a reason and click ok. To remove the “Blocked” reason, just click on the drop down and choose another status.


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Cross Campus Transfer Notes:

• It is important to do this process at the time the patient leaves the sending department.

• A Cross Campus transfer cannot have a destination of OR. The HNS will plan to the wakeup/post-op unit.

ED to ED

Not a part of Capacity Management – continue current process using Cross Campus Outpatient Conversation.

ED to Inpatient

ED provider admit order places patient on the Transfer List. Continue step by step from #2 below.

Inpatient to Inpatient

1 Click on patient on Bed Board. On the Actions Toolbar, select transfer, transfer patient. Patient now appears on Transfer List for that campus.

2 Click the ellipsis button on the Destination column on the Transfer List (screen shot below)

3 Select a unit on the other campus

4 Patient now appears on other campus Transfer List and normal bed planning can begin.

5 For ED transfers, place patient in checkout at the time of departure. Receiving unit to complete

transfer when the patient arrives. For inpatient to inpatient transfers, complete the transfer at the time the patient leaves the sending unit.

ED-IP to inpatient

Same as Inpatient to Inpatient

Mercy Mother Baby

If baby going to or coming from Mpls, no need for cross campus – just plan the bed and complete transfer. If baby going or coming from St Paul NICU, use Inpatient to Inpatient process.


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Capacity Management Downtime

During downtime – all Capacity Management Downtimes

• Communicate via text or in person with the HNS

• Call the Lead EVS for bed and linen requests

• Use a paper process for communicating with your unit EVS

During downtime – if all of the EMR is down

See the EMR Downtime Resource Center

During downtime – if PowerChart etc is working

Use Location Check In found under the PM Conversation (head icon) to move Outpatient and Observation patient encounters or to update a patient type (e.g. change the type from Emergency Department to Inpatient during the admission process).

Use Downtime Transfer or Downtime Cross Campus Inpatient Transfer to move existing Inpatient type patient encounters. These conversations can be found under the Conversation Launcher (Rocket icon).

After Downtime

When the downtime is over and Capacity Management is functioning, check your Bed Board for Bed Statuses and correct as needed. Check the Custodial Services List for beds that need to be cleaned or are on the list for cleaning and have already been cleaned.

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overview: step-by-step processes for clinical staff · 2019. 5. 2. · capacity management...

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