SARASOTA MEMORIAL HOSPITAL

PROCEDURE PS1094

TITLE:

SCM (CAREVISION) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

DATE: REVIEWED:

PAGES:

10-00-00 01/09/18 1 of 9

ISSUED

FOR:

Clinical and Business Systems Team, Nursing Units, and Ancillary Departments

RESPONSIBILITY: Nursing Units and Ancillary Departments

PURPOSE:

To establish a procedure when SCM Off-line or View Only. No order entry, document entry or result updates. Nursing units are responsible for following downtime procedures and maintaining Unit Downtime Disaster Kit.

PROCEDURE: PRINTED DOWNTIME REPORT BY PATIENT DOWNTIME REPORT BY UNIT

ACCESS TO PATIENT RECORD IF SCM OFF-LINE: A printed report of the inpatient/observation patient’s electronic record will be provided by STAT request to Call Center x6107 or in the event the Command Center is open x3800. Patient Downtime Report is updated every 1.5 hours. Report includes: Patient Summary- Demographics, Provider’s, Diet, Allergy, Activity Active Orders H&P All Consults Last 2 days of progress notes Active MAR 12 hours back and 12 hours forward Last 2 days of Labs All other results Last 2 days VS & IO Last 2 Nursing Shift Summary’s For extended SCM downtime events, inpatient and observation units will be instructed to print Patient Downtime Report by Unit on the unit Dex printer (big black printer). A printer document Box Code will be communicated to unit via email, Voalte or phone. Printed reports for procedural areas will be provided based on schedule and or upon request. Refer to Page 6 for link - Location of Dex Printer/report cross reference to Nursing Unit and printer instructions. The report for entire unit takes approximately half hour to print and will require 2 reams of paper. Separate and file each patient report in patient blue chart. Paper report should remain in chart after downtime event for HIM to process at time of discharge.

PATIENT PLACEMENT Transfers: Non-essential transfers should be limited and must be approved by nursing supervision or bed control manager.

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 2 of 9

NOTIFICATION ORDER ENTRY

Down time notification:

a. Staff will be notified of scheduled and unscheduled downtimes via variety of communication channels depending on event and time. Communication channels include Voalte, email, SCM log-in message, phone calls to areas and screen savers. A communication will be sent when system becomes available.

Proceed with Physician Orders as follows:

a. For downtime less than two hours: Use paper downtime requisitions for all STAT orders. Phone the ancillary departments to notify them of STAT orders. Routine orders may be entered in SCM once system is available.

b. For downtime greater than two hours or as advised by Nursing Supervision and Clinical and Business Systems: Use the paper downtime requisitions for all STAT and routine orders.

c. Have SMH paper Physician Order forms available and ready to be placed on charts as needed. All orders written must be retained as part of legal medical record.

d. Scan copies of medication orders to the Pharmacy. e. Order Sets to print are available on SMH Pulse, Downtime

Icon. Order sets not listed may be printed on request; Call Center x6107 for assistance. A copy of commonly used order sets for unit should be stored in unit disaster box.

f. All orders not sent via downtime requisition or called to ancillaries, must be entered into SCM when back online. – Exception: For admitted patients from ECC active- orders pertaining to admitted visit will be entered by receiving unit (i.e. Patient care orders). Ancillaries are responsible for entering all orders received during the downtime as outlined in their department specific downtime guidelines.

Orders that need to be entered in SCM when available include:

a. Active Patient Care Orders received during downtime b. Consults for ancillaries received during downtime (do not

enter if already called or order faxed, ex. IV Team or ICM) c. MD consults-Enter order and add MD in SCM as consult d. Dietary orders received during downtime e. Allergies on new admissions need to be entered or

confirmed.

NOTE: Order sets may be used to enter multiple orders if appropriate. Be sure to off check those ancillary orders that do not need to be reordered so as not to have duplicates.

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 3 of 9

Do not enter these Orders if departments notified by downtime requisitions/scans/faxes and calls. They will be entered into SCM by Ancillaries:

a. Pharmacy b. Radiology c. Lab d. Respiratory e. ICM f. IV Team Consult

FLOWSHEET/DOCUMENTS 1. Proceed with Flowsheet Data Entry as follows:

Chart flowsheet documentation on the paper Graphic Flowsheet, Integrated Narrative Note or other appropriate flowsheet forms. All units should have necessary clinical documentation supplies as part of disaster readiness. In addition, document templates to print are available on the Pulse, Downtime Icon.

a. If offline time is less than 2 hours, enter the data collected on paper in SCM when the system is once again operational. Retain the paper flowsheet as part of the permanent record.

b. If offline time is greater than 2 hours, the paper flowsheet entries are part of the patient record. These entries do not need to be entered in SCM.

c. If there are greater than eight (8) entries in a hour period, the paper flowsheet will be retained as part of the patient record. These entries do not need to be entered in SCM.

d. If the offline time occurs over a shift change, the paper flowsheet entries will be retained as part of the patient record. These entries do not need to be entered in SCM.

e. “Exception” Critical Care Areas. If offline time is greater than 1 hour, the staff will chart on paper downtime forms appropriate to each patient. The paper downtime forms will become part of the patient’s permanent record.

f. If paper flow sheets are retained, the only information that will be entered into the EMR once the system is back on line will be Intake and Output. This will be entered as a one time total for In and one time total for Out at the time the system is back on line.

g. “Exception” PACU Areas. If offline time is greater than 30 min, the staff will print PACU documents at time of transfer.

ANCILLARY RESULTS: 1. Laboratory -Individual Lab reports will print on units. Cumulative reports are contained within the Patient Downtime Report. Please retain printed lab reports until after SCM available. Call Lab for STAT results.

2. Other ancillary departments: Call for results and have them send paper copies of results unless otherwise dictated by their downtime procedures.

3. Surgery Information System (PACU and Endo Areas.) If offline time is greater than 30 minutes, the staff will print PACU documents at time of transfer.

4. Call HIM to fax Dictations on demand. 5. Medilinks Rehab and Respiratory- refer to the appropriate

downtime procedures.

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 4 of 9

EMAR DOWNTIME: A. Scheduled Downtime of SCM or EMAR: 1. SCM or EMAR may have scheduled downtime or the

interfaces may be down and new information will not be sent from pharmacy to SCM. During these situations, the clinical system team will give access to print paper MAR’s from SCM just prior to the downtime only.

2. To access the printable, paper MAR, go to SCM, printer icon, order management, and then EMAR today (5 am to 459 am) this visit. Print out and use as paper MAR. Note: When you hit print it will print MAR’s for ENTIRE UNIT-only hit print ONCE.

3. Paper charting on the MAR may only occur during a downtime, when EMAR is unavailable.

4. Once downtime is over, all medications on the EMAR that were given during the downtime, should be marked as “not done” with a reason as “see paper MAR.”

5. The paper MAR used during downtime will remain as permanent record in the patients chart.

B. Unscheduled/Unexpected Downtime of SCM or EMAR: 1. SCM or EMAR may have unexpected downtimes. The

Patient Downtime Report by Unit made available on the unit Dex printer contains a snapshot of the EMAR that is less than one hour old.

2. Nurses should reconcile and update paper MAR to indicate which medications have already been given, discontinued, or ordered since the time of the snapshot.

3. Charting on paper MAR’s may only occur during downtime.

4. Once downtime is over, all medications on the EMAR that were given during the downtime, should be marked as “not done” with a reason as “see paper MAR.”

REFERENCE:

None

REVIEWING AUTHOR (S): APPROVALS:

Robert Altiero, Director, Clinical and Business Systems Laurie LeBoutillier, Pharmaceutical Care Specialist Cherie Cecci, Lead Clinical Systems Analyst Wendy Kline, Advanced Practice Program Coordinator Janet Steves, Director, Nursing Business Administration Robert Altiero, Director ________________________ Dated: 01/02/18 Pam Ramhofer, VP CIO _______________________ Dated: 01/04/18

LINK TO EMERGENCY PRINTER LISTING:

Unit – Disaster Report Printer Location

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 5 of 9

Log of Patients who have Orders During Downtime

When SCM is functional certain orders will need to be entered into SCM in order to maintain a correct current chart. Most ancillary orders placed during downtime via Requisitions/faxes/scans/calls do not need to be entered. After appropriate orders have been entered, check off label and make notation on written orders in chart. Nurses should perform SCM and paper chart review to assure correctness. Orders that need to be entered in SCM when available include:

Active Patient Care Orders received during downtime

Consults for ancillaries received during downtime (do not enter if already called or order faxed ex. IV Team or ICM).

MD consults-Enter order and add MD in SCM as consult.

Dietary orders received during downtime Allergies on new admissions need to be

entered or confirmed. Note: order sets may be used to enter

multiple orders if appropriate. Be sure to off check those ancillary orders that do not need to be reordered so as not to have duplicates

Do not enter these Orders if departments notified by downtime requisitions/scans/faxes and calls, they will be entered into SCM by Ancillaries:

Pharmacy Radiology Lab Respiratory ICM IV Team Consult

ID Labels of Patients with Orders during Downtime

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 6 of 9

Downtime Printing Instructions

At Dex Printer on Unit Press Application Button

Select E.P.S. from application list

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SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 7 of 9

Select and highlight units DTReport Folder Press Next

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 8 of 9

Enter Pin (code provided at time of event) Press Next

TITLE:

SCM (CAREVISION)) OFFLINE – NO ENTRY OR UPDATES INTO SCM. SCM MAY OR MAY NOT BE VIEWABLE (STATIC) (scm02)

PAGE: 9 of 9

Select and highlight Downtime Report Press Next

Report will start printing

Separate and file each patient in blue chart.

EMERGENCY PRINTER LISTING LINK: Unit – Disaster Report Printer Location