Cosmas J. M. van de Ven, MD Director, Maternal-Fetal Medicine Phone: (734) 936-7573 Fax: (734) 647-1006 E-mail: [email protected] F 4835 Mott Hospital
1500 E. Medical Center Drive Ann Arbor, MI 48109-0264
PJPC Meeting Minutes Monday, September 25th, 2006
Attendees: R. Schumacher, L. Polley, D. Serlin, J. Schiller, M. Britton, A. Piehl, S. Kofflin, C. van de Ven
We reviewed the PJPC meeting minutes from August 28th, 2006 and a few corrections were made. The definition of chorio-amnionitis: We will delete the leukocyctosis ≥ 15,000 and will add the word baseline to the maternal and fetal heart rate. The baseline is defined as ten minutes.
Cos will send out an email to the obstetric care providers of the OB Standardization of Insulin Drip as well as the definition of chorio-amnionitis. The specific information in regards to the definition will be posted on the birth center website with a link from the resident’s website under the policies and guidelines.
The medical student clinical activities verification was discussed. We reviewed the attachment and we will add onto the last paragraph “using the chain of command is always encouraged and appropriate”. Cos will finalized the verification and then share this with the nursing staff. In addition, it will be shared with the residents and attending staff and will be provided to the new students when they start their rotation so that they know what the staff has been told.
Cos will propose to Mark Chames and Julie Perry to maybe make a small card with a list of skills that the Sub I is capable and has the autonomy to perform.
We discussed the Nextel phones. The initial concern was that with the introduction of the Nextel phones we would yet have another change in processes in the Women’s Hospital Birth Center in addition to OB TraceVue and OMP. However, after discussion we did recognize that the use of phones may be helpful, particularly given the high census status. We decided that Cos will try to assign a representative to go to the phone distribution and power user training on October 4th or 5th. This person will then collect the phones and bring them to the unit. Once the phones are on the unit we will discuss how to specifically implement the use of the phones. Most likely, we will start with the charge nurse and triage coordinator and expand from there as we feel is appropriate in regards to our work flow. Questions in regards to what the range of the
phones are and specifically what we use them for were briefly discussed. These phones are not intended to replace the birth center group pager.
The update on the use of Cytotec for post partum bleeding is postponed to next month. Given that we are going to electronic medical documentation, in particular the implementation of Care Link, it again becomes essential that the Pediatrician is known when the patient presents to the Women’s Hospital Birth Center. Cos will send out a reminder to faculty and residents to make sure that the patient is asked during the prenatal course who her pediatrician will be and that this is entered in OB TraceVue. We discussed with Linda Polley whether or not we will have a CRN available to cover the first few weekends following the implementation of OMP. Because we think this will add a significant amount of time to our daily activities we would like to spread out our elective surgeries over seven days instead of 5 days in order to take some load off the nursing and physician staff. We will further look at this since it will also change the nursing staff on the weekends and may end up not being of benefit.
OMP training and implementation:
The committee decided that the medications and allergy tabs will be turned off starting October 16, 2006 in OB TraceVue. The lab tab will still reveal whether or not labs are ordered, pending, or reviewed but not the actual value. The source of truth for all medications, allergies, and laboratory studies will be in the central data repository and will be accessible either through Care Web or Care Link. In regards to outside labs, these will be scanned into Care Web and attached as an imaged document.
Prescriptions in the hospital will be electronic only. Routine prescriptions for Motrin, Iron, and Colace will no longer be provided and there will be an instruction sheet in the discharge instructions that will include that the patient can purchase these medications over the counter.
Perinatal Electronic Medical Record Workflow Decisions September 25, 2006
Workflow and documentation of medications, allergies, and laboratory values/interpretation in the perinatal electronic medical record (OB TraceVue) are altered by the implementation of the computer physician order entry application, Carelink. In addition, paper records of transferred patients require availability in an electronic format. The recommendations listed in this
document are based on patient safety considerations. It was determined that documentation and document availability is best accomplished in one electronic source (the sources of information and the interfaces, or lack thereof, are documented elsewhere). This document describes the OBGYN, Family Medicine, Pediatric, and Perinatal Nursing Department’s standard requirement for viewing and documenting patient medications, allergies, labs and outside records during pregnancy care.
The three sources of electronic data that comprise the perinatal electronic medical record are: Careweb, Carelink, and OB TraceVue.
Summary Table:
Location of Information
Outpatient
(Health Centers, Triage, 23 hour Obs)
Inpatient
Medications Careweb PSL Carelink {all meds & immunizations} TraceVue {infusion titrations}
Careweb {immunizations}
Allergies Careweb PSL Carelink
Labs Careweb Carelink
TraceVue {Problems screen}
Specific Descriptions for Information Location
Abbreviation Full name Application Location
-- Prescription writer Careweb
CL Carelink Carelink
CW Careweb Careweb
eMR Electronic Medical Record OB TraceVue
OBTV OB TraceVue OB TraceVue
Medications
Decision:
1. Medication tab in OB TraceVue eMR will be shut off as of October 16, 2006. 2. Remove delivery medications from the Delivery1 screen
3. Documentation of medications A. Prenatal: Careweb PSL
1) Entered by intake nurse
2) Entered by provider at any time during care 3) Entered via prescription writer
B. Triage: Careweb PSL
1) Entered at discharge of patient from Triage 2) No entry if patient is admitted to inpatient status
3) Prenatal > Examination > Triage Nurse Assessment > Current medications question will remain as part of triage assessment of patient.
C. 23 hr Observation: Careweb PSL 1) Entered at discharge of patient
2) No entry if patient is admitted to inpatient status D. Inpatient admission: Carelink, OB TraceVue, Careweb
1) OB TraceVue
a. Titration of infusions in Charting > Medications Mainline IV
Oxytocin
Magnesium sulfate Insulin
Narcan
b. Admission > Admission > Current Medications > see PSL checkbox will remain as part of admission H&P
2) Carelink
a. All medications 3) Careweb
a. Newborn hepatitis B & HBIG?
b. Discharge medications entered via prescription writer c. Dictation > Update PSL and list meds prescribed
d. Inpatient pharmacy record of ordered meds is available for viewing
Allergies
Decision:
1. Allergies tab in OB TraceVue eMR will be shut off as of October 16, 2006. 2. Documentation of allergies
A. Prenatal: Careweb PSL 1) Entered by intake nurse
2) Entered by provider at any time during care B. Triage: Careweb PSL
1) Entered at discharge of patient from Triage
2) Entered at time of patient admission in Careweb PSL
3) Prenatal > Examination > Triage Nurse Assessment > Allergies question will remain as part of triage assessment of patient.
C. 23 hr Observation: Careweb PSL 1) Entered at discharge of patient
2) Entered at time of patient admission to inpatient status D. Inpatient admission: Carelink
1) Entered or reviewed by provider when admission orders are written
2) Entered or reviewed by nurse in emergency when admission orders are written as verbal orders
Labs
Decision:
1. Lab tab in OBTV will be altered to remove documentation of actual lab values to the documentation of labs completed/reviewed only as of October 16, 2006.
2. Lab tab in the Admission and PP/Delivery forms of OBTV will be shut off.
3. Remove lab value documentation from Delivery2 tab, Triage nurse assessment; replace with interpretation of labs (e.g. Needs RhoGam?, Needs Rubella on d/c?).
4. Documentation of abnormal lab follow-up will be done in the Problem list of OBTV. 5. Documentation of labs:
A. Prenatal: Careweb, OBTV
1) Interpretation of labs viewed in CW is documented in OBTV provider note. 2) In the Labs tab of OBTV, the following will be used for documentation:
a. Labs ordered at a visit may be documented as “ordered”
b. Labs with pending results in CW may be documented as “pending” c. Labs with results in CW may be documented as “reviewed”
3) Abnormal labs will be added to the Problems list indicating any appropriate follow-up required in the Comments field.
B. Triage: Careweb
1) Interpretation of labs viewed in CW is documented in OBTV provider note. C. 23 hr Observation: Careweb
1) Interpretation of labs viewed in CW is documented in OBTV provider note. D. Inpatient admission: Carelink.
1) Interpretation of labs viewed in CL is documented in OBTV provider note. 2) Review Problem List to determine any follow-up required for abnormal labs from prenatal care.
Outside Medical Records
Decision:
1. Scan/fax the lab page of all outside records into Careweb
2. Make recommendation to Careweb team that outside records, in their entirety (as relates to pregnancy care requirements), be included in the scan/fax document process.
3. Enter pertinent information from the paper transfer record to OBTV. This would minimally include:
a. Gravida/Para, LMP, EDD in the Pregnancy screen
b. Problems and diagnoses in the Problems screen (including notation that the record set was scanned into Careweb).
c. Positive medical history findings in Medical History screen d. Ultrasound findings in AP Testing screen
