Electronic Medical Record Help

PowerChart FAQ's (6-HELP for assistance)

Please check out the website for other helpful hints:

http://sites.google.com/a/nmh.org/residentinformatics/

Orders (Notify nurses verbally in addition to online for all STAT orders, Discharge orders, and last minute medication cancelations.)

1. How can I see currently active medication orders?
2. Why can't I use cancel/reorder to modify medication orders?
3. How do I handle orders on transfer to/from the ICU or to another service?
4. What happens to existing orders when patients go to the OR?
5. How do I place online admission orders for patients still in the Emergency Department or at home?
6. How can I tell when a patient will receive a first medication dose?
7. Why should I almost never change "requested start date/time" for medications?
8. How do I order a medication dose "NOW" and then begin a regular dosing schedule?
9. What are the established "frequencies" / "dosing schedules"?
10. How can I tell what medications my patient received?
11. How do I place a complicated Coumadin regimen order?

1. How can I see currently active medication orders? Use the medication section of the Orders tab to review easily all active and future orders. For this to work, though, you must have your filters correctly set. When on the "Orders" tab, choose: Options|Filters and then clear all check marks on the right side and select all on the left side including "include all days". Also select "sort" by "procedure name" to keep alphabetical sorting. Then click "save". Return
2. Why can't I use cancel/reorder to modify medication orders? Using cancel/reorder for a medication order would order a dose "now" and then at the next scheduled time. For example, if you wished to lower the Toprol XL dose from 100mg to 50 mg after today's dose was given, using cancel/reorder would generate an extra dose of 50mg immediately and begin the new regimen the following day. Instead, "cancel" the old order and enter a fresh new order at the new dose that will default to the next scheduled dosing time (tomorrow, in this example). When this function is improved, it will be re-enabled.
3. How do I handle orders on transfer to/from the ICU or to another service? For patient transfers, do not cancel all pre-existing orders. Adjust orders as needed for the transfer and then enter the transfer order. The receiving service will similarly review all existing orders. Return
4. What happens to existing orders when patients go to the OR? For current inpatients who go to the OR, all inpatient orders will remain active unless canceled by physicians. (This is the same process used for ICU transfers.)  Most importantly, review all orders immediately post op and cancel inappropriate orders. (For example, stop the pre-op heparin infusion order…) Continue to designate post op orders as "future" for activation after the patient arrives on the inpatient unit.
5. How do I place online admission orders for patients still in the Emergency Department or at home? Orders for patients not yet registered to an inpatient location (patients in the ER or being admitted from home) may be entered online but orders must be designated as "future" for them to be visible when the new inpatient "encounter" is established. When entering orders from an order set or individually, each order may be designated as "future" by scrolling down to the last order detail for each order and clicking "Yes" for the option "Order for Future Activation".
6. How can I tell when a patient will receive a first medication dose? When entering medication orders, the "requested start date/time" listed in the order details indicates precisely when that first dose will be given. As noted in the next FAQ, do not change this time unless you completely understand the dosing implications. Return
7. Why should I almost never change "requested start date/time" for medications? The "requested start date/time" reflects the timing of the first medication dose. If this is modified, the first dose will be given according to the newly specified start time. Subsequent doses, however, will occur as determined by the order frequency. Thus, if a new daily medication order start time is changed to 9AM, the patient will receive the first dose at 9AM and the regular dose will then also occur at 10AM, typically something you do not want to do. The exception for which changing the "requested start date/time" may be useful is when a daily medication order is entered after 10AM but you still want the patient to receive a dose today. In this instance, changing the start date/time to today would give a dose today and the next dose at the regularly scheduled time tomorrow. Return
8. How do I order a medication dose "NOW" and then begin a regular dosing schedule? When needing to give a patient a first dose before the scheduled time, enter two orders. The first order is for single dose to be given "now". If the next dose is desired at the usual administration time for the second dose, be sure to match exactly the administration time for the subsequent dose. See next response below for standard administration times. Return

 9. What are the established dosing schedules? See table:

10. How can I tell what medications my patient has received? The easiest way to tell is to use the Vitals/Meds tab in PowerChart. Since the time range is "since admission", it's much easier to navigate than the MAR tab. Return

11. How do I place a complicated Coumadin order? Use the Coumadin Order set (located by typing "Coumadin") and find the regimen the patient currently uses or customize a daily regimen using individual orders for each day of the week. This order set defaults administration to bedtime as is appropriate. Again, do not use cancel/reorder for Coumadin or any other medication order since an extra dose will likely result. Return

Orthopedic Surgery Pilot

This pilot offers an alternative way to enter online notes. When on the "Notes" tab in PowerChart, do the following:

1. Click the icon to open a Clinical Note and select your note type (Ortho H&P, Post Procedure Note, Progress Note).

2. Fill out the note content and click "Save". You're done.

• Screenshot of process
• Movie of process 

Problem List and Diagnoses

• Entering problems and diagnoses
   

Notes "Rules":

• All patients need an online housestaff generated H&P. For subsequent days create a new progress note or “copy forward” and update an existing note. An “addendum” to a student note does not suffice as a daily housestaff note.
• Any note “copied forward” whether it originated with a student, fellow resident, or attending becomes your own note. Your professional obligation is to review and update the entire content.
• To correct a student’s note, right the click the open note and choose “modify” which lets you add an addendum. Again, this does not suffice as a housestaff note for the day.
• Especially for non-ICU patients, the impression and plan should list problems, not systems. For example, list “pneumonia”, and not “pulmonary”. This is critical to understanding at a glance what is going on with your patients.
   

Efficient Medicine PowerNote H&P's: Start your H&P by double clicking the standarda "Precompleted" note:

Then, "fill in the blanks" by right clicking on top of the three asterisks and choosing "Open".

In order to insert vital signs from the flowsheet and results, you will still need to click on the left-hand and upper panes of the window. Overall, however, the majority of your note may be written working solely within the bottom frame.
 

Problems/Diagnoses: Soon you will be prompted to enter diagnoses/problems when completing admission order sets. The PowerChart way to think about this:

Problems = Past and current medical problems

Diagnoses = Active problems for which the current hospital stay is necessary

Viewing Results with Colors: If your labs aren't already showing abnormal values in red, please use the following "filter" settings. (Eventually, this should occur automatically.)

• Go to your Labs tab and choose Options|Properties|Display and set your colors by clicking the colored squares exactly as follows: Set New to Blue; set all other result colors to Red.