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Powerchart tipsproblems comments

Page history last edited by ppentecost@salud.unm.edu 11 years, 4 months ago

Tips/Solutions

To find vacular lab procedures (e.g. lower extermity doppler, areterial doppler, vein mapping), under "add orders" type "VL" and they will all pop up

Ultrasound is under US, X-rays are under XR

PT/OT - have to enter order for each (separate orders) - be sure to check "Inpt" and designate reason

PT/OT - notes found under "Text Rendition" in Clinical Notes section

MAR: change interval to 24 hrs to see the med administration easily

Use the Lab folder to order all AM Labs

Use 'Tear Off' to have 2 pages open on same patient (like wanting flowsheet open when doing depart)

Use Document Viewer and create an inpatient document list with only the documents you want to see

Change start time on meds and labs

CAGE protocol, you have to search with *CAGE

 

Depart Process

TheLink above will take you to information about this unique part of CPOE.  Present information includes a chart about who should be doing what with the Depart process and a list of non-prescription printers. 

 

 

Problems

Inefficient processes

Cannot change dose or frequency of meds using the "modify" function - must D/C and reorder

On Depart process unable to modify

 

Flaws in CPOE/Cerner

Depart med list not always working, sometimes will not pull in home meds, in these cases print out the 'home med list'

ER not seeing or doing orders

Evidence links are not working - DKA, diabetes,

VTE  Order set:  reference material is backwards

Hand off sheet still cutting patient information off at bottom - this is a problem for multiple providers including jcohen, ppentecost and krogers

 

Time delays

In Message Center, lab review taking inordinate amount of time (I timed it at 90 secs!!) to refresh between each lab needing review

Daily Rounds Summary takes 20 seconds to populate

 

Ordering difficulties

Cannot order heating pad

Librium is defaulted as PRN

 

Lab Problems

LAB frequently cancelled, not drawn, or not ordered correctly. Have had some major delays in care because of this.

 

Training deficiencies

Insulin order set being used incorrectly in almost all cases, residents choosing 'sliding scale only' with 0-6 units instead of going into sub plan with nutritional, basal, and correction doses

Nurses do not understand how to access Heparin Protocol directions/orders, resulting in inadequate anticoagulation, potential patient harm

 

Unresolved Processes

DKA on SAC patients

Transfers from SAC to Floor

Undefined process for transfers

What to do for OR patients

What to do with SNF patients - still should do PDF  snf transfer orders, also print out dialy rounds report

Need to figure out the OR to medicine floor transition.

 

Comments

I reported 3 PSN's today (11/08/09) related to CPOE.

Comments (5)

Betty Chang said

at 2:48 pm on Oct 30, 2009

Transferring patient from OR is a DISASTER!!!! PACU harrassing medical residents about rewriting orders. Surgeons refusing to rewrite orders post-op. Medicine having no idea what post-op orders are needed.

Anthony Karabanow said

at 2:56 pm on Nov 2, 2009

Albuterol tx orders apparantly (per RT) expire after 72 hrs despite the fact that such orders remain active in the computer. As a result, a pneumonia pt of mine failed to receive tx for several days.

Anthony Karabanow said

at 11:16 am on Nov 3, 2009

You cannot click on a panel (eg acute hepatitis panel) to see what exactly is being ordered.

Rush Pierce said

at 7:37 pm on Nov 8, 2009

We are having major problems with lab being cancelled or not done - I think this is multifactorial, sometimes not ordered correctly, sometimes nursing not drawing, sometimes lab not getting requisitiion. This is major NEGATIVE impact on patient care. Maybe hospitalists should organize meeting with 4W/5W nurses, lab, and IT

kcardon said

at 8:00 pm on Feb 1, 2010

Once a blood transfusion has been requested, it can never be discontinued. There are transfuse orders from several years ago saying "in-process/in-lab" and can't be deleted. Lab asked me to d/c a blood order on a patient who did not receive it during surgery - I couldn't find a way to accomplish this.

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