emr pjc downtime procedures - eastern health

EMR PJC Downtime Procedures

1 | P a g e Printed copies of this guide may be out of date. See EMR@eastern intranet

site for most up to date information. This guide updated 22/02/2017

Contents

A - EMR Downtime Action Summary Plan .................................................................................................... 3

Planned Downtime ................................................................................................................................... 3

Unplanned Downtime .............................................................................................................................. 3

724 Access Viewer .................................................................................................................................... 4

EMR is down ............................................................................................................................................. 4

PAS (HOMER) is down ............................................................................................................................ 12

Network Down–Printing Alternatives .................................................................................................... 15

Integration Engine(s) Down .................................................................................................................... 17

B - PLANNED DOWNTIME (EMR / PowerChart) ......................................................................................... 19

Prior to Downtime: ................................................................................................................................. 19

Print the Pharmacy Batch Print .............................................................................................................. 20

Print the FBC (if used) ............................................................................................................................. 21

During Downtime: .................................................................................................................................. 22

Post Downtime: ...................................................................................................................................... 22

Back-entry of downtime activity ............................................................................................................ 22

C - UNPLANNED DOWNTIME (EMR) ........................................................................................................... 23

Initiating a code yellow: ......................................................................................................................... 23

Initiating downtime ................................................................................................................................ 23

During Downtime ................................................................................................................................... 24

Post Downtime: ...................................................................................................................................... 27

What to do with the 724 Access Printouts ............................................................................................. 29

How to search for Pathology & Medical Imaging Results ...................................................................... 30

During Downtime: .............................................................................................................................. 32

Post Downtime: .................................................................................................................................. 33

D - MEDICATIONS ....................................................................................................................................... 35

Planned Downtime. ................................................................................................................................ 35

Unplanned Downtime. ........................................................................................................................... 35

E - Printing the MAR ................................................................................................................................... 37

How to Print the MAR for the ward ....................................................................................................... 37

Printing Medication Administration Record (MAR) for individual patients ........................................... 38

F - PATHOLOGY ........................................................................................................................................... 39

A




Planned Downtime ................................................................................................................................. 39

Prior to downtime: ............................................................................................................................. 39

During Downtime: .............................................................................................................................. 39

Unplanned Downtime ............................................................................................................................ 39

Pathology Collection ............................................................................................................................... 40

Pathology Reports .................................................................................................................................. 40

G - RADIOLOGY ........................................................................................................................................... 41

H - How to Print the Fluid Balance Chart .................................................................................................... 43

I - EMR / PowerChart Downtime Recovery Checklist ................................................................................. 45

J - Printing Downtime Path & Drs Orders extract report ............................................................................ 47

L - PAS DOWNTIME REGISTRATION/RECOVERY CHECKLIST - PJC .............................................................. 49

Opening MAR Files on 724 Access Viewer PC ............................................................................................ 50

P - PAS DOWNTIME REGISTRATION IN CERNER ......................................................................................... 51

Add a New Person .................................................................................................................................. 51

Add an Encounter ................................................................................................................................... 52

N - PAS Downtime Patient Movement Log – Peter James Centre ............................................................. 53




A - EMR Downtime Action Summary Plan

Planned Downtime A window of planned downtime is set aside each month to conduct any maintenance or upgrades.

The window is the third Wednesday of the month and will be a maximum of 4 hours between midnight

and 0400. The outage will only be utilised if there is work to be done. Some maintenance releases can

be completed with no downtime. In addition there will be a small outage each year to reset times for

Daylight Savings changeovers.

All clinical areas will receive communications well in advance of a planned outage.

Unplanned Downtime Users will be instructed to contact the Help Desk on ext 26700 if:

1. Users unable to access the system

If multiple users/workstations are experiencing problems, notify your Manager (during business hours)

or the Afters Hours Coordinator (after business hours) to alert the IT Help Desk who will assess the

situation and determine the cause of the outage.

Do not use downtime procedures unless a public address announcement or broadcast message has

been distributed by the IT Helpdesk.

2. System Freezes / Boots User out

Users may experience a freeze of the system or have their session terminated without warning. This is a

known problem that is monitored closely.

Users will be asked to notify IT Help Desk when it occurs and record the time the freeze occurred, what

function they were performing and what warning messages they received, if any, prior to the Freeze.

3. Information entered in the Patient Administration System (PAS /HOMER) has not come through

to EMR

Users may notice that admissions, discharges and transfers completed in the PAS/HOMER are not

appearing in EMR. This may be an indicator that there is a problem with the integration of the systems.

Report the problem to the Eastern Health IT Helpdesk.

4. System Slowness

Users may experience response times that are significantly slower than optimal for patient care

delivery. Problems with access or performance should first be reported to the IT Help Desk to enable

them to monitor the response time and determine the cause of the issue. In some rare cases the

‘slowness’ may indicate a larger problem and would constitute the same response as a full system

outage.

A




724 Access Viewer 724 Access Viewer provides 7x24 historical access to all clinical data currently available in EMR when the network experiences a planned or unplanned

downtime event. The data provided in 724Access Viewer is typically less than two minutes older than the data found in EMR at the time of the system going

down. You can retrieve data as far back as 30 days. 724 Access Viewer is installed on designated computers in clinical areas and is connected to a dedicated

printer to be used in the event of a downtime event.

Downtime Manager = Hospital Incident Controller or After Hours Coordinator

EMR is down

EMR is Down

FUNCTION DOWNTIME STRATEGY RECOVERY

Patient Lists

Patient Lists will be unavailable in EMR. Messages from the PAS will queue until EMR is available again.

Current Inpatient Lists –724 Access Viewer for ward lists

Custom Lists – delayed until EMR is available.

Wait until queued messages have been processed, and lists are up to date. Then can refer to Location Lists and Custom Lists etc. as per usual.

Allergies

Documentation of New Allergies

Delay if possible

Document allergies on the ALERT Divider at the front of the

patient file and on admission forms , paper drug chart and

Medication print outs from the 724 Access Viewer

Viewing /checking Previous Documented Allergies

Access Patient Information on the 724 Access Viewer

Nurse

Back enter allergies recorded during downtime.




EMR is Down


Prescribing

Inpatient

Medications

Prescribing

Discharge

Medications

NUM/ANUM will retrieve the paper drug charts from the Downtime

Pack.

New medications or modifications to existing orders to be written on

the drug chart

Downtime Manager will retrieve the Hospital Prescription forms from

the Pharmacy After Hours Cupboard

Order outpatient prescriptions on Hospital prescription forms-send

the three copies to Pharmacy for dispensing.

Pharmacists to facilitate filing of the red copy in the paper medical

record

If patient episode of care was only partly in the EMR outage then the

Discharging Doctor needs to ensure the GP gets a summary all

prescribing medications information

Doctor

Enter any additions / modifications on the paper drug chart into

EMR.

Stamp or record on the drug chart that electronic entry has been

performed.

Ensure that the drug chart is removed and placed into the paper

medical record once back entry has been performed.

Downtime Manager

Retrieve all paper Hospital Prescription pads and place in

Pharmacy After Hours Cupboard.

Medication Administration [Nurse]

From the 724 Access Viewer,

Print Medication Orders (Current),

Medication Orders (Future),

Medication Orders (Discontinued) and

Patient Information (Includes Allergies).

Record medication administrations during downtime on these printouts

For new and modified orders, record administration on the paper drug chart retrieved from the downtime pack

Attach printouts and drug chart together

Nurse

Using the Medication Orders (Current, future and discontinued) printouts reconcile nursing tasks performed during downtime. Chart the actual administration time when charting tasks and type ‘System Down’ in Comment

Printouts are then to be included in the paper medical record for scanning into CPF.

If a patient was discharged during downtime, access Patient Electronic Chart via patient UR search (not via the PAL) - follow above procedure to add any medication administering records to




EMR is Down


Note: Using clinical judgement print immediate requirements first.

electronic chart then review the patient’s MAR for any overdue tasks and delete/remove/cancel citing Patient Discharged as reason

Orders

(Pathology )

Delay placing order if possible.

If urgent, Use written order process i.e. Pathology Request

slips from Downtime pack.

Retrieve the Downtime Pack.

Take out Pathology Order pads and the Downtime Pathology

Order slip tray and place in the designated downtime

Pathology orders area.

Doctors Placing new orders - Use paper Pathology Orders

and label with a PAS patient label.

Place those in the Pathology Orders tray on the ward.

Document the orders placed in the progress notes in the

medical record.

Nursing - Sort Paper orders into Nurse collect orders vs

Phlebotomist collect orders.

Doctor

For orders that have been placed on paper during downtime - do nothing. Result will go into EMR when test completed.

Enter Orders in EMR that were delayed.

Check that any orders placed prior to downtime are on the system.

NUM/ANUM Retrieve all paper order pads and place back in Downtime pack. Return Downtime pack to the designated storage area.

Radiology Orders [Doctor]

NUM/ANUM will retrieve Downtime Pack and Radiology Order pads.

Delay orders if possible

If urgent , complete new orders on the Radiology Order forms

Ward Clerk to hand deliver to Medical Imaging

Doctor

For orders that have been placed on paper during downtime - do nothing. Result will go into EMR when test completed.

Enter orders that were held over or delayed. NUM/ANUM

Retrieve all paper order pads and place back in Downtime pack.

Return Downtime pack to the designated storage area.




EMR is Down


Pathology

Collections –

Existing Order

in Planned

Downtime

For orders placed prior to downtime but not collected:

NUM/ANUM print Downtime Path & Drs orders extract report from

Powerchart to view all orders that require collection during

downtime period.

NUM/ANUM to cross reference and review Downtime Path report

and PAL and identify:

- Urgent orders or orders due for collection for the anticipated

period of downtime.

- Orders that are Nurse collect vs. Pathology Collect.

- Pre-print pathology labels and requisition form

Specimen Collection

- Attach a PAS label located in the Medical Record to identify the

patient on the order slip.

- Take specimen using paper order to identify patient.

- Hand Label specimen with Name, Date of Birth, UR # or with a

PAS label plus Date, Time & Signature of collector

- Complete collection details on the paper order

- Take a photocopy of the order and give to the NUM / ANUM to

assist with charting tasks post downtime. Attach the Downtime

Path & Drs orders extract report with all photocopy requisition

forms

- Place order and specimen(s) in plastic bag and send to Pathology.

- Document the collection in the patient medical record

Specimens collected during downtime

Chart the collection:

Use the photocopy of the order and the Downtime Path & Drs

orders extract report that has been kept on the ward to back enter

collected specimens via PAL & QuickChart all collections made

during downtime period. Ensure that the actual correct date and

collection time are entered

Note: For orders actually placed during downtime charting will not

be required as no tasks will have been generated.




EMR is Down


Pathology

Collections –

Existing Order

in Unplanned

Downtime

NUM/ANUM to review PAL and identify:

- Urgent orders or collect now

- If there are orders needing collection, contact the EMR support

team to arrange requisition printing

Specimen Collection

- Take specimen using paper order to identify patient


PAS label plus Date, Time & Signature of collector Complete

collection details on the paper order

- Take a photocopy of the order and give to the NUM / ANUM to

assist with charting tasks post downtime



Pathology

Collections –

New Orders in

Planned &

Unplanned

Downtime

For new orders placed during downtime:

Order forms will be handwritten on the pathology order forms from

the downtime pack.

Specimen collection

- Attach a PAS label located in the Medical Record to identify the

patient on the order slip.

- Take specimen using Paper order to identify patient.





EMR is Down


PAS label plus Date, Time & Signature of collector

- Complete collection details on the paper order



Orders

awaiting

Co-Sign

Delay until EMR is available.

NB: The order can still be progressed without the co-sign occurring.

Doctor to log on to Message Centre and co-sign all orders.

Results –

Viewing

724 Access Viewer

Pathology, Radiology Results and Discharge Summaries - The data

provided in 724Access Viewer is less than two minutes older than the

data found in EMR. Data is retrievable to 30 days prior.

In addition Results can be accessed for:

Pathology: AUSCARE – Generic Auscare logins for medical staff will

be activated for the duration of the outage.

(Intranet home page, Select Applications, Select Pathology Reports ,

Enter mar135 for Username, Enter pjc123 for Password

Radiology Reports: Web 1000 – Intranet home page, Select

Applications, Select Medical Imaging, Use your current logon or

contact ICT for access

Messages containing the results reports will queue until EMR is

available and the results will subsequently be viewable in EMR.




EMR is Down


Discharge Summaries: CPF – Log directly onto CPF and access

scanned reports

NB Process to notify treating doctors of Critical results will not

change. These results will be phoned through.

Results -

Endorsing

Delay results endorsing process. Doctor

Review Patient Results Review tab and endorse any results that are

now available OR assigned Medical Officer messages in Message

Centre and clear any unendorsed results.

Documentation

(Diagnoses,

Alerts,

Input /Output

etc.)

Document on medical record forms.

Doctor

Back enter Diagnoses, Problems or Alerts, and procedures

entered during downtime as clinically required

Stamp or hand record on paper forms that data has been

entered in EMR and file in medical record

Nurse

Back enter Problems or Alerts and Fluid Balance Chart entered

during downtime as clinically required

Stamp or hand record on paper forms that data has been

entered in EMR and file in medical record




EMR is Down


Prescribing

Discharge

Medications

And Outpatient

Prescribing

Outpatients

Commence downtime procedures immediately.

Nurses in Outpatient Clinics are to retrieve the Hospital Prescription forms from the Prescription Cupboard in each Outpatient Department

Order outpatient prescriptions on Hospital prescription forms immediately

Wards, ED, Theatre

If expected discharge is during downtime then use paper otherwise delay till EMR is back.

Order discharge medications on Hospital Prescription forms

if required during downtime or within 24 hours will be with

Hospital co-ordinator

Outpatient Clinic Downtime Coordinator & Ward Downtime

Coordinator

Retrieve all paper Hospital Prescription and place back in

Downtime pack.

Return Downtime pack to the designated storage area.

Discharge

Summary

Delay if discharge is scheduled > 24 hours.

If Urgent – Handwrite Discharge Letter

Handwritten discharge medications /scripts generated during

downtime, will not automatically pull into the electronic discharge

summary. These will have to be manually added when

commencing the discharge summary after a downtime




PAS (HOMER) is down

All Patient Registrations, Admissions, Discharges and Transfers are done in PAS (HOMER)

The information only appears in EMR after the data has been entered in PAS (HOMER).

NB: If PAS (HOMER) is down, patients in EMR will remain in the location they were in at the time PAS (HOMER) went down.

PAS (HOMER) is Down

FUNCTION

DOWNTIME STRATEGY RECOVERY

Admission Retrieve PAS Downtime Pack Ward Clerk or AHC fills out Patient Information form. Look up URN in EMR, CPF or in copy of PMI (local search). Allocate a downtime UR #. to new patients (included in pack) Complete Downtime Patient Movement Log worksheet Register patients in EMR using Downtime Registration process. Print Downtime Patient Labels from off line printer ( 724 Access Device)

Ward Clerk or After Hours Coordinator to complete registration in PAS for all Downtime Registrations using the Patient Information form and the downtime patient movement log Coordinate with PJC and IT as to the resetting of the autonumber Fax the Downtime Patient Movement Log to the Global Patient Identifier (GPI) Team for urgent encounter merge

Transfers to Wards

Keep track of transfers on Downtime Patient Movement Log. Use patient name or URN searches rather than Patient Lists

Ward Clerks or AHS update PAS to reconcile patient locations

Discharges

Keep track of transfers on Downtime Patient Movement Log. Ward Clerks or AHS update PAS to reconcile patient locations

Ward Maps, Patient Lists

Utilise patient list in EMR to see where patients were located at the time PAS went down.

Outpatient Appointments

View future Outpatient Appointments in EMR if required. Keep appointment requests in hard copy until PAS is available

Make outpatient appointments in PAS.




PAS (HOMER) is Down

Pre-Admissions Patients who have been pre-registered via a Preadmission process.

Passport kept and manual admission process followed.

Back enter admissions

Radiology Orders

Delay radiology orders if possible. For current inpatients or new admissions with a previous UR #, order Radiology in EMR as per usual. Results will be posted to EMR as per usual Where a new UR # needed to be allocated (i.e. no previous EH UR #) ring Radiology for Results if urgent. Results will not be posted to EMR until PAS recovery Critical results will be rung through.

Nil Results will be posted in EMR after the PAS registration is processed for new admissions with new EH UR #

Pathology Orders

Delay pathology orders if possible. For current inpatients or new admissions with a previous UR #, order pathology in EMR as per usual. Results will be posted to EMR as per usual Where a new UR # needed to be allocated (i.e. no previous EH UR #) ring Pathology for results if urgent. Results will not be posted to EMR until PAS recovery Critical results will be rung through.

Nil Results will be posted in EMR after the PAS registration is processed for new admissions with new EH UR #

Pathology Collections

Collect and chart as per usual being aware that patient locations and patient lists may not be accurate i.e. they will display the patient location at the time the PAS went down

Nil Patient locations will be updates when PAS updates have been performed

Medication Orders

Continue ordering in EMR as per usual

Nil




Medication Administration

Continue administering and charting as per usual Nil

Pharmacy

Note that patient location is only accurate to the point of downtime. Ensure that ward staff advise of new admissions and transfers to ward pharmacists and check the “dispense from” location when verifying in Pharmnet

Nil




Network Down–Printing Alternatives

Network Down - Alternate Printing


Pathology Label Printers only

Hand label or use the PAS label Collector to sign , time and date the label Chart the collection in EMR as per usual procedure. Place the printed Pathology Order with the specimen in a plastic bag and send to Pathology.

Nil

Prescription Printers

Retrieve the Hospital Prescription forms from the downtime

pack.

Order outpatient prescriptions on Hospital prescription forms -

send the three copies to pharmacy for dispensing.

Pharmacists to facilitate filing of the red copy in the paper

medical record

Doctor

Handwritten discharge medications /scripts generated during outage will not have automatically populated the electronic discharge summary. These will need to be manually added when commencing the discharge summary. Downtime Manager to retrieve all paper Hospital Prescription pads and place back in Downtime pack. Return Downtime pack to the designated storage area.

Note:

If the wireless network is down and the standard network up – then revert to paper.

If the standard network is down and wireless network up – then revert to paper.

The above is to ensure only one system is used which will lessen any clinical risk




Pathology Requisition printers

Downtime Manager will retrieve Downtime Pack and Pathology

Order pads.

Orders not yet placed

Delay placing order if possible.

If urgent, use written order process i.e. Pathology Order

forms from Downtime pack.

Document the orders placed in the progress notes in the

medical record.

Downtime Manager Retrieve all paper order pads and place back in Downtime pack. Return Downtime pack to the designated storage area.

Printing Discharge Summaries

Delay printing output

Print and post discharge summary after printers are restored.

MRP print/Freedom of Information

Delay printing output If information is urgently required for a patient transfer, complete a Patient Transfer form

Complete backlog of Printing requests after printing is restored

Patient Transfer Documentation

From the724 Access Viewer, Print Medication Orders (Current),

Medication Orders (Future), Medication Orders (Discontinued)

and Patient Information (Includes Allergies).

Nil

Radiology Orders NUM/ANUM will retrieve Downtime Pack and Radiology Order

Pads.

Delay orders if possible

If urgent, complete new orders on the Radiology Order forms

Ward Clerk to hand deliver to Medical Imaging

Results – go to Medical Imaging in person as the phones will more than likely be out as well.

Radiology Enter all manual orders into the EMR then reconcile systems:

EMR

RIS

PACS




Integration Engine(s) Down The Integration Engine is pivotal in making all the systems talk to each other. The Integration Engine channels the messages between the PAS, EMR,

Radiology, Pathology and Pharmacy Systems. If there are delays in sending messages through the Integration engine, the normal processes will be disrupted.

It may appear as though all systems are working correctly. Indicators that something is amiss could be:

New admissions, transfers, etc. made in PAS will not appear in EMR

Messages are not being received in third party systems i.e. Pathology, Radiology, Pharmacy

Results from Pathology or Radiology are not appearing in EMR

It is the responsibility of ICT to advise key downtime personnel (in the event of any Integration downtime) the scope of the outage.

Integration Engine Down


Patient Lists/ MRN Search

New admissions may not appear in EMR .There may be no episode/ encounter in EMR in order to place orders.

Messages will flow through after Integration Engine is restored Ward Clerks will need to reconcile and check patient lists in their ward are accurate.

Radiology Orders NUM/ANUM will retrieve Downtime Pack and Radiology Order pads.

New orders are to be hand written on paper radiology order forms and

faxed to Radiology Angliss Fax

No: 9756 0439

Messages will flow through after Integration Engine is restored

Pathology Orders NUM/ANUM will retrieve Downtime Pack and Pathology Order pads.

New orders are to be hand written on paper pathology order forms





Integration Engine Down


Results & Results Endorsing

Commence EMR downtime process. Urgent/ Critical results will be phoned through by the ordering doctor


Discharge Summary Commence EMR downtime process Messages will flow through after Integration Engine is restored

Prescribing Medications

NUM/ANUM will retrieve the paper drug charts from the Downtime Pack.

New medications or modifications to existing orders to be written on the

drug chart

Note: Routine re-supply and dispensing new orders will not occur so

clinical staff will need to liaise with Pharmacy directly to dispense drugs.

Doctor Messages will flow through after Integration Engine is restored




B - PLANNED DOWNTIME (EMR / PowerChart)

Prior to Downtime:

1. Locate Downtime Pack

2. Access the PAL

Review the PAL and complete all outstanding tasks/collections

From PAL decide who will need Urgent Medications administered and Pathology orders collected during the downtime.

3. Pathology - print Downtime Path & Drs orders extract report from Powerchart

This list will determine the patients that require pathology collection during downtime.

4. Pathology - Ensure there is a printed pathology order form and specimen labels available for those patients requiring a collection during downtime

Double click on the red blood drop icon in the Patient Access List (PAL)

Click on Reprint Requisitions

Select the ward printer from the drop down list and click on OK

Click on Reprint Labels and click OK

Select the ward label printer and click OK

Attach the labels to the printed requisition form in preparation for specimen collection during downtime

B




Print the Pharmacy Batch Print Note: Occasionally there will be a ward Pharmacy Batch Print that cannot be printed by this method.

When this occurs refer to How to print the MAR for individual patients

1. Click on the Pharmacy Batch Print tab

2. Select the required Ward

3. Select the required Offset Note: Start Date Offset

Offset 0 = Print TODAY’s report From the time of printing until Midnight tonight E.g. Print at 1800 = tasks from 1800 to 2400)

Offset 1 = Print report for TOMORROW From Midnight tonight to time of printing tomorrow E.g. Print at 1800 = tasks from 2400 to 1800 tomorrow

4. Select the required printer

5. Click Run.

The report will print to the selected printer




Print the FBC (if used)

1. Open the Patient Chart and select MRP Print from the Task menu

2. Select Fluid Balance

3. Select required date range

4. Select For Internal Use Only

5. Select your Ward printer

6. Click Ok




During Downtime: Delay all medication, pathology and radiology orders unless Urgent.

Pathology:

For Urgent orders identified prior to downtime use pre-printed PowerChart orders and labels as per

usual. Send samples and orders to the laboratory.

For all new orders use paper slips in downtime packs and PAS labels.

Radiology:

For Urgent Radiology orders use paper orders in downtime pack and hand deliver to Radiology.

Medication:

Pre-existing orders can be administered on pre-printed MAR

All new orders and modifications to be placed on paper drug charts in downtime packs. The drug

chart is to be stapled to the pre-printed MAR Report. Both charts are to remain at the bedside until

back entry is complete.

Post Downtime: Incident Controller will notify your area via broadcast message that EMR (PowerChart) is now

available for use.

Resume system use as per normal. No further paper orders should be placed.

Pre-printed MAR Report & Drug Chart to remain at the bedside as a reference until all

administrations are signed off and new orders are back entered into PowerChart.

Once back entered paper MAR / Drug Charts are to be stamped or annotated to indicate entry into

EMR has occurred and placed in the medical record

Back-entry of downtime activity Nursing:

Chart all outstanding pathology and medication tasks.

For medications, use paper downtime MAR as reference:

- Click overdue doses on electronic MAR

- Change Performed date/time to actual administration time

- Change name in Performed by field (if administered by another nurse)

- Click Comment > type “System Down” > click OK > click green tick

- Stamp paper medication chart to indicate electronic transcription has occurred.

Total any volumes written on paper FBC and back enter this volume into “other“ section on

electronic FBC chart. If strict chart was in operation, more detail should be back entered.

Medicine:

No back entry of paper Pathology orders or Urgent Radiology orders.

Back enter any new/modified medication orders placed during downtime.

Pharmacy:

Check PharmNet and verify unverified orders.

Pharmacy department to refer to departmental procedures to process queued messages.




C - UNPLANNED DOWNTIME (EMR) An unplanned downtime is:

1. Users unable to access the system

If multiple users/workstations are experiencing problems, notify your Manager (during business hours) or

the Afters Hours Coordinator (after business hours) to alert the IT Help Desk who will assess the situation

and determine the cause of the outage.

Do not use downtime procedures unless a public address announcement or broadcast message has been

distributed by the IT Helpdesk.

2. Information entered in the Patient Administration System (PAS /HOMER) has not come through

to EMR

Users may notice that admissions, discharges and transfers completed in the PAS/HOMER are not

appearing in EMR. This may be an indicator that there is a problem with the integration of the systems.

Report the problem to the Eastern Health IT Helpdesk.

3. System Slowness

Users may experience response times that are significantly slower than optimal for patient care delivery.

Problems with access or performance should first be reported to the IT Help Desk to enable them to

monitor the response time and determine the cause of the issue. In some rare cases the ‘slowness’ may

indicate a larger problem and would constitute the same response as a full system outage.

Initiating a code yellow: If a problem is identified which impacts EMR the user contacts the IT Help Desk on ext 26700 for

assistance in determining the cause of problem. The user will escalate to their manager to escalate HIC

or After Hours Coordinator who will determine whether a Code Yellow is required.

Initiating downtime A Code Yellow is called for an unplanned downtime. The decision to call a Code Yellow can be made by any

member of staff. The instigator of the Code Yellow must in turn inform the Downtime Manager. A code

yellow will activate the Business Continuity Process across the site for all members of staff.

If an unplanned downtime occurs overnight, the After Hours Coordinator will send a page out to each ward

to notify them when a Code Yellow is called and also when the Code Yellow is stood down.

Downtime Manager

A downtime manager is the Hospital Incident Controller or After Hours Coordinator. They are responsible

for coordinating the downtime and calling stand down upon resolution.

C




During Downtime

1) Initiating a code yellow

Step Comment How to Guide Reference

Contact Manager or After Hours Coordinator

N/A Announcement will be heard across the site over

the WIP

2) Accessing Downtime Viewer


Locate your ward 724 Access Viewer Computer There is a dedicated 724 on each ward. N/A

Log into downtime computer (Open computer up) username and password located on 724 Downtime Viewer device

Accessing Downtime Viewer

From the desktop, open 724 Access and log in

(Access application)

username and password located on 724 Downtime Viewer device

Accessing Downtime Viewer

3) Downtime Viewing and Printing


Select your ward/location

N/A

Select your patient

View pathology and radiology results on 724

Access viewer

How to search for pathology results and radiology

reports on 724

View pathology results in AUSCARE Generic Auscare logins for medical staff will be activated for the duration of the outage. Go to Intranet home page, Select Applications,

N/A




Select Pathology Reports, and use mar135 for Username, pjc123 for password

View radiology reports on PACS XERO From the Intranet home page, Select Applications, Select Medical Imaging and use your current logon or contact ICT for access

N/A

Print relevant or required patient documentation The ward may require a list of outstanding Radiology or Pathology tests

Downtime printing of outstanding orders from 724

4) Ordering Pathology and Radiology

Delay all pathology and radiology orders unless Urgent or required now.


Pathology test required Use handwritten Pathology request forms in Downtime pack, stamp with downtime stamp and document in patient medical record.

N/A

Medical Imaging test required Use handwritten Radiology request forms in

Downtime pack, stamp with downtime stamp and document in patient medical record.

5) Pathology Collection


Check pathology requisitions Prioritise workload during downtime. Pathology collection guide

Take specimen Record date and time taken in patient medical record




6) Radiology


Review orders in downtime viewer

N/A Call radiology prior to sending patient as per Open

Access

7) Discharge medications


Order discharge medications on hospital

prescription pads

Further supplies:

- In hours from pharmacy

- Out of hours from after-hours cupboard

Ensure all three copies of discharge script is sent

to pharmacy as the red copy will be scanned into

the patient’s medical record

N/A




Post Downtime: 1) Pathology


Incident Controller will notify your area via

broadcast message that EMR is now available for

use.

N/A

Resume system use as per normal for future orders Alerts for future orders will not appear for orders written during downtime.

Orders entered pre downtime chart as taken. Recording of pathology collected during downtime

New pathology orders written on paper and taken

during downtime.

No action required results will appear in EMR. N/A

Enter pathology orders for the next day back into

EMR and destroy paper request.

If only urgent and required now tests are entered there should be no requirement to re-enter tests into EMR.

N/A

2) Radiology


Radiology tests ordered and/or test performed. No action required results will appear in EMR. N/A

Enter radiology orders for the next day back into

EMR and destroy paper request.

If only urgent and required now tests are entered there should be no requirement to re-enter tests into EMR.

N/A




Accessing Patient Records via the 724 Downtime Viewer

In the event of an unplanned downtime, staff can access up-to-date patient records via the 724 Downtime viewer (DTV) computer, which will be located on the ward. The 724 computers are run with an uninterruptable power supply and are updated every 2-3 minutes with patient’s records (Medical, Pathology & Radiology). Steps In the event of an unplanned downtime:

1. Locate the EMR Downtime pack on your ward

2. Locate your ward 724 Access Viewer Computer

3. From the desktop, open 724 Access

4. Login with the following details:

username and password located on 724 Downtime Viewer device




Printing ward documentation from 724 Access

Once you are logged into the 724 DTV, you will see patient lists for the wards which that machine is monitoring (there may be multiple wards - on your level, within your hospital, or covering other sites).

1. Select your ward from the Location and click on Search

2. Type your name in Username field, select DOWNTIME and click OK

3. Select the first patient on the list, then select the last patient, while holding the shift key on the keyboard

4. Click Print Chart

5. Select the date range

6. Select what to print

Print the Medication Orders – Current, Future, Discontinued

Scroll down and select Patient Information (Allergies)

7. Click Finish

8. Select the required Printer and click Print

What to do with the 724 Access Printouts Medications can be administered and signed for on the Medications print out from 724 Access.

All new medication orders and modifications are to be placed on paper drug charts in downtime packs.

The drug chart is to be stapled to the Medication Orders Report. Both charts are to remain at the

bedside until back entry is complete. The charts are to be stamped or annotated that data entry in EMR

is complete. They are then to be placed in the medical record.




How to search for Pathology & Medical Imaging Results Selecting Patients

1. Enter patient details (Name or UR)

2. Click Search

3. Select the required patient

4. Type emr in the username field

5. Select Downtime as the print reason and click OK

Result Search When searching for Results, always search in two places:

Under Lab Results (All Lab Results) – Pathology Numerical Results

Under Documents (All Documents) – Medical Imaging, Any text pathology reports including microbiology results

1. Click on Lab Results




2. Select Date Range (Back Max. 30 days)

3. Select Results Filter (Defaults to All Lab Results)

4. Click on Documents

5. Select Date Range (Back Max. 30 days)

6. Select required document




During Downtime:

Delay all medication, pathology and radiology orders unless Urgent.

Pathology Orders:


If urgent, use written order process i.e. Pathology Order forms from Downtime pack.

Document the orders placed in the progress notes in the medical record.

Viewing / Checking Orders already placed prior to Downtime

Access under Patient Information on the 724 Access Viewer

Pathology Collection:


Downtime Manager to review pathology requisition forms already printed to review / identify:

Urgent Orders or Orders due for collection for the anticipated period of downtime.

Orders that are Nurse collect vs. Pathology Collect.

Specimen Collection

Attach a PAS label located in the Medical Record to identify the patient on the order slip.

Take specimen using paper order to identify patient.

Hand Label specimen with Name, Date of Birth, UR # or with a PAS label plus Date, Time & Signature of collector

Complete collection details on the paper order

Take a photocopy of the order and give to the NUM / ANUM to assist with charting tasks post downtime

Place order and specimen(s) in plastic bag and send to Pathology.

Document the collection in the patient medical record


Order forms will be handwritten on the pathology order forms from the downtime pack.

Specimen collection


Take specimen using Paper order to identify patient.

Hand Label specimen with Name, Date of Birth, UR # or with a PAS label plus Date, Time & Signature of collector


Place order and specimen(s) in plastic bag and send to Pathology

Document the collection in the patient medical




Radiology:

Downtime Manager will retrieve Downtime Pack and Radiology Order pads.

If urgent , complete new orders on the Radiology Order forms

Ward Clerk to fax orders to Radiology Angliss Fax No: 9756 0439

Medication:

Pre-existing orders can be administered on the 724Access medications print out.

All new orders and modifications to be placed on paper drug charts in downtime packs. The drug chart is to be stapled to the pre-printed MAR Report. Both charts are to remain at the bedside until back entry is complete.

Fluid Balance Chart:

Document on paper FBC.

Post Downtime:

Incident Controller will notify your area via broadcast message that EMR (PowerChart) is now available for use.

Resume system use as per normal. No further paper orders should be placed.

Pre-printed MAR Report & Drug Chart to remain at the bedside as a reference until all administrations are signed off and new orders are back entered into PowerChart.

Once back entered paper MAR / Drug Charts are to be stamped or annotated to indicate entry into ehCare has occurred and placed in the medical record

Back-entry of downtime activity

Nursing:

Chart all outstanding pathology and medication tasks.

For medications, use paper downtime MAR as reference:

- Click overdue doses on electronic MAR

- Change Performed date/time to actual administration time

- Change name in Performed by field (if administered by another nurse)

- Click Comment > type “System Down” > click OK > click green tick

- Stamp paper medication chart to indicate electronic transcription has occurred.

Total any volumes written on paper FBC and back enter this volume into “other “ section on electronic FBC chart. If strict chart was in operation, more detail should be back entered.

Medicine:

No back entry of paper Pathology orders or Urgent Radiology orders.




Back enter any new/modified medication orders placed during downtime.

Pharmacy:

Check PharmNet and verify unverified orders.

Pharmacy department to refer to departmental procedures to process queued messages.




D - MEDICATIONS ONLY PLACE URGENT ORDERS

Planned Downtime. Prior to downtime:

Locate downtime pack.& 724Access

- Username / Password = ehcare/ehcare

Open PowerChart and Review / sign off all overdue / current tasks/administrations.

From PowerChart:

Print the MAR (Pharmacy Batch Report) for all patients in your ward.

Consider printing FBC if detailed information is required.

During Downtime:

Pre-existing orders can be administered on pre-printed MAR.

All new orders and modifications to be placed on paper drug charts in downtime packs. The drug chart is to be stapled to the Pharmacy Batch Report. Both charts are to remain at the bedside until back entry is complete.

Unplanned Downtime. Locate downtime pack. Username and password located on 724 Downtime Viewer device

Print from 724 Access PC:

Medication Orders: Current, Future and Discontinued.

Patient information (Allergies).

Medications can be signed for on the Medications print out from 724Access.

All new orders and modifications to be placed on paper drug charts in downtime packs. The drug chart is to be stapled to the Medication Orders Report. Both charts are to remain at the bedside until back entry is complete.

D




[This Page Has Been Intentionally Left Blank]




E - Printing the MAR

How to Print the MAR for the ward

This report is a replication of the MAR and can be used as a drug chart for administration over a 24 hour period.

To be printed & used in scheduled downtimes (Downtime Report). Click the Pharmacy Batch Print tab:

1. Click Pharmacy Batch Print

2. Select your Ward

3. Select the start date offset

4. Select your printer and click Run. The report will print to the selected printer

NOTE:

For today – select offset of 0. Prints from time of printing to midnight

E.g.: Printing from 1800 – Select 0, results from 1800 to 2400

For tomorrow – select offset of 1. Prints from midnight to the time of printing on the next day

E.g.. : Printing from 1800 – Select 1, results from 0001 to 1800

E




Printing Medication Administration Record (MAR) for individual patients

In the event of being unable to print the entire ward, the MAR can be printed individually for each patient.

1. Click Pharmacy Batch Print in the top menu bar

2. Click *Patient Only PJC MAR under the Batch Reports heading (left hand column)

3. Type patient’s surname in Name field > click Find Patient

4. Select correct patient > select correct encounter/admission (lower half of screen) > click OK

5. Select correct Printer

6. Click Run

7. Repeat from step 3 for remaining patients.




F - PATHOLOGY ONLY PLACE URGENT ORDERS

Planned Downtime

Prior to downtime:

1. Locate downtime pack and pathology order pads

2. Print Downtime Path & Drs orders extract report from Powerchart

3. Cross reference report and PAL and print pathology requisition form and labels

4. Ensure there is a printed pathology order form and specimen labels available for those

patients requiring a collection during downtime

Double click on the red blood drop icon in the PAL

Click on Reprint Requisitions

Select the ward printer from the drop down list and click on OK

Click on Reprint Labels and click OK

Select the ward label printer and click OK

Attach the labels to the printed requisition form in preparation for specimen

collection during downtime

During Downtime:

1. For Urgent orders identified prior to downtime use the pre-printed pathology orders

and specimen labels and Downtime Path & Drs orders extract report

2. For all new orders use the paper slips in downtime packs and PAS or handwritten labels

Unplanned Downtime 1. Locate downtime pack and pathology order pads

2. 724Access Username / Password = ehcare /ehcare

Pathology Orders:


1. If urgent, use written order process i.e. Pathology Order forms from Downtime pack 2. Document the orders placed in the progress notes in the medical record

Viewing / Checking Orders already placed prior to Downtime

1. Access under Patient Information on the 724 Access Viewer

F




Pathology Collection


Print Downtime Path & Drs orders Extract report from Powerchart. NUM/ANUM cross reference report and orders from the PAL. NUM/ANUM print pathology requisition forms and labels for orders to identify:

Urgent Orders or Orders due for collection for the anticipated period of downtime

Orders that are Nurse collect vs. Pathology Collect

Specimen Collection

Attach a PAS label located in the Medical Record to identify the patient on the order slip

Take specimen using paper order to identify patient.

Hand label specimen with Name, Date of Birth, UR # or with a PAS label plus Date, Time & Signature of collector


Take a photocopy of the order and give to the NUM / ANUM to assist with charting tasks post downtime

Place order and specimen(s) in plastic bag and send to Pathology.



Order forms will be handwritten on the pathology order forms from the downtime pack

Specimen collection


Take specimen using Paper order to identify patient.

Hand label specimen with Name, Date of Birth, UR # or with a PAS label plus Date, Time & Signature of collector


Place order and specimen(s) in plastic bag and send to Pathology


Pathology Reports 1. 724 Access Viewer

a. username and password located on 724 Downtime Viewer device b. Data will be available from the point of downtime to 30 days prior.

2. AUSCARE

a. Generic Auscare logins for medical staff will be activated for the duration of the outage. b. Go to Intranet home page, Select Applications, Select Pathology Reports, c. Enter geneh for Username, Enter eh123eh for Password. d. Search using Surname or UR with site Prefix. e.g.: B123456




G - RADIOLOGY

Only Place Urgent Orders

Retrieve Downtime Pack and Radiology Order pads

Complete new orders on the Radiology Order Pads

Fax orders to Radiology Angliss on : 9756 0439

Radiology Reports

1. 724 Access Viewer

724Access Username / Password = ehcare /ehcare

Data will be available from the point of downtime to 30 days prior. 2. Web 1000

From Intranet home page

Select Applications

Select Medical Imaging

Use your current logon or contact ICT for access

G




H - How to Print the Fluid Balance Chart

1. Open the Patient Chart and select MRP Print from the Task menu

2. Select FBC

3. Select Date

4. Select “For Internal Use Only”

5. Select your Ward printer

6. Click OK

H




I - EMR / PowerChart Downtime Recovery Checklist

Responsibility

Task Completed

Nursing

Enter Allergies recorded during downtime (Alert divider/ Admission forms, Paper Drug chart) into EMR

Reconcile tasks performed during downtime using the Medication Orders (current, future and discontinued) printouts .Chart the actual administration time when charting tasks and use “System Down” as reason.

Use the photocopies of pathology order forms to quick chart any collections (via PAL) performed during downtime

Enter alerts, problems and FBC from medical record forms

Medical Enter any additions or modifications on the paper drug charts into EMR. Ensure paper drug charts are stamped or annotated that entry into EMR has occurred and place the paper drug charts in patients’ medical records

Enter any pathology or radiology orders held over (note: it is not necessary to re-enter urgent orders placed on paper during downtime)

Enter any diagnoses problems, procedures or alerts from medical record forms

Downtime Manager Return all paper prescription pads to the After Hours cupboard

Return all pathology, radiology & FBC forms and any unused paper drug charts to the downtime pack

I




J - Printing Downtime Path & Drs Orders extract report Wards are able to run their own reports prior to a planned downtime to view the list of patients that require pathology collection during that time period. The report will generate a list of pathology items which have not been collected or are waiting for collection. Apply the following rules;

Collect Now, Urgent, Time studies and Outpatient will display the collection date/time entered at order entry.

Fasting and Routine orders in an Ordered (scheduled) status, will not display anything in the collection date/time column.

Fasting and Routine orders in an Ordered (dispatched) status, will display the status change date/time in the collection column. (The date the order changed from scheduled to dispatched)

1. Select Explorer Menu from the toolbar

2. Double click on the Main Menu and select Downtime Reports

3. Select the Downtime Path & Doctors Orders Extract Report

4. Complete criteria

Select *Output to File/Printer/MINE - MINE

Select *Facility – EH campus

Select *Location – ward (e.g. East)

Select *Collection Priority – Any*

Select *Outstanding Order Types – Both

Begin Date (e.g. Date of the downtime period commencement)

End Date (e.g. Date of the conclusion downtime period)

5. Click on Execute to generate

report

6. To view the entire report use the scroll buttons

to the bottom and the right of the screen

7. To print the report, select the print

icon on the top of the screen

8. Select the required local printer and click OK

Note: Cross reference this report with information

from the PAL to identify which patients require

pathology collection during the downtime period.

Keep this report together with the photocopied completed requisition forms once the specimen has

been collected and use to chart all outstanding orders post downtime.

J




L - PAS DOWNTIME REGISTRATION/RECOVERY CHECKLIST - PJC During Business Hours - Downtime Registration is completed by the Ward Clerk at PJC. Out of Business Hours - Downtime Registration is completed by the After Hours Coordinator at PJC. Receive CODE YELLOW advice for ‘PAS Downtime’

Retrieve the PAS Downtime Patient Movement Log Worksheet (Document Reference N)

Retrieve Personal Details Form (Document Reference EH 402400)

Retrieve the Downtime Registration in ehCare/PowerChart Instruction Sheet (P) Patient arrives for Admission:

Perform a patient name search in CPF and verify site. (You cannot search reliably in Cerner in the first instance, because if a patient does not have an encounter, no details are displayed)

Refer to Downtime Registration in EMR/PowerChart Instructions (Document Reference P )

Perform a patient search in Cerner

Therefore patient will be new or existing

For a New Eastern Health Registration follow the instruction to ‘Add Person’ using the next available UR number, which will be allocated by the Hospital Incident Controller/After Hours Coordinator from the Downtime UR list (during PAS Downtime the HIC/AHC will retrieve this list from the Health Information Services Office at PJC.)

For an Existing Eastern Health Registration follow instructions to ‘Add Encounter’

Record details on the PAS Downtime Patient Movement Log Worksheet Patient Discharge/Patient Bed Move/Patient Transfer:

Record details on the PAS Downtime Patient Movement Log Worksheet When PAS (Homer) is back On-line

HIC/AHC at PJC will communicate with the HIC/AHC at Wantirna Health to coordinate contact with IT and confirm that ‘Auto Allocation’ of UR is Turned Off

Enter all Downtime Admissions in Homer

Scan the PAS Downtime Patient Movement Log Worksheet and email this immediately to the GPI Team email address: *GPI Team or fax to: 9764 6291 (GPI Team will require this information for the encounter merge)

Maintain communication with the Nurse in Charge to alert of the cross encounter issue until the GPI encounter merge is complete.

Advise the HIC/AHC when Homer data entry is complete as HIC/AHC will communicate with the HIC/AHC at Wantirna Health, to coordinate contact with IT to communicate that auto allocation of UR can be turned back on.

Ensure all relevant Documents are returned to the Ward Downtime Pack ready for next time.

1. 1. If the patient has an existing Eastern Health Registration, but does not have a UR for this site, you will need to contact the Hospital Incident Controller/After Hours Coordinator to allocate the next available UR number from the Homer Downtime UR List (HIC/AHC will retrieve this list from the HIS Office PJC during PAS Downtime.)

2. 2. If the patient has an existing Eastern Health Registration for this site the UR field will auto populate.

L




Opening MAR Files on 724 Access Viewer PC (This is a backup procedure to generate the medication administration records if there are problems

with the 724 Access Viewer program)

1. Start PDFCreator program from the Desktop Icon or from the Program list.

2. Click Document in the Taskbar

3. Then click Add

4. Navigate to & open folder named MAR-Files on the Local Disk (C:)

5. Select required Ward File & Open

6. Make sure Edit PDF files with PDFArchitect is unselected.

7. Click Save

8. Navigate to MAR-Files folder & assign a File name:

9. File will open in Adobe Reader

10. Print File as required to Local Printer




P - PAS DOWNTIME REGISTRATION IN CERNER

Add a New Person

Follow the steps below to add a new patient record to the system.

This process is only to be completed if a patient does NOT exist in the system. Perform a patient search to ensure the patient does not exist in the system before proceeding.

Steps

To add a patient:

1. Clear any selected/highlighted patients- Click Patient List in the toolbar.

2. Click Clear All Selections in the dropdown list.

3. Select Downtime Register from the PM conversation drop-down list in the toolbar.

4. Confirm there is no patient record by searching for the patient. A list of patients will be displayed.

5. Click Add Person. The Organisation window displays.

6. Type * in the Facility Name field.

7. Click the Ellipsis (…) Button. A list of facilities will display.

8. Select the required facility.

9. Click OK. The Temporary Registration ONLY window displays.

10. Click Yes.

11. Complete all mandatory fields.

Note: If the mandatory fields are not highlighted:

a) Right-click anywhere in the screen

b) Select Highlight Required Fields.

c) Complete additional fields as required.

12. Click OK. The Document Selection popup window displays.

13. Select the printer from the list. Click OK.

14. Click OK.

15. Click Yes.

P

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Add an Encounter

Follow the steps below to add a new encounter for a patient.

Steps

To add an encounter:

1. Clear any selected/highlighted patients- Click Patient List in the toolbar.

2. Click Clear All Selections in the dropdown list.

3. Select Downtime Register from the PM conversation drop-down list in the toolbar.

4. The Person Search window displays. Select a patient from those listed.

5. Click Add Encounter. The Organisation window displays.

6. Type * in the Facility Name field.

7. Click the Ellipsis (…) Button. A list of facilities will display.

8. Select the required facility.

9. Click OK. The Temporary Registration ONLY window displays.

10. Click Yes.

11. Complete all mandatory fields.

Note: If the mandatory fields are not highlighted:

a) Right-click anywhere in the screen

b) Select Highlight Required Fields.

c) Complete additional fields as required..

12. Click OK. The Document Selection popup window displays.

13. Select the printer from the list. Click OK.

14. Click OK.

15. Click Yes.

53 | P a g e

Printed copies of this guide may be out of date. See EMR@eastern intranet


N - PAS Downtime Patient Movement Log – Peter James Centre ADMISSION

UR Surname Given Name DOB Sex M/F

Registration Date

Registration Time

Site Ward Bed No. Downtime FIN NBR

Data Entry Completed in Homer (Y)

DISCHARGE

UR Surname Given name Ward Destination Date Time Data Entry Completed in Homer (Y)

BED MOVE

UR Surname Given name Ward Bed Date Time Data Entry Completed in Homer (Y)

TRANSFER

UR Surname Given name Old Ward New Ward Date Time Data Entry Completed in Homer (Y)

N

54 | P a g e

Printed copies of this guide may be out of date. See EMR@eastern intranet

