Nursing and Allied Health Updates - Meditech Expanse

This page is to provide Nursing and Allied Health with updates in regard to Meditech EXPANSE.

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Discharge/Transfer Flags on Status Board	Jan 24, 2024	With this change, Discharge orders and Transfer orders will display in a separate column on the Status Board.	Decreases amount of space on status boards, removes admission orders that are not applicable for inpatients	MELT
Special Indicators on ED Tracker	Jan 24, 2024	A column will be added to several Trackers and ED patient lists to display Special Indicators (SI). The column will display any special indicators that have been added to the patient’s chart. Clicking on the SI column will open the summary page to view any additional information. WGH Triage/Waiting Room Tracker (ED) All Patients in Department Tracker (ED) FNHP ED All Patient List HSO Emergency Department List Lab Ed Patient List Medical Imaging EDM Tracker (go live date TBD) Pharmacy EDM Tracker DCCH/WLCH Triage/Waiting Room Tracker All Patients Tracker Pre Reg Tracker	Easily view if a patient has a special indicator Easily access addition information about special indicators	MELT
ED MedDir Suspected Stroke Order Set	Jan 29, 2024	A medical directive for suspected stroke will be available for use in ED. It has been built to replicate the paper medical directive located on SharePoint and does not include medications outside of fluids. How to Order Medical Directives tip sheet	Streamlines ordering process for nurses	ED Committee, MELT, PLC

Contact Plus Isolation Precaution	Jan 29, 2024	An option for “Contact Plus” isolation precautions has been added to orders and nursing assessments. CONTACT PLUS – applied when patient has diarrhea and/or vomiting AND gastroenteritis is suspected (e.g. Norovirus, C-diff) How is it different from Contact Precautions? Wash your hands with soap and water (preferred) Twice daily cleaning of high-touch surfaces Spore killing disinfectant required for C-diff – which includes hydrogen peroxide (please use to clean surfaces, and patient equipment if C-diff suspected) – these are labeled on the units in storage. See last page for addition information from IPAC	Allows for proper ordering and documentation of Contact Plus isolation precautions Improves patient and front-line staff safety	IPAC, MELT
Public Health Special Indicator	Jan 30, 2024	A new Special Indicator called Public Health will be available. The purpose of this special indicator is to improve communication between Yukon Communicable Disease Centre (YCDC) and YHC Emergency Departments. The special indicator will be managed by the nurses at YCDC. For those of you who work in the Emergency Department, more details as well as education resources will be sent directly from your manager.	Improves communication between YCDC and YHC	YCDC, ED, CHCAC, PLC, MELT
Admission Assessment Changes	Jan 31, 2024	Minor changes will be made to the Admission Assessment. A question regarding Oxygen and Suctioning set-up will be added and the following sections will be collapsed by default: Psychosocial History and Substance Use, Barthel Index and Baseline Data. The sections can be expanded as needed.	Simplifies initial view of assessment	Inpatient Committee, MELT
POCi Daily Frequency	Feb 5, 2024	Changes to POCi Daily Frequencies for Community Hospital’s. Daily POCi Laboratory orders will appear on patient's worklist in PCS as Care Item for specific frequency as ordered by provider.	Streamlines ordering	CHCAC, MELT, PLC

FOR INFORMATION

Item	Summary	Review/Approval
Breast Density Reporting to Patients	Starting January 2024, breast density will be directly reported to patients. The patient’s breast density category, along with related information, will be included in the results letter that patients receive from the Yukon Mammography Program following routine screening mammography.	Medical Imaging
Frequency for Nursing Update to PT/OT/SLP	The frequency for the "Nursing Update to PT/OT/SLP" Worklist item has been changed to 1900 and can’t be removed from the item.	Nursing
Room Number on FNHP ED All Patient List	The ED Room number will be moved from the secondary status board to a separate column on the status board.	FNHP
Lab Bundle Changes	The orders for Basic Metabolic Panel (BMP), Comprehensive Metabolic Panel (CMP), Liver Panel, and Extended Lytes Panel will now reflex each individual LAB order part of that panel.	Lab, PLC

If you encounter any issues or have any questions about these changes, please contact the support line at ext 8601 (internal) or (867) 393-8601 (external) or through JIRA at YHC-HELPDESK@wgh.yk.ca

Additional Information for Contact Plus

CONTACT PLUS – are applied when patient has diarrhea and/or vomiting AND gastroenteritis
is suspected (e.g. Norovirus, C-diff)

How is it different from Contact Precautions?

- Wash your hands with soap and water (preferred)
- Twice daily cleaning of high-touch surfaces
- Spore killing disinfectant required for C-diff – which includes hydrogen peroxide
(please use to clean surfaces, and patient equipment if C-diff suspected)
1. these are labeled on the units in storage.

Note: Use a Point-of-Care-Risk Assessment when there is a risk of splash or spray and wear
face and eye protection in these cases.

Remember: Keep sign posted until room cleaned – housekeeper will remove sign after
“discharge” cleaning is complete.

Refer to the following link here from Vancouver Coastal Health (VCH) for more information.

Contact IPAC for any questions / concerns 332-4173.

NAH Communication - December 2023

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Inpatient Report Print Out	Dec 13	The Inpatient Appointment report currently prints at 0745. With this change, the report will also print at 0900 to ensure that medical imaging appointments scheduled after 0745 are included on the report.	Report will include more Medical Imaging appointments	Med/Surg Medical Imaging MELT
Eat, Sleep, Console Assessment	Dec 13	The Eat, Sleep, Console report will now be available on MEDITECH as an assessment for Maternity The Assessment can be added to the worklist.	Improves documentation	Mat/Newborn Pediatrics
Blood Bank Orders and Interventions	Dec 14	When a blood product is ordered a Worklist item will now populate on the worklist There is a “P” attached to the worklist item that includes the Blood and Blood Product Policy (PE-GEN-50) as well as some other new recourses Blood Products on Worklist- Tip Sheet	A worklist item will help to flag nursing when a blood product has been ordered Improve blood product ordering workflow	Lab/Blood Bank PLC MELT

FOR INFORMATION

Item	Summary	Review/Approval
ED STEMI – Physician Reminders	As of December 18, the ED STEMI order set will now include a reminder for the fibrinolytic checklist, as well as a reminder to use the NSTEMI protocol if fibrinolytics are not indicated. This is to ensure the correct heparin protocol is being used.	ED Committee PLC
MPR Patient Tracker	A public tracker has been set up for MPR and Cast Clinic	Surgical Services
Locked Up Home Meds	A Home Medications section has been added to the Admission Assessment – Adult This assessment will pull to the discharge checklist Patient's Personal Medication Policy (CTL-140) Home Medication Lock Up Tip Sheet	MELT PLC
Diabetes Education and Dietitian Outpatient Reports	As of December 13, these reports will now display in the Reports tab instead of the Notes tab.	PLC
Pregnancy Weight Gain Query	The Pregnancy Weight Gain query on the MC Intake and/or Admission assessment will now auto calculate the weight gain based on the patient’s current weight and pre-pregnancy weight	Mat/Newborn
MEWS and PEWS Auto-Calculations	The MEWS and PEWS assessment will auto-fill based on the vitals documented within both Pediatric and Adult Vital Signs assessments Not all questions relate to vital signs directly and will need to be filled manually	CI

If you encounter any issues or have any questions about these changes, please contact the
1Health support line at ext 8601 (internal) or (867) 393-8601 (external) or through JIRA at YHC-HELPDESK@wgh.yk.ca

NAH Communication - July 2023
NAH Newsletter July 2023

NAH Communication - May 2023

Change	Change Date	Change Summary	Benefits	Review/Approval
Inpatient Face Sheet	April	A “NEW” report called Inpatient Face Sheet has been built. The Report includes: Demographic Information Contacts First Nations Information Resuscitation Status Please note our team is working on having more pertinent information pull to this section of the report	One print out for all listed information Simplify information gathering for Medevacs and Transfers	CNLs Stefanie Ralph
Secure Medical Unit (SMU) Updates	May 2	Two NEW assessments have been added to Standard of Care SOC: Acute Mental Health: MH Crisis Plan. Paper document to be scanned into chart > Scanning Documents Tip Sheet MH Patient Safety Plan NEW clinical panel MH Patient Safety Plan created > Clinical Panels-EMR Tip Sheet NEW Standard of Care POC: Seclusion: Includes NEW assessment MH Secure Room Treatment Tool as well as some adjustments to the existing Seclusion Observation Record > Adding Seclusion Assessments Tip Sheet	Enhance documentation and where to view documentation	MWU Clinical Working Group
Hospital Security Officer (HSO) Access	May 2	HSOs have been granted limited, view only access to the chart. They can now view the MH Patient Safety Plan and other select areas.	Improve relevant information sharing	YHC Privacy Team
Intraoperative Record Updates	May 24	NEW Oximeter Location question. Surgical Counts: Count will now have the selection “N/A” along with the existing “Correct” and “Incorrect” options. Count will also be a required question. If Surgical Count Performed has “N/A” selected, Count will automatically select N/A to save clicks. Irrigation Solution: Will allow multiple solutions to be selected when necessary	Improve documentation accuracy and ease. Improve closing case process.	OR Manager
Inpatient Endoscopy Workflow Changes	May 29th	NEW Report Notice of Inpatient Endoscopy will print out on the Unit when an Inpatient has been booked for an Endoscopy. An NEW worklist item Inpatient Endoscopy Instructions has been added This worklist item contains instructions, as well as a free text for nursing to enter the date and time of the procedure. It is CRUCIAL nursing understands this process in order to eliminate the issue of missed endoscopies, due to improper prep. If you have any questions regarding this new process reach out to a CNL, CNE or CIS – Sam Woodbeck.	Streamline the process for notifying nursing when an Endoscopy is booked.	Inpatient Committee CCM MED/SURG

Item	Summary	Review/Approval
Printing from the EMR	The print screen button was removed, from the bottom right hand corner of the screen, as part of the PPU We have created a Printing from the EMR - tip sheet that outline common printing workflow The Snipping Tool should not be used at any time to print from the chart, unless this has been an approved method by the MEDITECH Expanse Team or your leadership. If you or your team has a workflow that requires the use of the Snipping tool please submit a helpdesk ticket so we can help to develop a better workflow	PPU feature

NAH Newsletter - May 2023
NAH Newsletter - April 2023

March 2023 - NAH Communication

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Medical Directive: Pre-op Pediatric Analgesia	April 5	Medical Directive for Surgical Services – Pre-Op Pediatric Analgesia Hold queue can be used to order Medical Directive for pre op visit, this includes: Acetaminophen dosing Ibuprofen dosing The directive will flow to the nursing worklist for the nurse to enter the medication orders once the patient is weighed. The medication order will auto calculate the proper dose if the patient is weighed, and the weight is documented in the system.	When patient is weighed on return for OR nursing will give appropriate doses of pre op medications Acetaminophen and Ibuprofen dosing will be calculated based on the patient's most current weight	PLC, NAHLC, Surgical Services, CNE’s, MAC
New OR Slate for Surgical Services	April 5	A new OR Slate will start printing to Surgical Services printers. Will print to: SDC at 0645 OR at 0645 PACU at 0830 MDR will also receive the new slate and will continue to receive it the day before at 0600. Printing OR Slate Tipsheet	The new slate is customized for WGH to better enhance its usefulness for the Surgical Services department.	OR Manager
Create Override Reason for Not Scanning Wristband	Date to be determined	Drop down menu will now populate when nursing overrides scanning patient wristbands	Higher scanning rates and the potential to collect data to determine what the barriers are for scanning patient wristbands	NAHLC & Inpatient Committee

FOR INFORMATION

Item	Summary	Review/Approval
Scanning:”Picture,Wound”	Any images of wounds not related to the OR (e.g. provided by EMS) can be scanned under the new document type called PICTURE,WOUND.	Beth Henderson, Health Records
Caesarean Section Recovery Policy	On March 13, A Caesarean Section Recovery Policy was added to the Anes Post C-Section Epimorph order set and is pre-selected. The policy will flow to the nursing worklist.	Mat Newborn Committee
ED Face sheet	A field for Triage Intervention has been added. The contact section has been fixed, now being set up to display the first 2 contacts listed with max 2 phone#. For more contacts, if applicable, one needs to access the account info.	Dr.Chau

Feb 2023 - NAH Communication

Priority Pack Upgrade: Reminder

Our team is hard at work getting ready for the upcoming upgrade to the MEDITECH system.

This means our work on change requests is limited at this time.

Urgent changes that impact patient safety or cause significant disruption to workflows will be addressed as needed.

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Changes to Frostbite Protocol	Dec.	When the frostbite protocol is ordered by a physician the worklist will now reflex to include the interventions and assessments necessary to complete by the nurse. Within these interventions and assessments are the instructions required for nursing: Hydrotherapy,[Sa1] Wound Care, and Frostbite Protocol	Decrease confusion for nursing Provide continuity when following the frostbite protocol	PLC NAHLC
IV Fluid changes – search function	Feb. 3	To better facilitate IV fluid ordering, all IV fluids are now compiled in a set named: Nursing must search for the desired IV fluid under “New Sets[Sa2] ” instead of “New Meds”.	Improves IV fuid ordering	P&T PLC
Clarity on deferring / rescheduling / cancelling a case	Feb. 6	New workflow for deferring/rescheduling/canceling surgical cases established with OR booking Tip sheets for OR Booking process are here: Scheduling and Waitlisting Cases – SUR Scheduler-REG Canceling Cases-SUR Scheduler-REG Deferring Cases-Day of Procedure– SUR Scheduler-REG Linked SUR Case—PAT Desktop-REG	Increased clarity for scheduling and enhanced scheduling statistical reports	OR Manager
PCA changes	March. 6	Patient Controlled Analgesic (PCA) assessment will be been moved from the MAR to the worklist A new Clinical Panel for PCA has been added. This will provide a place to easily view doses attempted vs. doses received - and is built to resemble the previous Pain Management Flowsheet	More intuitive for Nursing Increase charting accuracy	NAHLC Inpatient Committee PLC

FOR INFORMATION

Item	Summary	Review/Approval
Medical Directives	Reminder: Medical Directives are all “order sets”. When searching in PCS or EDM, the default search location is “orders”. The nurse should click on “New sets” and then search their keyword (ie: MedDir or seizure) to gain access to the Medical Directive and protocol to implement	N/A
Discharging Scheduled Surgical Admits when OR Cancelled	New DC Dispositions have been added for Surgical Services. While these dispositions will be available to all users, they should only be utilized in the surgical services department IN-OR Home (Surg Deferred) IN-OR LTC (Surg Deferred)	Health Records CNL Manager Surgical Services
Canadian Hospital Injury Reporting and Prevention Program (CHIRPP)	The CHIRPP Assessment has been relaunched in the Emergency Department of all 3 acute hospitals. The assessment populates the worklist based on the selected Chief Complaint. This data is collected and analyzed to improve the lives of all Canadians.	Nursing Leadership & YHC Corporate Leadership

Dec 2022 - NAH Communication

1Health Nursing & Allied Health Communication – Dec 2022

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Delay Code added to Intraoperative Record	Dec. 8	“Prev. Case Canc. – Pt Not Ready” was added as a delay code. This code is for instances when the previous case has been canceled and the next the patient for the next OR case is not ready.	Enhance accuracy of delay code selection	OR Manager
Alternate Dressing for Wound Vac Order	Dec. 9	“Alternative Dressing (if unable to maintain VAC 22hr/day)” has been added to the Wound Vac order	Mandatory field within MD order will ensure alternate dressing is ordered	CNE
PACU/SDC patients recovering in ICU	Dec. 20	ICU nurses can now chart through PCS when recovering patients in the ICU. Nurses who have access to the SUR module should continue to chart through there (ie. Floats) Helpful Tip Sheet: PACU/SDC Recovery in ICU - PCS	ICU nurse will be able to access the PACU/SDC assessments	Critical Care Manager
Non-Invasive Ventilation Assessment	Dec. 22	The Non-Invasive Ventilation Assessment has been delineated into two assessments BIPAP/CPAP and High Flow Oxygen Therapy will now have their own assessment inside the Non-Invasive Ventilation Assessment	Less confusion for end users More relevant assessments for each	CNE

FOR INFORMATION

Item	Summary	Review/Approval
“Create Chart” Tip Sheet	Tip sheet available for OR nurses when creating a chart after hours: Create Chart (After Hours Case) - SUR	Surgical Services
First Nations Health Program (FNHP) Note Category	“First Nations Health Program” has been added as a NOTE category This category allows Allied Health team members to easily locate the First Nations Health Program Notes	First Nations Health Program
Onsite Respiratory Virus Testing	Respiratory Panel-WGH order includes Covid-19, Influenza A, Influenza B and RSV Orderable at all 3 YHC facilities Testing is done on the GeneXpert, in house at WGH Reserved for symptomatic, admitted or likely to be admitted patients Other Respiratory orders COVID-19 testing is still available as a single test competed at WGH or as a single test sent out to be completed at BCCDC Respiratory Viruses order includes Influenza A and B, RSV and COVID-19 and is sent out and completed at BCCGC[H1]	LAB[H2]
Liquid Base Cytology Pap Test	BCCA is changing to the liquid-based cytology method for Pap testing. Communication has been sent out to all providers. Supplies are a direct order from BCCA, but all specimens and requisitions will be forwarded to WGH Laboratory for transport to BCCA. There is no change to report distribution of pap testing from BCCA[H3] .

Page last updated: 15 Apr 2024, 10:36 AM

Nursing and Allied Health Updates - Meditech Expanse

NAH Communication - January 2024

NAH Communication - December 2023

NAH Communication - July 2023

NAH Newsletter July 2023

NAH Communication - May 2023

NAH Newsletter - May 2023

NAH Newsletter - April 2023

March 2023 - NAH Communication

Feb 2023 - NAH Communication

Dec 2022 - NAH Communication

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