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 Workflow – WGH to Community Hospitals	Early December	Discharge Transfer functionality in Discharge Plan can be used for inpatients transferring from WGH to a community hospital. Allows the sending physician to suggest orders for the receiving physician. The receiving physician can then review the suggested orders and decide to continue or omit the orders. With this change, Prescriptions and Problem Reconciliation are not required with a Discharge Transfer – once the discharge disposition is selected by nursing, the required red asterix will be removed. Patients must be fully discharged from WGH for the orders to cross/be visible to the receiving hospital Tip sheets will be posted here prior to go live.	Streamlines ordering for receiving facility Improves BPMH process on future admissions Better continuity of care between YHC facilities	PLC (November 7, 2022) NAHLC (Nov 8, 2022)
PT/OT Consultation with Hip Fracture	Oct 31	All patients admitted with a hip fracture will have PT/OT ordered automatically.	Patient rehabilitation will not be delayed	PLC SME: Ortho/ Surgery
Urine Pregnancy Test POCi	Nov. 15	All Urine Pregnancy Test POCi results will now be documented on MEDITECH. Helpful Tip Sheet: Documenting Urine Preg POCi-EDM	Consistent place to view and chart results	PLC ED Committee Lab
Max Dose Rules	Nov. 28	Loperamide and Acetaminophen will now have a max dose rule built into the MAR. A warning will appear if the maximum dose is reached in a 24hr period. The user will be asked to indicate a reason why they want to exceed that maximum dose. If the prescriber inputs an alternative max dose that will appear in the label comment, nursing will need to calculate the 24 cumulative dose and ensure the max dose is not exceeded. This is the current workflow	Decrease risk of accidental administration over max dose range	PLC P & T
Inactive Home Meds	Dec. 6	Inactive Home Medications will display in PURPLE to highlight that they are inactive	Easily differentiate between inactive and active medications	NAHLC
Discharge Document Barriers to Discharge	Dec. 5	Barriers are identical to old assessment, built new assessment to fix previous issues Specific status boards with barriers will be updated to display old and new queries will exist on these status boards until the last patient using the old query is discharged. Recall function will not work on new query until first documented	Barriers to Discharge will no longer recall visit to visit.	SME’s NAHLC
Home Care – Special Indicator	Dec. 7	New Special Indicator for Home Care that is available to all YHC locations When expanded it will display the home care coordinator and phone number if documented Available on the secondary status board, as part of the special indicators Will be removed from barriers documentation since moving to special indicator Tip sheet on Special Indicators: Special Indicators – EDM/PCS	Home Care info will now be easily visible	TCC CNL Group Social Work
Clinical Panels for Maternity	December	Maternity Specific Clinical Panels have been added for Nursing	One place to see patient data in a simple format	Mat/Newborn Committee
PKU Order	December	When ordering a PKU the Specimen query will now default to “Send someone to collect” instead of “Nurse to Collect”	Reduce number of order entry errors	Mat/Newborn Committee

FOR INFORMATION

Item	Summary	Review/Approval
BPMH Status Added to PHA Med Reconciliation Assessment	When the BPMH Status query is updated through the assessment, it updates the BPMH Status throughout MEDITECH.	Pharmacy Manager
New Reg Type POSTMORTEM	Lab will be able to register Referred-In accounts for expired patients.	Lab Health Records
Gastrointestinal Assessment	“Obese” and “Gravid” can now be documented under the description of the Abdomen assessment. “Rigid” is now an option under palpation	Nursing
Home Medication Widget on Snapshot	A Home Medication Widget has been added to the snapshot for all inpatients. The widget will display if the home medications are with the patient and the disposition (i.e. “Locked up”)	Nursing
Postpartum Intervention	An acute pain scale is now embedded into the Postpartum Intervention for Maternity	Maternity Nursing
Isosource Order	Isosource 1.2 w Fiber (1.5L) has been added to MEDITECH	Dietary
MRS Caseload Report	An MRS Caseload Report can now be pulled for the MRS team	MRS
Social Work Census	A Social Work Census Report can now be pulled for the Social Work team	Social Work

Reminder: Admission Cancellations in ED

The below is the workflow when an admission of an ED patient has been cancelled:

ED Physician cancels Admission Order
ED Physician adjusts all document and report types
Nursing to notify the Registration Clerk of the cancellation; this should be done as soon as the admission is canceled and no later than when the patient leaves the ED.
Reg Clerk will undo the admission and bring the account back to an ED visit

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 at YHC-HELPDESK@wgh.yk.ca

October 21 - NAH Communication

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Care Plan Special Indicator	Week of Oct 24^th	Care Plan will be a Special Indicator that allows all health care providers to document high level information on the patient’s electronic health record Helpful Tip Sheets: Viewing ED Care Plan as a Scanned Document Scanning Care Plan to the Chart Special Indicators Care Plan Special Indicator	Moves the care plan to a location where all health care providers and allied health have access to view pertinent patient care information across all modules. Ie: pharmacy, nursing, physicians, lab, registration, etc. All areas with access to the Special Indicators have the option of documenting patient’s Care Plan Special Indicator Improves consistent and timely delivery of specialized care that is right for the patient and their unique needs when accessing YHC services	NAHLC
Status Board Colour Schemes Update	Oct. 25	Status board colours related to sex/gender will be removed A Reactive Behaviour Special Indicator will highlight a patient name in magenta 2 patients with the same name will highlight both patient names in yellow	Consistent colour schemes across YHC Increased safety when dealing with reactive behaviors	NAHLC
TPN Workflow	Oct. 18	TPN assessment has been moved from the MAR and will now to be documented as a worklist item Helpful Tip Sheet: TPN Worklist Assessment	Reduce documentation errors. Easier for Physicians and Nursing to review charting.	Inpatient Committee
Newborn Hearing Test	Upcoming	Easy access to Newborn Hearing Screen Helpful Tip Sheet: Printing Newborn Hearing Screen	Improves communication with Yukon Hearing Services.	Mat Newborn Committee
Care Consent Act SDM display	Oct. 26	SDM information as entered in the Care Consent Act (CCA) order will be added to nursing and allied health secondary status boards. The status for the CCA order will also display above the SDM information. Green Flag = CCA order is active Red X = CCA order is canceled, completed, or otherwise inactive. NOTE: SDM information will continue to display once the CCA order is canceled. Please verify the CCA status. SDM information will only display on patient visits in which the CCA order was entered. (It will not carry over next time a patient is admitted).	To increase the visibility and accessibility for clinicians of all allied health areas to locate a current patient SDM.	NAHLC

FOR INFORMATION

Item	Summary	Review/Approval
OB/GYN no longer Admit Provider for C-sections	Registration will now list the GP OB as Admitting Provider instead of the OB/GYN for newborn admissions by c-section, this will ensure the surgeons do not get newborns added to their rounds list anymore.	Mat. Newborn Committee
eMAR	This month pharmacy will be working on changes to the give line style for injectable medications Example: methylprednisolone 125 mg (62.5 mg dose) currently displays: Give: 0.5 injection(s). This type of medication give line style will be reviewed and modified to display a give line style in of either Give: 0.5 mL or Give 62.5 mg / 0.5 mL	Pharmacy NAHLC
Newborn Capillary Blood Gas Documentation	Newborn Capillary Blood Gas documentation will now be a separate intervention. This allows for a clearer picture of this documentation and prevents double charting	Mat Newborn Committee
Dawson City Community Hospital Bed Changes	The bed names will now be seen on the Tracker as 1-6 The virtual rooms have been removed	CHCAC

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

Sept 23 - NAH Communication

1Health Nursing & Allied Health Communication – Sept 2022

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/Approval
Admit Request BPMH Request	Sept. 27, 2022	A new “Admit Request” order has been built for physicians. This order will trigger a RED flag to appear on the nursing ED Tracker in the new “Adm Req” column, notifying of the request for a patient admission (there will no longer be an ADM REQ status for ED patients) This order will also create a request for BPMH (Best possible medication history – prev. MedRec) which will be visible on Physician, Pharmacy, and all Nursing status boards and trackers Check marks will be replaced with a BPMH column. 3 status options will be visible – REQ (Requested), I/P (In progress), CMP (completed) A standalone “BPMH Request” is available for all providers The BPMH column will update from either the Admit Request or the BPMH Request order, and can be completed based on the provider doing the BPMH There will be support on site from Sept 27^th – Sept 29^th to assist with these changes, including pharmacy and med rec tech support. Tip sheets for Admission and all other changes available here: Physician Education Page: https://1healthyukon.ca/1health-physician-education Nursing & Allied Health Education Page: https://1healthyukon.ca/1health-nah-education	Quick notification of Admit Requests Standardizes admission process for all physicians (surgeons can admit from Web Acute) Flags med rec technician that a BPMH is requested for all patients being admitted Communicates BPMH status with new indicator on ED Trackers and Web Acute Status Board Standalone BPMH Request order will now be available	PLC NAHLC ED Committee CHCAC PAC
New ED Tacker for DCCH and WLCH for POV accounts	Sept. 07, 2022	POV accounts can be seen on a POV Tracker. The workflow to “Find Account” and “add to My List” will no longer be used. ED Trackers (DCH AMBC pre-arranged ED, WLH AMBC pre-arranged ED)	Easy location for staff to find accounts Decreased incidence of patients being missed when registered for POV’s	CHCAC
Adjusting Bed Management Desktop	Sept. 30, 2022	WGH Nursing MPA’s will be adjusted on the Bed Management desktop to only allow the functions they need.	Decrease risk for error with registration functionality	NAHLC

IMPORTANT FOR ALL

The Bedside Bulletin accessible within the Snapshot should not be used for daily charting or to communicate with the physicians. This section is not a legal part of the chart and was designed to help support the transfer of accountability at shift change for nurses only. The information here is not saved when a patient is discharged, and is not visible by physicians.

The 1Health Team has made it a priority to focus on communication within the EMR and between all providers in our upcoming sprint cycle.

FOR INFORMATION

Item	Summary	Review/Approval
Split Order Type	The split order type has been approved for use when a dose of medication requires multiple strengths (of the same medication) to provide the required dose prescribed and will be entered as a single item on the eMAR. There are instances where it is not possible to enter a prescribed dose one entry and will require two entries that will be CONCURRENT linked together. When medications are CONCURRENT linked, the eMAR will provide a pop up to alert the user and both doses should be administered. Two examples of when entries will be CONCURRENT linked together are: Patches and Combination tablets/capsules.	Pharmacy, NAHLC, 1Health Team
Discontinue Telemetry Order	A “Discontinue Telemetry” order has been built for physicians. This order will allow specific discontinue instructions for nursing. The “Discontinue Telemetry” will be added to the nurse's worklist when ordered.	PLC
Historical Order View	Historical orders are currently set to only display the last 14 days by default. The default will be changed so that all historical orders will be displayed. A Date/Time Range can be added, if needed.	PLC, 1Health Team
Maternity Education Flowsheet	The education documentation for nursing will be simplified. GO LIVE is Sept, 27, 2022	Maternity Subject Matter Experts/ 1Health Team
Compound Ordering	Commonly prescribed compounds have been pre-built to improve ordering for inpatients. This applies only to compounds that are NOT commercially available and must be compounded by the pharmacy department.	PLC
Maternity Outpatient discharge	Nursing will now have the ability to discharge outpatients on maternity via the “Discharge Summary”, calling Registration has been removed from the workflow.	Maternity Subject Matter Experts/ 1Health Team
Maternity Worklist D/C Checklist	The Patient discharge checklist is being removed from the Worklist for Maternity; Maternity nurses will now only use the specific Maternity Patient Discharge intervention which is relevant. GO LIVE is Sep 27.	Maternity Subject Matter experts, 1Health Team
Adult Invasive Ventilation Assessment	In the Adult Invasive Ventilation assessment, the I:E Ratio query will be changed to free text from a number field, allowing nursing to document an accurate ratio.	ED/ICU Subject Matter Expert, CNE, 1Health Team
Adult Non-Invasive Ventilation Assessment	In the Adult Non-Invasive Ventilation assessment, the HFNP size query will be changed to a group response. Nursing will now be able to select Small, Medium, or Large.	ED/ICU Subject Matter Expert, CNE, 1Health Team
Nursing Assessment Categories	All nursing documentation will now be displayed under “Nursing” in the Nurse/Allied Health section of the Chart. Previously, assessments displayed under “Nursing” and notes displayed under “Nurse”.	NAHLC

Inpatient Discharge to Home Changes

July 19 - NAH 1Health Communication

CHANGE SUMMARY

Change	Change Date	Change Summary	Benefits	Review/ Approval
Adding Associated Data to PRN Pain Medications on the MAR	July 20, 21, 22	The last documented Temperature, Temperature source, Pain level, and Pain scale used will be viewable on selected PRN Pain Medications in the MAR in a small box called Associated Data.	Associated data will guide the process for nurses to be able to recognize and avoid double documentation between the MAR and the worklist Having Associated Data in the MAR prevents the need for the nurse to exit the MAR and see the previously documented vital sign or pain assessment, and the ability to document within the MAR if needed	NAHLC
Adding MAR Pain Assessments to PRN Pain Medications	July 26, 27, 28	MAR Pain Assessments are being added to effected Pain Medications	Re-assessments will appear at 60 minutes on MAR, post administration of a prn medication. Tip sheet available here. Pain assessment and temperature can be documented, if not already documented in the worklist (check Associated Data). Prompts nursing to complete pain re-assessment.	NAHLC
Set Enable Ingredient/Dose Checking for IV/ALT Types to "Yes" in ED Module when scanning	July 25, 2022	When you are not administering the full dose of medication in a vial, you will have to note the administered dose. Nursing will now be notified if the medication’s dose being scanned is not equal to what is ordered. If the Dose to be Administered does not match the Ordered Dose, then it will highlight in red.	This functionality has been live in all other areas of the hospital; therefore, this change is to standardize the MAR functionality of the ED to all areas.	1Health Team and YHC leadership
“Reason Action Taken” Comment added to vital signs	July 15	For all areas, the comment field “Reason action taken” has been added to the vital sign assessments under oxygenation	If there are adjustments made to O2 administration, the reasoning can be commented here	1Health Team & YHC Leadership
Inpatient Flowsheet/ Clinical Panel	July 5	A new Inpatient Flowsheet has been created to pull a variety of information into one view. The Flowsheet is located under the Flowsheet tab for physicians and the Clinical Panel tab for nursing. The flowsheet includes the following patient information: Vital Signs, Glucose, Bowel Movements, Labs, Imaging, Microbiology, Pathology, Provider Notes, Nursing Notes, Allied Health Notes, Medication Administrations, Intake & Output, CIWA and COWS.	Flowsheets reduce clicks for physicians and nurses and provide one central location for viewing patient information	Inpatient Committee (June 22, 2022) PLC (June 28, 2022)
DCCH/WLCH ED Access Change	August 4	The ED/PCS access for nursing in DCCH/WLCH is being adjusted to allow proper display of ED patients	New ED access is identical to previous, NO CHANGE in current use Trackers and Status boards in ED and PCS will now display the correct columns of data (I.e., colour schemes, room numbers) No more incorrect overlap of areas causing confusion ie. EDM for discharging ED patients and PCS for discharging Inpatients	Community Hospital CNL’s, 1Health team

FOR INFORMATION

Item	Summary	Review/Approval
1Health Yukon Project/Operational Update	See attached communications that was circulated June 15^th to all committee chairs at YHC to be distributed to staff for an update on 1Health committee structure, issue reporting and prioritization, communication, and the 1Health team. Also posted to the Nursing and Allied Health updates webpage.	1Health Team/NAHLC
Nursing and Allied Health Education Material	As of June 30, there is now a link in YHC Links folder to the Nursing and Allied Health website. All communications will be emailed out, and posted to this page. The updates website includes a direct link to the Nursing and Allied Health Education website. New and updated TIP SHEETS will be added regularly	1Health Team/ Educators
Downtime	Nursing and Allied Health webpage contains links to all Downtime Resources including site preparation, quick reference guides, how to use iPeople, and more. Decision was made at NAHLC to place the code to open the keyboard on the Network down computers in the Downtime Binders.	NAHLC, 1Health team, YHC IT
Maternity Assessment Updates	RH status is now visible from the patient’s secondary status board MC Vaginal Exam now has comment boxes for dilation and cervical length so that ranges can be added Oxytocin IM order post delivery no longer requires a co-sign Maternity Outpatients was added to status board list options MC Non Stress Test now allows for ranges to be documented	Maternity Subject Matter Expert/ 1 Health Team
Arterial Line Assessment	Arterial line assessment for waveform has been updated with the following options: Normal; Underdamped; Overdamped; Absent	Critical Care Committee; CNE’s
Implement Rollover POV accounts into Inpatient or SDC accounts	Following CIHI standards, when a patient is admitted or go to the OR directly from a POV visit, the current POV visit will roll over into an inpatient account without creating a separate account.	1Health Team, Registration, Surgical Services
Link to Care after Death Policy	Link to Care after Death policy is accessible through MEDITECH. Accessed by clicking on the globe icon attached to the Care after Death intervention. This improves access to the policy.	Director Clinical Practice & 1Health Team
Labetalol Continuous Infusion	As of June 28^th, this order is now available in LIVE.	Pharmacy and Critical Care

1Health Yukon Project/Operational Update
Overview
To further the stabilization of 1Health, some changes to the organization of the work are underway. The information below summarizes those changes for YHC Committees and other partners/stakeholders.
1Health Committees
Two 1Health focused committees have been formed to ensure appropriate end-user involvement and prioritization of issues.
The Physician Leadership Committee (PLC) is responsible for prioritizing, reviewing and approving changes that impact physician workflow within the system. This committee replaces the previous Physician Advisory Committee.
The Nursing and Allied Health Leadership Committee (NAHLC) is similarly responsible for prioritizing, reviewing and approving changes that impact nursing and allied health. The chair of NAHLC will sit at PLC to ensure alignment between the committees.
Membership of the 1Health committees include representation for each of the YHC committees and members are expected to bring 1Health YHC committee items to PLC and/or NAHLC as required.
Issues Reporting and Prioritization
Urgent/emergent issues with MEDITECH can still be supported by our 1Health on-call team that are available 24/7 via dialing 8601 (internally) or 393-8601 (externally). Issues of MEDITECH support include:
- Issues with order entry process and documentation
- Issues with system functionality, process and procedure, and workflows
Other on call services already in existence at YHC should be leveraged whenever possible for clinical situations. The pharmacy and lab team are familiar with MEDITECH and can offer support.

Hardware, log in to computers, YNET and all other IT issues should be reported via the YHC IT department at 8602 (internal).

1Health issues and requested changes can be reported in the following ways:
1. Via e-mail into Jira - YHC-helpdesk@wgh.yk.ca
2. Via a PLC/NAHLC member that sits on your committee
3. If you are unsure where to go, please reach out to Sarah Harrison - Sarah.Harrison@yukonhospitals.ca – 1Health Clinical Leadership and Coordination - Acute
Any near miss, or incidents that impact patient safety should be reported through the RMPro system. You can find RMPro in the YHC links folder.

Tip Sheets are available on SharePoint via the 1Health Information Hub. The 1Health team is actively updating these and will have a new website to launch that will house these documents in a more accessible and user friendly platform.

Moving forward, all issues, changes or improvements to the systems will be prioritized by PLC and NAHLC. Previous committee issues and lists have been incorporated into this prioritization process.
Regardless of how an item is received, it will go through the same prioritization process.
Work is being planned in 2-4 week sprints, where prioritized items will be resolved.

Communications
A monthly communication will be sent out to NAHLC and PLC members to share with respective YHC committees. The communication will outline all the system changes and other key items. See attached physician communication for an example of format and content.
As prioritization will be done at PLC and NAHLC, it will allow members to also bring back information on the sprints and work being completed to the respective YHC committees

1Health Yukon team consolidation
As of November 30, 2022, all 1Health Yukon resources (HSS and YHC) has been consolidated into a single structure to better align and leverage our resources. The focus of the team is on YHC stabilization, as directed by the 1Health Steering Committee, but as the project continues to evolve additional work with HSS is anticipated. For further questions related to the team please reach out to Paul Payne, A/Director, 1Health Yukon – Paul.Payne@yukon.ca
The chart below shows the functional structure of the team:
Documenting on Discontinued Medications

Have you ever spent a solid portion of time staring at a patient’s eMAR trying to figure out how to document that you have removed a fentanyl patch because the order was discontinued – or any other medication for that matter??? Did your inability to resolve this issue cause anger, frustration, and just a general feeling like you are stuck in a system you do not understand?
Unfortunately, we are currently unable to document on discontinued meds.
This poses a problem for nursing to identify on the eMAR what was done with a medication once it was discontinued. For now, while this issue gets addressed at a higher level, we ask that nursing document their actions on a discontinued medication in a note, or consult with the physician about re-ordering the medication so that proper documentation can happen.
Write a Note
Select the Medication Note option from the Write Note tab of the patient’s chart.
Then document in that note what action was taken.
If a medication required a co-signature, the nurse performing waste witness should enter a note on the patient’s chart separately, indicating that they witnessed the medication being removed/wasted, etc.
Procedural Sedation Assessment

The Discharge Instructions for both adult and children who have received procedural sedation is now accessible directly from the Procedural Sedation Assessment for nursing in MEDITECH.
You will now see a “P” in the assessment that when clicked will bring up the discharge instructions handout that you can then print and review with the patient.
This came from a request from Nursing, as there was already existing language in the assessment referencing the instruction sheet, now there is no need to search for the assessment in SharePoint.
Newborn Point of Care (POC) Glucose Testing

A request for change from the Mat/Newborn committee has been moved to Live today, May 2, 2022.
You will observe this change on the OBS Post Delivery Newborn order set as well as the OBS MED/DIR NEWBORN sets

Capillary Blood Glucose POC has been changed to Capillary Blood Glucose POC – Neonatal

The Canadian Pediatric Society Management of Hypoglycemia protocol is also now attached for nursing to reference.

Nursing is also able to search for and add Capillary Blood Glucose POC – Neonatal to their worklist as a separate intervention outside of the Newborns sets.
Updating Collection Defaults - "Nurse to Collect" or "Lab to Collect"
- There are several lab orders in the LIVE Meditech system that have been identified to have the incorrect collection defaults.
- Once these collection defaults are corrected, nurses and physicians will no longer need to change the default collection field when the order is placed.
Example: an HPV sample is normally collect by a Nurse and then sent to the lab. Currently, the default is “Lab to collect”, therefore the nurse has to enter the order and change the collection default manually to correct it. Once the change is implemented, when an MD orders HPV it will flow to the worklist and default to “Nurse to collect”.
- This change has been approved by YHC lab, the order management team, and facilitated by 1Health to streamline the lab ordering process and reduce human errors.
- The work to implement these changes will commence in MEDITECH on May 3^rd. If you encounter any issues with lab ordering at this time please contact the 1Health support line at ext 8601 (internal) or 393-8601 (external). If you have questions regarding lab collections please call the lab extension at 8739.