Nursing and Allied Health Updates - Meditech Expanse

YHC staff re: LTC Meditech Abeyance.

As of May 1, information found within the LTC inpatient account and summary section of the Meditech chart will no longer be updated or maintained by the LTC team. The specific impacts are outlined below.

Transfer from LTC to hospital: Updated information will be provided via a printed Hospital Transfer Report (HTR) when a resident of LTC is sent for assessment or admission to Whitehorse General Hospital or Dawson City Community Hospital. The printed package will contain the current code status, allergies. special indicators, medications, demographic information, and contacts.

• Code status must be verified and confirmed from the printed Hospital Transfer Report on arrival to ED/admission as inpatient.
• Allergies must be verified and confirmed on arrival to ED/admission as inpatient.
  1. Clinical staff should refer to the printed Hospital Transfer Report from LTC for additional allergies not appearing in Meditech.
  2. New allergies entered in acute will remain on the clinical record for subsequent admissions.
• Special indicators must be verified and confirmed on arrival to ED/admission as inpatient.
  1. Special indicators will be entered by acute clinicians only during the period of abeyance
  2. Clinical staff should refer to the printed Hospital Transfer Report from LTC for special indicators not appearing in Meditech.
• Home medication list must be validated on arrival to ED/admission as inpatient.
  1. A paper copy of the MAR will be provided by LTC staff along with the printed Hospital Transfer Report
  2. PHA tech will complete the BPMH upon decision to admit in the usual manner.
• Demographic information/Contact list must be confirmed by registration staff on arrival to ED/admission as inpatient.
  1. Up-to-date information will be available from the printed Hospital Transfer Report from LTC or from the resident/caregiver accompanying them.
  2. Demographic and contact information may be available in Meditech; however after May 1, should not be assumed to be current.

Discharge from hospital to LTC: Discharge will mostly follow the workflow of a typical inpatient/emergency department patient being discharged home.

• Print a discharge package to send to the LTC home with the patient that includes any care

orders. discharge prescriptions, and a current medication list.

• LTC nurses will contact the ordering physician to resolve any medication conflicts or if clarification is required upon readmission to the LTC home. If the resident is under the care of the LTC contract physicians, they will be the first point of contact for LTC staff.

Admission to LTC from home or hospital: As is the current practice. admissions to a LTC home will be coordinated through the admissions team. Written orders and best possible medication history will form part of the admission package along with the discharge plan from YHC.

Questions can be directed to Danielle Marchewa at Danielle.Marchewa@yukon.ca or 867-332-1134.

Summary of Change:

• The Stated Complaint (SC) column on the ED Tracked will be changed to Reason for Visit (RV)
• The registration clerk captures the stated complaint as expressed by the patient at time of reception
• During the time of registration the patient often adds on complaints which are more acute or changes their statement. Then the clerk will edit their original data entry in the Reason For Visit field during registration.
• With this change being made, that edit will display on the tracker for the triage nurses, who may adjust the order of patients they triage based on the complaint entered.

Benefits to Change

• More accurate representation of patients reason for visit, hence faster responses by the triage nurse
• Ensuring as many patients with COVID positive screening are identified (add on identifier later)
• Easier and direct communication to the nurse (using the tracker) avoiding delays
• Admission diagnosis can be displayed for admitted ED patients on the tracker (if entered)

This change has been reviewed and approved by ED Committee, and will be moved to Live on April 26^th, 2022.

A report has been run for the YHC emergency departments to identify medications that are commonly administered as one times doses.

The pharmacy team is ensuring that all these strings have a ONCE ONE option to decrease the amount of clicks and changes required to commonly used medications in the ED. ED Order Sets that contain these medications will all be changed to ONCE ONE dosing as well.

These changes will be occurring over the next week, and are the beginning modifications required if 1Health is to look at future implementation of the ED Filter functionality within MEDITECH.

The ED Lab Bundles will be updated for Community Hospitals to include a "WLCH/DCCH On-Site Laboratory" section and a "Send Out Laboratory" section. This change has been approved by the CHCAC Committee.

A complete list of the Community Hospital ED Lab Bundles was sent via email to physicians. If you require this list, please do not hesitate to contact the 1Health team.

The updated bundles will go live on April 6, 2022

The Abbott ID POCT Assessment on the worklist has been adjusted to include a reminder regarding the paper form (still required), a location for nursing to document the test results, and to document whether or not a PCR was collected/sent. YHC leadership and IPAC have reviewed and approved these changes.

These changes will be visible in Live on March 22, 2022.

Users will be able to document auscultated heart sounds and non-pitting edema assessment findings on the Cardiovascular assessments.

The following assessments will be updated on March 22, 2022: Adult Physical Assessment, ED Physical Assessment, ED Cardiovascular Assessment, Cardiovascular Assessment, and the Pediatric Physical Assessment.

The issue in the MEDITECH Live environment has been fixed, and this change will be made on March 15, 2022.

Summary

Patch Assessments have been streamlined to be the same patch assessment for all patch administrations. Administrations will trigger re-assessments every 12 hours as per documentation standards, and a Removal assessment based on the removal schedule of the patch ((i.e. A Nitroglycerin removal assessment will trigger 12 hours after you’ve applied the patch).

FOR ACUTE: Opioid patches will require a co-sign upon removal

FOR LTC: Opioid patches will require independent double check on administration and removal

Benefits

• Streamlined process simplifies patch administration, assessment, and removal for nursing
• Easier to view historical patch administration on the MAR

New tip sheets for MAR Patch Assessments and Adjusting MAR Assessments are available, and if you encounter any issues with patch administration please contact the 1Health help desk at ext 8601 (internal) or 393-8601 (external).

For Nursing/MD’s:

Summary: The Pharmacy team will be making internal changes to medication orders. This change will affect a small number of existing medications on patients at Copper Ridge Place and WGH.

Nursing: Since the drugs will be reordered, this will result in a notification on the eMAR requiring you to Acknowledge the medication again before administering. No additional e-signatures will be required of physicians.

Rationale: These changes within the pharmacy module support standardization of medication building.

These changes will commence on March 10th at 12:00 pm.

If you encounter any issues administering medications after this change please contact 1Health support at 8601 (internal at YHC) and 393-8601 (external).

For Pharmacy (Save On & YHC):

Summary: The Pharmacy team will be making internal changes to medication orders to change the order type utilized in the medication order. This change will affect a small number of existing medications on patients at Copper Ridge Place and WGH. The following order types will be inactivated as approved by Jamie Steeves:

Please use order type = MED instead

Not needed, previously used for TPN

Pharmacy: Once the change is complete, please utilize the order type of MED to replace the use of all other order types.

Rationale: These changes within the pharmacy module support standardization of medication building

These changes will commence on March 10th at 12:00 pm.

If you encounter any issues after this change please contact 1Health support via Lori Thibodeau, Kaitlin Rafuse, or Karen Giordano.

Summary: Both of these changes were scheduled to be updated in MEDITECH today, and due to an issue we discovered when moving changes to the LIVE environment we ill NOT be moving ahead with those changes today.

We do not anticipate this problem to persist, and we will provide an update as to when these new assessments and patches will be available.