Using-EPIC-in-the-ED

Report
Using EPIC in the Emergency
Department
Marc Etkin, MD
Associate Clinical Professor of Pediatrics
Division of Emergency Medicine
Rady Children’s Hospital
UPDATED 7/1/13
LOGGING IN
• When you arrive, log in to a computer using your log in and
password
• Ability to log in to many different computers
• Be sure to either log out, or SECURE your computer when not
in use
SIGNING IN
Press Sign In when
you start your shift
Press Sign Out when
you are done with
your shift
SIGNING IN
Uncheck the attending provider
box
Assign yourself a role (fellow,
resident, medical student) by
picking from the drop down
menu
SEEING PATIENTS / SIGNING UP FOR PATIENTS
• See which patient is next to be seen in the zone you are
working by pressing the ED Manager button.
• Patient’s waiting to be seen are highlighted GREEN.
Choose the patient that has been waiting longest by time
and acuity.
• Signing up for a patient will move them from the MD
Next to See column to the My Patients column.
SIGNING UP FOR PATIENTS
Assigning yourself to a patient’s treatment team:
Hover over the patient and click the right mouse button.
Use Assign Me to add yourself to the patient Treatment Team.
USING THE HISTORY SECTION
• Double click on a patient’s chart to open the chart.
• Review the patient’s allergies, pre-encounter medications,
problem list, and PMH.
• Make sure to press the “Mark as Reviewed” button after
reviewing each section.
USING THE NOTEWRITER / DOCUMENTING YOUR NOTE
• Get to the Provider Note by clicking on the ED Provider Notes
link in the ED Navigator
• Press on the My Note button to open the Note Writer section
(if it is not open already).
USING THE NOTEWRITER / DOCUMENTING YOUR NOTE
You will be presented with 5 tabs: HPI, ROS, Physical Exam, Procedures, and
Note.
Note Writer, HPI tab selected
USING THE NOTEWRITER / DOCUMENTING YOUR NOTE
• You can go straight to the Note by pressing on the
Note tab.
• EPIC can generate a note for you by using
templates already in EPIC. Type in a chief
complaint into the “Add Complaint” field to use
this function.
• Fill in each section: HPI, ROS, and Physical Exam,
& document any procedures.
• Be sure to fill in the ED Course and Medical
Decision Making section with differential
diagnoses, which attending you saw the patient
with, interpretation of lab results, etc.
USING THE NOTEWRITER / DOCUMENTING YOUR NOTE
• Place the cursor at the top of the note, and use the F2
button to tab through the note to make sure that all of
the *** and variables have been filled in/answered.
• Fill in data for the ROS, PMH, and Social or Family Hx.
• SHARE your note until you are completely done with it.
• ALWAYS PRESS THE SHARE BUTTON WHEN YOU STEP
AWAY FROM THE COMPUTER SO THAT YOUR NOTE
WILL BE SAVED.
• Press the “refresh” button to incorporate any lab
results and other data into your note.
• SIGN the note once it is complete. Enter the correct
attending as your co-signer.
ORDERING LABS
Use the ORDERS link in the ED
Navigator to enter orders
Alternate method for entering
orders (NOT RECOMMENDED)
ORDERING LABS
• To order a lab, type in the name, or part of the name, under the ED Order
section, and a list will pop up. If you don’t see the test that you want,
change tabs to view the Facility List of tests that are available at RCHSD.
• Tests ordered from the ED are prioritized as STAT, and are defaulted that
way in the system. Please do not change this priority.
ORDERING LABS
• Remember to fill in fields that are marked with a red “!”. These fields are
mandatory and need to be entered to satisfy lab requirements.
• Some lab tests are grouped together in Order Sets. To find a particular
order set for your chief complaint, look under the Order Sets section of
the ED Navigator. EPIC often suggests order sets based on information
already entered about your patient.
• Commonly used order sets:
–
–
–
–
–
–
–
–
1.
2.
3.
4.
5.
6.
7.
8.
New onset Diabetes (DKA)
Sickle cell pain
Orthopedics
Laceration repair
Asthma
Bronchiolitis
Croup
Anaphylaxis
ORDERING LABS
•
Pick the name from the Preference List that pops up. Notice how the Preference
List has given two choices, using the example of Urinalysis.
•
Highlight the test that you want to order, and press the “Accept” button. A
window will open with fields generated by Meditech.
ORDERING LABS
• If you would like the test run in the ED by the
nurse, enter the test as a POCT (point of care
test).
• Can be done for urinalysis, rapid strep, urine
pregnancy, blood glucose, stool occult blood,
and gastric occult blood.
• Blood gases can be run in the ED if entered as
an iStat gas.
ORDERING RADIOGRAPHS
• In the Order section of the ED Navigator, type in
the body part or type of image that you want to
obtain and a list will appear.
• Fill in all fields marked with a red “!”
• Type the presenting symptom, and any other
clinical history, into the COMMENT section of the
order.
• Some radiographs are already grouped together in
Order Sets. To find a particular order set for your
chief complaint, look under the Order Sets section
of the ED Navigator. EPIC often suggests order sets
based on information already entered about your
patient.
ORDERING RADIOGRAPHS
Make sure XR orders say
Emergency Dept after
the order
Enter symptoms and
room # here in the
Comments section (60
character limit)
LOOKING UP RESULTS
• Numbers in the Lab and Img columns on the Track Board
indicate
Resulted
Expected
Ordered
studies.
LOOKING UP RESULTS
• You can view lab results by single clicking the patient name on
the Track board, and selecting the Results report. You will
also find other ways to view labs results as you become more
familiar with EPIC.
LOOKING UP RESULTS
Links to detailed lab reports
Click here to get Results Report
LOOKING UP RESULTS
• Radiology films can be viewed in EPIC by going to the Imaging tab under
the Chart Review section . There is a link in EPIC to take you to the PACS
system once an exam has been completed. However, it is often easier to
use the PACS system directly to view an image.
DISCHARGING A PATIENT
• When you are ready to discharge your patient home, go to
the Discharge section of the ED Navigator.
DISCHARGING A PATIENT
Fill in the fields for
Clinical Impression,
Pt Status, Orders,
Follow-up, and
Discharge
Instructions.
Enter DISCHARGE
ORDERS under the
orders section.
Type in specific
information in the
Discharge Instruction
section. Trainees do
not have access to
the Disposition field.
DISCHARGING A PATIENT
• Discharge medications should be entered into the Discharge
Orders section. This section is only for orders to be acted
upon after the patient leaves the ED.
• When you enter an outpatient prescription in the Discharge
Order section, you will be prompted to enter the prescription
details. Make sure the prescription is defaulted to print in the
ED by pressing the PRINT button.
DISCHARGING A PATIENT
Review the medications
listed in Medication
Review to make sure they
are accurate (correct dose
and medication).
Discontinue medications
by pressing D/C. Modify
doses by pressing Modify.
Make sure you Sign the
order after making any
changes.
ADMITTING A PATIENT
• After discussion with the attending, place an
order for Admission in the Order section by
typing “Admit”.
• Enter the admitting provider and the admitting
service (red “!”).
• Placing an order for admission changes the
disposition to admitted.
• Fill in the sections for Clinical Impression and
Condition in the ED Navigator Discharge section.
• After discussion with the attending, let the charge
nurse know about the admission.
FINISHING YOUR SHIFT / TURNOVER
• When you are done with your shift, Sign Out from the ED.
• When you sign out, you can assign your patients to an incoming
resident or fellow, either individually, or all at once.
• Signing out will prompt you to reassign your patients and remove
you from the ED list of providers available to see patients.

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