downtime policy clinical 01052010 by 1q981Zt

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									                    REID HOSPITAL & HEALTH CARE SERVICES

 CLINICAL/PATIENT CARE AREAS – COMPUTER OUTAGE CONTINGENCY
                            PLAN

PURPOSE: To assure patient care is not interrupted the Contingency Plan is to be implemented when the
computer system (Siemens-Invision) is down and affecting patient care.

ORDER ENTRY:
Departments affected
Cardiac/Pulmonary Rehabilitation
Laboratory
Food & Nutrition Services
Materiel Services
Rehabilitation Services
Radiology
Patient Resource Services
Heart Services
Respiratory Care
Neurology
GI/Bronch Lab
Patient Placement/Registration


COMPUTER DOWNTIME ORDER FORM

       The Computer Downtime Order Form is located on the Reid Intranet under Quick Links then
        “Clinical Downtime”.
       The Computer Downtime Order Form will be completed for all physician orders affected by the
        system downtime.
       Call the performing department for all STAT/ASAP orders.
       Transcribe all information on the Computer Downtime Order Form as appropriate for the
        test/procedure needing performed.
       A separate Computer Downtime Order Form must be used for each ordering department by
        Date/Time/Priority.

FAX THE COMPLETED COMPUTER DOWNTIME ORDER FORM TO THE PERFORMING DEPARTMENT

       Fax Computer Downtime Order Form :
            1. Stat/ASAP Orders – fax immediately and call the performing department.
            2. Discontinued/Canceled orders – fax ASAP
            3. Tests/Procedures requiring a prep and/or needing scheduled i.e. MRI, CT, Stress Test,
                 Endo, Upper GI, etc. - fax when the order is transcribed.
            4. Orders with Date/Time/Priority greater than one hour from start of the computer outage -
                 faxed one hour prior to the time needing performed.
       Place transcribed Computer Downtime Order Forms that have not been faxed in a downtime file by
        Date/Time/Priority of the orders.
       Retain original Computer Downtime Order Form.
       The performing department will contact Nursing/Ordering Department of procedures needing
        scheduled with date/time and if a standard patient prep is required.
       Patient preps are located on the Reid Intranet under Quick Links then “Clinical Downtime”.
       The performing department will document completed tests/occurrences on the faxed Computer
        Downtime Order Form.
BACKLOADING ORDERS WHEN THE SYSTEM IS AVAILABLE

      The performing department will fax the completed Computer Downtime Order Form to
       Nursing/Ordering Department if there are future occurrences needing to be entered.
      The performing department will backload all completed orders/occurrences.
      Nursing/Ordering Department will backload future occurrences if applicable and all “Nursing
       Orders”.

COMPLETED COMPUTER DOWNTIME ORDER FORM

      The “completed” Computer Downtime Order Form will be kept on the chart under the
       Miscellaneous tab.
      The HIM (Health Information Management) will remove the Computer Downtime Order Form once
       the patient is discharged.

RESPIRATORY CARE/HEART SERVICES/NEURO/GI AND BRONCH – Additional Considerations

      Use the text phone for orders involving Respiratory Care and EKG in addition to following the
       above downtime process.
      In the event the department is closed leave a voice mail message in addition to following the above
       downtime process.
      The department will call results to the Nursing/Ordering Department.
      The department will contact Nursing/Ordering Department of procedure (procedures needing
       scheduled) date/time and if a standard patient prep is required.
      The Nursing/Ordering Department will print the standard patient preps from the Reid Intranet under
       Quick Links then “Clinical Downtime”.
      Standard patient preps with medication instructions must be faxed to Pharmacy.
      Complete the Computer Downtime Order Form for diet instruction orders listed on the standard
       patient prep and fax to FNS.
      Send a completed Computer Downtime Order Form to discontinue the diet instruction orders once
       the procedure is complete.

RADIOLOGY – Additional Considerations

      Radiology will contact Nursing/Ordering Department of procedure (procedures needing scheduled)
       date/time and if a standard patient prep is required.
      The Nursing/Ordering Department will print the standard patient preps from the Reid Intranet under
       Quick Links then “Downtime Forms”.
      Standard patient preps with medication instructions must be faxed to Pharmacy.
      Complete the Computer Downtime Order Form for diet instruction orders listed on the standard
       patient prep and fax to FNS.
      Send a completed Computer Downtime Order Form to discontinue the diet instruction orders once
       the procedure is complete.
      Radiology will call results to the Nursing/Ordering Department.

LABORATORY – Additional Considerations

      Lab results will be tubed or hand delivered to the Nursing/Ordering Department on a Lab/Cerner
       results requisition.
      If Invision and Lab Cerner are both down complete a “Computer Downtime Order Form” one-hour
       prior to the time each occurrence is due for existing and new daily/timed orders.
MISCELLANEOUS

       Nursing staff will enter Nursing Orders when the system is available.
       Patient Placement/Registration will call the nursing units regarding new admissions.
       Transfers and discharges will be called to Patient Placement/Registration. Patient
        Placement/Registration will notify Environmental Services. Nursing staff will enter transfers and
        discharges when the system is available.
       ALL orders will continue to be faxed to Pharmacy.

INVISION PRINING DOWNTIME

The following will not print:

       Orders, results, and orders to other departments ex. FNS - NPO and Tube Feeding.
       Protocols ex. Vaccines, Pneumonia Admission Orders, MRSA Screening orders, and DVT.
       All Referrals to departments.

    Orders can be entered into Invision as usual. Notify all ancillary departments with patient name,
    number, and order.

    Call ALL referrals to the appropriate departments.

       Admission Home Medication Sheet

    Use the Downtime home medication form, transcribe the medication orders and fax to pharmacy.

CLINICAL DOCUMENTATION DOWNTIME FORMS

       Clinical Documentation Downtime Forms will be used when the system is down.
       Forms are located on the Reid Intranet under Quick Links then “Clinical Downtime”.

BACKLOADING DOCUMENTATION WHEN THE SYSTEM IS AVAILABLE

       The clinician does not need to stay until the system comes back up if their shift has ended.
       The clinician on duty is responsible for backloading the information in the system. All
        documentation backloading will take place within 4-6 hours of the system recovery.
       After an extended period of computer outage and the system is back on-line consider calling in
        extra staff or keeping staff that would be sent home “no work” (with appropriate skills and
        knowledge to backload the data.
       When entering the information the clinician backloading will indicate in the “backloaded for” field the
        name of the clinician that completed the downtime form.
       When backloading information always remember to change the date and time to the actual date
        and time the observations were done.
       When backloading vital signs it is important to backload the oldest information to the most recent
        information. This is critical when backloading patient weight. In order for the weight gain/loss
        calculation to work correctly, the oldest weight must be backloaded first then most recent.
       Clinical Documentation Downtime forms (original with handwritten documentation) are a permanent
        part of the medical record and will be kept on the chart under the “Narrative” tab.
                  Downtime – Nursing (Clinical/Patient Care Areas)


MEDICATION ADMINISTRATION

       Situation # 1 – MAK/Pharmacy up and Invision down
            A. Staff CAN CHART the administration of existing medications in MAK.
            B. Staff CANNOT VERIFY/Chart new/revised/discontinued orders or CHART the
                 administration of new or revised medications.
       Situation # 2– MAK /Pharmacy down and Invision up or MAK/Pharmacy/Invision down
            A. Staff CANNOT VERIFY /CHART existing/new/revised/discontinued medications in MAK.


        NOTE: Medication administration must not be interrupted due to any system downtime. Use
        paper MAR.

        Reminders:

        Medication orders are listed on the Nursing Rounds Report.

        If Invision is up the MAR can be viewed under # 11 Display Results, then #20 MAR/IVAR Display

Notification of Nursing Leadership

        After 30 minutes Information Services will call the Operator to page the Unit Director of the Week or
        the House Supervisor to extension 3400 to notify them of MAK downtime. The Unit Director of the
        Week/House Supervisor will follow the MAK Downtime Checklist (located on the Intranet under
        Downtime Forms). The Help Desk will notify the Unit Director of the Week or the House Supervisor
        once system recovery is complete.

        If MAK downtime extends beyond 4 hours, every attempt to notify the Director of Nursing, Director
        of Patient Safety, and the Chief Nursing Officer should be carried out by the Unit Director of the
        Week or the House Supervisor.

PROCESS for Documentation on Downtime MAR

       After 30 minutes, Information Services will print the paper 3 day MAR's to each nurse station.
       Handwrite new or revised medication orders on the paper MAR.
       Print a blank MAR from the Intranet Downtime forms for patients admitted during the downtime.
       Notate discontinued orders by writing “DISC” over the medication order on the paper MAR.
       Circle medication occurrences “not administered” and write your initials beside the circled
        occurrence.
       To indicate a medication has been “administered” mark a line through the occurrence/time and
        write your initials beside the administered occurrence.
       Hand write appropriate information such as initials of second nurse, administration site, reason,
        glucose, pulse, etc. beside the occurrence.
       Hand write initials, signature, and title on the bottom of the downtime MAR.
       Do not use highlighters on the MAR.
OMNICELL

       Access to Medications: Omnicell profiling is turned off at the profiling cabinets. All medications
        stored in the cabinet are available for access by nurses, not just those specifically ordered for the
        patient.
       Access to New Patients: Names of patients admitted during the downtime will not display at the
        Omnicell cabinet. Nurses must ADD the patient's name to the cabinet in order to remove
        medications. Selecting the default name of "UNKNOWN PATIENT" is not acceptable.
       A communication/instruction card will be placed on each Omnicell cabinet during the downtime to
        serve as a reference for the nurse. Cards are placed and removed by IS Help Desk Staff.

DOWNTIME PROCESS FOR MEDICATION RECONCILIATION

        Invision and/or Pharmacy / MAK Down
        1.       Attempt to print the Medication Reconciliation.
        2.       Obtain patient MAR and Home Medication Order Sheet.
        3.       Ensure Medication Reconciliation form is accurate.
        4.       Continue with Medication Reconciliation process.
        Medication Reconciliation System Down
        1.       Obtain patient MAR and Home Medication Order Sheet.
        2.       Ensure MAR and Home Medication Order Sheet are accurate.
        3.       Copy both forms for the Physician to identify medications to be taken at home.
        4.       Continue with Medication Reconciliation process.

BACKLOADING ONCE MAK /PHARMACY AND/OR INVISION ARE BACK UP

       The clinician does not need to stay until the system comes back up if their shift has ended.
       The clinician on duty is responsible for backloading the information in the system. All
        documentation backloading will take place within 4-6 hours of the system recovery.
       After an extended period of computer outage and the system is back on-line consider calling in
        extra staff or keeping staff that would be sent home “no work” (with appropriate skills and
        knowledge to backload the data).

MAK Backloading

       VERIFY all new/revised/discontinued orders in MAK using the physician order sheet and the
        downtime MAR.
       Override medication, patient ID, second nurse, etc. Use the “Override Reason” – “Computer
        Downtime”.

       Scheduled medications: Once the medication is highlighted and the “Override Reason” is
        selected a “Downtime Recovery Charted Date/Time” window appears showing the date/time the
        occurrence was scheduled to be given. Select the “Accept” button. (Change the date/time if
        appropriate prior to selecting the “Accept” button).




       Non-scheduled/PRN medications: Once charted, go to the “Charted List” tab and revise the
        date/time to the time the medication was administered. The “Downtime Recovery Charted
        Date/Time” window only appears for scheduled medications.
       One-time/Stat/ medications: Use the “Pharmacy Review Pending” function to chart the one time
        occurrences if not on the “Active Worklist”.
       The downtime MAR (original handwritten) will be kept permanently in the chart under the
        Narrative Tab.
       Downtime MAR’s of patients discharged during the downtime will not be backloaded. Charging will
        be handled by Pharmacy.

Note: Periodic Downtime Drills will be scheduled as a review.

New     June 11, 2007               Revised: January 5, 2010

								
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