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Iview IO Intake and output

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Iview IO Intake and output Powered By Docstoc
					                                         Iview

Effective March 17, 2009, Nursing and Respiratory Therapy associates at Methodist
Le Bonheur will begin documenting clinical information directly on the Iview tab from within the
patient’s electronic medical record.

Physicians and associated physician roles will be able to view nursing and respiratory clinical
information on the Iview tab         in a flow sheet format.

Other tabs that contain clinical information in the flow sheet format, such as Quickview, VS/Pain
or Adm/DC, will not change and may continue to be utilized for patient information. Clinical
information will continue to be located on the Forms tab.

The clinical areas include:
   • Medical Surgical / Specialty – 5 South, 5 West, 6 Central, 6 West, 7 Central, 7 West
       All clinical information will be located on the Iview tab except I/O will be on the I/O tab.
   • Critical Care – NICU, PICU, CVICU, TCU – All clinical information will be located on the
       Iview tab except I/O will be on paper.
   • PACU – Clinical information will be located on the Iview tab, Forms tab and on paper.
       I/O will be on Iview.
   • SDS – Clinical information will be located on the Iview tab, Forms tab and on paper. I/O
       will be on paper.
   • DTU – Vital Signs and Nursing Assessment will be located on the Iview tab. Clinical
       Information will also be located on the Forms tab.
   • Dialysis – Clinical Information will be located on the Iview tab and on paper. If the
       patient is from the critical care areas, the I/O will be on paper. If the patient is from
       Med/Surg area, the I/O will be on the I/O tab.
   • EMU – Clinical information will be located on the Iview tab and on paper. I/O will be
       located on the I/O tab.
   • MEG – Vital signs and Moderate Sedation will be located on the Iview tab.
   • GI Lab – Admission information will be on paper. The actual GI procedure
       documentation will be on the Reports tab in the Surgery folder. Post GI procedure
       documentation will be completed in Iview.
   • Starlight – Clinical Information will be located on the Reports tab in the Surgery folder.
       The recovery of the patient will be on Iview.
   •
Cardiac Catheterization Lab documentation will be completed in MAC Lab and will be printed
and placed on the chart until the Interface is complete.

The Emergency Department documentation will not change. RDAI will continue to be utilized
in the Emergency Department.

The hospital facilities that are currently documenting nursing and respiratory information on
Iview are Methodist North (since 11/2007) and Methodist Germantown (since 06/2008).




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Clinical information is available on the Iview tab at Methodist South and Methodist University
even though the nursing and respiratory associates do not directly document on this tab. Some
clinical information flows forward to this tab but is not as extensive.

Viewing Clinical Information and Navigating the Iview Tab

Bands

The nursing and respiratory therapy clinical information is available in bands located on the left
side of the display.




Available Bands include:
   • Vitals View MD
   • Respiratory MD
   • MD Meds and Treatments
   • Events MD
   • Assessment MD
   • Nutrition MD
   • Dialysis
   • Lines MD
   • Treatments/Procedures
   • Tubes/Devices
   • Graphs
   • ECMO/CRRT

Band Category

Each band will contain categories of information for review.

If there is clinical information in the category within the band, there will be a check mark in front
of the category name.




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If there is clinical information in the category within the band that has a check mark and red
exclamation mark, this indicates the category contains critical information.




To view clinical information
   1.     Click the band name.
   2.     Click the category to be reviewed.

In the example below:

            •    The Vitals View MD band was clicked first.
            •    The category of Vitals Signs was then selected.

As the bands are selected, the lettering of the band name will become bold.




Band Information – The following will provide the band name and information which may be
included on each band.

Vitals View MD
    • Vital signs
    • Oxygenation
    • Measurements - weight, height. BMI and head circumference
    • Hemodynamic measures

Respiratory MD
   • Oxygen therapy
   • Respiratory treatment pre and post assessments
   • Cough/suction
   • Incentive spirometry

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   •   T, C and DB
   •   Ventilator settings
   •   Ventilator bundle
   •   High frequency ventilation
   •   Surfactant administration

Meds & Treatments MD
  • Bedside Blood Glucose monitoring
  • Supporting Titration Info
  • Vital Signs
  • Anti – Coagulant flow sheet
  • Diabetic flow sheet

Events MD
   • MD Notify
   • Apnea/Brady/DeSat episodes
   • Intubation

Assessment MD
   • Head to Toe Assessments
   • Breast Feeding Assessments
   • Bottle Feeding Assessments
   • GI Output
   • Urinary Output

Nutrition MD
   • Oral nutrition
   • Enteral feeding
   • Bottle feeding assessments
   • NG/OG tube site information
   • GI Output
   • Urinary Output

Dialysis
    • Hand Off
    • HD patient info
    • Labs
    • Vital Signs
    • Oxygenation
    • Measurements




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Lines MD
   • IV therapy
   • IV intake
   • CVAD
   • Arterial line
   • PA Line therapy
   • PICC line insertion
   • PICC assessment

Treatments/Procedures
   • Car Seat Challenge
   • CRRT
   • Eye exam
   • Hearing Screen
   • Procedures at Bedside
   • Thermoregulation
   • Phototherapy
   • NB Screening
   • Enema

Tubes/Devices MD
   • Urinary site/output
   • Rectal Tube/fecal bag/output
   • NG/OG site
   • CT/output

ECMO/CRRT
  • Assessment/Lab
  • Treatment Information

Clinical Information Display

When the IView tab is initially opened, the Search Criteria bar will default to the last 24 hours of
clinical information.

To Change the Display of Clinical Information
   1.    Right click on the Search Criteria bar.
   2.    Select from the options of Last 48 hours,
         Last 72 hours, Admission to Current,
         Today’s Results or Other.




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The Search Criteria will have to be changed on each individual band unless the default is
changed for every band.

To Change the Search Criteria for all Bands
   1.       Click on the Customize View icon.

   2.       Select the Preferences tab.

   3.       The first item listed is the Default Retrieval Type. Click the Drop Down Menu and
            select the appropriate time frame.




   4.       Click OK. The default display criteria will change for every Band except the Graph
            Band.

Defaulting Bands Open

Another feature that can be customized to make viewing clinical information easier is the Default
Open feature. By setting bands to default open, this avoids clicking on the band each time a
chart is opened.

   1.      Click on the Customize View icon.

   The Customize tab will be open. The band category titles will display in blue.

   2.      Click the Collapse All button            at the bottom of the Customize window.




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   3.      The category titles will then list. Click the box beside the categories that should
           be open when the Iview tab is selected.




NOTE
Please be very selective of the band/categories that are defaulted open, as the more that are
chosen to default open, the more data that has to load, thus increasing the period of time it
takes it to open.

Pertinent Values

Below the search criteria bar is an area in which pertinent values may be displayed separately
from the other clinical information. This allows you to focus on particular clinical information.

There is a drop down menu and color coded categories that include Critical, High, Low,
Abnormal, Flag and Unauth. The color of the result will correspond with the color of the
category, if that results value falls into one of the categories. In addition, the options of And /
OR are available.

To Display Pertinent Values in a Flow Sheet Utilizing the Search Feature


   1.       Click the drop down Menu in the Find Item area.




    2.       Select a category to be reviewed.

            If clinical information is available in the option chosen and the search criteria date
            display is inclusive of the information, it will display.

            In the example, Cuff SBP/DBP is selected. This is information is available on the
            patient and displays at the top of Iview.


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To Display Pertinent Values in a Flow Sheet Utilizing the Options of Critical, High, Low,
Abnormal and Flag

   1.        To group values at the top of the flow sheet, click the type of values for review.

   2.         In the example, High will be selected to demonstrate how the information will
             display.




   3.        More than one option may be chosen. In the example, High and Low are selected.
             Be sure to make sure the options of And / Or are appropriately selected, so the
             information will display.




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Iview Column Display

The columns of actual clinical information will default to Q8H.

To change the display of the flow sheet columns

   1.       Right click on the date in the columns

   2.       Select the appropriate time for the column display.




The system will alert you when your selection will display 500 or > columns, as this may
interfere in system performance. You may still select the option, by clicking OK.




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Clinical Information that has a number within brackets beside the data, indicates the number of
values available for that data point.




To view all of the clinical information inclusive of the bracket:

   1. Double left click the value and the Result Details window will open.




   2. To view subsequent values, click the Next button                      located at the bottom of
      the window.

Flag
The clinician may flag the value                  . This is done to bring attention to the value.



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Comments
The clinician may make a comment about the value. This will be indicated by the black triangle

in the right upper corner of the value cell.

To view the comment:

    1.   Double left click the comment icon. The Result Details window will open.
    2.   Click the Comments tab.
    3.   The comment will display at the bottom of the screen.

Value Calculation

The green calculator in front of some of the values will provide the calculation of how the value
was obtained.

   1.       To display the calculation, hover over the value name.
             In this example, the calculation for MAP is displayed.




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Legend

When viewing clinical information on the IView Tab, there are symbols and letters that will
appear beside the value. There is a legend available that will explain the meaning of these
symbols and letters.

To view the legend

   1.        Click Options on the top menu bar and select Show Legend.




Graph Band

Iview allows for the display of standard and custom graphs. Prior to selecting a graph, be sure
the Search Criteria is properly set.

   1. Click on the Graph band.

   2. Four folders will display: Favorites, BMDI, I/O Totals and Standard graphs.




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            •    Favorites – Customized graphs that have been saved.
            •    BMDI Acquired Data – This folder is not in use.
            •    Intake & Output Totals – This folder is not in use.
            •    Standard – Pre-built graphs

Standard Graph

   1.       To view one of the Standard graphs available, Click the Plus Sign
            by the Standard Graph folder.

   2.       The Standard Graphs available will be provided in a list.




   3.        Double left click the title of the graph to display. More than one graph may be
             selected.

The clinical information will graph for the time frame selected in the Search Criteria bar.




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   4.       To close the graph, click the folder icon with the red arrow, located just above
             the graph.

Custom Graph
The option to create a customized graph is available.

   1.       Select the New Graph icon.

   2.       The Advanced Graphing Wizard window will open.




   3.       Complete the name of the graph. Select Standard Graph as the Graph Template
            Type. Click Next




   4.       The Advanced Graphing Wizard: Specify Items will open.




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   Search for the items that will be included on the custom graph. In the example systolic and
   diastolic blood pressure were moved to the Selected Items.




   5.       Click Finish.

   6.       The graph will display.




Any of the data points may be double left clicked to view more details.

The graph may be saved to the Favorites folder in the Graph Band.


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   7.       To Save, click within the graph and click the Save icon.


   9.        The graph will now be listed in the Favorites folder.

Viewing Clinical Information on the I/O tab

When viewing clinical information on the I/O tab, the volumes of specific solutions will display.




The specific solution will display in the Continuous Infusions.




To view the order information, hover over the drug name and the order details will display.




The enteral intake will be documented on the I/O tab. To view the order details, please go to
the Order tab.



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