NEXTGEN NURSE VISIT(FAMILY/INTERNAL MEDICINE)

DEMONSTRATIONThis demonstration reviews a few examples of nurse visits. They are prepared using the Family Practice templates, but workflow would be identical for Internal Medicine, and similar for many other specialties.

This has been prepared with EHR 5.6.5.61 and KBM 7.9 and 7.9.1. Subsequent updates may display cosmetic and functional changes.

Use the keyboard or mouse to pause, review, and resume as necessary.

There is no audio with this exercise.

Example 1: B12 Shot

In this example, a patient with B12 deficiency comes in for a vitamin B12 injection. This will be completed by the nurse.

The nurse opens patient’s chart. If necessary, display the History Bar and create an encounter for today by clicking New.

Click the Template Module.

Select Intake-OV. (This will be among the recommended preferred templates at setup.)

Select visit type of Nurse Visit.

Select your provider, e.g., the clinic supervising attending that day.

(The nurse is likely working with several providers at a time, so it is important to confirm this selection from patient to patient.)

Perform the 4-Point check.

Patient

Location

Provider Date

It is a good idea to check vital signs, at least BP, at most any nurse visit.Click Add.

Record vital signs.

When done, click Save, then Close.

Vital signs display in the grid.

Click in the first Reason for Visit box and click the blank at the top of the list. Then type B12 shot.

Next, click Office Services.

Click in the Display order set box and select Office Meds.

Scroll down the list until you see Vitamin B12 Injection. As we opened the chart, we noted the patient has a chronic problem of Other b-complex deficiencies 266.2, so we’ll select the injection associated with that diagnosis.

The injection, associated with this diagnosis, appears here.

If you don’t see the medication associated with a satisfactory diagnosis, you can click Add or Update Assessment.

You’ll probably see the diagnosis you need on one of the lists here; if not, you can use the available methods to search for it.When done, click Save and Close.

If there is a medication/diagnosis combination that is frequently used that you don’t see on the Office Meds order set, notify the EHR Team, so that they can add it.

When you’ve made your selection, click Place Order.

The injection appears on the Today’s Orders grid.When you’ve given the shot, double-click on Vitamin B12 Injection.

Click Completed.

Click in the Admin/other 1 box, and select Ther/Proph/Diag Inj, SC/IM in the popup.

If you don’t see the administration code on this popup, you can click the Dropdown Arrow to search for other codes.

Click Submit to Superbill. Text confirms the submission of the injection and the administration code.

When done, click Save, then Close.

Click Close again here.

Display the Navigation Bar.

Then click Offline. A visit note showing the B12 injection will be generated offline, and you are done. You can close the patient chart.

Example 2: BP Check

In this example, a patient comes in for a blood pressure check. This will be done by the nurse, who will discuss it with the clinic attending (or other appropriate provider).

Click the Template Module.

Select Intake-OV. (This will be among the recommended preferred templates at setup.)

The nurse opens patient’s chart. If necessary, display the History Bar and create an encounter for today by clicking New.

Select visit type of Nurse Visit.

Select your provider, e.g., the clinic supervising attending that day.

(The nurse is likely working with several providers at a time, so it is important to confirm this selection from patient to patient.)

Perform the 4-Point check.

Patient

Location

Provider Date

Click in the first Reason for Visit box and select BP check.

To record vital signs, click Add.

Record vital signs. A minimum of BP and pulse would be appropriate for a BP check.

When done, click Save, then Close.

Vital signs display in the grid.

Take your laptop to the clinic attending or other appropriate provider. The attending notes the BP, and opens the Medication Module.

The patient is noted to have been on metoprolol ER 50 mg daily for at least a month.

The attending titrates up to metoprolol ER 100 mg daily, and completes the new prescription.The medication module may now be closed.

Go to the SOAP tab, and add Hypertension as an assessment.

You could use My Plan/Orders to make a note, but it is probably simpler to type something in the Comments box. For this example, we’ll type Increased metoprolol to 100 mg daily. Nurse BP check 3 wks.

Display the Navigation Bar and click Offline to generate a note.

Either the provider or the nurse generates the Patient Plan.

Print this for the patient.

The nurse explains the dosage change and follow-up instructions to the patient, concluding the visit.

Note that, as seen by going to E&M Coding, this encounter merits a 99211 charge.

If the patient has commercial insurance, it would be reasonable to submit this charge. (For Medicaid patients, we often skip this.)

Example 3: INR Check

In this example, a patient comes in for an INR check. This will be done by the nurse, who will discuss it with the clinic attending (or other appropriate provider).

Click the Template Module.

Select Intake-OV. (This will be among the recommended preferred templates at setup.)

The nurse opens patient’s chart. If necessary, display the History Bar and create an encounter for today by clicking New.

Select visit type of Nurse Visit.

You may note that Coumadin Visit appears as one of the visit types. While a logical choice, we are not currently using the templates that leads to.

Select your provider, e.g., the clinic supervising attending that day.

(The nurse is likely working with several providers at a time, so it is important to confirm this selection from patient to patient.)

Perform the 4-Point check.

Patient

Location

Provider Date

Under Reason for Visit, click the blank at the top of the list, then type INR check.

Click Add to record vital signs.

Record vital signs. A minimum of BP and pulse would be appropriate for an INR check.

When done, click Save, then Close.

Vital signs display in the grid.

Perform the INR test, then click Office Services.

Scroll down the list until you see the line for INR/PT associated with the diagnosis of Long-term Use of Anticoagulants. Click on this.

Click in the Display order set box and select Office Tests.

Enter the result in the Detail box.

Click Submit to Superbill, then Place Order.

Take your laptop to the attending or other appropriate provider, who notes the INR and reviews the medication list as necessary. (The provider would also generate a new Coumadin prescription if necessary.)

In one of the tabs that displays the Chronic Problem List, double-click on the reason for the Coumadin, in this case Phlebitis and thrombophlebitis.

The provider reviews the indications for Coumadin, the INR goal, and planned duration.

Click Close.

Go to the SOAP tab and add the phlebitis diagnosis to the assessment list.

You could use My Plan/Orders to make a note, but it is probably simpler to type something in the Comments box. For this example, we’ll type Continue current Coumadin 5 mg daily; repeat INR 1 month.

Display the Navigation Bar and click Offline to generate a note.

Either the provider or the nurse generates the Patient Plan.

Print this for the patient.The nurse relays the plans to the patient, completing the visit.

Note that, as seen by going to E&M Coding, this encounter merits a 99211 charge.

If the patient has commercial insurance, it would be reasonable to submit this charge. (For Medicaid patients, we often skip this.)

This concludes the NextGen Family/Internal Medicine Nurse

Visit demonstration.

I went to a bookstore and asked the saleswoman where the Self Help section was.

She said if she told me it would defeat the purpose.

This concludes the NextGen Family/Internal Medicine Nurse

Visit demonstration.

I went to a bookstore and asked the saleswoman where the Self Help section was.

She said if she told me it would defeat the purpose.