Overview - Inside Prov

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Overview ADT ASAP Clin-Doc Stork Anesthesia OpTime
Overview On November 5th 2017, the Epic system will discontinue daylight savings time and revert back to
standard time. As a result, the 1:00 AM hour will occur twice and end user workflows will be impacted.
While some functionality within Epic is impaired during the time change, the system will remain live to
allow users to utilize as many functions as possible. Users should review this guide to be informed about
all impaired functionality and temporary workflows.
Synopsis
Posted: Nov. 1, 2017
Bed Charging Patients will not have a second bed charge added for the repeated 1 AM hour.
Billers can manually correct these charges in hospital billing account maintenance after the patient is discharged. The IS team will work with partners in the billing office to facilitate this correction. No user intervention is required.
Track Boards, ED Manager, and Reporting
Inaccurate reporting due to the DST time change also affects Clarity, the ED Dashboard, Reporting Workbench, the Track Board, and the ED Manager.
Users must be aware that they might see negative times in reports or in columns on the Track Board or ED Manager.
Best Practice Advisories
Best Practice Advisories with/without lockout times do not adjust for the time change.
Be aware you may get errors for this reason. Alerts with specific follow-up times are automatically adjusted for the time change and will display properly.
Ruptured Membrane and Cervical Exam Calculations
Calculations for ruptured membranes and cervical exams occurring prior to the time change can be up to one hour off.
Clinicians will need to be notified of the discrepancy in these exam calculations.
Action Required:
ADT Events
ADT events during the 2nd occurrence of the 1 AM hour outside of the ED may appear out of order.
Avoid entering ADT events during the 2 hour time change. Double check that events display in the correct order in Event Management and manually compress the time if necessary to ensure that events display in the correct order. A hospital note should be added to document the actual time of manually compressed events and the reason for doing so.
Narrators
Event Logs or Patient Timeline may have timestamps that do not accurately reflect order of events.
Narrators display yellow banner warning users viewing Event Logs or Patient Timeline that events may appear out of order. Code, Sedation, and Trauma Narrators should not be used during the repeating 1 AM hours. Document on paper as per hospital downtime policies for any code or sedation procedure that will occur over this time period.
Infusions Infusions running during the time change may display the incorrect length.
Infusion lengths should be double checked for any that are running during the time change and the correct length
should be entered into the comment field of the MAR for any that display incorrectly.
Flowsheet Charting Times will not display in the correct order for charting done during the time change.
Manually compress the time using the manual compression chart and add a note with the SmartText template to record the actual time.
Medication Administration
The system will not automatically adjust medication schedules for Standard Time.
Manually compress the time using the manual compression chart and add a comment to record the actual time. Review all scheduled medications at the beginning of each hour to make sure that no doses are missed.
IV Volume Calculations
IV volume calculations will not display correctly due to the change to time change.
Add a column at after the second occurrence of the 1 AM hour and manually enter the amount of fluid that has infused since the last time the volume was entered.
Point of Care Devices
Point of Care Devices must be adjusted to the new time before they are used to have the time of testing be correct.
Point of Care Devices must be docked in their stations at 02:01 to allow their systems to adjust settings to the new time before they are used to have the time of testing be correct.
Device Integration
Device integration systems will not adjust for the time change and without intervention the second 01:00 to 02:00 hour would overwrite the existing first hour resulting in permanent loss of that data.
Users will need to manually document device data for exactly 1 hour starting at the beginning of the second occurrence of the 1 AM hour (01:00 AM – 01:59 AM PST). Device data will resume populating the data validation tank starting at 02:00 AM PST. Users will be able to validate and pull device data from that point forward. Manual documentation of device data should include a comment of “compensating for daylight savings time”.
Labor Calculations Labor Calculations spanning the change to Standard Time can be off by up to one hour.
Manually calculate the labor lengths and document this as a Progress Note. After signing the Delivery Summary Physicians will click Chart in the Obstetrics History activity to open the patient’s chart and manually update the labor lengths using the data in the Progress Note the nurse has entered.
Anesthesia Daylight savings time change may affect the accuracy of an anesthesia record.
If a surgery is expected to cross over the time change, we recommend documenting the entire case on paper and have the charting scanned into the
Pre-Op documentation
Anesthesia Start
LDA’s
Anesthesia Stop
Post-Op documentation
Close Encounter
Case Tracking Events Case Tracking events that occur during the time change may record the incorrect time.
Change the case tracking event times so that the amount of time between events is accurate rather than the actual times. Then add a note to document the actual times of the events and the reason for manually changing the time.
ADT
Changeover
Daylight Saving Time (DST) Change Event – November 5, 2017 1:00am – 2:00am – Resets Computer Clocks to Reflect Standard Time
When the clocks are set back, patients could have existing ADT events that now occur in the
future. Until 2:00 AM, any subsequent events appear to pre-date the existing events. The
system does not allow this. ADT recommends that ministries avoid creating ADT events during
the second hour, 0100-0200, to avoid these issues. It is best, however, to avoid ADT events
during both hours when possible. This includes transfers, discharges, etc.
If it is absolutely necessary to perform a transfer or discharge during this time, and you get
errors, you will need to use Event Management to adjust the times.
We’ve included a sample resolution log to be used for tracking encounters that need to be
reviewed or corrected.
The compression utility will automatically compress all ADT events originating in the ED which
are documented as having occurred during the 2 hour time change window. The only exception
is bedding of patients which does not compress the time due to the fact that is not a field to
specify the time when bedding a patient. Manual compression for patient bedding is only
necessary when the event displays out of sequence in regards to all other ADT events. If
bedding displays in the correct order of events, no manual compression is necessary and there
is no reason to modify the timestamp.
Additionally, Admitting should create a Hospital Account Note to manually document the event
and the actual time that the event to log the change in a few places. Hospital Account Notes
located on the Coverage Info form should be created for all ADT events that occurred during
the time change with the event and time stamp.
Departments:
Enter the actual time of the event during the typical work flow screens and the compression
utility will automatically change the time to ensure that all events are recorded sequentially. A
green flag will appear next to these ADT events to show that they have been edited from the
original time entered. Narrators will also display yellow banner warning users viewing Event
Logs or Patient Timeline that the patient has information from at least one overlapping hours
and the timestamps may not accurately reflect order of events. Add a Hospital Account Note to
record the ADT event and the actual time for the purpose of historical reference.
* For arrivals, the time is not compressed until at least two ADT events have occurred within
the two hour DST timeframe. So for instance, if a patient is arrived at 1:26 in the 1st hour, this
time will not change to 1:13 until another ADT event (e.g. rooming) has occurred before
2am. This may be worth calling out since some users might think that the compression is not
working because it didn’t update the moment the arrival event was entered.
Bedding Patients:
When bedding a patient, there is not a field to enter a time and the system uses the current
time to record the event. Therefore, admitting staff will need to complete the routine bedding
workflow and then update the rooming event manually in the event log to compress the time
to account for out of sequence events that occur in the second occurrence of 1:00 AM.
Narrators display yellow banner warning users viewing Event Logs or Patient Timeline that the
patient has information from at least one overlapping hours and the timestamps may not
accurately reflect order of events. Add a Hospital Account Note to record the ADT event and
the actual time for the purpose of historical reference.
Hourly Bed Charges
In the case of hourly bed charges, be aware that these charges do not take the daylight saving
time changes into account. In the fall, patients will not have a second bed charge added for the
repeated hour. You can manually correct these charges in hospital billing account maintenance
after the patient is discharged.
ASAP What: Daylight saving time ends on November 5th and the 1:00 a.m. hour repeats. During this
time, EPIC displays ASAP patients in the department for one hour more than actuality, which
causes issues such as not being able to room patients be before they arrive, discharge before
they are admitted, and so on.
Fix: ADT times will be compressed so that ADT events stay in order and allow ASAP workflows to continue.
Compression only applies to ADT events. Events in the patient event log other than ADT events are not compressed. The ADT Events that have been compressed will display a green flag next to it indicating it’s been edited.
Narrators display yellow banner warning users viewing Event Logs or Patient Timeline that the patient has information from at least one overlapping hours and the timestamps may not accurately reflect order of events.
Do not use the Code, Sedation, or Trauma Narrators during DST fallback. You cannot fire the code, sedation, or trauma end events at a time prior to the start event. It’s important that this documentation be accurate and in order.
Do not use the Data Validation to pull vitals. Please enter them manually, entering a comment on one vital in any given set of vitals to indicate the accurate time.
Infusion times can be off. If you have a running infusion during the DST hour, please enter the date/time and length of infusion in the comment field in the MAR.
Enter comments with the date/time whenever there may be some confusion about the
time of the event.
How this works: The system takes the minutes between two action times and divides by 2. For example, 1:30 a.m. = 1:15 a.m., see below.
12:59 a.m. > 12:59 a.m. (no conversion needed)
1:00 a.m. > 1:00 a.m.
1:15 a.m. > 1:07 a.m.
1:30 a.m. > 1:15 a.m.
1:45 a.m. > 1:22 a.m.
1:59 a.m. > 1:30 a.m.
1:00 a.m. > 1:30 a.m.
1:15 a.m. > 1:37 a.m.
1:30 a.m. > 1:45 a.m.
1:45 a.m. > 1:52 a.m.
1:59 a.m. > 2:00 a.m.
2:00 a.m. > 2:00 a.m. (no conversion needed)
NOTE: Arrival times are not converted until the patient is roomed or dismissed. Once an arrival time is converted, the arrival event in the Patient Events Log appears as edited.
This does not apply to patient updates or updates to admission, discharge, or transfer times. We recommend waiting until after 2:00 a.m. to perform these updates. Also, the times of ED events, births, and deaths are not altered by this functionality.
If users attempt to update a patient's record during either iteration of the 1:00 a.m. hour, they are warned to wait until after 2:00 a.m. to make the update.
Users are also warned if they are attempting to update a time that was converted, as this might prevent other actions from taking place for the patient.
Example: Here you can see on the right side the time the patient is To room AH1 at 13:00 and
the time of the move from AH1 is 13:06. The difference in these two times equals 6 min. Epic
divides this difference by 2 and documents this transfer, on the left, as 3 min ahead of last the
event.
Patient Statuses:
Please verify all the patient statuses and manually change their status if they need to be
updated after the DST hour ends.
Track Boards, ED Manager, and Reporting:
Please note: Inaccurate reporting due to the DST time change also affects Clarity, the ED
Dashboard, Reporting Workbench, the Track Board, and the ED Manager. Because the system
can calculate a negative time between events, users might see these negative times in reports
or in columns on the Track Board or ED Manager
Time Changeover
Daylight Saving Time (DST) Change Event – November 5, 2017 1:00am – 2:00am – Resets Computer Clocks to Reflect Standard Time
How does this affect me?
The hour between 01:00 and 02:00 happens twice on this one day of the year. To avoid duplicate or lost entries for the same hour we are providing the following charting guidelines.
Documentation Flow Sheets:
Chart all events by manually compressing both 1 AM hours in 30 minute intervals. This will be done using the time compression chart that is included at the end of this document and by manually adding a column when necessary. The purpose of manually compressing timestamps is to ensure that all documentation is kept in the correct sequence. (Click Here to Jump to the Compression Table)
As an example - if you documented at 01:15 a set of Vital Signs and need to document again in
1 hour (what would have been 02:15 but is once again 01:15). To do this you record the vitals
that you took at (01:15 AM Daylight Time) in the first occurrence of the 1 AM hour with the
timestamp of 01:07 AM. Then you would manually add a column for the vitals taken at (01:15
AM Standard Time) during the second occurrence of the 1 AM hour and change the column
time to 01:37 to keep the second entry in correct sequence chronologically. For both events
you should add a comment “compensating for daylight savings time” and include the actual
time that the event occurred – but note that there may still be some entries out of sequence.
Assessment Charting required during the second hour can be done in the Notes section as a
Progress Note. There is a Smart Text template to assist you with this charting called “November
2017 Daylight Savings Time End” that contains the basic charting elements to start your note.
You can delete what is not needed and add your own smart phrases or simply free text to
complete documentation of any pertinent patient issues that occur during this second hour.
Code Narrators/Sedation Narrators:
Code Narrators/Sedation Narrators should not be used during the first or second hour as they will overwrite anything documented in the first hour. Document on paper as per hospital downtime policies for any code or sedation procedure that will occur over this time period.
Medication Administration:
The system will not automatically adjust medication schedules for Standard Time. A 02:00 scheduled medication could potentially be missed. Document medication administrations during the first occurrence of the 1 AM hour as you normally would. For any medications delivered in the second occurrence of the 1 AM hour, manually compress the administration time and add the comment “compensating for daylight savings time”. See Compression table at the end of this document. (Click Here to Jump to the Compression Table)
Be sure to review scheduled meds at the beginning of every hour to be sure no doses are
missed.
Work with your Willow team pharmacist on any medications that have time sensitive deliveries
to assure the medication times are adjusted appropriately.
IV Volume Calculations:
IV volume calculations will not correct for the change to Standard Time. You will need to add a column at after the second occurrence of the 1 AM hour and manually enter the amount of fluid that has infused since the last time the volume was entered.
Point of Care Devices:
Point of Care Devices must be docked in their stations at 02:01 to allow their systems to adjust settings to the new time before they are used to have the time of testing be correct.
Integrated Device Documentation:
Device integration systems will not adjust for the time change and without intervention the second 01:00 to 02:00 hour would overwrite the existing first hour resulting in permanent loss of that data. This issue is more complicated for users in Montana and Idaho which reside in the Mountain Time Zone, but are hosted on a server in the Pacific Time Zone. Washington Users: All users in Washington will need to manually document device data for 2 hours which will
include both occurrences of the 1 AM hour (01:00 AM – 01:59 AM PDT) and (01:00 AM – 01:59
AM PST). Device data will resume populating the data validation tank starting at 02:00 AM PST.
Users will be able to validate and pull device data from that point forward. Manual
documentation of device data should include a comment of “compensating for daylight savings
time”.
Montana and Idaho Users: All users in Montana and Idaho will need to manually document device data for 2 hours which
will start during the second occurrence of the 1 AM hour (01:00 AM – 01:59 AM MST) and will
continue through 02:59 AM MST. Device data will resume populating the data validation tank
starting at 03:00 AM MST. Users will be able to validate and pull device data from that point
forward. Manual documentation of device data should include a comment of “compensating
for daylight savings time”.
Oregon and California Users: All users in Oregon and California will need to manually document device data for exactly 1
hour starting at the beginning of the second occurrence of the 1 AM hour (01:00 AM – 01:59
AM PST). Device data will resume populating the data validation tank starting at 02:00 AM PST.
Users will be able to validate and pull device data from that point forward. Manual
documentation of device data should include a comment of “compensating for daylight savings
time”.
Alaska Users: All users in Alaska will need to manually document device data for exactly 1 hour during the
second occurrence of the 1 AM hour (01:00 AM – 01:59 AM AKST ). Device data will resume
populating the data validation tank during the second occurrence of the 1 AM hour starting at
02:00 AM AKST. Users will be able to validate and pull device data from that point forward.
Manual documentation of device data should include a comment of “compensating for daylight
savings time”.
Best Practice Advisories:
Best Practice Advisories with/without lockout times do not adjust for the time change. Be aware you may get errors for this reason. Alerts with specific follow-up times are automatically adjusted for the time change and will display properly.
Stork
Labor Calculations:
Labor Calculations spanning the change to Standard Time can be off by up to one hour. This can affect both the Delivery Summary and filing labor lengths to Obstetrics History. You will need to:
o Manually calculate the labor lengths and document this as a Progress Note. o After signing the Delivery Summary Physicians will click Chart in the Obstetrics
History activity to open the patient’s chart and manually update the labor lengths using the data in the Progress Note the nurse has entered.
Ruptured Membrane Calculations:
Calculations for ruptured membranes occurring prior to the time change can be up to one hour off. Clinicians will need to be notified of the discrepancy in the reports related to Ruptured Membrane times.
Cervical Exam Calculations:
Calculations for cervical exams occurring prior to the time change can be up to one hour off. Clinicians need to be notified of the discrepancy in the reports related to Cervical Exams.
C-Sections:
The main issue with surgical deliveries is related to Case Tracking event documentation. The documentation of timing information is affected. You should:
o Change the case tracking event times so that the amount of time between events is accurate.
o Add a nursing note that includes the actual times for that patient, even if it looks incorrect because of the time change.
This will ensure that the patient is charged correctly, and that the actual case times are
documented on the patient’s chart.
Charting After This Event:
After making any necessary 02:00 adjustments for IV Fluids and POC devices charting can resume as normal
Anesthesia
Changeover
Daylight savings time change may affect the accuracy of an anesthesia record. If a surgery is
expected to cross over the time change, we recommend documenting the entire case on paper.
This should be treated like any other case documented on paper. It is very important the
Anesthesia paper record reflects an accurate assessment of the care provided to the patient
during this time period to ensure a good hand over to other care givers and ensure accurate
billing.
Daylight Saving Time (DST) Change Event – November 5, 2017 1:00am – 2:00am – resets computer clocks to reflect Standard Time
How does this affect me?
To avoid duplicate or lost entries during Daylight Savings Time we’re providing the following charting guidelines.
Document entire case on paper
Scan paper document into chart
Back document in Epic: o Pre-Op documentation o Anesthesia Start o LDA’s o Medications o Anesthesia Stop o Post-Op documentation o Close Encounter
Anesthesia providers are responsible for sending correct billing information to their billers.
Each group should make their billers aware of possible problems ahead of time
OpTime
Time Changeover
Case Tracking events can be impacted by the time change. This can potentially impact cases that span over midnight on the evening when daylight savings time changes. Daylight savings time affects the actual documentation of timing information. It also affects functional areas that depend on this information, including charging and procedure time averaging.
Adjust Timing Events to Reflect Time Elapsed Between Key Events:
Since charging and procedure time averaging depend on the amount of time in between key
events rather than the actual times, nurses should:
Change the case tracking event times so that the amount of time between events is accurate rather than the actual times. In the example below, the patient enters the room at 1:30 AM and exits at 1:55 AM. The patient was actually in the room for 1 hr and 25 mins as the clock fell back one hour at 2:00 AM due to the time changeover. The nurse should adjust the time to reflect the duration of time the patient was in the room.
Time documented originally by selecting the Now button:
Adjusted time to reflect the actual duration of the event:
Due to the time changeover, in the above example, the actual time is now 01:55 by the clock. The nurse has adjusted the timing of the event to reflect the duration of the event.
Add a nursing note that includes the actual times for the patient, even if it looks incorrect because of the time change:
Nursing notes seen in Chart Review:
.
By documenting the correct amount of time and adding a note with the actual timing
events, nurses ensure that the patient is charged correctly, that surgeons have appropriate
time added to their average, and that the actual times are documented on the patient’s
chart.
Enter This Time in Epic to Account For Repeating 1:00
AM Hr
Enter This Time in Epic to Account For Repeating 1:00
AM Hr

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