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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
Posted: Nov. 1, 2017
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
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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”.
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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:
Posted: Nov. 1, 2017
Adjusted time to reflect the actual duration of the event:
Posted: Nov. 1, 2017
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.
Posted: Nov. 1, 2017
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
Posted: Nov. 1, 2017