sutures newsletter


P & T Approvals, FDA Warnings About Codeine-Containing Meds, NSAIDS, Proglycem

Pharmacy Focus

See highlights of the June meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Food and Drug Administration has issued warnings about codeine-containing medicines in children, nonsteroidal anti-inflammatory drugs and Proglycem in infants.

Mark Your Calendar

Grand Rounds

Click here to view a schedule of all upcoming grand rounds.

Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

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Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

Notes, 'Fat Tab' Among CS-Link Updates

Several improvements were added recently to CS-Link™, including the ability to write notes via Haiku and Canto.

Please note one change in particular: All order functions now are grouped into one "fat tab" called "Manage Orders." The current "Order Entry" function can be found within "Manage Orders" and will be along the right-hand column.

Also note that your ordering preference list will be accessed via the "+New" button. This change brings all ordering options onto one screen and serves to remind us to utilize the preferred "Modify" or "Discontinue" buttons for changes to existing orders, rather than using a nurse communication.

For more information about the improvements, including screen shots, see this PDF at CS-Link Central.

Inter-Facility Transfer Report — Psychotropic Meds

The Joint Commission (TJC) requires hospitals to obtain a Physician Certification Statement (PCS) when patients are transferred to skilled nursing facilities (SNFs) on psychotropic medications. In an effort to satisfy this requirement, a new documentation section has been added to the Inter-Facility Transfer Report navigator. The PCS is generated automatically and printed as part of the Inter-Facility Transfer Report for use by the receiving facility.

This improvement will:

  • Satisfy the TJC requirement to obtain a Physician Certification Statement prior to discharging patients to SNFs with psychotropic medications
  • Help in continuum of care when patients transferred to SNFs
  • Help ensure timely patient care with regard to ordering and dispensing of psychotropic medications at the receiving facility

Optimization of Clinical Swallow Evaluations

To encourage providers to use Clinical Swallow Evaluations when appropriate for patients, this feature incorporates a recommendation for a Clinical Swallow Evaluation prior to ordering a Video Swallow Study (VSS). This enhancement supports using needs assessment to drive clinical decision-making.

When physicians place an order for VSS and a patient does not have a Clinical Swallow Evaluation on file, an Alternative Alert will pop up asking if physicians would like to "Accept Alternative" recommended order or "Continue with Original Order."

This improvement will:

  • Support utilizing needs assessment to drive clinical decision-making prior to ordering a Video Swallow Study
  • Encourage providers to use Clinical Swallow Evaluations when appropriate for patients, providing clinicians with information regarding:
    • Whether the patient's dysphagia is oral or pharyngeal
    • Readiness for the radiologic study (patient must be alert and able to accept food in the mouth)
    • The oral reaction to various tastes, temperatures, and textures in the oral cavity
    • The presence of any swallowing apraxia or any abnormal oral reflexes such as a tonic bite
    • Postural and behavioral needs of the patient that must be addressed during the radiographic study

Optimal benefits from a VSS are dependent on stability of patient's medical status, behavior and cognitive level.

Clinical Overview Report

This report puts together frequently used reports in one Patient Summary report in order to make it easier to navigate and view patient data. The report is based on best practice experience at other hospitals.

This improvement will create one unified view of multiple reports, including team-based communication, patient flags and key clinical data.

Handoff/Rounding Tool

This piloting handoff tool will assist with team sign-outs and enable auto-generated rounding reports.

A new SignOut button will be added in the patient list toolbar for physicians to document a patient summary and a to-do list. This will automatically populate the SignOut report under the patient lists with the ability to print multiple patient reports per page.

This improvement will create a better handoff and rounding report for physicians.

Notes and Manage Orders — "Fat Tabs"

Notes and Manage Order buttons have changed to the "Fat Tab" format. Order Entry and Order Review no longer are available as standalone activity tabs.

The Manage Orders tab is now the primary screen for placing orders and access to Order Review. The ordering preference list is now found by clicking on "+New" button.

This improvement will:           

  • Provide visual distinction of the most commonly used physician activity tabs for inpatients
  • Assure utilization of the preferred Manage Orders activity

CHF: Patient Identification — Best Practice Advisory

In Med-Surg areas, nurses will now complete an assessment for certain patients who are at risk for congestive heart failure (CHF). If the nurse assesses that the patient potentially has CHF, and if the patient doesn't already have CHF on their problem list, physicians will see a Best Practice Advisory (BPA) that asks whether CHF should be added to the problem list.

If a patient has an order for a loop diuretic, an ejection fraction less than 40 percent, a BNP greater than 300 or documented shortness of breath, Med-Surg nurses will be required to complete a CHF assessment on the patient. Nurses will indicate that a patient potentially has CHF based on the criteria in a sidebar report.

If a Med-Surg nurse indicates that a patient potentially has CHF, physicians will see a BPA that asks whether it is appropriate to add CHF to the patient's problem list. If the patient has CHF, the physician should add it to the problem list by opening the Problem List activity from the BPA.

This improvement will:

  • Help identify patients with CHF so that nursing, pharmacy and nutrition staff can be notified to provide appropriate patient education
  • Help track patients with CHF, so that physicians can better manage care for these patients

VTE Prophylaxis Best Practice Advisory

If an adult patient has been admitted for more than 24 hours and if VTE prophylaxis has not yet been addressed, physicians will see a Best Practice Advisory (BPA) that prompts them to address prophylaxis.

A new BPA will display for physicians if they have not addressed VTE prophylaxis for an adult patient who has been admitted for 24 hours. VTE prophylaxis is considered "addressed" only with one or more of the following orders:

  • Mechanical prophylaxis
  • Pharmacological prophylaxis
  • Contraindication for both mechanical and pharmacological prophylaxis
  • Low risk for VTE; no prophylaxis needed

These orders can all be found in the VTE order set suggested by the BPA, and in the IP General Admission Order Set.

This improvement will help prevent VTE in at-risk patients.

Care Everywhere — Data Reconciliation

If there is outside data to reconcile, you will now see the hyperlinks within the Care Everywhere summary report in the following sections:

  • Allergies
  • Problem List
  • Medications

A second way to access the activity is to click the hyperlink that appears within the Allergy, Meds and Problem List activities.

These will appear only if there is data to reconcile in these activities.

The link display button has listed "Reconcile with Patient's Chart." Once the link has been selected, click Add or Discard to add the allergy, problem or medication to the Cedars-Sinai chart. Click Discard if you don't want to bring it in. These actions have no impact on the source organization.

When you choose to add a medication, there is the option to edit additional details about the med. The source organization automatically pulls into the Comments field. If we already have the medication in our system, it will ask if you want to discontinue the duplicate med.

For more information on this improvement, view this PDF at CS-Link Central.

Haiku/Canto Notes Entry

You will now see hyperlinks to document the following notes within Haiku/Canto Care:

  • Consult — Initial
  • Discharge Summaries
  • H&P
  • Operative Report
  • Post-Op (Brief Op Note)
  • Procedures
  • Progress Note — Doctor
  • Progress Notes (this is available in the ambulatory encounter context)

Click on the Note link to display and select a Note Type. Once identified, enter and sign the note.

Order Entry — Manage Orders

Inpatient physicians no longer have access to Order Entry activity. Physicians have to use Manage Orders activity to enter or place orders.

Diabetic Supplies Order-Set Enhancement

Names have been updated to familiar terms for supplies and medications under sections Meters/Test Strips/Lancets, Test Strips Only and Insulin Pens & Needles.

Meters/Test Strips/Lancets

  • Change from FreeStyle UniStik Lancet to FreeStyle Lancet
  • Change from FreeStyle Test Strip to FreeStyle Lite Test Strip

Test Strips Only

  • Change from FreeStyle Test Strip to FreeStyle Lite Test Strip

Insulin Pens & Needles

Additional options: BD AutoShield-DUO Safety Pen Needles 30G x 5mm

Miscellaneous (new section)

  • Glucose tablets
  • Glucagon Emergency Kit
  • Home Sharps Container

DME Order Enhancement

The DME order now has a new question option for specifying Hospital Bed. This new question has dropdown options of: Bed Cradle (18"-27"), Full Bed Rails, Full-Electric Hospital Bed, G-1 Alternating Pressure Pad and Pump, G-2 Low Air Loss Mattress, Half Bed Rails, Over Bed Table, Semi Electric Hospital Bed, and Trapeze.

This improvement will make it easier to order hospital beds for discharge.