Cerner Lab Upgradewith 2Hour Order Entry Downtime

September 28th 10-12noonSimultaneous implementation of two projects:

Cerner Laboratory Information System (LIS) will replace the current GE (LIS)

Abbott Diagnostics automated chemistry line will replace the current Beckman instruments

ACTIONS NURSING UNIT TO TAKE NOW TO PREPARE

●Staff unit appropriately: (higher than a normal Saturday)●Schedule an MR and ●Schedule one extra nurse

●Make sure Downtime Kits are fully stocked for all types of Downtime documents before September 28th ●physician order (POS) sheets (remove all triplicate forms you

may still have)● lab requisitions

●Look for emails, articles and Nurse Alerts with the latest details prior to the day

Order Ample Supply of DT Lab Requisitions and POS

E-docs link to order downtime requisitions:https://edocsprod.mc.vanderbilt.edu/EDocsView.aspx?EDocsId=3363

PreDowntime – Day of● Providers encouraged to:

● Order routine lab tests prior to 10am● Avoid ordering serial labs prior to 12N

● Nurses to ● Sort Batch print of requisitions to remove those dated and

timed after 12 Noon 9/28/2013. Discard them● Dock Glucometers at midnight as usual then begin scanning

account # on armband instead of MRN● Send specimens prior to 10 am whenever possible

● MR ● Print extra HEO lab labels, have POS ready to stamp for

providers● Sort batch requisitions, shred those timed for after 12 noon

● SSS to round on units to remind about the downtime processes

During Downtime-Provider and Nursing Instructions

● DT Orders entered on STAMPED/LABELED downtime physician order sheet

● New labs sent with STAMPED/LABELED DT paper requisitions● Labs ordered prior to DT will be sent with the HEO/Wiz requisition

printed at order time UNTIL 12NOON● Medications ordered during DT will be faxed to pharmacy per normal

HEO/WIZ DT procedures and will be entered by pharmacy then available in Admin-Rx

● Labs will be resulted as usual though possibly slower● Systems Support onsite for inpatient areas to assist with questions

related to downtime● Clinical Operations Engineers will be onsite to support outpatient areas

using VOOM

During Downtime – MR● Be prepared to assist nurses and providers with stamped/labeled

DT POS, and lab requisitions as needed● Fax medications orders to pharmacy so they can enter into HMM

● Nurses will then be able to administer meds in Admin-Rx● Notify these services by phone of any new orders and a DT

requisition:●Radiology●Respiratory Therapy or Rehab Services ●Heart Diagnostic Test (Echo, EKG)●Lab:

● Labs will continue to be done during the downtime and results posted in StarPanel

● Critical Labs will be communicated to provider/unit per protocol● Questions during the DT can be called to the lab hotline:

After Downtime- Nursing Nursing Instructions:●Charge RN will ensure that remaining HEO

requisitions timed after 12 NOON are thrown away

●SSS/DT Team -Active Lab orders in HEO will be dc’d and reentered starting at 12 noon ●New HEO requisitions will be printed as the

orders are re-entered in HEO/Wiz●Any lab that needs to be sent prior to receiving

the new HEO/Wiz requisition should be sent with a DT requisition

After Downtime-Nursing, cont.Nurse Instructions:Verify labs carefully – the team dc’ing and re-entering the orders will not know what you sent, order changes etc. during the downtimeAsk: ●Was this lab sent during the downtime?●Do we still need this lab? Did it get dc’d on paper or

verbally during the DT●Which requisition should be used? – if you have 2

HEO requisitions, use the requisition with the most recent “request date/time” on the requisition

After DT – MR and PharmacistsMRs (or designee): ●Enter “ongoing non-pharmacy” written orders

into HEO/Wiz●Written completed orders during Downtime will

NOT be back-entered into HEO/WizPharmacists:●enter “ongoing” written medication orders into

HEO/Wiz●Once processed in HMM, medication orders

display in Care Organizer to be verified

After Downtime-ProvidersProvider Instructions:●All lab orders in HEO/Wiz will be dc’d and

reentered to allow HEO to communicate the order to Cerner lab

●Lab orders will be reentered as “written” to avoid multiple co-signatures needed but be prepared as some may occur

After DT cont. Changes for Point of Care Blood Glucose,

GEM, & Hemoglobin A1C Testing

• Inpatient Nurses will now scan patient’s account number and not the MRN

• Outpatient nurses will scan/enter the Epic account number on the label or encounter form

Reference Numbers & Resources for Lab Upgrade 9/28/13

• 3-HELP – HelpDesk will contact lab or support group to assist as needed

• VUMC Lab to see new reference ranges• www.lab.vu.com or click on this StarPanel icon:

• 5-LABS during the DT for lab questions• SSS website for DT Process questions:

• SSS Downtime webpage• Link to order DT Forms from E-docs:

• https://edocsprod.mc.vanderbilt.edu/EDocsView.aspx?EDocsId=3363