NURSE COLLECT/I&O 2G

Nurse Collect/I&O 2G Overview

For RNs/ LPNs/ PCTs

Activating Charting

When charting an entire column double click on the time at the top of the column to open the entire column.

When documenting only one section double click on that section header and open that section. When

documenting on only one item right click in that cell and click on Add Result. The check marks indicate that

charting can occur.

Dynamic Groups

To document on an item that you may have more than one of, such as chest tubes, ostomy’s, catheters, etc. you can

open and add as many of the items as needed. Simply click on the grid with the blue arrow and it will open the label

box allowing you to label the item.

Dynamic Groups Continued

When the label box is opened you must select the site, size, and type. All three are not always required but you

can’t select OK until required fields are complete. When you have completed the selections click OK and you will

return to the flowsheet.

Dynamic Groups Continued

When you return to the flowsheet you can chart on that item. The answers you selected become the name of

that dynamic group. You can add as many groups as needed as long as you label each one. If you do not label

each item you will not be able to sign the charting.

Customizing Your View

To customize your view to add or take away an item from your flowsheet (such as adding a route of urine output)

you select the Customize View Icon

Customizing Your View Continued

When the customize window opens check each item that you want to add to your flowsheet and select

OK. To take away items that you do not need on your flowsheet (if they have never been documented)

take the check mark out of the box. When you return to your flowsheet it will be updated .

Reference Text

Click on Reference text (blue text) to open

the reference text window. Reference text

provides charting guidance, care plan

information, or policy and procedure. To close

the window click OK.

Nurse Collect

Hovering over the Need to Collect/Task Description area causes the Container View description pop up box to

appear. This box displays the specimen collection information sorted by the required container. If you click on the

Order View button, the pop up box changes to reveal the same collection information sorted by the specific labs

ordered.

Nurse Collect/Collections InquiryNurse Collect/Collections Inquiry

When collecting laboratory specimens, go to the Nurse Collect tab on the task list. The routine and AM labs will populate

the Nurse Collect tab 10 minutes before it is due to be collected. Urgent, Emergent and some Time Study labs will

populate the Nurse Collect tab immediately. Once you have collected your labs click on the yellow square and complete

the lab you are submitting. If for some reason you were not able to collect one of the specimens uncheck that box, then

click OK. If you want to see what is due throughout your shift click on Collections Inquiry at the top right of the page.

When you collect the lab make sure you complete the task before you send the blood to the lab or the lab will not run it.

When collecting laboratory specimens, go to the

Nurse Collect tab on the task list. The routine and AM

lab task will populate the Nurse Collect tab10 minutes

before it is due to be collected. Urgent, Emergent,

and Timed Studies as appropriate will populate the

task list immediately. Once you have collected the

specimens, click on the yellow square and sign off the

collected labs. You must complete the task on the

task list or the lab will not run the test.

The collections associated with the chosen task will have check marks defaulted in the box beside them. If you were

unable to collect all specimens seen in the window, uncheck the items you were not able to collect. Then, click OK. To

see what collections are due during your shift, click on Collections Inquiry in the top right of page. The list of all labs

ordered will open. If you have the same task twice on the task list, look at the orders and be sure it really is a duplicate.

If it is a duplicate complete one and then chart ―not done‖ on the other task.

Nurse Collect/Collections Inquiry Continued

When you click on Collections Inquiry, the screen

above opens. It contains a list of all the ordered labs

for a patient. The status of Dispatched means the

label has already printed and a task should exist. The

status of Pending is a future lab collection. Click on all

of the labs for which you need labels and tasks or

replacement labels. Then, select the correct label

printer for your unit. Next, select Labels and the

window to the right opens up. Click Print. If you are

drawing labs early, when you print your labels early it

will cause the task to fire early so you can complete it

prior to sending the specimen.

Point of Care Testing

Point of Care Testing (POC)

POC testing results will be located on the lab results tab of the chart. These include Glucose, Hemoglobin,

Hematocrit, ABG’s, and some Chemistries.Accucheck results will display in the Chemistry Section of Lab Results. These results flow automatically when the machine is

docked and the full patient account number is entered correctly. The full account number must include leading zeros and the

last four suffix numbers. DO NOT enter the patient’s MRN. You MUST also enter at least one comment in the Accucheck

machine. Every patient test must include the comment ―meter cleaned‖. Please add any additional comments as appropriate.

Specimens resulted utilizing IStats will display in the Hematology, Chemistry, or ABG bands depending upon the test resulted.

They will have ―POC‖ listed in front of the test name to distinguish them from a specimen resulted by the laboratory.

Other Point of Care test results such as Rapid HIV, Urinalysis and ACT, will be in the Point of Care Testing section.

To create new or view existing graphs of numeric data for a patient, go to the Graphs tab. Existing graphs available

to all users are BMDI Acquired Data, Intake & Output Totals and Standard Graph Vital Signs graph. To see the

graphed data, select the desired graph from the available options and the data (based on the data charted for the

time period identified at the top of the graph window) will generate as illustrated above. Multiple graphs can be

displayed at the same time in the graph window, but you may need to scroll to see each one. This band functions

the same for ICU and Med/Surg area.

Graphing

Create graph

icon

Graphing

To graph go to the Graphs tab and select the graph you want to see. Select the elements you want graphed and the

graph will generate to the right. You can graph BMDI, Intake and Output and Vital Signs Graph to populate all at one

time but you will need to scroll to see each one. This is the same for ICU or Med-Surg.

Administering IV Piggy Backs Over Time

When administering IV medication intermittently, check to see that the Infused Over box has a time displaying. If it does

not already have a time populated by the pharmacy, add the amount of time that you want the medication to infuse

over, for example 6 hours is 360 minutes. If no time is defined, the full medication volume will chart at one time.

Administering IV Piggy Backs Over Time, Continued

When the Infused Over time is entered correctly, the medication will be divided evenly over the defined period. In the

example above, infusing the medication over six hours will document 42 ml on the I & O for each of the six hours.

Confirming Intermittent IV Medication on the I&O Tab

The volume to infuse each hour will populate the I&O tab with a checkmark and a question mark beside it. As the

time becomes current time or past time the checkmark becomes green and the question mark becomes blue.

They will stay these colors and serve as a reminder to the nurse to confirm the intake as it actually infuses. The

nurse confirms the results by right clicking on the amount and selecting confirm for that infusion volume and

question mark disappears. If the nurse does not confirm the infusion the checkmark and question mark continue

to display and the volume will not be added to the I&O totals. (You do not have to confirm each hour as it occurs,

you can wait until the infusion completes or you are ready to do your shift totals to confirm the amounts.)

Documenting PCAs

To begin bag, open the chart details box and complete the required fields, Remember the dose

per hour and the rate/volume per hour are not the same unless the concentration is 1:1. Fill in the

dose and the unit of measure (mg/hr, kg/mcg/hr, etc.). Basal rate in this example is 2 mg/hr.

Documenting PCAs

After the dose of 2 mg/hr is entered, the rate of 10 ml/hr fills in automatically. Once all fields are

completed, click Apply and then the green check mark to return to the MAR.

CPOE Orders Management PolicyThe CPOE Orders Management Policy determines the conditions under which nurses can enter orders. All nurses

must be familiar with the orders Management Policy and Provisions. The policy covers emergent events, PowerPlan

initiation, verbal orders, conditional orders/protocol orders, suspending orders when transferring between units,

canceling/reordering labs, etc. A copy of this policy is located on each unit in the CPOE reference Manual.

Ordering Labs

The Pathology Lab manual is a reference manual

located on the MCG Home Page which includes

information such as names of tests, common

names and abbreviations, type of tube & volume

of specimen required for testing, special

requirements for transporting specimen to lab,

reference or ―normal‖ ranges for result

interpretation & any notes pertaining to patient

care, causes for rejection, turnaround time or

approximately when results should be expected,

etc.

Laboratory specimens are cancelled for a variety of reasons. Some of the more common reasons for cancellation

•hemolyzed

•quantity not sufficient (QNS)

•improper transport (i.e. Ammonia or Lactic Acid not on ice, Methotrexate not wrapped in foil)

•incorrect specimen container

•labeling issues (name on labels sent with specimen and label on specimen do not match, unlabeled

specimens)

To get a label for a lab that must be re-drawn, right click on the original lab order entered by the physician and

choose ―Copy‖. The collection priority should be ―Timed Study‖ and the Collection Start date/time must be the

current date and time. This will ensure you get a label immediately after ordering.

The specimen label includes the information about the patient, the accession number, the test ordered, the container

required, the ordering physician and the order priority.

Completing the Specimen Label

**Only use ballpoint pens on the specimen labels. Lab will reject your sample if the label smears.

Make sure the proper label is being used. The accession

number will match the task. You can look at the task details to

identify the correct accession number.

Accession

Number

PRINT the date and time of the Specimen collection, not the

task time. This must match what you enter as the performed

date/ time on the task list.

PRINT your username—this is your PowerChart login name.

Label the specimen container according to the instructions

available in the unit resource manual. Some examples are in the

following slides. Send all pieces of the label with the specimen to

the lab, even if you think you have extra parts.

If you have more than 1 label which requires the same specimen

container, a single specimen can be sent with all the labels in the

bag if the samples all go to the same processing lab and the

sample is of a sufficient quantity. Make sure one of the labels is

attached to the specimen.

Quick Facts on Laboratory Label Printing

If a laboratory test is ordered with:

Routine Priority with no Frequency and no DurationLabels: The specimen labels will qualify to print at the next scheduled Collection List time if the specimen type is Blood or Urine. Any other specimen type will print immediately. Collection times are: ICU every even hour, non-ICU 0400, 1200, 1700, 2200 and Behavioral Health 0700.

Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/RT will be able to view this task at the appropriate time.

This order will not repeat.

Routine Priority with ONCE frequency (Duration not applicable)Labels: The specimen labels will qualify to print at the next scheduled Collection List time if the specimen type is Blood or Urine. Any other specimen type will print immediately. Currently the non-ICU times are 0400, 1200, 1700, 2200; ICU times are every even hour; Behavioral Health is 0700.

Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/RT will be able to view this task at the appropriate time.

This is a one time order.

Routine Priority with AM LAB, MTH LAB, MWF LAB, TTHSA LAB Frequency with no Duration TimeRoutine should always have a designated Duration and Duration Unit. Without the defined duration, the lab will be ordered for every defined day until the order is discontinued or patient discharges.

Label: The specimen labels will print at the scheduled AM collection time designated by the unit if the specimen type is Blood or Urine. Any other specimen type will print immediately. Contact the nursing unit for the specific collection times. Collection times are: ICU 0200, non-ICU 0400 and Behavioral Health 0700.

Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/RT will be able to view this task at the appropriate time.

Quick Facts on Laboratory Label Printing Continued

Routine Priority with AM LAB, MTH LAB, MWF LAB, TTHSA LAB Frequency with Duration TimeRoutine should have a designated Duration and Duration Unit.

Labels: The specimen labels will print at the scheduled AM collection time designated by the unit if the specimen type is Blood or Urine. Any other specimen type will print immediately. Collection times are: ICU 0200, non-ICU 0400 and Behavioral Health 0700.

Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list print time. The nurse/RT will be able to view this task at the appropriate time.

Timed Study Priority with Q Interval Frequency with Duration TimeTimed Study must always a Start date and TimeTimed Study must always have a designated Duration and Duration Unit.

Labels:With a Start Date & Time entered as Today & Now – the first specimen label will print immediately. The remaining orders (if the Duration is>1 time) will print with the closest previous Collection List to the time set by the interval time assigned to the order if the specimen type is Bloodor Urine. Any other specimen type will print immediately. If the assigned time for any of the remaining orders is after the closest previous list hasprinted, the label will print immediately.

With a Start Date & Time entered as a specific date & time – the label will print with the closest previous Collection List to the time set by theinterval time assigned to the order if the specimen type is Blood or Urine. Any other specimen type will print immediately. If the assigned time forany of the remaining orders is after the closest previous list has printed, the label will print immediately.

Tasks: The Nursing and/or RT collection task will fire when the order is placed and will show a collection time equal to the collection list printtime. The nurse/RT will be able to view this task at the appropriate time.

Urgent Priority with ONCE Frequency (Duration not applicable)Urgent Priority can ONLY be used with the Frequency of ONCE.

Labels: Specimen labels will print immediately.Tasks: Nursing/RT collection task will show immediately.

Emergent Priority with ONCE Frequency (Duration not applicable)Emergent Priority can ONLY be used with the Frequency of ONCE.

Labels: Specimen labels will print immediately.Tasks: Nursing/RT collection task will show immediately.

How to read and complete a laboratory specimen label

Collection Date

Collection Time

Priority

Cerner Username

Patient name & MRN

Tube Type

Tests Ordered

Ordering Physician

Collection Tube Label

Accession Number

Aliquot Labels

Laboratory Specimen

label sets are divided

into 3 areas:

Demographic Label

Large label on top of

the label set

Specimen Tube

Barcodes – 1 to 2

tube labels per label

set

Aliquot Labels - 4

aliquot labels for lab

use or for

Microtainers.

Only use aliquot labels on

0.5mL microtainers

Examples of Properly labeled tubes:

This slide shows examples

of incorrectly labeled specimens

Multiple labels on one tube

Best Dressed Tubes Chart from Beckman Coulter TOP Training CD