New updates and changes within eStar announced
Included below is a summary of some of the largest changes within eStar over the last several days (as well as some that are scheduled to be completed soon):
PRN Analgesia
Changes were made in mid-April to ordering PRN analgesia within eStar. These changes have been made to avoid therapeutic duplication or indications that overlap. Joint Commission standards and VUMC policy (CL 30-06.10) require PRN orders to have indication for use with clear instructions.
Changes to ordering PRN analgesics include:
- Associating words “mild, moderate, and severe” with pain scale
- Removing “mild pain” option for opiate medications
With the change, PRN analgesia now require selection of a checkbox, rather than just entering comments. This helps ensure pain assessments are performed. Clinicians should select “Pain – see pain scale in comments” if not using a checkbox with a pre-defined scale.
Clinicians should remember to complete all required fields when ordering PRN analgesics. They may also update their preference lists, as needed, to include this change.
Additional information is available in the Tip Sheet “Changes to Ordering PRN Analgesics” (available from within Learning Home Dashboard or Hubbl).
Orders Review
One of the requested changes from the Hospital Discharge workgroup was an update to viewing how and where discharge prescriptions are routed. New functionality allows for clinicians to view the status of medications ordered for discharge.
- Routing method can be viewed in the “Class” column
- Destination pharmacy can be viewed in the “To Pharmacy:” column
Additional information is available in the Tip Sheet “Status of Discharge Prescriptions” (available from within Learning Home Dashboard or Hubbl).
Medication List Updates
Recent updates to medication lists within eStar will help clinicians quickly document most accurate reason for discontinuing medications. These changes include:
- New default (“quick”) discontinue reason buttons for Therapy completed, Duplicate order, Entry error and Side effects.
- Inpatient Prior to Admission (PTA) Medication List now filtered by discontinue reason Entry error
- “Delete” button in Admission Medication Reconciliation navigator can now be used to instantly remove erroneous medications from PTA Medication List
- Erroneous medication no longer displays for inpatient medication reconciliation or at discharge
- Outpatient After Visit Summary (AVS) medication list now filtered by discontinue reasons Therapy completed, Duplicate order and Entry error
- Medications discontinued for these reasons will not print on AVS
These changes were implemented to:
- Optimize the inpatient PTA list Admission Medication Reconciliation process, by not requiring providers to address medications deemed as entry errors
- Provide patients in VUMC clinics with cleaner, less confusing information by not instructing them to “stop taking” medications they already stopped (or never started) taking
A few items to consider:
- Medication list discontinue reason buttons can be added/ customized by clicking on wrench icon
- During inpatient Admission Medication Reconciliation, clicking “Delete” button will automatically discontinues medication with discontinue reason of Entry error (note: other clinicians who may see “Remove NOW” button should not use this discontinue reason)
- Clinicians should select the correct discontinue reason to ensure accurate medication list on outpatient AVS
- Changes made to medication list after printing AVS must be communicated to patient
- For patients with multiple outpatient encounters on same day, AVS reports for these visits will show net medication changes with each change labeled with provider who made change
Update to Patient Report and Current Meds and Results (CMR)
Effective Thursday, April 19, several changes will be made to the Patient Reports List and the CMR. These are being implemented to add necessary information, improve formatting, and reduce the number of printed pages.
A new, condensed version of the CMR report includes:
- Header for every page
- Admission weight
- Updates to allergy display
- Reorganization of medications meds
- Reorganization of vital signs, with most recent first and addition of averages
- Removal of list of Active Orders
- Reconfiguration of lab display (to show last four results, looking back over previous four days)
- Addition of Radiology orders over last 48 hours, as well as their status
This condensed version will now serve as the default selection (instead of Scratch census) from the Reports dropdown. The original (long version) CMR of the report can be located at the bottom of the Patient Reports list.
Additional Changes
The team has deployed additional changes, as indicated below, that will impact inpatient clinicians. Tip Sheets for all of these are available via the Learning Home Dashboard (as well as Hubbl):
- Vital Signs report available in sidebar
- Helps improve tracking and trending of vital signs over encounters
- See Tip Sheet “Vital Sign Report & Cross Encounter Vital Signs Report
- New chart review quick filter to more easily locate labs in progress
- See Tip Sheet “Chart Review Quick Filter: In Process Lab”
- Clarifications to specialty diet order
- See Tip Sheet “CHANGE to Specialty Diet Order”
- Work/school excuse now in inpatient discharge navigator
- See Tip Sheet “Inpatient School/Work Excuse section of the Discharge Navigator”