VeHU Class 180

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VeHU Class 180

• New Documentation  Charting the Patients Course

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HOUSE KEEPING

• This is a 1.5 Hour Class
• Restrooms are located
• Cell Phones
• Please turn off or change to vibrate
• If you must answer a call, please leave the room.

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HOUSE KEEPING

• Please,
• No questions during the presentation.
• Questions written on the 3X5 card will be
  answered at the conclusion of the presentation.
• For questions not answered,
• the question and the answer will be available on
  the web.

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Faculty

• Danielle Colucci, RN/MSN
• New York Harbor Healthcare System (Manhattan
  Campus)
• Nursing Informatics Coordinator
• Dan Petit
• Hines, IL VA
• Office of Information Computer Specialist

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Class 180 Overview

• The Vitals Interface with CASMED
• Danielle Colucci
• Clinical Flowsheets
• Dan Petit

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Objectives CASMED Interface

• Brief Overview of the interface developed for the
  CasMed 740 device (Patch GMRV57)
• Description of the functionality at NYHHS
• Lessons learned

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CASMED 740

• CASMED 740 measures
• Blood Pressure Readings
• Pulse (Heart Rate)
• SpO2 (Pulse Oximetry)
• Temperature

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History

• January 2005 CasMed monitor is nationally
  approved for interfacing vitals with CPRS (in
  areas outside the ICU setting).
• July 2005 Frank Traxler, a programmer from Hines
  OIFO, enlisted integrated sites to test a new
  interface between the Vitals GUI application and
  the CASMED vitals signs monitor.
• July 2005 NYHHS begins participating in the
  pilot as the representative for VISN 3. The
  Patch GMRV57 v3 was installed in the production
  account
• August 2005 The GUI Program was installed on
  workstations in Primary Care and also ER Triage
  for testing.
• August 2006 IRM began a pilot with the CasMed
  mounted to the Flo Cart on the Med/Surg Units.

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Functionality of Patch GMRV57

• Modifies the Vitals Graphical User Interface
  (GUI) software to query a CASMED 740 vital signs
  monitor.
• Retrieves data provided by that monitor and
  displays the data it in the Vitals Input
  template.
• The user can complete the data entry and then
  save it to the vitals database.

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Patch GMRV57 How does it work?

• The workstation must be connected to the CasMed
  400 by a cable.
• The CasMed can hold up to 480 Readings and purges
  itself every 24 hours.
• The interface will only ask for the current
  readings on the device.
• The interface does not provide for batch
  downloads of data.

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What if

• What if there was a way to eliminate the need to
  transcribe? What if we could use technology to
  save time and eliminate transcription errors?

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Benefits

• Prevention of transcription (documentation)
  errors
• A transcription error is defined as, A specific
  type of data entry error that is commonly made by
  human operators. Human transcription errors are
  usually the result of typographical mistakes
  caused by striking the wrong key on a keyboard,
  or by striking two or more wrong keys because of
  finger misalignment with respect to the
  keyboard.

http//searchsqlserver.techtarget.com/sDefinition/
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Benefits

• Ensures timely entry of Real Time Vitals at the
  Point of Care!
• Increases efficacy of documentation!

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Benefits

• Joint Commission National Patient Safety Goals
• Requirement 1A
• Use at least 2 patient identifiers when
  providing care, treatment or services

Scan the patients wristband to bring up the
record and then take the vital signs.
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CASMED Interface Flowchart
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CASMED Interface Flowchart
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If the CasMed Monitor is not turned on or
connected to the PC, the user will get an error
message
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The Read Monitor Button addition to Vitals GUI
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Old Toolbar
New Toolbar
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What if..
..the CasMed could be mounted to the Flo Cart?
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Mounting Solution for Flo Cart
Easy Slide Capability for Quick Removal from the
Flo Cart
Mount with Temperature Probe on the inside of the
cart
Delrin Mounting Device
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In order to connect the CAS Med Monitor to the
new FLO cart, a set of three cables was needed
for each cart
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1
3
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Where are we now?

• Primary Care and ER Triage are utilizing the
  interface
• BioMed is in the process of ordering the cables
  and mounting devices for the Flo Carts on the
  Med-Surg Units

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Lessons Learned

• Importance of Interdisciplinary collaboration!
• Significance of designating a team leader.
• Impact of training!
• Magnitude of time saved!

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Lessons Learned

• Interdisciplinary communication is a key to
  successful implementation
• Significance of designating a team leader

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Impact of Training on Staff

• Staff training on the Read Monitor button
• Staff were hesitant to start something new

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Lessons Learned

• Promote the value of RTV (real time vitals)

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Conclusion

• In conclusion
• We are blessed with the opportunity to work in
  conjunction with many talented and driven
  programmers. Without their hard work and
  innovative ideas, there would be no creation of
  patches such as the CASMED Interface.
• Staff and patients alike both benefit from these
  cutting edge point of care technologies.
• For questions re the CASMED Interface, please
  contact

Frank Traxler Programmer Hines VA, CIOFO
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Clinical Flowsheets
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Clinical Flowsheets Then
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Clinical Flowsheets Today
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Add Data

• Input form is dynamically created from the view
  definition.
• Data validation is done utilizing standard
  terminology.
• Filters defined for the observations in the view
  are also applied to the input form and applied at
  the observation level during input.

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Add Data
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Corrections

• Corrections are done by selecting the erroneous
  observation directly from the flowsheet.
• Users may edit their own observations but not
  others without the MD MANAGER role being
  assigned.
• Complete audit trail is kept for every change to
  an observation

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OOPS, Gotta make a correction
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Pivot

• Pivot is a method of switching the axis that
  displays the times and terms.
• Totals are only displayed when the x-axis is set
  to Terminology List.
• This feature can be locked out at the view level.

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Pivot
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Alarms

• Alarms are in place to mimic a sticky note or a
  scribbled reminder placed on the paper flowsheet.
• They are patient specific.
• Based on standard terminology so they are unit of
  measure independent.

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Alarms
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Alarm Message
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Reports

• Dynamically built from the flowsheet definition
• Output to any Windows printer available to the
  workstation
• No corrected observations included for a clean
  final copy
• Individual comments can be included if desired
• Available to the CP Note Writer for submission
  into Progress Notes.

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Reports
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And Finally!

• Questions ?
• Queries ?
• Posers ?