Epic Inpatient Clinical SystemsFundamentals

Epic Inpatient Clinical SystemsFundamentals Name of first screen that user sees when they log in - Answer Startup activity List of patients that I am following - Answer My List A list of patients that is automatically updated by the system - Answer System List Tabs along the left of the screen in a patient's chart - Answer Activities How can you tell there is an abnormal value? - Answer appears in red Schedule - Answer list of scheduled surgical cases as well as outpatient appts- 1st startup activity that surgeons see Patient List - Answer all admitted patients you are assigned to Patient header - Answer bar across the top of the patient workspace- key pieces of info are here (mrn, allergies, etc.) System list shortcut - Answer Accordion Report - Answer allow you to drill down and trend patient info- only info from the current admission, useful for patients in the ICU or PACU, customizable Intake/Output activity - Answer view-only activity used to review a patient's daily intake and out put in table or graph format Time Mark - Answer indicate that they've already seen the notes documented up to this point File Time - Answer time the user clicked Sign and saved the note to the patient's chart Note Time - Answer time note was composed modify an order - Answer actually means the original order is canceled or discontinued and a new order is placed discontinue an order - Answer orders that are no longer needed or are being replaced pended order - Answer saved order that has not been signed preference list - Answer most commonly placed orders for a given unit or specialty synonym - Answer different name for same order- use things like brand names, mnemonics EnRol - Answer Enhanced Record Lookup- search against the first few letters Order requiring cosign - Answer orders that the physician has to review and give a final stamp of approval. principal problem - Answer main reason for the patient's admisssion chronic problem - Answer ongoing problems that will not be resolved before discharge NoteWriter - Answer document patient's progess & current condition using point and click functionality Macro - Answer predefined set of values that can be pulled into a note with a click of a button Why is it important to update the Problem List? - Answer current hospitalization, multidisciplinary care, future care, decision support, billing, notes, my chart, meaningful use Incomplete vs Signed - Answer How can physicians ensure they're accurately billing the patient? - Answer -sign notes, be sure correct problem is identified, review charges acknowledge orders - Answer you have seen the order work list view and filter - Answer tool to help nurses view and prioritize the task they need to complete during their shift How does adding yourself to the treatment team help maintain the system list? - Answer When should a clinician remove themselves from the patient treatment team? - Answer when no longer assigned, transfers to new unit, assignment made in error What's the purpose of sticky note communication? - Answer communicate info that shouldn't become a permanent part of the patient's medical record multi vs single patient work list - Answer Multi patient is accessed through Patient Lists Single patient is accessed through the Patient's chart applying a filter vs changing the view - Answer MAR - Answer not a review tool, intended for documentation PRN medication - Answer given as needed, must include a reason for when the med should be administered dual sign off - Answer a second nurse must verify the rights , !! on MAR overdue dose - Answer not given within an hour of due time, not automatically marked as not given Willow Inpatient Pharmacy