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<div> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">APS Workflow</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt">This document will take the user through:</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <a href="#adding_a_patient_to_the_APS"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Adding a patient to the APS service</span> </a> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <a href="#Rounding"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Rounding on the APS</span> </a> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 72pt; text-indent:-18pt"> <span style="font-family:'Courier New'; font-size:11pt">o</span> <span style="font:7.0pt 'Times New Roman'">       </span> <a href="#Modifying_Orders"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Modifying an Order</span> </a> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <a href="#Transitioning"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Transitioning patient off the APS+/- Follow Up list</span> </a> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <a href="#Transitioning"/> <a href="#Inpatient_Consultation"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Completing an Inpatient APS consult </span> </a> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <a href="#Inpatient_Consultation"/> <a href="#telephoneassess"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Following an APS patient discharged from hospital (telephone assessment)</span> </a> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">When a decision is made to place a patient having surgery on the APS, it is </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">VERY IMPORTANT </span> <span style="font-family:Calibri; font-size:11pt">that the surgical service NOT place any orders in the following classes:</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <span style="font-family:Calibri; font-size:11pt">Analgesics</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <span style="font-family:Calibri; font-size:11pt">NSAID’s</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <span style="font-family:Calibri; font-size:11pt">Sedatives</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <span style="font-family:Calibri; font-size:11pt">Anti-pruritics</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Symbol; font-size:11pt">·</span> <span style="font:7.0pt 'Times New Roman'">        </span> <span style="font-family:Calibri; font-size:11pt">Anti-emetics</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Any surgical orders written before the APS orders will TRUMP the APS orders.  In this scenario, the anesthesiologist should receive notification that drugs contained in the above classes have already been ordered.  In this case, the anesthesiologist will  have to DISCONTINUE these drugs so that the APS drug orders are in force during the APS phase of care (you will see how to discontinue orders in this document).</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">At Go Live, there will likely be confusion in that the surgical service may not choose to order any pre-admission patient meds, leaving everything to you.  This is NOT the case.  APS policy states that a patient may continue to receive their usual anti-depressants, anti-psychotics, anxiolytics, anti-convulsants and benzodiazepenes unless otherwise ordered by the anesthesiologist.  Translated, the surgical service can order these drugs.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a name="adding_a_patient_to_the_APS"/> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">Adding a patient to APS</span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt">in EPIC will be a two-step process</span> </p> <ol type="1" style="margin-bottom:0pt; margin-top:0pt"> <li style="font-size:11pt; line-height:107.92%; margin-bottom:8pt; margin-top:0pt"> <span style="font-family:Calibri; font-size:11pt">Completing the Acute Pain Service Orders</span> </li> <li style="font-size:11pt; line-height:107.92%; margin-bottom:8pt; margin-top:0pt"> <span style="font-family:Calibri; font-size:11pt">Completing the APS consultation</span> </li> </ol> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">While in the Intraprocedure workspace, click ‘Orders’ in the toolkit.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-1.png" width="714" height="390" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> <span style="font-family:Calibri; font-size:11pt">Use “aps” as a keyword.  Once you find the ORDER set, you should favourite it.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-2.png" width="864" height="472" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-3.png" width="863" height="501" alt="C:\Users\DAMISK~2\AppData\Local\Temp\SNAGHTMLf617522.PNG" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">The next three screen shots show the extent of the APS order set.  All nursing interventions are ticked off by default.  As with other order sets, you will learn to customize in Personalization so that you don’t need to fill out your preferred options repeatedly.  You will even be able to make multiple variations of a particular order set (including a blank version).  If you don’t like the default dosing of a drug, feel free to change.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Notice the default order </span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">“General\Admission\Patient on Acute Pain Service (APS)”.  </span> <span style="font-family:Calibri; font-size:11pt">This selection is responsible for getting the patient onto the</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold"> “CIV” or “GEN APS Active Patients”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-4.png" width="864" height="470" alt="" style="border:none"/> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-5.png" width="864" height="472" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-5.png" width="864" height="472" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Once you have completed the orders, hit </span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">“Sign” </span> <span style="font-family:Calibri; font-size:11pt">at the bottom right.  Your patient will be admitted to the APS immediately (you will be able to see patient on the “CIV/GEN APS Active Patients” roster) and your orders will become active once the patient is admitted to the PACU.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Now, you need to document your </span> <a name="APS_Consult"/> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">APS Consult</span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt">note.  Hit “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Go to</span> <span style="font-family:Calibri; font-size:11pt">” and select “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-6.png" width="864" height="472" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">This will take you to the APS navigator.  This is where you will also access APS rounding notes, a generic anesthesia consult note and progress notes.   </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">The steps below illustrate how to create a speed button to take you to the APS Consult note.  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">1.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">Hit the wrench in the Consult note section and it will open up the speed button workspace.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">2.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">Hit the magnifying glass and begin typing “ATL AN APS INITIAL” and you will find ONE match.  Accept this selection and you will have created a speed button</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-7.png" width="864" height="406" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-8.png" width="864" height="470" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Notice that the patient has been identified as being on the Acute Pain Service (from the initial order set created in the OR)</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Hit the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS Consult” </span> <span style="font-family:Calibri; font-size:11pt">speed button or “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Consult Notes\+Create Note in Notewriter</span> <span style="font-family:Calibri; font-size:11pt">” and you are presented with your consult note.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-9.png" width="864" height="470" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> <span style="font-family:Calibri; font-size:11pt">Notice the </span> <span style="background-color:#ffff00; font-family:Calibri; font-size:11pt">yellow</span> <span style="font-family:Calibri; font-size:11pt"> highlighting.  These are “</span> <a name="smartlists"/> <span style="font-family:Calibri; font-size:11pt">smart lists</span> <span style="font-family:Calibri; font-size:11pt">”.  It looks like a bunch of crazy syntax but it is going to allow you to choose from pre-determined text.  To complete, place your cursor over the first </span> <span style="background-color:#ffff00; font-family:Calibri; font-size:11pt">yellow</span> <span style="font-family:Calibri; font-size:11pt"> shading (in this case, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Consult Type</span> <span style="font-family:Calibri; font-size:11pt">” and hit </span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">F2</span> <span style="font-family:Calibri; font-size:11pt">.  You will get a list of options from which to choose.  A </span> <span style="background-color:#ffff00; font-family:Calibri; font-size:11pt">yellow</span> <span style="font-family:Calibri; font-size:11pt"> drop down-indicates you have one choice.  A </span> <span style="background-color:#00ffff; font-family:Calibri; font-size:11pt">blue</span> <span style="font-family:Calibri; font-size:11pt"> drop down-multiple choices.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">When obvious, we have put the most common response as the default selection.  Hit the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">enter</span> <span style="font-family:Calibri; font-size:11pt">” key and you will move on to the next smart list.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Hit “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Control-Z</span> <span style="font-family:Calibri; font-size:11pt">” or back arrow if you need to go back.  If a drop down list consists of wild cards (***), this will allow you to add text NOT available in a particular list.  If you select wild cards as your option, you MUST type something in lieu of the ***, otherwise you will not be able to sign the note.  You can also free text in your note.  Place your cursor outside any blue or yellow highlighting and enter relevant information.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">This will take some getting used to.  If you really mess things up, just cancel the note and start again.  “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Sign</span> <span style="font-family:Calibri; font-size:11pt">” the note when complete  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-10.png" width="788" height="413" alt="" style="border:none"/> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">A charge capture window now displays.  At the present time, both the Civ and Gen rely on the provider in the OR to bill for the APS Consult.  Therefore, click “Cancel Session” to move past this requirement.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-11.png" width="864" height="470" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You have now satisfied the two prerequisite steps to admit to the APS.  Orders have been generated and the patient now resides on the list.  Complete all other required intraprocedure documentation.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-12.png" width="864" height="472" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a name="Rounding"/> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">Rounding on the APS</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">The Patient List status board allows us see patients currently assigned to the APS.  You will favourite this list so that is easily accessible.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-13.png" width="718" height="485" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="background-color:#00ff00; font-family:Calibri; font-size:11pt">Highlighting</span> <span style="font-family:Calibri; font-size:11pt"> the patient (not double clicking) will show relevant information at the bottom of the screen under “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Anesthesia Summary”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Hit the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS</span> <span style="font-family:Calibri; font-size:11pt">” button to navigate to the APS navigator (should look familiar from when you completed the APS consult).</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-14.png" width="677" height="470" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Now we are back in the APS Rounding Navigator. Unlike ACUPAM, the APS Consultation and daily progress notes will live under separate tabs.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Notice how the APS Consult note completed in the OR lives in the “Consult Note” section.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-15.png" width="864" height="430" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Now it’s time to round on the patient.  There are two ways to open up a new APS note.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">1.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">Click on “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">+Create Note in Notewriter</span> <span style="font-family:Calibri; font-size:11pt">” or </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">2.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">use the speed button that you have created, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS Rounding</span> <span style="font-family:Calibri; font-size:11pt">”.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-16.png" width="909" height="329" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt">Create your note using the appropriate sections (APS Rounding, IV PCA Use, Neuraxial block,…..)  </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">PLEASE REMEMBER TO USE THE PULL DOWN TO LABEL THE SERVICE AS “</span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">Acute Pain Service</span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">”.  This will allow easy filtering of all notes when doing APS Rounds</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt">Any button you hit forces text to your note.  There is also a summary box in every section to allow for free text.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-17.png" width="642" height="255" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt">When you have completed your note, click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Sign</span> <span style="font-family:Calibri; font-size:11pt">”.  You will be now be prompted to bill your visit.  Document the billing provider and select “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">+Add</span> <span style="font-family:Calibri; font-size:11pt">” to bring up the preference list to drop charges.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-18.png" width="566" height="196" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Select the appropriate charges and click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Accept</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-19.png" width="443" height="259" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You will be prompted for a diagnosis.  This must be completed as MOHLTC will not accept these charges without a diagnostic code.  Click on the Dx icon (link).</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-20.png" width="415" height="239" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt">You are presented with a list of problems that are currently on the patient’s problem list.  If you don’t like what you see, you can add a diagnosis.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 72pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-21.png" width="562" height="245" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 72pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:14pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt">Click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Add diagnosis </span> <span style="color:#538135; font-family:Calibri; font-size:14pt; font-weight:bold">+</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">” </span> <span style="font-family:Calibri; font-size:11pt">type</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold"> “pain” </span> <span style="font-family:Calibri; font-size:11pt">and enter.  Select</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold"> “pain” </span> <span style="font-family:Calibri; font-size:11pt">from the match and click “Accept” (not pictured)</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 72pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-22.png" width="864" height="146" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 72pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt">Charge capture block re-appears with the new diagnosis. Click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Accept</span> <span style="font-family:Calibri; font-size:11pt">” and you’re done with current note.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-23.png" width="466" height="216" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <span style="font-family:Calibri; font-size:11pt">Notice the list of progress notes in the navigator with all progress notes for this patient and the body of my most recent note visible.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-24.png" width="580" height="272" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">It is very common for an APS nurse to document a note on the patient.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">In this case, it is critical that the APS nurse tick, “Cosign required”</span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt">(in this example, we are assuming that Sylvain Boet is the RN).</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-25.png" width="340" height="208" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">When the note is now opened by another user, the APS progress note by the RN (or anyone else) will appear.  Notice “Cosign Needed” </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-26.png" width="396" height="297" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">As the supervising physician on the APS, I can now edit, copy, Cosign or Attest the note.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-27.png" width="599" height="267" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a name="Modifying_Orders"/> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">Modifying Orders on the APS</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">One of the most common things we do on the APS is to make adjustments to the APS regiment.  From within the APS navigator, click on “Manage Orders” or click on the “Orders” icon.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-28.png" width="864" height="470" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Go to the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Active tab</span> <span style="font-family:Calibri; font-size:11pt">”.  There would typically many orders in addition to those for the APS.  You may want to filter orders by “Phase of Care”.  The Acute Pain Service is a virtual phase of care created for TOH by EPIC.  Only the current active APS orders will appear.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-29.png" width="864" height="293" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">It is decided that the patient may benefit from Pregabalin and Nabilone.  Neither drug was originally ordered and we cannot modify the original order sheet.  You have several options but the most reliable one would be to use a Quick list that exists specifically for the APS.  Click on “Q</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">uick List</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-30.png" width="551" height="146" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Select “Acute Pain Service” and you will see a wide selection of meds that are specific for the APS Phase of Care.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-31.png" width="777" height="421" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Depending on the medication order, a Rx box regarding the specifics of the order will appear.  In other situations, we have defaulted the specifics and they automatically move to the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">New Orders</span> <span style="font-family:Calibri; font-size:11pt">” section.  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Click on </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">Pregabalin</span> <span style="font-family:Calibri; font-size:11pt">.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Confirm that you are ordering the correct dose, correct route, correct frequency (if the frequency is incorrect and the appropriate dosing schedule is not presenting as a quick select, use the magnifying glass to find the correct frequency).  If you need to specify a time limit, then use the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">For</span> <span style="font-family:Calibri; font-size:11pt">” and select either doses, hours, days.  Click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Accept</span> <span style="font-family:Calibri; font-size:11pt">” to move the order to the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">New Orders</span> <span style="font-family:Calibri; font-size:11pt">” section.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-32.png" width="589" height="441" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Click on </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">Nabilone</span> <span style="font-family:Calibri; font-size:11pt">.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-33.png" width="299" height="218" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">The order went directly to “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">New Orders</span> <span style="font-family:Calibri; font-size:11pt">”.  Sign the orders once you are done making modifications.  Notice the specifics.  If you are not happy with the default dose, click the link to open and make the required changes.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">At this point, your new orders may not be active but moved to “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Signed and Held</span> <span style="font-family:Calibri; font-size:11pt">”.  This allows the RN to peruse any new order on a patient.  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-34.png" width="569" height="263" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">The RN will release the orders and they will then be found in the “Active” section.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-35.png" width="567" height="224" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Modifying an active drug uses the same concept described above. If you decide you want to “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Discontinue</span> <span style="font-family:Calibri; font-size:11pt">” a drug, then click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Discontinue</span> <span style="font-family:Calibri; font-size:11pt">”.  It will appear as “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Orders to Discontinue</span> <span style="font-family:Calibri; font-size:11pt">” in “New Orders”.  If you want to modify a pre-existing drug, then click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Modify”.  </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt; font-weight:bold">Please note that for drugs that follow a weaning process, it is NOT necessary to discontinue.  Once the patient has been weaned off, the RN can enter the “Active Orders” and “Discontinue” </span> <span style="color:#000000; font-family:Calibri; font-size:11pt">(If a patient is seen on a visit and a modality has already been discontinued, it would make sense to discontinue it at this point).</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-36.png" width="633" height="207" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:16pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a name="Transitioning"/> <span style="color:#ff0000; font-family:Calibri; font-size:16pt; font-weight:bold">Transitioning-Discontinuing Patient from the APS</span> <span style="color:#ff0000; font-family:Calibri; font-size:16pt; font-weight:bold">/Moving Patient to the Follow Up list</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">In the vast majority of cases, the APS transitions a patient from IV parenteral to oral meds before discontinuing from the service. </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">In the EPIC world, Anesthesia has agreed to take responsibility for ensuring an orderly transfer of all transitional meds </span> <span style="font-family:Calibri; font-size:11pt">(rather than the current traditional “suggestions” requiring a cosign by the attending service).</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">To do, this make sure that all your transitional meds are active and all IV parenteral meds have been discontinued.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">When rounding, navigate to the APS Active Patient list.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-37.jpeg" width="278" height="335" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Find your patient, highlight and click on the APS icon to get to the navigator.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-38.jpeg" width="667" height="187" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You are now back into the PAU navigator.  Multiple options to manage the orders on this patient.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-39.jpeg" width="272" height="289" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">To keep it simple, you may want to sort by: </span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Phase of Care, Go to: APS</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-40.jpeg" width="729" height="386" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a name="telephoneremoval"/> <span style="font-family:Calibri; font-size:11pt">The first thing we need to do is to “Discontinue” the patient from the APS.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-41.jpeg" width="864" height="373" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Doing this first will prevent some Advisories from appearing which will stop you in your tracks.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">For each drug, click “Modify”.  At this point, a medication box may open for you to confirm or modify the order you plan to transition.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-42.jpeg" width="864" height="359" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Keep going until you have dealt with every medication/other order contained in the APS Phase of Care.  This may seem cumbersome, but it does provide an extra level of safety in that you are forced to see what drugs/orders you are transitioning. </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">DO NOT SIGN </span> <span style="font-family:Calibri; font-size:11pt">yet.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-43.jpeg" width="864" height="427" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Go to the pulldown “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Options</span> <span style="font-family:Calibri; font-size:11pt">” (partially hidden below) and select, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Phase of Care</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-44.jpeg" width="482" height="256" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt">The current phase of care, “Acute Pain Service” is ticked for all orders.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 72pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-45.jpeg" width="448" height="265" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Change the phase of care to “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">On Unit</span> <span style="font-family:Calibri; font-size:11pt">” and click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Accept</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-46.jpeg" width="408" height="237" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You are now returned to the Orders.    Click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Sign</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-47.jpeg" width="252" height="282" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Notice that the phase of care with all the transitioned orders shows as “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Scheduled</span> <span style="font-family:Calibri; font-size:11pt">”.  This will insure that the RN no longer sees “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Acute Pain Service</span> <span style="font-family:Calibri; font-size:11pt">” phase of care.  That should hopefully dissuade the RN from calling anesthesia for any issues related to these orders.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-48.jpeg" width="822" height="408" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">In certain situations, you may wish to discontinue the patient from the APS but continue to follow.  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Navigate to the Quick List section and select “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Acute Pain Service</span> <span style="font-family:Calibri; font-size:11pt">”, then the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Follow Up\Acute Pain Service Follow Up</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You may also choose to let the attending know that the patient has been discontinued from the APS.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-49.jpeg" width="796" height="192" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">When all this has been done, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Sign</span> <span style="font-family:Calibri; font-size:11pt">” the orders.   Once again, you will be asked questions regarding the phase of care that the order(s) should be applied to.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-50.jpeg" width="557" height="181" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Make the appropriate changes and “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Accept</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-51.jpeg" width="539" height="215" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Navigate to the list, “APS Follow Up” and your patient should now reside on this list.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-52.jpeg" width="271" height="233" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:16pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> <a name="Inpatient_Consultation"/> <span style="color:#ff0000; font-family:Calibri; font-size:16pt; font-weight:bold">In patient APS Consultation</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You receive a call from the floor to see a patient in consult for consideration.  You proceed to the floor.  You can find this patient under the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS Consult</span> <span style="font-family:Calibri; font-size:11pt">” list or under the inpatient unit (in this case, A3)</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-53.png" width="809" height="491" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Clicking the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Inpatient consult to Acute Pain Service</span> <span style="font-family:Calibri; font-size:11pt">” link opens up the consult note for review.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-54.png" width="675" height="395" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <br style="page-break-before:always; clear:both"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Highlight the patient and click the “APS” icon (Not the Consult (Pre-Proc) icon)</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-55.jpeg" width="565" height="132" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You are back in the APS Rounding Navigator.  This time, you want to work within the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Consult Note</span> <span style="font-family:Calibri; font-size:11pt">” section.  Either click on 1)“</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">+Create Note in Notewriter</span> <span style="font-family:Calibri; font-size:11pt">”, use pulldown list to do the same or 2) click on “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS Consult Note</span> <span style="font-family:Calibri; font-size:11pt">” speed button if you have created.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-56.jpeg" width="516" height="354" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You are now presented with the APS Consult Note.  Please remember to put “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Acute Pain Service</span> <span style="font-family:Calibri; font-size:11pt">” as the type of Consult.  This will be helpful for future filtering.  If a RN is doing the consult, then “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Cosign Required</span> <span style="font-family:Calibri; font-size:11pt">” must be selected.  If a resident is doing the note and wants to review with staff before signing off, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">pend</span> <span style="font-family:Calibri; font-size:11pt">” is the appropriate step as it will not be officially on the record for others to see until signed.  </span> <a href="#smartlists"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">An explanation regarding quick lists is found on page 12 of this document.</span> </a> <span style="font-family:Calibri; font-size:11pt">  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-57.jpeg" width="286" height="442" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">You have now completed step 1 of the process.  However, you still need to </span> <a name="consultorderapsmeds"/> <span style="font-family:Calibri; font-size:11pt">ORDER the APS meds</span> <span style="font-family:Calibri; font-size:11pt">.  </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Go to the ORDERS tab.  Type in “acute pain service”.  Make sure you favourite this order set for the rest of time.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-58.jpeg" width="864" height="269" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a href="#howtoorder"> <span style="color:#0563c1; font-family:Calibri; font-size:11pt; text-decoration:underline">Refer to Page 4 of the document for Order completion instructions.</span> </a> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a href="#howtoorder"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Return to the patient list, highlight the patient and click the link, “complete”.  This will remove the patient from the Consult list.  Your orders have placed the patient on the Active roster.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-59.jpeg" width="635" height="424" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:16pt; line-height:107.92%; margin:0pt 0pt 8pt"> <a name="telephoneassess"/> <span style="color:#ff0000; font-family:Calibri; font-size:16pt; font-weight:bold">Outpatient Telephone Assessments</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">In EPIC, outpatients need to be transferred from the APS Active list and placed into a telephone follow up list BEFORE they are discharged/removed from APS Active list.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">This workflow describes the steps to place the patient onto the telephone list.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> Please follow the steps listed below.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> Otherwise, you run the risk of losing your patient and then having + difficulty getting them on to the Telephone list.</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">1.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">Complete your APS orders as per usual</span> </p> <p style="margin:0pt 0pt 0pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">2.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">Identify your patient on the respective “CIV/GEN APS Active Patient” list</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">3.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">When discharge is imminent (that would be immediately if catheter is placed in an outpatient setting), MOVE your patient from this list to the “Shared Reminder Lists\CIV/GEN APS Telephone Follow Up” list (drag and drop).</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold"> </span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-60.jpeg" width="758" height="311" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">4.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">“Discontinue” your patient from the APS.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> To do this, find your patient on the “APS Active Patient” list and click on the “APS” icon.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> This will take you to the APS navigator.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-61.jpeg" width="710" height="163" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">At the bottom of the navigator, you will see the “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Discontinue</span> <span style="font-family:Calibri; font-size:11pt">” button.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> Click this button and your patient will fall off the inpatient list. </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-62.jpeg" width="421" height="280" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">5.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">You now want to telephone your patient. Open “Patient Lists”, highlight your patient and click on the Shared Reminder List\ “CIV-GEN-RIV APS Telephone Follow Up” tab.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-63.jpeg" width="568" height="216" alt="" style="border:none"/> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">6.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">You are now back in the APS navigator.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> Click on “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">+Create Note in Notewriter</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 18pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-64.jpeg" width="568" height="249" alt="" style="border:none"/> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">7.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">You now see the APS rounding progress note.</span> </p> <p style="margin:0pt 0pt 0pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt">Any of the rounding tabs can be used to document your note.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-65.jpeg" width="584" height="208" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-66.jpeg" width="581" height="175" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:11pt">8.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:11pt">When you no longer want the patient on the telephone list.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt">Identify patient on the telephone list.</span> <span style="font-family:Calibri; font-size:11pt"> </span> <span style="font-family:Calibri; font-size:11pt"> Right click and “remove patient”</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt 36pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-67.jpeg" width="480" height="399" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">When patient is no longer being followed as an outpatient, then go to list, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">APS Telephone Follow Up</span> <span style="font-family:Calibri; font-size:11pt">”, highlight patient, </span> <span style="color:#ff0000; font-family:Calibri; font-size:11pt">RIGHT</span> <span style="font-family:Calibri; font-size:11pt"> click and REMOVE.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-68.jpeg" width="425" height="252" alt="" style="border:none"/> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <span style="font-family:Calibri; font-size:11pt">Patient no longer on list.</span> </p> <p style="font-size:11pt; line-height:107.92%; margin:0pt 0pt 8pt"> <img src="/plugins/servlet/benryanconversion?pageId=37715997&amp;attachment=APS+Workflow_long-20190607.doc&amp;name=37879850&amp;val=/image-69.jpeg" width="411" height="206" alt="" style="border:none"/> </p> </div>
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