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Pacemaker Protocol

 

 

 

For the   Inpatient   the process is the following:

1. Go to the   Orders activity   of the patients chart

2. Go to the   Orders for Ambulatory Care/Visit   tab

3.Place an order for Ambulatory referral to Cardiology

2. Select UOHI

3. Sub-specialty - Electrophysiology

4. Cardiac Device assessment

5. Choose appropriate reason - Pre-op consultation, Radiation therapy device assessment, Endoscopy protocol, MRI

6. Complete clinical questions: Device, Surgeon, Surgery, Date and time of, Use of electocautery

7. Enter a name so that staff can return the completed form to the correct dept/person

8. Clinical question

9. Timeframe expected in the future

 

The   outpatient   workflow is the following:

1. Amb referral to Cardiology

2. UOHI selected

3. Sub-specialty - Electrophysiology

4. Cardiac Device assessment

5. Choose appropriate reason - Pre-op consultation, Radiation therapy device assessment, Endoscopy protocol, MRI

6. Complete clinical questions: Device, Surgeon, Surgery, Date and time of, Use of electocautery

7. Enter a name so that staff can return the completed form to the correct dept/person

8. Clinical question

9. Timeframe expected in the future

 

The protocol information   can now be viewed in the chart . Users will need to go to the   Referrals tab   in Chart Review,   select the Referral order , and in the report that appears, there is a   Protocol Summary section   which details all the information the nurse and physician entered.

 

 

REMEMBER-If a consult to the Pacemaker Clinic is initiated in the PAU, it is IMPERATIVE that you create a task.  Below is a modified document which describes this process.

 

 

 

 

 

 

 

 

Specific to the PAU assessment is a tab titled, “ Tasks ”.  Tasks lists all the prerequisite items that must be accomplished before a patient is cleared to come to the OR.  The RN is the primary “keeper of the list”.

Items currently on the list include:

a.      Advanced directive and living will

b.      History and Physical

c.       Health history questionnaire

d.      PAU triage

e.      Pregnancy test

f.        Preprocedure orders

g.       Surgical Consent

 

 

Often, additional tests or requests for information OTHER than what is included on the PAU order set will be asked for by the anesthesiologist.

 

In these cases, anesthesia is responsible for ordering the relevant test/consultation.

 

As an example, in addition to the usual PAU orders (“Anesthesiologist Preoperative Orders”) it is determined that a patient requires a nephrology consult and it is important to see an old anesthesia record from an outside hospital.

 

To access the regular PAU orders, Go to tab, “ Order Sets ”.  Make sure you favourite this order set so that you are not constantly looking for it.

 

 

 

 

Open this order set and complete the usual Preoperative Orders. 

 

 

The PAU order set contains the most common consults we tend to request (copied exactly as per the paper form).  Notice that there is no option for nephrology.

 

 

 

You need to order the nephrology consult.  ALL outpatient consults use the prefix, “ Ambulatory referral ”.  You must use “ ambulatory ” as a keyword or you will not find this group of consults.

 

 

 

 

 

This brings up a long list.

 

Now that you know this, you may want to be more specific using, “ ambulatory referral to nephrology ” as a keyword.

 

 

 

Double click on the correct consult.

 

 

 

Complete the consult.  Any field with a   MUST be completed or you will NOT be able to sign the order.

 

 

Once you have completed ALL required fields, click “ Sign Orders

 

 

 

Depending on the situation, you may now be presented with a dialogue box titled, “Phase of Care”.  EPIC runs on this premise.  Every order is intended for one or more phases of care. 

 

You can see that the NaCl infusion (if necessary), D5W solution (if necessary) and the preop Tylenol are being HELD until the day of surgery (Preprocedure).  These orders were all defaulted in the PAU Order Set (Anesthesiologist Preoperative Orders).

 

The system now wants to know which phase of care should be labeled for the ambulatory (outpatient) referral to nephrology.  “Pre-Admission Testing” would be most appropriate.

Click on “ pre-admission testing”. Click to highlight the Context which is the name of the upcoming surgery (in this example, “Shadow Charting Procedure”), then “Accept”

 

 

 

 

 

Now you need to ask for the old anesthesia records.  There is NO order in EPIC for this so you have to add it as a task.  In addition, you will use this function to inform the RN that you have also requested the consult to nephrology.

 

 

You will now see the Preference List generated for this purpose.  You can see the descriptor to account for the nephrology consult (“ Clearance-Nephrology ”) but there is currently nothing to describe the need for old anesthesia records. 

In this situation, you will choose the generic, “Clearance-Other”, then Accept.

 

 

It is now important to elaborate on what you mean by “other”

 

 

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