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<div> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">Pacemaker Protocol</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">For the</span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">Inpatient</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt">the process is the following:</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">1. Go to the</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">Orders activity</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt">of the patients chart</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">2. Go to the</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">Orders for Ambulatory Care/Visit</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt">tab</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">3.Place an order for Ambulatory referral to Cardiology</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">2. Select UOHI</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">3. Sub-specialty - Electrophysiology</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">4. Cardiac Device assessment</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">5. Choose appropriate reason - Pre-op consultation, Radiation therapy device assessment, Endoscopy protocol, MRI</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">6. Complete clinical questions: Device, Surgeon, Surgery, Date and time of, Use of electocautery</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">7. Enter a name so that staff can return the completed form to the correct dept/person</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">8. Clinical question</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">9. Timeframe expected in the future</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">The</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">outpatient</span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt">workflow is the following:</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">1. Amb referral to Cardiology</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">2. UOHI selected</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">3. Sub-specialty - Electrophysiology</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">4. Cardiac Device assessment</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">5. Choose appropriate reason - Pre-op consultation, Radiation therapy device assessment, Endoscopy protocol, MRI</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">6. Complete clinical questions: Device, Surgeon, Surgery, Date and time of, Use of electocautery</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">7. Enter a name so that staff can return the completed form to the correct dept/person</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">8. Clinical question</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">9. Timeframe expected in the future</span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> </p> <p style="margin:0pt"> <span style="color:#000000; font-family:Calibri; font-size:12pt">The protocol information</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">can now be viewed in the chart</span> <span style="color:#000000; font-family:Calibri; font-size:12pt">. Users will need to go to the</span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">Referrals tab</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt">in Chart Review,</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">select the Referral order</span> <span style="color:#000000; font-family:Calibri; font-size:12pt">, and in the report that appears, there is a</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt; font-weight:bold">Protocol Summary section</span> <span style="color:#000000; font-family:Calibri; font-size:12pt"> </span> <span style="color:#000000; font-family:Calibri; font-size:12pt">which details all the information the nurse and physician entered.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="color:#ff0000; font-family:Calibri; font-size:14pt; font-weight:bold">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.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Specific to the PAU assessment is a tab titled, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Tasks</span> <span style="font-family:Calibri; font-size:11pt">”.  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”.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Items currently on the list include:</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">a.</span> <span style="font:7.0pt 'Times New Roman'">     </span> <span style="font-family:Calibri; font-size:12pt">Advanced directive and living will</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">b.</span> <span style="font:7.0pt 'Times New Roman'">     </span> <span style="font-family:Calibri; font-size:12pt">History and Physical</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">c.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:12pt">Health history questionnaire</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">d.</span> <span style="font:7.0pt 'Times New Roman'">     </span> <span style="font-family:Calibri; font-size:12pt">PAU triage</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">e.</span> <span style="font:7.0pt 'Times New Roman'">     </span> <span style="font-family:Calibri; font-size:12pt">Pregnancy test</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">f.</span> <span style="font:7.0pt 'Times New Roman'">       </span> <span style="font-family:Calibri; font-size:12pt">Preprocedure orders</span> </p> <p style="margin:0pt 0pt 0pt 36pt; text-indent:-18pt"> <span style="font-family:Calibri; font-size:12pt">g.</span> <span style="font:7.0pt 'Times New Roman'">      </span> <span style="font-family:Calibri; font-size:12pt">Surgical Consent</span> </p> <p style="margin:0pt 0pt 0pt 36pt"> <span style="font-family:Calibri; font-size:12pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-1.png" width="624" height="265" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Often, additional tests or requests for information OTHER than what is included on the PAU order set will be asked for by the anesthesiologist. </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">In these cases, anesthesia is responsible for ordering the relevant test/consultation.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">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.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">To access the regular PAU orders, Go to tab, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Order Sets</span> <span style="font-family:Calibri; font-size:11pt">”.  Make sure you favourite this order set so that you are not constantly looking for it.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-2.png" width="606" height="368" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Open this order set and complete the usual Preoperative Orders.  </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">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.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-3.png" width="626" height="227" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">You need to order the nephrology consult.  ALL outpatient consults use the prefix, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Ambulatory referral</span> <span style="font-family:Calibri; font-size:11pt">”.  You must use “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">ambulatory</span> <span style="font-family:Calibri; font-size:11pt">” as a keyword or you will not find this group of consults.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-4.png" width="623" height="202" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-5.png" width="624" height="239" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">This brings up a long list.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-6.png" width="679" height="234" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Now that you know this, you may want to be more specific using, “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">ambulatory referral to nephrology</span> <span style="font-family:Calibri; font-size:11pt">” as a keyword.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-7.png" width="625" height="73" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Double click on the correct consult.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-8.png" width="625" height="515" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Complete the consult.  Any field with a </span> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-9.png" width="36" height="32" alt="" style="border:none"/> <span style="font-family:Calibri; font-size:11pt">  MUST be completed or you will NOT be able to sign the order.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Once you have completed ALL required fields, click “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Sign Orders</span> <span style="font-family:Calibri; font-size:11pt">”</span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-10.png" width="625" height="220" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">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.  </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-11.png" width="624" height="363" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">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).</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">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. </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">Click on “</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">pre-admission testing”.</span> <span style="font-family:Calibri; font-size:11pt"> Click to highlight the Context which is the name of the upcoming surgery (in this example, “Shadow Charting Procedure”), then “Accept”</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-12.png" width="624" height="367" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">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. </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-13.png" width="425" height="259" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">You will now see the Preference List generated for this purpose.  You can see the descriptor to account for the nephrology consult (“</span> <span style="font-family:Calibri; font-size:11pt; font-weight:bold">Clearance-Nephrology</span> <span style="font-family:Calibri; font-size:11pt">”) but there is currently nothing to describe the need for old anesthesia records.  </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">In this situation, you will choose the generic, “Clearance-Other”, then Accept.</span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-14.png" width="557" height="319" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt">It is now important to elaborate on what you mean by “other”</span> </p> <p style="margin:0pt"/> <p style="margin:0pt"> <img src="/plugins/servlet/benryanconversion?pageId=38469640&amp;attachment=PAU_Pacemaker+Protocol.doc&amp;name=38567940&amp;val=/image-15.png" width="409" height="366" alt="" style="border:none"/> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> <p style="margin:0pt"> <span style="font-family:Calibri; font-size:11pt"> </span> </p> </div>
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