Clinical Downtime Resource Manual

Clinical Downtime Resource Manual
Clinical Downtime
Resource Manual
(Last Modified June, 2015)
Table of Contents
Downtime Information ................................................................................................................ 5
Introduction ..................................................................................................................................... 5
General Information ........................................................................................................................ 6
Communication and Notification ..................................................................................................8
Planned and Scheduled Maintenance Downtime ........................................................................... 8
Reporting a Possible Downtime ................................................................................................. 10
NETWORK DOWN .......................................................................................................................... 10
POWER OUTAGE ............................................................................................................................ 10
Preparing for Downtime ............................................................................................................. 11
Downtime Preparation Checklist ................................................................................................... 11
During Downtime .......................................................................................................................12
Admissions, Discharges and Transfers ........................................................................................... 12
Scheduling and Registration ...................................................................................................................12
Cerner Downtime ............................................................................................................................................ 12
Cerner Health Card Validation Downtime Procedures ..........................................................................14
Short Ministry of Health Downtime ................................................................................................................. 14
Extended Ministry of Health Downtime .......................................................................................................... 15
Patient Flow Management System: Downtime Procedure (RMHCL) ........................................... 16
Coordinated Access Team (CAT) .................................................................................................... 16
Admitting Department ................................................................................................................... 16
Inpatient Units ............................................................................................................................... 16
Medication Reconciliation ........................................................................................................... 17
Transportation ............................................................................................................................... 19
Leave of Absence ........................................................................................................................... 19
Patient Care ................................................................................................................................... 20
Downtime Patient Care Orders ..............................................................................................................20
Medication Related ................................................................................................................................20
Printing the Medication Orders from 724 Access ..................................................................................22
Non-Medication Related ........................................................................................................................24
Laboratory ..............................................................................................................................................26
Packed Red Blood Cells (PRBC) Transfusion ...........................................................................................28
Diagnostic Imaging, Non-Invasive Cardiology, EEG & Ivey .....................................................................29
Diet and Tube Feeding Orders ...............................................................................................................29
Allied Health ...........................................................................................................................................29
Allergies ..................................................................................................................................................29
Progress Notes and Consults ..................................................................................................................32
Billable Items ..........................................................................................................................................32
Patient Safety Reporting System (PSRS).................................................................................................32
Recovery ................................................................................................................................... 33
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Roles for Back Entering During Recovery....................................................................................... 33
Back Entering Time .................................................................................................................................34
Registrations .................................................................................................................................. 35
Patient Flow Management System (RMHCL) ................................................................................. 35
Coordinated Access Team (CAT) ............................................................................................................35
Admitting Department ...........................................................................................................................36
Inpatient Units........................................................................................................................................36
Medication Orders ......................................................................................................................... 37
How to back enter on someone else’s behalf ........................................................................................37
Non-Medication Orders ................................................................................................................. 37
Diet and Tube Feeding ................................................................................................................... 38
Lab Orders ...................................................................................................................................... 38
Consults.......................................................................................................................................... 38
Allied Health................................................................................................................................... 38
Allergies.......................................................................................................................................... 38
Systems Downtime ................................................................................................................... 39
GroupWise ..................................................................................................................................... 39
PACS SYSTEM - Image Access during EPR / Cerner Downtime ...................................................... 39
Powerchart Users: ..................................................................................................................................39
Centricity Web Users: .............................................................................................................................39
PACS Users (RA1000 software version): .................................................................................................40
Image access during PACS downtime ............................................................................................ 40
Powerchart Users: ..................................................................................................................................41
Centricity Web Users: .............................................................................................................................41
Urgent Care Department: ......................................................................................................................41
RAI-Mental Health (TREAT System) ............................................................................................... 41
RAI-Long Term Care (RAI-LTC) ....................................................................................................... 42
SJHC TREAT SYSTEM - OCAN .......................................................................................................... 42
NRS (National Rehabilitation System)............................................................................................ 42
Momentum MDS ........................................................................................................................... 42
Workload Measurement System (Infomed - Promiso) .................................................................. 43
Muse .............................................................................................................................................. 43
Pyxis Medication Cabinet............................................................................................................... 43
Appendix ................................................................................................................................... 45
Appendix A: Downtime Admission, Discharge and Transfer Logs ................................................. 45
Appendix B: Best Possible Medication History .............................................................................. 49
Appendix C: Transfer Authorization Form ..................................................................................... 50
Appendix D: Physician Order Form ................................................................................................ 51
Appendix E: Laboratory Report...................................................................................................... 52
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Appendix F: Microbiology Laboratory ........................................................................................... 53
Appendix G: Diet Orders Tracking Sheet ....................................................................................... 54
Appendix H: Allergy Record (Downtime record, additional information) .................................... 55
Appendix I: Billable Items .............................................................................................................. 56
Appendix J: Patient Safety Reporting System (PSRS) Form ........................................................... 57
Appendix K: Pyxis Downtime Medication Log ............................................................................... 58
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DOWNTIME INFORMATION
Introduction
As computers are now embedded in our daily workflow processes, disruptions to access can have
serious consequences. In London and Region, the electronic patient record (EPR) maintains 99.9 %
uptime and averages more than 3500 logins per day.
This Downtime Manual is intended to provide all clinical areas with a framework from which to build
specific downtime processes and procedures. Within this manual you will find methods for each
computerized process that requires a paper process during downtime as well as templates providing
instructions as to how to complete paper forms properly. In addition, downtime recovery plans are
included to ensure continuity and integrity of data in our electronic patient records.
All areas are responsible to develop, maintain and communicate their own internal downtime
procedures, using this manual as a guide.
For further information on downtime, refer to the Corporate Policy.
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General Information
Downtime is broadly defined as the time during which a computer system is unavailable for use as a
result of a malfunction (unplanned) or regular preventive maintenance (planned)
This manual is for inpatient and outpatient units. This is a generic manual, if your area needs to add
specific instructions please do so for your unit.
Planned Downtime
Planned downtime occurs in a controlled fashion. Information Technology Services (ITS) endeavours to
ensure all users are aware of any upcoming downtimes and expected duration of downtimes. Planned
downtime for regular maintenance may be required from time to time, but is kept to a minimum. A
schedule of upcoming, planned downtime may be accessed by going to the St. Joseph’s home page,
and clicking “Weekly Downtime Schedule” in the system status area of the intranet site.
Unplanned Downtime
Unplanned Downtime
In this manual, procedures for unplanned downtime will be in a dashed box
Unplanned downtime occurs as a result of unforeseen circumstances such as power failures, hardware
failures or software failures.
Degrees of Downtime
The extent of computer downtime may vary. The downtime may impact only certain locations or
certain applications or it may be widespread. Knowledge of the extent of the downtime and the
systems involved is critical, as it will help to determine the processes that the unit or clinical area need
to implement. Refer to the system status area on the home page for information on the extent of
downtime and estimated duration.
If staff suspect there is a computer failure or downtime, they should either consult the St. Joseph’s
Intranet home page or call the Helpdesk (ext. 44357) for computer status information. If staff suspect
there is a computer failure or downtime, they should either consult the St. Joseph's intranet home
page or call the Helpdesk (ext. 44357) for computer status information. The system status is displayed
in the System Status section of the Intranet. Click on the word “Show” in this section to display more
detailed system status. If there seems to be a computer problem that is not flagged in the system or on
the Helpdesk system status line, contact the Heldesk at extension 44357 immediately. Do not assume
that someone else has called.
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When to Implement Downtime Procedures
Each clinical area has a different level of tolerance to downtime, and that level of tolerance may vary
throughout the day. Due to the interconnectedness and interdependency of all our clinical EPR
systems, it is essential that all areas move into and out of downtime procedures together. During
significant system slow downs or downtime, direction to move into DOWNTIME procedures will be
made by ITS and clinical leadership and communicated broadly to clinical areas. Upon system
recovery, a communication will be sent to all clinical areas to resume use of the EPR.
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COMMUNICATION AND NOTIFICATION
Planned and Scheduled Maintenance Downtime
For systems other than the Electronic Patient Record (Cerner):
Information Technology Services (ITS) is committed to ensuring all supported systems continue to be
available to end users. Occasionally, downtime will be required on these systems to allow ITS to
complete system maintenance or to apply a fix to a known defect. During these system downtimes,
ITS will work as quickly as possible to ensure downtime is kept to a minimum. Information about these
planned downtimes is posted on the weekly downtime schedule and can also be found on the ITS
Calendar by clicking on any date on the calendar highlighted in red. Information about the planned
downtime will include:
 Name of system affected,
 Reason for downtime,
 Start and end dates and times,
 Any additional information that will benefit users.
Electronic Patient Record (Cerner) Downtime:
Major EPR/Cerner maintenance or upgrades may occur at a different time of the week/weekend.
These downtimes will be communicated broadly prior to the downtime window.
Unplanned System Maintenance Downtime
On occasion, systems supported by ITS may experience unplanned service
degradation or become unavailable. During these unplanned downtime
incidents, ITS will update the "System Status" located on each hospital’s intranet
site (St. Joseph’s Home Page).
There are six ‘System Status’ dashboard buttons that will indicate the relative current status of ITSmanaged systems. These buttons are updated as soon as ITS becomes aware of, and can confirm, a
major system affecting issue. Left click on the link beside the button for detailed information about
the slowdown or downtime. Leaders may wish to print this and post it for staff information. To print
this information, while in the detail screen, right click and select print.
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Left Click on text
beside the button
To print this screen, RIGHT click
and select Print
For significant system outages, the email system or overhead paging system (if email is down) will be
used to communicate the details of the situation. If a Code Grey (critical infrastructure failure) is
enacted, all Code Grey procedures will be followed.
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REPORTING A POSSIBLE DOWNTIME
NETWORK DOWN
Call the Help Desk (44357) to inform them of failure. Please look at the St. Joseph’s Home Page for
updated status.
POWER OUTAGE
Call Helpdesk (44357) to inform them of failure. Please look at the St. Joseph’s Home Page for updated
status – from a workstation on emergency power.
•
Workstations on emergency power (red power outlets) will function normally.
•
For workstations not on emergency power please refer to Network down procedures.
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PREPARING FOR DOWNTIME
Downtime Preparation Checklist
(What should every floor have available for downtime)
 Emergency Power
Each clinical area must have at least one
computer plugged into emergency power.
 Patient Census – print during system slow
downs or prior to planned downtime.
 Downtime and Helpdesk Phone Numbers –
should be located on each unit or beside the
downtime PC at all times.
 Diet Worksheet – print from Cerner
PowerChart prior to a planned downtime.
 Commonly used “On Call” schedules.
 Commonly used pagers.
 Unit fan out list.
 Commonly Used Forms
 MAR (Medication Administration Record) – A
24-hour MAR will be printed on the unit prior
to planned downtime.
ST. JOSEPH’S HEALTH CARE Forms
Allergy Record
General Lab*
Microbiology**
Diagnostic Imaging
Nuclear Medicine
CT
MRI
Medication Reconciliation Forms
Medication Administration Record
Order Number
200311
71821
8460-4085
S32756
77068
200192
76154
RMHC - 200229
PWH - 200230
SJH - 72036
SJH - One Time Stat 76532
SJH - 7 day 75610
PWH - 31 day 75606
RMHCL - 31 day 75621
SWFCMH - 31 day 75616
*Please refer to the Allergy section for the Allergy Documentation Policy reminder.
**Gen Lab Requisition includes Hematology, General Chemistry, Coagulation, Blood Gases, Urine
Tests, Hepatitis and HIV Serology, Therapeutic Drug Monitoring, Toxicology, Trace Elements,
Hormone, Immunology, Flow Cytometry.
***Microbiology Requisition includes Virology, Fungal.
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DURING DOWNTIME
All paper documentation that is created and used during a downtime must be included in the
permanent Patient Health Record for back entering and future reference.
Admissions, Discharges and Transfers
Scheduling and Registration
Cerner Downtime
Procedure for All Registration Points for Cerner Downtime
Track all patient activity and changes when the Cerner system is unavailable. This includes the
tracking of all ODS (One Day Stay), out-patient visits, in-patient admissions and in-patient
admission requests, discharges, transfers, deaths, changes to patient demographics,
physician/service changes, accommodation request changes and patient flag notification.
An official notification of all pre-planned System Downtime will be sent out.

Do not use Person Management or Patient Scheduling after official notification of
Downtime
Registration information may not all save if you are still in system after the designated downtime
During an Unplanned Downtime
For an unplanned downtime contact the Helpdesk at 44357 for a status update or
check the intranet to confirm whether the system is available for use.
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PIN Information
For PIN information, all registration points must contact Health Record Services at the
following extensions:
SJH
During regular hours (Monday
– Friday)
65586 - daily from 0600-2000
During off shift (evenings,
nights, weekends)
66015 - Monday - Friday from 2000-0600
Parkwood
During regular hours (Monday
– Friday)
During off shift (evenings,
nights, weekends)
44033 - daily from 0800 to 1600
65586 - daily from 0600-0800 and 1600-midnight
66015 - daily from midnight - 0600
RMHCL
During regular hours (Monday
– Friday)
47302 - daily from 0800 to 1600
During off shift (evenings,
nights, weekends)
65586 - daily from 0600-0800 and 1600-midnight
66015 - daily from midnight - 0600
South West Centre for Forensic Mental Health Care
During regular hours (Monday
– Friday)
During off shift (evenings,
nights, weekends)
49615 - daily from 0800-1600
65586 - Monday - Friday from 0600-0800 and 16002000, Saturday and Sunday from 0800-1600
66015 - Monday - Friday from 2000-0600
Please provide the following information:
 Patient full legal name, preferred name and previous name(s)
 Birth date
 Sex
 Patient care area, and call back extension
Note: The Soundex function is not available in the Downtime CPI search used by Health Records.
Accurate spelling must be communicated.
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Health Record Services will:
1. Search patient on back-up CPI,
2. Communicate existing PIN information if patient found,
3. Communicate new PIN information if patient is not found. (new PIN #’s assigned will be
3000 series)
Note: New PINs assigned at this time will be from a different-looking, pre-determined, pool of
chart numbers.
Registration Points will (if applicable to your area):
1. Manually record patient information on patient forms,
2. Type/print/imprint an armband (if required),
3. Manually produce a Patient and/or Visit card(s) (if required),
4. Manually record all inpatient, outpatient and one-day stay registrations,
5. Manually record all transfers, discharges, physician and service changes,
Admission, Transfer and Discharge logs are Appendix A of this manual.
Cerner Health Card Validation Downtime Procedures
Cerner Downtime
Validation will not be possible during a Cerner downtime. Validation will happen automatically
when the registration or appointment is added after the downtime unless Post Downtime
Registration is used. If Post Downtime Registration is used to register the patient and the visit is
later modified using the full registration conversation, validation will need to be initiated
manually. If validation is done the day after the registration occurred, validation will still be
correct for most registrations.
Short Ministry of Health Downtime
Periodically when the Ministry validation system is down, the user will receive the response code
“90-Information n/a” or “99-System n/a”. Alternately, they may receive no response and will be
advised that the validation has not completed when they finish scheduling or registering the
patient. If they are aware that the Ministry system has been unavailable more frequently than
normal or for longer than 15 minutes, they should contact the Helpdesk at 44357 or 4-HELP.
The users need to follow site-defined procedures as to whether registrations need to be modified
and validation manually triggered after Ministry of Health back up.
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Extended Ministry of Health Downtime
If the Ministry of Health database is down for an extended period of time (e.g. when Ministry of
Health is on strike), ITS will turn off the HCV functionality. The health card number should be
entered into the system but the validation will not occur.
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PATIENT FLOW MANAGEMENT SYSTEM: DOWNTIME PROCEDURE (RMHCL)
Coordinated Access Team (CAT)
0800-1600 Monday - Friday. The Coordinated Access Team (herein referred to as CAT) uses
admission, transfer and discharge tracking paper form to gather information from all the inpatient
units during the day. Keeping track of all patients census, number of available beds, patients out
on LOA, planned/possible discharges and forecasting for possible admissions after hours.
Following same process, CAT communicates and updates information from other hospitals and
partners in community with regards to planned future admissions. This information is shared
between CAT, Clinical Records and the Admitting department and inpatient units throughout
daytime hours and reviewed at end of day at 1600. Also at 1600, CAT hands off and communicates
current census and standing in the hospital to the OIC (Officer in Charge office). Between 16000800 Monday - Friday, weekends and holidays, OIC continues with same paper process tracking
after hour admissions, transfers or discharges, updating the information from all inpatient units
applicable. OIC hands off information back to CAT office Monday - Friday at 0800 who then
confirms with Clinical Records.
Admitting Department
Paper tracking of all admissions/transfers/discharges, as shared by the CAT office. Onsite
admissions during the daytime hours and St. Joseph’s Grosvenor site after hours, weekends and
holidays.
Inpatient Units
Communicate any patient transfers, admissions or discharges with housekeeping staff, either
directly with unit specific housekeeping staff or by pager.
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MEDICATION RECONCILIATION
Medication Reconciliation – Admission
Admission medication order form should be used to document the Best Possible Medication
History (found in Appendix B) and Admission Medication Orders.
Medication Reconciliation – Transfer
1. The sending unit will print the medication profile and their BPMH (Best Possible
Medication History found in Appendix B) to the receiving unit. The receiving unit will:
2. Use the medication profile and BPMH (Best Possible Medication History found in Appendix
B) to complete the med rec on transfer.
3. New orders will be written on the Physician Order Form (form # 30581) - included in
appendix D and will be sent to Pharmacy and placed in the Patient Health Record for back
entering purposes.
4. Fax orders to Pharmacy with the patient’s allergy information (found in the Patient
Information printout of the 724 Access system).
5. Prepared medications will be delivered to nursing unit or picked up from pharmacy.
Medication Reconciliation - Discharge
Print a prescription listing all required discharge medications.

Use 724 to compile the list of active medication and home medications from the patient’s
profile.

Reconcile this profile with medication requests in the Patient Health Record

Write the discharge prescriptions

In order to meet legislative requirements, the prescription must be signed by the provider.

One copy should be placed in the Patient Health Record to be back entered in the recovery
stage of the downtime

Pharmacy will contact the floor to get an update of who have been discharged.
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Unplanned
Medication Reconciliation – Admission
1. Admission medication order form should be used to document the Best Possible
Medication History and Admission Medication Orders.
2. A copy of the BPMH needs to go in the Patient’s Health Record to be back entered
during the recovery stage of the downtime
3. Fax orders to Pharmacy with the patient’s allergy information.
Medication Reconciliation – Transfer
The sending unit will print the medication profile from 724 Access which includes the BPMH
(Best Possible Medication History) to the receiving unit. The receiving unit will:
1. Use the medication profile and BPMH (Best Possible Medication History) to complete
the med rec on transfer.
2. New orders will be written on the Physician Order Sheet and will be sent to Pharmacy
via email or phone and placed in the Patient’s Health Record to be back entered during
the recovery stage of the downtime
3. Fax orders to Pharmacy with the patient’s allergy information (found in the Patient
Information printout of the 724 Access system).
4. Prepared medications will be delivered to nursing unit or picked up from pharmacy as
per current practice.
Medication Reconciliation - Discharge
Print a prescription listing all required discharge medications.

Use 724 Access to compile the list of active medication and home medications from the
patient’s profile.

Reconcile this profile with medication requests in the Patient’s Health Record to be
back entered during the recovery stage of the downtime

Write the discharge prescriptions

In order to meet legislative requirements, the prescription must be signed by the
provider.

One copy should be placed in the Patient’s Health Record to be back entered during
the recovery stage of the downtime.

Pharmacy will contact the floor to get an update of who have been discharged.
Reconciliations forms are in Appendix B in this manual
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Transportation
1) Go to appendix C and copy the "Patient Transfer Authorization Form". If you are able to access the
internet you can print off the form from the Hospital Transfers website
(https://www.hospitaltransfers.com/transfer/document/ptac_nonoutbreak_230409.pdf)
2) Fill out all the necessary information and fax the form to the number indicated at the top
3) Keep the form in the Patient’s Health Record
Leave of Absence
All preplanned LOA orders will be submitted electronically 24 hours prior to a planned downtime
to ensure electronic dispensing prior to patients leave.
Unplanned
A paper Leave of Absence Medication Request (refer to your unit specific downtime form stock)
form will be completed indicating all medications that need to be prepared by pharmacy for the
patient’s leave. To meet legislative requirements, the paper request must be signed by the
provider if any narcotics are required.
LOA Process:

A paper request (as per site policy) listing all required LOA medications to be prepared
by pharmacy.
o Use 724 to compile the list of active medication and home medications from the
patient’s profile.
o Reconcile this profile with medication requests in the Patient’s Health Record to
be back entered during the recovery stage of the downtime
o List all required LOA medications on Leave of Absence Request form
o In order to meet legislative requirements, the paper request must be signed by
the provider if any narcotics are required.
o One copy should be placed in the Patient’s Health Record to be back entered
during the recovery stage of the downtime
o Pharmacy will contact the floor to get an update of who have been discharged.

Prepared medications will be delivered to nursing unit or picked up from pharmacy as
per current practice.
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Patient Care
Downtime Patient Care Orders
There are now two options available for placing orders during downtime:
1. Use existing supply of blank order sheets or print a blank Patient Care order form and fill in the
written orders.
2. Print the Powerplan from the Clinical Downtime Powerplan homepage *new option*.
https://apps.lhsc.on.ca/regional/hugo/downtime/index.html
Important : The PowerPlans have the orders listed and in some cases pre-checked.
Either way you will still need to:

Stamp every page with a patient addressograph

Have a Provider fill in the orders and sign

Photocopy the form and send a copy to Pharmacy for the medication orders (or send the yellow
copy if applicable)

Fill in paper requisitions for laboratory and diagnostic imaging orders

Keep a copy of the order sheet in the patient’s chart

Back enter orders into the system when the downtime is over
Medication Related
IMPORTANT: Refer to the allergy documentation policy reminder, under the allergy section, to see how
to access allergies during a downtime
New Medication Patient Care Orders
1) To prepare for a downtime, the 24 hour Medication Administration Record (MAR) will need to
be printed.
2) The provider writes the new order on a Physician Order Form (form # 30581) - included in
appendix D.
3) The nurse/clinician transcribes the new medication order onto the printed 24-hour MAR or
changes the existing medication order.
4) The nurse/clinician will fax a copy of the form to Pharmacy.
5) The clinician administers the medication and signs that it has been administered on the paper
MAR.
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Unplanned
1) An announcement will be made when a downtime is going to be more than 30
minutes notifying everyone that they are able to start printing from the 7/24
Access program.
2) Print the 7/24 MAR titled “Medication Orders – Current” form (see the
“Printing a Form” section of the 724 Access User Guide located at the beginning
of this manual).
3) The provider writes the new order on a Physician Order form (form #30581).
4) The nurse/clinician transcribes the new medication order onto the printed 24hour MAR or changes the existing medication order.
5) The nurse/clinician will forward a copy of the Physician Order form to
Pharmacy via fax.
7) After the Medication Orders-Current print-out from the 7/24 Access program
expires, the nurse will initiate a new hand-written MAR for documenting
medications.
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Printing the Medication Orders from 724 Access
When you log in it will automatically come up with the patient list
1) Click the patient
2) Enter the reason why you are accessing the patient’s information in the “Audit Information!”
window
3) On the left hand side select “Medical Administration”
4) You can view at this point or print
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5) On the top left hand corner of the screen select file, and print
6) Specify the print from section and select the print out that you would like to have printed
Note: Please print off the “Patient Information” print out as well to include allergy information
7) Click “Finish”
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Example of a Medication Order – Current print out:
Non-Medication Related
New Non-Medication Physician Orders form
1) The provider writes the new order on a Physician Order form and completes the necessary
requisitions (i.e. Radiology)
2) The order/requisition will be sent/called to the appropriate department
IMPORTANT: Make sure all orders are kept and back entered within the timeframe specified
Unplanned
1) An announcement will be made when a downtime is going to be more than 30
minutes notifying everyone that they are able to start printing from the 7/24 system
2) The provider writes the new order on a Physician Order form and completes the
necessary requisitions (i.e. Radiology)
3) The order/requisition will be sent to the appropriate department
IMPORTANT: Make sure all orders are kept and back entered within the timeframe
specified
To print the current orders from 724 Access follow the same steps as the medication orders
except you would go under the “Orders” tab and select orders when in the print screen”. Refer to
these steps at the end of the “Medication Related” section.
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Example of an Order printout from 7/24 Access:
A copy of the Physician Order Form is appendix D of this manual
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Laboratory
Ordering
Lab work that is required during downtime will be ordered using the paper requisition process. All
lab specimens sent to the lab must be appropriately labeled and be accompanied by the
appropriate paper requisition. A paper requisition form will be completed by the Nurse. Refer to
Appendix E for the paper requisition form.
The requisition/collection label must include:
 Patient’s name (first and last names)
 Patient Identification Number (PIN)
 Patient’s date of birth
 Patient’s location (critical information so lab can call results to correct area)
 Ordering Physician’s name (first and last names)
 Date and time of specimen collection
 Cerner User ID (printed legibly)of the person who collected the specimen
 For TRANSFUSION Medicine – Cerner User ID along with signature of the person who
collected the specimen
The specimen container label must include:
 Patient’s name (first and last names)
 Patient Identification Number (PIN)
 Patient’s date of birth or OHIP number
 The type of specimen and/or site of collection (e.g. organ/tissue site, wound site)
*** Note: There MUST be two patient identifiers on the specimen or sample ***
Non-Essential Bloodwork
In the event of EPR downtime, routine or non-essential blood work should be postponed until the
systems are fully recovered.
**Staff should NOT draw non-essential blood work during downtimes**
Delays in reporting:
Due to the significant impact of downtime on the lab workflow, results will be delayed. The lab will
make every effort to maintain service on all critical bloodwork. Do not send non-essential
bloodwork during this time.
Transport of Samples and Requisitions
Transport of samples and requisitions will occur in the usual manner.
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Receiving Results
Critical results will be called to the unit from the lab. Results will be recorded on the Telephoned
Lab Report. (Form #11931). Other non-critical results will be faxed to the unit from the lab if a fax
is available.
Microbiology results may be sent to clinical areas on the Microbiology Downtime Report Form
(Appendix F).
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Packed Red Blood Cells (PRBC) Transfusion
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Diagnostic Imaging, Non-Invasive Cardiology, EEG & Ivey
All orders for tests such as x-rays or ECGs should be ordered using the appropriate paper
requisition form. Contact the department by phone to request services and send the completed
requisition with the patient. See detailed PACS downtime procedures on pages 38 to 40 of this
manual.
Diet and Tube Feeding Orders
If possible, changes in formula and diet orders should wait until after the computer systems are
restored.
Diet orders for new admissions, order changes, food allergies, discharges and patient transfers
should be called to the diet office. These new orders may be tracked on the Diet Orders Tracking
Record (Appendix G).
Location
SJH
PWH
RMHL
SCFMHC
Phone Extension
57324
57324
57324
57324
Allied Health
Orders for allied health are to be recorded in writing on the patient care order sheets in the
Patient Health Record.
Nurse or delegate is to inform the relevant allied health service/professional(s) via telephone, fax,
pager, or in person of order placed.
Allied health professional must be paged, as per protocol, if it is a stat order.
Allied health professional should also check the paper health record for orders to allied health
recorded on the Physician Order Form.
For outpatient allied health referral orders, the relevant outpatient paper referral form is
completed and faxed or mailed via interoffice mail to the appropriate allied health service or
program.
Orders are acknowledged in Patient Health Record by relevant allied health professional.
Allergies
IMPORTANT: Documenting Allergies Policy Reminder
As per policy, it is the accountability of the regulated health care professional to confirm and
document a patient’s allergies during their hospital stay. In the case of a computer downtime and
electronic documentation of allergies is not available, it is the professional accountability of the
Regulated Health Care Professional (most often the nurse) to continue to document allergies
accordingly. Furthermore, it is the professional responsibility of the nurse to assess the
appropriateness of a prescribed medication for a patient by confirming the patient’s allergy status;
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during downtime this will be done by checking the patients allergy status on the 724 system, and
confirming with the patient, and in case of changes or updates that may have occurred during the
downtime, confirm with the Allergy Record in the patient health care record. During a downtime,
nurses must ensure that any changes or updates to a patient’s allergy status are captured in
writing on the Allergy Record, and clearly communicated to the oncoming care provider during
transfer of accountability (shift change report) and any other necessary departments such as
pharmacy and/or dietary. Please refer to the Documenting Allergies policy for more details.
724 Allergy access and printing instructions:
1. Open 724 from the downtime PC. NOTE: Patient record is only accessible from the
downtime PC the patient was registered to when Cerner Powerchart became inaccessible.
2. Open patient record from patient list or search using the patient search option.
To view the allergies electronically:


Click on the Allergies tab at the top of the patient information window
To print a list of current active allergies

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Click ≥ File ≥ Print ≥ check mark Patient Information
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To Add or Change Allergies
1. The “Allergy Record” form (form# 200311 – Appendix H) to document any additions and/or changes.
2. A faxed copy of the Allergy Record form with any additions and/or changes will need to be provided to
Pharmacy.
3. Place printed paper allergy record and the paper form with additions and/or changes in the front of
the Patient Health Record.
4. Reconcile paper allergies to electronic allergies when the system is back up.
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Progress Notes and Consults
If consults or referrals are required, the order is added to the Physician Order form and the service
or department should be contacted directly by phone.
Billable Items
1) Fill out a “Billable Items” form (as found in Appendix I)
2) Fax the form to the business office for your site
Patient Safety Reporting System (PSRS)
The PSRS system is interfaced with the EPR receiving patient demographic information. During EPR
downtime, staff will not be able to access the patient names/PINS so therefore will be unable to
enter an event. In the event of a system downtime, events must be entered into the PSRS once
the system is functioning again.
If the system is down for 8 hours or more, or if the downtime extends over a shift change and the
staff member involved will not be returning within 24 hours, details should be reported on the
PSRS Extended Downtime Form. Unit leads will need to decide who is responsible for entering
these events when the system is again functional. Once the event is entered into the system, the
paper copy is to be destroyed. Do not file on the medical record.
The PSRS Form can be found in Appendix J
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RECOVERY
Roles for Back Entering During Recovery
Role
Task
Details
Admitting
Registration when clerks are
not working (night shift)
Nurses will call admitting with all
of the transfers and discharge
information to back enter.
Clerks
All of the Registration back
entries
Clerks will be given time to
complete the registration before
others are able to go into the
system.
Diagnostic Imaging
Diagnostic Imaging Orders
Diagnostic Imaging will be doing
their own back entries.
Diagnostic Cardiology
ECG , Stress, Holter and Echo
Orders
Diagnostic Cardiology will be
doing ECG, Stress, Holter and
Echo back entries.
Labs
Lab Orders
The Labs will be doing their own
back entries.
E-Mar
Nurses/Registered Health
Professional
Pharmacy
Nurses will be completing their
EMars once Pharmacy has
entered any new orders during
downtime.
Nurses will need to document
existing overdue medication tasks
in their MAR that have occurred
during downtime.
Patient Care Orderable
Nurses will back enter any new
patient care orderables that
occurred during downtime
Registration
Nurses will call admitting with all
of the transfers and discharge
information to back enter.
Medication Orders
Pharmacy is back entering the
medication orders for all of the
nets - time will also need to be
given to pharmacy to do these
entries before regular pharmacy
orders are filled.
Recovery for anyone discharged will need to be noted that they discharged during a downtime. All
med recs will be recorded on paper.
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Back Entering Time
All of the back entries will need to be done ideally before the end of the shift. Worst case scenario
the entries can be done by the end of the next shift.
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Registrations
All Registration Points: will be responsible for entering all patient information into the system
immediately after it is back up.
The Post Downtime conversation WILL be used to back enter all admission after a downtime.
1. Launch Post Downtime Conversation to enter all patient information from admission log.
2. Search patient in CPI
If patient is not found:
• click ‘ADD PERSON’
• immediately edit the PIN field to remove the auto-assigned system PIN and type in the
new PIN assigned by Health Record Services during Downtime
• Failure to edit the PIN as outlined above will result in duplicate PINs for the patient
If patient is found:
• click ‘ADD ENCOUNTER’ and complete conversation
• If patient is found in CPI search with previous visits, yet Health Records assigned a new
PIN during Downtime, follow through with above ‘ADD PERSON’ steps, inserting new
Downtime PIN assigned, and contact Health Record Services immediately to report the
duplicate PIN occurrence
• Failure to enter the PIN as outlined above will result in duplicate PINs for the patient
3. Populate all fields then click on OK to save.
4. All registrations must be completed once the Post Downtime information has been
entered. To do this, open the Registration or Emergency Registration Conversation,
Highlight the appropriate visit and click OK to complete the registration.
5. Complete ALL patient information and finish the conversation. Repeat steps 4-5 for all
patients.
Patient Flow Management System (RMHCL)
Coordinated Access Team (CAT)
CAT office will complete any pre-registration for any planned admissions that happened during
down time, confirm paper information matches bed board information.
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Admitting Department
Admitting will complete any inpatient registrations for patients that have been admitted and
moved to an inpatient bed. Confirm proper unit and bed locations for registered clients.
Inpatient Units
Attending to completing any information missing in the Patient Flow Management System.
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Medication Orders
All new medication orders will be back entered into the system by pharmacy as soon as possible.
How to back enter on someone else’s behalf
1)
Override the defaulted
time and date and enter
the actual time that the
medication was
administered.
2)
Change the
performed by to
your name
3)
Select “System
Downtime” as the
Early/Late Reason
Non-Medication Orders
The nurse on duty will back enter all of the new non-medication orders written during the
downtime
The following orders do not need to be back-entered by unit staff:

Lab tests for which the specimen/requisition are already in the lab

Diagnostic or other tests for which the requisition has been sent and/or the test completed

Medication orders
Each patient care area is responsible for ensuring that the orders are back-entered by the end of
the shift.
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Diet and Tube Feeding
All diet orders must be entered into the system by unit staff as soon as possible after the system
recovers. This includes diet order changes, new admissions, discharges and patient transfers.
Lab Orders
All back entries for lab orders will be entered by the lab.
Once the announcement is made that Cerner downtime is over, please continue to send only
STAT/essential blood work to the lab for the next 2 hours. The lab must order into Cerner all the
blood work received during downtime and populate the results into Powerchart. These two hours
allows this to be completed before all non-essential blood work arrives to be processed.
Consults
Nursing will enter consults in Cerner Powerchart and mark as complete if the consult has taken
place.
Allied Health
The nurse or delegate back enters all the allied health orders into the system once the system is
back up. The relevant allied health professional will need to complete all orders which are tasked
to their task list and which he/she has already addressed during downtime.
Allergies
Adds/Changes/Cancels of allergies during a downtime will be completed by any Regulated Health
Care Professional. It is the entire care team’s responsibility to review the Patient’s Health Record
for any allergy adjustments that may have occurred.

Allergy adjustments should be completed and/or verified prior to proceeding with any
medication orders.

All allergies should be entered or validated electronically prior to medication orders being
entered.

This process will ensure the appropriate alerts are acknowledged and take into account for
orders and administration of medications
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SYSTEMS DOWNTIME
GroupWise
When GroupWise is experiencing downtime, please use the telephone and fax to communicate
messages
IMPORTANT: GroupWise and GroupWise Messenger are independent systems. No other systems
are affected if GroupWise is on downtime. Cerner applications and the Internet are still available.
PACS SYSTEM - Image Access during EPR / Cerner Downtime
Powerchart Users:
EPR/Cerner systems is down, Users will not be able to view Medical imaging reports or images
through Powerchart.
EPR/Cerner systems “slow downs” due to performance issues: Access to Medical images and
reports completed during this period may be delayed for Powerchart users, however, prior images
and reports will be available.
Dictated reports will be available via telephone conversation with the Radiologists, through exam
notes used in PACS, or through the listen access system during the downtime.
One view users have access to Medical Imaging procedures from March 2009.
Please contact the helpdesk for account information.
Centricity Web Users:
The process to view images through Centricity Web (for users with PACS accounts) is as follows:
 In Centricity Web, choose the “All Studies” tab.
 Type in today's date in the date field
 Type in the patient's last name
 Select patient from the list
 NOTE: The exam will likely appear as “unspecified” in the procedure column.
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An index of patients with the requested last name will be displayed. A second identifier must be
used to select the correct patient. (IE: given name).
Dictated reports will be available via telephone conversation with the Radiologists, through exam
notes used in PACS, or through the listen access system during the downtime.
Reports via Exam notes will be viewable when exams are opened in PACS
CD’s and limited film images are provided when PACS is down.
PACS Users (RA1000 software version):
The process to view images through PACS/Centricity (when Cerner is down for users with PACS
accounts) is as follows:
 In PACS choose the “All Exams” tab
 Type in today's date in the date field
 Type in the patient's last name
 Select patient from the list
 NOTE: The exam will likely appear as “unspecified” in the procedure column.
An index of patients with the requested last name will be displayed. A second identifier must be
used to select the correct patient. (IE: given name).
Dictated reports will be available via telephone conversation with the Radiologists, through exam
notes used in PACS, or through the listen access system during the downtime.
Reports via Exam notes will be viewable when exams are opened in PACS
CD’s and limited film are provided when PACS is down
Image access during PACS downtime

All imaging performed during the downtime can only be viewed in the department

Current and historical digital imaging is unavailable

All images produced during downtime will be available on Picture Archive
Communication System (PACS) PACS when the system is returned to normal
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Powerchart Users:
When PACS system is down - Users will not be able to view any images through Powerchart.
However Medical Imaging reports will be available.
Dictated reports will be available via telephone conversation with the Radiologists, or through the
listen access system.
Typed reports will be available through Powerchart.
One view users have access to Medical Imaging procedures from March 2009.
Please contact the helpdesk for account information.
Centricity Web Users:
PACS is unavailable.
One view users have access to Medical Imaging procedures from March 2009.
Please contact the Helpdesk for account information
All Departments and Clinics:

Critical areas will have studies delivered via film or CD.

Non critical areas may view the images on the modalities in the Radiology department.

Dictated reports will be available through the listen access system, telephone conversation
with the radiologists, or a hand written report on the film envelope

PLEASE NOTE: Report generation will be delayed during downtime procedures

Typed reports will be available through Powerchart
Urgent Care Department:

General Radiology procedures will be filmed and delivered to Urgent Care for viewing.
Films will be picked up and returned to radiology for reporting.
All imaging procedures will be available on PACS when the system is returned to normal.
RAI-Mental Health (TREAT System)
The RAI-MH is a module within the TREAT System and is used by the inpatient mental health
teams. The TREAT System is interfaced with the EPR receiving patient demographic information
for RAI-MH assessments. During an EPR downtime, clinicians will be unable to complete RAI-MH
assessments. In the event of an EPR downtime, clinicians would require notification of the
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downtime and would resume completion of RAI-MH assessments immediately following the
downtime.
RAI-Long Term Care (RAI-LTC)
The RAI system is interfaced with the EPR, receiving admission, discharge and transfer
information. When the EPR is down, staff will not be able to access new patients in this system.
Once the EPR system is recovered, all data will be entered into the system as soon as possible.
SJHC TREAT SYSTEM - OCAN
OCAN is a module within the TREAT system and is used by the outpatient ACT teams. The TREAT
System is interfaced with the EPR receiving client demographic information for OCAN assessments
when the client is scheduled as an OCAN Initial Assessment. During an EPR downtime, clinicians
will be unable to schedule a client that has never had an OCAN assessment (ACT Initial
Assessment), if the client had previously been scheduled the clinician will be able to complete the
OCAN within TREAT. In the event of an EPR downtime, clinicians would require notification of the
downtime and would resume completion any previously unscheduled assessments immediately
following the downtime.
NRS (National Rehabilitation System)
NRS is a CIHI mandated system for Rehabilitation and Specialized Geriatric Services Beds at
Parkwood Hospital. The NRS system is interfaced with the EPR, receiving patient demographic
information. During EPR downtime, staff will not be able to access the information on newly
admitted patients. Once the system is available, this data must be entered into the system. If the
system is down greater than 12 hours, a paper NRS assessment may be initiated. For patients who
are currently in the NRS system, the discharge assessment may be completed regardless of EPR
status.
Momentum MDS
The MDS System is connected to the EPR via real-time ADT interface. The interface receives
patient demographic information which is necessary for the completion of CCRS-RAI assessments.
In the event of an EPR downtime, the MDS system would still continue to operate and
assessments could be completed for existing patients. However, clinicians/health records staff
would require notification of the downtime since the EPR downtime would prevent the flow of
ADT information into MDS, resulting in inaccuracies in the bed board (e.g. newly admitted patients
would not appear in the software). Once the EPR is again operational, patient demographic
information would flow across the interface into MDS and then QMCDS staff would crossreference the data with Health Records data to ensure that no patients are missed.
In the event of a Momentum MDS downtime, the system is not accessible and cannot be used,
and as a result, clinicians and health records staff would need notification of this downtime.
Interface ADT data will wait in the queue until the MDS system is again operational and
completion of assessments can be completed.
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Workload Measurement System (Infomed - Promiso)
The Workload Measurement System is interfaced with the EPR receiving patient demographic
information for newly admitted patients. In the event of an EPR downtime, clinicians should
contact QMCDS and ask to manually enter patient information into the system. When EPR is back
up, ITS assist with resending backlog of patient information to InfoMed.
In the event of Infomed - Promiso downtime, clinicians should track workload manually and enter
it into the system once the system is functioning again.
Muse
In the event of planned or unplanned downtime of the MUSE system, data will be stored in the
ECG carts. If there are >200 tests, then the tests must be saved as hard copies. Once the MUSE
system is operational, all data will be downloaded and reported electronically.
Once operational, normal downloading of data will occur.
Pyxis Medication Cabinet
Pyxis machines are plugged into emergency power outlets. In the event that there is a power
failure or machine failure and access to the machine is required, the nurse should obtain the Pyxis
downtime envelope kept on each nursing unit using Pyxis. This envelope contains two keys, a list
of contents of the machine, medication log and a narcotic count sheet. To access the machine:

Pull the machine away from the wall.

Insert the right and left keys into the corresponding locks on the back of the machine and
remove the back panel.

Inside the machine on the right hand side are red levers for each drawer.

Push the lever to the right (once to unlock, twice to open)

Remove the medication and close the drawer.

Record medication removed on the medication log (Appendix K).
If the admission, discharge, transfer (ADT) interface is down, and patients are not appearing on
the Pyxis machine, the nurse may remove non-narcotic medications under the patient
“Wardstock”. If a narcotic is required, the nurse must ‘add’ the patient to Pyxis. To ‘add’ a patient
to Pyxis:

From the main menu, select Patients

Select New Patient

Enter the patient information including last name, first name, PIN, date of birth and sex.

Select the ADT tab

Enter the following information:
o Patient’s room number
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o Patient’s bed number
o Date patient was admitted
o Nursing unit

Click SAVE
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APPENDIX
Appendix A: Downtime Admission, Discharge and Transfer Logs
DOWNTIME ADMISSION LOG
ADMISSION DATE:
Initiate new sheet for each day
Post Downtime
Photocopy for Pharmacy and Billing (send to Karolanne Bolton and Dee Dee Gelanyi if downtime is greater than 24 hrs)
PIN
PATIENT NAME
FROM
TO
Last name, First Name
Room and Bed
Room and Bed
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PHYSICIAN
Page 45
SERVICE
Time of
Entered
Transfer
by
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Clinical Downtime Resource Manual
DOWNTIME TRANSFER LOG AND/OR PHYSICIAN/SERVICE CHANGES
DATE:
Initiate new sheet for each day
Post Downtime
PIN
Patient Name
Discharge
Room
Via
Discharge to
Time of
Discharge
Entered
Surname/First Name
Disposition
Number
Amb
(Institution name)
Discharge
Delay Reason
by
D-VIC,
Y/N
Initials
Expired
Photocopy for Pharmacy
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Clinical Downtime Resource Manual
DOWNTIME DISCHARGE LOG
DISCHARGE DATE:
Initiate new sheet for
PIN
each date.
Patient Name
Surname/First Name
Discharge
Dispositio
n
Room
Number
Via
Amb
Y/N
Discharge to
(Institution
name)
D-VIC,
Expired
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Time of
Discharge
Discharge
Delay Reason
Entered
by
Initials
Clinical Downtime Resource Manual
Appendix B: Best Possible Medication History
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Clinical Downtime Resource Manual
Appendix C: Transfer Authorization Form
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Clinical Downtime Resource Manual
Appendix D: Physician Order Form
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Clinical Downtime Resource Manual
Appendix E: Laboratory Report
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Clinical Downtime Resource Manual
Appendix F: Microbiology Laboratory
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Clinical Downtime Resource Manual
Appendix G: Diet Orders Tracking Sheet
Diet Orders Downtime Record Sheet
Date:____________________________________
Time:______________________________
PIN
Name (last, first)
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Room
Location
Current
Diet / Allergy
Location
Status
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Clinical Downtime Resource Manual
Appendix H: Allergy Record (Downtime record, additional information)
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Clinical Downtime Resource Manual
Appendix I: Billable Items
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Clinical Downtime Resource Manual
Appendix J: Patient Safety Reporting System (PSRS) Form
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Clinical Downtime Resource Manual
Appendix K: Pyxis Downtime Medication Log
Date
Patient
Drug/Dose
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QTY Nurse Signature
Beginning
Count
Ending Count Wasted
amount
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Witness
Signature
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