Harbor:ORCHID Downtime - Revision history

Bchap23: /* ED Computer Downtime Emergency Instructions */

2025-03-27T13:33:45Z

ED Computer Downtime Emergency Instructions

← Revisión anterior		Revisión del 13:33 27 mar 2025
Línea 13:		Línea 13:
	** Call the ED AOD (& Dr. Chappell) - will initiate a call with hospital leadership to discuss internal disaster		** Call the ED AOD (& Dr. Chappell) - will initiate a call with hospital leadership to discuss internal disaster

			===Communications===
			* If no internet:
			** Go to ambulance bay to use cell to call AOD
			** Distribute disaster radios
			** Utilize the red phones (they are physical landlines, not VOIP) - phone list for areas of the hospital with the downtime binder

	<br />		<br />

Bchap23 at 13:18, 27 March 2025

2025-03-27T13:18:13Z

← Revisión anterior		Revisión del 13:18 27 mar 2025
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	*** Synapse		*** Synapse
	** Call the Help Desk at 323-409-8000 to report the problem.		** Call the Help Desk at 323-409-8000 to report the problem.
	** Call the ED AOD - will initiate a call with hospital leadership to discuss internal disaster		** Call the ED AOD (& Dr. Chappell) - will initiate a call with hospital leadership to discuss internal disaster

Bchap23: /* ED Computer Downtime Emergency Instructions */

2025-03-27T13:17:30Z

ED Computer Downtime Emergency Instructions

← Revisión anterior		Revisión del 13:17 27 mar 2025
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	*** Paging system		*** Paging system
	*** Synapse		*** Synapse
	** Assign someone to see if any of the affected systems can be used from nearby locations outside the SE building, such as the psych ED, D-9, or the nursing administration office in the hallway leading to the cafeteria.
	** Call the Help Desk at 323-409-8000 to report the problem.		** Call the Help Desk at 323-409-8000 to report the problem.
			** Call the ED AOD - will initiate a call with hospital leadership to discuss internal disaster

Rossf: /* Teams Downtime Tracking List */

2022-12-14T16:40:44Z

Teams Downtime Tracking List

← Revisión anterior		Revisión del 16:40 14 dic 2022
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	*The board will NOT be used to communicate orders, but only to track status.		*The board will NOT be used to communicate orders, but only to track status.
	*When patients depart the department, move them to the designated sheets.		*When patients depart the department, move them to the designated sheets.
			*The password to modify the setup is "Downtime". Please do not use it unless you are an administrator.
	<gallery>		<gallery>
	Tracking List Location.png		Tracking List Location.png

Rossf: /* Preparation Checklist for Planned Downtime */

2022-12-12T22:34:01Z

Preparation Checklist for Planned Downtime

← Revisión anterior		Revisión del 22:34 12 dic 2022
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	□ Remind attendings to check their prescription pads.		□ Remind attendings to check their prescription pads.

			□ Develop just-in-time training plan.

	<br />		<br />
	'''T-2 Days:'''<br />		'''T-2 Days:'''<br />

Rossf: /* Preparation Checklist for Planned Downtime */

2022-12-11T09:03:38Z

Preparation Checklist for Planned Downtime

← Revisión anterior		Revisión del 09:03 11 dic 2022
Línea 356:		Línea 356:

	'''T-2 Weeks:'''<br />		'''T-2 Weeks:'''<br />
	~~□Check~~ with Mario that forms are stocked		□ Check with Mario that forms are stocked. Assemble 100 packets of MD 253, nursing note/MAR page 1 (20 with peds nursing note for PED), MSE, and order form. Check that 10 EMTALA forms are in the AED.

	~~□Assemble 100 packets of MD 253, nursing note/MAR page 1 (20 with peds nursing note for PED), MSE, and order form. Check that 10 EMTALA forms are in the AED.~~		□ Registration checks stocks of downtime forms, labels, wristbands

	~~□Registration~~ checks stocks of downtime forms, labels, wristbands

	□ Check that 724 Level computers are working.		□ Check that 724 Level computers are working.
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	□ Check that pharmacy scanners are working.		□ Check that pharmacy scanners are working.

			□ Remind attendings to check their prescription pads.
	<br />		<br />
	'''T-2 Days:'''<br />		'''T-2 Days:'''<br />
	□ Registration checks that forms are ready to be moved to router		□ Registration checks that forms are ready to be moved to router
	*□ Get names of staff who will be on during downtime and add them to the team with the Teams Tracking List
			□ Get names of staff who will be on during downtime and add them to the team with the Teams Tracking List
	<br />		<br />

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	□ Check that 724 Level 2 computers are running.		□ Check that 724 Level 2 computers are running.
	~~<br />~~
	~~<br />~~

	~~'''T-2 hours:'''<br />~~


	<br />		<br />

	'''T-1:30'''<br />		'''T-1:30:'''<br />
	*Medication and other orders than radiology and lab will go to paper.		*Medication and other orders than radiology and lab will go to paper.

	□ Put the downtime forms on the counter in each area.		□ Put the downtime forms on the counter in each area.


	□ Check that there are sheets of labels in each patient's folder. Call registration if more are needed.		□ Check that there are sheets of labels in each patient's folder. Call registration if more are needed.

	□ Print the 724 charts of patients in the waiting room.		□ Print the 724 charts of patients in the waiting room.

	<br />		<br />

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	times and can be used for downtime documentation. Must reconcile with most recent		times and can be used for downtime documentation. Must reconcile with most recent
	medications added/given.		medications added/given.


	<br />		<br />

	'''Just before downtime'''<br />		'''Just before downtime'''<br />
	*Radiology orders can be placed in ORCHID up until the downtime.		*Radiology orders can be placed in ORCHID up until the downtime.
	~~<br />~~




	'''After recovery:'''<br />		'''After recovery:'''<br />

Rossf: /* After recovery */

2022-12-10T21:29:09Z

After recovery

← Revisión anterior		Revisión del 21:29 10 dic 2022
Línea 245:		Línea 245:

	==='''After recovery'''===		==='''After recovery'''===
	*Registration		'''Registration'''
	~~□ Registration will quick reg patients back into ORCHD (making sure to select DOWNTIME~~
	~~= YES within the quick registration conversation and entering in the downtime M RN/~~
	~~FIN). Nurses will NOT do quick reg to avoid duplicates~~

			□ Registration will quick reg patients back into ORCHD (making sure to select DOWNTIME = YES within the quick registration conversation and entering in the downtime MRN/FIN). Nurses will NOT do quick reg to avoid duplicates
			*Nurses should NOT quick register patients to avoid creating duplicates.'''
			*Patients who arrived during downtime and are already admitted will first be quick registered into Firstnet and then admitted using the admissions process.


			'''Discharged Patients'''

	*Discharged Patients
	□ The charge nurse will enter into ORCHID: chief complaint, arrival time, diagnosis, disposition, last providers, last room, and		□ The charge nurse will enter into ORCHID: chief complaint, arrival time, diagnosis, disposition, last providers, last room, and
	time left ED.		time left ED.

	*Active Patients

			'''Active Patients'''

	□ Nurses will re‐associate patients to their devices (e.g., bedside monitor, ventilator).		□ Nurses will re‐associate patients to their devices (e.g., bedside monitor, ventilator).
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	to the downtime MAR.		to the downtime MAR.

	□

	□ RT will enter their own medications.		□ RT will enter their own medications.

	* For downtime less than 4 hours, enter:		'''For downtime less than 4 hours, enter:'''

	□ All vital signs		□ All vital signs

	- In situations in which vital signs are being documented more frequently than every		*In situations in which vital signs are being documented more frequently than every
	one hour, hourly vital signs may be entered and must include the last set of vital		one hour, hourly vital signs may be entered and must include the last set of vital
	signs.		signs.
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	□ POCT results for ONLY those devices do not normally send results to ORCHID.		□ POCT results for ONLY those devices do not normally send results to ORCHID.

	□ For downtime greater than 4 hours, enter:
			'''For downtime greater than 4 hours, enter:'''

	□ Most recent vital signs.		□ Most recent vital signs.
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	□ All intake and output.		□ All intake and output.

	*Registration will quick register patients who arrived during downtime using the downtime quick registration function. '''Nurses should NOT quick register patients to avoid creating duplicates.'''
	*Patients who arrived during downtime and are already admitted will first be quick registered into Firstnet and then admitted using the admissions process.
	*When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.		*When the system comes back up, clinicians should stop documenting on paper and continue documentation in ORCHID.
	*Providers will enter all ongoing orders except medications for patients still in the ED at recovery. This will include entering the Request for Admit and diagnoses.		*Providers will enter all ongoing orders except medications for patients still in the ED at recovery. This will include entering the Request for Admit and diagnoses.
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	*For patients that were admitted and have departed the ED at recovery, back-entry of information into ORCHID will be the responsibility of the personnel on the units caring for them at that time.		*For patients that were admitted and have departed the ED at recovery, back-entry of information into ORCHID will be the responsibility of the personnel on the units caring for them at that time.
	<br />		<br />

			'''Paper Documents'''

			□ Paper documents will be collected in bins for later retrieval by HIM. These documents
			will be scanned into ORCHID once the system is up.

			- The white copy always follows the patient (unless departing the hospital)

			- The pink copy is used by UR for admitted patients

			- The yellow copy is collected at each nursing station for ED use and later collection by
			HIM.





			'''Point of Care testing results'''

			*POC devices that are interfaced (i.e., send results to ORCHID electronically).

			□ Manually enter results for patients who were not in ORCHID prior todowntime
			(e.g., admissions).

			- Do not manually enter results for patients who were in ORCHID prior todowntime
			(doing so will result in double documentation of results).

			*POC devices not interfaced (i.e., clinician manually enters results in ORCHID).

			□ Manually enter all results in ORCHID.


	'''Medication documentation after recovery'''		'''Medication documentation after recovery'''

	□ Give carbon copied paper downtime charts to pharmacy for review and reconciliation of		□ Give carbon copied paper downtime charts to pharmacy for review and reconciliation of
	medications administered in the ED.		medications administered in the ED.

Rossf: /* Discharges */

2022-12-10T21:20:06Z

Discharges

← Revisión anterior		Revisión del 21:20 10 dic 2022
Línea 229:		Línea 229:
	*Other discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. There are no custom DHS instructions. There is no record kept of what was written or printed.		*Other discharge instructions can be printed from the 724. Go to the FirstNet Search Tab. Choose any patient and click the "Patient ED" button on the left. You can search through any standard discharge instruction and modify as you wish. There are no custom DHS instructions. There is no record kept of what was written or printed.
	*Nurses will move departed patients to the corresponding sections on the Teams Tracking list. Lab and radiology will ensure that the necessary orders are in on the back end as part of their recovery process.		*Nurses will move departed patients to the corresponding sections on the Teams Tracking list. Lab and radiology will ensure that the necessary orders are in on the back end as part of their recovery process.
			*IF the Teams tracking list is unavailable, the ED clerk will keep a log of patient departure times and dispositions.
	</br>		</br>

Rossf: /* Waiting room and triage */

2022-12-10T21:18:10Z

Waiting room and triage

← Revisión anterior		Revisión del 21:18 10 dic 2022
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	*The router will start the nursing triage note on each patient with name, sex, chief complaint, arrival time and triage priority. These forms will be taken to the triage nurse.		*The router will start the nursing triage note on each patient with name, sex, chief complaint, arrival time and triage priority. These forms will be taken to the triage nurse.
	*A senior triage nurse will be assigned the sole job of managing waiting flow of waiting room patients from router to triage to MSE to final room. She will use stacks of sorted patient charts and/or a list.		*A senior triage nurse will be assigned the sole job of managing waiting flow of waiting room patients from router to triage to MSE to final room. She will use stacks of sorted patient charts and/or a list.
	*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order. If the patient is sent to a room for RME or treatment,their completed triage form will		*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order. If the patient is sent to a room for RME or treatment,their completed triage form will accompany them. If the patient is sent back to the waiting room, the triage form will be sorted by ESI score and arrival time and kept on the triage counter.
	accompany them. If the patient is sent back to the waiting room, the triage form will be sorted by ESI score
	and arrival time and kept on the triage counter.
	*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.		*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.
	*If the patient is sent to a room for RME or treatment, their forms will accompany them.		*If the patient is sent to a room for RME or treatment, their forms will accompany them.

Rossf: /* Waiting room and triage */

2022-12-10T21:17:50Z

Waiting room and triage

← Revisión anterior		Revisión del 21:17 10 dic 2022
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	*Registration will use the Level 1 724 (if available) to look up the MRN of patients already in the DHS system. They will give them a FIN from the list of downtime FINs.		*Registration will use the Level 1 724 (if available) to look up the MRN of patients already in the DHS system. They will give them a FIN from the list of downtime FINs.
	==='''Waiting room and triage'''===		==='''Waiting room and triage'''===
	*Print the 724 charts of patients in the waiting room.
	*The router will start the nursing triage note on each patient with name, sex, chief complaint, arrival time and triage priority. These forms will be taken to the triage nurse.		*The router will start the nursing triage note on each patient with name, sex, chief complaint, arrival time and triage priority. These forms will be taken to the triage nurse.
	*A senior triage nurse will be assigned the sole job of managing waiting flow of waiting room patients from router to triage to MSE to final room. She will use stacks of sorted patient charts and/or a list.		*A senior triage nurse will be assigned the sole job of managing waiting flow of waiting room patients from router to triage to MSE to final room. She will use stacks of sorted patient charts and/or a list.
	*~~Patients who are “bring back now” or have chest pain of cardiac origin~~ will ~~be taking directly~~ to a treatment ~~area and~~ will ~~be quick registered by~~ the ~~registration staff in those areas.~~		*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order. If the patient is sent to a room for RME or treatment,their completed triage form will
	*Stable patients will wait in the waiting room ~~and~~ will be ~~called to~~ the ~~registration windows for full registration~~.		accompany them. If the patient is sent back to the waiting room, the triage form will be sorted by ESI score
			and arrival time and kept on the triage counter.
	*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.		*The triage nurse will sort the triage forms by acuity and arrival time and call patients in order.
	*If the patient is sent to a room for RME or treatment, their forms will accompany them.		*If the patient is sent to a room for RME or treatment, their forms will accompany them.
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	*Sort the 724 printouts on patients that were in the ED prior to downtime in with the forms of newly triaged patients.		*Sort the 724 printouts on patients that were in the ED prior to downtime in with the forms of newly triaged patients.
	*A nurse will visit each patient in the waiting room to create a list of all patients. This list will be compared to the piles of charts in the "waiting for room" and "waiting for triage" stacks to ensure that nobody has been missed. [This will not be necessary for a planned downtime, as the time of the switch from regular registration to downtime registration should be clear].		*A nurse will visit each patient in the waiting room to create a list of all patients. This list will be compared to the piles of charts in the "waiting for room" and "waiting for triage" stacks to ensure that nobody has been missed. [This will not be necessary for a planned downtime, as the time of the switch from regular registration to downtime registration should be clear].
			*Stable patients will wait in the waiting room and will be called to the registration windows for full registration.
	*Consider calling the sheriff for assistance with crowd control if needed to separate patients from family members if needed to determine who has been accounted for.		*Consider calling the sheriff for assistance with crowd control if needed to separate patients from family members if needed to determine who has been accounted for.
	<br />		<br />