Electronic Health Record Downtime Guidelines

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Documentation Recovery Procedures Ending Downtime

Ending Downtime:

The responsible persons convey the end of downtime:

▪ Determine downtime “All Clear” and communicate status to the Support Desk. (Informatics Coordinators/Supervisors if a facility/workplace downtime is called).

▪ Service Desk will update upfront message regarding downtime status that is heard when calling the Service Desk.

Recovering Documentation:

▪ All documentation on paper during downtime is to be scanned into the EHR unless otherwise indicated on the downtime form.

▪ If recovering documentation from another unit/person, add a comment to the documentation field: o Enter information of the actual date/time of documentation by inserting the date/time into the EHR. o If a large amount of information is being recovered, the clinician entering the information may enter a Clinical Note indicating that the recovery of information has been entered by proxy.

Example of a Clinical Note: “Date/time: Intake form information entered into EHR on behalf of Virginia Henderson, RN, after downtime event.”

▪ A Clinical Note should be entered by the nurse assigned to patient care that an EHR Downtime occurred (Date/Time from-to outage if known)

Outpatient and Procedural Areas (excluding Emergency Services)

▪ General Information: Procedural areas will only recover patient information for those areas.

▪

Patient Care Documentation: o

No manual entry of documentation or medication information is recovered.

▪

Provider Orders: o Recover only medical orders on patients that will be transitioning to Inpatient or Observation status. o See Appendix B for recovery of order.

▪ Medication Orders and Administration: o

Outpatient or Procedural patients transitioning to Inpatient or Observation status: only areas closing operations before electronic record becomes available: o Write “Administered during Downtime” on the MAR sent to pharmacy.

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o Scan the paper orders and MAR of medications administered during downtime to the pharmacy. o If area closes operations before electronic record becomes available: ▪ Use paper MAR to document all meds given during the downtime, scan to pharmacy. The concern is both continuity of care and the risk perspective (i.e., meds given with reaction and not being able to find this occurrence) as well as a billing issue. Tasks/Activities: o Complete tasks/activities that are generated after entering orders when the EHR becomes available. o Chart “NOT DONE” for tasks/activities completed during downtime and documented on paper. (Comment: Documented on paper during downtime).

▪

Emergency Services:

▪ General Information: Emergency Services only recovers patient information for patients remaining in those areas.

▪

Patient Care Documentation: o

Any patient transitioning to inpatient or observation: all documentation during downtime remains on paper. Patient care documentation will resume in the EHR when the EHR becomes available. RN to enter Absolute Information (see Appendix A) when EHR becomes available. *Depending on caregiver workload, the Lead/House supervisor will determine if additional resources are needed to recover Absolute Information. ▪ If patient is transferred during downtime, the receiving unit recovers Absolute Information when the EHR becomes available. Enter all orders written during downtime (exception: Medical Imaging and Lab. Orders will remain on downtime requisitions and entered by those departments as written). o Send the documents to HIMS for processing after they have been entered as written. ▪ Medication Orders and Administration: o Fax orders to Pharmacy if medications are not available in Pyxis. o Pharmacy to recover all faxed medication orders (note: nurse to contact pharmacy if patient is being discharged, nurse needs to be able to document meds in the EHR that were administered for timely d/c). ▪ Tasks (for remaining patients in the ED when the EHR becomes available). o Document on tasks that are generated after entering orders when the EHR becomes available. o Chart “NOT DONE” for tasks completed during downtime and documented on paper (comment: Documented on paper during downtime) ▪ Provider Orders: o ▪ RN to review all orders recovered into the EHR for patients remaining in the ED area.

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o Change time to the actual time a task was completed on previously existing tasks that have completed but not documented on yet.

Anesthesia Providers:

▪ This section applies only to facilities that have implemented the Surgical Anesthesia Module. ▪ Anesthesia Providers document on paper when downtime occurs, even if the downtime ends during the time the patient is still in the operating room. ▪ The anesthesia record is scanned into the EHR. ▪ The registered nurse recovers only “Absolute Information” (See Appendix A for Absolute Information). ▪ General Information: The receiving nurse/nurse caring for the patient recovers “Absolute Information” (see Appendix A for “Absolute Information”) ▪ Provider Orders o All orders are to be recovered after downtime (see Appendix B for Order recovery) o Review and validate that all orders written during downtime have been transcribed. (RN) o Date/Time/Sign and indicate “EMR order recovery checked.” Rationale: Recovery of all orders, medications, and verifying requisitions written during downtime is essential to patient care and safety. Verifying this recovery indicates complete review. Wait for pharmacy to enter medications ordered during downtime and then document administration of medications when eMAR becomes available. ▪ Reconciling Medication Orders / Tasks o Enter the name of licensed clinician who administered the medication. o Enter the date and time of medication administered during downtime as noted on the paper MAR. o Complete the medication task, as indicated, for medications administered during downtime (including stop times). o Enter comment on medications recovered during downtime “See paper MAR .” ▪ Verify all medication orders generated during downtime interval with original written physician order and as entered into the eMAR by the pharmacy, with a second check, date, time, and signature on the original written physician order form. ▪ Notify pharmacy if downtime medication order is not entered into the eMAR during recovery period and re-send order if directed by the pharmacist. ▪ Patients discharged during downtime who received medications: o Write “Patient Discharged” on the MAR. o Send copy of paper Medication Administration Record (MAR) to the pharmacy. o Recover medications ordered and administered during downtime. Inpatient/Observation Care Areas: Medication Orders and Administration: ▪

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Tasks/Activities:

▪ All tasks/activities are reconciled by the caregiver and/or receiving nurse.

Provider Notes:

▪ ED Providers will use dictation or paper forms in place of electronic notes during downtime ▪ Inpatient Providers will use paper progress notes during downtime.

Physical Therapy:

▪ Staff will document in the EHR under daily note indicating that downtime occurred specifying date/time patient seen and include a note saying, “See downtime scanned documentation. ”

Care Coordination:

Recovery of Documentation:

o Care Coordination: CM Assessment, Discharge Planning and Care Manager note must be updated when Cerner Downtime is complete.

Respiratory Therapy:

Recovery of documentation:

▪ All treatments/therapies documented on a downtime form will be scanned into the EHR by the receiving unit • Changes to ventilator settings done during downtime (see Appendix A)

Copies of treatments/therapies may be sent to the RT department by the Respiratory Therapist for departmental use.

Test Results

▪ Verify all results during downtime period populate the EHR.

Admission / Discharge / Transfer Information

▪ Nursing or support personnel are to enter the ADT orders into the EHR to track correct service codes and locations (making sure to back date/time the order) for each ADT order on paper. ▪ Patient Financial Services updates ADT information in MS4 when EHR operational.

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Documentation, Additional Information, and References:

Documentation

▪ Use official downtime forms for documentation located either in a secure place within the unit or by accessing the downtime repository. o Each downtime form should have a patient label or at minimum, printed patient full name, Date of Birth, Medical Record Number (MRN) and Financial Number (FIN). ▪ Electronic Recovery of Absolute Information assists to maintain patient care records for continuity and patient safety. (See Appendix A for “Absolute Information”). ▪ When the EHR is available the nursing staff is to enter one clinical note indicating an EHR downtime occurred and approximate dates/times if known

Additional Information

References

Keywords:

Downtime

Electronic Record

EMR EHR Forms

MAR

Medical Record

Scheduled Downtime

Unscheduled Downtime

724 Downtime Compute

Appendix:

A: Absolute Information Recovered into the EHR Appendix

B: Recovery of Orders into the EHR Appendix

C: Recovery of Essential SurgiNet Documentation into the EHR

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Downtime Recovery Guideline Procedures

Overview: Step by step instructions for recovery into MS4.

▪ All patients have to be entered into MS4.

▪

Select Menu Option 1

▪

Press Enter

▪ Search for the patient following Banner Search Guidelines o If the patient has been a previous patient ▪ Update the patient demographics on the 4 dudes screen per routine registration procedure. o If the patient has been assigned a downtime medical record number ▪ Ensure that the information is entered into the demographics of the patient.

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On the demographic maintenance page 1

▪

Complete all required fields. o

Before entering the next screen ▪

Add the downtime medical record number.

▪

In the Medical record # field o Replace the *CALC with the downtime medical record number assigned to the patient. o Enter and complete the demographics. o Enter into the screen to create the account.

Instead of creating a new account,

▪ Enter the account number that was assigned during the downtime in the ACCT# field. ▪ Enter and complete the update of the account.

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