Transcription
Best Practice AlertConnexall Integration
Presenters:Gerri JacksonAssociate Director, Applications Development andSupportJenny LiuInterface Analyst
Topics BPA Recent Implementations Future
MountSinaiHealthSystemAtAGlance
LocationsMount Sinai Beth Israel: An 856-bed teaching hospital founded in 1889 on Manhattan'sLower East Side.The Mount Sinai Hospital: A 1,171-bed tertiary and quaternary-care teaching facilityfounded in 1852.Mount Sinai Queens: As a 235-bed licensed acute care facility in Astoria.Mount Sinai Roosevelt: With 505 beds, Mount Sinai Roosevelt is a full-service communityand tertiary-care hospital with an Emergency Department serving Midtown and the westside of Manhattan. Founded in 1871.Mount Sinai St. Luke's: With 523 beds, Mount Sinai St. Luke's serves as the principal healthcare provider for the West Harlem and Morningside Heights communities and operates oneof Manhattan's few Level 1 trauma services. Founded in 1847.New York Eye and Ear Infirmary of Mount Sinai: With 69 certified beds, New York Eye andEar Infirmary of Mount Sinai is one of the world's leading facilities for the diagnosis andtreatment of all diseases of the eyes, ears, nose, and throat, as well as relatedconditions. Founded in 1820.5
Overview:When the lab sends a high potassium result message to Epic,and no order is entered after an hour, Epic emails Connexall.Connexall then sends the alert to Vocera.The RN’s acknowledgement goes back to Epic and files on theflowsheet.
Cloverleaf formats HL7message and passes toEpic EMR viaflowsheet interfacePatient meets establishedcriteria for BPA and emailsent toconnexall@mountsinai.orgConnexall scansoutlook folder foremails at determinedtime intervalWORKFLOWConnexall receivestheacknowledgementand formats HL7message to Cloverleafengine (HIC)Caregiveracknowledgesalert on VoceraConnexall formatsmessage and sends toappropriate devicebased on assignment(EIC)
1. Epic identifies the result status for a patient. When the statusmeets the criteria, Epic emails Connexall in a predefinedformat.Potassium result in EPIC:
2. Email from Epic to the ConnexallThe email contains information regarding: the alert type the patient name the current assigned patient bed location
3. Connexall’s Email Input Client converts the email to an Alert
4. Alert goes to the caregiverConnexall formats the message for the appropriate Vocera device.HyperkalemiaHigh Potassium
4a.Nursing admin buy in for new workflow:Concerns: alarm fatigue nursing responsibility
Total alarms triggered on selected units
5. Healthcare Informatics Client (HIC) sends theacknowledgment back to Epic via the Interface Engine
6. Cloverleaf formats the HL7 message and passes it to Epic EMRvia flowsheet interfaceAlert type:Alert received by:Date Alert Ack’d:Time Alert Ack’d:
Recent Connexall Implementations Rounding Reminder Suppression – OFF UNIT Posey Alerts Philips IntelliVue Patient Monitors New Connexall site Connexall reminder for Vocera exchange16
Rounding Reminder – Off Unit Rounding reminder willtrigger even when thepatient is off the unit A Connexall script wasimplemented tosuppress the RoundingReminder alert whilethe Off Unit alert isactivated in NurseCall17
Hourly Rounding Report Hourly rounding documented via nurse call system integration- Indicates rounding status real-time- Accounts for when patient is off the unit- Measures compliance percentage
Posey Alarm One of Mount Sinai’s fall-prevention programs A new Posey alarm has been implemented to detect patientsfalling in high risk of fall unitsNurse Call equipment jack19
Philips IntelliVue Monitor – PILOT Collects vital signs data from Philips IntelliVue CablelessMeasurements and IntelliVue Patient Monitors Provides basic assessment guidance, helping the staff torecognize the early signs of deterioration in patients20
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For Patients: In step down units With BMI higher than 40 Not physically active Challenges: Any body movement can shift the nasal cannula, this givesinaccurate readings Patients don’t like using the nasal cannula when they’re awake Moisture in the tubing can cause false readings Update: One of the step down units stopped using Philips monitors The other step down unit is in trial with both Philips monitors andRespiratory Motion Exspiron monitors. Philips measures ETCO2 while Exspiron measures minute volume (withexternal chest-padsets)
New Connexall Site – 6 unitsChallenge: Predominately per diem staff/users can be in any given unit Unwilling to use role based assignmentSolution: Put all per diem staff into one group Attached the per diem group to every template along withthe permanent staff group23
DAC
Connexall reminder for Vocera exchange A method of exchanging VOCERA at the change of shift rather than purchasing new Voceras foreach of our 120 staff. The biggest challenge will be staff accidentally leaving with the badges at the change of shift. Setup reminder to staff at 7:03am and pm to say " please give your VOCERA badge to theoncoming shift."
Future:o Possible Capsule Neuron integrationo Sepsiso Critical labs
Thank you
Cloverleaf formats HL7 message and passes to Epic EMR via flowsheet interface Caregiver acknowledges alert on Vocera Connexall receives the acknowledgement and formats HL7 message to Cloverleaf engine (HIC) Connexall sc
