New Citrix Receiver – Rollout Begins 6/18/18

The IT Team announced an upgrade to the Citrix Receiver 4.9 for all hospital service areas. The new Citrix Receiver is designed to eliminate desktop clutter and allow end users to manage their Citrix icons in a convenient “storefront.”  The rollout will take place June 18th through June 22nd.  The Help Desk will staff additional agents during the rollout and the Desktop Team will round on units to provide Support.  The rollout schedule is as follows:

  • Monday, June 18th              Pharmacy & Lab
  • Tuesday, Junet 19th             Inpatient Nursing Units, Physician devices, Registration
  • Wednesday, June 20th        Surgical Services
  • Thursday, June 21st             Medical Imaging
  • Friday, June 22nd                 Care Coordination

Citrix Receiver Training Guide

Allergies will be listed as unknown severity by nursing staff

Nursing and pharmacy will list patient allergies in the EMR. The severity of the allergy cannot be assessed by the nursing and pharmacy staff. Therefore the allergy severity will be listed as “unknown”. This will default to the presumed to be severe for the drug alerting.

Physicians can go and edit the severity based on history and clinical judgement.

Please edit the informant source to physician. This will allow the severity to flow from one admission to the next.

How to reprint a prescription in Paragon 14

Paragon 14 has some changes to reprinting prescriptions. Please see here for details.

Page will be available under the Doctor => Paragon menu.

MRSA Isolates and E Test

Centegra lab will now perform an e-test on all MRSA isolates obtained from a sterile site with microscan mic >=2.

With additional testing e-testing many isolates may have lower had mic of <1.5 expanding options for treatment.

This additional step will take an additional day to report out.

Paragon 14 Upgrade Complete

Paragon 14 went live at 6pm Sunday March 18, 2018.

Current known issues:

  1. Census issues – Some EMPG hospitalists did have issues with missing patients from default census. Solution: Please review your filters, please look at “Groups”. Make sure “Hospitalist Physicians Med Grp of Ill LLC” is checked. Please save the filter. – resolved 03/22/18 10am
  2. E-prescription error – This issue has been resolved. If you were able to send electronic prescriptions you should have functionality. Prescribing controlled substances is a different process. – resolved 03/22/18 2pm
  3. Completed Physdoc notes are not crossing over to MPF. Items can be viewed under “Documents” in Clinician Hub. – issue resolved 3/19/18 at 9am
  4. MPF (medical records) opens in separate window- This is the new default starting in Version 14. The pop-up window will close (even if minimized) when the focus is changed from the current patient. Previous issues of an orphaned window leading to hanged state should not occur. – Issue closed 03/20/18
  5. Rounding report patients do not appear in sorted order by bed number. – Issue resolved 03/20/18

Last updated 3/19/18

Doctors Day Lunches

Medical staff:

Please join us for our Doctors Day Lunch April 3rd-5th 2018.

McHenry details

Huntley details

Woodstock details

Paragon 14 upgrade

What?

Paragon will be upgraded from version 13.x to version 14

When?

Saturday 3/17/18 at 10p to Sunday 3/18/18 5p

What will be unavailable?

All Paragon applications including Clinician Hub (physician access) and Clinical care station ((nursing access)

What will be available?

PACS, MPF (medical records), T systems, OB and anesthesia Centricity, MUSE and CVIS

For instructions on accessing MPF during downtime see here.

What about labs?

Labs will be printed and placed in the paper chart.

What about notes?

Physicians will dictate notes during downtime.

What about orders?

Paper order sheets and prescriptions will be used during downtime.

What are the new features in Paragon 14?

  1. Updated Patient Card: Patient demographics are easier to see in the upper left hand corner.
  2. Patient Profile (NEW): Report containing information such as advanced directives, allergies, demographics, family history, implants, home medications etc are now available in a single report. This report can be customized by the end user for their practice
  3. New flowsheet search capabilities: Some flowsheets such as Lab can get very difficult yo navigate especially on long admissions. This new search function will allow the user to quickly scroll the needed row. In this example I searched for “chest”. I was taken to the Chest X-ray row with the specific row highlighted.
  4. Prescription writer: Now allows for secure electronic submission of controlled substances

 

Potassium Chloride Injection Shortage

We have been alerted by Pfizer Inc. that Potassium Chloride Injection will experience a supply interruption due to Hurricane Maria and the inability of their other manufacturing plants to keep up with demand. The Pharmaceutical Purchasing Group at CHS checks for supply on a daily basis. While we expect some supply to arrive this week, our stock is very low at this time. Please consider the use of oral potassium products wherever possible. Potassium Acetate and Potassium Phosphate riders are an alternative in appropriate patients. In addition, Large Volume Parenteral Products (D5% – 0.2% NS with KCL, D5%-0.45% with KCL and D5% – 0.9% NS with KCL) are other alternatives.

Thank you for your assistance during this shortage.

Updated Guidelines for Prevention of Perinatal Hepatitis B

Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC) published a summary of existing recommendations and provided updated and new recommendations on the prevention of hepatitis B virus infection in the United States.

The new and updated recommendations are:

General Recommendations:

  • For all medically stable infants weighing ≥2,000 grams at birth and born to HBsAg-negative mothers, the first dose of hepatitis B vaccine should be administered within 24 hours of birth.
  • Permissive language for delaying the birth dose that was previously used in the recommendations has been removed.

Identification and Management of HBV-Infected Pregnant Women:

  • All hepatitis B surface antigen (HBsAg) positive pregnant women should be tested for hepatitis B DNA to guide the use of maternal antiviral therapy during pregnancy for the prevention of hepatitis B virus transmission.
    • A brief summary of the American Association for the Study of Liver Diseases (AASLD) guidelines for the use of maternal antiviral therapy to reduce perinatal Hepatitis B virus transmission is also included in the MMWR.

Management of Infants Born to Women Who Are HBsAg-Positive:

  • Infants born to women for whom HBsAg testing results during pregnancy are not available but have other evidence suggestive of maternal hepatitis B virus infection (presence of maternal HBV DNA, maternal HBeAg is positive, or the mother is known to be chronically infected with hepatitis B) should be managed as if born to an HBsAg-positive mother.
  • For infants who are transferred to a different facility after birth, staff at the transferring and receiving facilities should communicate with each other regarding the infant’s HepB vaccination and receipt of hepatitis B immune globulin (HBIG) to ensure prophylaxis is administered in a timely manner.

Management of Infants Born to Women with Unknown HBsAg Status

  • If it is not possible to determine the mother’s HBsAg status (e.g., where confidential safe surrender of infant occurs shortly after birth), the vaccine series should be completed according to the recommended schedule for infants born to HBsAg-positive mothers. Post-vaccination serologic testing and revaccination, if needed, is recommended for these infants.
  • For HBsAg-negative infants born to HBsAg-positive women who show no serologic immune response after receiving the initial HepB vaccine series, revaccinate the infant with a single challenge dose of HepB vaccine and repeat serologic testing (HBsAg and anti-HBs) one to two months later. If the infant remains HBsAg negative and has an anti-HBs of <10 mIU/mL following single dose revaccination, complete the second series on schedule with the two additional Hep B vaccine doses followed by post-vaccination serologic testing one to two months after the final dose.
    • Alternatively,basedonclinicalcircumstancesorparentpreference,HBsAg-negative infants born to HBsAg-positive women who show no serologic immune response after receiving the initial HepB vaccine series may instead be revaccinated with a second 3- dose series and retested one to two months after the final dose of vaccine.
    • As a reminder, post vaccination serologic testing of the infant should include HBsAg and anti-HBs. Anti-HBs testing should be performed using a method that allows detection of the protective concentration of anti-HBs (> 10mIU/mL).

Video Language Line Now Available

In order to address our interpreter needs across campuses, we are going to test a new interpreter device that will better serve our community. We have 3 Interpreter on Wheels (IOW) devices that we will pilot for 2 weeks, beginning 11/8/17. The device will allow us to meet Joint Commission standards as hospitals are required to use a qualified interpreter when communicating with patients & families who have limited English proficiency.

You simply choose from 35 different  languages including American Sign Language and a qualified interpreter will join you via IPad Video Web Camera. In caring for patients 24/7 this will provide a more personalized approach in comparison to the phone service we currently use.

ED Specialists, Chaplains and Interpreter Team Lead will be trained as super users for your convenience on 11/8/17. However, the intuitive product will have written instructions attached. We can begin to use the devices 11/8/17.

The IOW will be stored in the ED of CHM, CHH & CHW. If you would like to use the device, please contact ED and sign out the IOW. There will be a log sheet which will ask you to provide some feedback as we consider using this tool for patient care. After usage the device will ask you to rate it 1-5.