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:
- 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
- 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
- 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
- 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
- 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.
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?
- Updated Patient Card: Patient demographics are easier to see in the upper left hand corner.
- 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
- 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.
- Prescription writer: Now allows for secure electronic submission of controlled substances
Potassium Chloride Injection Shortage UPDATE 7.30.18
Potassium Chloride Injection Shortage – although product is still in short supply, Centegra pharmacies have been successful in obtaining supply. The manufacturer expects release on 8/23/18. At this time, we estimate we have at least a 4-week supply and can now begin using without restriction.
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.
Antimicrobial Stewardship – New Program
Starting Feb 2018 we will move to a three tiered system of antimicrobial stewardship. For all the details go to Clinical -> Infection prevention -> Antimicrobial Stewardship.
Clostridium Difficile Guidelines 2017 – Updated
IDSA and SHEA have updated guidelines for 2017. Please see here for details.