Post on 29-Jan-2022
transcript
© 2016 Houston Methodist Hospital (all rights reserved). This material may not be copied, modified or distributed without the express prior written approval of Houston Methodist Hospital.
Epic BCA/Downtime Manual
Houston Methodist Hospital System
2
Contents Purpose ................................................................................................................................. 3
Summary ............................................................................................................................... 3
Downtime Scenarios ............................................................................................................. 4
Downtime and Recovery Notification ..................................................................................... 7
Communicating During Downtime ....................................................................................... 10
Downtime Kits ..................................................................................................................... 11
Before Planned Downtime ................................................................................................... 11
During Downtime ................................................................................................................. 12
Downtime Check List ........................................................................................................... 13
Downtime Reports ............................................................................................................... 14
Downtime PCs in your Department ...................................................................................... 16
Nursing Downtime Procedures ............................................................................................ 16
Recovery Procedure ............................................................................................................ 18
Appendix 1: How to access SRO ......................................................................................... 25
Appendix 2: How to access BCA Web ................................................................................. 26
Appendix 3: How to access BCA PCs ................................................................................. 28
Appendix 4: Ongoing Testing Required by Application Team .............................................. 29
Drill 1: Introduction to BCA/Downtime Support Resources ............................................... 29
Drill 2: Use Shadow Read Only (SRO) (Scenario 1) ........................................................ 30
Drill 3: Use BCA Web (Scenario 2) .................................................................................. 30
Drill 4: Use BCA PCs (Scenario 3) ................................................................................... 30
Appendix 5: Pharmacy Downtime Manual ........................................................................... 33
Appendix 6: Patient Access Downtime Manual .................................................................... 35
Appendix 7: Surgical Downtime Manual .............................................................................. 43
Appendix 8: Inpatient Downtime Manual.............................................................................. 55
Appendix 9: Emergency Department Downtime Manual ...................................................... 63
Appendix 10: Lab Downtime Manual ................................................................................... 71
Appendix 11: HOD Downtime Manual ................................................................................. 73
Appendix 12: Ambulatory Downtime Manual ....................................................................... 79
Appendix 13: Radiology Downtime Manual ......................................................................... 87
Appendix 14: Cardiology Downtime Manual ........................................................................ 91
Appendix 15: Rehabilitation Services Downtime Manual ..................................................... 92
Appendix 16: Food and Nutrition Services Downtime Manual ............................................. 98
Appendix 17: Health Information Management (HIM) ........................................................ 103
Appendix 18: Billing ........................................................................................................... 104
Appendix 19: Definitions, Acronyms and Abbreviations…………………………………...…105
3
Background Information Purpose
The purpose of the Epic BCA/Downtime Manual is to define both the necessary process and computer functions required to maintain patient care activities during downtime and to outline the recovery process. The manual outlines how clinicians will process and handle information during downtimes and transition back to full functionality of Epic systems.
Clinicians reference the downtime manual when Epic is unavailable due to any scheduled and unscheduled downtimes. Clinicians are expected to follow a detailed process for capturing and recording data on appropriate forms and entering that data into Epic during the recovery period.
Clinicians need to be familiar with their downtime kits. The downtime kits contain relevant paperwork to be used in the event of a scheduled or unscheduled Epic downtime.
Scheduled downtimes due to system upgrades or “fixes” will be coordinated at times when
patient care is least impacted.
Summary
The manual describes the process that clinicians will follow when there is an interruption to
the department due to a power outage, computer downtime, or other technical interference
(i.e. Citrix outage).
This manual is structured in three parts:
1. Downtime Preparation: Outlines the key information required to prepare for a
scheduled or unscheduled downtime.
2. During Downtime: Outlines clinical and revenue cycle downtime procedures
when the system is unavailable.
3. After Downtime: Outlines clinical and revenue cycle downtime procedures while the
system is in recovery.
The manual outlines how to determine specific downtime levels based on the sub‐
workflows and detailed scenarios from action through recovery, when the downtime is
complete.
Hospital wide communication protocols are outlined in the Houston Methodist IT
Continuity Escalation Plan.
4
Downtime Scenarios There are three types of downtime scenarios which use different BCA tools.
Scenario # Network/SRO Status Tool(s) available to view patient data
1 SRO up Wide Area Network up Local Area Network up
SRO (Supports Read Only)
BCA‐Web
BCA‐PC
2 Wide Area Network down Local Area Network Up
BCA‐ Web
BCA‐PC
3 Wide Area Network down Local Area Network down
BCA‐PC
4 Data Center Access down BCA‐PC
Scenario 1: Use SRO ‐ Networks is up, Epic is down and Supports Read Only (SRO) is available
Scenario 1 Instructions:
Instructions Screenshot
How to log into SRO:
Log into the SRO environment. This allows clinicians to navigate Epic Hyperspace in a similar way; however it prevents clinicians from entering any new information into the system.
READ ONLY
Holly Hall, TX Data Center
5
Instructions Screenshot
Use your Epic Hyperspace username and password.
Upon login, these are indications that you are in a Read-Only environment (SRO).
Record downtime events on paper forms which are available in your downtime kits.
Keep paper forms until information is recovered into the system.
6
Holly Hall, TX Data Center
Scenario 2‐4: Use BCA Web or BCA PC – All other scenarios
Hospital/Clinic
Local Area Network
Wide Area Network
BCA PC
Scenarios 2‐4 Instructions:
Instructions Screenshot
How to log into BCA Web:
Access BCA Web from the desktop icon or from the following link: https://epiclbebcawprod.houstonmethodist.org/BCAWeb-8.2/prelogin.html
BCA WEB
Login using your Epic Hyperspace user name and password.
Select your Department/Unit from the Folder List.
Print necessary reports.
Record downtime events on paper forms which are available in your downtime kits.
Keep paper forms until information is recovered into Epic.
*If BCA Web is not available, please use BCA PC.
How to log into your BCA PC:
Identify your BCA PC. This device has a label that reads “Epic BCA Downtime Device”.
7
Instructions Screenshot
Log into BCA Printing using the icon on the desktop.
Use your Epic Hyperspace username and password.
Select reports to print critical patient information.
Downtime and Recovery Notification Type of Downtime Communication Plan
Scheduled Downtime
Users will be notified in advance of the planned downtime event via email. These email notifications/flyers can be printed by management/supervisors and posted to visible bulletin boards in staff areas and may include in staff huddles.
IT will phone Operations Administrators/Administrative Coordinators/Centralized Billing Office at affected facility/facilities 1 hour prior to scheduled downtime as a reminder of impending downtime.
Operations Administrators/Administrative Coordinators/Centralized Billing Office will utilize in-house pagers/phone communication to notify units/departments of impending downtime.
Recovery
8
Type of Downtime Communication Plan
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office that the system has been restored and that ADT areas will brought online first.
IT will notify ADT areas that they may initiate census/downtime event reconciliation.
ADT areas will notify IT when they have completed census/downtime event reconciliation.
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office that ADT reconciliation has been completed and all other users will now be brought online.
IT will notify end users via email that the system has been restored, ADT events have been reconciled, and recovery procedures/data entry can be initiated.
Operations Administrators/Administrative Coordinators/Centralized Billing Office will utilize in-house pagers/phone communication to notify units/departments that the system has been restored, ADT events have been reconciled, and recovery procedures/data entry can be initiated.
IT will utilize Everbridge alert to Management level Distribution list that system has been restored.
Pharmacy will notify each department as appropriate when Medication Order Reconciliation is complete.
Unscheduled (Small Scale)
Downtime
Users will notify Help Desk of system interruption.
Help Desk/IT will assess/identify problem.
IT will notify managers/supervisors of affected areas to initiate downtime procedures.
Recovery
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office that the system has been restored and that ADT areas will brought online first.
IT will notify ADT areas that they may initiate census/downtime event reconciliation.
ADT areas will notify IT when they have completed census/downtime event reconciliation.
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office that ADT reconciliation has been completed and all other users will now be brought online.
IT will notify end users via email that the system has been restored, ADT events have been reconciled, and recovery procedures/data entry can be initiated.
Operations Administrators/Administrative Coordinators/Centralized Billing Office will utilize in-house
9
Type of Downtime Communication Plan
pagers/phone communication to notify units/departments that the system has been restored, ADT events have been reconciled, and recovery procedures/data entry can be initiated.
IT will utilize Everbridge alert to Management level Distribution list that system has been restored.
Pharmacy will notify each department as appropriate when Medication Order Reconciliation is complete.
Unscheduled (Large Scale)
Downtime
Users will notify Help Desk of system interruption.
Help Desk/IT will assess/identify problem.
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office of downtime.
IT will utilize Everbridge alert to management level distribution list to notify that the system is down and to initiate downtime procedures.
IT will notify users via email to initiate downtime procedures.
o Code White email script: “The [Epic] system is down. Estimated
length of downtime is XXX (if known). Initiate downtime procedures. Access clinical data using XXX (SRO, BCA-PC, BCA-Web).
Operations Administrators/Administrative Coordinators/Centralized Billing Office will utilize in-house pagers/phone communication/overhead to notify units/departments of unscheduled downtime and initiation of downtime procedures.
o Code White overhead page script: “May I Have Your Attention, please? Code
White Downtime.” Recovery
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office that the system has been restored and that ADT areas will brought online first.
IT will notify ADT areas that they may initiate census/downtime event reconciliation.
ADT areas will notify IT when they have completed census/downtime event reconciliation.
IT will notify Operations Administrators/Administrative Coordinators/Centralized Billing Office that ADT reconciliation has been completed and all other users will now be brought online.
IT will notify end users via email that the system has been restored, ADT events have been reconciled, and recovery procedures/data entry can be initiated.
10
Type of Downtime Communication Plan
o Code White email script: “The [Epic] system is restored. Initiate
recovery procedures.
Operations Administrators/Administrative Coordinators/Centralized Billing Office will utilize in-house pagers/phone communication to notify units/departments that the system has been restored, ADT events have been reconciled, and recovery procedures/data entry can be initiated.
o Code White overhead page script: “Code White Downtime All Clear.”
IT will utilize Everbridge alert to Management level Distribution list that system has been restored.
Pharmacy will notify each department as appropriate when Medication Order Reconciliation is complete.
Communicating During Downtime Department Communication
Pharmacy Written orders will be scanned/faxed to Pharmacy
Medications not in PYXIS will be delivered to units via pneumatic tube or courier
Laboratory Utilize Downtime Lab Requisition Forms with labeled specimens
STATs and Critical Values will be called to unit by Laboratory, all other results will be scanned to unit or sent by pneumatic tube
Radiology Fax order and call department
Nutrition Fax order and call department
Therapies (PT/OT/SP) Contact the department via telephone
Respiratory Call/Overhead page/or use pager system/wireless communication device (ex. Vocera) to notify therapist assigned to unit
o HMWB, HMSJ, and HMSL also can fax to respiratory department, but should still follow with phone call or page to therapist
Patient Access Services- ADT (Admission/Discharge/Transfer)
Admission
ED/Admitting Physician will make a bed request using the phone to the Clinical Bed Coordinator/Administrative Coordinator
Clinical Bed Coordinator/Administrative Coordinator will fill out ADT Downtime Event Form and fax to Patient Access Services
Clinical Bed Coordinator/Administrative Coordinator will notify ED staff and receiving inpatient unit of patient bed assignment
11
Transfer
Inpatient clinical staff will fill out ADT Downtime Event Form and fax to Clinical Bed Coordinator/Administrative Coordinator and Patient Access Services
Clinical Bed Coordinator/Administrative Coordinator will notify transferring and receiving departments of patient bed assignment
Discharge
Inpatient clinical staff will fill out ADT Downtime Event Form and fax to Clinical Bed Coordinator/Administrative Coordinator and Patient Access Services
Downtime Kits Every department will create and maintain an Epic downtime kit. The downtime kit should contain the following:
o Facility Phone Numbers list
o Downtime policy/procedure documentation
o Downtime checklist
o Blank labels
The following blank forms and other information will be in the downtime kit:
Nursing Documentation forms (Flowsheet Records)
Blank MAR forms
Blank Physician order forms
Blank Progress Notes
Downtime Event forms
Requisition Slips
Department specific order sets and forms Pharmacies should have blank labels on hand prior to any downtime. In the event of a planned downtime, the blank label supply should be checked and if necessary, use the Custom Label activity to print blank Med and IV labels.
All Areas/Departments have created their own Downtime Kits. Each department’s kits have necessary paper forms and access to instructions to support clinicians to provide patient care.
Before Scheduled Downtime Enter Orders: Orders, Ancillary procedures and Labs to be completed during
downtime should be entered in Electronic Medical Record (EMR) before downtime begins.
Organize Downtime Forms: Downtime forms are located in the Downtime Kits. During scheduled downtimes, prepare any needed forms before downtime begins.
Coordinate Patient Labels: Place patient labels on downtime paper forms including
12
each page of the paper flow sheet if needed.
During Downtime This section provides information about what to do during a downtime. This includes:
1. Downtime Checklist: Easy to access information for clinicians.
2. Downtime Reports.
3. Downtime PCs.
4. Downtime Procedures (see the appendix for specific departmental information).
13
Downtime Check List
☐ Communicate that downtime procedures are in effect to other clinicians.
☐ Identify your Downtime kits and BCA PC.
☐ Assess the Downtime level based on the availability of SRO, BCA Web and/or BCA PCs.
☐ Follow Downtime Procedures based on the Downtime Level (see below).
Downtime Type
LEVEL 1 Scheduled
Access SRO *Minimal Paper
Charting
LEVEL 2 Unscheduled
Access BCA Web &/or BCA Computer & Printer *Start Paper Charting Immediately
Tool to access Epic information
Supports Read Only (SRO)
BCA Web and/or BCA PC
Instructions Log into the SRO environment
READ ONLY Use your Epic Hyperspace username and password Access read‐only version of Epic Record downtime events on paper forms Keep paper forms until information is recovered.
From any workstation: Open the BCA Web icon or enter the following URL into internet browser:
BCA WEB
https://epiclbebcawprod.houstonmethodist.org/BCAWeb-8.2/prelogin.html Log in using your Epic Hyperspace user name and password. Print the appropriate reports. Record downtime events on paper forms Keep paper forms until information is recovered *If BCA Web is not available, locate your BCA PC:
Identify your Downtime Workstation and log into the BCA Printing icon
Login using your Epic Hyperspace username and password
14
Print the appropriate reports.
☐ Print patient labels and put labels on patient forms
☐ Distribute/make available downtime forms
☐ Create/update patient paper chart
☐ Begin the recovery process (see page 18)
☐ Once system is back up notify clinicians to return to normal operations
☐ Collect all documentation for Health Information Management (HIM)/Medical Records to scan into the medical record (see the full recovery procedure on page 18)
Downtime Reports Departments Report Name Report Description
Patient Access Census Shows basic information about patients in the hospital, such as date of birth, admission time, and attending provider
Ambulatory Clinics
Clinical Summary Shows clinical data for each patient, including active orders, recent results, and vitals.
Daily Appointment Report (DAR)
Shows information about upcoming appointments within a department for use during a downtime
Emergency Departments
Census Shows basic information about patients in the hospital, such as date of birth, admission time, and attending provider
15
Departments Report Name Report Description
Medical Administration Report (MAR)
Provides medication administration information about a patient during a downtime.
Clinical Summary
Shows clinical data for each patient, including active orders, recent results, and vitals.
Lab Census Shows basic information about patients in the hospital, such as date of birth, admission time, and attending provider
HOD DAR Shows information about upcoming appointments
within a department for use during a downtime
Clinical Summary Shows clinical data for each patient, including active orders, recent results, and vitals.
Medical Administration Report (MAR)
Provides medication administration information about a patient during a downtime.
Inpatient Medical Administration Report (MAR)
Provides medication administration information about a patient during a downtime.
Clinical Summary Shows clinical data for each patient, including active orders, recent results, and vitals.
Census Shows basic information about patients in the hospital, such as date of birth, admission time, and attending provider
Surgical Master Daily Schedule
Shows all of the scheduled cases for the day
Pick List Provides case information about the patient, including supplies for surgery, drugs, instructions, etc.
Preference Cards Provides case‐neutral information about surgeons' preference cards.
Clinical Summary Shows clinical data for each patient, including active orders, recent results, and vitals.
MAR Provides medication administration information about a patient during a downtime.
Anesthesia Record
Shows anesthesia records in which the patient hasn't been marked Ready for Procedure.
Pharmacy Rx Med Profile Shows patient‐specific medication information, such as relevant results, allergies, and all medications
Census Shows basic information about patients in the hospital, such as date of birth, admission time, and attending provider
16
Departments Report Name Report Description
Rx MAR Provides medication administration information about a patient during a downtime.
Rx Cart Fill Full by Dept.
Shows information for orders that are dispensing from a cart.
Downtime PCs in Your Department
Every department has an allocated downtime workstation. These computers are identified with a sticker that reads-Epic BCA Downtime Device.
Nursing Downtime Procedures
Documentation: 1. Print necessary Downtime Reports from BCA Web or BCA Downtime PCs as appropriate
(Clinical Summary, MAR, etc.). Retrieve appropriate documentation, order, and requisition
forms from Downtime Kits.
2. Document Assessments, Interventions, Plan of Care, I&O’s, IV’s, IV Titration, and Vital Signs
on the paper flow sheet.
3. All new orders are placed either on blank Physician Order forms or pre-printed Order Sets
found in Downtime Kits and placed in the order section of the Downtime Clinical Summary in
patient paper chart.
4. Document medication administrations on paper MAR report as outlined in next section. For
new patients, use blank MAR forms found in the Downtime Kit.
Medication Administration:
1. For patients that have an electronic medication profile, Medication Administration Record
(MAR) reports will be printed from BCA Web or BCA PCs.
2. For new patients and/or patients without an electronic med profile, use blank MARs found in
Downtime Kits.
3. Update paper Medication Profiles with new medication orders received since the time of
printing and throughout the downtime. For medication schedules use standard administration
times.
a) Transcribe new orders onto the paper Medication profile & administration schedules in
the designated time column. (Include comments and/or end times if specified.)
b) Mark discontinued meds by writing “Discontinued” next to the entry and crossing out the
medication name using a single line through the medication entry. Initial, date, and time
entry.
c) If a medication is changed, discontinue the original order as above, and transcribe the
new order as a new medication entry.
17
4. Perform manual verifications of the 7 rights of medication administration during each
administration; Right patient, right medication, right dose, right route, right time, right
monitoring, and right documentation.
Orders:
1. Continue to fax/tube written medication orders to Pharmacy with patient information,
including location. Medication order processing should not be affected.
2. Use manual requisition forms for other orders.
a) LAB/Transfusion Services Orders
i. For labs not entered in Epic, send specimen with a patient label and completed
downtime Laboratory Requisition form(s). Lab requisition forms must have patient
name, MR #, account #, physician and patient location.
ii. Fax/tube copy of written order and blood requisition form for new blood transfusion
orders to Blood Bank. Blood Bank will call the unit when blood products are ready for
pickup.
iii. All samples must have collector’s and witness’s initials, collection date and time on
the label.
b) Patient Care Supply‐ Call Central Supply/Supply Chain for patient supply/equipment
requests.
c) Radiology Orders‐ Fax order and call department for Radiology, CT, MRI, Angiography
orders.
3. For other ancillary orders please call or page the specific departments (PT/OT/ST, RT, Case
Manager, Social Worker, Chaplain, etc.)
4. For Diet Orders ‐ Call/fax order to Food and Nutrition Services.
Test Results:
1. Radiology reports & images will be available on the PACS system ONLY.
2. Lab results will be faxed/tubed to units. Critical values will be phoned to the units.
3. Document Glucose‐meter results on the paper flow sheet.
4. For other results‐ call the appropriate department.
Automated Dispensing Cabinets (ADC… i.e. Pyxis)
New medication orders or changes will not cross into the Automated Dispensing Cabinet (ADC).
ADCs will be placed on critical override to allow access to medications. Manually add new patients
into cabinet for override dispensing.
ADT‐ Admit/Discharge/Transfer: For Admission call Patient Access Services.
Clinicians need to track transfers and discharges on the ADT Downtime Event Form and fax
completed forms to Patient Access Services.
Refer to steps in Appendix 8: Inpatient Downtime Manual for admission /discharge/transfer
procedures.
18
After Downtime (Recovery): This section outlines the steps clinicians should take once the system has been recovered.
Recovery Procedure
IT/H
elp
De
skIn
terf
ace
sA
DT
En
d U
se
rsH
IM
Downtime Recovery Workflow
Start
IT Communicate to Interface Team that Epic is back up
from a downtime IT Communicate to ADT that
interfaces are on
ADT Registration Follow process for getting ADT reconciled. Use downtime MRN
and CSN where needed
Interfaces Team Send messages to Epic and
communicate to IT
ADT RegistrationCommunicate to IT that all
admission/discharge/transfers are entered
ITCommunicate to all end users
that Epic is now available
End UsersComplete reconciliation of
pertinent data based on policy and length of downtime
End UsersReconcile MAR once Pharmacy reconciles medication orders
End UsersEnter note in patient chart
that patient was seen during downtime
End UsersContinue care as usual
HIMCollect paper documents and
scan into medical record
19
Recovery Procedure / Tasks
Step Detail Responsible
IT/Helpdesk Communicate to ADT and Interfaces that Epic is back up.
Once ADT and Interfaces are reconciled, IT/Helpdesk communicates to users that Epic is now available.
IT/Help Desk
ADT Follow process for getting admissions reconciled. Use downtime MRNs and CSNs where needed.
Communicate to IT/Helpdesk that ADT is
reconciled.
ADT Registration
Interfaces Interface engine releases queued
messages to Epic and communicate to
IT/Helpdesk when complete.
Lab and Radiology orders/results are received in Epic
Interfaces Team
End users Other users complete reconciliation of
pertinent data based on policy and length of
downtime.
Reconcile MAR once pharmacy reconciles
medication orders.
Enter Epic Downtime Event Note for all
patients in the facility during downtime.
Clinicians
HIM Collect paper forms and scan into Epic HIM
20
After Epic Downtime
DO NOT resume documentation in Epic until instructed even if Epic appears to be back
online. A “CODE WHITE ALL CLEAR” will be initiated when EMR is all clear and ready to use.
(Instructions will be sent when system is ready & stable)
Upon Resuming Documentation in Epic:
Step Detail Responsible
1 Verify the census (ensure that patients are in correct room and bed). Transfers and discharges need to be entered by Patient Access Services using ADT Downtime Event Form.
Nursing Patient Access
2 Enter in Epic all non‐medication orders (ancillary consultations, nursing activities, etc.) 1. The following departments will be entering orders sent
with manual requisition slips; Radiology, Laboratory and Non‐Invasive Cardiology. Respiratory orders will be entered in Epic by designated Respiratory Therapist. a) Downtime orders must be acknowledged after
verification in the electronic system. 2. Prior to resuming documentation of meds in Epic, you must
verify the electronic Medication Administration Record (MAR). A. Confirm new medication orders and schedules in Epic’s
MAR (highlighted items) against the Physician Orders & paper MAR.
B. Discrepancies in order entry and/or future schedules must be communicated to Pharmacy for corrections prior to confirming the order.
C. Orders must be acknowledged after verification in computer.
D. Medication Administration: Nursing will keep the original paper orders in the chart until the patient is discharged. Then they will be scanned into the medical record by HIM staff.
Nursing
3 Before removing medication schedules generated during downtime, verify administration of dose and document against the schedules with the appropriate reason.
Nursing
4 Documentation forms used during the downtime will become a Nursing
21
Step Detail Responsible
permanent part of the medical record. Place forms in the designated section of the chart and discard interim reports (Clinical Summary, etc.) in the confidential recycle bin.
5 In Epic- Add Downtime Documentation o Open Vitals flowsheet o Select Add Rows o Search for and add the Downtime Documentation
flowsheet group to the flowsheet. o Document “Downtime Begin” and “Downtime End”
times in the flowsheet rows that now appear at the top of the flowsheet.
Nursing
6 Intravenous Medication Reconciliation Instructions o Reconciliation is the process of updating and
documenting IV bags and/or continuous infusions following an interruption in computer documentation. IVs should be reconciled after a downtime for the accurate documentation of intake and output.
I. During Downtime:
a) Document IV bags and the corresponding IV intake volume on the paper flow sheet.
b) Continue to hang IV bags in the correct sequence while on paper.
II. After Downtime: Update IVs in Epic.
a) End bags that were completed or stopped during computer downtime. (Verify remaining volume prior to ending bags)
b) Scan current bags into the system to resume computer documentation. Note: Make sure to adjust the volume of each bag to the actual remaining volume upon resuming online documentation.
c) If a bag previously hung is still infusing, update the remaining volume.
Nursing
7 Post –Downtime Recovery: Once the system becomes available, clinically required data will be entered into Epic System. Paper documentation created during downtime will be placed in the patient’s chart.
Nursing
8 Essential Data – ADT must reconcile patients’ locations into the system and make sure that MRNs are resolved.
Patient Access
9 Downtime Event Note: All patients system wide will need the Nursing
22
Step Detail Responsible
following event note completed in order to satisfy regulatory compliance:
A. From the Notes Activity, select “Create Note” and enter a note type of “Downtime Event Note”.
B. Create a downtime event note using Downtime Event Note SmartText
23
Documentation Recovery
For all existing patients, update the patient chart based on any events that happened during downtime.
High Priority Critical Elements for Inpatient
Downtime ≤ 1 hour
Downtime 1-3 hours
Downtime > 3 hours Entering
User
Height/Weight
Enter all Nursing
Allergies
Lines/Drains/Airways
Isolation and Infection Flags
Code Status
FYI Flags
Pregnancy Status
Medication Orders
Use the “Transcribed from paper” mode, enter orders into Epic: Enter all medication orders
Pharmacist
Medication Administration
Enter all (**do not enter until Pharmacy communicates that they have
finished recovering orders**) Nursing
Non-Medication Orders
Enter all Nursing non-medication orders including future labs, diet, activity, ancillary consults, etc. (Do not enter orders for
medications or performed labs)
Nursing
Respiratory Orders Enter all Respiratory non-medication orders Respiratory
Imaging Orders Enter all orders performed during downtime to reconcile exams Radiology
Problem List Enter all Provider
Inpatient Admission Data Sets
Downtime ≤ 1 hour
Downtime 1-3 hours
Downtime > 3 hours Entering
User
Prior to Admission Meds
Enter all
Enter all for patients admitted during the downtime
Nursing Patient (head-to-toe) Assessment
Enter all for patients admitted during the downtime
Fall risk Initial assessment for all patients admitted during the downtime Braden scale
Inpatient-other critical data
Downtime ≤ 1 hour
Downtime 1-3 hours
Downtime > 3 hours Entering
User
Vitals
Enter all
One set per shift or if pertinent others occur Device integration units-do not back enter-the data will file when the system comes back up
Nurse
Intake/Output I & O shift totals Nurse
Blood Administration Enter all Nurse
Vent settings Enter last settings Respiratory
Care plan Enter all Nurse
24
Notes Scan in Scan
Code Documentation Scan in (TBD medication entry) Scan
Discharge Instructions Scan in Scan
Ancillary Clinical Services
Downtime ≤ 1 hour
Downtime 1-3 hours
Downtime > 3 hours Entering
User
PT/OT/SLP/Evaluation and Re-Evaluation
Enter all
Enter last assessment PT, OT,
SLP,
PT/OT/SLP/Treatment Plan
Enter all PT, OT,
SLP
Oncology/Ambulatory
Clinical Services
Downtime ≤ 1 hour
Downtime 1-3 hours
Downtime > 3 hours Entering
User
Oncology - Any manipulation of the Treatment Plan or Therapy Plan, including: completing treatment day, dose changes, and schedule change.
Enter all
Nurse
Oncology - Cancer Staging (new or revised)
Enter all
Provider
Oncology/Ambulatory - final lab results from non-Houston Methodist labs
Enter all
Nurse
Oncology/Ambulatory - any new items or updates that are pushed to MyChart: problem list, med list, allergies, immunizations, preventative care/health maintenance, test results, history, vital signs
Enter all
Nurse
Oncology/Ambulatory - MyChart activation code generation for new patient or proxy
Enter all
Nurse
Problem List Enter all Provider
25
Appendix: Appendix 1: How to access the Support Read Only (SRO) environment Use this approach if Epic Hyperspace is not available (i.e. Scheduled Downtime)
Staff log into any workstation on their unit.
Find the SRO icon located on the desktop. This icon will be pointed to the SRO environment.
READ ONLY
Login using your Epic Hyperspace User ID and Password
Navigate SRO the same way you would using Hyperspace. Record downtime events on paper and keep in the patient’s chart until the system has been recovered.
26
Appendix 2: How to access BCA Web Use this approach if Epic Hyperspace and Shadow Read Only (SRO) is not available (i.e. Unscheduled Downtime)
Access BCA Web using the BCA Web icon on the desktop or
use the URL listed below from any browser.
https://epiclbebcawprod.houstonmethodist.org/BCAWeb-8.2/prelogin.html
BCA WEB
Log‐in with your network ID and password.
Navigate to your Department/Unit folder from the list.
Select your report from the list.
27
View or print appropriate reports.
Within the Folder List, the following reports may be available (Clinical Summary, MAR, DAR, Scheduled Orders, Census (see page 14 for a complete list by department)).
28
Appendix 3: How to access BCA PCs Use this approach in all other scenarios
BCA PCs should be used if SRO and BCA Web are not available.
Epic Downtime Reports: Print out applicable downtime reports. Reports should have a copy that is immediately filed into the patient’s paper record (if appropriate). Follow this procedure to access the BCA reports:
Instructions Screenshot
Log on to the BCA workstation. Use your domain login information for access to the workstation
Double click the BCA Reports icon on the
desktop
For username/password enter in your Epic Hyperspace login information
Once logged in, user will be able to select reports and print
29
Appendix 4: BCA Readiness Required by Application Team
Initial Training:
Training will also be provided as part of the standard curriculum.
Ongoing Drills: It is recommended that quarterly BCA drills are scheduled and are incorporated as part of the scheduled Disaster Drills. This process will be jointly coordinated by the following groups.
Component Lead Contact
BCA PCs Network Tech Analyst IT Infrastructure
BCA Reports Application System Analyst IT – ClinDoc, OpTime, ASAP, Willow, Ambulatory, Beaker and HODs.
BCA Drills Facility Nurse Champions Denise Martin
BCA Policies and Procedures Nurse Managers HMHS – All Entities
The purpose of downtime drills is to educate clinicians of what resources they have available during different scenarios of downtime.
Drill 1: Introduction to BCA/Downtime Support Resources The purpose of this drill is to ensure clinicians are aware of downtime equipment and resources; and that they are properly deployed in their department.
Step 1: Locate your BCA/Downtime PC:
The BCA PC should have a sticker labeled “Epic BCA Downtime Device” on the top. The PC should also have a sticker identifying the device name on it such as “1D3PRE_DT13”.
Step 2: Locate the BCA/Downtime Printer:
The BCA Printer should have a sticker labeled “Epic BCA Downtime Device” on the top. The printer should also have a sticker identifying the device name on it such as “1D3PACU_LJ02”. The printer will also be connected to the BCA/Downtime PC by a USB Plug.
Step 3: Locate the Epic Support Read‐Only icon and the Downtime Printing icon: These icons should be on your desktop, the icons will be used depending upon the scenario during downtime.
30
READ ONLY
Step 4: Locate your downtime kits: This may be a binder, cart, box, etc. The kits should contain the Downtime Procedure Manual, paper forms to use during downtime, and any other necessary forms that your department/unit will need if Epic is down.
Drill 2: Use Support Read Only (SRO) (Scenario 1)
The purpose of this drill is to educate clinicians on an alternate way of using Hyperspace during a downtime. Step 1: Log into Epic Read Only (SRO): This can be located on any PC desktop or Workstation on Wheels (WOW).
The shadow read‐only icon will enable you to view Epic in read‐only.
READ ONLY Step 2: Navigate through SRO like Hyperspace: No new information can be entered but you can review any information on patients that was previously entered in Epic before it went down.
Drill 3: Use BCA Web (Scenario 2) The purpose of this drill is to educate clinicians of an alternate option of getting patient information if the SRO application is unavailable.
Step 1: Begin Downtime Procedures: Explain what and overhead page of “Code White” signals. Step 2: Go to BCA Web: Click on the BCA Web icon or enter the URL into a browser.
https://epiclbebcawprod.houstonmethodist.org/BCAWeb-8.2/prelogin.html
BCA WEB
Step 3: Log into BCA Web: The login page for BCA Web will come up and you will enter you normal login information.
Step 4: Review Patient Reports: Navigate through the folders to find your Department/Unit
Folder. Once the reports come up you can find the patients in your department/unit and view/print reports as needed.
31
Drill 4: Use BCA PCs (Scenario 3) The purpose of this drill is to educate clinicians on an alternate option of getting patient information if SRO and BCA Web are both unavailable.
Step 1: Begin Downtime Procedures: Explain what and overhead page of “Code White” signals. Step 2: Find the BCA/Downtime PC
The BCA PC should have a sticker labeled “Epic BCA Downtime Device” on the top. The PC should also have a sticker identifying the device name on it such as “1D3PRE_DT13”.
Step 3: Log into the BCA Printing Icon: Look on the desktop for the “BCA Printing” icon, this icon will allow you to print the same reports that you get from BCA Web. Use your normal login information to get into Downtime Printing.
Step 4: Find Patient Reports Needed: Once logged into “BCA Printing” the Reports Screen appears. Here you can filter by Department, Location, PC and Report Type Tags. You can view all patient reports and choose the ones you would like printed.
32
Possible other drills include:
A) Test IT Communication Plan The purpose of this drill is to educate clinicians on the proper steps of communicating with IT during a downtime to ensure proper patient care.
B) Recovery
33
Appendix 5: Pharmacy Downtime Manual
BCA PCs and Downtime Reports
Site Location BCA Name Department Reports
HMH HMH PHARMACY (DB1-002 Central Pharmacy Office)
1DB1PHAR_BCA Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
HMH HMH Fondren ICU RX Satellite
1F3PHAR_BCA Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
HMH HMH RX OPC 22 Satellite
1OPC22PHAR_BCA
Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
HMH HMH Fondren RX OR Satellite
1FANE_DT01 Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
HMH HMH Main OR RX Satellite
1M3OR_DT02 Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
HMH HMH RX OPC 19 Satellite
1OP19SURG_DT10 Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
HMH HMH RX OPC 18 Satellite
TBD Willow Pharmacy RX Profile, Pharmacy RX MAR, Census
34
Pharmacy Department Downtime Workflow
Pharmacy Procedure / Tasks ‐ ALL
Step Detail Responsible
Downtime
Communicate that department is in downtime period.
Is SRO available?
– Yes: Log into the SRO environment and use the
read‐ only mode of Epic to view relevant patient data.
– No: Proceed to the next step. – Are BCA web available?
o No: Identify your BCA PC to access the reports.
o Yes: Use BCA web to access report.
o Is the length of the downtime short? Yes: Print off required reports
(Rx MAR, Rx Profile and Census Report).
No: Print all required reports (Rx MAR, Rx Profile and Census Report).
– Receive new orders by fax and provide first
doses. – Put labels on medication with patient MRN
and information (DOB) – Record what has been sent on paper. – Keep all paper forms until the system has
recovered.
Pharmacy
Leader
Pharmacist
35
Appendix 6: Patient Access Downtime Manual
BCA PCs and Downtime Reports
Site Location BCA Name Department Reports needed
HMH HMH ADMITTING
1M1PAS_DT10
ADT ADT Downtime Census,
ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH ANATOMICAL PATH
1M3LAB_DT27 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH ENDOVASCULAR
1M2AOD_DT21
ADT ADT Downtime Census,
ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH MAIN RAD IMAGING
1M2IMG_DT02 1M2RAD_DT15
ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH MAIN 3NW AOD 1M3AOD_DT41 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH MAIN ED 1M1EDEMS ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH APEC 1OP22RAD_DT34
1OP22RAD_DT45
ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH MAIN BREAST CENTER
1SM7BRCT_DT60 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH OP TREATMENT 1WP11NS_DT03 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH KIRBY BREAST CENTR
1KB1IMG_DT17 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
36
Site Location BCA Name Department Reports needed
HMH HMH VOSSED 1VO1ED_DT09 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH KIRBY ED 1KE1ED_DT31 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH PEARLAND ED 1PL1ED_DT15 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH CANCER CTR ANNEX
1AX1RONC_DT07
1AX1RONC_B
ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH Admin TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH Transplant 1OP26TPC_DT34
1SM12TPC_DT193
1OP26TPC_DT30
1SM12TPC_DT104
ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH OPC 18 TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH Jones 10 1J10NS_DT14 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH OPC 2 TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH Smith 5 TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH ORTHO HMH SM 2600 TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
37
Site Location BCA Name Department Reports needed
HMH HMH West Houston Imaging
5KI1IMG_DT20
5KI1IMG_DT10
ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH BED & PT MGMT 1D4CSCH_DT10 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH OPC 21 1OP21CANC_DT73 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH BMT IP 1M8SENS_DT10
1M8NENS_DT03
1M8PHAR_DT04
ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH BMT OP 1M8SWNS_DT24 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH MAIN 8NW 1M8NWNS_DT20 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH Main 9 TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH International Services
1ST5INTL_DT04 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH Telecom/Operators
1D2TELCOM_DT15 ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
HMH HMH Volunteer Services
TBD ADT ADT Downtime Census, ADT Downtime Event Form, ADT Downtime Event Log
38
Patient Access Department Downtime Workflow
HM Patient Access Downtime Workflow
Do
wnt
ime
Reg
istr
atio
nA
dm
it
Patient Access Communicate that department is in downtime period
Patient Access Use BCA Web
Is BCA Web available?
Epic is down
RegistrationUse existing MRN/CSN. Use ADT downtime registration
form to capture patient information.
RegistrationUse the ADT
Downtime Event Form and Log to
capture the event information
Registration
Assign patient a downtime MRN/CSN, use ADT
downtime registration form to capture patient
information.
Patient AccessPrint necessary census reports and downtime event forms from BCA
workstation
No
Is this a new patient?
No
Yes
Yes
RegistrationProvide patient with consent
forms for signing. Place all forms in patient chart
RegistrationRecord dates and
times for every event on the ADT Downtime Event
Form and Log
RegistrationRefer patient to appropriate area – Lab, Radiology, etc.
Does the patient need to be admitted?
Yes
No
RegistrationIdentify a bed and
call transport, record the event in the ADT Downtime Event Form and Log
End
39
Patient Access (ADT) Procedure / Tasks – ALL
Step Detail Responsible
Downtime Communicate that the department is in a downtime scenario.
Is the SRO available?
– Yes: Log into the SRO environment to view relevant patient information.
o Use necessary forms to record clinical, charge and time information.
o Keep paper copies in the patient chart until the system has been recovered.
– No: Are BCA PCs available? o Yes: Use your Epic Hyperspace
username and password. o No: Log into BCA Web and use your
Epic username and password. – Print BCA Reports (Downtime Census and
Scheduling Reports) from the BCA workstations. – Print necessary forms from the BCA
workstations and start using ADT Downtime Event Log to record events.
Patient Access Registration
Registration Is this a new patient?
– No: Use existing MRN/CSN, MRNs and CSNs will be displayed in the existing Census Report. Use ADT Downtime Registration Form to capture patient information and events.
– Yes: Assign patient a downtime MRN and CSN. Use ADT Downtime Event Form to capture patient information.
– Use the ADT Downtime Event Log to capture event information.
Patient Access Registration
40
Step Detail Responsible
Admissions Does the patient need to be admitted?
No: Refer the patient to the appropriate area(s) (Surgery, Transport, Lab, Radiology, etc.).
Yes:
o Provide patient with forms for signing; place forms in patient chart.
o Call Clinical Bed Coordinator/Administrative Coordinator to identify a bed.
o Call transport and record the event using the Downtime Event Form and Log
o Move the patient to the identified bed
o Provide clinicians with patient chart
Make sure that dates and times of every event are recorded on the ADT Downtime Event Form and ADT Downtime Event Log
Registration
Downtime Patient Station When Epic is brought back up, any admission information needs to be entered via downtime patient station. This admission information will be entered into the system prior to being available to other users. After the admission information is input via patient station, the discharge and transfer information will be completed. After all ADT information is completed, the system will be returned to normal operation and all users will be permitted to log on. To use downtime patient station, click on the downtime patient station button on the toolbar. Do not use the ED track board, as there is no way to input downtime CSNs or MRNs via the track board.
41
Downtime patient station looks the same as regular patient station except this will bring up the box seen below after you click on new ED arrival. Enter the MRN previously created or use the downtime MRN. , Click accept. (It is possible that the MRN was established earlier, and therefore you do not have a downtime MRN, but you do have a downtime CSN.)
42
When you click on arrive, you will see this dialog box. Enter the downtime CSN that was assigned during downtime (from your hand written event log).
That’s it! Now everything else is entered in the usual fashion.
43
Appendix 7: Surgical Downtime Manual
BCA PCs and Downtime Reports
Site Location BCA Name Department Reports needed
HMH
APEC 1OP22RAD_DT34 1OP22RAD_DT45
OpTime
Master Daily Schedule
HMH
HMH Centralized Scheduler
1KN1PAS_DT59 1KN1PAS_DT70 1KN1PAS_A
OpTime
Master Daily Schedule
HMH
D3 Pre
1D3PRE_DT13 1DPRE_DT13
OpTime
Master Daily Sched, Clinical Summary, MAR, Case Log
HMH
D3OR
1D4OR_DT10
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
D3PACU
1D3PACU_DT25
OpTesia
Master Daily Sched, MAR, Clinical Summary, Anesthesia
Summary
HMH
Main Pre
1M3PREOP_D10
OpTime
Master Daily Sched, Clinical Summary, MAR, Case Log
HMH
Main OR
1M3OR_DT02
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
Main PACU
TBD
OpTesia
Master Daily Sched, MAR, Clinical Summary, Anesthesia
Summary
HMH
D6OR
1D6OR_DT06
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
D6PACU
1D6PACU_DT07
OpTesia
Master Daily Sched, MAR, Clinical Summary, Anesthesia
Summary
HMH
Fondren Pre
TBD
OpTime
Master Daily Sched, Clinical Summary, MAR, Case Log
HMH
Fondren OR
1F3ANE_DT01
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
OPC Pre
TBD
OpTime
Master Daily Sched, Clinical Summary, MAR, Case Log
HMH
OPHTH OR
TBD
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
OTO OR
TBD
OpTesia Master Daily Sched, Pick List,
Pref Cards, Clinical/Anesthesia Summary, MAR, Case Log
HMH
OPC PACU
TBD
OpTesia
Master Daily Sched, MAR, Clinical Summary, Anesthesia
Summary
44
Site Location BCA Name Department Reports needed
HMH
OPC 18 Pre
TBD
OpTime
Master Daily Sched, Clinical Summary, MAR, Case Log
HMH
OPC18 OR
TBD
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
OPC18 PACU
TBD
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log HMH
OPC 19 Pre
1OP19PRE_DT40
OpTime
Master Daily Sched, Clinical Summary, MAR, Case Log
HMH
OPC 19 OR
1OP19SURG_DT10
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
HMH
OPC19 PACU
1OPC19PACU_DT41
OpTesia
Master Daily Sched, MAR, Clinical Summary, Anesthesia
Summary
HMH
HMH ENDO
1SM6GI_DT05
OpTesia
Master Daily Sched, Pick List, Pref Cards, Clinical/Anesthesia
Summary, MAR, Case Log
45
Downtime Central Scheduling Workflow Sc
he
du
ling
– E
xisti
ng
Ap
po
intm
en
t R
eq
ue
stSc
he
du
ling
– N
ew
Ap
po
intm
en
t R
eq
ue
stSu
rgic
al C
ase
Sc
he
du
ling
Downtime Surgical Workflow
Start
Scheduler Staff: Communicates – EPIC is down &
department is in downtime period
Is this during business hours?
Refer to Surgical policies and procedures
NO
Scheduler print Schedule Request Log and keeps
paper copies until system has been recovered.
End
Scheduler prints Master Daily Schedule report
from downtime workstation
Prints Schedule
Request Log,
Fax a copy of DAR
for PAT, MDS – PRE/
OR/PACU.
Prints latest schedule
for the day – SPD/
Materials for
procedures that day.
Is SRO available?
Scheduler logs into SRO Environment to patient scheudle
YES
NO
YES
Start
Refer schedule request to the OR
Charge Nurse
NO
End
During Recovery, all
scheduled
procedures need to
be logged in EPIC
Is this during business hours?
Record the request on the schedule
request logYES
Scheduler schedules new appointment
manually based on the print out copy
Fax confirmation of appointment to original
requestor
OR Scheduler – logs in SRO & use read-only mode of EPIC to
view relevant patient data
OR SCHEDULER
communicates
downtime to all
surgical department
staff & immediately
begin downtime
procedure
Is SRO Availble?StartIs the BCA Web
Available?
OR SCHEDULER
communicates
downtime to all
surgical department
staff & immediately
begin downtime
procedure
YESNO
OR Scheduler – logs in BCA PC
OR Scheduler – receives surgery request by phone
or fax
YESNO
Is surgery within the next 24
hours?
OR Scheduler – schedules procedure manually base
on availability. During recovery – need to enter all
data to EPIC
NO
OR Charge NURSE receives
scheduling request by phone
and record surgery and book
on availability. OR Scheduler
can schedule procedure with
Charge RNs approval.
Include list of operation,
surgeon , room time, special
needs and allergies.
End
SPD/Materials – prints off preference card/pick list
from the BCA workstations and prepare equipment.
46
Downtime Central Scheduling Workflow
Step Detail Responsible
Existing Appointment Request
Communicate that Epic is down and department is in downtime period.
Is this during business hours?
No: Refer to the surgical policies and procedures.
Yes: Is SRO available?
Yes: Log into the SRO environment to patient schedule.
o Print schedule request log. o Keep paper copies until system
has been recovered.
No: Log in to BCA web and print DAR and Clinicians Daily Schedule from downtime workstation using Epic Hyperspace user name and password.
o Print schedule request log. o Fax a copy of the DAR and daily
schedule to PAT clinic and Preop/ OR and PACU department for any changes on schedule for the next day which is an end of day process providing latest copy of schedule.
o Print out preference cards, pick list and schedule for SPD and materials for procedures that day.
Scheduler
New Appointment Request
Is this elective surgery?
Yes: Record the request on the schedule request log.
o Schedule new appointments manually
o Fax confirmation of the appointment to the original requestor via orders now.
No: Refer schedule request to the OR Charge Nurse
Scheduler
47
Step Detail Responsible
Downtime (Scheduling)
Communicate downtime to Surgical Department
clinicians and immediately begin downtime
procedures.
Is SRO available?
Yes: Log into SRO using any PC. Record all events on paper.
No: Is BCA Web available?
o Yes: Log into BCA web using any PC. Choose your device and print relevant reports. Record all events on paper.
o No: Find your BCA PC and log in using your Epic Hyperspace user name and password. Print relevant reports. Record downtime events on paper.
Print paper copies of forms or get forms from the Downtime Binder. Receive surgery requests by phone or by fax.
Is surgery within the next 24 hours?
Yes: Connect directly to OR Charge Nurse.
No: Connect to Central Scheduling.
Central Scheduling:
Print BCA Reports (case log summary and master
daily schedule) from the BCA workstations.
Print off and fax preference cards and schedule to
SPD and OR Clinical. Include list of operations,
surgeons, room, time, special needs and
allergies.
OR Charge Desk:
Receive schedule by phone or fax.
OR Charge record surgery request and book
based on availability.
Include list of operations, surgeons, rooms, time,
special needs, and allergies.
SPD/Materials:
Print off preference cards/pick list from the BCA
workstations and pick lists and prepare
equipment.
Central Scheduling
SPD
Materials
OR Charge
Unit Clerk
48
Downtime Surgical Department Workflow A
DM
ITTI
NG
PR
E –
OP D
ep
art
me
nt
INTR
AO
P D
ep
art
me
nt
PA
CU
/Re
co
ve
ry D
ep
art
me
nt
AO
D/P
ha
se 2
Downtime Surgical Workflow
Start
Unit Clerks communicates
downtime to all surgical dept staff &
downtime procedure begins
IS SRO available?
Unit Clerk prints Master Daily schedule, labels for
that day. Registers patients on the MDS &
record pt’s time of arrival
Unit Clerks verify
patient’s info from
intake chart and
walks pt over to AOD/
Preop and puts all
forms in patient’s
paper file
Is SRO available?
Staff puts patient in preop room & does
inventory of pt’s belongings
Clinical Staff – create
lab/radiology/BB
requisition order and
send paper request
form with specimen to
lab and/or patient to
radiology
Clinical Staff uses periop nursing Bo document pt
info, patient time of arrival and provide
patient with labeled band.
Clinical Staff – gathers info on health history, fall
risks, skin, meds, allergies, NPO and
performs POC testing if necessary
Does patient require radiology/lab/blood bank
orders?
YES
Intra RN –
completes PREOP
Checklist for
patient. Use periop
downtime nursing
record to document
relevant findings
and record follow
up orders
Intra RN – Documents “In
Room time”, time out,
incision time, positioning and
skin condition. Use printed
forms to fill out relevant
implants(if any), charges and
supplies. Use pronted forms/
labels to submit any
specimen to pathology/lab.
Is BCA Web Available?
NO
YES
Unit Clerk finds the BCA PC and Logs in
NO
To AOD?Preop Area
To AOD?Preop Area
Start
Anesthesia Staff – follows anesthesia
downtime procedures
Clinical staff starts pt’s IV and finishes PREOP
documentation
Clinical Staff sends patient to OR department
NO
Clinical Staff sends patient to OR department
Intra Clinical Staff –
pulls preference
card for procedure
Start
Intra RN – saves
copy of implant
used and additional
supply items used
for charges.
Document patient
tracking events.
Intra RN –
Document “Out of
Room” time and
send patient to
recovery, drop off
patient to recovery
with the intra-op
sheets.
Drop off patient to PACU
PACU process
patient through
recovery including
physician orders
(Surgeon and
Anesthesia orders).
Documents in
flowsheet.
PACU RN Contract
house supervisor
by phoneto identify
a bed and transport
to department
Drop off patient to PACU
PACU RN receives
patient and record
Time of Arrival
Start
PACU RN –
prepares patient for
admission to floor
Transport patient from
a surgical department
to inpatient unit,
marking to bed
assigned bed, room
and floor
Move patient to next level of care (floor/
ICU
Is the patient inpatient?
YES
Transport patient to
AOD/Phase 2 or
Day Surgery and
mark out of PACU.
PACU staff takes
note of time
NO
Move patient to AOD/Day Surgeyr
or Phase 2
Clinical staff cares for patient
till patient meets discharge
criteria, If not – physician
writes admission/o
Clinical Staff
receives patient in
department and
document data on
downtime periop
nursing
documentation
form. Marks patient
in Phase 2
Start
Clinical Staff –
documents
discharge criteria
met, prepares
discharge forms
and provides any
additional
educational
Patient /guardian
signs discharge
form, copy of which
stays in h
Move patient to AOD/Day Surgeyr
or Phase 2
Does the patient meet discharge
criteria?NO
END
YES
49
Surgical Departments Procedures
Step Detail Responsible
Admitting
Unit Clerk/Secretary
Communicate downtime to surgical department clinicians and immediately begin downtime procedures.
Is SRO available?
Yes: Log into SRO to navigate similar to how you would use Epic. Record all events on paper forms.
No: Is BCA web available? o Yes: Log into BCA Web using your Epic
Hyperspace user name and password. Print all necessary reports and record events on paper forms.
o No: Identify your BCA PC and print necessary reports. Record events on paper forms.
Unit Clerk
Pre‐Op
Registration:
Register patients on the master daily schedule and record time of
Arrival.
Verify patient information from intake charts and on
case log
Summary.
Walk patient over to the AOD/Pre-Op Department.
Put completed forms in the patient’s paper file.
Unit Clerks:
Put patient in pre‐op room.
Do an inventory of patient’s belongings. Clinicians:
Use perioperative nursing admission record to document patient information.
Verifies patient information.
Records time of arrival. Use Patient Arrival Log.
Provides a patient band.
Gathers the following patient information:
o Health history taken by nurse
o Assess for fall risk
o Assess skin
o Meds reconciliation
o Confirms allergies and nil per os (NPO) (fasting)
o Draws labs, urine and pregnancy test, as
required.
Surgeon:
50
Step Detail Responsible
Marks patient updates the H&P.
Does the patient have an implanted cardiac device?
Yes: Follow the implanted cardiac process.
No: Proceed to the next step.
Does the patient require lab/transfusion orders?
Yes: Clinicians – Create lab and/or radiology requisition order and send paper form with patient to lab.
No: Clinicians – Send patient to OR department.
Anesthesia Clinicians:
Follow the anesthesia downtime procedures, including anesthesia consent forms.
Pre-Op Clinicians:
Start patient’s IV.
Intra ‐Op
Intra-Op Clinicians:
Print appropriate preference cards.
Complete the pre‐operations check list for patients using forms from the BCA workstation.
Take patient to the OR
Record the time the patient arrives in the OR using OR timesheet.
Position patient appropriately for surgery
Use current intra‐ops nursing records to document
relevant findings and record any follow‐up orders.
Use printed forms to fill out Main OR charge sheet, Operating Room Misc. Charges, and any other relevant charge sheets including implants.
Record the time out of the OR using OR timesheet.
Put forms in patient chart copy of charges should stay in
unit for keying in during recovery phase.
Use printed forms and labels to submit any specimen for
testing.
Prepare the patient to hand off to recovery.
Drop patient off at recovery and record the time.
Drop off patient documentation,
specimens and intra‐op sheets.
Clinicians
51
Step Detail Responsible
Recovery
Post Anesthesia Care Unit (PACU) clinicians:
Receives patient post op.
Record the arrival time.
Process the patient through recovery and process any physician orders.
Is this day surgery?
Yes: PACU Registration:
Does the patient meet discharge criteria?
Yes: PACU Registration submits PACU time, charge, supplies and nursing forms.
o PACU Registration: Prepare discharge forms and provides any additional education material as required.
o Patient signs discharge forms.
o Patient is moved to Phase 2 – AOD Department.
No: PACU clinicians: o Contact House Supervisor by
phone to identify a bed and transport department.
o Prepare patient for admission/transfer. o Move patient from surgical department to
inpatient care unit
PACU (Clinicians)
52
Downtime Pre‐Admission Testing (PAT) Workflow P
re-A
dm
issi
on
Te
stin
g (
PA
T)
Pre-Admission Testing (PAT) Workflow
Start
PAT Registration Staff – communicate downtime to all staff
in the department and immediately
downtime procedure begins
Is SRO available?
PAT Registration Staff pronts off schedule and
relevant forms and stickers
PAT staff finds the BCA PC and Logs in
PAT Staff logs into the SRO
environment & user read only mode of
EPIC to view relevant patient data
Is BCA Web Available?
PAT Staff – Identify which patients need clinic visits VS PAT
Screening Calls
Does patient require clinic
visit?PAT Staff – Phones patients and record
answers to the general
questionnaire. All paper copies.
NO
PAT Staff -Phones patient and register/schedule for clinic
visit
PAT Staff – Record registration staff on the PAT log and completes the
consultation. Fulls out paper copies of any required lab, radiology and or
specimen forms
YES
PAT Staff – Discharge patient
End
PAT Procedures
Step Detail Responsible
Downtime
Communicate downtime to surgical department clinicians and immediately begin downtime procedures.
Is SRO available?
Yes: Log into SRO to navigate similar to how you would use Epic. Record all events on paper forms.
No: Is BCA web available? o Yes: Log into BCA Web using your Epic
Hyperspace user name and password. Print all necessary reports and record events on paper forms.
o No: Identify your BCA PC and print necessary reports. Record events on paper forms.
Use PAT forms (including patient registration, consent forms, etc.). You can print them off of the BCA workstation or you can find them in the downtime binder
Identify which patients need clinic visit versus phone calls.
Does patient require clinic visits? o Yes: PAT Registration phone
patients and register for clinic visit. PAT Registration:
Record registration on the PAT log.
Complete the consultation and fill out paper copies of any required lab, radiology and/or specimen forms.
Discharge patient.
PAT Registration
53
Step Detail Responsible
o No: PAT Clinical phone patients and record answers to the general questionnaire. Put paper copies in the patient’s chart.
Downtime Surgical Charges
Op
tim
e C
ha
rge
s
Downtime Surgical Charges Workflow
Start
Clinical Staff – Records Level of
Care and all charges on paper superbill/fee slips/implants
used.
Clinical Staff – Record orders in superbill
Clinical Staff – Submit all orders/
facesheets
Unit Clerks communicates downtime to all
surgical dept staff & downtime procedure
begins
End
Downtime Surgical Charges Procedures
Step Detail Responsible
Downtime
Clinicians:
Record the level of care and charges on the bill/fee slips, copy of charges should be kept in unit.
Record orders on bill.
Submit orders/fee sheets.
Copy of implants used in procedure should be kept for billing purposes.
Clinicians
54
Anesthesia Department Downtime Workflow
Anesthesia Department Downtime Workflow
AN
ESTH
ESIA
De
pa
rtm
en
t
Start
End
Document PACU
handoff on
anesthesia form
and staff patient
transfer out of
PACU
Has the patient been marked
ready for surgery?
Anesthesia Staff – Use pre-anesthesia evaluation form &
Event report
Anesthesia Clinical Staff – prints episode report,
Event report and Optime Master Daily Schedule
and use BCA anesthesia record form
Transfer patient to PACU
Anesthesia Clinical Staff – Record all information using the Episode report
Clinical Staff communicates that the
department is in downtime and begins
procedures immediately
Anesthesia Staff – user paper
Physician Orders as required and
Anesthesia record
PRE YES
NO
INTRA
PACU
Anesthesia Procedure Tasks-ALL
Step Detail Responsible
Pre‐Anesthesia
Communicate that the department is in a downtime and immediately begin downtime procedures.
Print the BCA Reports (Episode Reports, Event Reports and OpTime Master Daily Schedule) from the BCA workstations.
Has the patient been marked for surgery?
No: Use Pre‐Anesthesia Evaluation Form and Event Report.
Yes: Record information using the Episode Report. o Use paper copies of physician order sets as
required.
Anesthesia Registration
Post Anesthesia Care Unit
Has the patient been transferred to PACU?
Yes: Use the PACU Care Record to record information.
Clinicians
Recovery Process
Copy of preference cards used for supplies and for billing purposes will remain intact and stored in a designated area to be entered by designated person once the system has been restored data should be entered into EPIC.
Staff responsible for transcribing the record/documents into EPIC data that drives billing – i.e. event times, in/out of OR, PACU times, etc.
Nurse(s) will have the option to verify information entered into Epic for Accuracy.
Completed paper chart will be sent to HIM for
Staff Nurse
Data Entry Personnel
Nurse Auditor
55
Step Detail Responsible
document scanning purposes.
Downtime kits are to be returned to nurse’s station on each unit and the unit clerk/nurses are responsible to replenish used forms.
Appendix 8: Inpatient Downtime Manual
BCA PCs and Downtime Reports
Site Location BCA Name Department Reports needed
HMH HMH ALKEK 7 1AL7NS_DT13 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH ALKEK 8 1AL8NS_DT13 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH BMT IP 1M8SENS_DT10
1M8PHAR_DT04
1M8NENS_DT03
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH WP IP REHAB 10 1WP10NS_DT19 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH WP IP REHAB 9 1WP9NS_DT15 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 10E 1D10ENS_DT07 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 10W 1D10WNS_DT14 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 4W 1D4WNS_DT20
1D4WNS_DT14
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 7E 1D7ENS_DT09 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 7W 1D7WNS_DT08 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 8E 1D8ENS_DT04 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 8W 1D8WNS_DT08 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 9E 1D9ENS_DT11 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH DUNN 9W 1D9WNS_DT08 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
56
Site Location BCA Name Department Reports needed
HMH HMH DUNN ICU 1D3SICU_DT45
1D3SICU_DT48
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH FONDREN 11 1F11NS_DT12 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH CONF HRT FAILURE 1F11NS_DT28 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH FONDREN 12 1F12NS_DT11 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH FONDREN CCU 1F10CCU_DT02
1F10CCU_DT13
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH FONDREN ICU 1F3ICU_DT12
1F3ICU_DT08
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH JONES 10 1J10NS_DT11 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH JONES 11 1J11NS_DT19 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH JONES 9 1J9NS_DT10
1J9NS_DT13
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH M6SW 1M6SWNS_DT17 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 4NW 1M4NWNS_DT16 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 4SW 1M4SWNS_DT10 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 5 1M5NWNS_DT09 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 6NW 1M6NWNS_DT19 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 7N PSYCH 1M7NWNS_DT18 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 7SW 1M7SWNS_DT16
1M7PHAR_DT11
IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH MAIN 8NW 1M8NWNS_DT20 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH FONDREN MICU 1F2ICU_DT43 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH NEURO ICU 1M4NICU_DT21 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH SNF 1WP8NS_DT19 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH NURSERY LEVEL ii 1M6NSRY_DT08 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
57
Site Location BCA Name Department Reports needed
HMH HMH JONES 8 1J8NS_DT18 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
HMH HMH OBS UNIT M3SW 1M3SWNS_DT14 IP Clinical Summary, MAR, Respiratory Therapy Clinical Summary
58
Inpatient Downtime Workflow
Inpatient Downtime Workflow
Clin
ical
Be
d
Coo
rdin
ato
r/A
dm
inis
trat
ive
Coo
rdin
ato
r
Inp
atie
nt
New
Pat
ien
tD
isch
arge
HIM
Downtime
Start
Charge Nurse/Manager/US
Communicate that the department
should begin downtime procedures
Is SRO available?
Yes
Inpatient StaffLog into the SRO
environment to view relevant patient
information
Inpatient StaffRetrieve necessary
forms from Downtime Kit to
record clinical data/place orders
Inpatient StaffKeep paper copies until system has been recovered
End
NoIs BCA Web available?
Yes
Inpatient StaffPrint BCA Reports (Census, Clinical Summary, MAR)
Inpatient StaffRetrieve necessary
downtime documents and
forms from Downtime Kits
Inpatient StaffPlace all forms in
patient paper chart
Is this a direct admit?
No
Inpatient StaffIdentify the BCA PC
and print BCA Reports (Census, Clinical Summary,
MAR)
Patient AccessProvide inpatient
unit with downtime MRN and necessary consent and patient
forms
Yes
ED/Surgery/HODSubmit a patient bed request by phone or fax to
Clinical Bed Coordinator/
Administrative Coordinator
Clinical Bed Coordinator/
Administrative Coordinator
Reference the Bed Board Log Form
Clinical Bed Coordinator/Administrative Coordinator
Assign patient’s bed and notify charge nurse by phone or page.
Complete Downtime Event Form and fax to Patient Access
Services
Clinical StaffComplete necessary
clinical documentation and
handoff report
Clinical StaffPlace all forms in
patient paper chart
Clinical StaffTransport patient to
appropriate department
Clinical StaffComplete all
necessary forms and place in patient
paper chart
Is this patient being
discharged?
No
Clinical StaffComplete all
necessary forms and place in patient
paper chart
Yes
Clinical StaffPrint discharge
instructions. Print patient education
from BCA workstation via
kramesondemand
Clinical StaffDischarge patient
Unit Secretary
Update Department Log. Fill out Downtime Event Form and fax to
Patient Access Services and Clinical Bed Coordinator/Administrative
Coordinator
Clinical Bed Coordinator/
Administrative Coordinator
Update Bed Board Log Form
Unit SecretaryCollect all paper
downtime forms to be scanned by HIM
End
HIMScan paper
downtime forms into Epic
59
Inpatient Procedure / Tasks ‐ Step Detail Responsible
Inpatient Unit Communicate that the department is in downtime period. Is SRO available?
Yes: Log into the SRO environment to view relevant patient data.
No: Is BCA Web available? o Yes: Log into BCA web to print
necessary reports. Retrieve necessary forms from
Downtime Kit to record clinical data/place orders.
Keep paper copies until system has been recovered
o No: Identify the BCA PC and print BCA Reports (Census, Clinical Summary, MAR)
Retrieve necessary forms from Downtime Kit to record clinical data/place orders.
Place forms in the patient paper chart.
Is the patient a direct admit?
Yes: Patient Access to provide Inpatient Unit with downtime MRN and necessary consent and patient forms.
No: Submit a Patient Bed Request by phone or fax to Clinical Bed Coordinator.
Charge Nurse Unit Secretary
Clinical Bed Coordinator/ Administrative Coordinator
Reference the Bed Board Log Form.
Assign patient’s bed and notify charge nurse by page or phone.
Inpatient Staff notifies the Clinical Bed Coordinator/Administrative Coordinator and updates the Bed Department Log and fills out the ADT downtime event form. Fax downtime event form to Patient Access Services
Clinical Bed Coordinator/ Administrative Coordinator
New Patient Complete the necessary clinical documentation and handoff report.
Place forms in the patient’s paper chart.
Transport patient to the appropriate department.
Clinicians
Patient Discharge
Complete necessary clinical documentation. Is the patient being discharged?
Yes: Print patient education from kramesondemand.com. If the network is not available, physicians can access discharge
Clinicians
60
Step Detail Responsible
instruction forms from the Downtime Kit. o Notify Clinical Bed
Coordinator/Administrative Coordinator and complete the ADT Downtime Event Form.
o Fax ADT Downtime Event Form to Patient Access Services.
o Discharge patient.
No: Complete necessary clinical documentation and place in patient’s chart.
Recovery IT will notify users via email/overhead page (Code White All Clear) when system is up and recovery process may begin.
o DO NOT reconcile MAR until your unit/department is notified by Pharmacy that medication order reconciliation is complete.
o Refer to detailed Recovery Procedure on page 18.
Clinicians
HIM Collect paper forms and scan into Epic HIM
61
Inpatient/ADT Downtime Communication Workflow
ADT Communication Workflow
Dis
cha
rge
Ad
mit
tin
gT
ran
sfe
r
Downtime
Start
End
Patient needs to be admitted
ED/Surgery/HODSubmit a patient bed request by phone or fax to
Clinical Bed Coordinator/
Administrative Coordinator
Clinical Bed Coordinator/Administrative Coordinator
Assign patient’s bed and notify charge nurse by phone or page.
Complete Downtime Event Form and fax to Patient Access
Services
Patient Access Services
Receives Downtime Event Form and
updates Downtime Event Log
Patient Access Services
Add patient to Patient List Report
StartPatient is ready for
discharge
IP Clinical Staff/Unit Secretary
Fill out downtime event form
End
IP Clinical Staff/Unit Secretary
Fax form to Clinical Bed Coordinator/
Administrative Coordinator and Patient Access
Services
StartIs this a facility to facility transfer?
IP Clinical Staff/Unit Secretary
Fill out downtime event form
IP Clinical Staff/Unit Secretary
Fax form to Clinical Bed Coordinator/
Administrative Coordinator and Patient Access
Services
Refer to Admit and Discharge steps as
outlined above
EndNo
Yes
Step Detail Responsible
Admission ED/Surgery/HOD makes a bed request by phone to the Clinical Bed Coordinator/Administrative Coordinator.
Clinical Bed Coordinator/Administrative Coordinator fills out ADT Event Form and faxes it to Patient Access Services.
Patient Access Services receives the faxed form and records the information from the form on the ADT Downtime Event Log.
ED/Surgery/HOD
Discharge IP Clinicians complete the ADT Downtime Event Form.
IP Clinicians fax form to Clinical Bed
IP Clinical Staff/ Unit Secretary
62
Step Detail Responsible
Coordinator/Administrative Coordinator and Patient Access Services.
Patient Access Services receives the faxed form and records the information from the form on the ADT Downtime Event Log.
Transfer Is this a facility to facility transfer?
Yes: Refer to Admit and Discharge steps as outlined above.
o Patient Access Services receives the faxed form and records the information from the form on the Downtime Event Log.
No: IP Clinicians fill out ADT Event Form and fax to Clinical Bed Coordinator/Administrative Coordinator and Patient Access Services.
IP Clinical Staff/ Unit Secretary
63
Appendix 9: Emergency Department Downtime Manual
BCA PCs and Downtime
Reports
Site Location BCA Name Department Reports needed
HMH HMH Main ED 1M1EDEMS ASAP Clinical Summary, MAR, Census
HMH HMH VOSS ED 5VO1ED_DT16 ASAP Clinical Summary, MAR, Census
HMH HMH KIRBY ED 1KE1ED_DT21 ASAP Clinical Summary, MAR, Census
HMH HMH PEARLAND ED 1PL1ED_DT18 ASAP Clinical Summary, MAR, Census
64
Downtime Workflow (if Epic is down)
65
Procedure / Tasks ‐
Step Detail Responsible
ED Admission
Communicate to all staff that downtime is in effect and immediately begin downtime procedures.
Is SRO available?
o Yes: Registration log into the SRO environment and use the read‐only mode of Epic to view relevant data.
o No: Is BCA web available? Yes: Log into BCA Web from
any PC. Print clinical summary, census report and labels for patients.
No: Identify you BCA PC and print clinical summary, census report and labels for patients.
Put patient labels on every form.
Create or add to soft charts for existing patients.
Distribute forms to physicians and nurses.
Is it a new patient?
Yes: Did the patient arrive by ambulance?
o No: Proceed to triage section. o Yes: Primary Nurse record patient
information on the ambulance intake record.
Registration registers patients via arrival log.
Create paper chart with ADT downtime event form and labels and pass to Unit Clerk.
Document using the arrival logs. o No: Registration registers patients
using the arrival log. Use ADT downtime event form. Print labels. Create paper chart with ADT
downtime event form and labels to pass to Unit Clerk.
Document via arrival logs.
o Unit Clerks put patient labels on every
form.
o Distribute forms to clinicians.
Registration
Unit Clerk
66
Step Detail Responsible
Triage Primary Nurse initiates the Emergency Services Record form
Primary Nurse
Primary Assessment
Primary Nurse
Complete the secondary nursing assessment and the nurse initiated orders (NIO) form
ED Physician
Use the Emergency Services Record form
Does the patient require lab work?
Yes: Unit Clerk completes the Lab Request Form with specimen and send to the Lab.
o Send specimen to Lab via Tube.
o Lab results are reported by fax. o Check the fax machine regularly and
put results into the patient’s paper chart. o Call Lab for results (if results not
received by 30 minutes).
No: Does the patient require radiology? o Yes: Unit Clerk uses the radiology
computer downtime request form. Send radiology request via phone or
fax. Abnormal radiology requests are
reported by phone or fax. Check the fax machine regularly
and put results into the patient’s paper chart.
Call Radiology for results (if results not received by 30 minutes).
o No: Proceed to secondary assessment.
Information to be put in patient’s paper chart. Orders to be communicated with a Unit Clerk.
Additional specialized forms to be printed from the BCA workstation.
Primary
Nurse ED
Physician
Unit
Secretary
Primary Nurse complete: Clinicians
– Nursing Care Record, Unit Secretary Secondary Assessment
– ED Clinical Record, – Progress Record, and – Epic Downtime Form – Vitals as required.
Pharmacy
ED Physician complete:
67
Step Detail Responsible
– ED Clinical Order,
– Subsequent ED provider orders and – Physician Orders as required. Physician orders will be located on the downtime workstation and on the intranet. Information to be put in patient’s paper chart. Orders to be communicated with a Unit Clerk. Additional specialized forms to be printed from the BCA workstation. Communicate with the Unit Clerk for the form to be printed and put in the patient soft chart. Physician order sets and other forms will be located on the downtime workstation and on the intranet.
Pharmacy Clinicians
– For pharmacy orders that cannot be fulfilled in ED.
Send medication orders to pharmacy department
by fax.
– Pharmacy to review in case of dosage questions. Pharmacy to receive request by phone.
Clinicians
Laboratory For laboratory requests use the Lab Requisition Form.
– Orders to be communicated with a Unit Clerk. – Reference table below to provide sufficient
patient information. Keep orders and results in patient paper chart.
Clinicians Unit Secretary
Discharge/Admit/ Transfer
Is the patient ready for discharge?
– Yes: ED Physician/Primary Nurse will print emergency discharge instructions and ED discharge form from the downtime BCA workstation.
o Complete ED Charge Sheets.
– No: Does the patient need to be admitted? o Yes: ED Physician makes a bed request
using the phone to call House Supervisors/Bed Control.
o Fill out the Inter Facility Transfer Form. o House Supervisors/Bed Control fills out the
ADT event form and sent to ADT.
o Complete ED Charge Sheets.
– Send completed patient forms to HIM for scanning.
Once patient admitted/transferred photocopy the forms. Keep the originals in the ED and pass on the copies of the patient paper chart to the appropriate department.
– Send ED Chart copy with patient.
ED
Physician
Hospitalist
Unit Clerks
House Supervisor / Patient Access
68
Step Detail Responsible
– Send original orders and EKG results with patient. Send chart with patient when patient is being admitted or
transferred
Charges Use new charge sheets to capture relevant billing information. Keep original in patient paper chart and send to HIM
Billing
HIM
Downtime Patient Station When Epic is brought back up, any admission information needs to be entered via downtime patient station. This admission information will be entered into the system prior to being available to other users. After the admission information is input via patient station, the discharge and transfer information will be completed. After all ADT information is completed, the system will be returned to normal operation and all users will be permitted to log on. To use downtime patient station, click on the downtime patient station button on the toolbar. Do not use the ED track board, as there is no way to input downtime CSNs or MRNs via the track board.
Downtime patient station looks the same as regular patient station except this will bring up the box seen below after you click on new ED arrival. Enter the MRN previously created or use the downtime MRN. Click accept. (It is possible that the MRN was established earlier, and therefore you do not have a downtime MRN, but you do have a downtime CSN.)
69
When you click on arrive, you will see this dialog box. Enter the downtime CSN that was assigned during downtime (from your hand written event log).
70
That’s it! Now everything else is entered in the usual fashion.
71
Appendix 10: Lab Downtime
Manual BCA PCs and Downtime
Reports
Site Location BCA Name Department Reports needed
HMH HMH LAB 1D2LAB_DT28 Laboratory Medicine Census
HMH HMH MAIN 5 PATHOLOGY LAB
MCM560_DT02
Laboratory Medicine Census
HMH HMH BLOOD BANK
1D2BBANK_DT02
Laboratory Medicine Census
72
Lab Downtime Workflow
Inpatient Lab Downtime Workflow
Inp
ati
en
t La
b S
taff
Downtime
Start
Lab Staff Communicate that
the department should begin
downtime
procedures
Is SRO available?
Yes
Lab StaffLog into the SRO
environment to view relevant patient
information
Lab StaffRetrieve necessary
forms from Downtime Kit to
record clinical data/place orders
Lab StaffKeep paper copies until system has been recovered
End
NoIs BCA Web available?
Yes
Lab StaffPrint BCA Reports (Census, Clinical Summary, MAR)
Lab StaffRetrieve necessary
downtime documents and
forms from Downtime Kits
Lab StaffFile all forms
accordingly per department procedures
No
Lab StaffIdentify the BCA PC
and print BCA Reports (Census, Clinical Summary,
MAR)
Lab Staff Reconcile all lab
orders post downtime
End
Procedure / Tasks –
Lab should have preprinted sample labels with instrument IDs in their downtime kits.
Step Detail Responsible
Downtime
Communicate that Epic is down and department is in downtime period.
Is SRO available?
Yes: Log into the SRO environment to view relevant patient data.
No: Is BCA Web available? o Yes: Log into BCA web to print
necessary BCA reports. o No: Identify your downtime PC
and print necessary BCA reports
Retrieve necessary forms from Downtime Kit.
Keep paper copies until system has been recovered.
Reconcile all lab orders post downtime.
Inpatient Staff
73
Appendix 11: HOD Downtime
Manual BCA PCs and Downtime
Reports
Site Location BCA Name Department
Reports needed
HMH HMH HEART TRANSPLT
1OP26TPC_DT34
1SM12TPC_DT193
1OP26TPC_DT30 1SM12TPC_DT104
HOD Clinical Summary, MAR, DAR
HMH HMH LIVER TRANSPLT
1OP26TPC_DT34
1SM12TPC_DT193
1OP26TPC_DT30 1SM12TPC_DT104
HOD Clinical Summary, MAR, DAR
HMH HMH LUNG TRANSPLT
1OP26TPC_DT34
1SM12TPC_DT193
1OP26TPC_DT30 1SM12TPC_DT104
HOD Clinical Summary, MAR, DAR
HMH HMH PANCREAS TRANSP
1OP26TPC_DT34
1SM12TPC_DT193
1OP26TPC_DT30
1SM12TPC_DT104
HOD Clinical Summary, MAR, DAR
HMH HMH RENAL TRANSPLT
1OP26TPC_DT34
1SM12TPC_DT193
1OP26TPC_DT30
1SM12TPC_DT104
HOD Clinical Summary, MAR, DAR
HMH HMH WH
TRANSPLANT
TBD HOD Clinical Summary, MAR, DAR
HMH HMH SL
TRANSPLANT
TBD HOD Clinical Summary, MAR, DAR
HMH HMH LUBBOCK TRANSPLANT
TBD HOD Clinical Summary, MAR, DAR
HMH HMH SPEECH OP JONES
TBD HOD Clinical Summary, DAR
HMH HMH SPEECH OP SUNSET
1SS6IM_DT12 HOD Clinical Summary, DAR
HMH HMH VASC ACCESS TEAM
1M2PICC_DT01 1M2EV_DT02
HOD Clinical Summary, MAR, DAR
HMH HMH L&D PROCEDURES
TBD HOD Clinical Summary, MAR, DAR
HMH HMH
NEUROPHYSIOL
OGY
1M4NENS_DT07
HOD Clinical Summary, MAR, DAR
HMH HMH RESP
CARE PFT
1OP22PUL_DT06
HOD Clinical Summary, MAR, DAR
74
HOD Downtime Workflow ‐ P
ati
en
t In
take
Ch
ec
k In
Do
wn
tim
eP
rovid
er
Vis
itC
he
ck O
ut
Reco
ve
ry
HOD Department Downtime Workflow
Start
Check In/Registration: Communicate
Downtime to all staff and begin
downtime procedures
Is SRO available?Is BCA Web available?
Patient access:Log into BCA Web
Patient access:Log into the SRO
environment to view relevant patient
information
Patient access:Identify the BCA PC
and login.
Check In/Registration: Daily: Print Department
Appointment Report (DAR), Clinical
Summary, and MAR
Y
N
N
Y
Check In/Registration:
Record patient’s status as arrived on
the Department Appointment Report
(DAR)
Check In/Registration:
Collect Payment if required and record
in daily cash log
New Patient?
Check In/Registration:
Patient complete new patient packet
Photocopy patient identification and insurance
Place non-clinical forms in designated areas for scanning
Put clinical forms, clinical downtime report in patient chart and place in
designated area for clinical staff
Check In/Registration:
Patient completes required forms per visit type
Put clinical forms, clinical downtime report in patient chart and place in
designated area for clinical staff
Check In/Registration:
Notify clinical staff of patient arrival
Y
N
Clinical Staff:Verify patient name and obtain intake
information on downtime encounter form, including any vital signs, history (allergies,
medications) that are pertinent to department and specialty
Clinical Staff:Notify provider of patient ready status
Provider:Document relevant
findings or notes
Provider:Document
assessment and plan
Provider:Document
Medications, Lab/Radiology, Referrals
Provider:Record any follow-
up orders on downtime
encounter form
Provider:Charges: indicate level of care and diagnosis, orders,
other charges
Provider:Provider signs the
completed downtime
encounter form
Clinical Staff:Collect patient’s completed forms
Check Out/Registration:
Collect payment (if not collected at
check in) and record in daily cash log
Follow up appointment?
Check Out/Registration:
Record follow up appointment
information. This will be used to
contact patient for scheduling once the system is available
Check Out/Registration:
Record completion of appointment on
the Department Appointment Report
(DAR)
Clinical Staff:Open the encounter and enter discrete data from the downtime encounter form, including orders,
LOS/CPT codes
Check In/Registration: Check in patient on the schedule. Record any co
payments received. Schedule any follow up
appointments
Clinical Staff:Scan paper forms to the
encounter
Clinical Staff:Notify provider to close
encounterEnd
N
Y
75
Procedure / Tasks ‐ Step Detail Responsible
Downtime Communicate downtime to all ambulatory clinic staff, immediately begin downtime procedures
Is SRO available?
Yes: Log into SRO using your Epic Hyperspace user name and password.
No: Is BCA web available? o Yes: Log in using
your Epic Hyperspace user name and password.
o No: Identify your BCA PC.
Print clinical summary and DAR report for that day.
Clinic Manager
Call Processing / Scheduling
1. Patient calls will be recorded on downtime phone log, including:
1. Patient Name
2. DOB
3. Return phone number
4. Reason for call
5. Contact name and relationship
6. Provider name
7. Call recipient
2. Call processor determines the reason for the call:
Is the reason for the
call due to an urgent
medical need?
Yes:
c. Call processor transfers the call to appropriate clinician, as per clinic protocol.
d. Clinician
documents call
with patient on
downtime phone
log.
No:
e. Call processor
records reason for
Front Desk
76
Step Detail Responsible
call on downtime
phone log.
f. Call processor
routes message to
appropriate staff
for follow‐up per
clinic policy.
No: Is patient requesting an appointment? a) Call processor informs patient that
scheduling systems are down and they will be contacted to schedule an appointment as soon as systems are restored.
b) Call processor enters patient information on downtime phone log. If the patient’s prefers, they may also call back at a later time.
3. Call processor will place
phone logs in designated
place for recovery process.
Check In 1. Record the patient’s arrival time on printed
DAR.
2. Collect payment, if required. Record payment on DAR.
3. Is patient a new patient?
Yes:
a) Ask the patient to complete a new patient packet.
b) Copy patient identification and insurance cards (if copiers are functional).
c) Place non‐clinical forms in designated area for scanning.
d) Collect clinical forms, clinical downtime report and place in designated area for clinical staff pick‐up.
No:
a) Request the patient complete required forms for specific visit type.
b) Place clinical forms, clinical downtime report in designated area for clinical staff pick up.
Check In/Registration
77
Step Detail Responsible
4. Notify clinical staff of patient arrival per clinic policy (i.e. light system, phone call etc.)
Patient Intake
1. Obtain intake information on the downtime encounter form per clinic policy. This could include:
a) Verify patient name
b) History (allergies, medications, etc.)
c) Vital signs
2. Notify provider of patient ready status per clinic policy (i.e. forms placed in door etc.)
Clinical Staff
Provider Visit
1. Document relevant findings or notes for patient on downtime encounter form
2. Document the assessment and plan: a) Medication orders:
i. Provider writes order on prescription pad. ii. Clinical staff copies prescription and places
with patient’s forms. b) Lab and Radiology orders:
i. Provider completes paper requisition/order form.
ii. Clinic staff records two patient identifiers (patient name and SSN or DOB) on requisition/order form.
iii. Is the procedure performed in‐clinic? Yes:
a) Clinical staff notifies lab or radiology technician of pending order, per clinic decision.
b) Lab or radiology results are sent to the ordering provider for review.
No: a) Clinical staff faxes requisition/order
to performing location, or gives to patient to present upon arrival at performing location.
c) Referral orders: i. Provider records referral on the downtime
referral form. ii. A copy of the referral form is provided to the
designated staff to complete referral, per clinic policy.
iii. Place completed referral form with patient’s clinical forms.
iv. Fax/phone referral.
3. Patient follow‐up:
Provider Clinical Staff
78
Step Detail Responsible
a) Provider records any follow‐up orders on downtime encounter form.
4. Charges:
a) Provider indicates level of service and any other charges on downtime encounter form.
b) Provider records diagnoses and orders on downtime encounter form.
5. Provider signs the completed forms.
6. All clinical documentation associated with patient visit is retained by clinical staff
7. All other documents are delivered to the appropriate personnel.
Check Out Check Out/Registration staff collects payment if not collected at check in and records on daily cash collection log, if applicable.
1. Is a follow‐up appointment needed? Yes:
a) Check Out/Registration staff records follow‐ up appointment on schedule request log.
b) Check Out/Registration staff notifies patient they will be contacted for scheduling as soon
as the system is available. No:
a) Record completion of appointment on DAR. 2. Check Out/Registration staff notes completion of
appointment on printed DAR. 3. Check Out/Registration staff places documents in
designated location for recovery procedure.
Check Out/Registration Staff
Recovery Check In/ Registration: 1. Check in patient on the schedule. 2. Record any copayments received. 3. Schedule any follow up appointments. 4. Send copayment receipt to patient if necessary.
Clinical Staff:
1. Open the encounter and enter discrete data from the downtime encounter form, including orders, LOS, CPT codes.
2. Scan paper forms to the encounter. 3. Notify provider to close encounter.
Check In/ Clinical Staff
79
Appendix 12: Ambulatory Downtime Manual
BCA PCs and Downtime Reports
Site Location BCA Name Department Reports Needed
HMH INT MED HMH ST 1130
1ST11MPCG_DT20
1ST11MPCG_LT15
Ambulatory DAR, Clinical Summary
HMH INT MED HMH ST 1950
1ST19IM_DT24 Ambulatory DAR, Clinical Summary
HMH URO HMH ST 2100
1SM22OB_DT10
1SM22OB_DT05
Ambulatory DAR, Clinical Summary
HMH HMH HEALTH INFO MGMT
1ST5MREC_DT05 Ambulatory DAR, Clinical Summary
HMWB MPCG Centralized Call Center
3HG5MPCG_LT02 3HG5MPCG_LT03
Ambulatory DAR, Clinical Summary
HMWB FAM MED WB WCP 390
3SP3MPCG_LT06 3RM2MPCG_LT02
Ambulatory DAR, Clinical Summary
HMWB FAM MED WB WCP 400
3SP4MPCG_LT17 Ambulatory DAR, Clinical Summary
HMWB INT MED WB WCP 400
3SP4MPCG_LT17 Ambulatory DAR, Clinical Summary
HMWB URO WB WCP 400
3SP4UR_LT05 Ambulatory DAR, Clinical Summary
Baytown FAM MED BAYTOWN 201
4AX2MPCG_LT09 Ambulatory DAR, Clinical Summary
Cypress FAM MED CYPRESS 200
3RM2MPCG_LT04 Ambulatory DAR, Clinical Summary
Harris Co FAM MED HARRIS CO 970
1HC2MPCG_LT01 Ambulatory DAR, Clinical Summary
Heights FAM MED HEIGHTS
1HE2MPCG_LT05 Ambulatory DAR, Clinical Summary
Memorial FAM MED MEMORIAL 155
1SF1MPCG_LT15 Ambulatory DAR, Clinical Summary
MONT FAM MED MONTG 100
8RM2MPCG_LT01 8RM2MPCG_LT01
Ambulatory DAR, Clinical Summary
MT BELV INT MED MT BELV 600
4MB1MPCG_C Ambulatory DAR, Clinical Summary
HMSL FAM MED SL MOB3 400
2M34FAM_DT47 2M34FAM_DT16
Ambulatory DAR, Clinical Summary
HMSL INT MED SWEETWTR
2M34FAM_DT16 Ambulatory DAR, Clinical Summary
80
Site Location BCA Name Department Reports Needed
210
Spring FAM MED SPRING FQ
3RM1MPCG_LT08 Ambulatory DAR, Clinical Summary
HMSTJ FAM MED ST JOHN 412
6B14PHYS_LT04 Ambulatory DAR, Clinical Summary
HMSTJ INT MED ST JOHN 412
6B14PHYS_LT04 Ambulatory DAR, Clinical Summary
HMW URO WH MOB2 325
5B23UR_DT08 Ambulatory DAR, Clinical Summary
HMW URO GYN WH MOB1 350
5B23UR_DT08 Ambulatory DAR, Clinical Summary
West U FAM MED WEST U 200
1BS2MPCG_LT12 Ambulatory DAR, Clinical Summary
West U INT MED WEST U 200
1BS2MPCG_LT12 Ambulatory DAR, Clinical Summary
Spring FAM MED STERLING RDG
8RM1MPCG_LT09
Ambulatory DAR, Clinical Summary
Spring INT MED STERL RDG A
8RM1MPCG_LT09
Ambulatory DAR, Clinical Summary
Missouri City FAM MED SIENNA 110
2FM3FAM_LT02
Ambulatory DAR, Clinical Summary
HMSJ URO SAN JAC 211
4P12SPG_DT02
Ambulatory DAR, Clinical Summary
Bellaire FAM MED BELLAIRE 175
1BL1MPCG_LT13
Ambulatory DAR, Clinical Summary
Bellaire INT MED BELLAIRE 175
1BL1MPCG_LT13
Ambulatory DAR, Clinical Summary
HMWB ENDO WB WCP 400
3SP4END_LT05
Ambulatory DAR, Clinical Summary
HMSJ URO SAN JAC 211
5B13OB_DT07
Ambulatory DAR, Clinical Summary
HMH HMH SUNSET MARKETING
SSCALCTR_DT04
Ambulatory DAR, Clinical Summary
Baytown INT MED MT BELV 600
4MB1MPCG_LT04
Ambulatory DAR, Clinical Summary
Baytown FAM MED MT BELV 600
4MB1MPCG_LT04
Ambulatory DAR, Clinical Summary
81
Site Location BCA Name Department Reports Needed
Conroe FAM MED LEAGUE LINE
TBD Ambulatory DAR, Clinical Summary
Pearland FAM MED PEARLAND 200
TBD Ambulatory DAR, Clinical Summary
Pearland INT MED PEARLAND 200
TBD Ambulatory DAR, Clinical Summary
Houston FAM MED EL CMNO RL
TBD Ambulatory DAR, Clinical Summary
HMSTJ ENDO ST JOHN 302
TBD Ambulatory DAR, Clinical Summary
Texas City ENDO TX CITY 200
TBD Ambulatory DAR, Clinical Summary
HMSTJ INT MED ST JOHN 302
TBD Ambulatory DAR, Clinical Summary
Webster FAM MED WEBSTER
TBD Ambulatory DAR, Clinical Summary
Sugarland FAM MED RIVERST 105
TBD Ambulatory DAR, Clinical Summary
Sugarland INT MED RIVERST 105
TBD Ambulatory DAR, Clinical Summary
82
Ambulatory P
ati
en
t In
take
Ch
ec
k In
Do
wn
tim
eP
rovid
er
Vis
itC
he
ck O
ut
Reco
ve
ry
Ambulatory Department Downtime WorkflowPrimary Application: EpicCare Ambulatory
Secondary Application: Care Everywhere, MyChart
Start
Check In/Registration: Communicate
Downtime to all staff and begin
downtime procedures
Is SRO available?Is BCA Web available?
Patient access:Log into BCA Web
Patient access:Log into the SRO
environment to view relevant patient
information
Patient access:Identify the BCA PC
and login.
Check In/Registration: Daily: Print Department
Appointment Report (DAR) and clinical downtime report
Y
N
N
Y
Check In/Registration:
Record patient’s status as arrived on
the Department Appointment Report
(DAR)
Check In/Registration:
Collect Payment if required and record
in daily cash log
New Patient?
Check In/Registration:
Patient complete new patient packet
Photocopy patient identification and insurance
Place non-clinical forms in designated areas for scanning
Collect clinical forms, clinical downtime report and place in designated area
for clinical staff
Check In/Registration:
Patient completes required forms per visit type
Put clinical forms, clinical downtime report and place in designated area for
clinical staff
Check In/Registration:
Notify clinical staff of patient arrival
Y
N
Clinical Staff:Verify patient name and obtain intake
information on downtime encounter form, including any vital signs, history (allergies,
medications) that are pertinent to department and specialty
Clinical Staff:Notify provider of patient ready status
Provider:Document relevant
findings or notes
Provider:Document
assessment and plan
Provider:Document
Medications, Lab/Radiology, Referrals
Provider:Record any follow-
up orders on downtime
encounter form
Provider:Charges: indicate level of care and diagnosis, orders,
other charges
Provider:Provider signs the
completed downtime
encounter form
Clinical Staff:Collect patient’s completed forms
Check Out/Registration:
Collect payment (if not collected at
check in) and record in daily cash log
Follow up appointment?
Check Out/Registration:
Record follow up appointment
information. This will be used to
contact patient for scheduling once the system is available
Check Out/Registration:
Record completion of appointment on
the Department Appointment Report
(DAR)
Clinical Staff:Open the encounter and enter discrete data from the downtime encounter form, including orders,
LOS/CPT codes
Check In/Registration: Check in patient on the schedule. Record any co
payments received. Schedule any follow up
appointments
Clinical Staff:Scan paper forms to the
encounter
Clinical Staff:Notify provider to close
encounterEnd
N
Y
83
Procedure / Tasks ‐ ALL Step Detail Responsible
Downtime Communicate downtime to all ambulatory clinic staff, immediately begin downtime procedures
Is SRO available?
Yes: Log into SRO using your Epic Hyperspace user name and password.
No: Is BCA web available? o Yes: Log in using
your Epic Hyperspace user name and password.
o No: Identify your BCA PC.
Print clinical summary and DAR report for that day.
Clinic Manager
Call Processing / Scheduling
3. Patient calls will be recorded on downtime phone log, including:
8. Patient Name
9. DOB
10. Return phone number
11. Reason for call
12. Contact name and relationship
13. Provider name
14. Call recipient
4. Call processor determines the reason for the call:
Is the reason for the call due to an urgent medical need?
Yes:
Call processor transfers the call to appropriate
clinician, as per clinic protocol
Clinician documents call with patient on
downtime phone log
No:
Call processor records reason for call on
downtime phone log.
Call processor routes message to appropriate
staff for follow- up per clinic policy
Is patient requesting an appointment? Yes:
Front Desk
84
Step Detail Responsible
Call processor informs patient that scheduling systems are down and they will be contacted to schedule an appointment as soon as systems are restored.
Call processor enters patient information on downtime phone log. If the patient’s prefers, they may also call back at a later time.
3. Call processor will place phone logs in designated place for recovery process.
Check In 1. Record the patient’s arrival time on printed DAR. 2. Collect payment, if required. Record payment on
DAR. 3. Is patient a new patient?
Yes:
Ask the patient to complete a new patient packet.
Copy patient identification and insurance cards (if copiers are functional).
Place non‐clinical forms in designated area for scanning.
Collect clinical forms, clinical downtime report and place in designated area for clinical staff pick‐up.
No:
v. Request the patient complete required forms for specific visit type.
vi. Place clinical forms, clinical downtime report in designated area for clinical staff pick up.
4. Notify clinical staff of patient arrival per clinic policy
(i.e. light system, phone call etc.)
Check In/Registration
Patient Intake
3. Obtain intake information on the downtime encounter form per clinic policy. This could include:
e. Verify patient name
f. History (allergies, medications, etc.)
g. Vital signs
Notify provider of patient ready status per clinic policy (i.e. forms placed in door etc.)
Clinical Staff
Provider Visit
1. Document relevant findings or notes for patient on downtime encounter form
2. Document the assessment and plan:
a. Medication orders:
i. Provider writes order on prescription pad.
ii. Clinical staff copies prescription and
Provider/Clinical Staff
85
Step Detail Responsible
places with patient’s forms.
b. Lab and Radiology orders:
i. Provider completes paper requisition/order
form.
ii. Clinic staff records two patient identifiers
(patient name and SSN or DOB) on
requisition/order form.
iii. Is the procedure performed in‐clinic?
Yes:
Clinical staff notifies lab or radiology
technician of pending order, per clinic
decision.
Lab or radiology results are sent to the
ordering provider for review.
No:
Clinical staff faxes requisition/order to performing location, or gives to patient to present upon arrival at performing location.
c. Referral Orders i. Provider records referral on the downtime
referral form. ii. A copy of the referral form is provided to
the designated staff to complete referral, per clinic policy.
iii. Place completed referral form with patient’s clinical forms.
iv. Fax/phone referral. 3. Patient follow-up:
Provider records any follow‐up orders on downtime encounter form.
4. Charges:
Provider indicates level of service and
any other charges on downtime
encounter form.
Provider records diagnoses and orders on
downtime encounter form.
5. Provider signs the completed forms.
6. All clinical documentation associated with patient
visit is retained by clinical staff.
7. All other documents are delivered to the
appropriate personnel.
86
Step Detail Responsible
Check Out Check Out/Registration staff collects payment if not collected at check in and records on daily cash collection log, if applicable.
1. Is a follow‐up appointment needed? Yes:
a. Check Out/Registration staff records
follow‐ up appointment on schedule request log.
b. Check Out/Registration staff notifies patient they will be contacted for scheduling as soon as the system is available.
No: a. Record completion of appointment on
DAR. 2. Check Out/Registration staff notes completion of
appointment on printed DAR. 3. 3. Check Out/Registration staff places
documents in designated location for recovery procedure.
Check Out/Registration Staff
Recovery Check In/ Registration: 5. Check in patient on the schedule. 6. Record any copayments received. 7. Schedule any follow up appointments. 8. Send copayment receipt to patient if necessary.
Clinical Staff:
4. Open the encounter and enter discrete data from the downtime encounter form, including orders, LOS, CPT codes.
5. Scan paper forms to the encounter. 6. Notify provider to close encounter.
Check In/Clinical Staff
87
Appendix 13: Radiology Downtime Manual
Site Location BCA Name Department Reports needed
HMH HMH MAIN RAD IMAGING
1M2IMG_DT02
1M2RAD_DT15
Radiology Department appointment reports & Schedule Orders Report
HMH HMH Main US 1D2CT_DT05
Radiology Department appointment reports & Schedule Orders Report
HMH HMH Main CT (D2) 1D2CT_DT02
Radiology Department appointment reports & Schedule Orders Report
HMH HMH Main CT (ER-(1st
floor- M161)
1M1EDEMS Radiology Department appointment reports & Schedule Orders Report
HMH HMH Main MRI (B1) 1MB1IMG_DT01
Radiology Department appointment reports & Schedule Orders Report
HMH HMH Main Nuclear Medicine
TBD Radiology Department appointment reports & Schedule Orders Report
HMH HMH Main Breast Center TBD Radiology Department appointment reports & Schedule Orders Report
HMH HMH ENDOVASCULAR
1M2AOD_DT21
Radiology Department appointment reports & Schedule Orders Report
HMH HMH ENDOVASCULAR PACU
1M2EV_DT02
1M2PICC_DT01
Radiology Department appointment reports & Schedule Orders Report
88
HMH HMH OPC RAD IMG
1OP17RAD_DT07
Radiology Department appointment reports & Schedule Orders Report
HMH HMH OPC US
1OP17US_DT01
Radiology Department appointment reports & Schedule Orders Report
HMH HMH OPC CT
HMH OPC CT
1OP17NS_DT01
Radiology Department appointment reports & Schedule Orders Report
HMH HMH OPC MRI 1OP16IMG_DT01 Radiology Department appointment reports & Schedule Orders Report
HMH HMH OPC NUC MED
OP17NM_DT07
Radiology Department appointment reports & Schedule Orders Report
HMH HMH OPC Endovascular TBD Radiology Department appointment reports & Schedule Orders Report
HMH HMH KIRBY BREAST CENTR
1KB1IMG_DT17
Radiology Department appointment reports
HMH HMH KIRBY ED (HMH Kirby ED IMG)
1KE1ED_DT31
NPI951FBD
ASAP (?)
Radiology
Department appointment reports & Schedule Orders Report
HMH HMH VOSS ED (HMH Voss ED IMG)
1KB1IMG_DT17
ASAP (?)
Radiology
Department appointment reports & Schedule Orders Report
HMH HMH WEST HOUSTON IMG
5KI1IMG_DT20
5KI1IMG_DT10
Radiology Department appointment reports
HMH HMH PEARLAND ED (HMH Pearland ED IMG)
1PL1ED_DT18
ASAP (?)
Radiology
Department appointment reports &
89
Schedule Orders Report
HMH HMH XR NRG TBD Radiology Schedule Orders Report
Procedure / Tasks ‐ ALL
Radiology Downtime Workflow
Tech
no
logi
stR
adio
logi
st
Communicate that Epic is down and department is in downtime period
Log into the SRO environment and use the read-only model of Epic to
view relevant patient data
Log into BCA Web and print necessary reports (DAR and SO
reports)
Use radiology downtime
requisition form/report
Receive imaging requests by fax or paper copy from
ordering departments
IS BCA Web available?
Is SRO available?Epic is down
Reads exams in RIS/PACS
Dictate exam in powerscribe: results
interface to PACS
Phone ordering provider or patients
care team per critical results policy
Maintains downtime log to reconcile
completed exams when EPIC is
restored ensuring reports available in
EPIC
Is this an a new order?
Is this an abnormal finding?
Record request on downtime paper log
Complete the downtime log with pertinent patient information/keep
paper copy of imaging order
Print any necessary reports (DAR and SO
reports) from BCA PC workstations
Yes
No
Yes
No
Yes
No
Downtime documentation is complete; exams
and medications are reconciled in patients chart
No
yes
Performs exam and sends to PACS
Is RIS IC Down?
No
Yes
Primary Application: RadiantSecondary Application: None
Procedure / Tasks ‐ ALL Step Detail Responsible
Downtime Facilitate any downtime phone calls and faxes to the associated departments
Imaging Clerical Staff
90
Step Detail Responsible
Downtime 1. Communicate that the department is in downtime period.
Is SRO available?
Yes: Log into the SRO environment to view relevant patient data.
No: Is BCA Web available? • Yes: Log into BCA Web to print
necessary reports (DAR, and SO reports).
• No: Identify your downtime BCA PC and print necessary reports (DAR, and SO reports).
2. Use the downtime requisition forms and reports. 3. Review imaging faxes and paper orders received from ordering departments.
Is this a new order? • Yes: Record new order on the
downtime log. • No: Place labels on the
downtime log and complete any additional information. Retain a copy of the physician order form.
4. Perform exam and send to PACS.
Technologist
Downtime Is RIC IC down? (interim workflow until last go-live)
Yes:
No: Read exams in RIS IC/PACS. Dictate exam in Powerscribe. Results interface to PACS.
Is this an abnormal exam?
Yes: Phone ordering provider or patient’s care team per critical results policy.
No: Technologist will maintain a downtime log and reconcile exams when Epic is recovered.
Radiologist
Recovery Reconcile downtime log when Epic is recovered to ensure completed exam reports are available.
Technologist
91
Appendix 14: Cardiology Downtime Manual
Site Location BCA Name Department Reports needed
HMH HMH CARDIO NUC MED
1MB1NMED_DT07 Cardiology Department Appointment Report (DAR) & Schedule Orders Report (SO)
HMH HMH CARDIO
VASCULAR
1F9CARD_DT76 Cardiology Department Appointment Report (DAR) & Schedule Orders Report (SO)
HMH HMH CARDIO DIAG
OPC
1MB1IMG_DT02 Cardiology Department Appointment Report (DAR) & Schedule Orders Report (SO)
HMH HMH CARDIO MRI
OPC
1OP16IMG_DT01 Cardiology Department Appointment Report (DAR) & Schedule Orders Report (SO)
HMH HMH CATH LAB 1AL10CATH_DT05 Cardiology Department Appointment Report (DAR) & Schedule Orders Report (SO)
92
Procedure / Tasks ‐ ALL
Cardiology Downtime Workflow
Tech
no
logi
stC
ard
iolo
gist
Communicate that Epic is down and department is in downtime period
Log into the SRO environment and use the read-only model of Epic to
view relevant patient data
Log into BCA and print necessary
reports (DAR and SO reports)
Use downtime requisition form/
report
Receive imaging requests by fax or paper copy from
ordering departments
IS BCA Web available?
Is SRO available?Epic is down
Read exams in Ancillary systems
Report signed in ancillary system,
results interface to Epic
Phone ordering provider or patients
care team per critical results policy
Maintains downtime log to reconcile
completed exams when EPIC is
restored ensuring reports available in
EPIC
Is this an a new order?
Is this an abnormal finding?
Record request on downtime paper log
Puts labels on downtime log and
complete other per pertinent patient information/keep
paper copy of imaging order
Print any necessary reports (DAR and SO
reports) from BCA workstations
Yes
No
Yes
No
Yes
No
Downtime documentation transcribed into
relevant sections of chart. Exams and
medications reconciled in patients chart
No
Yes
Performs exam and sends to ancillary
system
Is the ancillary system down?
No
Documents procedure
completely in paper downtime forms
Yes
Procedure / Tasks ‐ ALL Step Detail Responsible
Downtime Facilitate any downtime phone calls and faxes to the associated departments
Imaging Clerical Staff
Downtime 1. Communicate that the department is in downtime period.
Is SRO available?
Yes: Log into the SRO environment to view relevant patient data.
No: Is BCA Web available? • Yes: Log into BCA Web to print
necessary reports (DAR, and SO reports).
• No: Identify your downtime BCA PC and print necessary reports (DAR, and SO reports).
2. Use the downtime requisition forms and
Technologist
93
Step Detail Responsible
reports. 3. Review imaging faxes and paper orders received from ordering departments.
Is this a new order? • Yes: Record new order on the
downtime log. • No: Place labels on the
downtime log and complete any additional information. Retain a copy of the physician order form.
4. Perform exam and send to ancillary systems.
Downtime Are the ancillary systems also down?
Yes: Is this STAT? o Yes: Read on modality. o No: Interpret after systems are
restored.
No: Create report for exam in ancillary systems. Sign the study in the ancillary system. Results interface to epic, will be available when Epic is restored.
Is this an abnormal exam?
Yes: Phone ordering provider or patient’s care team per critical results policy.
No: Technologist will maintain a downtime log and reconcile exams when Epic is recovered.
Cardiologist
Recovery Reconcile downtime log when Epic is recovered to ensure completed exam reports are available.
Technologist
94
Appendix 15: Rehabilitation Services Downtime Manual
BCA PCs and Downtime Reports Site Location BCA Name Department Reports Needed
HMH HMH WP IP REHAB 10 1WP10NS_DT19 Rehabilitation Services
Patient Summary
HMH HMH WP IP REHAB 9 1WP9NS_DT16 Rehabilitation Services
Patient Summary
HMH HMH PT OT REHAB 1M1PTOT_DT10 Rehabilitation Services
Patient Summary
HMH HMH ACUTE SPEECH 1N2SPCH_DT01 Rehabilitation Services
Patient Summary
95
Rehabilitation Services Department Downtime Workflow
Rehabilitation Services Downtime Workflow
New
Ref
erra
lsD
ow
nti
me
Do
cum
enta
tio
nR
eco
very
HIM
Downtime
Start
Charge Therapist/Manager/US
Communicate that the department
should begin downtime
procedures.
Is SRO available?
Yes
Charge Therapist/Manager/US
Log into the SRO environment to view
relevant patient information.
Charge Therapist/Manager/US
Retrieve necessary forms from
Downtime Kit.
Charge Therapist/Manager/US
Keep paper copies until system has been recovered.
End
NoIs BCA Web available?
Yes
Charge Therapist/Manager/US
Print BCA Reports (PT/OT/SP Therapy Patient Summary).
Charge Therapist/Manager/US
Retrieve necessary downtime
documents and forms from
Downtime Kits.
No
Charge Therapist/Manager/US
Identify the BCA PC and print BCA
Reports (PT/OT/SP Therapy Patient
Summary).
TherapistVerify current patients have
evaluation and plan of care prior to
treatment.
TherapistPlace all paper
forms in patient chart.
Therapist/ManagerDocumentation will be scanned in. Enter
charges.
Charge Therapist/Manager/US
Collect all paper downtime forms to be scanned by HIM.
End
HIMScan paper
downtime forms into Epic.
Charge Therapist/Manager/USRecord new
referrals received via phone.
TherapistVerify written order and review patient
chart prior to treatment.
Charge Therapist/Manager/US
Notify therapists of new referrals.
TherapistComplete all
documentation on paper forms/
progress notes.
Is documentation being transcribed during same
shift as care was performed?
TherapistEnter
documentation and charges as you
normally would.
Yes
NoTherapist/Manager
Enter Downtime Event Note.
96
Rehabilitation Services Procedure / Tasks – ALL Step Detail Responsible
Downtime Communicate that the department is in downtime period. Is SRO available?
Yes: Log into the SRO environment to view relevant patient data.
No: Is BCA Web available?
Yes: Log into BCA web to print necessary reports.
o Retrieve necessary forms from Downtime Kit to record clinical data.
o Keep paper copies until system has been recovered.
No: Identify the BCA PC and print BCA Reports (Patient Summary)
o Retrieve necessary forms from Downtime Kit to record clinical data.
o Place forms in the patient paper chart.
Charge Therapist Manager Unit Secretary
New Referrals New referrals will be received via telephone and recorded by discipline by the Charge Therapist/Manager/Unit Secretary. Each referral recorded will include the time the call was received, the name of the patient, DOB, location and patient account number. On weekends or when no secretary is present, the referrals will be recorded on the department answering machine and logged every hour until end of shift in the manner described above.
New referrals will be seen per department policy.
All staff should verify written order and review paper progress notes from other disciplines (MD, RN, SW), prior to rendering patient care.
Charge Therapist Manager Unit Secretary
Documentation Complete documentation on paper forms or blank notes
Therapists
Recovery Reconcile patient lists with Epic.
Transcribe downtime documentation into Epic. o Is documentation transcription being
performed before the end of the shift in which the care occurred?
Yes: Enter documentation and charges as you normally would, modifying time rows to reflect the time that care was performed.
No: Documentation will be scanned into Epic by HIM. Enter charges for care performed using
Therapists Managers
97
Step Detail Responsible
the “Flowsheet Charges” section. Modify time and date rows to reflect the time that care was performed.
Using the Notes Activity, enter Downtime Event Note indicating length of downtime and location of downtime documentation:
HIM Collect paper forms and scan into Epic. HIM
98
Appendix 16: Food and Nutrition Services Downtime Manual
BCA PCs and Downtime Reports Site Location BCA Name Department Reports Needed
HMH HMH NUTRITION 1MB1FNS_DT04 Nutrition Dietary Report
Food and Nutrition Services Department Downtime Workflow
Food and Nutrition Services Downtime Workflow
Ord
ers
Do
wn
tim
eD
ocu
me
nta
tio
nR
eco
very
HIM
Downtime
Start
FNS Call Center/Diet Office Staff
Communicate that the department
should begin downtime procedures
Is SRO available?
Yes
FNS Call Center/Diet Office Staff
Log into the SRO environment to view
relevant patient information
FNS Call Center/Diet Office Staff
Retrieve necessary forms from
Downtime Kit
FNS Call Center/Diet Office Staff
Keep paper copies until system has been recovered
End
NoIs BCA Web available?
Yes
FNS Call Center/Diet Office Staff/Patient Services LeadershipPrint BCA Reports (Dietary Report)
FNS Call Center/Diet Office Staff/Patient Services LeadershipRetrieve necessary
downtime documents and
forms from Downtime Kits
No
FNS Call Center/Diet Office Staff/Patient Services LeadershipIdentify the BCA PC
and print BCA Reports (Dietary
Report)
Clinical Nutrition Staff
Document complete note on a blank
progress note form
Clinical Nutrition Staff
Place all paper forms in patient
chart
Clinical Nutrition Staff
Enter Downtime Event Note
USCollect all paper
downtime forms to be scanned by HIM
End
HIMScan paper
downtime forms into Epic
FNS Call Center/Diet Office Staff
Record new orders received via phone/fax/downtime order sheets on downtime
record
Host/HostessReview downtime
report and downtime order
sheet for changes prior to passing
meals
FNS Call Center/Diet Office Staff
Enter any new orders or changes in
diet orders into CBORD
Host/HostessCollect any
downtime order sheets from patient
care units
Patient Services Leadership
Review downtime procedure with
host/hostess and provide copies of downtime order
sheets and guidlines
FNS Call Center/Diet Office Staff
Verify new orders, changes in diet
orders, and nourishment
requests were entered into CBORD
Clinical Nutrition Staff
Enter critical, pertinent info from
paper documentation into
Epic
99
Food and Nutrition Services Procedure / Tasks – ALL Step Detail Responsible
Downtime Communicate that the department is in downtime period.
Notification that the Epic system is down o The FNS Call Center/Diet Office will notify
the following individuals and groups of individuals that the system is down:
FNS administration Patient Services Leadership Team Dietitians Dietetic Technicians Hosts / Hostesses
Alpha numeric notification: o HMH- The following notification is to be
sent: “Epic system down. Implement downtime procedure. Host/hostess report to Call Center”.
The notification above is to be sent as an alpha numeric page to the following individuals and groupings in the wireless paging system:
FNS Administration (grouping) FNS Dietitians (grouping) FNS Patient Services Leadership
(individuals on duty) FNS Hosts / Hostesses (each one
listed in wireless paging system) o Other entities- The following notification
is to be sent: “Epic system down. Implement downtime procedure. Host/hostess report to Diet Office”.
In addition to above, the notification is also to be communicated verbally to the Patient Services leadership team on duty.
Is SRO available?
Yes: Log into the SRO environment to view relevant patient data.
No: Is BCA Web available?
Yes: Log into BCA web to print necessary reports.
o Retrieve necessary forms from Downtime Kit to record clinical data.
o Keep paper copies until system has been
FNS Call Center/Diet Office Staff Patient Services Leadership
100
Step Detail Responsible
recovered.
No: Identify the BCA PC and print BCA Reports (Dietary Report)
o Retrieve necessary forms from Downtime Kit to record clinical data.
Responsibilities of Patient Services leadership on duty:
Assure that all FNS Call Center/Diet Office phones are staffed and have FNS Downtime Record Sheets to record messages.
o If necessary, reassign employees to cover the phones.
o Provide each call center station with sufficient copies of FNS Downtime Record Sheets.
o Review downtime procedures with staff.
Verify that the notification of downtime reached the appropriate individuals.
Review the downtime procedure with host/hostesses and provide them with copies of the following to be distributed to nursing:
o FNS Downtime Guidelines o FNS Downtime Order Sheets
Orders Host / Hostess’s responsibilities:
For each patient care unit (PCU) assigned, pick up copies of:
o FNS Downtime Guidelines o FNS Downtime Order Sheets
Review guidelines with nursing staff (especially the unit secretary).
o All diet changes, nutrition consults and other FNS requests are to be called into FNS Call Center/Diet Office.
HMH (713) 441-2500 HMW (832) 522-1200 HMWB (281) 737-1355 (fax) HMSL HMSJ (281) 428-4441 HMSTC (281) 599-4356 (fax) HMSTJ
o In addition to calling in the orders, the order is to be written on the FNS Downtime Order Sheet.
Before passing meals, nourishments, etc., review the FNS Downtime Order Sheet for changes.
FNS Call Center/Diet Office responsibilities:
Host/Hostess
101
Step Detail Responsible
Record each call on the FNS Downtime Record sheet.
Follow-through with each order: o For diet changes, allergies, etc., enter the
updated information into CBORD. o Initiate the order as appropriate, e.g.,
send diet order to kitchen. o Page clinical staff as appropriate, e.g.,
nutrition consult requests. o Page formula clerk as appropriate, e.g.,
new formula orders or changes.
Handling of Enteral Nutritional Formulas:
Using the most current formula list, update the formula list as changes are received.
If formula labels were not generated prior to system going down, hand-write the formula labels.
Prior to distributing formulas, check the FNS Downtime Order sheet on each patient care unit.
Clinical Nutrition staff responsibilities related to food service:
Dietitians provide assistance as needed to the Host/Hostesses on their patient care units.
Dietitians review with nursing the FNS Downtime Guidelines (as back up communication).
Documentation Documentation by clinical nutrition staff:
Documentation during downtime: o Document complete note on a blank
“progress note” form in the progress note section of the paper chart.
o Use the heading “Nutrition” and document the date and time in the left margin.
o All medical record entries should be written legibly in blue or black ink.
o Include signature, title, credentials (RD) to complete documentation. Pager number is optional.
o If an error in documentation is made, the error should be lightly scored through, via a single line, signed and dated.
o Liquid paper and labels are not to be used to cover incorrect or revise documentation. List date, time, and initial next to correction.
Clinical Nutrition Staff
Recovery Recovery Documentation by clinical nutrition staff:
Enter critical, pertinent info from hand written
Clinical Nutrition Staff
102
Step Detail Responsible
“progress note” into Epic as a “late entry due to system down”.
Decision to repeat excerpts of manual documentation to be decided on an individual patient case basis, staffing needs, prioritization, etc.
After Epic restored, enter reference to handwritten documentation using Downtime Event Note in Notes Activity:
Reconciliation of orders When Epic has been restored:
Host / hostesses are to bring the FNS Downtime Order Sheets to the FNS Call Center/Diet Office.
The FNS Call Center/Diet Office is to verify that changes in diet orders, nourishment requests, etc. were entered into CBORD using the:
o FNS Downtime Order Sheets from the patient care units
o FNS Downtime Record sheets
The FNS Call Center/Diet Office will verify that nutrition consult requests were received by the dietitian or dietetic technician.
Retention and disposal of FNS Downtime Order Sheets and FNS Downtime Record Sheets
Retain the sheets in a secure location within FNS Call Center/Diet Office for 3 weeks
After 3 weeks, dispose of sheets via approved recycle bins for confidential information.
Host/Hostess Call Center/Diet Office Staff
HIM Collect paper forms from patient chart on unit and scan into Epic
HIM
103
Appendix 17: Health Information Management (HIM)
HIM Downtime Workflow
HIM Downtime Workflow
Dow
ntim
eR
eco
very
HIM
Downtime
Clinical StaffComplete necessary
clinical documentation
using paper downtime forms
Clinical StaffPlace all forms in
patient paper chart
Is downtime greater than 3
hours?
No
Clinical StaffTranscribe clinical
documentation into Epic
Yes
Clinical StaffTranscribe required documentation into
Epic. Any documentation that
is not transcribed remains in paper
chart.
Unit SecretaryCollect all paper
downtime forms to be scanned by HIM
End
HIMScan paper
downtime forms into Epic
End
HIM Procedure / Tasks – ALL Step Detail Responsible
Downtime Complete necessary clinical documentation using department specific downtime forms found in each unit’s Downtime Kit and place in patient’s chart.
Clinicians
Recovery Is downtime greater than 3 hours?
No: Transcribe downtime clinical documentation
into Epic and resume clinical documentation in
Epic.
Yes:
o Transcribe required downtime
documentation into Epic (refer to for
detailed list of items to be transcribed vs.
scanned based on length of downtime)
and resume clinical documentation in
Epic.
o Collect all paper forms to be scanned by
HIM
Clinicians/Unit Secretary
Recovery Is downtime greater than 3 hours?
Yes: Retrieve/receive downtime documents and scan into patient’s medical record.
HIM
104
Appendix 18: Billing
Billing Downtime Workflow
Billing Downtime Workflow
Do
wn
tim
eR
eco
very
Downtime
Billing StaffDocument all
transactions on paper and hold until system is recovered
Billing StaffInput data and
documentation that transpired during
downtime.
End
Billing StaffHold any corrections
that are normally done electronically
Billing StaffDivert incoming calls
to message. Suspend outgoing
phone calls.
Billing Procedure / Tasks – ALL Step Detail Responsible
Downtime All transactions will be documented on paper including money collection and held until Epic is recovered.
Any corrections that are normally done will be held until system performance can be resumed.
Incoming phone calls will be diverted to message.
Outgoing phone calls will be suspended.
Billing Staff
Recovery Input data and documentation that transpired
during downtime.
Billing Staff
105
Appendix 19: Definitions, Acronyms, and Abbreviations ADT: Admission, Discharge, Transfer
ADS: Automated Dispensing Systems
BCA: Business Continuity Access. Epic defines BCA as the process of maintaining continuity of
clinical information from the Epic system during downtime situations.
BCA PC: Business Continuity Access via PC
CSN: Contact Serial Number
Downtime: Refers to a time when a computer system is not functional. The level of the downtime
determines what and how much information is processed manually. A Level 1 (see below)
Downtime should be assumed until it is announced otherwise.
Epic: Electronic repository for clinical patient information.
Epic BCA web: When access to Epic Hyperspace (Citrix) is down, but the local area network
(LAN) is still available, BCA Web is an application that can be opened from any workstation and
gives access to standard downtime reports (the same ones available on BCA workstations). It is
NOT read‐only access to Epic Hyperspace.
Epic BCA (downtime) workstations (BCA PC): A dedicated Epic workstation that is on a secure
electrical network (emergency power) that contains periodically updated Epic patient reports. It
must be attached directly to a printer (not networked) that is also powered by an emergency
power source.
Primary and Secondary Server Failure is defined as a period when both the primary and
secondary servers have failed.
HIPAA: Health Insurance Portability and Accountability Act.
HOD: Hospital Outpatient Department
Interface Down: Data communication between two interfaced systems is not functional.
IT: Information Technology
LAN: Local area network.
Network Failure: The network is unavailable.
Downtime workstation can be used to view and /or print reports to provide orders and
other clinical data. The orders and clinical data are current up to the time the batch report
106
was run in the system.
Downtime workstation reports are available on inpatient units.
MRN: Medical Record Number
OR: Operating room.
PACU: Post anesthetic care unit
PAS: Patient Access Services
PAT: Pre‐admission testing
Scheduled downtime: A planned event occurs when ITS closes access to the computer system
for the purpose of maintaining or updating the software or hardware. The duration of this type of
downtime is usually known and communicated beforehand, and typically occurs after hours.
SRO: Supports Read‐Only access to the Epic system. The look and feel is the same as the
normal Epic Hyperspace, however ambulatory clinic clinicians cannot “write” any data to the
shadow server. Please note that the information is only as current as the last copy from the
production (PRD) environment to the SRO environment.
Terminal or Printer Failure: An unexpected failure of one piece of equipment. If this occurs,
please use another piece of equipment until it can be fixed or replaced.
Unscheduled downtime: An unplanned event usually occurring as a result of network, power, or
system failure. The duration of this downtime is usually unknown.
US: Hospital unit secretaries/clerks
WAN: Wide area network