CPRS TrainingCPRS Training

June 2005June 2005

Patient Select ScreenPatient Select Screen

Patient name, SSN, Last 4

Setup Default lists

Process Notifications

Patient Select ScreenPatient Select Screen You can use the full SSN, Patient’s first initial of last name and last 4, full You can use the full SSN, Patient’s first initial of last name and last 4, full

last name etc.last name etc. To look for Team lists, Select Teams from the Patient Select box and type To look for Team lists, Select Teams from the Patient Select box and type

the name of the team.the name of the team. To process Notifications, Highlight the notification that you want To process Notifications, Highlight the notification that you want

processed and hit the Process button. If you want to process all processed and hit the Process button. If you want to process all notifications, hit the Process All button. These notifications are usually notifications, hit the Process All button. These notifications are usually unsigned notes, orders, etc.unsigned notes, orders, etc.

Team ListsTeam Lists

After selecting Team, type the name of the team. To save the list as your default, Press SavePatient List Settings. This can be done with any of the PatientList types.

CPRS Cover PageCPRS Cover Page

Menu BarCover Page AreasTabs

CPRS Coversheet CPRS Coversheet OverviewOverview

Menu optionsMenu options There are Menu Options available for each Tab.There are Menu Options available for each Tab. Left clicking File will let you pick a new patient or refresh patient informationLeft clicking File will let you pick a new patient or refresh patient information Tools and Vista Apps have a number of links/programs that all areas may use.Tools and Vista Apps have a number of links/programs that all areas may use.

Left click patient’s name to bring up Demographic information.Left click patient’s name to bring up Demographic information. To find Next of Kin, Last admission, surgery dates, etc.To find Next of Kin, Last admission, surgery dates, etc.

Left click Provider box to select the Visit and Provider.Left click Provider box to select the Visit and Provider. Needed when entering orders or consults. This will be the provider that Needed when entering orders or consults. This will be the provider that

receives notification to sign an order or get results from a test.receives notification to sign an order or get results from a test.

Double left clicking any of the items on the cover sheet area will bring up Double left clicking any of the items on the cover sheet area will bring up more detailed information for that item.more detailed information for that item.

Left clicking a tab will take you to that Page.Left clicking a tab will take you to that Page.

Remote data will be highlighted if there is information available at other Remote data will be highlighted if there is information available at other VA’sVA’s

Medications TabMedications Tab

Medications Sections

Medications Section ContinuedMedications Section Continued

First section will be Patient’s current location MedicationsFirst section will be Patient’s current location Medications If inpatient, there will also be listed Outpatient meds as well as non VA meds.If inpatient, there will also be listed Outpatient meds as well as non VA meds.

You can increase the viewable area of a section by left clicking and You can increase the viewable area of a section by left clicking and dragging a section.dragging a section.

To Do This: Hover the mouse pointer over the edge of the area until it changes To Do This: Hover the mouse pointer over the edge of the area until it changes to a sideways T with up and down arrows. Left click and hold the mouse down to a sideways T with up and down arrows. Left click and hold the mouse down while increasing or decreasing the size of the area.while increasing or decreasing the size of the area.

Double click a medication order for more detailed information about the Double click a medication order for more detailed information about the order.order.

You can also increase the size of the columns.You can also increase the size of the columns. To Do This: Hover mouse pointer over the line that divides two columns. It will To Do This: Hover mouse pointer over the line that divides two columns. It will

change to two arrows with a horizontal line. Left click and hold the mouse change to two arrows with a horizontal line. Left click and hold the mouse down while changing the size of the column.down while changing the size of the column.

Orders TabOrders TabTypes of orders that are viewed

Orders written for this patientWrite orders using these

To change what orders you see, Left Click View and then Custom Order ViewOnce you’ve customized your view, you can left click on “Save as Default”

Highlight the Status and Highlight the Status and Service/SectionService/Section

If you want to only display If you want to only display orders for a specific time orders for a specific time range, Select Only List range, Select Only List Orders Placed…Orders Placed…

To create a more specific list, To create a more specific list, Left click the + in front of the Left click the + in front of the name and then the detail you name and then the detail you wantwant

Orders are Separated by Service

Order Start/Stop time andStatus

Who verified the orderNrs=Nurse

Clk=Ward ClerkChart=Chart Review

Life of an OrderLife of an Order Once an order is written, depending on the order type, it will Once an order is written, depending on the order type, it will

have a Status (sts) of unreleased.have a Status (sts) of unreleased. Releasing an order in CPRS is the same as signing an order on paper. Releasing an order in CPRS is the same as signing an order on paper.

For nurses taking verbal orders, it’s the same as writing an order and For nurses taking verbal orders, it’s the same as writing an order and signing it as a verbal order.signing it as a verbal order.

Once the MD signs the order or the RN releases the order, the Once the MD signs the order or the RN releases the order, the status will change.status will change.

Medication orders will have a status of Pending…until pharmacy Medication orders will have a status of Pending…until pharmacy verifies the order. After verification, the orders will be Active. They verifies the order. After verification, the orders will be Active. They may also be Expired, DC’d etc.may also be Expired, DC’d etc.

Medication orders that are not verified by Pharmacy will not have a Medication orders that are not verified by Pharmacy will not have a stop date.stop date.

Text (Nursing) and some other types of orders once signed (released) Text (Nursing) and some other types of orders once signed (released) automatically are Active.automatically are Active.

To take action on an order. To take action on an order. Highlight the order and Left click Highlight the order and Left click ActionAction

Nurse would also Complete an Nurse would also Complete an order or verify an order from this order or verify an order from this option.option.

Release without MD signature Release without MD signature allows you to take a allows you to take a Verbal/Telephone order. It is Verbal/Telephone order. It is recommended that you use this recommended that you use this method when taking a verbal method when taking a verbal order.order.

Signature on Chart says that you Signature on Chart says that you are putting in an order that is are putting in an order that is written on paper some place.written on paper some place.

Action also lets you Change an Action also lets you Change an order or Discontinue/ Cancel an order or Discontinue/ Cancel an orderorder

**Note** If you verify an order **Note** If you verify an order before it has been verified by before it has been verified by pharmacy, you may need to pharmacy, you may need to reverify that order.reverify that order.

If you want to take action on If you want to take action on multiple orders, hold the CTRL key multiple orders, hold the CTRL key down while left clicking the ordersdown while left clicking the orders

Verifying an OrderVerifying an Order

Verifying an order means that it is Noted. You’ve seen the Verifying an order means that it is Noted. You’ve seen the order and have made sure that the order is handled as it order and have made sure that the order is handled as it should be (when applicable).should be (when applicable). If it’s a medication order, that its appropriate for the patient If it’s a medication order, that its appropriate for the patient

and that when the time comes to give it, there are no and that when the time comes to give it, there are no reservations as you see it. For ECU, this may also mean that reservations as you see it. For ECU, this may also mean that you have ensured that the medication label or hand written you have ensured that the medication label or hand written entry is on the MAR and ready to be administered.entry is on the MAR and ready to be administered.

Verification can also be done by ward clerks designating that Verification can also be done by ward clerks designating that they’ve seen the order and if necessary, taken action on the they’ve seen the order and if necessary, taken action on the order (printing lab requisition slips/labels)order (printing lab requisition slips/labels)

Verify an Order continuedVerify an Order continued

Verification columns will be blank if the order isnot verified.

Verify an Order continuedVerify an Order continued

To verify an order, left click to highlight then orderThen select Action from the menu bar

and then Verify

Verify an Order continuedVerify an Order continued

Once the order has been verified, the verifier’s initials will appear on either the nurse

column or Clerk column

Nurse

Ward Clerk

NotesNotes The Notes Tab allow users to put in progress notes or The Notes Tab allow users to put in progress notes or

other data that needs to be seen by other users.other data that needs to be seen by other users. Notes are assigned titles and are usually attached too tools Notes are assigned titles and are usually attached too tools

that help format the note, called Templatesthat help format the note, called Templates To write a New Note:To write a New Note:

Click on Notes TabClick on Notes Tab Left Click “New Note”Left Click “New Note” Select a Note Title (if there is a template attached, it will Select a Note Title (if there is a template attached, it will

launch, otherwise you have a blank writing pad”launch, otherwise you have a blank writing pad” If you are using a template, once you are done, hit finish.If you are using a template, once you are done, hit finish. Sign the note using Action, “Sign Note Now” or Save the note Sign the note using Action, “Sign Note Now” or Save the note

to edit later with “Save without signature” to edit later with “Save without signature”

Notes TabNotes Tab

Note TitlesBody of the Note

Creating a New Note

Setting Up Note TitlesSetting Up Note Titles

From the menu bar, Left click From the menu bar, Left click Tools and then Personal Tools and then Personal PreferencesPreferences

Left Click Notes tabLeft Click Notes tab

Left Click Document TitlesLeft Click Document Titles

Leave Document Class set to Progress NoteLeave Document Class set to Progress Note In the Document Titles box, Start typing the name of the note you In the Document Titles box, Start typing the name of the note you

wish to add to your default list.wish to add to your default list. Left click the title and then select Add.Left click the title and then select Add. The title will be displayed in “Your list of titles”. To remove it, The title will be displayed in “Your list of titles”. To remove it,

highlight it and left click removehighlight it and left click remove

Once the custom titles are setup and NewNote is selected, the titles will appear in this list.

New NotesNew Notes

Remember, when completing a note, all fields that have an * in Remember, when completing a note, all fields that have an * in front of them must be filled in.front of them must be filled in.

When the note is completed, select finish. This places your note When the note is completed, select finish. This places your note in the chart, Unsigned.in the chart, Unsigned.

At this point you can either “Sign Note Now” or “Save Without At this point you can either “Sign Note Now” or “Save Without Signature”Signature”

If you Sign the note, you will not be able to edit it…only add If you Sign the note, you will not be able to edit it…only add addendums to the note.addendums to the note.

If you Save without signature, it saves the note so you can If you Save without signature, it saves the note so you can edit/add to it.edit/add to it.

Save Without SignatureSave Without Signature

If you’re using “Save Without Signature” to continue using a template If you’re using “Save Without Signature” to continue using a template in the future, you must remember where you stopped on the in the future, you must remember where you stopped on the template. It’s a good idea to stop end of a section so you can start at template. It’s a good idea to stop end of a section so you can start at the beginning of the next selection.the beginning of the next selection.

You must use the “Edit Progress Note” from the Action option in the You must use the “Edit Progress Note” from the Action option in the menu bar. You must also have the note you wish to edit highlightedmenu bar. You must also have the note you wish to edit highlighted

You’ll notice that your cursor will be placed at the bottom of the You’ll notice that your cursor will be placed at the bottom of the document that you are editing. This is so that if you reuse a document that you are editing. This is so that if you reuse a template, it will insert the new data at the bottom of the note. You template, it will insert the new data at the bottom of the note. You could move your cursor around and free type any text into the note if could move your cursor around and free type any text into the note if you wanted too.you wanted too.

When editing a progress note DO NOT use the New Note option. If When editing a progress note DO NOT use the New Note option. If you find that you have a blank page, its because you used New Note you find that you have a blank page, its because you used New Note instead of Edit Progress Note.instead of Edit Progress Note.

If you signed the note, you will not be able to edit a note.If you signed the note, you will not be able to edit a note. If you signed a note, you will not be able to delete a note.If you signed a note, you will not be able to delete a note.

Save Without Signature ContinuedSave Without Signature Continued

After Finishing a note, hit Action And then Save Without

Signature

Save Without Signature ContinuedSave Without Signature Continued

When you’re ready to edit the progress noteWhen you’re ready to edit the progress note Highlight the Unsigned noteHighlight the Unsigned note Select Action from the Menu barSelect Action from the Menu bar Select Edit Progress Note from the list of options.Select Edit Progress Note from the list of options. Select Templates and then left click on the + in front of Shared Select Templates and then left click on the + in front of Shared

TemplatesTemplates Scroll down to the name of the template that you are usingScroll down to the name of the template that you are using Sometimes templates are located by department or division.Sometimes templates are located by department or division. Left click on the + to get to the section/note that you are usingLeft click on the + to get to the section/note that you are using Double click the templateDouble click the template Scroll down to the area that you left off in. Sometimes you have to open Scroll down to the area that you left off in. Sometimes you have to open

up areas that will have *’s for required fields…such as the time of entry.up areas that will have *’s for required fields…such as the time of entry. You can ignore the previous sections if you’ve filled them out already. You can ignore the previous sections if you’ve filled them out already.

The template is just a tool to help you touch all the areas that need to be The template is just a tool to help you touch all the areas that need to be addressed.addressed.

Once you are done, select finish. You can “Save Without Signature” as Once you are done, select finish. You can “Save Without Signature” as many times as you need too. Sign the note once it is complete.many times as you need too. Sign the note once it is complete.

Save Without Signature ContinuedSave Without Signature Continued

Highlight the unsigned Note

Left Click Templates

Save Without Signature ContinuedSave Without Signature Continued

Left Click the + in front of Shared templates

Save Without Signature ContinuedSave Without Signature Continued

Scroll down to your area and Expand the group by hitting

the +

Save Without Signature ContinuedSave Without Signature Continued

You’ll notice that the icon willchange from just a folder to a file

Folder combo

Lab TabLab Tab

The Lab Tab gives you access to lab results. It allows you The Lab Tab gives you access to lab results. It allows you to display the data in a variety of ways and is customizable to display the data in a variety of ways and is customizable to each user.to each user.

Lab Tab ContinuedLab Tab Continued

Various ways to view results

Results

Reports TabReports Tab

The Reports Tab displays certain data in a more viewable The Reports Tab displays certain data in a more viewable format. format.

Not all patient data will be in reports…Some of the things Not all patient data will be in reports…Some of the things you can find thereyou can find there Allergies (remote data)Allergies (remote data) Historical Medication Administration in the Inpatient side Historical Medication Administration in the Inpatient side

(BCMA reports)(BCMA reports) Inpatient Flowsheets (Careplan, Coag, etc)Inpatient Flowsheets (Careplan, Coag, etc) Inpatient VitalsInpatient Vitals

You may find the reports tab does not have data that every You may find the reports tab does not have data that every user needs, just realize that it is there.user needs, just realize that it is there. This is where you’ll find remote data.This is where you’ll find remote data.

Reports TabReports Tab

When a user first clicks on the Reports tab, the only options When a user first clicks on the Reports tab, the only options that are visible are the reports and the data from the reports. that are visible are the reports and the data from the reports. When the user clicks on a report, CPRS uses the requesters When the user clicks on a report, CPRS uses the requesters default date range setting under personal preferences. This default date range setting under personal preferences. This by default is set to the last 2 years worth of databy default is set to the last 2 years worth of data

Once you run a report, CPRS will then ask for a data range to Once you run a report, CPRS will then ask for a data range to customize it. The problem is that you may have to wait for customize it. The problem is that you may have to wait for 10 minutes for the first report to run (set to the last 2 years)10 minutes for the first report to run (set to the last 2 years)

In order to fix this, all users should change their default In order to fix this, all users should change their default preferences. This is a one time preference change.preferences. This is a one time preference change.

Once this default setting is changed (to a shorter period of Once this default setting is changed (to a shorter period of time) you can then go back and select a date range that time) you can then go back and select a date range that meets your needs. meets your needs.

Reports Tab PreferencesReports Tab Preferences

To change personal preferences for ReportsTo change personal preferences for Reports Select ToolsSelect Tools Select Personal PreferencesSelect Personal Preferences Click on ReportsClick on Reports Click on “Set all Reports” under All ReportsClick on “Set all Reports” under All Reports Change the start date to be within 14 days of today’s dateChange the start date to be within 14 days of today’s date It may seem awkward at first, but when you run the report it It may seem awkward at first, but when you run the report it

doesn’t use those exact dates…it uses T (today) – the number doesn’t use those exact dates…it uses T (today) – the number of days you set. In this example T-14of days you set. In this example T-14

Hit OK on each screen to back out.Hit OK on each screen to back out.

Report Tab Preferences ContinuedReport Tab Preferences Continued

When you first click on Reports Tab, you’llnotice that you are not able to select a date range

???

Reports Tab Preferences Reports Tab Preferences ContinuedContinued

While on the reports tab, Left clickTools and then Personal Preferences

Reports Tab Preferences Reports Tab Preferences ContinuedContinued

Left Click Reports

Left Click “Set All Reports”

Reports Tab Preferences Reports Tab Preferences ContinuedContinued

Change the Start Date to 14 daysfrom today’s date

Hit OK

In this example, when the reportis run, it will default to T-14

Reports Tab Preferences Reports Tab Preferences ContinuedContinued

Once you’ve actually ran a report, you can then customize the time range

Remote DataRemote Data

If the Remote Data box is blue, there is remote data available.If the Remote Data box is blue, there is remote data available. Remote data is data that has been entered at another VA and Remote data is data that has been entered at another VA and

that isn’t displayed until you request it.that isn’t displayed until you request it. Allergies are a good example of remote data that you may Allergies are a good example of remote data that you may

request.request. To get remote data:To get remote data:

Left click the Remote Data box (if its not blue, there is no data Left click the Remote Data box (if its not blue, there is no data available)available)

Select the sites you want data from. Usually you’d select all Select the sites you want data from. Usually you’d select all locations. A Check indicates that it is selected, unchecked box locations. A Check indicates that it is selected, unchecked box means its not selected.means its not selected.

Once you’ve identified the sites, left click on the report you want. Once you’ve identified the sites, left click on the report you want. Portland information will automatically be displayed and up to 30 Portland information will automatically be displayed and up to 30 seconds or so later, other sites data will appear (if there is seconds or so later, other sites data will appear (if there is information)information)

Remote Data ContinuedRemote Data Continued

If a patient has Remote DataThe Remote Data box will be blue

Remote Data ContinuedRemote Data Continued

Left click the Remote Data box and CheckAll Available Sites

Remote Data ContinuedRemote Data Continued

For Remote Allergy Data, Click the + next to Clinical Reports and double click Allergies.

Remote Data ContinuedRemote Data Continued

When you first run the report, Portland data willautomatically be displayed. Wait 15 or so seconds

for other sites to load.