ORCHID will be down this weekend when Daylight Savings Time ends early Sunday morning (November 5) .  That means the EHR across DHS will not be available for normal orders, documentation, and results review.  These general procedures will also be used during other downtime situations.
Scheduled Downtime: Sun Nov 5 00:45 am Daylight Savings Time to sometime after 02:00 am Standard Time.

What do you need to know?  Depending on your clinical duties, please review the following.

If you are caring for inpatients anytime this weekend, prepare beforehand and ensure recovery is accurately performed first thing Monday morning.

If you are working during downtime, review and be ready to perform downtime procedures (e.g. for order entry and admissions) and recovery procedures.  As a general tip, orders that are urgent/emergent or need to completed during downtime should follow downtime procedures (i.e. be written on paper).  Orders that will be performed later and can wait until after the scheduled downtime should be entered electronically when ORCHID returns.

Three important resources:

• Your email (look for “DHS Broadcast”)
• ORCHID Portal on the Olive View Intranet (forms, info, paper forms)
  (go to the OV Intranet Home > ORCHID Portal > ORCHID Downtime section)
• This guide below!

Timeline

Preparation:

• Saturday Night – Prepare for downtime by prepping patient lists, placing electronic orders, and completing any documentation BEFORE 00:30 am.  Last call for orders to appear in the chart and be viewed during downtime is 00:45 am.

Downtime:

• 00:45 am – Downtime starts. Follow downtime procedures.
• For chart review, read-only access of a copy of the chart will be available on any workstation through Level 1 724Access.  To access this, open the Cerner program folder as you normally would, but instead of clicking PowerChart, open the “724 Read Only” folder and open the “PowerChart Read Only” application. See these instructions for more info.  This is a copy of the chart through 00:45 am.
• For further chart review, read-only access is also available through Level 2 724Access, which is only available on designated workstations (labelled with a yellow sticker, usually located at the nursing station).

Recovery:

• After 02:00 am – Downtime ends and Recovery begins.
• Sunday Morning – Ensure recovery is completed, e.g. electronic back-entry of uncompleted orders, verification of back-entry, back-entry of notes.

PREPARATION

• Orders
  • Place medication orders by 00:30 if possible.
  • Place laboratory orders (including AM labs for the next day) by 00:30 if possible.
• Patient Lists
  • Print your sign-out and/or patient list before 00:30.
• Notes
  • Sign daily notes by 00:30. For uncompleted notes, make a back-up copy, and sign the note during Recovery.

DOWNTIME

• Chart Review & 724Access
  • Level 2 724Access allows you to access patient charts with information from the last 10 days and upcoming 3 days only. Check your email for the generic username and password. A 724Access workstation is located in each inpatient nursing unit and ED pod.  You must use the 724Access workstation in the unit where the patient is/was located.
  • Other ORCHID workstations will have special Level 1 724Access starting 00:45.  Log in with your own username and password.  See this for instructions to log-in. This is a full read-only chart copy up until 11:45.

• New Vitals, I/O’s, POCT Results, Medication Administration
  • These data will be recorded on paper by the nurse.
• New Lab Results
  • STAT and Critical results will be called and/or faxed to the nurse. The nurse should verbally relay the result to you.
  • Other lab results will be printed and sorted in the Laboratory. To review the results, go to the 1st Floor Laboratory, enter with door code , and search by patient name for a printout of your result.
• New Radiology Results
  • New studies will be limited to STAT and Critical studies.
  • Reads may be limited to STAT studies and Critical results.  The Nighthawk is available for verbal communication.  Prelim reads/dictations will be placed in Synapse.  To review prelim reads, open Synapse from your workstation desktop – don’t link to Synapse from ORCHID.
• New Orders
  • All orders during downtime must be handwritten on the Physician’s Order form.  Please remember that all blocks of orders require your name, signature, date, time, and at least two patient identifiers (stickers with name, DOB, MRN).
  • Use designated order forms.  These are available from the OV Intranet > ORCHID Portal > Downtime Forms, or Intranet > Forms > OVMC > Medical Record Forms or in the nursing station.
  • Place completed orders in the patient’s hard chart and place it in the designated orders bin/rack for the unit clerk/nurse to process (like old times!).  In the ED, place written orders in the designated bin in the ED pod. Be sure to alert the nurse and clerk about any STAT orders.
  • Keep track of placed orders because uncompleted orders will need to be re-entered electronically during recovery! Nonessential orders (e.g. orders that do not need to be carried out during downtime) can likely wait until recovery.
  • TIPS on handwritten orders: Use a pen with blue or black ink and medium thickness. Write clearly and legibly for others to read. If you make an error, use a single strikethrough to cross-out the error AND sign-date-and-time the correction. Avoid banned abbreviations.
• New Documentation
  • Handwrite notes on physician Progress Note forms.  You must sign, date, and time all pages of notes. All pages must have patient identifiers (stickers with name, DOB, MRN).  Consider typing and saving your note in another place (e.g. Word), so that you can copy-and-paste your note into ORCHID during recovery.  Notes can usually wait and be completed in ORCHID during recovery.
• New Admissions
  • Use the designated downtime General Admission and Physician’s Order forms.  Follow procedures for placing new orders.  In the ED, place orders in the designated bin in the Pod for the nurse/clerk to process.
• New Discharges
  • Limit discharges if reasonable.  Discharges require Patient Instructions (use the form) and the Discharge Order set.
• Do not discard any written notes or orders. Leave them in the hard chart. These remain part of the permanent chart.

RECOVERY

• Orders Placed During Downtime
  • For inpatients: Back-enter all ongoing/incomplete orders or changes to ongoing orders, except completed lab orders, completed radiology orders, or medications that were previously ordered on paper.  Orders that should be back-entered include the following:
    • Request for Admit, Place in Observation, Admit to Inpatient, and the MED General Admit order set
    • Transfer order
    • Resuscitation status
    • Isolation status
    • Allergies
    • Diet
    • Restraints
  • The following will be back-entered by other services, but please reconcile these:
    • Medications (updated by Pharmacy)
    • Hold status (updated by Psychiatry)
• Documentation Requiring Back-Entry
  • Back-enter all History & Physicals, Discharge Summaries, Ambulatory Provider Notes, and Procedure Notes electronically into ORCHID.
• Vitals and I/O’s During Downtime
  • For downtime <4 hours, the nurse will back-enter these results
  • For downtime >4 hours, the nurse will back-enter at least the most recent results
• POCT Results During Downtime
  • Results will be uploaded into ORCHID
• Medication Administration During Downtime
  • The clinician who administered the medication should back-enter those meds into the MAR
• New Orders and Notes
  • Resume normal workflows involving electronic order entry and documentation.
• The recovery process must be completed within 24 hours!
• Do not discard any written notes or orders. Leave them in the hard chart. These remain part of the permanent chart.