Tippy - Save, Share or Sign an Order?

Tippies can be quickly adopted with immediate workflow benefits...

• Save, Share or Sign an Order?

With the exception of some orders that require co-sign before action can be taken, orders are marked for actioning upon signing. When immediate action is not needed or appropriate, orders can be pended or "Saved" for later review by the prescriber or, for example, an attending physician. Consulting services often pend orders with a notation such as “recommended by Infectious Diseases team”.

Inpatient unsigned saved orders are automatically deleted after a specified number of hours depending on the "Save" option chosen, so it is important to be aware of remaining unsigned orders:

• Save, ready for review: When saving orders for consideration by another clinician, the prescriber should mark the planned actions as "ready for review" when prompted. This type of unsigned order will be auto-deleted after 72 hours.
• Save, ready for review, share: This option sets up the saved orders as ready for review while initiating a secure chat (for communication to other prescribers) with the saved orders attached. Again, this type of unsigned order will be auto-deleted after 72 hours.
• Save, not ready for review: Orders saved in a not ready for review state can only be acted upon by the saving prescriber. This type of unsigned order will be auto-deleted after 36 hours.

Unsigned order can easily be tracked by adding the "Unsigned Orders (All)" column to a patient list. To add the column, right-click on the patient list of choice and select properties, search for the column name and add, and rearrange as needed to view.

For more information:

• Manual: Signing, Saving and Sharing Orders

Tippy - Updating Primary Care Provider Associations

Tippies can be quickly adopted with immediate workflow benefits...

• Updating a Patient's Primary Care Provider

Connect Care uses information about a patient's primary care provider (PCP) to facilitate a number of automated communications. These can include:

• admission, discharge and death notifications
• consultation and referral tracking
• alerts to key test results, and 
• sending copies of summative documents (e.g., operative reports, discharge summaries) 

Although patients are asked to confirm their primary care provider at every Connect Care registration, changes can occur between the start and end of an encounter. It is important for providers to know how to change the primary care provider name (or clinic) associated with a patient chart.

Editing PCP information is easy. Either select (click on) the Storyboard (leftmost column of any open chart) row where provider names appear, or use chart search to jump to the "Care Team" chart activity. A "Patient Care Team" section has a tool for adding a PCP. 

This is used to identify a PCP when none was previously specified. The same tool is used to enter a new PCP name to replace a previous outdated PCP association.

The current PCP attachment is highlighted in "Transition Planning" reports that appear in the sidebar of inpatient, emergency and outpatient charts, as well as admission and discharge navigators. Selecting the PCP link will open an advanced PCP attachment editor that supports attachment management. Communications can be generated to confirm attachments or request new attachments.

For more information:

• Manual: Patient-Provider Attachments
• Manual: Shared Documents

Tippy - Pend, Share or Sign a Note?

Tippies can be quickly adopted with immediate workflow benefits...

• Pend, Share or Sign a Note?

Automated actions can be triggered by the signing of a note. For example, signed summative documents (e.g., discharge summaries) are automatically shared with Netcare and primary care providers when signed. After a document is copied to external systems, additional work is required if the same document needs to be re-shared. It is especially disruptive for community practices to sort through multiple copies of shared documents. 

Best practice makes use of two alternatives to signing:

1. "Pending” a note saves its current state as a draft but does not trigger any automated distributions. The author can return at any time to complete the note. Other authorized prescribers (e.g., attending physician) can take over a pended note by opening it for “Edit”. Pended notes appear within the “Incomplete” tab of the Notes activity within an opened chart.
   
   
2. "Sharing” a note saves the current state as a draft and does not trigger any automated distributions. The author, and other members of the clinical team (e.g., other trainees), can continue to work on the summative report. Authorized prescribers (e.g., attendings) can also take over a shared note by opening it for “Edit”. This workflow allows teams to collaborate in the preparation of summative documents, like discharge summaries.

Pended and shared notes are not available for viewing outside Connect Care, or the current Connect Care patient encounter. Once an authorized prescriber signs a pended or shared note, it becomes finalized, is visible on the appropriate Notes activity tab, and automated distribution actions (e.g., primary care provider copy, Netcare copy) are triggered. Any manual routing should be saved until after the note is signed.

For more information:

• Manual: Shared Documents

Documenting Legal Challenges

Legal considerations may affect how consent is obtained and care is provided. Examples include health interventions in the context of abuse, custody challenges, dependency and lawsuits.

A helpful tip sheet has been updated with specific instructions about use of Legal Advice Clinical Notes and Document scans attached to the chart. A "release restriction" flag may be placed on a patient's chart.

• Manual: Consent
• Tip: Confidentiality Documentation