1. Inpatient Lab EHR setup Leslye Rauth RD, CDE Clarence Smiley MPH, MT(ASCP)

2. 3 (maybe 4) main steps • Setup lab package for Immediate Collect. • Setup lab package for Phlebotomy Collection time(s). • Create EHR Quick Orders for type of lab collect (SP, WC, LC, IC). • Teach lab phlebotomist to use lab package to generate collection lists.

3. Lab package nomenclature

4. There is a difference between types of lab collection • Labs can be collected under a variety of conditions. (Inpatient & outpatient settings) • For facilities that have Inpatient wards, lab collection should correctly reflect when, where, and how collected. • Who collected? (i.e. Ward personnel, lab personnel, etc…)

5. There is a difference in types of lab collection • LC means that lab will collect blood at a defined point in time (i.e. 7 AM). EHR Quick Orders will have to be set up to support this. • Depending on parameters, LC labs will be collected at the next scheduled collection time. • IC means just that; immediate. Usually a provider has ordered a lab to be collected in Inpatient dept at that moment. • You could use SP for someone in Inpatient, provided you actually send the patient to lab.

6. Lab package nomenclature

8. Summary of tasks to be completed • Setup Lab Package to display “Immediate Collect” during lab orders • Add main menu item in EHR “Inpatient Labs” • Create Quick Orders for the types of draws that will occur in an Inpatient setting (SP, WC, LC, IC) • Create an Inpatient Lab Order menu for scheduled AM draws

9. Summary of tasks to be completed • Create an Inpatient Lab Order menu for Immediate Collect type draws (i.e. not scheduled for AM draws) • Add lab package menu options to generate collection lists and labels • Using the lab package to generate collection lists and lab labels for inpatient AM draws • Add menu option to inpatient nursing personnel to track inpatient AM lab draws

10. How to set up lab package for “Immediate collect” • Under programmer mode, navigate to Fileman file 69.9 (Laboratory Site) • Populate the Immediate Collect division parameters with your site. • Turn on the Immediate Collect prompt. • The parameters of Immediate Lab Collect define one institution. Therefore, multidivisional sites can have different parameters for each division. • Create Quick Orders using standardized format, LRZ IC Glucose or LRZ SP Glucose.

11. File 69.9 parameters • Immediate Collection Division-If your laboratory provides specimen collection service outside of the normal routine collection (i.e. Inpatient), enter data about your particular site here. • Minimum response time-number of minutes lead time that is necessary for collection. • Max number hours allowed ahead-used to allow orders to be placed into the future. • Start time and End time-times when Immediate Collect orders can be collected during day.

14. Quick Order for Immediate Collect

15. Inpatient Labs menu

16. Immediate collect labs

17. Order dialog for “Immediate Collect”

18. Notes • Make sure to “hang” the quick order with the appropriate menu. • LRZ IC GLUCOSE should go on LRZM IC labs menu (Immediate collect menu) • LRZ LC GLUCOSE should go on LRZM LC labs menu (AM lab collection)

19. Setting up LC (lab collect) parameters in RPMS • Set up in Fileman files 69.9 • Time is in 24 hour format. • Orders placed after the cut off time will be defaulted to the next routine lab collection • Users order tests with the Lab Test Order (lab collect) [LROW] option or LC

20. File 69.9 for LC parameters • Phlebotomy Order Cut-off time-orders placed after the cut off time will be defaulted to the next routine lab collection • Phlebotomy Collection time- time a collection list will be generated and/or routine phlebotomy is performed • Division-Allows a multidivision site to define which collection times are applicable to which division

21. File 69.9 for LC parameters • Collect [name of day] orders in - number of days until the next routine phlebotomy • Ignore holidays - Enter a “YES” in this field if the lab will perform routine phlebotomy collections on holidays

22. Setting up LC (lab collect) parameters in RPMS

23. Quick Order for AM labs

24. Inpatient Labs menu

25. AM or “LC” Lab Collect dialog

26. Order dialog for “Lab Collect”

27. Additional menu options in lab package to generate collection lists and labels Menu options to add are: • LRTASK PHSET • LRPHITEM • LRPHEXCPT • LRUFCLS • LRDRAW

28. Additional menu options in lab package to generate collection lists and labels

29. Options for phlebotomy • Create a new Collection list - This routine is run each night by task-man to create the collection list. • Itemized routine lab collection - allows an itemized receipt of routine lab collection from the ward. All collections received must be individually entered. • Receipt of routine lab collection from wards - After routine phlebotomy collection is completed, accessions are designated as being in the lab by running this function. • List of lab orders not collected - lists orders which have not been collected by the phlebotomists after routine collection by lab on the ward. • Print single future collection label - This option is a single label version and this option requires the user to supply the Order Number and it only prints a single label at a time. This is useful for Immediate Collect type orders.

30. Additional menu option for Inpatient nursing A summary of ward/clinic orders not yet accessioned. This function may be appropriate for the wards to use to determine their quality assurance of chart transcription to lab orders.

31. Reasons to set up lab package correctly • Supports facility in its efforts to implement EHR. • Correctly reflects where labs are collected and performed, especially for multi-divisional sites. • EHR is designed to reflect the lab package, so it is advantageous to set up lab package correctly. • Labs ordered via lab package are accounted for and leave a virtual “paper trail”. • Save valuable time and resources (i.e. labs ordered “outside” lab package usually have to be repeated because the original paper order and result are sometimes lost)

32. Questions?