Inpatient Student Nurse Online E-Learning Companion Guide PDF

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INPATIENT STUDENT NURSE ONLINE E-LEARNING EPIC INPATIENT

Companion Guide UnityPoint Corporate Training Team

© 2020 Epic Systems Corporation. Confidential.

Effective Date: April 6, 2021

Aurora Milne, Epic Instructional Design Analyst

Table of Contents Introduction........................................................................................................................................................ 3 Sign In ............................................................................................................................................................... 3 Overview of Hyperspace in an Inpatient Setting ................................................................................................ 5 Overview of the Brain ........................................................................................................................................ 6 Nurse Reviewing the Chart ................................................................................................................................ 7 Documenting in Flowsheets............................................................................................................................... 8 Overview of Flowsheets................................................................................................................................. 8 Document an assessment ............................................................................................................................. 9 Document daily cares .................................................................................................................................... 9 Managing LDAs Using the Avatar .................................................................................................................... 10 Administering Meds on the Web MAR ............................................................................................................. 11 Navigate in the MAR .................................................................................................................................... 11 Administer a medication............................................................................................................................... 12 Documenting IV Fluids and Medication Drips .................................................................................................. 12 Take the Final Exam........................................................................................................................................ 13

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Introduction 

This guide is intended as a supplement to the online student nurse e-learning curriculum.



The curriculum should be completed in the following order: Title

Minutes

Course Abbreviation

START HERE - Introduction to Inpatient Student Nurse 5 Online Training

ICLN0910e

Sign In

7

INP701

Overview of Hyperspace in an Inpatient Setting

9

CLNINP001

Overview of the Brain

7.5

INP084

Nurse Reviewing the Chart

5

INP067

Documenting in Flowsheets

7.5

INP061

Managing LDAs Using the Avatar

3.5

INP085

Administering Medications on the Web MAR

5

INP062

Documenting IV Fluids and Medication Drips

11

INP160

ICLN0910x_EHQ-ICLN Nursing Student 100 Test

30 (15 Questions)

ICLN0910x

Sign In INP701 ❖ Begin your shift: We’ll start by covering some beginning of shift tasks. I'll show you how to: ▪

Log in to the system

▪

Sign in for your shift

Log In Credentials 

ID: IPSN02



Password: train



Department: STE Neuro



Log in to the Epic system with your credentials. Your Department today is STE Neuro.

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

If you need to change your department, click on the magnifying glass, or selection tool, to switch departments.

Sign in Scenario 



Patients You are assigned: ▪

Molly Bigleague

▪

Molly Jollyrancher

Department: STE Neuro



The first thing you need to do is sign in to indicate that we're here and take over the patients assigned.



Signing In allows you to see patient information quickly, at a glance, and lets other members of the treatment team know you are providing care.



Click Sign In



Enter your typical shift information in the top section of the window.



At the end of your shift time, you will automatically be removed from the treatment team.



Next, we'll review and update your patient assignments in the bottom half of the window.



Find your login department. ▪



Click Add and search for your department. (STE Neuro)

Find your two patients. ▪

Click the check box next to the patient's name.



Click Sign In.



I'm now signed in for my shift.



If we need to update our list of patients we care caring for, click Sign In and update Sign In. When a patient is discharged, they will be removed from your list. If you need to continue any documentation, find the Recently Discharged folder for your hospital. • •

Navigate to Patient Lists Navigate to the Recently Discharged system lis t folder.

•

Recently Discharged → Recently Discharged – Your hospital → {24H, 4Day, or 4Day admitted only}



When you are finished with your shift, click Sign Out.



If you forget to complete this step – it is ok! If you Signed In, remember you will automatically be Signed out at the Shift End time.

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Check Your Understanding 

What do you have to do so other providers know you are caring for a patient? ▪

A) Drag the patient to your My List

▪

B) Sign In to the patient’s treatment team

▪

C) Write a note

Overview of Hyperspace in an Inpatient Setting CLININP 001 

Common Workspaces and Tools: ▪

Hyperspace Toolbar: Easy access to most frequently used activities. Can be modified.

▪

Epic button: Less frequently used activities.

▪

Workspace Tabs: Tabs are used to arrange information. ▪ ▪

Brain: Start Up activity. Timeline view of tasks. Patient Lists: At a glance information. Use to view patient reports and the Recently Discharged Folder.

As a student, you will not be able to Acknowledge new orders. 

To open a patient’s chart: ▪

Double-click the patient’s name from either the Brain or Patient Lists.



Storyboard: basic patient information always displayed on left side of screen.



Activity Tabs: Each tab takes you to a different area of the patient’s chart.



Click the “X” on a workspace tab to close the patient’s chart. In the demo video, you saw how you can Right-Click and “Assign Me.” Thi s is NOT the UnityPoint Health recommended way to sign yourself to a treatment team. Use the Sign In method you learned in the previous lesson.

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Check Your Understanding 



Match the section of the Hyperspace screen with its purpose: ▪

Main Toolbar

______

▪

Home Workspace

______

▪

Storyboard

______

▪

A. Contains the most appropriate activity for you to start in each day.

▪

B. Contains your most frequently accessed tools and activities.

▪

C. Contains details about the chart you are currently in.

True or False: You don’t need to log out when you are done working in Hyperspace.

Overview of the Brain INP084 

Brain: ▪

It's a timeline view of the tasks you'll complete for each of your patients. ▪



The patient card on the left features: ▪

At-a-glance information about the patient such as their age, attending provider, principal problem. etc.

▪

Interactive icons on the patient card show you the patient's new orders, required documentation tasks, and PRN orders. ▪





Note: You must be assigned to a patient's treatment team to see them on the Brain.

If you aren't sure what an icon means, you can hover to discover.

The timeline includes icons for tasks that are upcoming, overdue, and complete. ▪

Notice the different task symbols for meds, labs, and assessments. Green check marks denote a completed task.

▪

The check box filters on the toolbar allow you to limit the types of tasks you see on the timeline.

▪

You can also change the view to the previous shift to see what care was already provided to the patient.

You can also add your own custom tasks to the patient's timeline. ▪

Click the current time block on your patient's row to open the task window.

▪

Click the green plus sign.

▪

Enter the task.

▪

Confirm the current date and time are listed and click Accept.

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Check Your Understanding 



Select tasks that can be completed directly in the Brain. Select all that apply: ▪

☐ Medication Administration

▪

☐ LDA Placement

▪

☐ Specimen Collection

▪

☐ Order Acknowledgment

How do you open a patient’s chart from the Brain? ▪

A) Double-click anywhere in the patient card.

▪

B) Double-click anywhere on the patient timeline.

▪

C) Single-click the patient’s name

Nurse Reviewing the Chart INP067 

Use the Brain and Patients Lists to review patient information without opening the chart.

Summary Reports In the demo video, you saw the Systems Review report. At UnityPoint Health, the default report to get a goof overview of your patient is the Kardex report.



Use the Summary activity and reports to get an overview of the patient and the start of your shift.



Reports you may find most beneficial: ▪

Kardex-IP

▪

Active Orders

▪

Meds

▪

Event Log

▪

Comp (Comprehensive Flowsheet)

▪

Intake/Output

Notes Activity 

Review the patient’s most recent notes from this current admission in the Notes activity.

Chart Review 

Review a patient’s notes from past visits and admissions.

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Chart Search 

Search for specific patient information.

Check Your Understanding 

True or False: The only reports available to you are listed as buttons in the report toolbar.



Which of the following can you view in the Summary activity? Select all that apply.



▪

☐ Lab orders

▪

☐ Vitals

▪

☐ In Basket messages

▪

☐ Medications

Which tool should you use to find information related to a particular condition? ▪

Documenting in Flowsheets INP061

Overview of Flowsheets 

Flowsheets are designed to track a large amount of patient data over time. In Epic, clinicians document this information in the Flowsheets activity.



As a student, you will be required to enter the name of your preceptor. As a student, you will be required to document a cosigner for your documentation. You will need to enter the name of your nurse preceptor/instructor at the window prom pt. The window appears automatically when you open the Flowsheet activity:



Be sure to document data at the correct time.

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File and Edit Documentation 

Hashmarks on the left side of the cell indicate data is pending. Your documentation files automatically when you move to another screen, or you can click File to save at any time.



To edit a cell, just click back in it and change the value.



Enter a comment by clicking on the piece of paper icon.

Document an assessment 

In Epic, chart by exception, meaning only document abnormals, or WDL, Within Defined Limits. A patient population must be selected to “cascade” in the appropriate screenings. • Adult: Delirium (ICDSC) screening, Braden Score, and Hester Davis Fall scale cascade in. • Peds: Braden Q, Cummings Fall Risk, and PEWS (peds early warning signs) cascade in. • OB: Braden and OB Fall Risk Assessment scale appear • SNF: (skilled nursing facility) CAM delirium, Braden, and Hester Davis

It is not necessary to document every row. Document what was assessed and abnormals only.

Find flowsheet rows 

Use the search field to help find specific rows if not sure where it is located in a flowsheet.

Add flowsheet templates 

Some documentation pieces are too large and are kept on their own separate flowsheet.



Common flowsheets you might need to add: ▪

Blood Administration

▪

CIWA Score

▪

Restraints

▪

Stroke



Use the Flowsheet Template selection tool to search for available flowsheet.



Use the wrench to customize your default flowsheets.

Document daily cares 

Use the Daily Cares/Safety flowsheet to document patient care such as: ▪

Intentional Rounds

▪

Mobility

▪

Hygiene

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▪

Comfort

▪

Feeding

▪

Appetite

Check Your Understanding 

You took a patient’s temperature an hour ago in the Pediatrics department and are just now getting around to documenting it in Flowsheets. To begin documentation, you should click: ▪

A) File

▪

B) Insert Column

▪

C) Add Column

▪

D) Details report



True or False: A nurse can see flowsheet documentation that was completed by other clinical users.



You are documenting in a patient’s chart and notice a piece of paper icon next to a patient’s previous heart rate value. What does this icon mean? ▪

The value was taken from a monitor.

▪

The value was changed after clicking File.

▪

The document has not been filed yet.

▪

There is a comment entered for the value.

Managing LDAs Using the Avatar INP085 

In Epic, the following areas of documentation are referred to as LDAs:

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Check Your Understanding 

What actions can be taken on LDAs from the LDA Avatar? Select all that apply: ▪

☐ Remove LDAs

▪

☐ Assess LDAs

▪

☐ Add LDAs

Administering Meds on the Web MAR INP062

Navigate in the MAR 

MAR = Medication Administration Record



Use the tabs along the top to filter.



The current hour is shaded.



Colors have different meanings. Use the Show background icon to see what they mean:



Hover over icons to discover what they are or use the Legend in the toolbar.

© 2020 Epic Systems Corporation. Confidential.

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Administer a medication 

In Epic, to administer a med, you: ▪

Scan the patient's barcode.

▪

Scan the med's barcode.

▪

Verify and update the dose, rate, and other information on the admin form.

▪

This is how we check the five rights: Patient, med, route, dose, time.

Edit a medication administration 

On the MAR, click the Given action.



Select the Edit administration checkbox:

Check Your Understanding 

On the MAR, how can you quickly find administration instructions for a medication? ▪

Click the View Instructions check box

▪

Look at the medication row

▪

Click the Admin Instructions button



True or False: After a medication has been administered, it cannot be edited.



True or False: You can see medications from prior hospitalizations on the MAR.

Documenting IV Fluids and Medication Drips INP160 © 2020 Epic Systems Corporation. Confidential.

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

To document an IV medication: ▪

Scan the patient’s barcode.

▪

Scan the med’s barcode.

▪

Link the medication to the IV line it will be infused through.

▪

Review the medication details and check the 5 Rights.

Intake/Output 

Document Intake/Output from the flowsheet.



Intake is not documented automatically, because it must match what actually occurred from the IV pump. Epic Calculator: Always document what happened. Epic’s volume calculator suggests volumes, but the suggested value may not be accurate. Use the infusion pump to determine actual volume infused.

End of shift totals 

End-of-shift documentation should always be entered in a time column within your shift.



When other treatment team members, such as the providers, review a patient’s intake and output, they will use the Intake/Output report in the Summary activity.

Check Your Understanding 

True or False: Intake volume is documented automatically.



How do you see suggested intake volumes?



▪

Click the calculator

▪

Click the sy...