DOWNTIME CHECKLIST

System Downtime

Reportinabilitytoaccesstothe EnterpriseInformation Systems(EIS)helpdeskat <insert number>

Follow any instructions received from EIS or AOD regarding downtime

Log out of Electronic Health Record

IdentifyBusiness Continuity(BCA)Workstations (if using EPIC)

Ensure BCAS are plugged intored(emergencypower)outlets (if using EPIC)

AccessBCAicon on the designatedClinicalWorkstation (if using EPIC)

Identify and gather downtime forms (See downtime forms list)

Retain /Batchcopies of all hardcopyorderswritten during downtime forclinicalrecoverybackloading

Be prepared torespond tochanging workhoursand dutyassignments when directed.Implementadmit/transfer‘nofly’period

Implementmanualdowntime documentation and programming oftheAlarisInfusionpumps

Logintoshadow“readonly”electronicenvironment(as notified)toread/printpatientinformation documented priortodowntime.

Retain /Batchcopies of all hardcopyorderswritten during downtime forclinicalrecoverybackloading

Utilize hard copyformsfordocumentation,including pMARandother down-timeforms (found in the unit’s Downtime Forms Box):

  • retain forclinicalrecoverybackloading
  • filein hard copymedical record forscanning byHID
  • Utilize downtime requisitions with EHRpatientlabels foralltest/procedurerequisitions.

System Restored/Operational

Enteressentialelements on newlyadmitted patients somediation orderscan beentered andvalidated

Complete alladmissions,transfers and discharges inEHRas soon afterproductionenvironmentis restored as possible
Completecensus reconciliation toassure theUnitCensusLog is updated andaccurate

Receive newwristbands with barcodes on anypatientadmitted during downtime;remove and replace wristband thatdoes nothave the bar code

NotifyCommand Centerthatcensus reconciliation is complete andaccurate(Command CenterwillnotifyPharmacythatmedication orders written duringdowntime can be enteredintorecordandvalidated)

Receive notification thatPharmacyhas completed medication recover

Reconcile newlyadmitted patientsin Pyxis

Reconcile pMAR toeMAR(Be sure toIVStopcompleted ordiscontinued meds in theeMAR)

Enterallgiven medication administrationsin eMAR and enter“downtime” in thecomments

LinkPyxis override pullsas soon as pharmacyhas back-entered the medication orders

Entercontinuous and future orders written during downtime in EHRManage Orders using “written”mode

Return toelectronicdocumentation of patientdatainEHRincludingeMAR

Resume pumpintegrationforcontinuous medications using backassociation*If intermittentmedication backassociate ONLYifremaining durationis 1hourorgreater*

Validateventilatorand CardiacMonitordevice data where present

Complete backentryof data documented during downtime(see Documentation –PostDowntime JobAid)

Redockglucometers and iStats

Reconcile data on hard copyforms with backentereddata inEHR

Reconcile workListActivity

DocFlowsheet: Use“skip”functionality

DocLabCollection Date/Time:Documentactualtime;Labwillbe on Downtimeprocedures

OrderCompletion:Procedures thatare completed during downtime should bemarked as “completed”

File allpaperdocumentation intoeach patient’s paperchartforscanning byHID

DOWNTIME FORMS

Caregivers willdocumenton downtime forms during planned andunplanned ElectronicHealth CareRecord downtime
DocumentationType / DowntimeForms
ClinicalDocumentation / Nursing Forms
Therapies:documentonpaperformsusedpriortosystemimplementation
Admission / AdmissionDowntimeRecord
HistoryandPhysical / H&PRecord
PhysicianOrders / PhysicianOrderSheet
Providersencouragedtowriteone-timeordersonly(exceptmedications).
Lab/Radiology/Diet/TherapyOrders / DowntimeRequisition Forms
MedicationOrders / RNsignsoffordersandtranscribesonpMAR;yellowcopysenttopharmacyincludingweightandallergies;Pharmacistpreparesmedicationanddelivers
PhysicianOrderSheetyellowtailplacedinPharmacyPick-Upbox
MedicationAdministration / pMAR
PhysicianDocumentation / ProgressNotes
CarePlans / InterdisciplinaryPlanofCareformsusedpriortosystemimplementation
PatientEducation / Patient/FamilyEducationRecord
PCERs
Transfer / ProgressNotes
SBAR
Discharge / ProgressNotes
Patient/FamilyEducationRecord
PCERs

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DowntimeDocumentationKeyPoints
BarCodeMedicationAdministrationProcesses:
Administermedicationsdueorrequiredduringthistimeutilizingthe5Rightsofmedicationadministrationwithoutbarcoding.
Whenthesystemisavailable,documentanymedicationsgiveninthedowntime.
Scanthepatient’swristbandtoopentheMAR
Selectthemedicationadministeredduringdowntime.
Note:Theadministrationalert,‘BarCodeNotScanned’willopen.
  • Select‘Systemdowntime’
  • Changethetimetotheactualtimeadministered
  • Select‘Accept’.

eMARMedicationDocumentation
Scanthepatient’swristbandtoopentheMAR;selectthemedicationadministeredduringdowntime.
Note:Theadministrationalert,‘BarCodeNotScanned’willopen.
  • Select‘Systemdowntime’
  • Changethetimetotheactualtimeadministered
  • Select‘Accept’.
ManuallyadjustadministrationtimeoneMARfororderswithaQ1hour(ormorefrequent)interval.
Forexample,if0100doseand0200dosescheduled,document0100and0101withacommentonthe0101administrationtonotethecompensationforDST.
Becausethisstepwilladdanadministration,thelastscheduledadministrationwillneedtobecanceled.

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