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VANDERBILT UNIVERSITY MEDICAL CENTER

Nursing Documentation

What's New in Nursing Documentation

 

 

June 12, 2013

  • VUH and VPH:  PAIN-AD Scale will now auto-calculate
  • NICU and NBN:  The N-Pass, NIPS and NWI will now have auto-calculating scores. Newborn Nursery -  NIPS scale was re-built in order for the auto-calculation feature to work. Previous NIPS documentation will be viewable but no longer chartable.
  • ICUs:  ICU/SD Assessment/Intervention and Peds Assessment/Intervention tabs - Pulmonary - Added new field of "Extubation Details" with options for "Self extubation" or "Accidental extubation".

June 4, 2013

  • ALL VUMC - Links menu: Added KRAMES "Adults" & "Peds" Patient Education Resources. 
    All Assessment/Intervention tabs: Added "In and Out Cath" shared field.
  • VUH - Vitals I/O tab:  Added "Nutr by Nursing" secontion below I&O Summary.- share with assessment tab.
  • VUH & VCH - Education Record:  Added "Cardiac Medication Education".

May 21, 2013

  • Launch HEO/WIZ from HED will be rolled out to ALL departments - PowerPoint

May 14, 2013

  • NICU & Newborn Nursery  - "PC-PSV VG" added in NICU Airwary devices & "Bilight Mgmt" in Phototherapy additional options
  • ALL VUH -  "Blood Transfusion Cosign Result" changed &  added "PEP Therapy" in Pulm/Resp

May 7, 2013

April 30, 2013

  • Click here - For 7N-VUH and 5C-VCH: Piloting a short cut to get from HED to HEO/Wiz while maintaining patient  context.
  • Click here - For Adult ED & Peds ED:  Procedure on Unit /Consult at Bedside - Added "Obstetrics/Gynecology" .
  • Click here - For VUH & VCH:  Blood Transfusion tab - Added "All Lines" to tab.
  • Click here - For VUH, VPH, VCH except NICU: Assessment/Invention tabs - Add "Intouch bed w.isogell mattress"  to dropdown
  • Click here - For 10S, S64 & S74:  Neuro - "CAM assessment now Auto-Calculates".

April 23, 2013

  • Click here - For VUH & VCH (except NICU) - Assessment tab - Added "Laceration Repair"; Blood Transfusion tab - Added "O2 Sat%"
  • Click here - For EMER - Adult ED - Vitial Signs - Added "ETCO2"
  • Click here - Hold and Resume Orders Review Tools

April 16, 2013

  • Click here - For ALL Departments - Added new output for Vesicostomy
  • Click here - For VCH - Peds Fall Assessment - Added new option to the Medication usage dropdown

April 9, 2013

  • Click here - For ALL VUMC - Urinary catheter require "Inserted Date"
  • Click here - RASS Score changes
  • Click here - For VUH and VCH (except NICU and Newborn Nursery) - Assessment tabs - FALL RISK/SAFETY
  • Click here - For OB - PIV charting added below CIWA charting
  • Click here - For NICU - SQC charting is now available on the NICU Assessment tab
  • For VCH: PEWS DAS will be available for all Peds Acute Care Units

April 3, 2013

  • Flu screening is complete for this season.  The Flu screening questions have been removed from all nursing admission history form.  Only Pneumovac screening remains

April 2, 2013

  • Click here - For VUH and VCH (except NICU & Newborn Nursery) - New addition Ventilator type: "Home ventilator"
  • Click here -  For VCH (except NICU & Newborn Nursery) - Peds VSI&O; PCCU Quick Assessment & AdminRx - added new intake option
  • Click here - For 5A, 5C 7A & NICU - Donor Breask Milk has new charting option

March 19, 2013

  • Click here - ALL VUMC - Changes to Vitals I&O, CIWS & Plan of Care/Discharge Plan.
  • Click here - VUH & MCJCHV except VPH and NBN - Added option to output
  • Click here - VCH only - Changes to Peds Vitals I&O and Peds Assessment/Intervention

March 12, 2013

  • Click here - For Children's Hospital 5A, 5C & 7A - PCCU Quick Assessmennt document change

March 5, 2013

  • Click here - For ALL - Restraint document changes.  Education Record changes
  • Click here - For PCCU - PCCU Quick Assessment
  • Click here - For PEDS ED and PEDS Acute Care - New links for PEWS Resource
  • Click here - For OB

February 26, 2013

  • Click here - For ALL VUH - Changes to send message, Cardiovasular & Pulmonary assessment on MedSurg/Intervention tab
  • Click here - For VUH & VCH - Tube level documentation tips added to hover in I&O
  • Click here - For OB Triage - Fetal evaulation
  • Click here - Adult & Peds ED - Oral ETT added to airway type, additional head & neck assessment choices

February 20, 2013

  • Click here -  For ALL areas - Updates to Links...HED/AdminRx Training Resources
  • Click here - For CRC - The Adult Falls tab has been removed in HED
  • Click here - For VUH - CAM-ICU result will no longer allow copy

February 12, 2013

  • VPH will receive PICC and PIV charting on their VPH Assessment tab

  • Click here - All VUMC lexicomp
  • Click here - CRC/S31 priority problems and safety
  • Click here - 10N SAT documentation changes in HED
  • Click here -  Peds ED new field for Full Cardiac Monitor
  • Click here - Adult ED Modifications Documentation in HED

Janurary 29, 2013

December 14, 2012

  • Click here - New Flu Screening section on Admit History 

December 11, 2012

  • Click here -  ALL VUMC critical results notify, safety additions

  • Click here - Nursing History Updates 12/7/12 (2)

  • Click here - VUH & VCH Flolan & Rass Score changes

December 4, 2012

  • Click here -  ALL VUMC except NICU - Fall Risk & Priority Problem changes

  • Click here -  VUH add sutures to procedure options 

November 27, 2012

November 13, 2012

  • Click here  - VUMC - CIWA enhancements- changes to pain location- IV med drips- safety changes
  • Click here - VCH except NICU - formula addition

 October 30, 2012

  • Click here  - For All VUMC - Plan of Care/Discharge Plan Tab 
  • Click here -  For VUH and VCH Assessment tab:  NEURO;  IV Other;  Vitals I&O or QuickAssess.
  • Click here -  VUH only
    • Assessment tab: Special Neuro - new charting fields for Neuro Deficits and Stroke

    • New Safety Documentation:  Non-Implemented units and Implemented unit changes

    • Education Record: Role Communication- Interpreter Name change

October 16, 2012

  • Click here - Regular updates to HED documentation with screenshots
  • Click here - Heparin Drip education specific for 5 South and 6 South pilot, but visibe to everyone
  • Click here - Safety and Eduction roll out screenshots
  • Click Here - Notify Section Changes

October 9, 2012

  • Click here - 
    • ALL VUMC:  Pain > Pain Interventions > Added “nerve block
    • VUH & VCH:  Intakes > Added “TPN with Lipids”
  • Click here -
  • VCH > 5A and 5C: PCCU Quick Asmnt > PCCU Quick Assmnt  &  Peds Asmnt/Intervention  > Cardiovascular - Added new Alarm Settings options
  • PCCU Quick Asmnt > VENTILATOR > added multiple new fields 

 October 2, 2012

  • Click here - For VUH and VCH except NICU and NN: Assemnt >Neuro>The Glasgow Coma Scale and Pediatric Glascow Coma Scale
    • For ALL VUMC: PAIN > Pain Interventions> ‘MD notified removed replaced with ‘MD/NP notified’
    • For 11NM, 6A, 6B, and 8S: AdminRx>Infusion Status ‘Rate Increase’ and ‘Rate Decrease’ added to the dropdown

September 24, 2012

  • Click here - Influenza Screening returns to the Adult, OB and VPH Nursing Admission history.
  • Click here - HED AdminRx has been updated with 2 new results for Influenza and Pneumovax vaccine administrations

September 18 & 24, 2012

  • Click here - For 5A,, 5C and 11S - Peds Asmnt/Interventn > CARDIOVASCULAR > SG-PA Catheter.  New charting fields of RA waveform and LA waveform have been added
  • Click here - Immunization screening update for September 24, 2012.  Please print, post, and share with all HED users in your area

September 4, 2012

  • Click here - For ALL VUMC - ASMNT tabs> CVC trended data> Gauge/Length - addition of 19g x 1 ¼

    • For 11NM, 8S, 6A, and 6B - Precautn/Isoltn section has been added to the Chemotherapy/Infusion tab

August 28, 2012 

  • Click here - APPLIES TO ALL 3 HOSPITALS!
    • Changed "Removed By:" to a text fill-in & "Removal Order By:" to a dropdown
    • Added "very dry" and "peeling" to Skin Condition dropdown
    • Added Argatroban to the Antiocoagulant Education dropdown
    • For ALL VUMC - ASSMNT and Pain tab > Pain Self-Report>Pain Scale-PAINAD scale added to dropdown options

August 21, 2012

  • Click here -  ALL VUMC - HED changes for 8.21.12  &  For ALL VUMC except NICU and Newborn Nursery & for OB 

August 14, 2012 

  • Click here - For All VUMC >Pain>Pain Site &  For ALL VUMC>Pain>Cannot Self-Report Pain>Physiologic Cues  

  • Click here -  For VCH to include Peds ED & Peds ED

August 7, 2012

  • Click here - On the OB Triage tab:Update to the Domestic Violence screen to match the Nursing Admission history;  & For CVICU:On the IV Med Drips class: Added Bivalirudin/Angiomax

 July 31, 2012

  • Click here --  OB and VCH changes as well as new Safety/Falls risk changes

July 17, 2012

  • Click here for "Upgrades to Inpt. Nursing Documentation Tools in HED and StarPanel Admission History coming Tue., July 17, 2012

July 11, 2012

  • Click here for "Change to Immunization Screen on Admission History" forms used with ADULT Inpatients was made today, Wed., July 11.

July 2, 2012 and July 9, 2012

  • Click here for Advance Directive (Purple form) in Starpanel & Vancomycin Advisor in HEO/Wiz 

June 19, 2012

  • Click here for updates in HED effective 6/29/12
    • Increase in font size on all tabs
    • New Vancomycin Advisor on 7/9/12

April 17, 2012

 

This page was last updated June 11, 2013 and is maintained by Karen Hughart