September 25, 2018

eStar changes and updates announced

Updates to Suicide Screening Workflow in eStar

As of September 19, eStar will now feature a number of revisions to the suicide screening workflow, including updates to the Suicide Ideation BestPractice Advisories (BPA) and order panel. These changes will help improve clinical workflow and enhance patient safety, and will only apply to workflows in Vanderbilt University Hospital (VUH) and Monroe Carrel Jr. Children’s Hospital at Vanderbilt (MCJCHV).

The updates build on the implemented a new policy and intake workflow that was implemented in June 2018. The policy requires that inpatients aged 12 years or older are screened by triage/intake nurses for suicide using the Columbia Suicide Severity Scale (CSSR). Interventions are then provided/ recommended based on results of the CSSR, including clinician-focused BPAs that appear upon opening the patient chart

Updates include:

  • If the patient scores yellow, orange or red on the (CSSR), mental health resources will now auto-populate on the patient’s after visit summary (AVS)
  • Red, yellow and orange BPAs are updated to reflect changes to resources
    • Updates to BPA verbiage to reflect the provision of mental health resources on the AVS
    • Changes to “Acknowledge” reasons on Yellow and Orange BPAs
  • “1:1 patient order” within Suicide Precautions Panel will now display as “1:1 visual observation”
  • Order will trigger the “Sitter” icon within Unit Manager and will send a message to VandyWorks (similar to how the “Sitter at bedside” order works)

 

Clinicians continue to be empowered to order actions based on results of CSSR and to discuss with the patient why mental health resources are provided on AVS.

View the Tip Sheet Revising SI: BPA’s and Order Panel (available within Learning Home Dashboard and Hubbl) for more information.

Meropenem Dosing

Meroponem is currently administered in Vanderbilt University Hospital (VUH) as extended infusions given over three (3) hours. While studies show extended infusion of these antibiotics improves patient outcome and is associated with lower mortality rates and shorter length of hospital stay, the time to steady state concentrations in the tissues is delayed

Based on this data, the Vanderbilt Antimicrobial Stewardship Program (VASP) recommends standard infusions (loading doses) as first dose only for meropenem. Beginning September 26, first doses of meropenem may now be ordered and given as 30-minute infusion, to be followed by maintenance doses infused over three (3) hours.

Prescribers should:

  • Select order panel for meropenem with loading dose followed by maintenance dose
  • Select loading dose option with frequency of “Once”
  • Select maintenance dose and frequency to follow loading dose
    • Frequency selected will also determine how long after the loading dose is given that the maintenance dose will begin (e.g., loading dose is ordered to be given at 0900 and frequency selected for maintenance dose is Q8H, meaning maintenance dose will begin at 1700)

View the Tip Sheet Meropenem as a Loading Dose (available within Learning Home Dashboard and Hubbl) for more information.