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Ebola Information
posted:10/22/2014
Ebola Information
Click here for a powerpoint presentation regarding Ebola.

Click Here for an Ebola Resource Guide and Fact Sheet.











HERO provider update for September 2014
posted:10/13/2014
The provider update is available by Clicking Here
Pending Cultures from the ED
Discharge Medication Reconciliation
Initiation of Powerplans
Consent for Transfusion
Readmission Alert
Correctional Insulin for Discharge Medication List

HERO provider update for July 2014
posted:7/8/2014
The provider update is available by Clicking Here
Summary of the changes:

New Fluid Analysis Powerplan
New Thoracentesis and Paracentesis powerplans to include orders for the procedure and the corresponding fluid analysis
Reminder about the Quality Measures Tool
New Diabetes Management Outpatient section in the Discharge Orders powerplan
Reminder about DME and Face to Face Requirements

HERO provider update for May 2014
posted:5/23/2014
The provider update is available by Clicking Here

If you provide care in the inpatient setting, please take a moment to read the attached update regarding a series of changes to HERO. These changes will be implemented starting next Tuesday, May 27. These changes are driven by protocol and policy changes and/or with intent to improve patient care.

Some of the changes will impact powerplans and will thus require those users with personal powerplan favorites to re-save their favorite powerplans if impacted. Because of the impact on favorites, we try to make changes to powerplans infrequently, but do need to keep them current with best practice and policy.

Summary of the changes:
New Activity Order to Accommodate the Mobility Protocol
New Bed Placement Orders - Increased Care Needs, Telemetry, and Critical Care Beds
New GI Prophylaxis Powerplan for Stress Ulcer Prevention
New DME Powerplan and “Face to Face” Documentation Requirements
New Diabetes Management Powerplan
New BMI in Patient Banner Bar
Changes to Urinary Catheter Insertion and Continuation Orders to Reflect the New Urinary Catheter Removal Protocol
Changes to Code Status Order to Reflect Policy Changes – Removal of Comfort Care Option and Comments and Special Instructions
Changes to MRI Orders to Guide Appropriate Utilization
Updates to Outpatient Prescriptions Powerplan

New Policy for plasma transfusion
posted:4/7/2014
To: All Excela Health Practitioners ordering blood products
From: Charles Choi MD, Tissue and Transfusion Committee Chairperson
Subject: New Policy for plasma transfusion.

The Excela Health blood bank will be following new AABB guidelines and American Red Cross recommendations, necessitated by anticipated reduced inventories of group AB plasma. Recent best practice is to generally exclude plasma donated from females who have been pregnant, to mitigate risk of transfusion related acute lung injury (TRALI). As a result, the following change is implemented beginning April 1, 2014:

1. Group A plasma will be provided for emergency release to adult patients when the patient's blood group is unknown or group AB plasma is unavailable.

2. Patients should be ABO typed as soon as possible to allow transfusion of group-specific plasma

3. Pediatric, cardiac surgery, and transplant patients, and patients with TTP requiring exchange transfusion will continue to receive group-specific plasma only.

Please contact Charles Choi MD, transfusion committee chair, with any medical questions at 724-537-1853.
Patti Schildkamp, Blood Bank system supervisor, can be contacted with nursing/technical questions at 724-537-1573.

HERO Office Staff Training Sessions – Being Offered NOW!!!!
posted:10/28/2013
Click Here for more details.

Webchart/Homecare Portal Announcement
posted:5/6/2013
On Monday night, May 6 we will be implementing the new Webchart/Homecare Portal application (eliminating the Homecare tab in ePortal).  The link can be found on the navigation area to the left.

Reporting of Suspected Transfusion-Associated Infections
posted:11/30/2012
The safety of the voluntarily donated blood supply has been steadily improving during the last fifteen years. This improved safety of the blood supply, including the decreased risk of transfusion transmitted infections such as HIV and viral hepatitis, has been accomplished by improvements in donor selection and testing procedures. The risk for Hepatitis C transmission through a blood transfusion has been decreased to an estimated 1 in 1,900,000 transfusions, the risk for Hepatitis B transmission to 1 in 205,000-488,000 and the risk for HIV-1/2 transmissions to 1 in 2,100,000 transfusions.1
Despite the rarity of transfusion-associated Hepatitis and HIV infections (along with HTLV I and II, CMV, West Nile Virus, and parvovirus infections), sporadic cases can occur. Physicians are reminded to still consider the possibility of post-transfusion-related infections in the follow-up examinations of recently transfused patients. Suspected cases must be reported by the physician to either an Excela Health Blood Bank or Infection Control Department so that involved donors can be investigated.
Charles Choi, MD
Excela Health Tissue and Transfusion Committee
1 The Institute for Transfusion Medicine, Transfusion Medicine Update, Issue #2, 2009.

New Venous Thromboembolism Prophylaxis Recommendations and Order Sets
posted:11/13/2012
From:  William A Jenkins, MD, FACEP / Venous Thromboembolism Prophylaxis Team
As I am sure that you are all aware, the American College of Chest Physicians (ACCP) released new guidelines this year regarding the prevention of venous thromboembolism (VTE) and the use of antithrombotic therapy for VTE prevention. These guidelines can be reviewed in their entirety in CHEST for those of you who wish to review the entire guideline.
Excela Health has been working for several years to improve the VTE protection provided to our patients. In conjunction with nursing and as a project in partnership with Highmark and now CMS, Excela has taken great strides to support a nursing risk assessment program for VTE beginning hospital day one providing mechanical compression stockings to nonambulatory patients pending the physician’s assessment of VTE risk and the implementation of pharmacologic VTE prevention where indicated. The use of pre-printed order sets and the use of a comprehensive power plan in Cerner has aided the physicians in following the most evidence based guidelines for VTE prophylaxis for our inpatients.
As the guidelines have recently been modified, this monograph will highlight the newest changes and recommendations and provide examples of changes to the pre-printed order sets and the Cerner power plan.
The Guidelines:
The clinical recommendations are designed to consider the balance of benefit and harm that result in the decision to provide VTE prophylaxis to our inpatients. The guidelines acknowledge that not all patients require VTE prophylaxis and suggest a risk stratification methodology (The Padua Prediction Risk Score) to determine those patients at highest risk.
The Padua Prediction Risk Score
Risk Factor Score
· Active cancer 3
· Previous VTE 3
· Reduced mobility 3
· Known thrombophilic condition 3
· Recent (≤ 1 month) trauma/surgery 2
· Elderly (≥ 70) 1
· Heart/respiratory failure 1
· AMI/ischemic stroke 1
· Acute infection/Rheumatologic disorder 1
· Obesity (BMI≥30) 1
· Ongoing hormonal therapy 1
Point 1
Patients are deemed high risk if their Padua Risk Score is ≥ 4 or they are admitted to a critical care unit and considered clinically critically ill. (The guidelines address the critically ill however they are not necessarily part of the formal Padua Scoring System. We have modified our score to assure those in critical care areas automatically fall into the high risk category for efficiency and ease in ordering prophylaxis).
Patients are considered low risk for VTE if their risk stratification score is 3 or less.
Point 2
For acutely hospitalized patients considered low risk for VTE the guidelines recommend AGAINST the use of either pharmacologic or mechanical VTE prophylaxis. It should be stressed that the patient’s risk level may change throughout the course of their hospitalization and thus risk determination is a dynamic process that should be re-evaluated with each change in patient condition or transition of care. The physician must document “low risk/no prophylaxis indicated” – this is easily accomplished on the order sheet or order set.
Point 3
As stated above, regardless of risk score, critically ill patients (those in the ICU or deemed critically ill clinically) should receive prophylaxis. Low molecular weight heparin (LMWH) or low dose unfractionated heparin (LDUH) is recommended. For critically ill patients who are bleeding, or at high risk for major bleeding mechanical thromboprophylaxis is recommended until a time when pharmacologic agents can be safely initiated.
Point 4
For acutely hospitalized patients considered high risk for VTE the guidelines recommend anticoagulant thromboprophylaxis with LMWH, LDUH bid, LDUH tid, or fondaparinux (arixtra). For high risk patients who are bleeding, or at high risk for major bleeding mechanical thromboprophylaxis is recommended until a time when pharmacologic agents can be safely initiated.
Attached you will find a copy of the Excela pre-printed order sheets designed to take you through the risk stratification process for VTE and provide you with the ordering choices for appropriate evidence based VTE prophylaxis. In addition, you will find copies of the screens in Cerner dedicated to VTE prophylaxis.
VTE Prophylaxis Power Plan screen shots
VTE Prophylaxis Order Set draft document

New Transitional Orders PowerPlans – Monday November 12
posted:11/7/2012
In an effort to assist with timely entry of common “tuck-in” orders for patients admitted after hours, the HERO team has developed 4 transitional orders PowerPlans to cover the most common evening admissions at Latrobe and Frick, and ultimately Westmoreland Hospital.

Transitional Orders General Surgery
Transitional Orders Medicine
Transitional Orders Orthopedics
Transitional Orders Urology

These PowerPlans contain the admission/observation order, code status, common nursing tasks, basic diet/NPO options, common IV fluids, common medications, and common diagnostic testing ordered by each of these disciplines. While the common items for other subspecialties may not be represented in this content, we can add additional options in the future if the content is available.

The nursing staff will begin to use these on Monday, November 12. When calling to obtain orders for an after hours admission, a nurse may utilize one of the transitional orders PowerPlans to quickly capture these “tuck-in” orders given by the admitting provider.

We hope that use of these PowerPlans will assist with timeliness of order entry and with accuracy of entry as most of the options in these sets are pre-configured to minimize manual data entry.

Ground Rules/Expectations:
-The provider will stay on the phone with the nurse while the nurse makes selections in order to make sure true “read back” is performed as part of standard policy for telephone orders.
-The provider or covering partner is expected to cosign these orders the following morning.
-The provider will complete admission medication reconciliation the following morning.
-The provider will complete the VTE risk assessment order the following morning if not otherwise completed as part of the initial orders.
-The provider will order all other non-urgent orders the following morning as part of routine rounds.

Providers are certainly free to use these PowerPlans for direct order entry as well and/or to use the standard admission PowerPlans available in the system. Direct entry by the provider has advantages in minimizing the risk of transcription error and in getting all orders complete with one step.

Thank you for your support of this new initiative. Please feel free to contact me with any questions.

David Rich, MD, FAAP
Chief Medical Information Officer

HERO (CERNER) EMR Training Sessions
posted:11/5/2012
The HERO EMR system implementation is scheduled for March 19, 2013 at Westmoreland Hospital.
Training for providers begins in January. Please see the attached original invitation and training schedules.
PLEASE SCHEDULE AS SOON AS POSSIBLE - CALL: 1-877-771-1234 OR 724-689-1360.
EMR TRAINING MEMO
HERO TRAINING JANUARY 2013
HERO TRAINING FEBRUARY 2013
HERO TRAINING MARCH 2013

Time Out - Joint Commission Finding
posted:8/24/2012
Performing a TIME OUT prior to all operative and invasive procedures is the policy of Excela Health and has proven to prevent wrong site, side, and patient procedures nationally. TIME OUT is required immediately prior to all non-emergent operative and invasive procedures done in any location (including at the bedside). TIME OUT is a pause immediately prior to the invasive procedure during which ALL activity stops and the team (at a minimum the physician and an RN or technician) :
· Identifies the patient
· Reviews the informed consent and ensures appropriate completion
· Confirms the planned procedure
· Confirms that the surgical / procedural site is appropriately marked
· Ensures that all anticipated equipment and medications are readily available
· Reviews anticipated post-procedure needs of the patient.
Performance of the TIME OUT will be documented by a member of the nursing staff.
During a recent Joint Commission Survey at Frick Hospital, it was identified by the survey team that a bedside thoracentesis was performed by a physician without the required TIME OUT (including site marking) being performed. This is an unacceptable and risky practice.
As a result of this observation, a very rigorous and extensive audit will be conducted over the next four months to assure 100% compliance with this policy in all locations.
If you have any questions, please contact Denise Addis, Director Accreditation and Regulation at 724-832-5163 or daddis@excelahealth.org . Thank you for your continued support and commitment to patient safety.

Professional Practice Evaluation Process
posted:5/31/2012
As discussed at the General Staff meeting, Excela Health has initiated the development of a Professional Practice Evaluation process.

The work of the Patient Care Evaluation Committees will be transitioned beginning July 1, 2012 to the Professional Practice Evaluation Committee, referred to as PPEC. The PPEC is a new multi-specialty committee and the foundation of the new process. The PPEC's sole function is to use its expertise to help colleagues on the Medical Staff improve their clinical practice. When concerns are identified in a practitioner's clinical practice, the PPEC may develop an individual performance improvement plan to address those concerns.

Below is a link to an information sheet and detailed process flow chart.  The policies can be found under the intranet at the Medical Affairs link then "Policies"

Professional Peer Evaluation Information Sheet 
PPE Flow Chart