Flowsheetstraining.eivf.net/documents/New Documents/Web/Flowsheets.pdf · Changing Flowsheet from Medical Notes and Prescription Tab • Click once on flowsheet icon to load flowsheet
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Flowsheet ..........................................................................................................................................................2 From Patient Explorer ................................................................................................................................2 Creating a New Flowsheet .........................................................................................................................2
Creating a Cycle Order ......................................................................................................................................4 Cycle Order Tab .........................................................................................................................................4 Medical Notes and Prescription Tab ..........................................................................................................4 Ordering Prescriptions for a Cycle .............................................................................................................7 Lab Notes Tab............................................................................................................................................8 Transfer Notes Tab ....................................................................................................................................9 Alerts and Checks Tab .............................................................................................................................10
Creating an Individualized Patient Flowsheet..................................................................................................12 Advanced Customization of Patient Flowsheet ........................................................................................15 Converting a Flowsheet............................................................................................................................18 Flowsheet Icons .......................................................................................................................................19
Flowsheet Lab Management ...........................................................................................................................26 Order Blood Test ......................................................................................................................................26 Order Ultrasound......................................................................................................................................26
Flowsheet Physician Review ...........................................................................................................................28 Continuing a Medication...........................................................................................................................28 Stopping a Medication..............................................................................................................................29 Decision Taken.........................................................................................................................................29
Flowsheet Review Notification.........................................................................................................................31 Notify Patient of Results and Instructions.................................................................................................31
From this screen, you may also change cycle medications or flowsheet. • Cycle medications may be added (+), deleted (x), or inserted by using the
icons under Labs and Medications. • Add function will add medication to the last row under SrNo. • Insert function can be used to insert med between desired elements. For
example, in the screen above you would place your cursor on line 5 (GnRH Lupron/Antagon) to insert a medication above this line.
• Delete function will delete line your cursor is on. • Cycle medications may also be changed in regards to dosage or duration. • Double click on Drug Icon listed under Rx Signature. • The following screen will appear. Adjust medication dosage or duration as
• Select cycle start date from drop down menu. • Select Preferred Pharmacy from drop down menu. • When complete, select save to send prescription to pharmacy.
Lab Notes Tab Lab Notes Tab is used to capture information regarding the egg retrieval, semen source, fertilization plan, and embryo source plan. This tab is extremely crucial in
linking donor oocyte or donor sperm to a recipient.
Egg Retrieval: • Select planned retrieval procedure (VOR, LOR, GIFT). • Select oocycte source. • Select source identification. For donor egg cycles, this may be a unique code
such as J221. • Select maximum number of embryos to transfer. • Check box if plan to reduce # at UT per protocol.
Semen:
• Select semen source. • Select donor ID if applicable. • Select semen condition (fresh or frozen) • Select semen collection method.
Fertilization: • Select fertilization (Normal or ICSI). • Check appropriate box if blastocyst transfer is recommended. • Check appropriate box if assisted hatching is recommended.
Embryo:
• Select embryo source. • Select source identification of embryo if applicable. • Select frozen embryo location . • Document vial availability. • Document maximum number of embryos to transfer. • Select Save.
Transfer Notes Tab Transfer Notes Tab was designed to allow documentation of mock transfer or transfer plan.
• Enter uterus size. • Enter uterus position. • Enter catheter type. • Check to indicate ultra sound and tech required. • Check to indicate stylette required. • Enter any special instructions. • Save.
eIVF™ Patient Explorer Creating a Cycle Order • 10
Alerts and Checks Tab The alerts and checks tab was designed to encompass compliances or checklists for each type of cycle plan. Most centers have required blood tests, injection classes and consents that must be completed prior to preceding with a treatment cycle. This screen is customizable and captures those requirements.
• Alerts/Checks are noted at the top half of the screen. • Compliances are noted at the bottom half of the screen.
Alerts/Checks
Compliance
eIVF™ Patient Explorer Creating a Cycle Order • 11
1. Parameter 2. Validity 3. Duration 4. Period 5. Remarks 6. Waived 7. Waiver Comments 8. Waived Time
• Compliances that are completed or waived will appear in blue text. • Compliances that are not completed will appear in red text. • Compliances that are expired will appear in orange text. • The compliances are linked to applicable tests through eIVF. • Therefore, if a blood test or a consent is completed elsewhere in the medical
record, the compliance parameter will automatically change to blue text to indicate completion of the objective.
• To Waive a Compliance: 1. Double click on parameter desired to waive. 2. The following screen will display.
3. Check Compliance waived box. 4. Waived Date and Time will automatically populate. 5. Enter any applicable waiver comments. 6. Select Save. 7. The compliance will change from red text to blue.
Check Compliance waived
Waiver Comments
Save
eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 12
• Lupron will appear in the flowsheet for days specified by protocol. • Next, the patient is to begin stimulation drugs two days after Lupron start.
• Stimulation meds will appear in the flowsheet for number of days specified by protocol. (Editing medication length and dosage will be discussed in another section)
• Stim Date will also need to be entered in field next to LMP. Press tab on keyboard. Stim dates will appear on left hand side of screen.
• The next event for this treatment cycle example would be trigger for egg retrieval.
• Place the cursor on the row for date desired to trigger and right click. • Select “Event Based Medication” and “Trigger”. • Also select “Mark Event as Trigger” (This is under the option for Event Based
Medication)
Lupron per treatment protocol
Stim meds per protocol
Enter stim date and press tab
Stim dates numbered
eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 15
• This protocol is formatted to import HCG injection, retrieval date, and embryo transfer when trigger is selected.
• Next check box to select patient for retrieval and check box to select patient for transfer. This will add patient to retrieval and transfer lists under embryology tab.
This example for a treatment cycle was exactly according to the written protocol. Of course, this rarely happens and patients often need to have their drug dosage changed or length of time on a particular medication changed according to level of response.
Advanced Customization of Patient Flowsheet
Changing dose of medication: • Double click on date and medication desired. • Screen will appear to allow you to adjust that particular medication name,
strength, and identifier tab on flowsheet. • There is also the option to select prescription duration. For example, you
want to change the patients dosage of Gonal-f to 300 U for the next two days.
• Prescription duration may also include daily, every alternate day, every third day, etc.
• Click save when changes complete.
Retrieval
Embryo Transfer
HCG
Select patient for retrieval
Select patient for ET
eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 16
• To add medication double click on date and medication column desired. The same screen as shown for section regarding changing dose of medication will appear. Select medication and dosage. Save.
• In order to add a medication that is not currently in a column header in the flowsheet, click on flowsheet format icon.
• Flowsheet format icon will bring you to the following screen. • Please refer back to Medical Notes and Prescriptions Tab instructions
regarding adding, deleting, or inserting medication.
Flowsheet format Icon
eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 18
• Next, select time desired and double click on the appropriate line. • The following screen will appear.
• Blood tests may be scheduled together. • Open folder to show ordered blood tests. • Check both lab tests (estradiol and progesterone) if desired. • Select Save.
Phone Call Icon allows you to document a phone call directly from the flowsheet.
Open folder
Check both lab tests if desired
Phone Call Icon
eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 21
• Single click on phone call icon to display the following screen. • Select who initiated phone call and enter message content. • Check to attach to patient chart. • Click Save when phone call documentation complete.
Flowsheet Format Icon allows you to change medications and access writing a prescription for patient’s cycle directly from flowsheet.
Attach to patient chart
Message content
Initiated by
Save
Flowsheet format Icon
eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 22
Flowsheet Lab Management Cycle related labs may be ordered from a patient’s flowsheet. This is the recommended way to order labs in the system because it will ensure a link between the lab and the flowsheet. Once the lab is resulted and released, it will immediately populate the flowsheet.
Order Blood Test
1. View desired blood test column. 2. Single click to check lab (order) for date desired. 3. In this example, Estradiol and LH were ordered. 4. Select Save.
Order Ultrasound
Cycle related ultrasounds may be ordered from a patient’s flowsheet. This is the recommended way to order ultrasounds in the system because it will ensure a link between the ultrasound and the flowsheet. Once the ultrasound is resulted, the follicle sizes and endometrial lining thickness will immediately populate the flowsheet.
Check to order Lab
eIVF™ Patient Explorer Flowsheet Lab Management • 27
Continuing a Medication When reviewing a flowsheet, it is not uncommon to keep a patient on the same drug regimen for several more days.
1. Single click on cell with desired med and hit enter. 2. The medication and dose listed on the previous day will appear. 3. If the drug is to be continued for several days, click on the cell with
desired med and drag down to highlight multiple lines as shown in the example below.
4. Hit enter and the following screen should appear.
eIVF™ Patient Explorer Flowsheet Physician Review • 29
Notify Patient of Results and Instructions After the physician reviews the flowsheet the patient is contacted by the nurse to review results and instructions.
• Right click to display the following screen. • Select patient communicated.
• The date, time, and user who communicated the information will be documented under the flowsheet review log.
• To view this documentation, select General tab. • Click on Flowsheet Review Log. • The following screen will display.
Patient Communicated
eIVF™ Patient Explorer Flowsheet Review Notification • 32
Flowsheet Cycle Outcomes Upon completion of a treatment cycle, outcome needs to be documented in several stages.
This screen will assist you in easily documenting fields required by SART.
• From flowsheet, select Outcomes Tab. • The following fields are available for documentation:
1. Cycle Status 2. Cancellation Date 3. Cycle Outcome 4. Pregnancy Test 5. Pregnancy Outcome 6. Number of Gestations 7. Number of Fetal heart beats 8. Reduction 9. Reduction Date 10. Number of fetal heart rates Post Reduction 11. Number Born 12. Outcome Date 13. Birth Outcome 14. Sex 15. Weight 16. Birth Defects 17. Notes