Best Practice Alert

Connexall Integration

Presenters:

Gerri JacksonAssociate Director, Applications Development and

Support

Jenny LiuInterface Analyst

Topics

BPA

Recent Implementations

Future

Mount

Sinai

Health

System

At

A

Glance

LocationsMount Sinai Beth Israel: An 856-bed teaching hospital founded in 1889 on Manhattan's Lower East Side.

The Mount Sinai Hospital: A 1,171-bed tertiary and quaternary-care teaching facility founded in 1852.

Mount Sinai Queens: As a 235-bed licensed acute care facility in Astoria.

Mount Sinai Roosevelt: With 505 beds, Mount Sinai Roosevelt is a full-service community and tertiary-care hospital with an Emergency Department serving Midtown and the west side of Manhattan. Founded in 1871.

Mount Sinai St. Luke's: With 523 beds, Mount Sinai St. Luke's serves as the principal health care provider for the West Harlem and Morningside Heights communities and operates one of Manhattan's few Level 1 trauma services. Founded in 1847.

New York Eye and Ear Infirmary of Mount Sinai: With 69 certified beds, New York Eye and Ear Infirmary of Mount Sinai is one of the world's leading facilities for the diagnosis and treatment of all diseases of the eyes, ears, nose, and throat, as well as related conditions. Founded in 1820.

5

Overview:

When the lab sends a high potassium result message to Epic, and no order is entered after an hour, Epic emails Connexall. Connexall then sends the alert to Vocera.

The RN’s acknowledgement goes back to Epic and files on the flowsheet.

WORKFLOW

Patient meets established criteria for BPA and email

sent to connexall@mountsinai.org

Connexall formats message and sends to

appropriate device based on assignment

(EIC)

Cloverleaf formats HL7 message and passes to

Epic EMR via flowsheet interface

Caregiver acknowledges

alert on Vocera

Connexall receives the

acknowledgement and formats HL7

message to Cloverleaf engine (HIC)

Connexall scans outlook folder for

emails at determined time interval

1. Epic identifies the result status for a patient. When the status meets the criteria, Epic emails Connexall in a predefined format.

Potassium result in EPIC:

2. Email from Epic to the Connexall

The email contains information regarding:• the alert type• the patient name• the current assigned patient bed location

3. Connexall’s Email Input Client converts the email to an Alert

4. Alert goes to the caregiver

Connexall formats the message for the appropriate Vocera device.

Hyperkalemia High Potassium

4a. Nursing admin buy in for new workflow:

Concerns:

alarm fatigue

nursing responsibility

Total alarms triggered on selected units

5. Healthcare Informatics Client (HIC) sends the acknowledgment back to Epic via the Interface Engine

6. Cloverleaf formats the HL7 message and passes it to Epic EMR via flowsheet interface

Alert type:Alert received by:Date Alert Ack’d:Time Alert Ack’d:

Recent Connexall Implementations

• Rounding Reminder Suppression – OFF UNIT

• Posey Alerts

• Philips IntelliVue Patient Monitors

• New Connexall site

• Connexall reminder for Vocera exchange

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Rounding Reminder – Off Unit

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• Rounding reminder will trigger even when the patient is off the unit

• A Connexall script was implemented to suppress the Rounding Reminder alert while the Off Unit alert is activated in NurseCall

Hourly Rounding Report

Hourly rounding documented via nurse call system integration- Indicates rounding status real-time- Accounts for when patient is off the unit- Measures compliance percentage

Posey Alarm

• One of Mount Sinai’s fall-prevention programs

• A new Posey alarm has been implemented to detect patients falling in high risk of fall units

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Nurse Call equipment jack

Philips IntelliVue Monitor – PILOT

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• Collects vital signs data from Philips IntelliVue CablelessMeasurements and IntelliVue Patient Monitors

• Provides basic assessment guidance, helping the staff to recognize the early signs of deterioration in patients

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• For Patients: • In step down units

• With BMI higher than 40

• Not physically active

• Challenges:• Any body movement can shift the nasal cannula, this gives

inaccurate readings

• Patients don’t like using the nasal cannula when they’re awake

• Moisture in the tubing can cause false readings

• Update:• One of the step down units stopped using Philips monitors• The other step down unit is in trial with both Philips monitors and

Respiratory Motion Exspiron monitors.• Philips measures ETCO2 while Exspiron measures minute volume (with

external chest-padsets)

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New Connexall Site – 6 units

Challenge:• Predominately per diem staff/users can be in any given unit

• Unwilling to use role based assignment

Solution:• Put all per diem staff into one group

• Attached the per diem group to every template along with the permanent staff group

DAC

• A method of exchanging VOCERA at the change of shift rather than purchasing new Voceras for each of our 120 staff.

• The biggest challenge will be staff accidentally leaving with the badges at the change of shift.

• Setup reminder to staff at 7:03am and pm to say " please give your VOCERA badge to the oncoming shift."

Connexall reminder for Vocera exchange

Future:

o Possible Capsule Neuron integration

o Sepsis

o Critical labs

Thank you