EpicCare Inpatient Fundamentals

Question 1

What does Epic call the first screen a user sees when they log in?

Answer 1

Startup Activity

Question 2

What is a My List?

Answer 2

A list of patients that I am following during my shift. I control the columns, the default report, and I manage the list of patients.

Question 3

What is a system list, and how can it be used to organized patients?

Answer 3

A list of patients that is automatically updated by the system. You can make a shortcut to these lists in a My List.

Question 4

How can a surgeon quickly sort her list of patients by unit?

Answer 4

Click the Unit column in Patient Lists.

Question 5

What types of information can a surgeon gather from reports at the bottom of the startup activities?

Answer 5

Vitals, I/O, Current Meds, and more

Question 6

How can a clinician open a patient’s chart?

Answer 6

Double-click the Patient Lists

Question 7

What are the tabs along the left of the screen in a patient’s chart called?

Answer 7

Activities

Question 8

How can you tell there is an abnormal value within a specified time interval in accordion reports?

Answer 8

There is a red corner in the cell for the interval containing the value.

Question 9

How is an abnormal value denoted in accordion reports?

Answer 9

The abnormal value appears in red.

Question 10

How can you tell if there are values hidden within a time interval in accordion reports?

Answer 10

A plus sign appears next to the value displaying in a given column.

Question 11

How do you know which notes are new?

Answer 11

A clock icon appears in a column next to the note.

Question 12

How can you quickly find a patient’s H& P within the Notes activity?

Answer 12

Click the H&P tab to see only H&P’s. Or, from the All Notes tab, click the Type column header to sort by note type.

Question 13

You want to Time Mark the new notes for your patient. Will that action Time Mark your patient’s notes for anyone else who opens her chart?

Answer 13

No. Clicking Time Mark automatically marks ALL notes as no longer new for the user who Time Marks, but nobody else.

Question 14

True or False? Time Mark means that you have actually read all of the notes in the patient’s chart.

Answer 14

False. Time Mark serves as a bookmark and organization tool for you. It simply marks the notes as no longer new.

Question 15

Assume the following scenario: You are searching for an order, and are unable to find it on your preference list, so you search the facility list and find it there. The next time you search for this same order, you don’t want to have to expand your search to the facility list. What can you do?

Answer 15

Add the order to your preference list by clicking the star to the right of the order.

Question 16

As you are writing an order for your patient, your pager goes off. What can you do with this unfinished order?

Answer 16

Pend the order by clicking Save Work.

Question 17

What must you do before that unfinished order can be acted upon?

Answer 17

Complete and sign the order.

Question 18

When searching for a dietary consult order, you enter “con die” in the search field. What search method are you using?

Answer 18

EnRol

Question 19

What happens behind the scenes when you modify the frequency of a medication order?

Answer 19

The original order is discontinued and a new order is entered. As a result, two rows appear on the MAR for nurses.

Question 20

What happens behind the scenes when you modify the rate of a medication?

Answer 20

The original order is modified. As a result only one row appears on the MAR for nurses.

Question 21

Dr. Asparagus would like to order an acetaminophen-codeine (Tylenol #3) tablet for his patient. In the search field he types “T3” and finds the order. Why did Dr. Asparagus find the order after typing “T3”?

Answer 21

T3 is a synonym for the acetaminophen-codeine (Tylenol #3) tablet order.

Question 22

Where should a physician go to order a patient’s home medication if it wasn’t originally ordered during the admission process.

Answer 22

Home Meds tab of the Orders activity—->Reorder Home Meds

Question 23

What does the pushpin mean if it is next to a problem in the problem list?

Answer 23

The pushpin indicates that the problem is a chronic problem (an ongoing problem for the patient)

Question 24

What is the Principal problem?

Answer 24

The Principal problem is the main reason for the patient’s hospitalization.

Question 25

When documenting with a positive/negative button in the NoteWriter, how can you quickly indicate that the specific condition is present or positive.

Answer 25

Left-click or click the plus sign

Question 26

When documenting with a positive/negative button, how can you quickly indicate that the specific condition is absent or negative.

Answer 26

Right-click or click the minus sign.

Question 27

When documenting with a positive/negative button, how can you quickly add a comment.

Answer 27

Hover your mouse cursor over the positive/negative button and start typing. Or, double click the positive/negative button to open the comments window and then start typing.

Question 28

How can you tell if a comment has already been added to a positive/negative button?

Answer 28

The positive/negative button is underlined.

Question 29

True or False? You can add free text to a note in the Note form.

Answer 29

True. You can add additional information to your note by using SmartPhrases or free text in the white space within the note.

Question 30

How do you add yourself to the treatment team for a patient?

Answer 30

Click Sign In and select your patients from the department list.

Question 31

How do you remove yourself from the treatment team for a patient?

Answer 31

Find the patient in the My Patients list. Right click on the patient’s name and select “End My Assignment”.

Question 32

How can you search for a patient that is not admitted to the hospital.

Answer 32

Click “Patient Lookup” to search through the entire database of patients, including those who are not admitted.

Question 33

What activity should you use to get report at the start of a shift?

Answer 33

Summary activity

Question 34

When writing a sticky note, what should you include at the end?

Answer 34

Your name and the date you are writing the note.

Question 35

True or False? When you log out, the system remembers all filters and views that you set on the Work List?

Answer 35

False. The Work List only saves the last view selected by the user. Th filter is not saved.

Question 36

How would you change the Work List to display only medication tasks organized by patient?

Answer 36

Change to Patient View and filter on Medications.

Question 37

True or False? The Work List only allows a nurse to view tasks for one patient at a time.

Answer 37

False. If the nurse selects a list of patients and clicks Work List, tasks for all patients on that list appear in the Work List to review.

Question 38

When first opened, for what time frame does the Work List display tasks?

Answer 38

Current Shift.

Question 39

True or False? The Work List includes all tasks that a nurse might have to complete throughout a shift.

Answer 39

False. There are things a nurse is responsible for that are not listed as discrete tasks on the Work List.

Question 40

Give two examples of using the Work List instead of the Due Meds report to review your patient’s medications. Then give two advantages of using the Due Meds report instead of the Work List.

Answer 40

Work List:

Question 41

What does an “!!” Icon next to a medication on the MAR mean? How is the administration workflow different for that medication?

Answer 41

The medication requires dual sign-off. Another nurse will need to review and verify the administration and enter his user ID & password when documenting the administration.

Question 42

You’re about to give a pain medication to a patient. You know the patient hasn’t received any doses of this medication, but you’d like to see the last time he received any pain medications over the last 24 hours. How can you do that without having to scroll through multiple shifts of the MAR?

Answer 42

Use the MAR Report in the MAR activity.

Question 43

How do medications that are discontinued appear on the MAR?

Answer 43

The medication row appears with all the cells highlighted in yellow.

Question 44

What is the main difference between documenting a PRN medication compared to a scheduled medication?

Answer 44

PRN medications do not have scheduled times that appear on the MAR. To document giving the medication, the nurse clicks anywhere in the cell and documents administering the medication.

Scheduled medications appear with a due time in the cell at the time the medication is scheduled to be given. To document administering the medication, click the due time on the MAR.

Question 45

Can a nurse document giving a medication that has NOT been verified by pharmacy?

Answer 45

Yes. He sees warnings that the medication has not been verified but can continue with the administration.

Question 46

What are the two reasons why a nurse might need to pull a medication from an ADS cabinet on override?

Answer 46

• No one has entered an order for the medication into Epic
• An order has been entered in Epic, buy pharmacy hasn’t verified it yet, so it does not appear on the patient’s profile.

Question 47

List at least 3 pieces of information that can be found in the Details report within the Flowsheet activity.

Answer 47

The value, comments, time taken, time recorded, user taken, user recorded, show audit.

Question 48

How do values appear prior to filing them to a patient’s chart? How do they appear after they are filed?

Answer 48

Values have a grayed edge in their cell prior to being filed.

Values do not have this icon after filing.

Question 49

True or false? If a clinician closes a patient’s chart without clicking File in the Flowsheet activity, any unfiled data in the Flowsheet is lost.

Answer 49

False. The system automatically files any pending data when the end user changes Flowsheet templates, leaves the Flowsheets activity, closes the patient’s chart, or logs out.

Question 50

If a clinician enters WDLin the “Within Defined Limits” row for a system, what does this mean?

Answer 50

“WDL” means that all values taken within that system fall within the defined range. No other data needs to be entered.

Question 51

True or False? Epic does not have an audit trail for values in Flowsheets that have been edited or deleted.

Answer 51

False. Epic does have an audit trail for edited or deleted data, and any values that have been edited or deleted are flagged.

Question 52

How does a nurse document that all values are normal except for a few?

Answer 52

Enter an X in the WDL row. (This documents that all values are within defined limits, except…) then enter the abnormal information in the appropriate rows.

Question 53

Where can a nurse look to find information on the “defined” values for a given row?

Answer 53

A nurse can view the Row Information in the Details report on the right side of the screen. This gives him information about normal values, possible choices, and the last filed data. If the Details report is hidden, click the left facing arrow in the middle of the right side of the screen to expand the report.

Question 54

When a nurse goes into a Flowsheet and wants to enter new values, what should be done before documenting any information to ensure the data is entered under the correct date and time?

Answer 54

The nurse should click the Add Col button or the Now hyperlink. This drops a new column with the current date and time. If charting values taken in the past, the
Insert Col button should be used.

Question 55

In the Problem List Section of the navigator, how can you mark a problem as the principal problem? What must this problem be marked as first?

Answer 55

You select the check box in the Principal column after indicating that the problem is a hospital problem.

Question 56

What is a SmartText and how can it be pulled in to a note?

Answer 56

A SmartText is a template for writing a note. It can be pulled in from the Insert SmartText field.

Question 57

Embedded within a SmartText are SmartLists. How can you start filling out a SmartList? Make a selection? Accept your Selection?

Answer 57

To start filling out a SmartList using the keyboard, press F2. To make a selection, use the SPACEBAR. To accept your selection, press ENTER.

To start filling out a SmartList using the mouse, use the Next Field option (under the All Other Tools menu). To make a selection, left-click, and to accept your selection, right-click.

Question 58

What is the purpose of a wildcard?

Answer 58

A wildcard, denoted by ***, is intended to provide the clinician with a place to enter free text.

Question 59

True or False? When creating a User SmartPhrase that includes a SmartText, a physician should insert the SmartText into the note before clicking the green plus sign.

Answer 59

False. If you are creating a User SmartPhrase that contains a SmartText, click the green plus sign first. Then pull your SmartText in to your note window. This prevents any patient specific information from being saved in your template.

Question 60

After creating a User SmartPhrase that includes a SmartText using the green plus sign, how can you pull the new text into a note to use it for patient documention?

Answer 60

You have created a SmartPhrase, so you can summon it into your note by typing a ‘dot’ and the SmartPhrase name or by clicking the List My Phrases (.my?) button.

Question 61

After filing a note to the patient’s chart, where in Hyperspace can that note be read?

Answer 61

The note can be viewed from the Notes activity or an encounter report in Chart Review.

Question 62

In which section of the medication reconciliation navigator do you decide whether a home Meds should be ordered for this admission?

Answer 62

In the Reconcile Home Medications section. You determine whether the medication should be Ordered, Not Ordered, Replaced, or Discontinued.

Question 63

When reviewing the patient’s home medications, what does the house icon indicate?

Answer 63

The house icon indicates that the medication was entered in Epic as an outpatient prescription.

Question 64

When reviewing the patient’s home medications, what does the person icon indicate?

Answer 64

The person icon indicates that the patient reported taking that medication.

Question 65

How can you quickly indicate the patient’s last dose of all home medications was today?

Answer 65

Click Mark Unreconciled Today in the Review Home Medications section of the navigator.

Question 66

Why might an Order Set be suggested in the New Orders section?

Answer 66

Based on a diagnosis listed in the patient’s Problem List, based on Best Practice Advisory, or based on the type of navigator.

Question 67

What does it mean to Sign & Hold an order?

Answer 67

It means that the order has been authorized, but is not released or active until the patient arrives to another location or stage of care.

Question 68

Why are orders signed &I held when written for a patient being admitted from the ED?

Answer 68

Orders are held so they are not sent to the ED. They need to be held until the patient arrives in the inpatient unit.

Question 69

What can you type in the search field if the patient tells you they are taking a medication but they don’t know the medication name?

Answer 69

Type “ Help” in the search field to add Unknown to Patient to the med list. ( You can also just type “ Unknown “. You might need to click the Database Lookup tab to find it.

Question 70

Before a nurse releases signed and held orders for a new patient who just arrived on the floor from the ED, what other step needs to be done first? What will happen if this step is not done?

Answer 70

Before releasing signed and held orders, the patient’s arrival on the unit must be confirmed in Epic using the Unit Manager activity. If this is not done, the system will think the patient is still in their original unit and orders might be affected (medications might be dispensed to the wrong place, etc.).

Question 71

What does it mean to release signed and held orders?

Answer 71

Releasing orders means you are making them active. Other clinicians will be notified of the orders and can start acting on them.

Question 72

True or False? Documenting the patient’s vitals in the navigator will also populate the Vital Signs Flowsheet template in the Flowsheets activity.

Answer 72

True. All documentation that you complete in a navigator will automatically populate the appropriate places throughout the patient’s chart.

Question 73

True or False? Best Practice Advisories (BPAs) notify clinicians of tasks that they must perform for the patient.

Answer 73

False. BPAs present the clinicians with suggestions to do things like add to the patient’s care plan or place orders. If clinicians don’t agree with the BPA suggestion, they can clear the check box in the BPA before clicking Accept.

Question 74

What are two ways templates can be added to the Care Plan activity?

Answer 74

Care Plan templates can be added automatically by accepting a recommendation in a Best Practice Advisory or they can be added manually by clicking Apply Template.

Question 75

What are two ways Education titles can be added to the Education activity?

Answer 75

Education titles can be added automatically if a Care Plan goal or intervention requires teaching, or they can be added manually by clicking Add Title.

Question 76

True or False? Teaching points are always attached to a teaching topic.

Answer 76

False. A teaching point can be added to a topic or directly to a title. The topic just serves as an organizer for multiple points.

Question 77

On which tab can you document progress of education provided to the patient?

Answer 77

The Education tab.

Question 78

How can you tell when a teaching point has been completed?

Answer 78

A green check mark appears next to it.

Question 79

How can you most efficiently document several teaching points to several learners?

Answer 79

Select multiple topics or points before clicking document, or select more than one learner after clicking Document for the appropriate pieces of the patient’s education.

Question 80

What should you do when all of the teaching points for a topic are complete?

Answer 80

Resolve the topic

Question 81

True or False? A Care Plan problem is the same thing as a medical diagnosis on the Problem List.

Answer 81

False. A Care Plan Problem is commonly referred to as a multidisciplinary problem that nurses or ancillaries are caring for. For example, “pain” or “ disorientation “ are multidisciplinary problems.

Question 82

How do you document an ongoing goal?

Answer 82

Highlight the goal and click Document. You can mark it ad “ Progressing” or “ Met this Shift”.

Question 83

How do you document a goal that was not met?

Answer 83

Enter “ Not Progressing “ in the Outcomes field. Then document a variance. Highlight the goal, click Add Variance and fill in the appropriate fields.

Question 84

What should you click to add a column to the Flowsheet for a specific time when documenting end of shift totals?

Answer 84

Insert column.

Question 85

True or False? It is best to use the Flowsheets activity to review Intake and Output totals?

Answer 85

False. The intake/output activity is the best place to review Intake and output totals.

Question 86

What button should you click to add an NG tube to the Flowsheet?

Answer 86

Add LDA

Question 87

When you first administer an IV medication, an extra window appears that doesn’t appear for oral Meds. What window appears and why?

Answer 87

The Link Lines Windows appears asking you to associate the intravenous order with one of the patient’s lines.

Question 88

When inserting a column to document your end of shift intake/output for a patient, why is it so important to make certain you are documenting in a column within your shift.

Answer 88

So that I/O totals for the next shift are skewed and include your shift’s totals.

Question 89

Number the following steps to indicate the order in which you would document administering an IV Piggyback. For each step, indicate which activity it would be done in. (Assume that you have already documented inserting a peripheral IV line on the patient).

Answer 89

Acknowledge the new order---1---Summary
Click on the scheduled due time--2--MAR
Link the order to a line---3---MAR
Document that you hung a "New Bag"-4-MAR
Document intake from IV piggyback-5-Flowsheets

Question 90

True or False? When you document starting a new bag of an IV piggyback, its volume is automatically included in the patient’s intake totals.

Explain your answer.

Answer 90

False. Just because an IV is started doesn’t mean the entire volume is infused. The nurse needs to manually enter the volume for an IV on the intake/output flow sheet.

Question 91

True or False? When you document starting a new bag of an IV piggyback, the rate and linked line documented on the MAR automatically appear on the Intake/Output flow sheet, but you must enter the volume infused.

Answer 91

True. You don’t want to document the entire 1000mL bag as having been infused just because you started it. The rate & linked line from the MAR appear on the Intake/Output flowsheet to help calculate the volume at the end of the shift or when the bag is done infusing.

Question 92

Which section of the transfer navigator must the physician use in order to reconcile all orders for a patient?

Answer 92

Transfer Orders. (Remember this “section “ is a Transfer Navigator unto itself.)

Question 93

Within the Transfer Orders Navigator, which section would a physician use to reconcile the orders that are currently active.

Answer 93

Review Current Orders

Question 94

What happens if a physician forgets to click either Continue, Discontinue, or Modify for an order in the Review Current Orders section?

Answer 94

The order is automatically continued, but it appears to other clinicians as not reconciled. If the order is a medication, it will be on the MAR hold.

Question 95

In which section , within the Transfer Orders Navigator, does the physician place the transfer order?

Answer 95

New Orders

Question 96

What is a signed &Sheldon order?

Answer 96

A signed & held order is an order that is signed, but it is not released or made active until someone releases the orders.

Question 97

True or False? A nurse has the ability to release orders individually from within the Release Orders activity?

Answer 97

True. The nurse would manually select the individual order(s) that need to be released, and then click Release. (This functionality would be used if an order(s) needed to be released before the transfer occurred).

Question 98

True or False? If a physician does not click Don’t Prescribe or Prescribe for a patient’s inpatient medications during discharge medication reconciliation, the medications will automatically be prescribed?

Answer 98

False. The inpatient medications will not automatically be prescribed.

Question 99

Dr. Jones is completing his discharge tasks for his patient Samantha, who is going home today. He needs to choose which task to do next: resolving problems on the Problem List or prescribing new outpatient medications. Which should he do first and why?

Answer 99

Dr. Jones should write new outpatient orders for Samantha first because he might need to associate those orders with a problem that will be resolved in this admission. Only active problems show up for selection during discharge medication reconciliation, so if he resolved the problem first, he wouldn’t be able to associate it with his new order.

Question 100

What is the difference between a discharge summary and patient instructions?

Answer 100

A discharge summary is a clinical summary of the patient encounter. They are typically read by other clinicians and remain part of the patients chart.

Patient instructions include a list of the patients take home medications and information are printed and given to the patient upon discharge.

Question 101

Can the physician see a list of the resolved problems for a patient. If so, how?

Answer 101

Yes, go to the Problem List navigator section and select the Past Problems check box.

Question 102

Can a nurse resolve multiple Care Plan problems at the same time? If so, how?

Answer 102

Yes, within the Care Plan activity, click the Resolve Problems button.

Question 103

What is the difference between operational reports and analytical reports?

Answer 103

Operational reports are real-time reports needed by end users to do their jobs. Analytical reports are over-time reports that show long-term trends and data.

Question 104

A report can be used to….

Answer 104

Retrieve data
Organize information
Display information
All of the above

Question 105

True or False? After running a report, a physician can hide some of the results so she can focus on a particular area of the results.

Answer 105

True. The physician can filter the results.

Question 106

True or False? End users must always indicate how long they want the results of their reports saved.

Answer 106

False. Users only need to save the results of a report if they want to view the results after the reports expiration time has passed.

Question 107

Where can clinicians go to search for other reports not found under the Favorites section of their reporting home?

Answer 107

The Reporting Workbench Library by clicking the My Reports hyperlink from the reporting home and selecting the Library.

Question 108

What is the purpose of an analytical report?

Answer 108

Analytical reports are used to look at trends in data and help you make decisions related to your department, specialty, or hospital. They often analyze data over an extended period of time.

Question 109

What are the three main characteristics that describe analytical reports?

Answer 109

Comprehensive
Summarized
Standardized

Question 110

What is Clarity?

Answer 110

Clarity is Epic’s primary analytical reporting solution. Clarity is a tool that extracts data from your Chronicles production system and loads it into a separate reporting server.

Question 111

True or False? End Users run a Chrystal Report from the Reporting Workbench at any time.

Answer 111

False. Chrystal Reports are run on a predetermined schedule that was created by the report programmer. End users can view the results of these reports from Hyperspace after they have been run.

Question 112

Where can a clinician see a list of all the Chrystal reports they have the ability to view?

Answer 112

From their Dashboard and Reporting Home. The status reads Ready to View when the results are available.

Question 113

How can someone see a list of all available Chrystal Reports?

Answer 113

They can log on the UserWeb and search through a list of all Chrystal Reports from the Report Repository.

Question 114

Where does an administrator configure the columns that will appear in a system list?

Answer 114

In the properties of the system list grouper.

Question 115

You’ve created a new system list for diabetic patients. There are admitted diabetic patients in your hospital, but none are on your list. Give at least two possible reasons why these patients aren’t on your list.

Answer 115

Reasons might include:
Your system list grouper doesn’t have any columns specified.
You didn’t check the box in front of your hospital in the list of Locations.
In the filter for diabetes, you might not have listed all of the various diagnosis codes that represent diabetes.
Providers might not have updated the Problem Lists for their diabetic patients.

Question 116

In the Properties of a system list, explain the difference between Patient Source and Filters.

Answer 116

Patient Source allows you to choose the location in which the system list should look for patients. It also gives you options for three common types of system lists-those based on unit, orders, and attending/admitting provider.

Filters give you a huge list of possible criteria including age, medications, and procedures, diagnosis, allergies, among others.
The filters tab has many more options than the Patient Source.