Oct. 27, 2020 Edition 65
Epic solutions for end of Daylight Saving Time
On Sunday, Nov. 1, Daylight Saving Time ends and the clocks will move back one hour, resulting in a second 1 a.m. hour. For all Centura Health hospitals and clinics this will impact activities that are dependent upon a timing sequence (including patient transfers, hourly medications and flowsheet documentation).
As part of our Fall Daylight Saving Time process, device integration will be taken down from 11:59 p.m. (23:59) Saturday, Oct. 31 until 2 a.m. (0200) Sunday, Nov. 1. (Kansas: 12:59 a.m. ) (0059) to 3:00 a.m. (0300) Sunday, Nov. 1 . Please refer to the instructions below for specific directions regarding how to handle this additional hour within Epic so we may continue to provide top quality, whole person care for our patients.
| Tip sheets are also available via the Learning Home Dashboards that provide further step-by-step instruction. | |
Inpatient Transfers and DischargesOverall, activity for transfers and discharges should be limited during the two 1 a.m. hours. If you must do a discharge or transfer during the second 1 a.m. hour, you will need to wait until the original event time has passed. The system will not allow a subsequent event to happen before the time of the previous event.
- Example: Patient is admitted at 1:15 a.m. (0115). Patient needs to be transferred to a different unit during the second 1 a.m. hour at 1:00 a.m. (0100). Event management will see this as an error. User will need to wait until original admit time has passed and therefore can transfer the patient at 1:16 a.m. (0116).
Hourly MedicationsIf a patient requires an hourly medication, clinicians should document the first hour and add a reference of “daylight saving time” in the comment field. The second hour should be documented at a time later than the first documented time with a comment of “standard time” and actual time given.
- Example: Medication is given at 1:15 a.m. (0115), please document at 1:15 a.m. (0115) with comment “daylight saving time”, the second hour medication is given at 1:10 a.m. (0110), please document at 1:16 a.m. (0116) with comment “Actual time given 0110 standard time”. For Alaris Pump Recovery, follow the “Fall Daylight Savings Time – Alaris IV Pumps” tip sheet.
FlowsheetsThe last filed values and graphs may be incorrect due to the repeating of the 1 a.m. hour. Complete the first 1 a.m. documentation within the window of 1 to 1:30 a.m. Then, complete the second 1 a.m. documentation within the window of 1:31 and 1:59 a.m. and add a comment indicating “daylight saving time”.
Blood BankOrdering and administration of blood products must be completed on paper for the two 1 a.m. hours. At 2 a.m., the total infusion volumes must be re-documented into the system.
LabFor Lab POC and blood bank systems, the time change will be automated. For Lab middleware system, the time change will be managed by Lab IT.
Hemodynamic SystemsThe interface for the MacLab Hemodynamic systems will be going down at midnight and will be turned back on at 2 a.m. Note that this will be a 3-hour period due to the repeated 1 a.m. hour. Following downtime policy, please use the Hemodynamic system for documentation and plan to manually post logs for any cases in Epic following the Daylight Saving Time (DST) period.
Best Practice AdvisoriesBest Practice Advisories (BPAs) are unreliable during the two 1 a.m. hours. Due to the time change, the BPAs could appear at incorrect times or not at all.
Surgery/OpTimePlease note on the snapboard you will want to assign staff to the case rather than the room during the DST period. Additionally, it is important for case tracking events to reflect the actual amount of time between events. Please change the case tracking event times so that the amount of time between events is accurate rather than the actual times. Add a nursing note that includes the actual times for that patient, even if it looks incorrect because of the time change.
- Example: A trauma patient enters the OR at 1:40 a.m. Then, as 1:59 a.m. passes it becomes 1:00 a.m. again. The case ends at 1:20 a.m. The case tracking event should reflect “In Room” at 1:40 a.m. and “Out of Room” at 2:20 a.m. This will correct the time in the room to 40 minutes (instead of -20 minutes). The nurse will write a note explaining the alteration in times.
- OR Manager/Directors: If there are any cases during the DST event, you must manually enter the anesthesia start and stop event for hospital billing purposes.
AnesthesiaAnesthesia cannot be documented in the system during the two 1 a.m. hours. All documentation must take place on paper so that it can be scanned back into the system later by Health Information Management (HIM). An admin event will need to be documented in Epic to close the encounter.
OB/StorkTime calculations will not be accurate during the two 1 a.m. hours. This includes hours of life of newborn, labor length, time since rupture of membranes (ROM), time since cervical exam, and labor and delivery events. Clinicians must manually calculate times and document the sequence of events in a note electronically.
*Please work with your biomed department to change the times on the fetal monitors as you normally would.Device IntegrationDevice integration cannot be used for a total of 3 hours. Device integration will be turned off at midnight and will be turned back on at 2 a.m. The impacted documentation will need to be completed on paper to be scanned back into the system later by HIM.
This includes the interfaces for Data Captor, Mac Lab, GE Carescape, Philips Intelivue, Epiphany – Rhythm Strips only and Obix.ED/ASAP
- Patients who have an event that caused a status change during the first 1 a.m. hour will incorrectly revert during the second 1 a.m. hour until that event time is reached again. This can cause track boards to filter incorrectly. If statuses are incorrect, they will need to be manually corrected.
- Emergent situations normally done in specialty narrators such as codes, traumas, strokes and STEMIs must be documented on paper during the two 1 a.m. hours and then scanned back into the system.
- Providers will need to manually adjust their shift times in Epic to account for the extra hour.
- ED alerts will be unreliable during the two 1 a.m. hours.
- Transfers and discharges of patients during the two 1 a.m. hours should be limited. If errors occur while trying to move the patient in the system, change the event times manually.
Questions?If you have any questions regarding this upgrade, please contact
Nicole Furlong, Epic Application Analyst Lead or call the Service Center at 303 643 4200.
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These instructions will prepare Epic users for Nov. 1, when clocks move back an hour and certain timing sequences are affected.
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