HTP605: Setup POE Unit(s) - Production Activation

Materials and Skills Needed

Step-by-Step Instructions

HTP reorganized/revised to include activation steps. BH 7/31/06

Summary of Pre-Activation Steps

Timeline Overview

1. 2 weeks prior: Setup/configure printers & scanners. Review IT "Minute-by-Minute" document.
2. 1 week prior:  Send out first Pathology notification. Check setup & location of printer/scanners Finalize Minute-by-Minute document.
3. 1 day prior:   Send out final Pathology notification. Final check of barcode printer/scanners. Special computer setup (POE client & PDS).

Two Weeks Prior to Activation

1. Setup/Configure Printers and Scanners
1. Assign each scanner to be installed to a DIGI Polling Process
   **Determine which polling process to add each scanner
   
   Scanners should be balanced over the total number of processes. If there are multiple scanners on a unit, do not assign them  to the same polling process.
1. In the Device File entry for scanners to be installed edit the DIGI Polling Process ID: (pointer to DIGI POLLING PROCESS file #1001993)
   
   DPP Device Restart: (for device administration to force the DPP to open this device)
2. After 5 mins the assigned polling process should pickup the device(s). Monitor using the following menu option;
    
   'POE Barcode Printer'
   'Digi Polling Process Management'
   'Inquire on Digi Polling Process'
   
   The device should be listed under its assigned DIGI Polling process with a status of 'IN USE'. This may take up to 5 mins. If the device status consistently shows 'NOT IN USE' then there could be problems with the DIGI connectivity. Perform a job exam of the Polling process and e-mail should be generated with the device name and location in the header with possible troubleshooting steps.
2. In the Device file for the Barcode printer, update the following field:
   - Hardware Responsibility: JHMCIS
3. Perform a final loop-back test of all hardware working together. (Refer to HTP #606 Part 'N')
   
   Have a JHMCIS net-tech, PDS staff member, or user scan a generic test label which should be on top of a barcode printer in the same vicinity as the scanner you just installed in PDS.
   
   A generic test label should print on the barcode printer whose test label you just scanned.
   
   Refer to HTP #606 for any additional troubleshooting tools or techniques.
   
   IT IS IMPORTANT THAT YOU RECEIVE CONFIRMATION FROM SOMEONE THAT THIS STEP HAS BEEN PERFORMED SUCCESSFULLY. ONCE THIS STEP HAS BEEN CONFIRMED THE HARDWARE IS READY TO BE RELEASED TO THE USERS FOR POE USE.
2. Review "Minute-by-Minute" Activation Plan for every POE activation.  IT creates a document that lists the tasks to be accomplished, with a date, time, and resource person for each.
   Review the Minute-by-Minute document, looking for the following steps/tasks:
1. IT to confirm that for all new locations, the collection schedule in Prod is correct.
2. IT to confirm that all lab-related MLM's have been updated and moved to Prod.
3. Notification of someone in PDS to activate the location. This should have the name of the PDS analyst responsible for that activation, as well as the name and pager number of the PDS programmer on-call.
4. IT to identify the first few patients to activate for each location, and e-mail the list to the PDS analyst(s).

One Week Prior to Activation

1. Send out initial Pathology Notification
1. Send an Exchange mail to the group called "Pathology POE Notification" about 1 week prior to activation.
2. The e-mail contents will differ depending on the units and services being activated.  Please refer to the following document on Path2 for examples: \Informatics_Shared\POE Eclipsys SXA\Examples POE Activation Messages.doc
2. Check setup and location of printer/scanners  -  PDS analysts should do a walk-through of the units that will be starting to use POE.  This allows them to become familiar with the location and layout of the nursing units, as well as the location of the barcode printer(s) and scanners. Most units will have one printer and two scanners, but some locations may have multiple printers.  Scanners are usually placed by each barcode printer and also by the tube station (or in dirty utility).  Note that the scanner by the tube station is frequently mounted on the wall.
1. Check the printers to make sure they are in a reasonable location.  Underneath counters and next to sinks are examples of unacceptable locations.
2. Check the cables attached to the printer and scanner digi boxes; they should be tied down with cable ties to prevent accidental disconnections.
3. Test every scanner by scanning the test label that is on top of the printer (or on the wall, in the case of the scanner by the tube station).
4. Touch base with the Clerical Associate to make sure the unit has sufficient label stock on hand. Where possible, storage of spare label stock in the Pyxis is recommended. Any concerns should be discussed with the charge nurse.
5. Any hardware or network problems should be reported via e-mail to the PDS programmer responsible for the setup (usually Qumars), copying George, Martine, Beth, and Sean.
3. Finalize Minute-by-Minute Plan  -  PDS should receive a copy of the finalized Minute by Minute Activation Plan from IT and make sure all tasks and contact information related to lab are correct.
4. To enable the unit to use the web-based reprint function add the unit to the FM Remote Database file.
1. Fileman; (E)dit
2. Enter (REMOTE DATABASE)
3. Enter (ORDERING LOCATIONS) at "EDIT WHICH FIELD: ALL//" prompt.
4. Enter through "EDIT WHICH ORDERING LOCATIONS SUB-FIELD: ALL//" prompt.
5. Enter through "THEN EDIT FIELD:" prompt.
6. Enter (POE) at the "SELECT REMOTE DATABASE NAME:" prompt.
7. Enter (name of the new POE ordering location) at the "SELECT ORDERING LOCATION" prompt.

One Business Day Before Activation

1. Final Pathology Notification - resend the notification e-mail from a week ago.
2. Final Unit Walk-through and Hardware Check
1. Make sure all problems from the previous check have been resolved.
2. Test the scanners one last time.
3. Any outstanding or new issues should be brought to the attention of PDS and IT by both e-mail and phone call, and resolved/retested before EOB that day. (Absence of cable ties is not a critical issue and does not require a phone call or need to be fixed by EOB.)
3. PDS Analyst computer tasks
1. Put yourself in the POE LOCATION mail group for a few days:
1. Jump to the Mail Group Edit function by typing ^MAIL GR .
2. Enter POE LOC for the group name, and at the "Select MEMBER prompt, enter your name and say "Y" to verify.
3. Add other PDS POE analysts, as needed. You're doing this because if IT forgets to contact you to activate the location, orders coming in from a new location will error out and an error e-mail will be generated from PDS noting that the location is not yet active for POE.
2. Add the new unit(s) to your production census lists:
1. Login to the Prod POE application.
2. In the upper left corner click File, Maintain List, New.
3. A Client Select Criteria box will pop up. Choose the location tab and select the last radio button "Include patients at selected locations only."
4. Click the plus sign by Johns Hopkins Hospital and click the plus sign by either Inpatient or Out- patient, depending on which type of unit you are adding to your patient list.
5. Scroll down to find the unit you want to add to to your list, click on it to highlight it and then click the Add button to make it a selected location.
6. Click the OK button and choose a name for the list; I usually use the ADT location name (e.g. HAL-5). However, since this is for my personal use, I might make it more descriptive: "NELW2 Nursery", or "104 HLC."
7. Click the OK button and the unit census will be added to your Patient List.
8. To remove a unit census from your Patient List, high- light the list name and select Edit, Delete Current List at the top of the screen.
3. Phlebotomy Preparation
1. Lois Tissue or Mike should have sent e-mail indicating any change needed for the barcode print order (i.e., in what sequence the labels for that location should print in the batch of labels for each round). Do a FM edit in the LOCATION file, and type the number in the "PHLEBOTOMY PRINT ORDER" field.
2. Also in the Location file, if the unit is to receive the Early AM Round, enter a "Y" in the field "EARLY AM PHLEBOTOMY LOC?"
3. Go to the Phlebotomy area and confirm with Lois Tissue or Margo that new phlebotomy notebooks have been prepared for the floors being activated (if appropriate), and the phlebotomists are aware of the change.
4. The Weinberg Blood Gas and Hematology labs are not open 24x7, so after a certain time, specimens get sent to main Hematology and Critical Care Labs. The PDS system cannot be configured to print one lab number on the barcode labels during the day and another lab number at a different time. When the first Weinberg units started using POE, Al Valentine decided that Weinberg lab numbers should print on the labels. Therefore, any future Weinberg locations must have the COLLECTION SITE field in the Location file set to SURGERY/WEINBERG.

Day of Activation

1. Location Activation and Order Monitoring
1. When called by IT to activate the unit, do a Fileman edit in the Location file for the appropriate location.  At the first prompt, type ^AM and enter the number for the item "AM PHLEBOTOMY TYPE".  You will be reviewing/editing the next 3 fields:
1. AM PHLEBOTOMY TYPE - There are 3 possible choices; make the appropriate choice based on info below and and then hit return to go to the next field:
1. STANDARD - this is the regular 02:30am round, and is used by all non-surgical floors.
2. EARLY AM - this is the 01:00 round, and is used by non-transplant surgical floors such as Marburg units.
3. BOTH EARLY & STD - only certain surgical units are allowed to have both rounds: those with transplant patients (Nel-6,7,8), Weinberg floors, and surgical ICU's (SICU, WICU, CSICU).
2. ECLIPSYS SXA ORDERING LOC? and type a "Y" and hit return to go to the next field.
3. NET ORDERS STAT IF POSSIBLE - If the unit activating is an ICU or other area from which orders should always be changed to Stat when possible in PDS, type a "Y" in this field and hit return. Otherwise, leave the field blank and jump out of the file.
2. Watch for first orders to make sure transmission policies and collection schedules are correct. For example, if AM lab orders are listed for "AM round" instead of for 02:30, call IT right away and have Perry Hunter check and fix the policies.
3. If you have time, once or twice the first day of activation go up to the unit and check the printer(s) and scanner(s) for proper function, label alignment, and see if users have questions.
4. If the activation location is an OR or PACU, there often are hold orders for Post-op AM labs the next day. These orders shouldn't be released until the patient has been transferred to a regular IP unit.  If done incorrectly, these orders may come to us with the PACU or ORHO location instead of the IP location, or with a past collection time (and get canceled as stale). We try to look out for these problems to make sure patients get the lab work they need and help the providers though the first few days of POE.
   
   If there are lab round orders earlier than tomorrow's AM, track 1-2 of those; otherwise track 1-2 of the AM Labs. Make sure they are listed for the right time (ie, the collection schedule is correct and they weren't canceled as stale), and check the next day to ensure that the orders did in fact end up in the lab batch. For any problems, notify the POE Command Center at 2-2018.
2. Troubleshooting
   If there are problems with barcodes or scanners, check to make sure the following are set up correctly.  There are HTP's that provide details if needed:
   
1. Location File (FM 607) - room bed entries in proper format if there is more than one barcode printer on the unit. Additionally, make sure all room beds are present.
2. Barcode Site File (FM 1084) - There should be one entry for every barcode printer. If multiple ADT locations share the physical unit, there must be entries for each ADT location.
3. Device File (FM 3.5) - There should be an entry for every barcode printer and scanner.
4. Digi Polling Process File (FM 1001993) - Each scanner should be assigned to a polling process.
   

Reference

 Appendix

Approval and Review

Medical Director (or Designee) Annual Review