111Query Your Way to Measurable Patient Outcome

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111 Query Your Way to Measurable Patient Outcome

• Diane Murphy RN, BCMA-C, Nursing ADPAC
• VA Healthcare Network Syracuse, New York
• Ruth Lewellen RN, MSN
• Louisville, Kentucky VAMC

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Housekeeping Class Objectives
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Housekeeping

• Questions
• 3x5 cards
• Web Page

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Objectives

• Identify steps to create customized and canned
  reports using the Query Tool.
• List steps to create a customized report using
  the Query Tool in HealthEVet.
• Describe the Graphing tool and it's potential
  uses.
• List how the graphing tool benefits in a Joint
  Commission review

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Query Tool- What is it?Limited Access

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Query Tool- What is it?

• Tool to Create Reports
• Software Application
• Reports for group patients
• Based on Criteria that you Specify

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Limited access

• Large Reports
• Data Confidentiality
• Research Considerations

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Query Tool- What is it?
Pre-Defined
User-Defined
Criteria
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Why Query Tool For Nursing?
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Why Query Tool for Nursing?Scenario 1 "Delay
of Discharge"

• Morning Report- It was reported by night shift
  that someone on 4North or 5North discharged 10
  hours after the physician wrote the order. It was
  mentioned that the patient was highly upset, but
  Nurse reporting this was passing it on to
  dayshift. The no one on duty knew who the Patient
  or why they had such a "Delay of Discharge ".

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Why Query Tool for Nursing?Scenario 1 "Delay
of Discharge" Continues

• Option 1
• Review G L (Gains Loss) sheet look-up 1
  patient at a time for the 15 Patients on 4North
  5North. Reviewing Orders and Notes.
• This would take some Time!

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Why Query Tool for Nursing?Scenario 1
"Delay of Discharge" Continues

• Option 2
• Use Query Tool-Looking at all the Discharge
  Patients for 4North 5North and the following
  criteria
• Discharge Orders
• Discharge Notes
• Bed washing Order
• Setup Timeline to see where the process is broken
• This sounds much faster

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Scenario 1 "Delay of Discharge"
Continues

• Select Report called "Bed washing Nurse Education
  Report"
• Select Patient population by clicking on the
  Hyperlink

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Scenario 1 "Delay of Discharge"
Continues

• Select the Patient or Patient Group
• Add to Left Column

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Scenario 1 "Delay of Discharge"
Continues

• Select Orderable Item

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Scenario 1 "Delay of Discharge"
Continues
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Scenario 1 "Delay of Discharge"
Continues
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Scenario 1 "Delay of Discharge"
Continues
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Scenario 1 "Delay of Discharge"
Continues
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Restraints /Seclusion

• Scenario 2
• Mr. X was in Restraints
• Was the right type of Restraints Ordered?
• If he had Med/Surg or Clinical Restraints, was
  the Patient assess prior to going into
  restraints-was that documented/
• What about 2 hour checks done?
• If in Behavioral restraints- face to face
  assessment by provider?
• Or a Debriefing Note done?

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Restraints Query
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Restraints Query with Orders Notes
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Falls Documentation

• Scenario 3
• Post Fall
• High Fall Risk?
• Morse Fall Scale
• Documentation of the Fall
• Reassessment of following Fall
• Does the care plan address falls?
• Transfer to another ward- Was that information
  Handoff to the people receiving that patient.

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Incomplete Orders Query
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Delayed Orders Query
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ADL Query
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Blood Transfusion with Pre-med Query
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CAP Query
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DNR Query
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Nursing Admission Assessment

• Timeliness
• Complete
• Nurse Screen
• Smoking Cessation Consult needed?

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Nursing Admission Query
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Why Query Tool For Nursing

• Allows Nurses to obtain Broad range of
  information in VistA/CPRS
• Review Several Records at one Time
• Review Several Performance Monitors at one Time
• Predefined Custom Reports
• Evaluation of Processes
• Time Money

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Why Query Tool for Nursing?

• Organizational Efficiency
• Time
• Money
• Clinical situations

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Cost/saving Analysis
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Cost/saving Analysis

• Problem Identified
• Too Long to Log in patients record to monitor
  documentation
• 3 Minutes for some NM
• 5 Minutes for the other NM
• Find a way to get it done faster

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Cost/saving Analysis
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Cost/Saving Analysis- NM Review 1 Monitor
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Cost/saving Analysis
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Cost/saving Analysis
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Cost/saving Analysis
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Cost/saving Analysis
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• Types of Reports

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Types of Reports

• Pre- Defined
• Abnormal Results Report
• Consult Status Report
• Incomplete Orders Report
• Recent Activity Report
• Schedule/Due Activity Report

• User-Defined
• Custom Report

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Setting Up Pre-defined Reports

• Abnormal Results Report
• Consult Status Report
• Incomplete Orders Report
• Recent Activity Report
• Schedule/Due Activity Report

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Setting Up Pre-defined Reports

• Click on Query Tool
• Select the Pre-defined Report from the upper
  Panel
• The criteria will display in lower pane
• Criteria in blue must be defined (Click on the
  Hyperlink)
• Criteria in Maroon has already been defined for
  you

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Setting Up Pre-defined Reports

• 6. Define the List of Patients
• 7. Select View Reports
• 8. Query Tool polls the database
• Sensitive Patients (select or deselect)
• 9. Report Displays

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Abnormal Results Report

• List of Patients with Abnormal results

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Consult Status Report

• Status of consults for a specified date range

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Incomplete Orders Report

• Select a particular status of order

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Recent Activity Report

• Orders documents in past 24 hours

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Schedule/Due Activity Report

• Orders Consults due

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Setting Up User-Defined Reports

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Custom Report
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Custom Report
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Custom Report
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Custom Report
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Custom Report
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Custom Report
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Custom Report Displayed
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Setting Up User-Defined Reports

• Custom Reports
• B. Miscellaneous related to all the reports
• Printing
• Exporting
• Editing

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. Miscellaneous related to all the Reports
Printing the Report

• Key ORRC QUERY RESULT EXPORT to Print Report
• Once report displayed-?Click on Print

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Setting Up Pre-defined ReportsExporting the
Report

• Key ORRC QUERY RESULT EXPORT to Export this
  Report
• Once report displayed-?Click on Export
• Type in name for exported Report? Browse for
  Location
• Click Save (text file)

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Setting Up Pre-defined ReportsExporting the
Report

• Type in name for exported Report? Browse for
  Location
• Click Save (text file)

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Import file into Excel
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Browse for text File

• Click on Title of Text file
• Then Click open

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• Text file is imported
• Click Next

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• You data is separated into columns
• Then Click next Finish

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• This box displays
• Click in the first box in your excel spreadsheet
  (cell)
• Then click "OK"

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Your Data Show In the Excel Spreadsheet

• Be sure to save this as another file from Excel
  not a text file

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Setting Up Pre-defined ReportsEditing a Report

• Can edit Both Pre-defined User-defined
• In the Query Tool's upper Panel-?Click on the
  Report you want edit
• Click Edit? Create Custom Report- Search Items
  panel is display
• Edit Report as needed.

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Graphing for Nurses

• Diane Murphy RN
• BCMA-C, Nursing ADPAC, CAC
• Syracuse, NY VAMC

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Purpose

• How To Set Your Personal Preferences
• Basic Graphing For Labs
• Advanced Graphing for BCMA Medications, Labs and
  Vitals
• Personal Graphing Templates
• Site Specific Templates

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The second way is from the tools bar (this may be
site dependant)
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Control CTLG From any tab
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Building Personal Graphing Templates
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• Open Graphing either from tool bar or from labs
• Click on Select/Define
• 1. Click on Patient items
• Scroll to Medication BCMA,
• double click to move to middle,
• click turn blue then
• use double arrow to transfer over to Items for
  Graphing

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1. Go back to Source 2. Scroll to Vitals 3.
Highlight 4. Use double arrows to transfer to
Items for Graphing
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• Click on Save Personal
• Name it.

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VISN Canned Graphing Templates

• Nursing ADPAC or Clinical Applications
  Coordinator Can Build

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To be able to save graph as a Public Graph you
have to set a VISTA OR parameter This is
controlled via an OR parameter NAME ORWG GRAPH
PUBLIC EDITOR CLASS DISPLAY TEXT CPRS Graph
Public Editor Classes MULTIPLE VALUED Yes
INSTANCE TERM Sequence Number
VALUE TERM User Class VALUE DATA
TYPE pointer VALUE DOMAIN 8930 VALUE HELP
Enter the User Class for public editing of
graphs. KEYWORD GRAPHING INSTANCE DATA TYPE
numeric INSTANCE HELP Enter a sequential
number for identifying the user class.
DESCRIPTION This parameter contains a list
of ASU user classes who's members are allowed
to edit public views and settings for graphs.
Users that belong to the user class entered at
the SYSTEM level have this authority. PRECEDENCE
5 ENTITY FILE
SYSTEM
Select
General Parameter Tools Option EP Edit
Parameter Values ---
Edit Parameter Values --- Select PARAMETER
DEFINITION NAME ORWG GRAPH PUBLIC EDITOR CLASS
CPRS Graph Public Editor Classes -----
Setting ORWG GRAPH PUBLIC EDITOR CLASS for
System V02.MED.VA.GOV ----- Select Sequence
Number 1 Sequence Number 1// 1 User Class
CLINICAL COORDINATOR//
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If you do not see Medications BCMA or Vitals as a
possible source. There is a VISTA parameter that
can be set by either your CAC or Software group
that will allow additional Source choices. The
more Sources you have may increase the time that
graphing loads.
Thanks to Mary Curtis!
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Personal graphing templates on top Canned site
or VISN templates
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For additional graphing information to the CPRS
Computerized Patient Record System (CPRS) User
Guide GUI version March 2007 http//www.va.gov/vdl
/documents/Clinical/Comp_Patient_Recrd_Sys_(CPRS)/
cprsguium.doc_Toc155518852 Pages 62 to 77
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Questions?