All department managers alert employees of scheduled downtime and review downtime procedures/responsibilities. In ancillary departments, make sure employee’s codes are current for order entry


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NameAll department managers alert employees of scheduled downtime and review downtime procedures/responsibilities. In ancillary departments, make sure employee’s codes are current for order entry
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CERNER DOWNTIME JANUARY 28, 2012
In the days before downtime:


  1. All department managers alert employees of scheduled downtime and review downtime procedures/responsibilities. In ancillary departments, make sure employee’s codes are current for order entry.



  1. Make sure all patients have an adequate supply of labels and face sheets.




  1. All areas make sure fax machines are in working order (including toner and paper) and will be manned during downtime. In the event there is a problem with a fax machine, notify the “HELP” desk at 4357.




  1. Ensure there is an additional cartridge for the unit printer(s) and adequate paper as multiple large print jobs will occur the afternoon of the downtime.




  1. Stock sufficient Miscellaneous Order forms NS-205 (item # 5456).




  1. Ensure adequate floor stock of the appropriate manual documentation forms:

    • Nursing Notes NS 372 (item # 87901) for VS and narrative charting

    • Charting By Exception Daily Assessment Form" for ROS, IV noting, ADL’s and equipment documentation:

          1. Adult NS 298 (item # 60674)

          2. Pediatric NS 299

          3. Mental Health NS 300 (item # 72187)

        • Nursing Activity Documentation” for interventions NS-383 (item # 95566)

        • ICU’s Critical Care Flow Sheet Adult (item # 5203) Peds (item # 5204)

        • Admission Profile for new admissions (Adult: NS 240 and NS 312; Peds: NS 314; Mental Health: NS 240 and NS- 343 and MH 155 and 156). Also for new admissions: Medication Administration Record (NS 306 item # 63361) and Home Medication Order Sheet (NS 359 item # 63587)

        • Worksheets for downtime: Downtime Diet List, Pharmacy ADT notification, Initiate Plan of Care worksheet (sent via email)


On January 28:


  1. Specific documents will be printed on the unit printers prior to the downtime. Make sure there is an additional cartridge for the printer and adequate paper. Documents will be printed before the downtime to provide relevant clinical information for reference during the downtime. These include:




    • Beginning around 0600, final radiology reports will print to the nursing units. Place on the patient chart under Tab 11.

    • The remainder of the reports will begin printing between 1800 and 1900:

      • Cumulative Lab Report for each patient. Place in the chart under the Tab 12.

      • Paper MAR (midnight to midnight 1/28) will print in pharmacy and pharmacy will distribute to nursing units. This will be used as a worksheet during the downtime.

      • 1 copy of a Physician Progress Note for each patient. Place in the chart under the Tab 9.

      • The “Home Medication Report” will print for each patient. Place in the chart under Tab 13.

      • Medication Summary for each patient. Place in the chart under Tab 13.

      • Diet list for each unit. Maintain at the nurses stations.

      • Caredex for each patient. This will have the most current orders as of the print time. Nurses will use this document to provide care, note new orders and communicate with other disciplines.


Managing orders/processes during downtime and recovery
Use the miscellaneous order form for new orders. Fax to the appropriate department. Call or page the appropriate department for stats or timed orders. They will pick up the miscellaneous order form when they come to the unit


  • Lab – The cumulative lab report will print. Lab results that become available between the cumulative lab report print and 2200 on 01/28 will print on the nursing unit. Nursing will place these sheets on the patient chart. New orders received after 2200 must be faxed to 765-3019. Remember to clearly record the ordering physician on the miscellaneous order form so the results will go to the correct physician. When the system comes back on line, lab will enter and result these items.


Note: For new lab orders that have duration (i.e. x 3 days) and the first one is to be done on the day of downtime, request one on a miscellaneous order form and fax. When the system comes up, nursing will need to enter the order for additional tests with the appropriate duration, less the one already ordered on the miscellaneous form (i.e. x 2 days).
Lab will draw previously ordered am labs as usual. Assuming that the system is back on line by 0700, these results are expected to be available by approximately 0900 on Sunday, January 29.


  • Radiology – Beginning with orders received after 2200 on 01/28, complete a miscellaneous order form. If a test needs to be performed before the system comes back up, call ER radiology at 5-8524; for CT, call 5-8644.


Note: For new radiology orders that have duration (i.e. x 3 days) and the first one is to be done on the day of downtime, request one on a miscellaneous order form and fax. When the system comes up, nursing will need to enter the order for additional tests with the appropriate duration, less the one already ordered on the miscellaneous form (i.e. x 2 days).


    • Meals: A diet list will print before the downtime. Use this list for communicating changes during the downtime. Keep the diet list updated with diet changes, including discharges, admits and transfers. For breakfast, fax (765-1139) the updated diet list by 0500. Any breakfast orders received after the list is faxed will need to be ordered on a miscellaneous form.

Upon system recovery, nursing will enter any new diet orders received during the downtime. “At Your Request” will not be impacted by the downtime.

    • Respiratory therapy orders – Contact Respiratory care for new orders received after 2200 on 01/28:

For blood gases, contact the department and complete the miscellaneous order form. Upon system recovery, respiratory care will enter and result the blood gases.

For nebulizations/respiratory medications, scan the order to pharmacy and contact respiratory therapy.

  • Medication Charting: A paper MAW will be printed by Pharmacy and delivered to the nursing units. The pharmacy also has a copy of each MAW. This should be used as a worksheet with meds being charted on line when the system comes back up; in the event that the system does not come up before the night shift nurses have finished their shift, the paper MAW will serve as documentation. This information will need to be entered when the system comes back on line (the nurse charting for another will do this on the electronic MAR).




  • During the downtime, all meds in Pyxis will be on override. Pharmacists will be located centrally in the Pharmacy. Keep a manual list of all discharges, transfers and expirations as they occur. Notify pharmacy of these by scanning the “Pharmacy Downtime ADT Notification” sheet. If unable to scan, fax to 765-3280.




  • If a Physician Power plan is needed during the downtime, it will be available from “LakeLink”.


Nursing Documentation


  1. Nurses should make every effort to plan care and complete their documentation prior to 2200. This will make the recovery process much easier when the system comes back on line. Remember to make sure the correct time is recorded on all interventions performed during the downtime. The interventions/tasks that were generated before the system goes down and after will display on the PAL/task list upon recovery. Remember to chart medication follow up at the appropriate time; when the medication is charted in the system for specified prn meds, a task is generated for medication follow up. Because medications will be charted after the downtime, the follow up intervention time will not be accurate. Be sure to change the time on the medication follow up form.




  1. Nursing documentation that must be entered into the system upon recovery: Admission Profile, Admission Assessment, Initiate Plan of Care and home medications on new admissions and Intake and Output on all patients.

In the event that it is necessary to chart by proxy for another nurse, the process is outlined below:


    • Change the date and time on the form to reflect the date and time the action was performed.

    • Select the Results Info icon located on the Tool Bar.

    • In the "performed by" box, click to the far right of your name and backspace to erase your entire name.

    • Type the last name of the user you are charting for in the "performed by" box. If there are multiple matches, select the binoculars to reveal a list of users. Select the appropriate user's name and select OK.

    • Note: When charting values for another nurse on the I and O tab, the nurse must validate that the data is appropriate but does not need to chart by whom the data was gathered. (However, any questions about values should be clarified with the person that recorded the data manually before entering in the system.)


Patient Wristbands
New admissions during the downtime will have a “downtime” wristband which uses a patient label. Admissions will place a label on the wristband. Upon system recovery, Bed control will notify admissions of the location of all patients admitted during the downtime. Admissions will print Cerner wristbands and tube to the appropriate nursing unit. NOTE: nursing will not be able to use the handheld devices and scan patient wristbands for medication administration until Cerner wristbands have been created and applied to the patients.
Bedside glucose
Results of bedside glucose testing performed during the downtime will cross to Cerner when the system comes back up. Remember to follow the hypoglycemia protocol and notify the physician as appropriate for results less than 60; and to notify the physician for a result of 400 or greater. Remember that a task will be generated when the system comes back on line for the nurse to chart the interventions for these abnormal results; the time of the task to chart interventions will be a function of when the system came back up rather than the time the intervention should have been performed. Remember to change the time of that task.


Order entry on recovery:
Any order that was requested via a miscellaneous form and performed during the downtime will be entered and resulted by the department performing the action (lab, radiology, etc). Nursing will enter all other orders except medications.
Pharmacy will enter medications orders with the date and time that the pharmacist enters the order, not when the order was written. Please make sure any duration orders are correct. Verify correct order entry using the written order and orders for review. Review carefully. Omissions in order entry by pharmacy will not be caught unless the written order and orders for review are compared with diligence.





01/2012

N Luttrell

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