Archive

Archive for the ‘Nursing Package’ Category

Consolidation of the Package

February 12, 2010 Leave a comment

We’ve made tremendous strides in our Radiation Oncology clinic as we are currently 100% electronic chart – ie I don’t really ever have a paper chart in my hand.  Yea!! The 2008 goal of an EMR is done.

The process has gone very smoothly, in large part I think to the StoreyQuickNotes and AutoHotKey functionality.  My clinic is one of 7 clinics and now administration has caught onto the progress that we have made and appreciates the time saving aspects.  So now, IS is looking at putting the code on the CITRIX client which would roll the shortcuts out to all the staff.  So usage on a daily basis would go from about 30-50 right now to 300+ patients and it would be a primary part of the global shift to an EMR for our 7 Radiation Oncology facilities.

As part of that move, I’ve spent some time consolidating the structure of the packages back into 2 packages.  There is an MD package and there is an Office Package.  The MD package is obviously oriented towards the physician workflow and the Office package contains shortcuts for Nurses, Therapists, and the Front Office Staff.

So I’ve posted a Nursing 97b to the download page.  I’m going to have it tried out in our clinic next week and make sure that I didn’t break anything in the merger and then I’ll roll it out as 1.00 Office once I feel like it has been through the paces.

All Packages have been Updated

November 16, 2009 Leave a comment

I’ve been a bit quieter but the work has continued.

Over the last week or so, I’ve updated and refreshed each of the 3 primary packages of StoreyQuickNotes including the MD Package, the Nursing Package, and the General Navigation Package.

The main addition is far better configuration of the packages for using the IMPAC schedule shortcuts. They now have a configuration page which should mean that there is no need for any “end user” to open the code if you don’t want to.

The list of things that I want to get done keeps getting smaller. I have a few more tweaks to the MD package but the others are getting close to what I’ll consider a full-release non-beta version.

Over the next week or so, I’ll get up some images of the new custom tray menu with some additional “How To” articles.

How To: Using Abbreviations / HotStrings

October 31, 2009 Leave a comment

General Package Abbreviations:

The following is the list of Hotstrings or Abbreviations used in the StoreyQuickNotes General Package

::po::by mouth
::qd::every day
::q::every
::qhs::every night at bedtime
::prn::as needed
::nv::nausea and vomiting
::appl::apply to affected region
::tid::three times a day
::bid::twice a day
::qty::quantity
::fuw::Follow Up Weight:

:c:Amox::Amoxicillin
:c:Lor::Lortab 5/500
:c:Lot::Lotrisone
:c:Sil::Silvadene

::nlrcar::Carafate Suspension, 2 teaspons, swish and swallow four times a day
::nlrlom::Lomotil, 1 to 2 by mouth every 8 hours as needed for diarrhea (max 8 per day)
::nlrsil::Silavdene, Apply to affected region three times a day
::nlrlot::Lotrisone, Apply to affected region three times a day
::nlrxyl::Xyloxyline, 1 tablespoon by mouth before meals, after meals, and before bedtime
::nlrnys::Nystatin Suspension, 1 teaspoon, swish well for 2 min and swallow four times a day.  Take 2 days past symptom resolution.

::disc::“INFORMATION PROVIDED BY THE PATIENT, PHARMACY, OR OTHER HEALTH CARE PROVIDERS.”
::meds::MEDICATIONS:
::chemo::CHEMOTHERAPY:
::all::ALLERGIES:
::phar::PHARMACY:

::nkda::No Known Drug Allergies

::mlist::
(
MEDICATIONS:


CHEMOTHERAPY:


ALLERGIES:


PHARMACY:


“INFORMATION PROVIDED BY THE PATIENT, PHARMACY, OR OTHER HEALTH CARE PROVIDERS.”
)

MD Package Abbreviations:

The following is a list of Hotstrings or Abbreviations used in the StoreyQuickNotes MD side of the package. It is copied from the code so the format is a little odd, but really pretty easy to read.

For example: ‘po’ will automatically be turned into ‘by mouth’

::po::by mouth
::qd::every day
::q::every
::qhs::every night at bedtime
::prn::as needed
::nv::nausea and vomiting
::appl::apply to affected region
::tid::three times a day
::bid::twice a day
::qty::quantity
::fuw::Follow Up Weight:

:c:Amox::Amoxicillin
:c:Lor::Lortab 5/500
:c:Lot::Lotrisone
:c:Sil::Silvadene

::nlrcar::Carafate Suspension, 2 teaspons, swish and swallow four times a day
::nlrlom::Lomotil, 1 to 2 by mouth every 8 hours as needed for diarrhea (max 8 per day)
::nlrsil::Silavdene, Apply to affected region three times a day
::nlrlot::Lotrisone, Apply to affected region three times a day
::nlrxyl::Xyloxyline, 1 tablespoon by mouth before meals, after meals, and before bedtime
::nlrnys::Nystatin Suspension, 1 teaspoon, swish well for 2 min and swallow four times a day.  Take 2 days past symptom resolution.

; ------------------ ABBREVIATIONS ONLY IN THE MD PACKAGE ------------------

; C1 option - do not conform to typed case : See Hotstrings and Auto-replace

::met::metastatic        ; updated to remove issue with 'm' turning into something more
::mets::metastasis       ; changed
::adeno::Adenocarcinoma
::adp::Adenocarinoma of the Prostate
:C1:scca::Squamous Cell Carcinoma	
:C1:nsclc::Non Small Cell Lung Cancer
:C1:sclc::Small Cell Lung Cancer
:C1:idc::Invasive Ductal Carcinoma
:C1:dcis::Ductal Carcinoma In Situ		

::l::left
::r::right
::br::breast
::wb::whole brain
::cw::chest wall
::abd::abdomen
::pros::prostate      ; removed pr is Progestion Receptors
::pb::prostate bed

::ha::headaches
::n::nausea
::v::vomiting
::f::fatigue
::di::diarrhea      ; Add 'i' due to the word "I'diarrhea" from "I'd" - funny bad typo 🙂
::tx::treatment		

::sig::significant
::ca::cancer
::co::complains of
::pt::patient
::dz::disease
:C1:xrt::radiotherapy
::chemo::chemotherapy
::muc::mucositis
::ery::erythema
::desq::desquamation
::med onc::medical oncology

:C1:rtc::Return To Clinic:         ; Added in version 1.0
:c1:fu::Follow-up

::imf::inframammary fold region    ; Added in Version 1.01
::ax::axilla
::mdes::moist desquamation
::ddes::dry desquamation
::mdbr::moist desquamation in the axilla and inframmary fold region

Use:

Using Abbreviations or HotStrings with AutoHotKey is as easy as typing. If you type any/many notes into your electronic chart, it is very useful to have a number of abbreviations readily converted to longer text.

Below is my current list that I am using in the MD and Nursing Packages. If you need to turn them off, there are a couple of options.

  • Exit the Program
  • Use the Win-S shortcut to Suspend the script

Notes:

:c:

Means the case has to match exactly for the abbreviation to be expanded.  ie ‘lot’ will not expand but ‘Lot’ will.

:C1:

Means the abbreviation will be expand to the expanded version and it will ignore your capitalization.  For example, ‘l’ doesn’t have a C1 modifier so ‘l’ turns into ‘left’ while ‘L’ turns into ‘Left’.  ‘RTC’ in contrast which has the C1 modifier, will always turn into ‘Return To Clinic:’ regardless of how you capitalize ‘rtc’.

Editing or Changing or Adding New Entries:

These are really very easy to change.  Simply open up the .ahk script by right-clicking and selecting ‘edit’.  From there you can scroll down to the bottom of the code and make changes.

The format is pretty easy and you can pretty much copy the format to add new ones or delete ones you don’t like.  As always, if you run into trouble the AutoHotKey Help Documentation is a great place to look.

Navigate the IMPAC schedule with ease!!

October 19, 2009 Leave a comment

Well today I’ve rolled my new favorite shortcut.

Backing up, last week I worked on integrating a few common tasks shortcuts into StoreyQuickNotes and today, I’ve rolled those packages out.  The results are pretty impressive with me using the Schedule Navigation shortcut around 30 times in the morning alone.

Basically, the shortcuts allow you to use the arrow keys to toggle which schedule you are viewing and to alter the days.

It is a small quick addition to the coding side but on the user side, it is now something that I’m going to rely on many times throughout the day.

HOW TO HAVE IT FUNCTION  IN YOUR CLINIC:

You must customize the 3 schedule names to match the names of the schedule in your Impac version.  I messed with trying to get this into a configure screen but it wouldn’t fly with Impac, so you are going to have to edit the code.

  • Replace the names of my 3 schedules with the names of your three schedules
  • Go in alphabetical order from your own personal list.
  • If you have trouble, you might add a slight delay like I had to for my sim schedule

Here is a snipet of the AutoHotkey code:

; ***************************
; Toggle Schedule - shared
; ***************************
ToggleSchedule(state)
{
	if (state<0)
		state=2
	else if (state>2)
		state=0	
	
	if (!state)
	{
		Send {tab 9}
		Send 21a-nlr    ; Customize '21a-nlr'
		Sleep 50            
		Send {tab}
	}	
	else if (state=1)
	{
		Send {tab 9}
		Send nlr-nurses station ; Customize
		Send {tab}
	}
	else if (state=2)
	{
		Send {tab 9}
		Send nlr-simulation ; Customize
		Send {tab}
	}
	
	return state	
}

#Up::
count_c:=count_c+1
count_total:=count_total+1
state:=state-1
state:=ToggleSchedule(state)
return

#Down::
count_c:=count_c+1
count_total:=count_total+1
state:=state+1
state:=ToggleSchedule(state)
return

#Left::
count_c:=count_c+1
count_total:=count_total+1
Send {tab 6}{enter}
return

#Right::
count_c:=count_c+1
count_total:=count_total+1
Send {tab 8}{enter}
return

Claims of Saving Hours – Sounds Rediculous But Is It?

October 7, 2009 Leave a comment

Using StoreyQuickNotes in my Radiation Oncology clinic, I claim to “save hours per week” for the staff.  It sounds a bit exaggerated, but is it?

I think that is a very true statement and here is the rational for that statement.

I use the shortcuts throughout all of the day and for me, on a non-weekly visit day, I would say it shaves about 3-5 mins per day.  This is mainly to speed up the image approval and document approval process within IMPAC (we use IGRT for several patients and those images are digital as well as the simulation films).

On days where I need to grab radiology images for patients,  I use the image grabber.  This is a bigger time saver so add 3-5 to that.  On days where I see weekly visits I think I save 5-10 min or so on not having to review and correct dictations from the prior day and by having all notes in one easy place to reference rather than document scrolling within IMPAC.  Note, I don’t think generating the notes are faster, but I think the overall process IS faster.

That gets me to an easy 30-45 minutes faster per week. Let’s say 30 minutes to be conservative – 6 min a day faster.

The biggest block of time is time saved on nursing documentation. As I’ve said before, we are ACR and JACHO accredited so we document a lot of things. Nursing assessment alone is 2-3 minutes faster per patient over paper. Multiply by 30 and you get 1 hour. In addition there is teaching and consults and medication lists which probably easily top 15 minutes extra in savings.

Finally there is time saved by dictation and transcription by not having to type up the 30 progress notes per week. This has to be 2 minutes per note which would be another hour.

Conservatively I come up with 2 1/2 hours cut from the staffs work week using AutoHotkey shortcuts. It is probably closer to 3 hours. After just 3 short weeks of use while transitioning to an EMR, I wouldn’t go back and it has definitely lessened the daily grind of getting through various tasks.

Positive Feedback: StoreyQuickNotes better than paper

September 30, 2009 Leave a comment

It has now been about 3 weeks since we have implemented StoreyQuickNotes into live patient care work in my clinic.  The Nursing package probably has the most use in the clinic setting.

One of the best chances for feedback is nursing staff who rotate to the facility occasionally.  In every other clinic they are using, and have used forever, paper.  In my clinic only, they are using a completely different method to enter their data into the patient chart.

So every day they work in the traditional paper version and occasionally, they use StoreyQuickNotes to enter the data.  This last week, a nurse using the electronic system for the 2nd time ever thought it was faster and easier than using paper.

To me, that was a huge statement towards showing just how good these shortcuts are working.  This is someone who really worried about the switch to an electronic chart, disliked the default IMPAC interface, and who isn’t computer friendly who, on her second run, liked the electronic interface better than the paper interface she uses 90% of the time.

Pretty big statement.  Progress continues.

MD and Nurse Package Updated

September 22, 2009 Leave a comment

Today I updated the Nurse and MD package.  A bit of code I wrote over the weekend didn’t transfer exactly correctly when used in the live setting so the files have been tweaked and updated.  That said, it was the first day of using the large combo package in the live clinic setting and it was successful.

Another big day down with any significant setbacks.  We are now working on a solid week and a half of live work in the clinic.

I will post something here when I update files on the site.  You can subscribe to this site if you like so you can be notified of any new updates to the code.