Problem: Some inpatients at Wave 2 sites were admitted before Wave 2 launch. Key information was transferred to Connect Care charts as part of a cutover process. This information was then validated by prescribers immediately after launch. If an admission order was missed, or medication reconciliation was not completed, efforts to discharge the patient post-launch can be blocked.
Context: When experiencing discharge challenges, an important first check should be for a valid admission order. Next, confirm that medication reconciliation has been completed. Patient transfers and discharges require a completed medication reconciliation so that accurate medication information follows the patient. Unattended admission order or MedRec work will be flagged in the "Sidebar Summary" that appears in the right sidebar of an open chart.
Solution: Attending to the following two checks should resolve most discharge blocks:
- Check for an Admission Order by looking in the "Order History" section of the "Orders" activity, and add an admission order if found missing.
- Open the Admission navigator (tab) with the chart open in the current inpatient encounter.
- Select the "Admission Orders" section (bottom of the navigator left column).
- Select "Review Home Medications":
- Ensure this list includes all medications that the patient was taking prior to admission.
- This step may already have been completed by nursing or pharmacy, as indicated by the "Med List Status" at the bottom of the listing.
- Select "Reconcile Home Medications" (must be done by prescriber):
- Complete documentation of reconciliation decisions by selecting "Don't Order" for any medications that were already ordered as part of cutover.
- If all home medications listed were already ordered for cutover, use the "Mark unreconciled Don't Order" button at the top of the screen for convenience.
- Review the new reconciliation actions and then Sign at the bottom of the right sidebar.
- Active Orders: Go to the "Orders" activity and hover over an order in the "Active Orders" tab to get an order report icon (📃) at the top right of the row for that order. Click on this icon to get a popup with information about the order. The order number is in brackets or parentheses.
- External Orders: Note the list of external orders at the bottom of the "External Orders" tab, and click on an order of interest to get a popup that includes the order number (in parentheses).
- Encounter Orders: If encounter orders have been signed, click on the order icon (📋) just to the left of the bottom right "Sign Encounter" button. Then, click on the individual order of interest, and note the order number in the Order Report.
- All contexts
- With a patient's chart open, use the Search function (top right of hyperspace or within StoryBoard) to find the "Order Review" activity.
- This can be used to list all orders for a specified time period (default is last 72 hours).
- Clicking on an order will reveal the Order Report (usually bottom half of screen) with the order number in it.
Problem: Wave 2 physicians accustomed to Netcare's "Program" lists (configurable to show inpatient, outpatient or other groups where a service group has assigned patients) may find that a Program list is inappropriately empty or incomplete after the associated site transitions to Wave 2.
A related issue affecting lists of patients associated with a Provider is addressed in a separate posting.
Context: With Wave 2 launch, some facilities take on new site names and new names for clinical service groups. If Netcare continues to seek Program patient panels with the older names, lists will be empty or incomplete.
In most cases, Netcare Program lists can be restored by correctly selecting the "Site" using new Connect Care naming conventions. Note in the image below that there is both a site called "University of Alberta Hospital" (pre-Connect Care naming convention) and a site called "EDM WMC University of Alberta Hospital" (post-launch Connect Care naming convention).
UPDATE (20201101): duplication of programs in Netcare lists has been fixed. It is still important to re-to confirm selection of the intended program in personal settings.
Be sure to select Connect Care sites using the new Connect Care site name. This will correctly populate searches for Program affiliated patients. The same care must be taken when editing "User Settings" to configure a default inpatient or outpatient program for lists.
Problem: Wave 2 physicians accustomed to Netcare's "My patients" list (configurable to show admitted, outpatient and other care relationships) find that the list is empty or incomplete even though they have active patient responsibilities at a Wave 2 site.
Context: Unlike Wave 1 sites, some facilities launching with Wave 2 have different admission, discharge, transfer (ADT registration information) systems that inter-operate with Netcare differently.
Solution: In most cases, Netcare provider lists can be restored by re-configuring "User Settings" in Netcare. Go to the "Patient Lists" section and re-select the "My Provider" value. Note that the "Provider Popup Search" tool may find more than one match for the intended provider name.
Select the row that includes "[Connect Care]". This should restore Netcare's "My Patients" list to include patients served in Wave 2 facilities.
Problem: Some users may experience dropped WiFi connections after upgrading to Apple iOS 14. Has something happened?
Context: Apple has committed to protecting the privacy of its users. With the recent release of iOS 14, a unique MAC address (device identifier) is generated for each network that a user might connect with. This defeats common methods for un-consented tracking of user movements.
Unfortunately, the Apple privacy protection may interfere with the device management strategy in use by some home or institutional networks (especially with mesh network extenders) and some virtual private networks. Symptoms include the mobile device reverting to cellular data use, even when an approved WiFi signal is strong.
Solution: Users experiencing problems can turn off private MAC addresses by going to network settings on their mobile device, selecting the affected WiFi network, viewing its properties, then turning off the "Private Address" feature.
Problem: Connect Care users may experience an unexpected or unusual problem when using the clinical information system and wonder whether this is being experienced by others and will be resolved.
Context: Sometimes systems that Connect Care depends upon may unexpectedly go down or otherwise not function as needed. The clinical information system remains up but one or more dependencies (e.g., scanning, printing, dictation, wireless, etc.) may be affected. Such problems trigger a "major incident" which is managed by established team and protocol.
- Bulletin Banner at the top of the Connect Care Clinician Manual (bar with message appears at top of all pages).
- Alert popup visible during the Connect Care login process.
- Fan-out communications (email, fax) appropriate to the groups most affected.
- Update to Connect Care status page (status.connect-care.ca).
Context: Mobile apps are continually improved, just as desktop interfaces (Hyperspace) are improved through periodic updates and upgrades. Some upgrades may be significant enough that a recent version of the mobile app is needed to communicate with system servers. However, mobile applications on user devices are largely under user control. Not everyone configures for automatic updates. It is a good practice to update the mobile app(s) periodically. The best time to do this is immediately after a system upgrade (watch the blogs).
Solution: Although Haiku and Canto can be updated from iOS or Android app stores, best practice is to do a re-install from the Workspace One "Catalog" installed on user devices when Connect Care Mobility is first enabled (see Manual).
Open the "Catalog" app, look for the Haiku or Canto listing, and select the "Installed" or "Install" button. It does not matter that the app is already installed. Re-installing updates to the latest version compatible with Connect Care servers, while preserving important configuration settings.