During the Downtime - Inpatient
  • Use Epic Read-Only to view data.
    • During a non-network downtime when the Epic Production environment is unavailable, users will be directed to the SRO, or Shadow Read Only, version of Epic. They will lose connection to the Production environment, and then will simply launch the SRO icon in order to access the SRO environments.
  • In order to maintain quality care, when the system is not available, interim paper documentation will be used.
    • Orders
      • Manual order forms will be available on each unit in the designated downtime location as well as available via the online form on demand system. Any paper order forms must have a patient label affixed. Order Sets from Epic will be available to be printed from the BCA PC’s. Any orders received during a downtime will either be faxed, tubed, or hand delivered to appropriate discipline
    • Clinical Documentation
      • Initiate use of paper downtime forms for any documentation that would otherwise be completed in Epic; any paper documentation must have a patient label affixed. When the system is unavailable, print a current MAR from the BCA PC on each patient. (All MARs can be printed at once). A blank Downtime manual MAR should be used for new admissions. Automated Medication Dispensing Cabinets will be placed on override according to hospital policy.
During the Downtime –Ambulatory
  • The evening before planned system downtime, print out the DAR/Patient Schedule, copay information report, and any clinical summary information needed.
  • Front desk/registration staff will use the printed schedule and co-pay report to check patients in. If a co-pay is due at the time of service, collect the co-pay and issue a receipt.
  • Orders – Orders will be placed manually during downtime.
  • Phone calls – document phone calls/telephone messages on paper as they are received. To schedule an appointment, take down the patient’s information and return the call when you are able to use the system to schedule the visit.
  •  If your clinic enters patient encounter information captured during downtime into the system (i.e. notes, orders, etc.) the designated party at each location should do so once the system is back up. Once the discrete information has been entered, the responsible party should also scan in the written documentation for that encounter. Verification that patient information has been entered correctly into Epic will be the responsibility of designated clinic staff at each location.
  •  After the paper forms utilized during downtime have been scanned into the system and verified, the clinic will be responsible for the maintenance and/or destruction of private health information.
After the Downtime – Inpatient
  • All assessment data will be entered into Epic upon completion of the downtime for downtimes less than 4 hours.
  • After downtime:
  • Document in EHR the start and end times of downtime in the Nursing Assessment Flowsheet>Provider Notifications>Events.
    • Regardless of the length of downtime, the following must be entered into the electronic record and back timed when the system is available.
    • Allergies
    • Home medications
    • Admission height
    • Admission weight
    • Admission problem list (must be entered by provider)
    • Daily weight
    • Pregnancy/Lactation status
    • Date/Time of Arrival and Discharge orders
    • All routine orders with continuing frequencies placed during downtime will be entered into Epic EHR by nursing staff with Order Mode of “Ordered During Down Time”.
    • All manual order forms with orders/signatiures must be retained and scanned into the EMR by the HIM department.
    • All provider orders are entered into the electronic record with the following exceptions:
      • Medication/IV orders that have been sent to the Pharmacy
      • Lab &/or Radiology (Imaging) orders that have already been called or tubed to the department: those departments will enter the orders into their system, which will then interface to Epic when the system is functional.
      • Orders that are completed during the downtime will not need to be entered into Epic.
  • Nursing will begin using the EMAR when the system is released to the nursing unit by pharmacy. All medications administered on the paper MAR are documented on the EMAR using the action of "During Downtime". The paper MAR is copied / faxed to pharmacy for the additional check of administrations.
  • If the system remains unavailable at the end of the current shift, patient data should be recorded by next shift responsible caregiver. The "Values by" feature in Flowsheets or the "Document for Another" feature in the MAR may be used to document previous care giver data. If transcribing data written by another care giver the manual forms must be sent to HIM to be scanned into the EHR.
  • Any manual documentation forms with data not back entered into Epic by the original documenter will be sent to HIM to be scanned into the EHR.

For planned Epic downtime, follow these directions:

Before Downtime

Review Preparing for Epic Downtime

Review BJC/WashU Core Downtime Policy

Before the downtime begins, save your work and log out of Epic