YOUR FIRST NURSERY SHIFT WITH CS-LINK

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1. Log in using User ID and password

2. Department: Choose “neonatology spec” for NICU/nursery

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PATIENT LISTS

 

Create a patient list for Nursery:

1. Click “create” in the upper left corner. Name your list “Nursery or Obs Nursery”.

2. Click “copy…” choose “MD PEDIATRIC”. Then “accept”.

3. Click the “system list” folder, then “team list”, then “Nursery-Obs”.  Right click “Nursery-Obs” and “copy system list.”

4. Right click the “Nursery or Obs Nursery” patient list you just created, and “Paste system list.”

5. Add patients to the “Nursery-Obs” list by right-clicking the patient, choosing “assign team”, and typing in “Nursery-Obs.”

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Create a patient list for NICU:

1. Click “create” in the upper left corner. Name your list “NICU”.

2. Click “copy…” choose “MD PEDIATRIC”. Then “accept”.

3. Click the “system list” folder, then “team list”, then “NICU Blue”.  Right click “NICU Blue” and “copy system list.”

4. Right click the “NICU” patient list you just created, and “Paste system list.”

5. Add patients to the “NICU Blue” list by right-clicking the patient, choosing “assign team”, and typing in “NICU Blue.”

 

ORDERS

 

When writing your own orders:

• When you are the primary team writing your own orders, be sure to click "sign orders" not sign and hold (i.e. all orders in the Nursery).

• When discussing orders with a nurse, please clarify that you are not giving them "verbal orders" but rather updating them on the orders that YOU will write. Verbal orders should be given only rarely if at all.

 

Saving partially completed orders:

• If you are interrupted while working on an order set, you can save your work by clicking “Pend Orders”

• To return to the order set, click “Pended/Held” in the menu bar

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SIGNOUT

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1. Under the patient list, next to “report,” click the wrench.

2. Choose any row and type “sign out”. Hit enter.

3. If you are in the nursery choose CSHS IP NURSERY-OBS SIGN OUT REPORT (Remember: you need to login as “Neonatology Spec” to see the nursery or NICU signout reports)

4. If you are in NICU choose CSHS IP NICU SIGN OUT REPORT

5. Use the up arrow at the bottom of the window to move to the top and click Accept.

6. To enter information, highlight the patient’s name, and click [Add/Edit comment]

7. You can use smart phrases in this screen

8. for NICU “.nicusignout”

9. for NSY: “.nsysignout”

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To print the signout:

1. click the “patient report” button near the top of the screen.

2. Check “NICU Sign Out” for the NICU, “Nursery-Obs Sign Out” for the Nursery

3. If not already defaulted, choose the printer name. Click “print”

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Search for other physican contacts:

1. You can also find PMD’s phone numbers from the “Provider Directory” section of “web activities”

 

DISCHARGES

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When the patient chart is opened go to the "discharge" navigator --> to go "discharge ord rec":

1. Reconcile medications for discharge

2. New orders for discharge: search "order sets" for "NEO IP DISCHARGE" and open the order set and complete all information

3. Review and sign

 

Note: Bedside RN needs DC diagnosis for discharge. In the discharge navigator, open “problem list” and make sure that the principal diagnosis is checked. The RNs will use this as the discharge diagnosis.

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TEMPLATES

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NICU H&P: “.NICUHP"

NICU Progress Note: “.nicurespn”

NICU Discharge Note: “.nicudc”

Delivery Room Note: “.deliveryroomnote”

Nursery H&P (for both HS and Obs): “.nsyhp”

Nursery Progress Note: “.nsypn”

Nursery Discharge Note: “.nsydcnote”

 

NICU/NURSERY-SPECIFIC ORDERS

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Admission Orders

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Routine Well-Baby Nursery newborns: 

Newborn protocol orders are entered by nurses on term, healthy newborns and sent to the PMD’s inbox for cosignature. These orders are active as soon as they are entered.   All babies are admitted to the mother-baby unit, regardless of whether they are in observation or not.

 

Newborns who are Obs From Birth: 

Enter the “Newborn Admission with Observation Status from Birth” order set.  This includes admission protocol orders and observation-care specific orders.

 

Newborns who are being moved from Well-Baby Nursery to Obs:  

If a baby is already admitted to the mother baby unit and then needs observation care, use the “Observation Care for Babies Already Admitted to Nursery” order set. This order set has observation-specific orders, and doesn’t duplicate the routine newborn protocol orders (e.g., eyes and thighs). It includes the order to “Change nursery status to observation care.”   Observation is a change in status, not a transfer!  Don’t use the transfer nagivator! Don’t cancel and reorder admission orders.

 

Newborns who are being moved from Obs to Well-Baby Nursery:  

 Simply enter an order to “Change nursery status to mother-baby care”.  You will want to reduce the vitals frequency to q8hrs in most cases and d/c any meds that are no longer indicated such as antibiotics. Again, this is not a transfer.

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Information on commonly used orders

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ANTIBIOTIC LEVELS

• Routinely done with the 4th dose of Gentamicin to decrease sticks on infants getting 48hr rule-outs.  If clinically indicated, they can be done earlier.

 

HYPOGLYCEMIA PROTOCOL

• The “HYPOGLYCEMIA PROTOCOL” order set includes changes based on 2011 AAP guidelines. 

  • No babies get Obs care unless symptomatic.

  • Babies that get the 24hr protocol are SGA and preterm (<37wk) babies

  • The first low glucose for asymptomatic babies only gets a regular feeding and recheck

  • Symptomatic babies with glucose <40 get a dextrose push, regardless of age

 

NICU RESPIRATORY ORDERS

How do I Initiate Respiratory Orders?

• Set your O2 Sat Goals at admission in the “NICU ADMISSION ORDER SET.”

• Use the “NICU RESPIRATORY THERAPY ORDER SET” to Initiate CPAP, NIPPV, or Vents (anything more intensive than high-flow nasal cannula).​

  • Open the AVEA order to start CPAP, NIPPV, or a conventional Vent (or select the HFOV or HFJV as needed).

  • Modify the ventilator adjustment parameters in the comments of this order as needed.

  • Choose a “CONDITIONAL” CBG or ABG in addition to any one-time blood gas orders.  Set your blood gas goals in the comments of this order.​

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Familiarize yourself with the other features of the NICU RESPIRATORY THERAPY ORDER SET, including

• “DISEASE-SPECIFIC MEDICATIONS” section

• “Curosurf”

• “Caffeine” (load and maintenance)

• “ Pre-intubation Meds”

• “Respiratory Therapy - NICU Ventilator Weaning Protocol” is our rapid vent weaning protocol (e.g., for use after surfactant therapy).

 

How do I Modify Respiratory Orders?

• Modify existing respiratory orders using the “ORDER MANAGEMENT” tab.   After entering your ventilator orders, you do not need to use the NICU Respiratory Therapy Order Set again unless you are switching ventilator types.

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