EPIC - Highlighting Contraindications and Other Clinical Safety Issues
This guide provides detailed information about when and how to highlight contraindications and other important clinical information to promote safe care of patients by all clinical providers.
Prerequisites
This article is only relevant if you have clinical access in Epic and perform patient charting.
Steps
It is important that relevant information be readily available to those providing clinical services to patients. In most circumstances, the Problem List, Management Plan, and other chart entries are adequate repositories of that information. However, in certain situations, it is valuable to draw the attention of members of the care team, particularly those not already familiar with the patient, to specific information necessary ensure appropriate, safe, and effective care. For example, clinical conditions that present absolute or relative contraindications for common treatment methods should be made obvious in the clinical chart.
In the Epic EHR system, a Care Coordination Note (CCN) should be created to facilitate the identification of important clinical issues by all care providers. CCNs appear at the top of the Problem List and can be viewed, created, and edited by anyone with access to the Problem List. Therefore, CCNs are accessible to clinicians and student interns, but are NOT accessible by support (front desk or billing) staff. This makes the CCN ideal to document clinical details that should be visible for those providing clinical care, without making those notes visible to Epic users without clinical access.
Students have access to write Care Coordination Notes. However, CCNs should always be created at the direction of and with oversight from the attending clinician, who must review, approve, and ultimately be responsible for anything noted in this area of the patient record.
To add a Care Coordination Note, click on the corresponding link on the Problem List page, as illustrated here:
In the “Care Coordination Note” field, enter the clinical information that merits highlighting and click “Accept”. Be brief and specific, e.g. Spinal HVLA manipulation contraindicated below the T12 level. Instrument-assisted spinal adjusting and soft tissue manipulation are allowable as clinically indicated.
The completed Care Coordination Note appears at the top of the Problem List as shown below. The CCN should be updated as necessary.
As indicated above, one has to navigate to the Problem List page to access Care Coordination Notes.
In order to draw attention to the CCN, a ***Patient Safety Alert*** (PSA) should be created. The PSA is a type of FYI Flag. It is a high priority alert that is obviously visible upon opening the patient chart. Like all FYI Flags, PSAs can be viewed by anyone accessing the patient record. Therefore, PSAs should not contain specific clinical information not intended for clinical providers. When used to draw attention to a Clinical Coordination Note, the PSA should simply indicate the presence of a CCN. Users with access to clinical information will be drawn to the CCN on the Problem List for details.
To set a *** Patient Safety Alert ***, click the “FYI” icon on the “More Activities” menu list.
To add a new flag, click
. Type an asterisk (*) and press enter to pull in the Patient Safety Alert flag type.
In the text box, enter an alert directing clinical providers to see the Care Coordination Note, e.g. “Clinical providers: see Care Coordination Note for important clinical information”, and then click “Accept”.
This is how a saved ***Patient Safety Alert*** appears to clinic providers:
This is how the ***Patient Safety Alert*** appears when accessing a patient record from the appointment desk or registration:
