Teaching with EHR Go EDUCATIONAL EHR SYSTEM
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Teaching Overview Teach concepts, skills, and clinical readiness using EHR Go™’s patients, activities, and portfolio EHRs.
EHR ACTIVITIES
EHR PATIENTS
Assign any of the EHR Go Activities for informatics and clinical practice.
Assign any of the EHR Go Patients for case-based EHR interaction:
EHR PORTFOLIO Assign the EHR Go Portfolio for a non-case-based EHR for documentation practice: •
Clinicals
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Assessment lab
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Skills practice
Supports case-based learning and clinical experiences throughout the curriculum
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Critical-thinking questions
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Quizzes
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Content illustration
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Group discussions
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Simulation-interview and exam practice
Makes Interprofessional education easy
Concept-based, realistic, and hands-on learning
PATIENT PROFILES
Name
Florence Cassidy Focus
Advancing Alzheimer’s
Synopsis
Holistic Care Considerations
This is an EHR patient case. Florence is a 78-year-old female diagnosed with Alzheimer’s dementia about a year ago. She is cared for in her own home with the assistance of her son, Anthony. Anthony brings his mother to the Alzheimer’s care clinic today with reports that his mom has become increasingly confused lately and she is having an especially difficult time administering her inhaled COPD medications. Florence and Anthony need a new plan of care as her Alzheimer’s disease progresses. Can your students help Florence and Anthony?
Suggested Teaching Uses Alzheimer’s disease progression, care and considerations.
INTERDISCIPLINARY
Prioritization/Delegation Teaching, resource-finding, and care planning in homecare
Medication options for COPD.
Family education. Home assessment and safety for in-home dementia care.
Medication regimen for patients with dementia. Challenges of treating co-morbidities with dementia.
Occupational Therapy: Home safety evaluation for dementia. Nutrition: Diet plans for patients with dementia. THERAPY
Pharmacologic Management of COPD medication regime has become difficult with the dementia
Treatment of co-morbidities with dementia.
Comprehensive care planning for the patient with dementia.
PHARMACY
Socioeconomic Unable to support self, related to cognitive disability, cared for by her son
Legal/Ethical Beneficence versus Non-maleficence
Medication options for Alzheimer’s.
NURSING
Communication Impaired due to progressing Alzheimer’s dementia
Community resources and caregiver fatigue associated with care of family member’s with dementia.
Options for in-home dementia care. PROVIDER
Ethnicity/Culture Caucasian/American
Social Work: Community support and caregiver support for dementia.
TEACHING TIPS
IPE LAB
Interprofessional Team Care Planning and/or Patient Care
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Pre-SIM Homework Read and review Raymond’s EHR activity and the following case resources: Guidelines for the Management of Pediatric Burns Mandatory Reporters of Child Abuse and Neglect
Simulation Scenarios SIM options A or B lab activity may be completed with a low or high fidelity manikin or person playing the role of Raymond. Raymond should be lying in a hospital bed with make-up indicating the burned portions of his body at the start of the simulation. Discussion only option C may be completed in the classroom, lab, or through an online discussion board. SIM option A Raymond is in pain. Needs assessment, pain control by age and weight, and wound care. The team must determine their legal obligations as mandatory reporters in this situation. SIM option B Raymond is severely burned and in shock. He needs appropriate fluid and airway support. He will need long-term rehabilitation following the acute phase of his care. Discussion only option C Students should contribute to an IPE plan of care for Raymond, including addressing short and long-term goals and interventions. Plan of care may be documented in the EHR or via a discussion board.
Evaluation Method(s) Depending on the selected SIM or discussion only option, evaluation may include any of the following: participation-only, graded preparation with pre-quiz, direct observation with oral or written feedback, self and/or peer-evaluation, moderated debrief, and/or written documentation and plan of care. Combine preparation expectations, EHR documentation, and debrief reflection for the best learning outcomes. Encourage students to reflect on the differences and similarities between professional roles and benefits to the patient when professionals collaborate on care.
Case Example
Raymond Ezell Case Synopsis
Raymond is an eight-year-old boy who has been brought to the ER with significant burns to his hands, arms and torso. Raymond has a learning disability and lives in a group home within the foster system. He sustained severe burns when he accidentally started a fire while playing with a barbecue grill lighter.
Teaching Concepts SIM option A Child with mild to moderate burns. Wound care, pain relief, and mandatory reporting for possible neglect. SIM option B Child with moderate to severe burns. Body surface area formula for fluid and electrolyte replacement, feeding and/or breathing support, pain relief, and advanced wound treatment. Possible shock. Discussion only option C IPE team reviews and discusses Raymond’s case, places orders in the EHR, and coordinates an interprofessional care plan.
PATIENT PROFILES
Name
Jacqueline Jones Focus
Psychiatric patient care
Synopsis
Holistic Care Considerations
This is an EHR patient case. Jacqueline, who goes by the name of Jackie, is brought into the emergent psychiatric treatment center by her mother and sister who are requesting protective inpatient hospitalization. They are concerned for the safety of Jackie and those around her. Jackie has always been “a bit difficult and eccentric” but over the last several years, her family feels her behavior has been “spiraling out of control.” Currently, Jackie is displaying bizarre behaviors and thoughts.
Ethnicity/Culture Caucasian/American Communication Impaired due to active psychosis Socioeconomic Unable to support self, related to psychological disability
Although it is not quite clear what is going on with Jackie, it is clear that she needs help. She is being committed to the facility for inpatient psychiatric care. Can your students help Jackie?
Pharmacologic Initiation of antipsychotic medications
Suggested Teaching Uses
Legal/Ethical Autonomy versus Non-maleficence
Introduction to the psychiatric patient. Biomedical ethics of psychiatric commitment. Legal issues in psychiatric healthcare. INTERDISCIPLINARY
Hallucinations, delusions and psychiatric care environments.
Involuntary commitment. Diagnosing acute psychiatric conditions. PROVIDER
Medications and treatment plans for patients experiencing psychosis.
Caring for and communicating with the delusional patient. Medication administration for the psychiatric patient. NURSING
Discharge planning with the psychiatric patient and family.
Patient chart review, data collection, medication reconciliation, interview and care plan writing. PHARMACY
Typical and atypical antipsychotic medications.
Diet and exercise plan for the patient on antipsychotic medications. THERAPY
Prioritization/Delegation Communication and care planning in psychiatric care
TEACHING TIPS
SIM LAB
Basic Inpatient Assessment
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Pre-SIM Homework Have students come to the sim lab having pre-planned by reviewing the following. Optional: Evaluate preparation with a short quiz at the beginning of lab. •
Read and review the following case resources in the Keith Patterson activity: Laparoscopic adjustable gastric banding – effects, side effects and challenges Laparoscopic adjustable gastric banding
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Read through Keith’s EHR and prioritize his care orders.
Simulation Scenarios
Case Example
Keith Patterson Case Synopsis
Keith is a 35-year-old male who had a laparoscopic gastric banding procedure yesterday. He is now stable and in the subacute unit under observation until discharge.
The lab activities may be completed with a low or high fidelity manikin or person playing the role of Keith. Keith should be lying in a hospital bed with an abdominal dressing intact at the start of the simulation. Simulation Beginner Introduce self to patient, teach Keith to use the incentive spirometer and assist him from the bed to the chair using a safe transfer technique. Simulation Intermediate Teach Keith about his discharge plan and administer injectable medications.
Teaching Concepts
Simulation Advanced Assist Keith up to chair and respond with a code when he complains of severe chest pain.
Beginner Patient introduction, incentive spirometry, transfer technique.
Evaluation Method(s)
Intermediate Injectable medication administration.
A variety of different evaluation methods are applicable based on which simulation option was used. Pair the documentation with a short post-lab debrief reflection for the best learning outcomes. Simulation Beginner Document a DAR or SOAP note on the Notes Tab following the simulation. Submit the documentation. Download for the Keith Patterson activity. Simulation Intermediate Document medication administration on the Meds Tab and a set of Vitals on the Vitals Tab. Submit the documentation in Step 3: Download for the Keith Patterson activity. Simulation Advanced Document an SBAR note on the Notes Tab during or following the simulation. Submit the documentation. Download for the Keith Patterson activity.
Advanced ACLS code protocol.
PATIENT PROFILES
Name
Jocelyn Wu Focus
Well Child Care
Synopsis
Holistic Care Considerations
This is an EHR patient case. Jocelyn is a 9 month old female infant who has been seen in the clinic since shortly after birth. She has been healthy and has primarily been seen for health maintenance visits. Health maintenance visits since one month of age are in the EHR. Jocelyn is the only child of Chinese-born parents, Jin and Le Na Wu. Le Na works for Capital One and was transferred to offices in Philadelphia while pregnant with Jocelyn. Jocelyn is cared for at home by her father Jin, who does not speak English. Mom, Le Na, works outside of the home and tries to accompany Jin and Jocelyn to most clinic visits.
Ethnicity/Culture Asian/Chinese/American Communication Primarily via mother, father does not speak English, patient is nine-months-old
Both parents bring Jocelyn here today for her 9 month health maintenance visit. Can your students help Jocelyn and the Wu family?
Socioeconomic Parents are professionals, Jocelyn is well-insured, family support is in China
Suggested Teaching Uses
Pharmacologic Management of vaccination schedule
Critical review of health maintenance for the infant. Plotting growth values on appropriate growth chart. Anticipatory guidance and normal developmental milestones. INTERDISCIPLINARY
Transcultural healthcare.
The well-child schedule of care. PROVIDER
Immunization schedule. Assessing vitals of an infant. NURSING
Developmental screening tools.
Rooming, scheduling. Intake assessment. MA/MO
Obtaining an interval health history.
Legal/Ethical Need for interpreter and non-English-speaking clients Prioritization/Delegation Anticipatory guidance
TEACHING TIPS
SKILLS LAB
Surgical Drain Care
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Pre-Lab Homework Have students come to lab with the following information prepared. Optional: Evaluate preparation with a short quiz at the beginning of lab. •
Read and review the following case resources in the Patricia Brenner activity: Jackson-Pratt Drain Image Skills Review – Jackson-Pratt Drain Care
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Describe the purpose for and the care of surgical drains.
Skills Lab Set-Up Have students work individually or in small groups in the lab. Each student will access a JP drain, empty it and document in Patricia Brenner’s EHR under the I&O section of the Vitals Tab.
Case Example
Patricia Brenner Case Synopsis
Patricia has just had a double modified radical mastectomy for stage IIIA cancer of the left breast. She had two JacksonPratt (JP) drains placed bilaterally intraoperatively. Her drains will need to be checked, drained, and documented in her EHR.
This lab activity may be completed with or without manikins. One or more JP drains with any or all of the following simulated fluids should be made available in the lab. Skills Station Option A JP drain with 65 mL serosanginous fluid Skills Station Option B JP drain with 10 mL of serous fluid Skills Station Option C JP drain with 90 mL of bloody fluid Skills Station Option D JP drain with 40 mL of pus-filled fluid
Evaluation Method(s) A variety of different evaluation methods are applicable to this in-lab activity. Choose from any or all of the following. •
Pre- or Post-Lab quiz covering the JP drainage process and identification of drainage types.
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Observed lab performance to assess appropriate procedure is followed when handling, draining, and evaluating the drain contents.
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EHR Progress Report submitted to assess accurate documentation of type and amount of drainage.
Teaching Concepts Purpose for surgical drains, emptying Jackson-Pratt (JP) drains, measuring and documenting surgical wound drainage.
PATIENT PROFILES
Name
Oscar Sanchez Focus
Discharge and healthcare economics
Synopsis
Holistic Care Considerations
This is an EHR patient case. Oscar Sanchez has arrived at the Emergency Room today with complaints of chest pain. After an initial cardiac work-up, following ACS Protocol, and administering a GI Cocktail in the ER, he is being discharged with some new medications and a diagnosis of non-cardiac chest pain. Oscar will need extensive discharge teaching and preparation from the provider, nurse and pharmacist. Can your students help Oscar?
Suggested Teaching Uses ACS Protocol, cardiac risk factors, pathophysiology, pharmacology, diagnostic and lab knowledge. INTERDISCIPLINARY
PROVIDER
PHARMACY
Socioeconomic At risk for economic crisis related to health needs exceeding financial limitations Pharmacologic Multiple cardiovascular medications that are unaffordable for the patient Legal/Ethical Inability to pay for prescribed medical treatment
Differential diagnosis of cardiac versus non-cardiac chest pain, therapeutic communication, discharge planning.
Prioritization/Delegation Teaching, resource-finding, and problem-solving issues with healthcare economics
Discharge planning.
Transition of care, discharge planning, prescription costs and insurance coverage.
Dietetic counseling for weight loss and GERD appropriate diet. THERAPY
Communication No impairment, speaks fluent Spanish and English
Discharge planning, healthcare economics.
Patient education on disease process, life style changes and medications. NURSING
Ethnicity/Culture Mexican/American
TEACHING TIPS
CLINICAL TIPS
Conducting the first Health History with a Clinical Client
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Pre-Clinical Homework Have students come to the clinical experience having arranged their own meeting time and place with their client. If the student is responsible for receiving consent, the consent form should be explained and signed prior to the interview. Student should be familiar with the EHR and the note template assigned.
Clinical Documentation Have the student use his or her own Portfolio EHR. Every student will have the Portfolio EHR activity available in their EHR Go™ account automatically. They should start a new session and choose a new note on the Notes Tab, selecting the assigned note template from the dropdown note index. For this activity, choose from the following note template types: Functional Health Patterns Assessment Health History (Nursing) Functional Assessment
Case Example
Pearl Homan Case Synopsis
Pearl is a 79-year-old female admitted to LTC facility for rehab services following pin placement for a patellar fracture one week ago. Before she was injured she was fairly active although she did have mild mobility problems. A partner, instructor or standardized patient can play the role of Pearl and allow students to practice obtaining consent, administering a health history and documenting the history results in Pearl’s EHR.
Evaluation Method(s) The student should download their EHR. Download and submit the PDF report as evidence of their work. Optional: In addition to the health history, have the student complete a journal entry about their experience, using one of the two journal note templates in the EHR. •
Clinical Journal
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Clinical Journal Insight Reflection
Teaching Concepts Administration and documentation of the first health history. Developing clinical readiness and therapeutic communication techniques. Practicing clinical documentation.
PATIENT PROFILES
Name
Dorothy Byrd Focus
Acute geriatric psychosis
Synopsis
Holistic Care Considerations
This is an EHR patient case. Dorothy is a 74-year-old resident of the Highlands Long Term Care facility who has a history of behavioral health issues, including dementia, agitation, and even physical violence towards the staff. Lately, she has exhibited signs of delusions and hallucinations. She has been admitted to the inpatient psychiatric unit at the Valley View Therapy Center. Since her admission, she has been in turns both agitated and tearful as well as cooperative and sleepy.
Ethnicity/Culture Caucasian/American Communication Agitated and sleepy by turns Socioeconomic Widowed Lives in nursing home (LTC) Medicaid
Her blood pressures are high and she needs a mental health assessment, medical review, therapeutic nursing care, and a pharmacotherapeutic review of her medications. Can your students help Dorothy?
Pharmacologic Polypharmacy Needs full medication review
Suggested Teaching Uses
Legal/Ethical Involuntary commitment Autonomy
Geriatric psychosis. Urinary tract infection (cystitis). INTERDISCIPLINARY
Working with agitated or delusional patients. Medication review.
Mental health assessment. Evaluation and management of geriatric psychosis. PROVIDER
NURSING
Culture and Sensitivity (C&S) results and antibiotic selection.
Medication administration. Therapeutic communication. Pain assessment. Fall risk assessment. Violent or aggressive patients. Mental health assessment.
Polypharmacy. Pharmacotherapeutic assessment and plan. PHARMACY
Identifying drugs that may increase confusion or cause psychosis in the elderly.
Behavorial Health: Mental health assessment and therapeutic plan. THERAPY
Prioritization/Delegation Geriatric assessment and evaluation Psychiatric assessment and evaluation
TEACHING TIPS
DIDACTIC TIPS
The Impact of Religious and Cultural Beliefs on Healthcare
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Pre-Class Homework Have students come to class with the following information prepared. •
Describe the purpose and patient considerations of each of Omar’s prescribed medications.
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Read and review the case resources of the Omar Tahiil Bashir activity.
In-class discussion Divide students into small discussion groups and have them answer the following questions for an ethical care discussion of Omar Bashir’s case. Identifying with the patient Can you share any examples of friends or family members who have particular beliefs about medications or healthcare treatments that are not founded in fact? e.g. Mistrust of immunizations, dislike of plastic surgery, belief that antibiotics will help every illness, etc. Understanding the situation What do you know about Methadone and why do you think Dr. Galloway at the Pain Clinic recommends starting Omar on Methadone? Knowing the facts What is the recommended starting dose of Methadone for a patient like Omar? What are the patient considerations with this medication? Exploring the options What other pain control measures could be helpful for Omar? Making an informed decision Do you believe the prescribing of Methadone is an ethical way to address Omar’s religious beliefs? Why or why not?
Evaluation Method(s) A variety of different evaluation methods are applicable to this in-class activity. Choose from any of the following. •
Presentations or discussion of the in-class discussion questions after the small groups meet.
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Pre- or Post-Quiz on Methadone, Omar’s medications, and/or any of the case materials.
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Ethical reflection paper on the justification for or against the prescription of Methadone.
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Simple credit for participation, with or without a make-up assignment. Make-up assignment could be to answer the five discussion questions in writing.
Case Example
Omar Tahiil Bashir Case Synopsis
Omar is a 58-year-old African-Muslim male with uncontrolled chronic back pain. He has refused narcotic pain medications because of religious reasons. However, his spinal pathology is worsening and the current pain relief plan is no longer clinically reasonable. He has been referred to the Pain Clinic for treatment and has been prescribed Methadone.
Teaching Concepts Ethical care, cultural and religious beliefs, chronic pain control, Methadone and alternative pain therapies.
PATIENT PROFILES
Name
Gordon Feldman Focus
End-stage renal disease (ESRD), Peritoneal dialysis, Peritontitis
Synopsis
Holistic Care Considerations
This is an EHR activity. Gordon Feldman is a 52-year-old-male with a history of TIA, HIV, HTN, GERD, diverticulitis, and ESRD on PD who presented to the ER four days ago with c/o abdominal pain, nausea, vomiting, and diarrhea, which all began the day prior. He has been on peritoneal dialysis for two years and was on hemodialysis for a few years prior to that. Gordon also suffers from chronic abdominal pain, has had several negative CT scans, and has been evaluated for peritonitis in the past but has never had confirmed infection. Before presenting to the ER, he missed a dialysis due to the pain. He received morphine in the ER but it didn’t help his pain and actually may have made it worse. He was admitted for probable peritonitis and was started on empiric antibiotics. He has now had five nights in the hospital and is starting to feel better. He seems ready for discharge, but needs a full plan. Can your students help Gordon?
Suggested Teaching Uses
INTERDISCIPLINARY
PROVIDER
Pathophysiology and treatment of peritonitis. Management of peritoneal dialysis and end-stage renal disease (ESRD). Monitoring fluid and electrolyte balance. Abnormal lab results. Logitudinal care record.
Managing patients in end-stage renal disease (ESRD). Managing patients with HIV. Selection, dosing, and monitoring of anti-infectives and anti-retroviral agents. Coordination of care.
Peritoneal dialysis and end-stage renal disease (ESRD). IV medication administration. Fluid and Electrolyte balance. Interpreting lab results. NURSING
PHARMACY
Pharmacotherapeutics with end-stage renal disease (ESRD). Anti-infectives, HIV anti-retroviral agents, drug selection and dosing with impaired kidney function. Lab result review. Nephrotoxicity of drugs.
Dietitics: Nutrition for end-stage renal disease (ESRD) and peritoneal dialysis. THERAPY
Ethnicity/Culture Caucasian/American LGBTQ Communication No communication deficits Socioeconomic Married Not Employed Insured Pharmacologic Anti-infectives HIV anti-retroviral agents Drug selection and dosing with impaired kidney function Legal/Ethical End-stage renal disease (ESRD) Prioritization/Delegation Managing patients in ESRD
TEACHING TIPS
DIDACTIC TIPS
Dosing Opioids for Palliative and Opioid Tolerant Patients
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Pre-SIM Homework Have students come to class with the following information prepared. •
Read and review the case resources in the Julia Morales activity.
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Review Julia’s EHR and develop a medication plan to treat her breakthrough pain using the guidelines in the Pharmacologic Management of Pain at the End of Life and Equianalgesic Dosing of Opioids for Pain Management articles.
In-class discussion Divide students into small discussion groups and have them answer the following questions for an ethical care discussion of Julia Morales’ case. Identifying with the patient What do you know about Hospice care? How do you think Julia and her wife Lucy are feeling today? Why? Understanding the situation What makes pain treatment at the end of life unique from other pain treatment plans? Knowing the facts What is the recommended dose of MS Contin for a patient like Julia? Is she currently taking more or less the recommended dose? Why do you think this is? Is the MS Contin working for her pain? Why or why not? What are the patient considerations with this type of medication? How do or don’t these considerations apply to Julia? Exploring the options What other pain medications or measures could be helpful for Julia? Making an informed decision What pain control plan, pharmaceutical and otherwise, would you recommend for Julia? Be specific.
Evaluation Method(s) A variety of different evaluation methods are applicable to this in-class activity. Choose from any of the following. •
Presentations or discussion of the in-class discussion questions after the small groups meet.
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Pre- or Post-Quiz on end-of-life pain control and/or any of the case materials in Step One.
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Simple credit for participation, with or without a make-up assignment. Make-up assignment could be to answer the five discussion questions in writing.
Case Example
Julia Morales Case Synopsis
Patient is a 65-year-old female with a four-year history of adenocarcinoma of the lung who is being placed in hospice today. She needs to be evaluated for safety, pain management and other needed services. Current pain medication is oral MS Contin 100mg. Julia takes 100mg MS Contin every 4 hours and commonly has break through pain that she rates as 6-9/10.
Teaching Concepts Hospice care, palliative care, cancer-related pain, pain control, opioid tolerance versus addiction, safe and effective opioid dosing.
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