INFORMATICS PROJECT 1

Nursing Informatics Project

Crystal Parks

Delaware Technical Community College

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Abstract

Electronic Medical Records and Nursing Informatics is at the front lines of healthcare. As

nursing embraces the change from paper documentation to electronic documentation nursing

informatics has taken on a new and respected role withing the healthcare spectrum.

Understanding the difference between IT who handles the components of the computer, privacy

protection, networking, and software updates and informatics which handles the creation and

development of the programs that are used for documentation it becomes clearer of the

importance to have nursing involved in informatics. Research, codes of ethics, legalities, and

federal privacy laws are all important factors that contribute to the development of the programs

used in the EMR. As organizations adopt the new software programs for the EMR of their

choice new policies, education, and data analysis is required through out the implementation of

the EMR to ensure all patient care is captured and can be studied for improvement.
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Nursing Informatics Project

Informatics was introduced to nursing over a decade ago. Nursing had preconceptions

of the Electronic Medical Record implementation. The knowledge base of seasoned nurses on

technology and computers did not support the transition to go smooth throughout the nursing

world. Most of this was due to the misunderstanding of what a computer and informatics

really was defined as. Separating the two and understanding that the computer itself was only

responsible for doing what the program was intended to do and what the user told it to do

relieved half of the stress on nursing staff. As with all computer’s software was now

important and companies had to upgrade. Important information once was ignored was now

vital because without the proper software certain programs would not run or run as

intended. Using computers at home we all are aware of the possible privacy threats such as

Trojan horses, worms, hoaxes, ransoms and many more not mentioned but when we combine

those threats to a patients EMR it is more dangerous. IT departments must stay abreast with

instillation of proper firewalls, anti-virus programs, and maintaining proper network

commands. IT employees are not the only ones responsible in the protection of the companies

and patient’s information but every employee. We accomplish this by adhering to company

policies regarding internet versus intranet use, prohibition picture and video recordings with

personal devices, posting on social media including Face book, twitter, Instagram, and snap-

chat. After all the new technology and terminology was discovered and learned by employees

using the EMR the realization of the benefits is realized. Now instant report of lab work,

imaging for x-rays and cat scans, physicians notes and orders, along with integration of

information from other health resources the patient may utilize is a click away with important

information that may have at one time taken weeks to obtain. Treatments, research, ideas, and
INFORMATICS PROJECT 4

discoveries are shareable in real time instead of months or years before information could be

published and reach millions of healthcare workers for education. The more healthcare

workers can take the time to understand the importance of informatics and developing new

programs to improve the patient's care along with sharing new discoveries and cures the more

we will continue to see improvement in healthcare.

Ethical and Legal Issues

Nursing documentation in electronic medical records poses a potential for improper

documentation especially in trauma and CPR patient situations. The documentation needed does

not only protect and record patient’s information but also protects the nurses themselves

recording proper tasks performed. Challenging as it is for healthcare members to care for

patients in such a critical health position nurses must keep and perform by their own virtue

values, morals, and integrity. Organizational policies, state laws, national laws, and Codes of

Ethics for Nursing must always be upheld and performed by all healthcare members in all

situations involving patient care. Ethical and legal issues are always a concern in the healthcare

field. Healthcare has grown and developed over many years, some years greater than others, and

will continue to grow. Alongside healthcare growth technology has also moved forward quickly

piercing into the healthcare world. As this occurred and continues to occur it brings more focus

on new ethical and legal issues particularly involving informatics and the technology world of

healthcare regarding patient’s privacy and record keeping. Nursing being the first defense of

proper record keeping in patients EMR’s it is the Code of Ethics in Nursing that defines our

duties.
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Charting

Nursing has always been responsible for documenting in patients charts pertinent

information such as vital signs, complaints from the patients, assessment of the patient’s

conditions, medications given or not given, abnormal findings, and communications between

physicians and nursing. In the past 10 years this documentation has changed drastically from

paper to electronic medical records posing different challenges for nursing documentation. While

nurses documented on paper only the nurse in possession of the chart writing the information

could document on the patients chart then signing their name at the end. Now having EMR’s

nurses sign into a computer with either a badge or sign on name and password. The paper chart

identified the nurse without question who gave medications, charted vital signs, and who spoke

with the physician for communication of status and orders. As the EMR world has invaded the

healthcare world nurses now must be much more aware of documentation in patient’s charts.

This especially becomes concerning when in a trauma or CPR situation. The nurse documenter

on paper for such situations was only focused on documenting while moving to electronic

records nurses are now freer to move around the room to help facilitate patient care. This leaves

the nurse who is signed into the computer for documentation reasons vulnerable for other

colleagues to document under their name for patient information. EMR documentation also

presents how accurate can a nurse now document legally and ethically on a situation not being

able to link the appropriate nurse to the proper tasks completed. This is a legal and ethical issue

that is taken serious on many levels.

Legal Ramifications1

Legally the nurse who documents the information in a patient chart electronically is the one who

is responsible for the information. If another nurse gives medication and is not the one who
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documents that she gave the medication with her proper sign on and the documentation nurses

signs off on the medication given it is considered false documentation. Both nurses will be held

accountable for the improper documentation organizationally, state and nationally. Nurses now

must be aware of leaving the computer signed on to their personal log on and allowing others to

document under their name. Furthermore, nurses documenting must be aware that they do not

sign off on important tasks completed inappropriately not performing the tasks. As in paper

charting you were able to document who gave what medications and who performed other tasks

where as in EMR documentation this poses a potential oversight or unable to attach proper

names to tasks. It also can cause a delay in real time accurate accounts of patient care waiting for

the nursing staff to finish the trauma/CPR code before documenting what they personally

contributed to the patients care.

Code of Ethics for Nursing.

Almost every provision in the Code of Ethics for Nursing can pertain to the relationship

between nursing and proper documentation in patients records. Provision 4 and 6 relates to EMR

documentation. Provision 4 states the nurse has authority, accountability, and responsibility for

nursing practice; makes decisions; and acts consistent with the obligation to promote health and

to provide optimal care. (“Code of Ethics PDF,” n.d.) Paragraph 4.1 addresses the responsibility

of the nurse to ensure the patient receives proper care and is accountable for their own practice.

Relating this to proper EMR documentation a nurse must be accountable for what they allow to

happen with their sign on and personal profile. 4.4 holds nursing accountable and responsible

for delegation of activities in accordance to organizational policies and state laws. As most

organizations have policies regarding EMR documentation and nurses being held accountable for

their personal sign on nursing is expected to uphold the policies to protect the organization,
INFORMATICS PROJECT 7

themselves, and the patients they care for. Provision 6 states the nurse, through individual and

collective effort, establishes, maintains, and improves the ethical environment of the work setting

and conditions of employment that are conducive to safe, quality health care. (“Code of Ethics

PDF”, n.d.) Both paragraphs 6.1 and 6.2 hold nursing accountable for virtues, morals, ethical

behaviors. EMR documentation is based around these characteristics of individuals and the

moral habits and behaviors that nurses exhibit while using electronic documentation. Since most

morals and values are learned behaviors that can be rewarded organizations focus on rewarding

nursing behaviors that exemplify proper use of EMR documentation. As real time documentation

of nursing care is vital for patients especially in trauma or CPR situations we must continue to

improve and protect nurses from legal and organizational failure. While a specific designated

documenter in code situations is used, they must appropriately label and document in the patients

EMR by linking the appropriate staff member to the task performed. In many areas of the EMR

there are spaces for flagged comments or drop-down boxes to associate co-workers’ names to the

performed tasks. This part of the documentation must be performed immediately. The nurse

responsible for documentation must also not leave the computer without logging off their

personal profile for any reason. If a colleague needs to document something “fast” they must

keep the behavior with morals and virtue values to sign off and allow the colleague to sign on

themselves to document. The other way a documentation nurse, especially in the trauma and

CPR codes, can accurately document while assisting their colleagues to maintain proper EMR

documentation is to revert back to keeping a paper log of when, what, and who performed what

tasks allowing their colleagues to document after the initial patient encounter is finished. As in

all nursing care electronic medical records posse another avenue for nursing to be cognitive of

upholding organizational policies, state and national laws while protecting their own profession
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and patients’ rights. The Code of Ethics for Nursing alongside of state regulations and laws and

organizational policies must be the trusted documents for nurses to refer to and perform by.

Keeping the virtue morals, values, and integrity of their own selves and nursing career will

continually guide us to complete the correct actions and behave in manners that are consistent

with proper use of EMR documentation.

Trauma Code Current Workflow

Trauma code activation is generated from EMS call board into the Emergency

Department. The unit secretary calls communication giving them the Trauma code and an

estimated time of arrival. Communication overhead pages and electronically pages the trauma

code activation. Nursing, radiology, pharmacy, anesthesiology, emergency physician, trauma

surgical physician assistant, security, ems, clinical administrator, registration and patient care

assistant reports to the trauma bay in the ED. Each representative must sign in by hand on the

sign in sheet usually located inside the room with the nurse documenter. The nurse documenter

obtains the trauma code flow sheet and massive transfusion protocol release to begin

documentation. Security clears the ambulance entrance and facilitates a clear path for the

arriving patient and healthcare mobile team to arrive. Patient is brought to the trauma bay where

the transporting paramedic with ems team begins to give the healthcare team report of the

mechanism of injury and patient condition followed by treatment received. EMS team member

gives registration patient information if available. Nurse documenting hand writes all

information down on paper flowsheet from paramedic report. Nursing and ED physician at

bedside transfer patient to stretcher, begin the proper trauma guidelines of care by stripping

patient of all belongings and clothes handing them to security. Patient assessment, vitals, weight,

and condition called allowed from bedside for nurse documenter to record. MTP (Massive
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transfusion protocol) initiated by paper and patient care assistant takes the paper with patients’

information to blood bank to retrieve blood products in a cooler. IV’s started and blood drawn

placed on the surface next to the nurse documenter until orders have been properly placed in the

EMR and proper identification is on the patient with a name band. Registration registers patient

with portable computer but must run to the registration window in the ED waiting room to

retrieve the patients name band and stickers. Radiology signs in waits to hear if there will be

bedside x rays that are needed first or if a cat scan will be priority. Depending on if radiology is

released from bedside radiology will return to the cat scan unit to prepare the cat scan for a pan

scan of the trauma patient. Clinical administrator will run for equipment needed or to facilitate

immediate transport to a higher level of care, prepare OR for immediate surgery, or secure an

intensive care unit bed assignment. Vital signs will be monitored with a Philips bed side monitor

but transcribed onto paper until EMR is initiated with triage 1 and monitor linked to patients

EMR. After priority care is completed and proper diagnostic studies are completed nurse

documenter will sit down at a computer to input the information from the trauma paper

flowsheet, vital signs, input physician orders completed, and sent lab work off. After level of

care determined patients documentation will be transitioned from paper to EMR and the unit

secretary will ensure after all participating parties of the healthcare team have signed both the

trauma flow sheet and sign in sheet the paper portion will be scanned in to merge with the

patients EMR.

Refer to Table 1

Trauma Code Revised Workflow

Trauma code activation is generated from EMS call board into the Emergency

Department. The unit secretary calls communications giving them the trauma code activation and

estimated time of arrival. Communications overhead pages and electronically pages the trauma
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code activation team. Registration automatically sets a Patient 1 trauma code EMR chart ready to

receive information for the patient arriving. Emergency physician, nursing, anesthesiology,

trauma surgical physician assistant, security, radiology, ems, clinical administrator, patient care

assistant, blood bank, and laboratory all receive the page. They all report to the trauma bay

where there is a badge sign on device on the outside wall of the bay. They tap their badge

electronically populating the Trauma patient 1 EMR that they have arrived date and time

stamped. The Security clears the ambulance ramp and hallways for the patient’s arrival. Patient

arrives to the trauma bay nurse documenter transcribes report from the paramedic/ems into the

Patient 1 Trauma Code EMR. Patients EMR trauma flow sheet does have the ability to

document what was performed and by who with drop down boxes prepopulated with the names

of the healthcare team that signed in by using their badge. Patient belongings given to security

and documented in the EMR. During this procedure the registrar is merging the Patient 1Trauma

Code EMR with the proper identification of the patient and printing the name band from the

portable workstation at the entrance of the trauma bay. Patient Assessment and treatment begins.

IV’s are placed and blood is drawn. Physician orders are entered real time by nurse documenter

populated with proper physicians’ names. As the Phillips bedside vital sign monitor is

preassigned to the computer to auto populate vital signs to the patients EMR the nurse

documenter clicks in the vital signs section of the EMR documenting real time vitals.

Blood work is properly identified and labeled with Patient 1 Trauma Code and taken by the

laboratory tech to the laboratory for quicker results. Blood bank arrived on sign in with the

Massive Transfusion Blood in the cooler and has appropriately handed off the cooler to the

Nurse documenter. The cooler with the blood has a tracking scanner device that associates it with

the patient. Radiology is at bedside for x-rays if needed or may be released to perform priority
INFORMATICS PROJECT 11

CT Scan. Order is already documented by the nurse documenter in the EMR if CT scan is

needed, so the CT Scanner is already prepared to use. The Clinical Administrator is preparing the

OR in case of the patient’s surgical needs and obtaining an ICU bed assignment. EMS is on

standby in the Emergency department in anticipation for the patient to need higher level of care.

Patient treatment is decided and the EMR along with the imaging can be pushed over to the

receiving facility, OR, or ICU for quicker, more efficient, accurate continuum of care. The blood

is not wasted because the tracker with patient identifier can be safely transferred to the ICU or

OR. The ED nurse is now relieved to continue other patient care.

Overall the patient care improves giving nursing and physicians increased bedside patient care.

The common delays related to a trauma code patient’s care being to the OR, ICU, or a higher

level of care facility is decreased. The organization’s cost decreases by reducing paper use,

errors, and decreasing incidental overtime by employee’s time documenting.

Refer to Table 2

Evidence Based Practice

Electronic medical records (EMR) is used in several areas of health care including

hospitals, long term care facilities, outpatient services, physicians’ offices, and home health

agencies. EMR’s are and will always be developing to be more efficient and user friendly. In

the acute care setting of a hospital EMR’s have improved patient outcomes, patient

satisfaction, physician communication, and team collaboration. The use of computer

documentation versus paper is improving data collection and completeness of charting

increasing accuracy and real time reporting of patient’s conditions. Several aspects of the

patient’s chart are implemented and used currently. Pharmacy uses the EMR for orders and

documentation of medications administered with accurate time stamps. Laboratories report lab
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results instantaneously especially high alert or critical values to physicians and

nurses. Emergency rooms utilize EMR’s for registration, triage, physician orders, and nursing

documentation of assessments, medication, and patient interactions. All this pertaining to

EMR documentation except the trauma flow sheet and code blue recordings.

Most trauma centers choose not to use the EMR Trauma flow sheet although they use EMR’s

for all other documentation purposes because of the fast pace demand during a Trauma Code.

Most facilities did not choose to use the EMR version of the trauma flow sheet due to the

intimidation of the length of the paper version being reworked into a component of the

EMR. It was a 12-month journey with a multidisciplinary team created of registration,

trauma surgeons, emergency managers, emergency trauma nurses, patient care assistants, IT,

and nursing informatics. Four trauma cases from paper documentation along with the

guidelines from the TNCC and ACS nursing processes guided the build of the software and

educational pieces. For success the EMR Trauma flowsheet must document trauma activation

time, classification, surgeon arrival time, Glasgow Coma Scale score and vital signs. After

identifying the crucial primary elements, they developed an educational process that was not

extremely lengthy and was user friendly. In a study conducted at the Oregon Health and

Science University pre and post EMR trauma flow documentation there was an overall

improvement and consistency of documentation in the Trauma EMR versus the paper

flowsheet version. The review committee compared 40 components of the trauma flowsheet

between EMR and paper. After the go live of the EMR version of trauma documentation they

found 18% degradation, and 25 % of improved completeness out of the 40 data components

chosen along with 80 % satisfaction from nursing staff using the EMR trauma flowsheet.

(Bilyeu & Eastes, 2013, p.167) Gunderson Health System also conducted a study of the
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implementation of the Trauma flowsheet into the Electronic Medical Record having similar

findings and reporting’s as Oregon Health and Science University’s study. Gunderson Health

System identified key aspects that was needed to implement the design and successful go live

with a trauma flowsheet electronically. These key lessons are: The programmer needs to be

aware of the capabilities and limitations of the EMR utilized within their organization and

then capitalize on that understanding. If the programmer does not have a clinical background

including trauma and emergency department experience, meetings must occur with the

bedside clinicians to understand the workflow. And testing the report with actual patient data

identified faults in the reports that were not identified until that step was included.

(D’Huyvetter, Lang, Heimer, & Cogbill, 2014. P.69) As the electronic medical record keeps

developing and improving more trauma facilities continue the switch from paper flowsheets to

EMR flowsheets. As companies learn from systems such as Oregon Health and Science

University and Gunderson Health System the trauma flowsheet continues to improve with

ease of use, data collection, completeness of patient documentation, and nurse satisfaction.

Nursing is a career that is continuously developing, changing, learning, and

researching healthcare topics including patient care, safety, and documentation. Paper

charting has been incorporated into nursing care for numerous years but as the technology

world has developed rapidly and is integrated into the healthcare world nursing

documentation has changed forever. Understanding informatics especially nursing

informatics allows the nursing world to embrace the newest documentation era of Electronic

Medical Records. Having patient history, primary physician notes, lab results quicker and

physician orders quicker; patient care has become more holistic, safer, and more efficient than

when documentation was on paper. The continuing change in structure of nursing careers
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involves informatics the more nursing will have a say in what computer programs and

documentation needs are needed to continue the improvement for patients and staff.

Policy

Trauma Flow Sheet Documentation

Policy Statement

Data will be collected using the EMR trauma flow sheet in a manner that ensures it is
relevant, timely, accurate, transparent and accessible.

Data will be assessed and managed in accordance with the ACT Health Data Quality
Framework to ensure that it is of a quality that is fit for purpose.

Correction of data will be done within 24 hours of patient arrival.

Purpose

The primary purpose of this policy is to ensure that accurate and timely documentation is
complete to support patient care during a trauma and facilitate expedient EMR’s for transferring
trauma patients within the facility or to a higher level of care facility.

The documentation will be collected for data and quality improvement for the trauma
patient workflow.

Scope

The policy applies to all nursing, physicians, patient care techs, and all other employees
that document during a trauma code.

All documentation of trauma patients will be complete, accurate, and timely according to
this policy.

Roles & Responsibilities

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It is the responsibility of all staff to ensure that data are:

 collected and recorded promptly and accurately at the time of patient care.
 collected in accordance with standards and documented procedures.
 appropriately updated as required to reflect changes in accordance with standards and
documented procedures; and
 corrected in a timely manner based on documented evidence in accordance with
standards and documented procedures.

All staff members have obligations to maintain proper documentation:

 contractually (contract of employment, service contract); and
 ethically (professional codes of practice).

More specific roles and responsibilities are outlined below. It is important to note that a
staff member may have more than one role at a time and that their roles may change for different
data.

Executives – All Senior Executives and Executive Directors are expected to:
 support the implementation of the trauma flowsheet documentation in the EMR and
collection of data for quality improvement.

Managers – Staff with a supervisory role should:

 ensure that staff are educated on the trauma flowsheet in the EMR
 ensure that staff are documenting in real time during patient care and according to the
facilities documentation policy.
 ensure that staff are
ICT Personnel –Staff members providing ICT support will:
 address system related trauma flow sheet program errors
 maintain updates and changes in a timely manner to the trauma flow sheet within the
EMR
 address system issues in a timely manner and ensure that stakeholders are identified of
issues that may impact data quality; and
 identify ways to improve data source information systems using the data quality
improvement cycle.

System Trainers –Staff members that train others in the use of the trauma flowsheet
EMR
will:
 promote bedside real time documentation of trauma patient
 include training materials the help facilitate complete accurate timely documentation on
the trauma flow sheet in the EMR according to the facility documentation policy

Data Managers and Analysts – Staff members that manage or analyze data will:
 address Data Quality Issues with the appropriate staff and managers
 ensure that relevant data standards are applied to the trauma flow sheet EMR
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 provide guidance on Data Quality Issues and problem resolution regarding the trauma
flow sheet EMR
 review and report on data quality including completion and use of the trauma flow sheet
EMR
 conduct root cause analysis of data issues regarding the trauma flow sheet EMR
 identify ways to improve the trauma flow sheet EMR

Clinical and Administrative staff – Staff members that capture or enter data on a form,
in a medical record, or in a system must:
 ensure data are captured and validated at the point of trauma patient contact.
 respond to any Data Quality Issues raised by the client.
 ensure data are correct, current and complete throughout the trauma flow sheet EMR
 ensure data are entered as close to real-time as possible.
 report Data Quality Issues as they are identified to the appropriate manager.
 escalate Data Quality Issues that impact on patient safety to the manager as a priority.
 participated in data quality collection and resolution regarding the trauma flow sheet
EMR
 address feedback regarding trauma flow sheet EMR from management and staff members
that participate in the resolution of issues as appropriate.

Evaluation

Outcome Measures

 The time from trauma patient arrival to transfer to in-patient unit, OR, or other facility.
 Data collected will be used to:
a. benchmark nurse patient care time and appropriate completed documentation of the
trauma patient
b. monitor improvements in delay of care of the trauma patient.

Method

Monthly the trauma subcommittee will collect data from the trauma flow sheet EMR
measuring completeness, accurate, timely documentation. Time of trauma activation to
patient arrival, time of trauma activation to arrival of all staff to report to the trauma
activation, door to doctor time, and patient arrival to decision to transfer or admit will be
measured.
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References

Bilyeu, P., & Eastes, L. (2013). Use of the Electronic Medical Record for Trauma

Resuscitations. Journal of Trauma Nursing, 20(3), 166-168.

doi:10.1097/jtn.0b013e3182a17195

Code of Ethics PDF. (n.d.). Retrieved from https://www.nursingworld.org/coe-view-only

Digital working is changing nursing.pdf. (n.d.). Retrieved from

https://drive.google.com/file/d/0By7MluRtLS9sS2EwQUZudzlRXzQ/view

D’Huyvetter, C., Lang, A. M., Heimer, D. M., & Cogbill, T. H. (2014). Efficiencies Gained by

Using Electronic Medical Record and Reports in Trauma Documentation. Journal of

Trauma Nursing, 21(2), 68-71. doi:10.1097/jtn.0000000000000031

Ethical Issues in Nursing Informatics. (2013, April 19). Retrieved from

https://cnornurse.wordpress.com/2013/04/19/ethical-issues-in-nursing-informatics/

Health-Informatics-and-Technology-Professional-Responsibilites-QSEN-ppt.pptx. (n.d.).

Retrieved from

https://docs.google.com/presentation/d/1KY_MJZFgt3eWJLTUdmEROem0hTj0yZSNL

0q8KSIgQhM/edit

Kuo, K. M., Chen, Y. C., Talley, P. C., & Huang, C. H. (2018). Continuance compliance of

privacy policy of electronic medical records: the roles of both motivation and

habit. BMC Medical Informatics and Decision Making, 18(1). doi:10.1186/s12911-018-

0722-7

No peeking allowed. (2016). American Nurse Today official Journal of the American Nurses

Association. Retrieved from https://www.myamericannurse.com/no-peeking-allowed/

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Rigby, M., Magrabi, F., Scott, P., Doupi, P., Hypponen, H., & Ammenwerth, E. (2016,

October). Steps in Moving Evidence-Based Health Informatics from Theory to Practice.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116536/

Sewell, J. P., & Thede, L. Q. (2013). Informatics and Nursing: Opportunities and

Challenges (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Successful Implementation of Electronic Trauma Documentation in a Level III Trauma Center-

It Can Be Done! [Web log post]. (2018, July 10). Retrieved from

https://www.himss.org/library/successful-implementation-electronic-trauma-

documentation-level-iii-trauma-center-it-can-be-done

Swan, B. A., Lang, N. M., & McGinley, A. M. (2004). Access to quality care: Links between

evidence, nursing language, and informatics. Nursing Economics, 22(6), 324-332.

Retrieved from

https://jdc.jefferson.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1006&cont

ext=nursfp
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Table 1

Trauma Code Activated by

EMS to ER
Unit Secretary Calls
Communications

Communications
Activates Trauma Code
Overhead/Electronic

Healthcare Team reports

to Trauma Bay

Healthcare Team Signs

On Sign In Sheet

Security Clears
Ambulance ramp and
hallway to Trauma Bay

Patient arrives to Trauma

Bay

Registration takes Patient Registration retrieves

Patient Care Tech information and Nurse Registration Patient Identification
Retrieves Blood from Documents on Trauma Band and Stickers
Blood Bank Flowsheet

Patient belonging to
security

Patient's Blood Drawn Patient Assessment and

Treatment

Blood sent to Lab

Patient needs No Radiology Released

Bedside Xray's to Prepare CT Scan

Yes

Radiology Performs
Bedside Xray's then
Prepares CT Scan

Transfer
Patient to
Higher Level
of Care No

Clinical Administrator
Patient to OR
Obtains ICU Bed
Yes No

Healthcare Team
Arranges Transportation
to Higher Level of Care Yes
Facility
Clinical Administrator
Preps OR

Nurse Documenter
Transcribes data from
paper to EMR

Patient Arrives in
Appropriate care area
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Table 2

Trauma Code Activation

From EMS to ED

Unit Secretary Calls

Communication to
Activate Trauma Code
Registration
Creates
Communications pages Trauma
Overhead/Electronical Patient 1
Trauma Code EMR

Healthcare Team Reports Security Clears

Blood Bank Arrives to Trauma Bay and Ambulance Ramp and
with MTP Blood Electronically Signs in Hallways
cooler

Patient Arrives to Trauma

Bay

Nurse Documenter Enters

Patient Information Report from Patient belongings given
received and merged EMS/Paramedics into to security
into EMR by EMR
Registration

Patient assessment and

treatment begin
Patient Arrives to Facility Vital Signs, orders, and
tasks performed input in
EMR real time
IV's placed blood drawn
labels taken to laboratory
EMR and Imaging
sent to receiving
facility
Patient needs
bedside x ray's No Radiology returns to CT
Scanner
EMS on Standby Prepares
transportation.

Yes Patient needs

OR Yes
No Radiology Tech performs
Patient needs X ray's
Higher Level
of Care

Yes
Clinical Administrator
Preps OR

No
Clinical Administrator
Assigns ICU Bed

Patient Arrives to ICU