NEXTGEN NURSE VISIT(OBGYN)

DEMONSTRATIONThis demonstration reviews examples of nurse visits using the OBGYN templates.

This has been prepared with EHR 5.6.5.61 and KBM 7.9.1. Subsequent updates may display cosmetic and functional changes.

Use the keyboard or mouse to pause, review, and resume as necessary.

There is no audio with this exercise.

Example 1: Pregnancy Test

In this example, a patient comes in for a pregnancy test. This will be completed by the nurse.

If the OBGYN-Home template does not display spontaneously, click the Template Module.

Select OBGYN-Home. (This will be among the recommended preferred templates at setup.)

The nurse opens patient’s chart. If necessary, display the History Bar and create an encounter for today by clicking New.

Select visit type of Nurse Visit.

If necessary, select New vs Established patient.

Select your provider, e.g., the clinic supervising attending that day.

(The nurse is likely working with several providers at a time, so it is important to confirm this selection from patient to patient.)

Perform the 4-Point check.

Patient

Location

Provider Date

Click in the first Reason for Visit box, select the blank at the top of the list, then type Pregnancy test.

It is often clinic policy to record some vital signs at nurse visits.Right-click on the Vitals grid and select Add new.

Record vital signs.

When done, click Save, then Close.

Vital signs display in the grid.

Perform the urine pregnancy test, then go to Nurse Doc.

Click Office Diagnostics (sometimes labeled “Office Services”).

Scroll down the list until you see the line for Urine pregnancy test associated with the diagnosis of Scanty or infrequent menstruation 626.1.Click on this.

Click in the Display order set box and select Office Tests.

The test, associated with this diagnosis, appears here.

If you don’t see the test associated with a satisfactory diagnosis, you can click Add or Update Assessment.

You’ll probably see the diagnosis you need on one of the lists here; if not, you can use the available methods to search for it.When done, click Save and Close.

If there is a test/diagnosis combination that is frequently used that you don’t see on the Office Tests order set, notify the EHR Team, so that they can add it.

Enter the result in the Detail box.

Click Submit to Superbill, then Place Order.

When done, click Close.

Inform the patient of the result, and send her to checkout.

Display the Nav Bar if necessary, and click Offline to generate a brief note documenting this visit. (You could click Preview to generate the note in real time, but it could take several moments, preventing you from moving on to other work.)

Example 2: Depo-Provera Shot

In this example, a patient comes in on schedule for her Depo-Provera injection.

If the OBGYN-Home template does not display spontaneously, click the Template Module.

Select OBGYN-Home. (This will be among the recommended preferred templates at setup.)

The nurse opens patient’s chart. If necessary, display the History Bar and create an encounter for today by clicking New.

Select visit type of Nurse Visit.

If necessary, select New vs Established patient.

Select your provider, e.g., the clinic supervising attending that day.

(The nurse is likely working with several providers at a time, so it is important to confirm this selection from patient to patient.)

Perform the 4-Point check.

Patient

Location

Provider Date

Click in the first Reason for Visit box, select the blank at the top of the list, then type Depo-Provera.

It is often clinic policy to record some vital signs at nurse visits.Right-click on the Vitals grid and select Add new.

Record vital signs.

When done, click Save, then Close.

Vital signs display in the grid.

Give the injection, then go to Nurse Doc.

Click Office Diagnostics. (Obviously, a Depo-Provera shot is not a diagnostic study, but you’ll see where we’re going in a minute. In some places this will have the more appropriate label of “Office Services.”)

Scroll down the list until you see the line for Depo-Provera associated with the diagnosis of …Contraceptive management V25.09.Click on this.

Click in the Display order set box and select Office Meds.

Click Place Order.

The injection appears on the Today’s Orders grid. Double-click on this.

Click Completed.

Click in the Admin/other 1 box, and select Ther/Proph/Diag Inj, SC/IM in the popup.

If you don’t see the administration code on this popup, you can click the Dropdown Arrow to search for other codes.

Click Submit to Superbill. Text confirms the submission of the injection and the administration code.

When done, click Save, then Close.

Click Close again here.

Send her to checkout, if you haven’t already.

Display the Nav Bar if necessary, and click Offline to generate a brief note documenting this visit. (You could click Preview to generate the note in real time, but it could take several moments, preventing you from moving on to other work.)

This concludes the NextGenOBGYN Nurse Visit

demonstration.

If the #2 pencil is the most popular, why is it still #2?

This concludes the NextGenOBGYN Nurse Visit

demonstration.

If the #2 pencil is the most popular, why is it still #2?