Nursing Inbox

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Inbox Navigation

Sign/Review Button

Edit/Accept Final Review Button

The Nursing Inbox will show you the details of any new, changed, discontinued, held, or unheld orders as well as radiology and laboratory results. It is through the Inbox that you will review and then acknowledge the orders and results by signing them electronically.  This acknowledgement is captured in the system Audit Trail. Once items are signed-off, they will be cleared from the inbox. Chart Review may be used if you need to see the items again after they have been signed off.

Important: Nursing students are not permitted to sign off items in the Inbox. Students use the Inbox to review new information about their patients only, therefore, are not to use the Sign/Review button or Accept Final Review button.

Inbox Navigation

1.   From the Patient Desktop, Patient Shortcuts menu, click Nursing Inbox.

The Nursing Inbox is divided into two main sections.

Note: You can sort by any of the column data by clicking on the headers.

1. Summary Grid:

Contains a count of items, organized by Kardex group on the far left (e.g. Laboratory, Radiology, etc.) and by item type.

The item types are outlined by the remaining columns, and indicate the following:

·         Criticals/Abnormals: displays the number of items that have returned critical or abnormal results. The colour coding for this column will be explained later.

·         Stat: displays the number of items that have been ordered as STAT. The physician must still verbally communicate any STAT items, as well as any items with a frequency of now.

·         Action Items: displays action items for physicians only. Nurses should not see anything in this column If you notice an order under this column please contact the Help Desk.

·         Orders to Review: orders that need to be reviewed  

·         ASO Orders to Review: column not used at UHN for Nursing Inbox

Note: To filter the items shown below, click on column or row headers. To show all items, click on All in the top left corner of the Summary Grid.

2. Summary Details:

Shows details for the Summary Grid items and organizes them according to category as indicated by teal banners and are as follows.  

·         Review Orders: orders that need to be reviewed

·         Review Results:  results that need to be reviewed

·         Discontinue Orders: orders that have been discontinued

The columns in the Summary Details section indicate the following:

·         Kardex:  category of item

·         Event time: time the result or order was entered into the system

·         Procedure: the name of the procedure or medication

·         Order/Result Information: displays the order or result information

·         Stat: displays the word “STAT” if the order was entered as a STAT item

·         Type: displays order type (new order, hold order, change order etc)

·         Status:  displays status of order or procedure (ie. Complete, active, etc.)

·         Colour coding:  indicates whether the item is critical (red exclamation mark), abnormal (bold and underlined) or a combination thereof

·         Indicators:  icon appears if there is extra information for the item. You can hover to read more, but have to open the item in full to read all the details.

-      Advisories (red exclamation marks!) could indicate a duplicate order, a potential for interaction with an existing order or that there are documented allergies to the drug or family of drugs.

-      Instructions (red pound/number sign#) could have medication product instructions for the order.

Note:  Right clicking on an event in the Inbox, gives you shortcuts to additional options such as Trend and Review Previous Results from which you can print.

Sign/Review button

The Sign/Review button removes the selected item(s) from the Inbox immediately and puts your electronic signature as the nurse who reviewed it. Only use this button when you are sure you reviewed all the details, like for a simple result value or discontinue order.

1.   Choose the appropriate order by clicking on it. If you wish to choose multiple orders, hold down the Ctrl key while clicking on the orders.

2.   Click on the Sign/Review button.

Note: You may notice the Select All button at the bottom of the screen. This will allow you to select all items in the Inbox. This button should be used with caution for two reasons:

·         If there are too many orders selected and then signed, the system may freeze. By clicking the Select All and then the Sign/Review button you are electronically acknowledging that you have read the order(s).

·         Using Select All and Sign/Review does not allow you to see the full details of an order.

Edit/Accept Final Review button

The Edit button opens the item full-screen so you can review the full details of the item. For example, you can read Advisories and special instructions from here by using the option buttons. Order details that are new on this screen includes anything in the top blue section, like who placed the order or if the drug has unique handling instructions. You can also look at the Department Reviewed field to see if Pharmacy has verified the order. If the item is a result, you may want to use the button options for lab trending or graphs.

1.   To view all the details of an order, and then sign off on it, choose the order(s) you wish to review, then click on Edit (bottom right hand side of screen).

The order details are now displayed on the screen. Click here for more information on fields displayed in the order.

It is important to ensure that you are viewing all information, so if a scroll bar appears, be sure to scroll through all fields. To electronically acknowledge and sign off the inbox item, choose the Accept Final Review button

When viewing an Inbox item in edit mode, the Additional Review option will appear when looking at results. Click Additional Review.

Additional review options will appear, such as Graph or Trend. Choose one of these options to view results in one of those formats.

Note: Allowing orders to accumulate in the Nursing Inbox results in the failure of the Whiteboard order notifications to update. Since there are always icons on the Whiteboard, you will never know whether there are new items for you to review on your patient.

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