NUR Flowsheet

Has anything changed from previous versions?

  • Code for printing flowsheets has been moved from PCI to NUR.
  • The existing standard flowsheet will be converted to standard flowsheet sections and a standard flowsheet format for each paper size (8.5 x 11, 8.5 x 14, 11 x 17) and orientation (landscape or portrait).
  • Customer defined flowsheet formats will also be converted to flowsheet sections and a corresponding entry in the Flowsheet Format Dictionary.
  • There are two new dictionaries: the Flowsheet Section and the Flowsheet Format.
  • Flowsheet Section Dictionary functions:
  • Organizes result data.
  • Groups result data.
  • Cell size defined.
  • Label format defined.
  • Result and label print graphics defined.
  • Flowsheet sections may be defined as either a graph, or as one of two spreadsheet formats.
  • Result data can be grouped into sections.
  • Totals and balances can be calculated using algorithms.
  • Flowsheet Format Dictionary functions:

Defines:Time Selections

Section Organization

Print collation

Grid formats

  • Different entries may be created in the Flowsheet Format Dictionary to accommodate different types of patients, purposes, results, and reporting needs. Defaults can be defined for nurses, locations, or for the entire facility.
  • For each entry in the Flowsheet Format Dictionary, you can define:
  • How sections are sorted (logically group results)
  • How time periods are built (using grid formats)

The Flowsheet Section Dictionary

This dictionary contains fields that relate to the printing of results on the flowsheet. Entries are either graphs or a spreadsheet with times printing across or down. You do not, however, define the time period for which results will be printed. This is done in the Flowsheet Format Dictionary.

Spreadsheet sections always adhere to the following formatting rules:

  • The spreadsheet section will be surrounded by a box.
  • Grid lines will appear between cells, as well as between cell column
    headers and results.
  • Rows within the results will alternate between a gray and white background.
Page One of the Flowsheet Section Dictionary

Mnemonic

Function: Uniquely identifies an entry in the Flowsheet Format Dictionary.

Required: Yes.

Response: A unique name, up to 10 characters in length. It is recommended that the mnemonic be a short, easily recognizable abbreviation for the flowsheet section, and should indicate what is included in the section.

Mnemonic (Continued)

Comments: In the dictionary, there will be several sections whose mnemonics are prefixed with a period. These are default entries that are based on the standard flowsheet data. Although the entries may be copied to new mnemonics and edited, you will not be able to directly edit any entries whose mnemonics are prefixed with a period.

The actual data which are included in the "." sections are defined on page two of the NUR Parameters (the “Intake”, “Output”, “Vital Signs”, and “Vital Sign Source” fields) and in the MIS Clinical Parameters (“Weight in Pounds” and “Weight in Ounces” or “Weight in KG”). Whenever an edit is made to the entries in the NUR Parameters, the system will automatically update the appropriate default Flowsheet Section Dictionary entries.

Active

Function: Determines whether the entry is being used in the Nursing module.

Required: Yes.

Response: Y or N. Y indicates that the entry is currently being used; N indicates that the entry is no longer being used in the Nursing module.

Type

Function: Defines the type of entry that is being created in the Flowsheet Section Dictionary.

Required: Yes.

Response: There are three possible choices:

  • GRAPH
  • SS/TM ACROSS (Spreadsheet Time Across)
  • SS/TM DOWN (Spreadsheet Time Down)

Comments: The entry in this field will define the prompts that will appear on page two of the Flowsheet Section Dictionary. If a section has already been filed, changing the entry in the "Type" field will delete the information on page two. There is a warning message, however ("Changing type will delete second page. Continue?").

Description

Function: Fully describes the flowsheet section that is being defined.

Required: Yes.

Response: Free text, up to 30 characters.

Comment: The description of the flowsheet section should indicate the contents of the section to users. This will make selecting the appropriate section easier when attaching it to entries in the Flowsheet Format Dictionary.

Date Format

Function: Allows you to define the format that will be used to display dates for entries in the section being defined.

Required: Yes.

Response: There are three possible responses for this field:

  • MM/DD (DD/MM for non US sites)
  • MM/DD/YY (DD/MM/YY for non US sites)
  • DAY - MON DD (DAY - DD/MON for non US sites)

Date Label Print Attributes

Function: Allows you to define how dates will appear on the printed flowsheet.

Required: No. If there is no entry made to this prompt, dates will print normally.

Response: There are three possible entries that can be made at this field. A lookup is available:

  • B – Bold
  • I – Italics
  • BI – Bold Italics

Label Width

Function: Defines the number of characters used for the label column(s).

Required: Yes.

Response: A number between one and 99

Comment: The impact of this entry will depend upon the section "Type" of flowsheet section that is being defined:

  • GRAPH – This number represents the number of characters of space which will be left between the Y-axis scales and the graph labels which print on the left and/or right sides of the graph picture. This value will be used to facilitate lining up the graph with other sections.
  • SS/TM ACROSS - (Spreadsheet Time Across) the number of characters allowed for the row label(s) is defined and the minimum number of characters allowed for each result column.
  • SS/TM DOWN - (Spreadsheet Time Down) Defines the number of characters allowed for the date column, as well as the minimum number of characters allowed for each result column.

Label Print Attributes

Function: This prompt defines the print characteristics for the label text.

Required: No.

Response: There are three possible responses. A lookup is available:

  • B – Bold
  • I – Italics
  • BI – Bold Italics

Page Two of the Flowsheet Section Dictionary (Graphs)

The prompts that appear on the second page will be based on the entry in the “Type” field on page one. The following paragraphs describe the prompts associated with a GRAPH type section.


Include Visit Markers

Function: Defines whether the system will indicate data from separate visits when displaying the graph.

Required: No. If this field is left blank, the system assumes "N".

Response: This is a Y/N field. If the response is "Y", the system will place a small upward pointing arrow which will indicate the start of each new visit.

Comments: In addition to the arrows, which appear below the graph, the system will indicate the account number for each visit, as well as the Admit or Service date and time.

Print Vertical Dividers

Function: Defines whether the system will print vertical lines at the cell dividers, which separate the time increments for the graph.

Required: No. If this prompt is left blank, the system will assume "N".

Response: This is a Y/N prompt. If you would like vertical lines to be printed, enter "Y". Entering "N" or leaving this field blank will prevent the vertical lines from being printed.

# Characters per Cell

Function: This prompt defines the number of characters that will make up each cell for a graph.

Required: No, but if you leave this prompt blank, the system assumes "0", which will cause corruption.

Response: A number between one and 99.

# Characters per Cell (Continued)

Comments: A cell can be defined as a block of time that is covered by the graph. For example, if a graph covers a 48-hour time period, with 8-hour increments, there will be a total of six "Cells" or sections of the graph. The time frame covered by the graph, along with the total number of increments, will be defined in the Flowsheet Format Dictionary.

If your graph section has been attached to a flowsheet format, and you edit this value, you should refile all of the formats to which the section has been attached. If the total width of your graph exceeds the maximum number of characters allowed for a page format, users will not be able to print flowsheets using that format. The maximum number of characters allowed will vary, depending on several factors such as page size, font size, paper orientation, etc.

Graph Size

Function: Defines the percentage of the page that will be used for the graph section.

Required: No, but if this field is left blank, the system will generate a graph which will be unreadable.

Response: A number between 25 and 100. This number represents the percentage of the page that will be occupied by the graph.

Comments: If a large range of numbers is being graphed (defined in the Y-Axis # of Increments), there may be overlap with the numbers and or labels of the graph. Flowsheet graphs should always be tested, and the graph size increased if you find overlap on the graph labels.

Y-Axis # of Increments

Function: Defines the total number of labeled points along the Y (vertical) axis
for a graph.

Required: No, but if you do not define the number of Y-Axis increments, you will not be able to assign Low and High Values to the graph.

Response: A number between one and 99.

Comments: The number of Y-axis increments must be divisible into the range of values entered in the Y-Scale section. The quotient cannot have more than two decimal places.

The number of Y-axis increments will also define the number of characters that can be used in the Primary and Secondary graph labels.

Y-Axis # of Sub-Increments

Function: Defines the number of unlabeled increments between each labeled point.

Required: No.

Response: A number between one and 99.

Comments: The number of Y axis sub - increments must be divisible into increment size. The quotient cannot have more than two decimal places.

Y-Scale

Function: Allows you to select either a primary or secondary scale for which you would like to define the appropriate range of values.

Required: For graphs, you must define a primary Y-Scale. A secondary Y-Scale is not required.

Response: There are two options: “PRIMARY” and “SECONDARY”.

Comments: The primary scale will appear on the left hand side of the graph, the secondary scale appears on the right hand side of the graph.

A secondary scale is used if multiple queries with very different ranges are placed on the same graph.

Low

Function: Defines the value that will appear at the bottom of the graph for either the primary or the secondary range.

Required: Yes, if you have made an entry in the “Y-Scale” field.

Response: A number, either positive or negative. The system will allow up to two decimal places.

Comments: Placing the higher range value in the “Low” field can create a descending scale.

The primary and secondary scales are user definable and the increment sizes are computed based on the "Y-Axis # of Increments" and "Y-Axis # of Sub-Increments" (the computed values must divide equally into their respective range, to two decimal digits).

High

Function: Defines the value that will appear at the top of the graph for either the primary or the secondary range.

Required: Yes, if you have made an entry in the “Y-Scale” field.

Response: A number, either positive or negative. The system allows up to two decimal places.

Comments: Placing the lower range value in the “High” field can create a descending scale.

Incr Size (Increment Size)

Sub-Incr Size (Sub-Increment Size)

Function: Displays the size of the increments and sub increments for either the primary or secondary range.

Required: No. The system will automatically generate these values.

Response: These are view only fields.

Comments: The “Incr Size” value is generated by dividing the difference between the “Low” and “High” values by the entry in the “Y-Axis # of Increments” field. The “Sub-Incr Size” value is generated by dividing the “Incr Size” value by the entry in the
“Y-Axis # of Sub-Increments” field.

Label

Function: Defines the label which will appear alongside the Y- Axis for either the primary or secondary range of the graph.

Required: No.

Response: This is a free text field, up to 20 characters.

Comments: Although the field is 20 characters wide, the number of characters that one can enter for a label will be based on the entry in the “Y-Axis # of Increments” field. If the label has more characters than the number of Y-Axis increments, the following error message appears: “Label won't fit on the graph. Max chrs is X.” Where X is the number of Y-axis increments. The label for the primary scale appears on the left hand side of the graph, and the label for the secondary scale appears on the right hand side of the graph.

The Results Section

The Results section is where you will indicate the actual queries and/or lab tests whose values will be graphed for the flowsheet section.

Field Type

Function: Allows you to define the type of entry that will be graphed.

Required: No, but the graph will not display any data.

Response: There are two options: QUERY and LAB TEST.

CDQ/LAB Test (Customer Defined Query/Lab Test)

Function: Defines which lab test results or query responses will be placed on the graph.

Required: Yes, if there is a “Field Type” defined.

Response: If the “Field Type” is QUERY, you will select a query that from the MIS Query Dictionary that is linked to a PCI Section. If the Field Type is LAB TEST, you will select a lab test defined as Reportable on page two of the LAB Test Dictionary.

Comments: The flowsheet pulls its data from the PCI module, so if results are not available in the PCI module, the data will not appear on the flowsheet.

Queries or lab tests which do not generate numeric results should not be attached to the graph, as the system will not be able to plot values. The system will generate a warning message if you attempt to attach a query to the graph that generates non-numeric results.

Graph Type

Function: Allows you to define the type of graph that will be used to represent the values for the query or lab test identified in the “CDQ/LAB Test” prompt.

Required: Yes, if there is a “Field Type” defined.

Response: There are three possible options:

  • BP (blood pressure) - the MEDITECH standard pressure graph symbols and labels will be used. This entry will only be used for B (Blood Pressure) type queries.
  • REGULAR (regular) - the symbols and labels are user defined based on the following choices:
  • ASTERISK
  • CIRCLE *
  • DOT *
  • INV TRIANGLE
  • LINE *
  • TRIANGLE *
  • X *

The symbols followed by an asterisk are not available for use with queries that appear on the same graph as a query using the TEMP Graph Type.

If a lab test is entered in the “Field Type”, the “Graph Type” must be REGULAR.

  • TEMP (temperature) - the symbols and labels defined for temperature in the NUR Parameters will be used. The TEMP Graph Type can only be used for queries.

Symbol

Function: Allows you to define the points which will be used to plot values on the graph for queries or lab tests with a “Graph Type” of "Regular”.

Required: Yes, if the “Graph Type” is "Regular".

Response: There are seven choices: ASTERISK, CIRCLE, DOT, INV TRIANGLE, LINE, TRIANGLE, and X

Comment: If a “Temperature” graph type is used, you will not be able to select the Circle, Dot, Line, Triangle, or X symbols for your “Regular” graph. Each symbol can be used only once per graph.

Label

Function: Used to define the descriptive text that will be used in the legend for points on the graph.

Required: No, but users will not know what values are being charted on the graph.

Response: Up to 15 characters of free text.

Comment: You will only stop here for queries or lab results with a “Graph Type” entry of "Regular".

Disp NR (Display Normal Range)

Function: Defines whether or not the system will display the normal range for a query or lab test result on the graph.

Required: No. If this prompt is left blank, the system assumes "N".

Response: This is a Y/N prompt. A “Y” response indicates that you would like the system to indicate the normal range of values for a query or lab test on the graph. A response of “N” indicates that you would not like the normal ranges to display.

Comments: The normal range for queries is defined in the MIS Query Dictionary using the 1st and 2nd Reference Value fields. Lab tests have their normal range defined in the Lab Test Dictionary, and can be age and sex specific.

If only one normal value is defined for a query or lab test, a dashed line on the graph will represent it; a normal range of values is represented by a shaded area on the graph.

Primary/Secondary

Function: Defines whether a query or lab test will be graphed using the primary or secondary range of values.