Nova Downtime Override

Hi Cindy! Is there a particular area that you are seeing this issue? Are your meters the wireless model?

We use to see this in our emergency room when patient visits weren't yet "arrived." We also see this in observation patients (which are considered outpatients) that are on a unit with meters that are assigned to the inpatient nova bucket. Results still transmit to the chart, but it's definitely not ideal when we want that positive patient identification on the meter.

We see it when there is an interruption of the ADT service to Nova Net.  We get Nova to restart the service and it eventually catches up.  If that is the case, Nova needs to find the root cause.  Our most recent issue involved a change to one of the demographic fields that exceeded the character length for the field and stopped the interface when this occurred.  We had to modify the characters coming from our HIS.  This interruption has occurred a few times a year and is generally a different cause each time.  Our IT support team also has access to check the interface to see if it is running properly.

I also agree with Katherine and if you have your meters divided into buckets in Nova Net, you might want to ensure they are assigned for the patient population in that unit or if the meters have been moved.

Hi 
I have this problem in the emergency room when the admissions, discharges, transfer information doesn't match the patient's location, too.  Are the meters actually mapped to a certain location or do they get all the ADT messages from the whole hospital? 

Are staff scanning the patient's wristbands then having to override? This isn't ideal but staff must still ask for patient's name and DOB which is matched to the wristband.

How do you "see" the downtime override...middleware, NOVA-Net...etc? Are those results held for review or do they pass through to the EMR?
Thank you

It depends on the size of your hospital and the volume of patients that come thru your ADT interface.  A meter can only hold a limited number of patient registrations before it deletes the oldest records.  Some of the hospitals in my system only have a single bucket.  I have my meters mapped to either IP or OP depending on the unit and this mapping is in Telcor QML too.  When a user scans the patient's armband and the patient is not in the meter's patient list, they get the prompt to override or try to scan again.  Sometimes this catches scanning errors due to a defective barcode on the armband.  Even if the user overrides and the number is for a valid patient, the result will transmit as usual.  In order to monitor the volume of overrides, I can call up a report in QML using a downtime filter; when we don't have issues, my overrides are about 1%.

I've had the same experiences as those above. A couple years ago on the HIS side they started using new room definitions like "outpatient in a bed", "observation", etc. We weren't aware of the changes so we didn't have the chance to re-map these locations - outpatient in a bed is actually an inpatient in our system! Who would have known?! Those patients weren't getting to the correct patient bucket in Novanet. 
I would start with Nova and see if a service is down and if they can help look at the patient flow behind the scenes. Just be sure to have some recent examples. Then you can pull in your middleware vendor to help with mapping if needed. 

The issue is occurring throughout the hospital. Our meters are wired. Previously I would see it mostly in our ED patients or those pesky observation patients, but now it seems to be all over the place. The results are going to the patient charts, but I'm just concerned about not having that positive patient identification.

Vicky, you brought up some good points that I will run by the Nova support person. We have filtered out all of the outpatient statuses, so the meters should only be getting the inpatient. We are a small 100 bed hospital, so I wouldn't think the meter would have issues with holding the record, but I will look more into that.

Thank you for all of your input!

Amanda, I run a report in QML to show what samples staff used the downtime override on.

We have assigned bucket and the maximum number of patients able to be in each patient list/bucket is 3000. I monitor my patients in Nova daily to make sure we aren't getting close the limit. We have had issues if the discharges are not happening appropriately in Epic, we can see issues. I would find out from Nova what the max limit is per bucket and see if you have approached this or gone past it. Good luck Cindy!!!

Katherine,
When you say discharges were not happening appropriately in Epic do you mean the encounters were not getting completely closed? We have been seeing issues with patients not getting discharge in NOVA and we believe this is because of the Epic encounters. 

Thanks! 

Hi Brittany! That's exactly right. So I just went back to find out the exact issue for one particular instance - we had members of the Epic team troubleshoot when I found the problem, and they were able to find that the Cadence EOD Job had stopped. They needed to enable scheduling again.  Not sure if that is helpful information or not, but I would provide a few examples of visits in Nova and they should be able to see what's going on with them in Epic.  Good luck!!