In-Patient Features (IPD) in Bahmni - Active Development

Introduction:

While Electronic Medical Record (EMR) systems have emerged as a cornerstone in revolutionizing the way healthcare professionals manage patient information and streamline clinical processes, the In-Patient Department (IPD) module stands out as a pivotal component, redefining the quality of care provided to in-patients.

What is the IPD Module?

The IPD module is the center of inpatient care within any healthcare organization with an in-patient care facility. It is a tool designed to manage the entire lifecycle of an in-patient's stay, from admission to discharge and beyond. This module seamlessly combines patient records, treatment plans, medication administration, and communication channels into a unified digital platform.

Key Features and Benefits:

  1. Efficient Data Capture & IPD Operations: The IPD module allows healthcare providers to capture, update, and retrieve patient information effortlessly. Every detail should be digitally recorded and instantly accessible, along with a holistic view of the IPD Activities.

  2. Care Coordination: This module facilitates seamless communication among the multidisciplinary healthcare team, ensuring that everyone involved in a patient's care is on the same page. Real-time updates and alerts keep all stakeholders informed.

  3. Medication Management: From prescription to administration, medication records are meticulously tracked, thus, minimizing errors, ensuring patient safety and optimizing the efficiency of the healthcare resources.

  4. Analytics and Reporting: Robust reporting tools within the IPD module empower healthcare administrators to assess departmental performance, monitor trends, and make data-driven decisions for process improvement [Later Phase].

  5. Patient Engagement: Patients and their families can access relevant information through secure portals, enhancing engagement and fostering a sense of empowerment in their care journey [Later Phase].

Figma Design UI Mockups (Under development)

Figma Link containing the mockups which are being designed/discussed: https://www.figma.com/file/P03DTVYO1zfD0lOzQKrn2b/MileStone1?type=design&node-id=5770%3A2511&mode=design&t=nVZQfKyEwwOLZgnh-1 (view only)

Prime Personas in IPD Module:

  • Provider (Doctor)

  • Head Nurse

  • Ward Nurse

  • ADT Clerk

  • Patient

IPD Workflow Persona-wise:

Provider:
image-20240107-102010.png
Head Nurse:
image-20240107-102059.png
Ward Nurse:
image-20240107-155326.png

IPD Workflow:

From Rx creation to listing in ‘Treatments’ section:
  • The Doctor creates the prescription in the Medications module to be administered in the IPD.

  • In the mean time, the patient gets admitted in the IPD.

  • In the ‘Visits' section of the existing Clinical Dashboard of the patient, system displays the link for the corresponding active IPD visit.

  • The user (user can be either Doctor or Nurse) clicks on the active IPD visit link.

  • System takes the user to the new IPD Dashboard.

  • All the prescribed medications are listed in the ‘Treatments’ section.

From scheduling medication tasks corresponding to the prescription to displaying in ‘Nursing Tasks’ as well as in the Drug Chart sections:
  • The Nurse clicks on the ‘Add to Drug Chart’ link to schedule medication tasks.

  • Scheduled medication tasks are listed in the 'Nursing Tasks' section.

  • The scheduled medication tasks are also displayed in the Drug Chart

From updating scheduled medication tasks from ‘Nursing Tasks’ to displaying the updated information in the ‘Nursing Tasks’ and the Drug Chart sections:
  • Once a medication task is updated from the ‘Nursing Tasks' section, the updated info gets reflected in the Nursing Tasks' as well as in the 'Drug Chart’ sections.

What is an IPD Dashboard:

An IPD Dashboard displays a patient’s information related to a specific in-patient visit. This dashboard has multiple sections, that display the patient’s details along with the Vitals and Nutritional Values along with the corresponding histories, Allergies captured so far, Diagnosis, Treatments (list of medications), List of Nursing Tasks that need to be fulfilled by the Ward Nurse, and the Drug Chart dashboard showing the medication administration records.

Each of these sections have accordion (a down arrow in the right), clicking on which, the corresponding section will open to display the respective details. By default, all the sections will remain open, unless configured otherwise.

This IPD Dashboard will have more sections in the future.

For ease of navigation, the dashboard has a navigation pane on the left, as and when more information get displayed in the dashboard, to get into a specific section of the dashboard easily, the user can use the left navigation pane.

Patient Header of the IPD Dashboard:

  • This section displays the IPD Patient demography, like name, age, Date of Birth, Patient Identifier.

  • Also the Address and Contact Details along with Relationships are displayed.

  • Clicking on the Patient Dashboard opens the existing Clinical Patient Dashboard in a new tab.

  • Clicking on the Discharge Summary opens the existing Discharge Summary in a new tab.

  • The back arrow takes the user to the originated page.

Vitals and Nutritional Values section of the IPD Dashboard:

  • This section displays the Vitals and Nutritional values along with the history.

Allergies section of the IPD Dashboard:

  • This section displays all the allergies of the patients captured so far.

Diagnosis section of the IPD Dashboard:

  • This section displays all the Diagnosis captured in the EMR along with Doctor’s notes, if any.

Treatments section of the IPD Dashboard:

The Prescription order(s) is created in the Medications module by the Doctor by indicating it as IPD.

Medication module displayed below:
Treatments section displayed below:
  • The Prescription orders created in the Medications module by the Doctor for the IPD patient, are listed in the Treatments section of the new IPD Dashboard.

  • If any ‘Instructions’ and ‘Additional Instructions’ are captured while creating the Prescriptions, they are displayed as Notes icon and can be viewed by clicking on the corresponding accordion.

  • The table in the Treatments display control displays Start Date, Drug Name, Dosage Details, Status (more on this later), Provider Name, and Action columns.

  • For all the prescribed medications, ‘Add to Drug Chart’ link is displayed in the ‘Actions’ column.

  • ‘Add to Drug Chart’ link gets enabled only when the Patient is admitted in IPD, otherwise system displays disabled ‘Add to Drug Chart’ link:

  • The ‘Rx’ tag indicates if a medication is a prescribed medication (there is emergency medication workflow which would not have prescription reference, more on this later). The STAT tag indicate if it is a ‘STAT’ (to be administered immediately) prescription.

  • Similarly there will be ‘PRN’ (As needed) tag for the corresponding medication and also ‘EMERG’ tag for emergency medication.

Scheduling medication tasks by ‘Add to Drug Chart’:

  • ‘Add to Drug Chart’ link is enabled only when the patient is admitted.

  • Clicking on the ‘Add to Drug Chart’ link corresponding to a prescribed medication listed in the ‘Treatments’ display control, brings up the ‘Add to Drug Chart’ slider on the right side.

  • The  ‘Add to Drug Chart’ slider displays the medication name and its attributes (which include Dose & unit, Duration & unit, Frequency, Route, Start Date, Instruction and Additional Instruction (if any)) from the Prescription Order) in disabled fields, enabled ‘Start Time’ field / ‘Schedule time’ fields (based on the prescribed frequency) and enabled ‘Notes’ field, along with ‘Cancel’ and ‘Save’ buttons.

Note: If the medication frequency is two / three / four times a day, then the system displays ‘Schedule Time’ field(s). If the medication frequency is once / every 30 mins / every 1 - 12 hrs a day / Nocte / STAT, then the system displays ‘Start Time’ field.

For medication frequency of once / every 30 mins / every 1 - 12 hrs a day / Nocte / STAT:
  • System displays the 'Start Time’ field (enabled).

For medication frequency of two / three / four times a day:
  • System displays the 'Schedule Time’ fields (enabled).

  • The 'Schedule Time’ fields are pre-populated with the Ward Medication schedules (pre-configured) as per the medication frequency. These are editable fields.

E.g., if the Ward Medication schedule is pre-configured in the system as 6:00 - 14:00 - 22:00 hrs, then the Schedule Time fields should be pre-populated with these time values.

Edge case: If a patient is admitted at 15:00 hrs, then while scheduling the medication tasks (with example of frequency of three times a day for 5 days), in the ‘Add to Drug Chart’ slider, system disables the first two doses slots of the Schedule time of the Start Date, displays the only enabled third dose slot pre-populated with 22:00, in the next row, displays the regular full days’ slots (6:00 - 14:00 - 22:00) for the next 4 days, and the remainder two slots on the sixth day (6:00 - 14:00).

‘Add to Drug Chart’ to ‘Edit Drug Chart’:

Once the medication task(s) is scheduled from the ‘Add to Drug Chart’ slider and the ‘Treatments’ section is refreshed, the ‘Add to Drug Chart’ link corresponding to the medication is changed to ‘Edit Drug Chart’.

 

‘Nursing Tasks’ section of the IPD Dashboard:

  • Once the medication tasks are scheduled, they are listed in the Nursing Tasks section with the corresponding name and attributes, schedule time and corresponding tag and status legend.

  • This section also has the feature to filter tasks based on their medication administration status.

  • These medication task tiles are sequenced based on their schedule time.

Updating an already administered task:
  • Clicking on one of these tiles, which is not updated yet, a slider opens up on the right side.

  • Clicking on the ‘Done’ toggle switch and entering the Notes (optional until the Dosing window is over), and by clicking on ‘Save’ button, Nurse will be able to update a specific medication task with the administered time.

Dosing Window: A configurable time window with respect to the Schedule time of a medication, beyond which the dose administration deemed late.

Once the task is updated with the administered time, the corresponding task gets updated as Completed and gets displayed accordingly in the Nursing Tasks section.

Indicating skipped medication task:
  • When a scheduled task is skipped for some reason (it could be for reason like, e.g., patient was in operation room at that time), Nurse will be able to update the task accordingly in EMR.

  • Clicking on the corresponding task tile brings up the same slider on the right side

  • Nurse clicks on the three dots in the slider.

  • ‘Skip Drug’ button appears.

  • Clicking on the ‘Skip Drug’ button brings up the mandatory ‘Notes’ field.

  • Once Notes is entered and ‘Save’ button is clicked, the corresponding task gets updated as Skipped and gets displayed accordingly in the Nursing Tasks section.

Emergency Medication Workflow:
  • When an emergency condition occurs for an In-patient and if there is no prescription available to mitigate the emergency situation, then based on the situation, after consulting with the on-call Doctor, the Nurse first administers the medication to take care of the situation and then capture the administered emergency medication details in the system.

  • The Nurse needs to click on the ‘Add Task’ button in the ‘Nursing Tasks’ section.

  • A slider opens up on the right side.

  • The Nurse selects the type, searches and selects the Drug Name, enters the Dose and Unit, select the Route.

  • Administration Date and Administration Time are defaulted with the system date and time. These fields are enabled, the Nurse can change them.

  • The Nurse searches and/or selects the Doctor’s name (whom the Nurse has consulted before administering the medication) in the ‘Acknowledgement Requested From’ field.

  • The Nurse enters a value in the mandatory ‘Notes’ field and clicks on the ‘Save’ button.

  • Once saved successfully, system displays a medication task with the tag ‘EMERG’ and administered time and status as Completed and displays the corresponding medication task tile in the Completed bucket in the ‘Nursing Tasks’ section.

  • System also displays the medication listed in the ‘Treatments’ section:

  • In the ‘Treatments’ section, the Start Date displayed is the ‘Administration Date’ selected in the slider, the corresponding Status column displays ‘Not Acknowledged’, Provider Name displays the Provider selected in the ‘Acknowledgement Requested From’ field of the slider and no link is displayed in the ‘Actions’ column.

  • The Save Emergency Medication task triggers a notification which is listed in the ‘Notifications’ tab in the Clinical module when the same Provider logs in. (this is under development, will update the User Guide soon on this)

  • In the ‘Drug Chart’ section, the Emergency Medication details are displayed as well. (this is under development, will update the User Guide soon on this)

  •  

Drug Chart section of the IPD Dashboard:

  • Once the medication tasks are scheduled through the ‘Add to Drug Chart’ slider, the medication is listed on the left panel of the Drug Chart and the scheduled (pending) medication task(s) are displayed on the right panel of the Drug Chart.

  • The hospital’s shift duration and start time can be configured in the system and based on that the date and shift time are displayed in the ‘Drug Chart’, similar to the ‘Nursing Tasks’ section.

In the following screenshot, the shift is configured as an 8 hours shift and the start time of the first shift of the day is configured as 6:00 hrs. Accordingly the following screenshot is displaying the second shift of the day.

  • Nurse can navigate back-n-forth using the left and right arrow to the previous and next shifts respectively. And the Nurse can come back to the current shift by clicking on the corresponding button.

  • Once the medication task is administered, the Drug Chart gets updated accordingly.

 

Jira View of Issues with Label ipd-team

Board Link: https://bahmni.atlassian.net/jira/software/c/projects/BAH/boards/55

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