============================================================================= Run Date: MAR 13, 2017 Designation: PXRM*2*35 Package : PXRM - CLINICAL REMINDERS Priority: Mandatory Version : 2 SEQ #49 Status: Released Compliance Date: APR 13, 2017 ============================================================================= Associated patches: (v)PXRM*2*24 <<= must be installed BEFORE `PXRM*2*35' Subject: LIFE SUSTAINING TREATMENT DIALOG Category: - Routine Description: ============ Patch PXRM*2.0*35 releases a new reminder dialog template to the field, without any changes to routines, data dictionaries, or other package functions; it deals with content only. The new reminder dialog template is: VA-LIFE-SUSTAINING TREATMENT. This reminder dialog template will be mandated for use upon release of Veterans Health Administration (VHA) Handbook 1004.03, "Life-Sustaining Treatment Decisions: Eliciting, Documenting and Honoring Patients' Values, Goals and Preferences." This Handbook will replace VHA Handbook 1004.3, "Do Not Resuscitate (DNR) Protocols within the Department of Veterans Affairs (VA)." The use of this reminder dialog template, the associated progress note title, and ancillary ordering processes, will introduce a significant practice change for most ordering providers in VHA. Facilities will be required to install and test this template within normal installation timelines as established by OIT. However, the new Handbook will allow 18 months for site implementation of the policy and the associated processes. Clinical Informatics staffs are encouraged to work closely with their local Life-Sustaining Treatment Advisory / Implementation groups to complete post-installation steps in support of facility deployment. The National Center for Ethics in Health Care (NCEHC) is the Program Office with oversight of this template and its associated processes. NCEHC will be available to help facilities meet the timelines to implement the associated practice changes and begin using this template with patients. This patch will only import the reminder dialog template, associated health factors, and multiple CPRS template fields. In order to make this process function as required in VHA Handbook 1004.03, each site that installs this template will also need to complete the listed post-installation actions. Multiple installation steps will be required, and some actions will be optional. These actions should be accomplished in your VistA/CPRS test account and then transitioned to your live account after successful testing in accordance with your facility's deployment strategy. These processes are outlined in the Installation section. Associated CA SDM Ticket(s): ============================ 1) I12322536FY17 - VA-LIFE-SUSTAINING TREATMENT REMAINDER DIALOG Associated NSR(s): =================== N/A Participating Test Sites: ========================= Captain James A. Lovell HCC (North Chicago, IL) VA Black Hills HCS (Fort Meade, SD) William S. Middleton Memorial VAMC (Madison, WI) VA Salt Lake City HCS CA SDM OVERVIEW: ================ 1) I12322536FY17 - VA-LIFE-SUSTAINING TREATMENT REMAINDER DIALOG PROBLEM 1: ========== New Reminder Dialog for Life Sustaining Treatment note template and orders were needed. RESOLUTION 1: ============= This patch, PXRM*2*35, distributes the new VA-LIFE SUSTAINING TREATMENT reminder dialog. Two routines are included with this patch, PXRMP35E and PXRMP35I. They are init tasks that add new entries to the REMINDER EXCHANGE (#811.8) file and the contents of these entries are installed during the post-init. These routines can be deleted after the install. This patch installs the following Life Sustaining Treatment reminder dialog: VA-LIFE SUSTAINING TREATMENT Build Components: ================= N/A Data Dictionary: ================ N/A Software & Documentation Retrieval Instructions: ================================================ This patch is being distributed as a host file. The name of the host file is PXRM_2_0_35.KID. This file should be downloaded in ASCII format. The Install and Setup Guide is also available on the servers. It is available as .pdf format. This file should be downloaded in BINARY format. The preferred method for obtaining these files is to use File Transfer Protocol (FTP) to download them from: ftp://download.vista.domain.ext/. This transits the files from the first available FTP server. Sites may also elect to retrieve the files directly from a specific server as follows: Albany ftp.fo-albany.med Hines ftp.domain.ext Salt Lake City ftp.domain.ext File Name: Description: Protocol: ========== ============ ========= PXRM_2_0_35_IG.PDF PXRM*2.0*35 Install BINARY and Setup Guide PXRM_2_0_35.KID PXRM*2.0*35 Host File ASCII Documentation can also be found on the VistA Documentation Library (VDL) at: http://www.domain.ext/vdl/ IMPORTANT: The new order and its associated processes will replace former Do Not Resuscitate (DNR) order processes. Refer to the Install and Setup Guide, PXRM_2_0_35_IG.PDF, for details. Since this is a significant practice change, these actions should be well coordinated with all personnel that will be impacted. Installation: ============= This patch can be loaded with users on the system. Installation will take ten to fifteen minutes. Refer to the Install and Setup Guide, PXRM_2_0_35_IG.PDF, for complete details. 1. Use the 'Load a Distribution' option on the KIDS installation menu. When prompted to enter a host file type in PXRM_2_0_35.KID 2. On the KIDS menu under the 'INSTALLATION' menu, use the following options, as desired: Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Backup a Transport Global 3. On the KIDS menu under the 'INSTALLATION' menu, use the following option to install the patch: Install Package(s) When prompted for INSTALL NAME, use PXRM*2.0*35 4. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//," respond 'NO'. 5. When prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//," respond 'NO'. 6. After successful installation, the following init routines may be deleted: PXRMP35E PXRMP35I Post Installation: ================== - Build and assign a new CPRS "orders display group": "Life-Sustaining Treatment." - Build Life-Sustaining Treatment Generic Orders, using the new order display group. - Build and assign a Life-Sustaining Treatment order set menu. - Add auto-discontinue rules to ensure that the Life-Sustaining Treatment orders DO NOT auto-discontinue upon patient movement or specialty change (e.g., admission, transfer, discharge, change from General Surgery to Neurology, etc.). - Add rules to ensure that no option to "copy" these orders is offered when delayed orders are written. - Build the CWAD progress note title, "Life-Sustaining Treatment." - The local title and print name must be, "Life-Sustaining Treatment." - The title must be linked to the national standard title, "Life-Sustaining Treatment Plan." - Link the VA-LIFE-SUSTAINING TREATMENT reminder dialog template to the progress note title "Life-Sustaining Treatment." - Edit the progress note title's document definition and business rules. - Edit the reminder dialog to automatically launch the new individual generic orders or the new order set and/or local consults and comfort care order sets. (Linking and launching the LST orders from the template is a local option and is not required. However, the ability to launch the orders from the template was highly esteemed and encouraged as a strong practice from all of the LST demonstration/test sites.) - Create VistA business rules and user classes to restrict the entering of the progress note, "Life-Sustaining Treatment" to personnel as defined in VHA Handbook 1004.03. - Create business rules and user classes to restrict the adding of addenda to this progress note by additional personnel to only those persons as defined in VHA Handbook 1004.03. Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;CLINICAL REMINDERS;**[Patch List]**;Feb 04, 2005;Build 206 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PXRMP35E Before: n/a After: B763545 **35** Routine Name: PXRMP35I Before: n/a After: B4054860 **35** ============================================================================= User Information: Entered By : Date Entered : AUG 26, 2013 Completed By: Date Completed: MAR 09, 2017 Released By : Date Released : MAR 13, 2017 ============================================================================= Packman Mail Message: ===================== No routines included