Zynx Update June 2012
 

ZynxCare Updated Content

For information pertaining to new or withdrawn evidence and other changes affecting plans of care in the ZynxCare modules during April through June 2012, click here.

General Announcements

  • ZynxCare now comprises 53 modules, 53 patient problems (located within the Patient Problems module), and 240 plans of care (which includes 107 starter plans of care).
  • The following changes will be rolled out to all ZynxCare content over the next two quarters as part of the June and September 2012 content publications:

    • Merged venues for medical condition plans of care (Admission and Discharge) and surgical procedure plans of care (Postoperative and Discharge) will more accurately reflect clinical workflow.
    • Starter content will include only 1 or 2 overarching expected outcomes per patient problem.
    • The Diagnostics, Medications, and Evaluation sections, as well as general assessments, will be removed from the plans of care to facilitate implementation and build in the EHR.
    • Evidence on medications, diagnostic tests, and organizational aspects will be moved into the “Condition-Specific Evidence” folder in medical condition/surgical procedure modules to facilitate evidence reviews in the inpatient setting.
    • “Organizational Aspects” folders will house evidence at the organizational level for Patient Problems submodules.

  • Here are the changes made at the patient problem level:

Module Name

Affected Venue

Change at Patient Problem Level
Asthma – Adult Admission/Discharge Deleted “Deep Venous Thrombosis – Risk of”
Asthma – Pediatric

Admission/Discharge

 Deleted “Nutrition Deficit – Risk of”
Bariatric Surgery Starter Deleted “Deep Venous Thrombosis – Risk of” and “Gas Exchange – Impaired”
Bronchiolitis – Pediatric Admission/Discharge and Starter Deleted “Nutrition Deficit – Risk of”
Coronary Artery Bypass Graft Surgery Postoperative/Discharge and Starter Deleted “Body Temperature – Risk of, Imbalanced”
Femur Fracture Starter Added “Injury – Risk of, Postfracture Complications”
Heart Failure Admission/Discharge Deleted “Pain – Acute”
Starter Added “Tissue Perfusion – Cardiopulmonary, Altered”
Hip Fracture Starter Added “Injury – Risk of, Postfracture Complications”
Deleted “Fluid Volume – Risk of, Imbalanced,” “Mental Status – Risk of, Impaired,” “Nutrition Deficit – Risk of,” and “Urinary Elimination – Impaired”
Pneumonia – CAP, Adult Admission/Discharge and Starter Deleted “Deep Venous Thrombosis – Risk of”
Sepsis – Adult Admission/Discharge and Starter Deleted “Fluid Volume – Risk of, Imbalanced”
Sepsis – Neonatal Admission/Discharge and Starter Deleted “Fluid Volume – Risk of, Imbalanced”
Starter Added “Gas Exchange – Impaired”
Sepsis – Pediatric Admission/Discharge and Starter Deleted “Fluid Volume – Risk of, Imbalanced”
Starter Added “Gas Exchange – Impaired”
Stroke – Ischemic Admission/Discharge and Starter (based on Rehabilitation/Discharge) Added “Cognitive-Perceptual Pattern – Impaired”
Total Hip Replacement Postoperative/Discharge Added “Infection – Risk of, Urinary Catheter–Associated Urinary Tract Infection”
Deleted “Urinary Elimination – Impaired”
Total Knee Replacement Postoperative/Discharge and Starter Added “Infection – Risk of, Urinary Catheter–Associated Urinary Tract Infection”
Deleted “Body Temperature – Risk of, Imbalanced” and “Urinary Retention”

New ZynxCare Modules

  • 1 module has been added during April through June 2012:

    • Personality Disorders

New ZynxCare Plans of Care

  • 52 plans of care (including 1 starter plan of care) have been added during April through June 2012:

Module

Venue
Abdominal Aortic Aneurysm Repair Postoperative/Discharge

Acute Myocardial Infarction

 Admission/Discharge
Alcohol Withdrawal Admission/Discharge
Appendicitis/Appendectomy – Pediatric Postoperative/Discharge
Asthma – Adult Admission/Discharge
Asthma – Pediatric Admission/Discharge
Bariatric Surgery Postoperative/Discharge
Bronchiolitis – Pediatric Admission/Discharge
Cesarean Delivery Postoperative/Discharge
Chronic Obstructive Pulmonary Disease Admission/Discharge
Colectomy Postoperative/Discharge
Coronary Artery Bypass Graft Surgery Postoperative/Discharge
Critical Care Management – Adult Admission/Discharge
Critical Care Management – Neonatal Admission/Discharge
Critical Care Management – Pediatric Admission/Discharge
Deep Venous Thrombosis – Treatment Admission/Discharge
Delirium Admission/Discharge
Depression Admission/Discharge
Diabetes/Hyperglycemia Admission/Discharge
DKA/HHS Admission/Discharge
Femur Fracture Postoperative/Discharge
Gastroenteritis – Acute, Pediatric Admission/Discharge
Gastrointestinal Bleeding – Lower Admission/Discharge
Gastrointestinal Bleeding – Upper Admission/Discharge
Heart Failure Admission/Discharge
Heart Valve Replacement Postoperative/Discharge
Hip Fracture Postoperative/Discharge
Hyperbilirubinemia – Neonatal Admission/Discharge
Hysterectomy – Abdominal Postoperative/Discharge
Hysterectomy – Vaginal Postoperative/Discharge
Lumbar Laminectomy Postoperative/Discharge
Newborn Management Admission to Level I Nursery/Discharge
Palliative Care Admission/Discharge
Percutaneous Coronary Intervention Postprocedure/Discharge
Perioperative Care Postoperative/Discharge
Personality Disorders Admission/Discharge
Starter Plan of Care (based on Admission/Discharge)
Pneumonia – CAP, Adult Admission/Discharge
Prematurity – Neonatal Admission/Discharge
Psychotic Disorders Admission/Discharge
Sepsis – Adult Admission/Discharge
Sepsis – Neonatal Admission/Discharge
Sepsis – Pediatric Admission/Discharge
Spinal Fusion – Adult Postoperative/Discharge
Stroke – Ischemic Admission/Discharge
Substance Abuse Admission/Discharge
Total Hip Replacement Postoperative/Discharge
Total Knee Replacement Postoperative/Discharge
Transient Ischemic Attack Admission/Discharge
Unstable Angina/NSTEMI Admission/Discharge
Urinary Tract Infection – Adult Admission/Discharge
Vaginal Delivery Immediate Postpartum/Discharge

Clinical Highlights

  • Due to the addition of a guideline on sexual activity and cardiovascular disease from the American Heart Association, the activity “Education, sexual activity” has been added to the following plans of care:

    • Acute Myocardial Infarction/STEMI
    • Coronary Artery Bypass Graft Surgery
    • Heart Failure
    • Heart Valve Replacement
    • Percutaneous Coronary Intervention
    • Unstable Angina/NSTEMI
  • Critical Care Management – Adult

    • Due to the addition of a guideline on delirium assessment and management from the American Association of Critical-Care Nurses, the following activity has been added to the plans of care:

      • Physical activity promotion

    • Due to the addition of a guideline on the prevention of aspiration from the American Association of Critical-Care Nurses, the following activity and reminder have been added to the plans of care:

      • Enteral tube placement assessment
      • Feeding intolerance signs and symptoms assessment
  • Palliative Care

    • Due to the addition of a guideline on end-of-life care from the Registered Nurses’ Association of Ontario, the following activity has been added to the plans of care:

      • Decision-making assistance

    • Due to the addition of a guideline on pain assessment in the patient unable to self-report from the American Society for Pain Management Nursing, the following item has been added to the plans of care:

      • Pain Assessment Scale

  • Patient Problems > Aspiration – Risk of

    • Due to the addition of a guideline on the prevention of aspiration from the American Association of Critical-Care Nurses, the following reminder and activities have been added to the plans of care:

      • Avoid the routine use of bolus feeding in patients who require enteral feeding
      • Enteral tube placement assessment
      • Feeding intolerance signs and symptoms assessment

    • Due to the addition of a guideline on the identification and nursing management of dysphagia in adults with neurological impairment from the Joanna Briggs Institute, the following activity has been added to the plans of care:

      • Swallowing assessment

 

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Zynx Update does not address the addition, deletion, or modification of clinical rules, nor does it address the addition of items or the deletion of non–evidence-based items from order sets or plans of care. Zynx Update is intended for use by quality improvement personnel who can review the information provided to help decide if modifications should be made to existing order sets, plans of care, and rules, based on changes to the evidence.