The A-Zs of Epic: A Housestaff Survival Guide

By Rondeep Brar, MD (Class of 2010)

Foreword: Welcome to the A-Zs of Epic: A Housestaff Survival Guide! I hope this document proves to be
useful. It is not meant to be all-inclusive but rather to provide assistance in efficiently performing basic and
advanced Epic tasks for the average medicine housestaff crunched for time.
This guide is organized into three sections: Getting Started helps the user with logging in/out, creating
patient lists, and assigning treatment teams. The Basics of the Epic Chart orients the user to the format of Epic
and the basic layout of the inpatient chart. The bulk of the document is the third section, Performing Specific
Tasks, which provides step-by-step instructions for 26 (hence the A-Z reference) critical Epic tasks.
It is my hope that the strength of this guide will be enhanced exponentially through
collaboration/teamwork. Its structure as a Wiki document allows it to be edited by you, the housestaff, with more
efficient ways of performing tasks and with methods for completing new tasks as Epic continues to evolve.
If you are entirely new to Epic, it may be useful to view this document while experimenting in the Epic
Playground software. Practice is the best way to become efficient with the Epic software.
Thanks for reading! Feel free to e-mail me with questions/comments/suggestions at rbrar@stanford.edu.
List of topics covered in this guidebook (in order presented): logging in/out, using/changing login contexts, creating patient lists, assigning
treatment team, adding patient summary tabs, admitting from emergency room, admitting from clinical decision area, admitting from intensive
care unit, direct admissions, placing active orders in the emergency room, printing patient lists, reviewing vitals, reviewing labs/microbiology,
reviewing imaging, writing progress notes, writing procedure notes, writing death notes, using note templates, locating last discharge summary,
efficiently searching outpatient chart, reviewing inpatient medication history, reviewing outpatient medication history, reviewing inpatient pain
medication use, determining transfusion history, determining insulin use, antibiotic history, reviewing overnight orders, using order sets (for
insulin, pca, comfort care, heparin infusions, and post-procedure labs), creating note templates, borrowing note templates from other users,
discharging home, discharging to skilled nursing facility, arranging home antibiotics, arranging home oxygen, arranging home nursing, providing
durable medical equipment on discharge, and writing discharge summaries.

Section 1: Getting Started

Logging In
1. Log in using your unique userid and password.
2. Under department, choose either MEDICINE SPLTY [9991019] or GENERAL MEDICINE SPLTY
[9991010]. These settings are your login context. Depending on which login context you use, Epic will
personalize your display and the options available to you.
Tip: For practical purposes, you should use either MEDICINE SPLTY or GENERAL MEICINE SPLTY at all
times except when working in the Emergency Room, at which time you should use the EMERGENCY
DEPARTMENT login context.
Tip: If you would like to change your login context while in Epic, you do not need to log out and log back in.
Rather, click on Desktop (top-left) and then Change Login Context.
Logging Out
Tip: When you are ready to log out, do NOT click the X in the top-right hand corner. This will shut Epic down
completely and force the next user to re-load the software (which is time-consuming).
Rather, click either Log Out or Secure. Both will securely exit your account from Epic. With secure, if you
log back in, you will return to the same screen or patient chart you exited from, whereas if you log out you will
start back at your home screen.

Patient Lists
Tip: The ability to create multiple patient lists is a strong point of Epic. You can create separate lists for your ward
patients, cross-cover patients, patients who need cultures followed, interesting patients (to present, follow, or write
case-reports), the ER, ICU, etc. This can dramatically improve your efficiency when covering dozens of patients on
multiple floors and services (i.e., when you are on call or night float).
Tip: By using Epics built in System Lists, your personal lists will automatically refresh themselves as patients
are admitted, discharged, and transferred to other floors.
Creating a Patient List
1. After logging in, you will be brought to your home screen.
2. Click on Patient Lists.
3. Click on Create.
4. In the Name section, type in your personal list name.
5. Dont click Accept yet. If you do, your patients wont display correctly on Epic. You first have to tell Epic
what data columns to display for each of the patients on your list.
6. To do this, click on Copy after you have typed in your list name.
7. From the choices given, scroll down and select TEMPLATE PHYSICIAN and click Accept.
8. You will now see several items, including bed. patient name, etc displayed in the Selected Columns area.
These are the data that Epic will display for the patients on your list. You can remove specific data columns by
highlighting them and clicking Remove to suit your needs.
9. Finally, click Accept to finish creation of your custom list.
10. You will now see your list appear under My Patient Lists. You may repeat this process to create multiple lists.
Tip: When Epic loads and you select Patient Lists to review your patients, you can designate a default list to
display first (i.e., of your multiple lists, suppose you would like Epic to display your Wards list by default). To do
this, place the mouse over your list of choice, right click, and select Default List.
Adding Patients to Your List
Lets assume you are intern A on Stanford Wards team 1. You have created a list called My Ward Patients using
the above directions. Now you would like to add your patients to this list.
1. Click on Patient Lists and expand the folder titled System Lists by clicking on the + sign. You will now
see the variety of system lists handled by Epic.
2. Now expand the MD Primary Team folder and you will see a list of all the primary teams in the hospital.
Cardiology, PAMF Medicine Wards, Stanford Medicine Wards, Team T, Bone Marrow Transplant, Hematology,
Oncology, the Medical ICU, and nearly every team in the hospital is listed in this section.
In our example, you would click on Med Univ 1A, keep the mouse button held down, and drag this list up into
your personal My Ward Patients list.
Your personal list will now display all patients assigned to Med Univ 1A.
Tip: The following are useful team designations to know under MD Primary Team: Stanford Wards = Med
Univ (teams 1-4), PAMF Wards = Med PAMF (teams 1-4), Team T = Med Tx-Hep, Cardiology = Cardiology
(teams 5a-6b), ICU = MICU (teams green and blue), Oncology = Oncology, and Hematology = Hematology.

Assigning Yourself to the Treatment Team

In order for Epic to know what patients belong to Med Univ 1A in our example, that intern must assign
him/herself to the Treatment Team. Epic keeps track of which patients are placed on which System List using this
treatment team designation.
To assign a treatment team, you first need to locate the patient in the hospital. Your patient will likely be in either
the Emergency Room (ER), Clinical Decision Area (CDA; the observation unit of the ER), or on a certain floor of
the hospital.
1. Consider the example of locating a patient in the ER. Under Patient Lists, expand System Lists, and then
expand Emergency Department. Click on the list titled Emergency Department to display all the patients in the
ER. For some odd reason, Epic displays this list in reverse order so that it may appear blank. To correct this, click
on the Bed column of the patient list to organize the patients by their bed number in the ER.
2. Scroll down to find your patient of interest. Place the cursor over your patient, right click, and select Treatment
Team. You may already see some ER nurses, residents, and attendings that have assigned themselves to the team.
3. To add yourself to the team, click on the Treatment Provider box under Treatment Team and type tt and
press enter. Scroll down and select your specific team. In our example, we would scroll down and select TT MED
UNIV 1A. Click Accept.
4. Under Relationship type Primary Team.
Once this is done, your patient will now appear under the MED UNIV 1A Epic System List. Since this is the list
you have placed in your personal My Ward Patients list, the patient will now appear on your personal list as well.
Tip: To remove a patient from the system list, right click on the patient, select treatment team, highlight the team of
interest (TT MED UNIV 1A in our example), and click Terminate.
Tip: When admitting a patient and entering the Treatment Team, you should enter your name, your residents name,
and your attendings name. For yourself, place your name (last, first) in the Treatment Provider section and write
Primary Intern in the Relationship box. Repeat this for your resident and attending, using Primary Resident
and Primary Attending, respectively, for the relationship box.
Tip: These treatment teams not only help Epic organize all patients within the hospital, but also help nurses decide
which physician to page. Keeping it up to date can save you many unnecessary pages.
Adding Additional Tabs to the Patient Summary Screen
Tip: Throughout this document, we will be referring to various tabs under the Patient Summary screen.
Depending on how your Epic account is set up, some of these tabs may not be available to you. To add a tab, follow
the instructions below.
1. Click on Patient Summary.
2. Click on the monkey-wrench icon at the far right.
3. Scroll down to the first blank Report field and type ip and press enter. A list of possible tabs will appear.
Choose your tab of interest and click Accept (most of the tabs you will use will be titled IP ACCORDIAN ####
where #### refers to the subject of interest. The tab will now appear under your Patient Summary display.
Tip: If your tab still does not display under Patient Summary after following the above steps, try to click the >>
icon on the right-side of the Patient Summary display. This will display all additional tabs that do not fit on your
current screen view.

Section 2: The Basics of the Epic Chart

Now that you know how to log in, change your log-in context, and set up your patient lists, you are ready to review
the Epic Chart. We will point out the basic features of the chart here. More details regarding specific tasks and
advanced functions will be discussed in the next section.
- Log in to Epic and select any patient (by double-clicking) to open their chart.
- Below is a brief description of each tab in the first column of the patient chart, beginning with Patient Summary.
Patient Summary: A data-rich section in which you can locate vital signs, recent labs/cultures/imaging, antibiotic
history, narcotic use, insulin use, a chronologic history of orders placed for your patient, a full medication
administration record (MAR), and a list of current indwelling lines/catheters and their dates of placement.
Chart Review: The equivalent of the outpatient chart. Useful for prior clinic notes, prior discharge summaries,
prior colonoscopies, etc. In reality, all inpatient notes get filed under Chart Review as well. However, inpatient
notes are much more easily viewed under the Notes tab in the patient chart.
Results Review: All laboratory, imaging, and culture data may be found here.
Intake/Output: Reviews daily fluids ins/outs as well as their sub-components (i.e., po, iv, urine, stool, drain output,
etc).
Synopsis: Not of utility.
Allergies: Here you can review and add to a patients allergies. Allergies are also displayed near the top-right of any
patients chart (above Attending.)
Problem List: Currently a matter of debate regarding whether housestaff are responsible for updating this section
prior to discharge. In general, if a major diagnosis, such as thyroid cancer, is missing from the patients automated
problem list, it probably should be added here. For less severe problems, such as GERD, updating this list will
probably not be feasible given your time constraints.
History: Also a section you typically do not need to use in the inpatient setting. If you feel compelled to add
something to a patients past medical history that is not part of the Epic record, however, you can do it here.
Imm/Injections: Immunization history for the admission may be reviewed here. A rarely used tab.
Notes: Contains all inpatient progress notes, including those from attendings, fellows, residents, interns, medical
students, speech therapists, occupational therapists, nurses, case managers, dietitians, etc. By default, it will display
notes in reverse-chronologic order (most recent note first). You can click on any of the column-headings, such as
author or category to change the way in which the notes are sorted. You can view specific note types, such as
h&ps or progress notes using the tabs at the top.
A few things to keep in mind: The filed time is when the note was electronically signed and the note time is the
time the note was started. Additionally, anytime you addend a signed note or an attending co-signs your note, the
filed time gets updated and that note goes to the top of the chart. Keep this in mind when reviewing the chart.
Consider the following example: You request a hematology consult on 11/2. The fellow writes a note that day and it
appears in the Epic chart. The next day (11/3) the hematology fellow writes another note. The hematology
attending reviews notes awaiting his signature and co-signs the 11/2 note but not the 11/3 one. This will place the
11/2 note above the 11/3 by their filed time. Be weary of this. Another common scenario is to suddenly see
multiple progress notes by one attending in the chart. For example, if the hematology attending co-signs all notes
from 11/2-11/7 in a single sitting on 11/7, they will populate the 6 most recent notes in the chart. Hence, always be
sure to compare the filed time and note time to make sure you are viewing the most recent recommendations.

Tip: Depending on the way an attending co-signs your notes, your notes may get re-named with your attending
appearing as the author. Your original note (with your name attached) is always preserved, however, in a blue hyperlink at the bottom of the note.
Order Entry: The most useful and quickest place to enter orders. Unfortunately, not all order entries are entirely
intuitive. For example, in replacing 40 meq of iv potassium, one would order 10 meq per hour and administer for
4 hours. Similarly, to provide a liter of saline, you may order saline at 200 cc/hour for 5 hours or 100 cc/hour for
10 hours. To explore and change the variety of details for an order (dose, frequency, start time, stop time, etc),
simply click on the blue hyperlink for each order before clicking Sign Orders.
Rounding: There are several useful things to do here. The PTA Med Document contains the prior to admission
medications that should be reconciled prior to discharge (more on this later).
Under orders an organized list of active medications, labs, nursing orders, and imaging is displayed. If one
needs to discontinue or modify an existing order (i.e., change medication dose/frequency, cancel an x-ray, increase a
cbc from q12 hrs to q8hrs, etc, this is the place to do it). New orders can also be placed here, but may be done more
quickly using the order entry tab. This section is best to modify or discontinue existing orders.
Under order sets various orders may be placed that come in pre-packaged bundles. These include insulin sliding
scales, insulin drips, anti-coagulation protocols, procedure-related labs (e.g. thoracentesis, paracentesis, lumbar
puncture, etc), comfort care protocols, and diagnosis-related protocols (e.g. sepsis), among several other entities.
Under Summary Line you may enter a short description of the patient for purposes of cross-cover and your daily
rounding report (i.e., the one-liner).
Consult: No need to use this tab.
Transfer: Used to direct the transfer of patients out of the ICU.
Discharge: Used to discharge patients from the hospital.
Now lets move on to performing specific tasks within Epic.

Section 3: Performing Specific Tasks

Tasks Prior to Patient Arrival to Floor
A: How Do I Admit a Patient from the Emergency Room?
1. Locate the patient in the Emergency Room and assign the appropriate treatment team (including team, intern,
resident, and attending). If you are unsure how to do this, refer to the Getting Started section above.
2. Open the patients chart.
3. Click the Admit Order ED tab.
4. Click Floor Orders.
5. Click Order Sets.
6. Type in admit and press enter. A list of pre-defined admission templates will pop-up.
7. Choose the admission template of interest. On the wards this will be IP MED GENERAL ADMIT. On
cardiology it will be IP CAR GENERAL ADMIT, and in the ICU/CCU it will be IP ICU/CCU GENERAL
ADMIT.
8. Click Open Order Sets.
9. Complete the order set.
10. When finished, click on Sign & Hold at the bottom to sign and pend your orders. A dialogue box will open
and list Patient Transfer under Reason for Holding. Leave this unchanged and click Accept. When your
patient arrives to the floor, your pended orders will be released by the accepting nurse.
If an additional dialogue box pops up asking for the names of an authorizing/supervising provider, enter your
attendings name.

Tip: The E.R. will place an admit to inpatient order after speaking with the admitting medicine resident. The
interns duty, then, is to evaluate the patient and place preliminary signed and held orders as above. Bare bones or
skeleton orders can be placed relatively quickly to keep patients moving through the ER. Just be sure that
important labs, imaging, and medications are ordered/reviewed early to preserve patient safety. And remember you
can modify your orders at any time.
Tip: As you complete the order set, you will be asked to either continue, discontinue, or modify existing orders that
have been placed in the E.R. Pay particular attention to medications here (for example, the ER often uses higher and
more frequent doses of narcotics than we do on the floor).
B: How Do I Admit a Patient from the Clinical Decision Area (CDA)?
1. Locate the patient in the CDA. To do this, click on the Patient Lists tab, expand System Lists, then expand
Emergency Department, and then click on Clinical Decision Area. These patients will typically be on the C1
ward of the hospital at present.
2. Assign the appropriate treatment team and open the patients chart.
3. Follow steps 4-10 in section A.
C: How Do I Admit a Patient from the Intensive Care Unit (ICU)?
1. Locate the patient of interest. Under the Patient Lists tab, expand System Lists then Nursing Units.
Stanford ICU patients are located either in the East or North ICU on the 2nd floor of the hospital. These
correspond to the E2 and NICU lists, respectively, under Nursing Units.
2. Assign the appropriate treatment team and open the patients chart.
3. Click on Order Entry. Type transfer patient into the order box and press enter. Select the transfer patient
order from the list of options.
4. Complete the required fields and click Accept.
5. Click Sign Orders to complete the transfer order. There will now be an active order indicating the patient is
ready for transfer. Now the patient will need transfer orders waiting for him/her upon arrival to the floor. To do this,
follow the directions below.
6. Click on the Transfer tab.
7. Click on Orders Upon Transfer then Order Sets.
8. Complete steps 6-10 from section A.
D: How Do I Admit a Patient Who is Scheduled for a Direct Admission?
Tip: Occasionally a patient will be directly admitted from the Cancer Center, home, or one of the specialty clinics.
Direct admission refers to a patient arriving immediately to the floor without having to go through the E.R. first. For
these patients, you cannot place Signed and Held orders ahead of time. You must wait for them to arrive to the
floor (which creates an electronic inpatient chart) and then you may enter their admission orders.
1. Locate the patient of interest and open their chart.
2. Click on Rounding.
3. Follow steps 5-9 in section A.
4. Click Sign Orders when complete (rather than Sign & Hold because, in this case, the patient has already
arrived on the floor).
E: How Do I Place Orders for E.R. Patients to Happen Immediately?
Tip: You can place active/immediate orders for patients you will be admitting from the E.R. Since it may be several
hours (in rare cases even >24 hours) before they arrive on the floor and activate your Signed/Held orders, it may be
helpful to order various labs/imaging (i.e., blood cultures, troponin, lactate, abdominal ct, etc) while they are in the
E.R. to expedite your workup.
1. Locate the patient in the E.R. and open their chart.

2. Click Order Entry.

3. Enter your order of interest and click Sign Orders when complete. These orders will be performed
immediately in the E.R. (often within 5-10 minutes of ordering).

Tasks for Patients Already on the Floor

Basic Tasks
F: How Do I Print a Patient List in the Morning?
1. Click on your Patient List tab and select your list of interest.
2. Click on the Patient Report tab.
3. Check the Rounding Report and/or MD Patient List tabs as needed. The Rounding Report is a detailed list
including medications, vitals, ins/outs, labs, etc. The MD Patient List, as the name suggests, is simply a list of all
patients and their locations.
4. Click Print.
Tip: Most interns print both the Rounding Report and MD Patient List at the same time. For signout, it is helpful to
place the MD Patient List on top of the Rounding Report. The to do list can be listed cleanly on the MD Patient
List (since this is often only one or two pages). The night-float intern, when carrying out the to do list or getting
called about your patients, can then refer to the Rounding Report beneath for additional information (such as current
medications, the one-liner, etc).
Tip: There is often a lag of 30 seconds to 2-3 minutes before your list will arrive at your selected printer. Dont
repeatedly print your list if it doesnt immediately arrive, or you will soon be printing out multiple lists on accident.
Tip: For most locations in the hospital, Epic has automatically selected the closest printer as its default. If it does
not appear, try to locate the printer # (usually a label taped on the printer itself) and enter PRINTER#### in the
Printer name section where #### refers to the printer #.
G: How Do I Review Details of Vitals and Ins/Outs Overnight?
There are several ways to do this. Some options include:
#1) Use the vitals and Ins/Outs from your printed morning report.
#2) Under Patient Summary, use the VSQ4 to view Q4 hour vitals. If your patient has been in the ICU, you
can use the VSQ1 tab to view hourly vitals.
#3) Ins/Outs (with detailed descriptions of their sub-components) may be found either in the Intake/Output tab
or by clicking on Patient Summary and then the I/O tab.
Tip: You may notice your rounding report notes a maximum temperature that does not clearly appear under the vitals
you see under VSQ4. Because of the way Epic deals with data entry timing, some of this data may not appear in
this view. If you switch to VSQ1 (even for a regular floor patient), you will often see additional data that does not
appear in VSQ4. Hence, it is useful to use the rounding report for a quick glance to see if your patient has been
febrile overnight, and then to refer to VSQ1 for specific details if needed.
H: How Do I Review Lab Results?
- One option is to click on the Results Review tab. By clicking on each of the individual categories, you will see
chronologic lab results for a specific category (e.g., Hematology for CBCs, Coagulation, for coags and dic
panels, Chemistry for metabolic panels and LFTs, etc).
- Another option is to click on Patient Summary and then Lab. This will display all laboratory and culture data
in chronologic order over the last 48 hours. This may be useful in the ICU when you have multiple labs constantly
returning every several minutes to keep your eye on the most up to date labs.

Tip: The default view for Results Review is to place most recent labs to the far right. Some people find this
visually difficult to line up with the appropriate labels in the left hand column. You can reverse the way Epic
displays these labs. Click on Results Review, then Options, and then check the box labeled Trend Dates in
reverse chronologic order.
Tip: You can easily trend and graph labs in Epic. To trend, click on Results Review and then expand the
laboratory list to locate your lab of interest. The data trend will be displayed in the results section. For example, to
trend a serum sodium, you would expand Chemistry, then General Chemistry, then click on Sodium, Ser/Plas.
Once the trend is displayed, you can click on the lab name (Sodium, Ser/Plas in this example) and then Graph to
visually plot the data.
Alternatively, once you become familiar with the way Epic labels labs, you can type your lab of interest into the
Search box in the Results Review section. For example, to trend a white blood cell count you would type in
WBC. Some of these labels are not entirely intuitive. For example, if you begin to type in Sodium, Epic may
default to Sodium, ISTAT rather than the true serum sodiums from the lab. You would have to type Sodium, S
to force it to display Sodium, Ser/Plas for true serum sodium results. This may feel awkward at first, but you will
quickly get the hang of it.
I: How Do I View Culture Results?
1. Click on Results Review then click on (dont expand) Microbiology. This will chronologically display
culture data. Abnormal culture results are marked with a red exclamation point. To view details of a specific
culture, double click the notepad icon.
Tip: Cultures under this section CAN be positive without a red exclamation point. This has to do with the way the
microbiology lab currently flags cultures. For example, blood cultures may have 4/4 bottles with gram positive
cocci in clusters that have not yet been speciated. Initially, you will see this data if you double click the notepad, but
it may not initially be labeled with a red exclamation point. Hence, you CANNOT rely on this tag to quickly screen
whether or not your patient has positive cultures.
Tip: To avoid the above pitfall, you can click on Patient Summary and then Micro. This will chronologically
display culture data as well as its results in a screen you can quickly scroll through (saving you the time of doubleclicking each notepad in the Results Review section). However, if a culture is positive, this view typically will not
display sensitivities. For this, you will need to return to the Results Review section a double-click the culture of
interest under Microbiology.
J: How Do I Review Imaging Results?
1. Click on Results Review. Expand Radiology to view all dictated and transcribed imaging results.
Tip: When you double-click the notepad icon to read the report of an imaging study, there is a link at the top stating
View Full Radiology Images Patient Level. Clicking this link will automatically open Centricity and load the
image of interest.
Tip: Often times on call, you will want to discuss imaging results with a radiologist. They are often extremely busy
and will often place a quick review of the study in Centricity to avoid multiple phone calls. Always check here first
before calling the radiologist. To look for this preliminary interpretation (often done within minutes for studies done
in the E.R.), click on the Exam Notes tab in Centricity.
For studies done several hours to a day prior that do not yet appear in Epic, they may have been dictated but
simply not yet transcribed. To listen to radiology patient dictations, dial 57617, then 20#, then medical record
number followed by #. Press 8 to skip to the next report.
Of course, for specific questions regarding an imaging study, particularly if it will effect patient care, speak with
the radiologist directly.
K: How Do I Write A Progress Note? Procedure Note? Death Note?
1. Click on Notes.

2. Click New Note.

3. Click Cosign Required and enter the name of your attending.
4. Under Type, enter progress note. If you are on a consult, you initial note type would be Consults and
subsequent notes would be Consult Follow-Up.
5. Type your note of interest. The use of templates is discussed in the advanced tasks portion of this document in
section V.
6. Click Accept to sign your note and save it to the chart.
Tip: If you wish to save your note but not yet sign it, click Pend. When you wish to resume your note, click on
Notes and then scroll to the right to reveal the Pended tab. Click on your note and then click Edit Note to
resume your work.
Tip: There is no need to type a brand new note each day when you plan to re-use some of the prior notes
components. Simply click on your last note, then click Copy in the top-right corner. This will open up a new
note, automatically copy in your previous notes text, and refresh the labs, vitals, and ins/outs.
Tip: These steps are the same used to write any note type, other than changing the label of the note under Type.
Tip: For procedure notes, list Procedures as the note type. When typing the note, click on the icon with the three
boxes at the top (between the plus sign and left arrow on the toolbar). This will allow you to select from preexisting note templates. Type in IP PROC and you will see a variety of procedure note templates, including those
for arterial lines, arthrocentesis, central line placement, central line exchange, lumbar puncture, paracentesis, and
thoracentesis. Select your note of interest by double-clicking. Edit it as you see fit. Press F2 to toggle between text
fields. Click Accept when you are finished.
Tip: For death notes, list D/C Summaries as the note type. The note template for this is IP DEATH
CERTIFICATE WORKSHEET. Note that this worksheet requires you to list the name of the ctdn (california
transplant donor network) representative you spoke with as well as a reference number (they will provide both of
these to you at the end of your phone call). For a deceased patient, you need to write two notes. One should be this
death certificate worksheet. The other should be an actual, brief discharge summary. Both are labeled as D/C
Summaries for the note type.

Advanced Tasks
L: How Do I Review the Last Discharge Summary?
1. Click on Chart Review.
2. Click on Notes/Trans.
3. Click on Filters.
4. Click on Category.
5. Look through the list for a discharge summary type note. This is usually listed as D/C Summaries or HXDISCHARGE SUMMARY depending upon how the user titled the note when entering it in Epic.
M: How Do I Find Specific Items of Interest in the Outpatient Chart?
Tip: You can easily collate the outpatient Epic chart into one large document that can be searched for particular
terms of interest.
1. Click on Chart Review.
2. Click on Notes/Trans.
3. Click on Select All.
4. Click on Review Selected. After a few seconds, depending on how large the outpatient chart is, the outpatient
notes will be chronologically displayed in one large document.
5. Click CTRL-F to search for your term of interest (similarly to searching a Microsoft Word document).

Tip: This is a very powerful tool. You can use it, for example, to find out the last time your patient saw a certain
physician, had a colonoscopy, or was admitted with chest pain depending on how you structure your search terms. It
is not the most elegant method, but it is the only way to search the outpatient chart at present.
Tip: You can also organize the outpatient chart by filtering the note types. To do this, click on Chart Review, then
Notes/Trans, then Filters, then Category. In this view, you may easily be able to select various categories of
notes, including progress notes, discharge summaries, h&ps, etc. Similar notes can be filed in a variety of different
category names because of Epics redundancy (i.e., there are several different ways an H&P can be titled) but this is
nevertheless a useful tool to focus your search in the outpatient chart.
N: How Do I Review the Inpatient Medication History?
1. Click on Patient Summary.
2. Click on MedHx. This will display your patients inpatients medications and administration history in various
categories, including scheduled meds, completed meds, discontinued meds, continuous infusions, and prn meds.
Tip: Green means a medication was given and red means it was not. You can click on any particular green or red
time to find out more details about that specific administration. You can also click on the medication itself, then
Full Administration Report to view the entire administration history of that medication for the current admission.
O: How Do I Know if my Patient Ever Received a Certain Medication?
Tip: Sometimes it is helpful to know whether your patient has received a certain medication at Stanford (e.g. heparin
in a patient who is thrombocytopenic, morphine in a patient with a morphine allergy, etc). If your patient is not a
great historian, the steps below might bring you to a quicker answer.
1. Click on Chart Review.
2. Click on Meds.
3. Click on Filters.
4. Uncheck the Current Meds Only box at the top.
5. In the Date Range section at the bottom, select the From and To dates you would like to filter through and
click the magnifying glass when you are done.
You will now see a variety of different medications. By clicking the various filters at the top, you can sort your
results by generic drug name, therapeutic class, and even ordering provider.
You may then double click a specific medication and then click on Full Administration Report to view further
details of the administration history during that hospital stay.
P: How Do I Review Details of Inpatient Pain Medication Use?
1. Click on Patient Summary.
2. Click on Pain.
3. You will see a graph of the patients reported pain levels and a correlating pain medication administration history
below. Corresponding vital signs are displayed as well.
Tip: For PCA usage, the best way to determine 24 hour usage is still to speak with the nurse directly. PCA use will
be displayed in this view, but at present variability in reporting methods make this view inaccurate. For example,
various RNs will chart in volume, concentration, or milligrams. Further, if the RN doesnt clearly document when
the PCA cartridge was changed, it is essentially impossible to determine details of PCA use from Epic alone.
* If you do not see Pain under Patient Summary, refer to Adding Additional Tabs to the Patient Summary
Screen in section 1.
Q: How do I Determine Transfusion History Overnight?

Tip: Similar to PCA usage, Epic does not yet have a full-proof way to view this. Your best bet remains speaking
with the nurse directly. However, you can use the I/O section to indirectly get an idea of transfusion requirements as
described below.
1. Click Intake/Output.
2. Under IN, expand the Blood section. Here you will see a variety of Transfusion Components. If you
place your mouse over the component and wait a second, a dialogue box will pop up displaying the component type
(e.g. prbc, platelets, etc).
By looking at the volume of each individual blood product given, you can indirectly infer how many units they
received. In general, pRBCs and platelets will be 200-300 cc/unit, ffp 150-300 cc/unit, and cryoprecipitate 10-15
cc/unit. These volumes are generalized and can have significant variability depending on specific scenarios.
However, they are useful to know to get a rough idea of transfusion requirements. If you need specifics regarding
overnight transfusions, again, the best way is by speaking to the nurse directly.
Tip: The Transfusion report under Patient Summary is not useful to accurately document transfusion history. It
is a more useful view for nurses to document pre/post transfusion vitals.
Tip: The TRANSFUSION SVC TESTS under Results Review is also not an accurate way to determine
transfusion history. This view reflects crossmatched blood and blood ordered from the bank, but not necessarily
blood products transfused to the patient.
R: How Do I Review Insulin Usage and Blood Sugars?
1. Click Patient Summary.
2. Click Diabetes.
This view will display the diet type, percent consumed, point of care blood sugars (in text and by graph), and
insulin administration. Place the curser over a specific insulin administration and wait 1-2 seconds to view
additional details (if available).
* If you do not see Diabetes under Patient Summary, refer to Adding Additional Tabs to the Patient Summary
Screen in section 1.
S: How Do I Review Antibiotic History?
1. Click Patient Summary.
2. Click Abx.
This will display a fever curve, wbc curve, cbc trend, and chronologic antibiotic administration history. Click the
left arrow at the top to view older data. You can change the view to q8/12/24 hours at the top-right to change the
amount of data displayed on your screen at once.
* If you do not see Abx under Patient Summary, refer to Adding Additional Tabs to the Patient Summary
Screen in section 1.
T: How Do I Review Orders Placed Overnight?
1. Click Patient Summary.
2. Click OrdHx. This will display a chronologic view of all orders placed on your patient.
Tip: When you cant find your fellow housestaff for signout, this is an easy way to get a quick idea of what
happened overnight.
U: Which Types of Common Tasks Require the Use of Order Sets?
Tip: Order Sets in Epic are used for orders that come in a bundle. For sliding scale insulin, for example, the order
set contains not only the insulin, but the nursing orders for fingersticks and a hypoglycemia protocol as well. Order
sets can be accessed by clicking on Rounding then Order Sets and then by typing in your Order Set of interest.

Click Open Order Sets, complete the orders of interest, and then click Sign Orders to activate them. Below are
examples of common order sets.
IP INSULIN DIABETIC KETOACIDOSIS = DKA order set.
IP INSULIN CONTINUOUS IV INFUSION = insulin drip order set.
IP INSULIN TRANSITION OFF IV INFUSION = transition off insulin drip order set.
IP INSULIN PUMP = insulin pump order set.
IP SUBCUTANEOUS INSULIN SCALE INITIATION = starting a sliding-scale order set.
IP SUBCUTANEOUS INSULIN SCALE MAINTENANCE = modifying a sliding-scale order set.
IP PAI PATIENT CONTROLLE ANALGESIA (PCA) = PCA order set.
HEPARIN PROTOCOLS = heparin drip order set.
IP MED COMFORT CARE = comfort care order set.
IP POST PROCEDURE ORDERS LUMBAR PUNCTURE = post-LP order set.
IP POST PROCEDURE ORDERS PARACENTESIS = post-paracentesis order set.
IP POST PROCEDURE ORDERS ARTHROCENTESIS = post-arthrocentesis order set.
IP POST PROCEDURE ORDERS THORACENTESIS = post-thoracentesis order set.
V: How Do I Create My Own Templates? How Do I Borrow Those of Others?
Tip: View the Epic Tip Sheet for greater detail regarding making progress note templates.
Tip: Epic allows you to create a smart phrase which is a template created by you. It can be as brief as a single
word or as long as entire progress note template. Whenever you are typing a note, you may enter .phrase where
phrase is the name of your smart phrase to automatically insert it into your note. The creation of a smart phrase is
described below.
1.
2.
3.
4.
5.
6.
7.

Click on Tools.
Click on SmartTool Editors.
Click on My SmartPhrases. This will open a Workbench tab.
Click New.
Type in the name of your SmartPhrase.
Type the text of your SmartPhrase
Click Accept when you are finished. Your smart-phrase is now created.

Tip: You can borrow smart phrases that have been created by your peers as well. Within the workbench, click
Open. In the User field, type in the name of the persons smart phrases you wish to view. Click Load User
Phrase List. That persons smart phrases will now appear. You can click Share and add yourself to the list of
users with whom to share the smart phrase to make it easily accessible for yourself as a dot phrase.
Tip: You do not need to spend time figuring out fancy ways to display labs and vitals in your progress note. People
will generally refer to the Epic chart directly for these details. Focus on succinctly describing details of patient care
in your note. This will also increase the liklihood that people will actually read your work.

Discharging Patients
W: How Do I Discharge My Patient Home?
1. Click on the Discharge tab.
2. Click the PTA Med Document. This list should accurately reflect the patients prior to admission (pta)
medications. This should be reconciled PRIOR to completing discharge orders.
These medications are initially inputted by the nurses. However, often times the medication, dose, or frequency is
actually incorrect.
Review the list. For pta meds that are inaccurate, click them, and then click Discontinue Med. If this was a
medication they actually werent taking, or if the dose or frequency is incorrect, enter Error under Discontinue

reason. After you re-enter the correct medications, this will prevent your discharge instructions from telling the
patient to both start and stop taking the same medication (which has long been a source of confusion in Epic).
Add additional medications to the pta med list as needed. Epic has a variety of names for various medications that
can quickly become confusing. For PO tabs, the easiest input format for Medication Name is #### PO, where
#### refers to the medication name. For example, if one were to enter tylenol in the Medication Name section,
Epic will generate dozens of confusing tylenol formulations to choose from. If one simply enters tylenol PO, the
first choice is a generic tylenol PO. For each pta medication you add, fill in the dose, route, and frequency (the
remaining fields may be left blank).
After this list accurately reflects the patients medications prior to admission, you have officially reconciled the pta
meds.
3. Now be sure the patients pharmacy is correct in Epic if you plan on faxing prescriptions. Click Orders (while
still in the Discharge navigator). At the top, you will either see a pharmacy name (e.g., Safeway) in blue or the
words No Selected Pharmacy. Click on this text and either verify the pharmacy is correct or enter a new
pharmacy if needed (use the built in search tool to find a pharmacy based on name, address, or phone #).
4. Now that you have reconciled pta meds and chosen the correct pharmacy, you can place your discharge orders.
Under the discharge tab, click Order Sets and open the order set titled IP GENERAL DISCHARGE ORDER
SET.
Complete the order set. This involves basic orders (discharge patient, diet, follow-up), review of pta meds, and
review of inpatient meds (giving you the opportunity to prescribe them if you so choose).
If you have discontinued pta meds that were entered in error, click on No Change when asked to review them as
part of the order set.
If you would like to order additional discharge medications, enter them in the order box under the blue bar with
Additional Discharge Orders. After entering the medication, you can click on it to edit the dose, frequency,
amount prescribed, and number of refills. If you wish to fax the medication, be sure the Fax box is checked. If
you will print it, click Print RX. If you would like to neither fax nor print the new medication, click the No
Print box when you are entering the medication details. Note that discharge prescriptions will print AT THE
PATIENTS FLOOR (not where you are sitting). So, if you are discharging someone on C3 and you are on DGround, your prescriptions will be waiting for you on C3.
If you would like to place referrals, you may also enter them in the Additional Discharge Orders box in the format
of refer ####, where #### refers to the specialty you are referring to.
If you would like to order follow-up imaging (e.g., a chest ct in 3 months), you may also enter this in the
Additional Discharge Orders box.
After you have completed the order set and entered your additional medications, imaging, and referrals, click Sign
Orders.
5. To verify all your hard work is accurately reflected, click on the Discharge tab and then click on Preview
AVS. This is the document the patient is given prior to discharge and should reflect all your major discharge orders
(activity, diet, follow-up, medication reconciliation, new medications, follow-up imaging, referrals, etc). Basically,
all your discharge orders will be found on this document.
If you need to edit some of your signed discharge orders, simply click on the Discharge tab and then Discharge
Report. You will find links to edit and remove various orders as you scroll down.
Once your AVS looks right, you are all done with your discharge!
X: How Do I Discharge My Patient To A Skilled Nursing Facility (SNF)?

1. Follow the same instructions as above in section W. However, instead of using the IP GENERAL
DISCHARGE ORDER SET use IP INTERAGENCY DISCHARGE ORDERS.
Tip: For discharge medications, you may select No Print as the SNF will directly administer the medications. Be
sure to review the AVS, though, as the SNF will administer medications based on these orders!
Tip: In the interagency order set, you have the opportunity to place pt/ot referrals, refer for a home health aid or
home nursing, order labs at the nursing home, and order home oxygen (under the Respiratory section of the order
set; you must specify the route and flow rate; you must also document that the patient requires home oxygen either
by pulse oximetry or blood gas either here or in your progress note).
Tip: If you are discharging a patient home but need to set up home oxygen, complete your discharge orders as
described in section W. Then open the interagency order set and fill out the request for oxygen under the
Respiratory section.
Tip: If you are discharging a patient home with home antibiotics, complete your discharge as described in section
W. Enter the antibiotics as Additional Discharge Orders. Then open the interagency order set and be sure to
place referrals to home nursing if needed. Speak with your case manager if you have questions.
Tip: If the patient needs a discharge device such as crutches or a hospital bed, complete your discharge as described
in section W. Then open the interagency order set as above and enter your request in the DME section under
DME Discharge Order. DME refers to durable medical equipment. Again, speak with your case manager if you
have questions regarding this process.
Y: How Do I Write My Discharge Summary?
1. Many people choose to dictate discharge summaries. If you choose to write one, click on Notes.
2. Click New Note.
3. Click Cosign Required and enter your attendings name.
4. In the Type section, enter D/C Summaries.
5. Type your discharge summary. You may do this free-hand, use one of your own templates, or use one of the preexisting templates. For the latter, click on the icon with the three boxes (in between the plus sign and left arrow on
the toolbar) and enter IP GEN DISCHARGE SUMMARY. You can press F2 to toggle to the next field if you
choose to use the pre-existing template.
6. Click Accept when you have completed your note.
Z: How Do I Write a Discharge Summary for a Patient That Was Discharged a Few Days Ago?
In this case you have three options:
#1) Dictate the discharge summary.
#2) If your patient was discharged within 72 hours, click on Patient Lists, expand Recently Discharged,
expand Recently Discharged, click the appropriate time-frame and select your patient from the alphabetically
sorted list. Double-clicking their name will open their chart in the inpatient environment with the familiar view,
allowing you to enter a discharge summary in the notes tab.
#3) If your patient was discharged more than 72 hours ago, you can still type a discharge summary by following
these steps. Click on Pt Station at the top. Enter the patients name or mrn and click Find Patient. Scroll
through the top list and click on Admission that reflects your patients recent admission. Then click Open
Chart. This will also open the chart in the familiar inpatient environment and allow you to enter a discharge
summary.