Clinical List Locks

In Logician a clinical list refers to specific items that are stored as "structured" data in the patient medical record. Examples of clinical lists are medication lists, problem lists, allergies, directives as well as certain other "structured" data elements.

Even though Logician allows users to have multiple documents relative to a single patient open at any time, it only allows one document at a time to change any of these list elements lest the right hand and the left hand are trying to do different things at the same time (so to speak).

If I enter or change a medication in Logician then print it out that medication is saved as a "signed" clinical list change and all is well with the world. Another user in another document will see that change & can make another change if needed. However, if I enter a medication change then do not print it out then it is an "unsigned clinical list change" and this will prevent other users from doing anything to any other clinical list until I finish what I am doing. If medications are "locked" then so are problems, allergies, etc.

The easiest way to deal with this is to AVOID leaving unsigned clinical list changes in your chart update. This is done very simply by keeping the "Sign Clinical List Changes" box checked on the "End Update" dialog.

YOUR RESPONSIBILITY AS A SUPERUSER (or whatever)

First & foremost, please do whatever you can do to keep less experienced users from leaving their clinical list updates unsigned.

This document, however, is to establish a workflow if someone leaves a clinical list element unsigned and another person needs to write a Rx, update problems, etc.

First--you need to establish which document is locking things up.

This is usually easy. It's the document with the little blue padlock on the document view.

Simply double click on that document then end update with the "Sign Clinical List Changes" box checked (see above).

Proposed Workflow for clearing other people's "Clinical Listlocks"

If someone in your clinic needs to use a chart and the listlock is held by another user in your clinic

o this is your responsibility. Either sign the listlock yourself or get the person who holds the listlock to sign it. This usually needs to be done ASAP so others can move on with their patient care.

If the listlock is held by another provider in another clinic

o start calling per the phone list going down the list of "superusers" in the other clinic. Insist that this needs to be done ASAP because it is holding up clinical care.

REMEMBER--when you sign the list you may print a prescription at the same time. Unsigned prescriptions are the most common reason for a listlock. You are responsible to be sure that the prescription you print has been properly dealt with.

RARELY this will not fix things. We have seen several cases of "Bogus clinical listlocks" where the appropriate actions are taken yet the "lock" remains. Please call the help desk or report this to your analyst since this will usually require technical intervention. You may have to write a paper prescription & send yourself a flag to enter this medication properly after the problem is fixed (could take a week).