Flow Sheets in Epic: Structure, Use Cases, and Management

Flow-Sheet Navigation & Visibility

• In the Navigator sidebar you can activate “Session Information Report” to see embedded flow-sheet content directly within that Navigator section.
• Inside the stand-alone Flow-Sheets activity you will not see a sidebar that tells you everywhere a given row is referenced—the linkage is unidirectional (Navigator → Flow-sheet), not the other way around.

Record Structure (Template → Groups → Rows)

• Level 1 Container = the template (the outermost “bucket”).
• Inside the template are groups (sometimes called “folders” or “sections”).
• Each group contains one or more rows (the actual cells users chart into).
• Exam Hint: Every chapter in the training manual starts by diagramming this hierarchy. Expect questions such as “Can a flow-sheet template contain only rows (no groups)?” (Answer: Yes, but it is rarely recommended for usability.)

Why Analysts & Clinicians Gravitate Toward Flow-Sheets

• They are the default answer to many documentation gaps because they:
– Store fully discrete, time-stamped data.
– Allow trending across encounters (Snapshot report, reporting workbench, etc.).
– Populate tables in SmartForms, letters, or export files.
– Require no build on the narrative side—simple checkboxes or numeric fields suffice.
• Danger: Over-use leads to “flow-sheet sprawl” (huge, duplicative lists that confuse users). Best practice is to extend existing templates/rows before creating new ones.

When Flow-Sheets Are the Right Tool

• “Include this discrete value somewhere else later” (e.g., trend BP in Snapshot).
• Need to capture data repeatedly over time with date/time granularity.
• Values must be reportable in Clarity/Caboodle or print automatically in tables.
• Simple numeric, coded, or Boolean fields; no images or rich text required.

When Flow-Sheets Are NOT the Right Tool

• Documentation requires images, long narrative text, or SmartTools.
• You want a hard stop that truly blocks workflow (flow-sheets can be “required” but do not freeze the screen; at 4\text{ h}01\text{ min} nothing forces completion).
• Need immediate decision-support pop-ups or complex logic—consider SmartForms, I SmartBlocks, or BPA rules instead.

Example: “Within Defined Limits (WDL)” Row

• Row name: Within Defined Limits under the Neuro assessment group.
• If a nurse charts “WDL,” the system implicitly documents all the bullet points listed in the row-information pane (e.g., pupils equal, movement symmetrical, etc.).
• Tip: Row-information pane always reveals:
– Allowed value types (numeric vs. coded vs. free text).
– What each coded value actually means clinically.
– The unique Row ID (needed for reports or build troubleshooting).

Adding Rows at the Point of Care

• Click “Add Rows” inside the open template. The search only queries rows already allowed by that template.
• Hidden rows: Some rows exist in the template but are suppressed by default; you can surface them ad hoc (e.g., adding “Neurological Interventions”).
• Template restrictions: If no match appears, the template is hard-restricted—switch to another template better suited to the moment.
• Persistence rule: Once you chart in an added row, it remains available for that patient for the remainder of the encounter (survives shift change) but does not auto-carry to future encounters.

User-Side Customisation Tools

• Wrench icon: Lets an individual reorder templates or load additional ones for their own view—no build ticket required.
• Search filter icon: Indicates a template/row is contextually filtered (e.g., visible only when a Blood Product order is active).

Template-Discovery “Buckets”

1. Current – what is already displayed (defaults + anything you added/documented).
2. Preference List – small, curated set analysts assign to a department or security class (NOT a personal user list). Think “PICU nurses’ top 5 templates + 4 common add-ons.”
3. Facility List – every active template in the current hospital. Larger, may include PT/OT rows, specialty rows, etc.
4. Database List – literally every record in FLT across the entire organisation (live or not, good/bad/ugly). Use sparingly.

Workflow Automations (Order-Triggered Rows)

• Blood Product order releases? System auto-adds vitals & transfusion reaction rows.
• High-risk infusions (e.g., vasoactive drips)? Titration and dosage rows drop into the Vitals template automatically.
• These rules are part of foundational build and reduce manual searching.

Clinical Content Review – Upcoming Exercise

• Scenario: A Mean Arterial Pressure (MAP) calculated row should auto-compute from SBP/DBP but is returning blank.
• After lunch the class will open Clinical Content Reviewer to trace:
– Row formulas.
– Prerequisite fields.
– Encounter context issues.
• Goal: Diagnose why the MAP row fails and implement the fix.

Practical & Ethical Considerations

• Over-documentation ≠ better care: Extra rows may distract nurses and delay charting—balance granularity with cognitive load.
• Required-but-non-blocking items (e.g., PICU dosing weight) rely on professional accountability rather than hard stops—ensure audit processes backstop patient safety.
• Transparent Row-Info panels help clinicians understand the clinical meaning behind coded shortcuts, supporting ethical data use and accurate reporting.

Connection to Earlier Lectures

• Build Hierarchy parallels other Epic records (templates ≈ SmartText categories; rows ≈ SmartData Elements).
• Order-trigger automation echoes Order Composer rules covered last week.
• Preference vs. Facility lists mirror the SmartTool preference hierarchy (user → department → system).

Key Takeaways

• Flow-sheets are powerful yet can be mis-applied; use them when discrete, time-stamped, trendable data is needed.
• Understand and respect the Template → Group → Row hierarchy.
• Leverage preference lists and order-trigger rules to keep clinicians out of the “database” swamp.
• Know the limits: images, narrative text, or hard-stop requirements call for other documentation tools.
• Always consult Row-Info for build IDs and clinical definitions before sending build tickets or studying for the exam.