SingHealth NGEMR · Epic training
Endo Nurse
101
Your pocket guide to Epic for Endoscopy Nurses, from booking the scope to sending the patient home.
your finger!
This eBook covers
Before we start
Tap, flip, learn
This eBook reacts to your finger. Look out for these.
Red buttons
Tap to reveal the answer or hidden tip.
Flip cards
Tap a card to turn it over and see what's behind.
Quick quiz
Pick an answer. Green is right, red means try again.
Step by step
Press Next step to walk through a workflow one click at a time.
Hotspots & games
Tap numbered dots on a screen, put events in order, and move a patient across the Status Board.
Turn the page
Use the bar at the bottom, swipe left or right, or press the arrow keys. Tap the page number for contents.
💡 Stuck in the real system?
Press F1 (or Fn + F1) anywhere in Epic to open your Learning Home with tip sheets and quick start guides.
Endo Nurse 101
What's inside
Tap any part to jump straight there.
Our cases
Meet your patients
Tap each card to see why they're here. You'll follow Kaya all the way through.
💡 Where you log in
Log in to SH Ambulatory Endoscopy Centre and GI Function Unit as your assigned nurse. Your login department decides which depot, schedule and Status Board you see by default.
Part 1 · Getting started
Find your way around
Four ways to reach any activity. Tap to flip.
Leaving the workstation?
The next person who logs in sees the same patient chart still open. Use it when a colleague will continue with the same patient.
The next person sees their own home workspace and has to open the chart again.
Part 2 · Scheduling
Meet the Snapboard
The scheduling tool for appointments, resources and room schedules.
The depot
Lists orders that still need scheduling. Sort by patient and press the first letter of the surname to jump, or use Search requests. The depot loads 200 at a time; click Load More if needed.
The schedule
Appointments that have been scheduled. At the Ambulatory Endoscopy Centre, each facility / endoscopy room is a column.
⚠️ Not seeing the orders you expect?
- First check you're looking at the right depot (search bar or settings button). Your login location sets the default.
- Then check the schedule (calendar section, bottom left).
🏷️ Scheduling Priority column
Shows the expected date for elective procedures and P1–P4 priority for emergency procedures.
Part 2 · Scheduling
Schedule Kayasched
Kaya's ward nurse in charge says the primary team wants her OGD tomorrow.
📅 Schedule from the Snapboard
- Open Snapboard from the toolbar or home workspace tabs.
- Search for Kayasched and select her inpatient OGD order. Expand the Details sidebar to read the doctor's instructions.
- Double-click the order to see the Order Specific Questions, then close.
- Click tomorrow in the calendar.
- Drag the order to an open slot. The bubble shows the exact time as you drag. Bedside scopes go to the bedside modality.
- Click Continue, complete the Decision Tree, click Apply.
- Check Appointment Review with the ward nurse, relay instructions, then Schedule. The order leaves the depot.
📋 Order Specific Questions tell you…
- If the patient is on anti-platelet, anti-coagulant, anti-diabetic meds or has a cardiac implant. Advise the patient accordingly.
- Any special equipment needed, so you can assign it now or later.
- Extra notes for the scheduler in Comments.
🌳 The Decision Tree
| Question | Why it matters |
|---|---|
| Requesting OU | The specialty she's admitted under. Triggers the TOSP charge. |
| Appointment Rationale | Goes to reporting for the Endoscopy Manager. |
| Patient class | Inpatient, outpatient and so on. |
💡 Green and red numbers
They show available slots per interval. In training you'll see many bookings in one slot; in real life each slot holds only one appointment.
Part 2 · Scheduling
Assign resources
Pre-assigning staff and equipment prevents overbooking, and it pulls into all later documentation.
👩⚕️ Add the circulating nurse
- Look at the icons on Kaya's appointment. They show which resources are still needed (e.g. Circulating Nurse, Proceduralist).
- In the resource sidebar, click the green + beside Circulating Nurse. Pick the nurse and Accept.
- Single-click Kaya's appointment to select it.
- Click the blue arrow next to the nurse's name, or drag the name onto the appointment.
- The icon disappears once assigned. Wrong person? Click the red arrow to remove.
- Repeat to assign the gastroenterologist as proceduralist, and any special equipment.
💡 Saves time later
Assigned staff show in the Assigned Staff column on the Status Board and appear as quick buttons in the Intraprocedure Narrator.
Part 2 · Scheduling
Two orders, one booking
Lucia needs OGD and colonoscopy. A combination procedure is scheduled together.
🗃️ From the Appointment Desk
- Click Appts on the toolbar and search for Lucia.
- Open the Active Requests tab (tabs only appear when there's data).
- Select both orders: click one, hold Shift and press the arrow key. Or pick one and tick the other on the related orders screen.
- Click Schedule and complete the Decision Tree.
- Book for 2 days later, finish and close the workspace.
🗃️ Appointment Desk layout
- Top: demographics and account information.
- Bottom tabs: Future, Past, Admissions, Active Requests.
- Bottom toolbar: actions for whatever you've selected.
Best when a ward nurse calls about a specific patient.
🏥 Patient Station
View past and future admissions and appointments. Find Patient › Select. The Encounter tab opens by default; choose the All filter to see scheduled appointments.
💡 Extra intervention?
The doctor flags it in the order, so the name shows as e.g. Colonoscopy w Ligation.
Part 2 · Scheduling
Change of plan
The ward calls back: Kaya now needs her OGD today.
🔁 Reschedule from the Appointment Desk
- Appts › find Kaya › her OGD is on the Future tab.
- Select it and click Cancel/Reschedule (or right-click).
- Reason: Doctor Request. Click Reschedule.
- The Decision Tree reappears. Confirm with the ward nurse nothing has changed.
- Start search on t (today). Pick an available slot button.
- Finish. The old appointment moves to the Past tab as Can (cancelled).
💡 On the Snapboard too
You can drag an appointment to a new time or room. You'll be asked for a change reason.
Part 2 · Scheduling
Kaya has arrived
Check her in so other staff know she's here.
✅ Why check in?
- Sends the order message to Enhanced ImageSys.
- You can't start endoscopy documentation until the appointment is checked in.
- Do it on the GI Status Board: right-click › Check In. (Snapboard and Appt Desk work too.)
- Status changes from Booked to Arrived. The chart doesn't open; refresh if needed.
⏱️ Wait time column
Minutes from check-in to In Procedure Room. Not started yet? Check-in to now. Icons confused you? Open the Legend.
⚠️ Checked in by mistake?
Right-click › Cancel Check In (Snapboard or Appt Desk) to return it to scheduled.
Part 3 · Preprocedure
Watch the Status Board
Every event moves Kaya along and changes her row. Press the button to walk her through the day.
Scheduled, not here yet.
⏰ What is an event?
An important moment in the patient's care with an exact date and time, such as In Pre-procedure Care, Scope In or Out of Recovery.
💡 Outpatients
Assigning an Assessment Room / Pre Proc Chair automatically updates the event to In Pre-Procedure Care.
Part 3 · Preprocedure
She came 15 min ago
Kaya actually arrived in preprocedure 15 minutes ago. Let's record the real time.
⏪ Back-document
- On the Status Board, right-click Kaya's row › Events › In Pre-procedure care.
- Right-click again › Events › All Events.
- Change the time of In Preprocedure Care to n-15.
- Double-click her row to open the chart. It opens to the Preprocedure Navigator.
⌨️ Try the time shortcuts
Type in any time or date field instead of picking. Try it:
n = now (minutes) · t = today (days) · w = weeks · + future · − past
Part 3 · Preprocedure
Arrival documentation
Vitals, history, home meds, allergies, LMP/pregnancy, labs, LDAs… all in the navigator.
🧭 Navigator = a checklist of tools
Sections laid out in workflow order. Click section names or use the keys:
F8 next F7 previous F9 close
Hover over the Storyboard sections on the left for a quick look at the patient.
👤 Staff
Assign yourself fast: type .me
💊 Home Medication
Review with the patient. One button records she took all home meds today or yesterday.
⚠️ Allergies: CMIS first
- A new drug allergy must be documented in CMIS, not directly in Epic. It auto-reconciles back to Epic and other institutions can see it.
- Click Mark as Reviewed: it means you've verbally verified with the patient, and it stops repeat pop-ups later.
- In training you'll see a red CMIS refresh banner. That's expected.
♀️ OB/Gyn Status
Shown for female patients only. Kaya is female, so update and review it.
📟 Device Select
Associate the monitor so vitals pull into the chart. Device data still needs validating.
Part 3 · Preprocedure
Is she ready?
The Tasks section (under Pre-Op Checklist) lists what must be done before the scope. Tap each task.
✔️ Completing a task by hand
The doctor documented the pre-sedation checklist in Notes. Mark the task Complete:
- Reason: Other (See Comments), or say it was done on paper.
- Comment: "Provider documented pre-sedation assessment checklist in notes activity."
Something missing? Send Message to the provider.
🛡️ Universal Protocol
- Review the checklist the ward nurse documented.
- Click Pre-op Checklist, answer each question individually, then Verify and Accept.
- Need to stop halfway? Click Pend.
- All tasks done = a tick on the Status Board.
Part 3 · Preprocedure
Release the orders
Orders activity tabs: Active Orders · Order Entry · Signed & Held · Labs/Tests
⏸️ Signed & held
Orders placed before they're ready to act on. You can't act on them until you release them. Tick the box beside the procedure name to select all › Release.
Once released, pharmacy can see and prepare the medications.
🪣 Phases of care
Each phase is a stage of the visit: Preprocedure, Intraprocedure, Postprocedure. Think of it as a bucket, or a tag on each order.
💡 Phases of care also decide
- Where and when to act on each order.
- Medication routing, together with the patient's location.
- Which orders auto-discontinue when she leaves the procedural area.
Part 3 · Preprocedure
Midazolam 3 mg
Kaya is anxious. The doctor asks you to give midazolam 3 mg IV.
💉 Order Entry tab
- Orders › Order Entry. Look up Midazolam injection 5mg/5mL.
- Route Intravenous, dose 3 mg.
- Show Additional Order Details › phase of care Preprocedure › Accept.
- Or use the Phase of Care button under Options in the sidebar.
- Click Sign. Order mode: Per protocol: cosign required.
- Ordering clinician: Gastroenterology, Physician. Authorising defaults to him too. Accept.
⚠️ Medication warnings
Have the doctor on the phone or nearby when you enter orders for them, so they can resolve interaction warnings. Ordering clinician without authorising rights (e.g. a Medical Officer)? Ask who the authorising consultant is.
Part 3 · Preprocedure
Document the IV line
LDA = Line, Drain or Airway. Every LDA has three pieces: insertion, assessment, removal.
🩹 LDA Avatar
- Navigator › LDA Avatar. Search "piv" or click Peripheral IV.
- Tap the site on the avatar, e.g. right forearm.
- Document placement date, time and gauge. Accept.
- Made a mistake? Click the PIV › pencil next to Properties › fix › Accept.
- To assess: hover the line › Assess › document › Accept. Anyone can assess, many times.
💡 Where does it go?
LDA Avatar documentation flows to the OR LDAs tab in the Flowsheets activity.
Part 3 · Preprocedure
Give it on the MAR
The MAR shows only active medications. Documenting a given dose automatically charges to NBS.
🖱️ Without the scanner
- Open the MAR. Click Link Lines and link to the PIV.
- Click the blue due icon on the midazolam row. (Click a time column header to give two meds at once.)
- Check dose, route and time. Barcode override reason: Scanner faulty.
- High-risk drug? Dual sign-off by a second nurse, without logging out.
- Accept.
✏️ Gave it 10 min ago?
Click the green given administration › tick Edit administration › override reason › change time to n-10 › add a comment › Accept.
💡 What does that icon mean?
Click Legend on the MAR. Nobody expects you to memorise every symbol.
Part 4 · Procedure
Into the room
Close the Preprocedure Navigator. On the Status Board, mark Kaya In Procedure Room. Her row turns blue; double-click to open the Intraprocedure Narrator.
Linear. Tools in a set order, section by section. Used in pre and post.
Flexible. Everything you need during the scope on one screen, in any order.
⚠️ The Event Log has bookends
It only shows documentation between when you first open the narrator and when you mark End Endoscopy Documentation. It isn't the patient's whole record.
💡 Pulled into the doctor's Endo report
Staff, medications and specimens documented between Start of Endoscopy Documentation and End Endoscopy Documentation.
Part 4 · Procedure
Tour the Narrator
Tap each red dot. Left side: things you do again and again. Middle tabs: things you do once or twice.
📍 Tap a red dot
Each dot explains one part of the Intraprocedure Narrator. Try all 8.
Part 4 · Procedure
Before you start
✅ Set up the case
- Staff: the proceduralist is already there from Snapboard. Click his name to mark him arrived.
- Add yourself as circulating nurse: .me › Accept. Both appear as arrived on the Event Log.
- Associate Devices › select SH Phillip Endo 01 so vitals pull in.
- Universal Protocol tab › review the preprocedure nurse's checklist › document a new Pre-op Checklist › Verify and Accept.
- Moderate sedation, so also do the Endoscopy Timeout › Verify and Accept.
- Equipment: pick the umbrella type (e.g. OGD), then select or scan the scope. The serial number fills in automatically.
⚠️ Scope not on the list?
Click Equipment not found for a new or loan item, and tell the Lumens team to add it. Adding a laser opens the Laser Safety Checklist.
Part 4 · Procedure
Put the events in order
These events are required for reporting. Tap them in the order they happen. 📄 = time pulls into the Endo report.
Tap the first event.
💡 Combination procedure?
When you document Scope In and Scope Out, write which procedure it is in the Comments field.
✏️ Wrong time?
Click the event in the Event Log, or use Events › All Events at the top.
Part 4 · Procedure
Sedate & monitor
Kaya is prepped. Give fentanyl 50 mcg and midazolam 3 mg, then start.
💉 In the narrator
- Flowsheets › Sedation. Check the Pre-Sedation Assessment is complete.
- Back in the narrator, give both drugs from the Medications section. Ordered by = the arrived proceduralist; Given by = you.
- Document Sedation Start, only if you're the sedation nurse. No sedation? Skip it.
- Document Scope In (and Cecum Reached for colonoscopy).
- Flowsheets › Vital Signs. Validate device vitals throughout. They flow to the Moderate Sedation tab.
- Pain assessment and score: Pain Monitoring tab.
🔗 Where do narrator meds go?
They show under Active Meds and MAR in the narrator, flow to the MAR activity, and charge NBS automatically. The doctor cosigns them.
📝 Quick Notes
Nursing Note: a quick observation or free-text assessment. Patient Position Note: e.g. for ERCP. Use F2 to make selections. It saves to Notes as Sedation Documentation.
Part 4 · Procedure
Specimens
The doctor takes biopsies. To search for a specimen you first need its source.
🧫 Specimens tab
- Search the source, e.g. Stomach (Sydney Protocol: Incisura, Antrum and Body biopsy). Or click Add.
- Document the required details and Accept.
- Print the specimen label and requisition form on the right printer.
- Click Mark as Sent when it leaves the Endoscopy Centre, for auditing.
- The doctor cosigns the specimens.
⚠️ One line, one histo/cyto test
- Each specimen line: 1 histo/cyto test, or several clinical pathology tests, or 1 histo/cyto plus several clinical pathology tests.
- Need 2 histo/cyto tests? Document 2 specimen lines.
- Don't pick POCT tests done in the Endo Centre here. This tab sends specimens to the lab.
Part 4 · Procedure
If it's not documented…
…it isn't charged, and it can't be traced in a recall.
🧰 Supplies tab
Search e.g. Disposable OGD Bx Forceps, or Add. Mark Used or Wasted and whether to charge wasted supplies. Barcode scanning works.
🔩 Implants tab
Search e.g. WallFlex Biliary RX Fully Covered Stent. An Implanted action is required for every chargeable implant. The charge code pulls in automatically.
⚠️ Fill in every implant field you can
If the implant is recalled, complete records help find the patients who have it, and tell apart those who need it removed from those who don't.
Not in the system? One-time item
Part 4 · Procedure
Close the case
The scope is coming out. Finish the documentation in this order.
🏁 Closing documentation
- Document Scope Out (procedure type in Comments for combination procedures).
- Data Validate: highlight device data and click Validate. Document the ACVPU score every 5 min.
- Intraprocedure tab › Associate Devices › remove the device.
- Universal Protocol › Sign-out › Verify and Accept.
- Document Sedation End and Staff Departed.
- Completion tab › pencil on Charge Capture › pick charges. They go to NBS when the log is posted.
- Verify the chart, then Out of Procedure Room and End Endoscopy Documentation. A tick appears on the Status Board.
Validated. Part of the chart.
Unvalidated. Not in the chart yet.
💡 Data Validate leaves the narrator
So it's best used near the end of the case, to validate lots of vitals at once.
Part 5 · Postprocedure
Into recovery
Kaya's OGD is done. What's the first thing you do? Give her a bed.
🛏️ Settle her in
- Status Board › right-click Kaya › assign a recovery bed.
- Mark the event In Recovery. Assigning a bed does not do this for you.
- Open her chart. The Postprocedure Navigator opens.
- Staff section: add yourself as recovery nurse.
- Recovery Assessment › document the Immediate Postprocedure Assessment (required).
💡 Need the anaesthesia note?
Chart Review › Notes tab.
Part 5 · Postprocedure
Rapid urease test
Kaya has a POCT Rapid Urease test (H. pylori). Point-of-care results go in Enter/Edit Results.
🔎 Getting there
Dropdown arrow right of the activity tabs › Lab › Enter/Edit Results. Or type it in Chart Search. Double-click the test.
💰 Final = charged
Setting status to Final triggers the charge to NBS and the order drops off the list.
Part 5 · Postprocedure
File the vitals
Device data flows in with a small line on the left: it isn't part of the chart yet. Tap a column's time to file it.
| BP | 124/78 | 118/74 | 219/140 |
| Pulse | 84 | 80 | 78 |
| SpO₂ | 98 | 99 | 98 |
| Resp | 16 | 14 | 16 |
0 of 3 columns filed.
⏲️ Insert Col vs Add Col
✅ WNR
Within Normal Range. Document an exception (X) and extra rows appear for detail. Change the display interval to how often you want to see vitals.
Part 5 · Postprocedure
Last checks
Remove the line
LDA Avatar › hover the PIV › Remove › today, now › Accept. It disappears from the avatar.
Endoscopy PADS
Score per your institution's policy and SOP.
Fall Risk
Document fall risk in its section.
🧾 Order Questions & TOSP
Review the answers the proceduralist gave, especially the TOSP code. It's sent to NBS when the doctor signs the Endo report.
🔄 Verify Procedure
Change the procedure or TOSP (Change Order, or No charge), or add one with New Order. Updating the procedure is the proceduralist's responsibility, before signing. After signing it needs an addendum.
⚠️ Verify Orders locks the procedure
It closes the chart and blocks the doctor's report while open. Only open it when needed, then reopen the chart.
Part 6 · Discharge
Going home
After an hour in recovery, Kaya is awake and alert. Give her the instructions and the After Visit Summary (AVS).
Use the Discharge sections.
Fill in the Handover Checklist instead.
📄 Discharge sections
- Flowsheets › Moderate Sedation: check the doctor marked Fit for discharge, then document Sedation Discharge criteria.
- Medication Rec Status: meds from the doctor's med rec. Tell her when to take them.
- Discharge Instructions: use F2 to jump between blanks. Type "No driving for 12 hours."
- Lumens AVS: scroll through meds, instructions, procedure, findings and scope images.
- Ambulatory Discharge: complete the checklist.
🖨️ Print button greyed out?
The doctor hasn't finished the postprocedure medication reconciliation. Once done, you can print the AVS.
✍️ Before she leaves
The doctor must have signed the procedure note (sends the TOSP charge to NBS). Check the last tick on the Status Board.
Part 6 · Discharge
Can Kaya go home?
Tick what's done. She can't leave until every item is complete.
✔️ Verify the chart
Document Recovery Care Complete and Out of Recovery as now › open Verify, check there are no warnings › verify as yourself › close the chart. A postprocedure tick appears on the Status Board.
💡 Then: Procedural Care Complete
Her row turns purple and drops off the Status Board. Find dropped-off patients on the Charge Status Board.
Part 6 · Discharge
Discharge Kaya
She's left the centre. Usually the PSA does this in Patient Station, but you can do it from the Status Board.
🚪 How
Status Board › right-click Kaya's row › Discharge. Or single-click the row and click Discharge at the top. Fill in the required fields and discharge.
Finish line
Final quiz
12 questions. First tap counts.
Answer all 12 to see your result.
You made it
Where to get help
Nobody expects you to be an Epic expert yet.
Press F1
Opens your Learning Home from anywhere. Or click the ? at the top right, or search "Help". Switch Learning Homes by clicking its name. Check What's New after go-live.
Practise
Work through the exercise booklet and after-class practice scenarios.
Ask people
Your super users, trainers and nurse managers can help after class.
Go-live readiness
Complete your readiness activities to get system access at go-live.
Lumens team
New or loan scope not on the equipment list? Ask them to add it.
Remember
Training covers the tools. Apply them to your centre's own policies and SOPs.