Nightingale Notes FAQs

Have a question about Nightingale Notes? Click on a subject below to view questions from other users on that topic.

• Customizing Nightingale Notes

  • Does the system alert you when a supply falls below its reorder point? Or are you required to run an inventory report periodically?

    • The system does not alert you when a supply runs below its set reorder point. There is a Supply Inventory Report that can be run to show this information.

  • I added a custom tab and a custom field for a phone number. When I use that field to enter the phone number I can only add numbers and not dashes or parenthesis (used number for data field instead of text).

    • When a custom field is set up there are several data types you can choose to decide what type of information is available in each field. If that field was set up with a data type of “number” then only numbers, and no other characters, like parenthesis or dashes are allowed. An alternative to using the data type of “number” is to use the data type of “text”. Using “text” allows you to enter numbers, letters and characters.
    • Another key point to remember is that custom fields using a data type of whole number or decimal, will have the options for sum, average, min, and max in the Report Wizard. Custom fields using text as the data type will not have options for those mathmatical operators.

  • Can you hide custom tabs that other programs will not be using?

    • At this time, you are unable to hide your Custom tabs by program use.

  • I added a custom tab for physicians but these additional fields do not show on the client details screen when I select the physician.

    • The custom tabs for physician are only available in the Set Up menu when you are working with a Physician. The custom tabs for physician are intended for very specific internal-agency use, and not for use at the client level.

  • I have added a custom tab and fields. Now I realize there is a mistake and I want to delete them. I cannot. What do I do?

    • You have the option of inactivating a custom tab. When inactivated, the custom tab will no longer display for users. If you really need to delete a customer tab you need to first delete any fields created for that tab. If any data has been entered in a field, that field can not be deleted and therefore the associated Custom tab can not be deleted. If no data was entered on any activity or client records for any fields on that custom tab, then the delete icon displays next to each field. Delete each field, and only then can you delete the tab.

  • I can’t delete an unused Custom tab that I created – why?

    • Before you can delete a Custom tab, you need to delete any fields created for that tab. If any data has been entered in a field, that field can not be deleted and therefore the associated Custom tab can not be deleted.
    • If your Custom tab cannot be deleted, you can make that Custom tab inactive by unchecking the active click box. This will make that Custom tab inactive and would not be available to your users. Inactive Custom tabs do not count towards the allowed 10 Custom tabs per section.

  • What do I do when an Employee leaves (under Setup)?

    • When an employee leaves you can make them inactive. From the Set Up menu, select Employees. Edit the employee record and uncheck the Active box.
    • You do have the option of deleting an employee from Nightingale Notes when they leave your agency IF they do NOT have any activities or clients assigned to them. If any activities exist for that employee, or any clients are assigned to them, they can no longer be deleted.

  • How do I delete a field that I don’t want my employees to use?

    • Fields that are on the Custom Field tabs may be inactivated or deleted by users with Supervisor privileges to the Set Up options. Other fields, that are standard, built in fields in Nightingale Notes can not be deleted. You may want to add and train on procedures with your employees to help them learn which fields not to use.

  • Can we enter a questionnaire our agency uses as a custom tab? How many fields can we enter on a tab?

    • Yes, absolutely. There is no limit on the number of fields you can put on a custom tab. It is important to remember when designing your custom tabs that the more fields you put on a single tab, the more scrolling you will have to do to see the fields at the bottom.

  • How can I add new items to appear on the Vitals screens without creating a new Custom Tab?

    • Several built-in fields on the Vitals screens appear as check-box lists. Administrators can add, modify, or delete items on those lists under Setup/Vitals.
    • An agency will need to add a Custom Tab to add any other new fields. If you have a field that you feel others would also like to see on the Vitals tab, please send your suggestion to CHAMP Support to add to the client “wish list” of future enhancements.

• Entering Information in Nightingale Notes

  • How do I view growth charts for my client?

    In order for the Growth Chart report to display in the Activity List Reports – on – Demand list the following are required:

    • The child must have its own Client record – its own admission.
    • The Born on Date in Client Details/Name and Address Tab has to be filled in AND the date has to be within the last 5 years.
    • The child must have a Gender filled in on the Client Details/Demographics Tab. At this point the report is available in the Activity List Reports – On-Demand. In order for any data to display on the report, at least one activity has to have at least one of the Child Vitals for Length, Weight, or Head Circumference filled in.

  • Why can’t I use the Copy button to create the next activity?

    • Copy activity is only available if charting exists for an activity.

  • How do I remove a ledger entry?

    • Ledger entries can not be removed. Enter a reverse entry to correct the ledger balance.

  • Why can’t I delete a claim file?

    • If a payment has been posted to the ledger for that claim it can no longer be deleted.

  • Why can’t I edit my activity?

    • Check to see if the activity is locked. If it is, a supervisor can unlock it. Or if the activity has been included in a billing cycle the activity cannot be edited. The claim needs to be deleted in order for the activity to be edited.

  • Can I allocate time to more than 1 service in an activity?

    • No. You need to enter the time for each service as a separate activity.

  • Can I charge an activity to more than 1 cost center at the same time?

    • No. You need to create a separate activity each time the cost center changes.

  • Does the client search function also search the aliases recorded in the admission tab for all clients?

    • Yes, the client search does search Aliases. If the client’s last name changes from ‘Smith’ to ‘Jones’, that client listed in the search as ‘Jones’.

  • If my supervisor unlocks my chart for me to correct a mistake how long will the chart remain unlocked for?

    • When a chart is unlocked, it remains unlocked until midnight.

  • I cannot type in a name in the physician, employee or diagnosis fields (related to the search fields).

    • These fields are all search fields. This means you cannot type just any names into those fields. You have to search for the physician, employee, or diagnosis that is already set up in your agency’s database. Use these boxes to search. Click in the box, like physician for example, and start typing as much as you know of the physician’s last name. A list of matches displays and you may select a name from that list. If you do not see a physician in the list, then a supervisor needs to add that physician or employee to the list using the Set Up menu.
    • If you do not see a diagnosis in the list of results, you will need to check the diagnosis to make sure.

  • I picked up a new client that I know has already been charted on by another program but when I look for this client in the system I cannot find them?

    • If the client is assigned to a program on the Client Admission tab and you are not also assigned to at least one of the programs the client has, you will not be able to see them in your client list. A supervisor needs to assign you to programs using the Set Up options.

  • I cannot add a city or state in those fields (pre-loaded zip codes)?

    • Nightingale Notes uses a nationally recognized address database to automatically populate the correct city and state when you enter the zip code. You only have to enter one field, the zip code, rather than all three fields.

  • I have entered a client but when I go back to the list I cannot find my client.

    • If the client is assigned to a program on the Client Admission tab and you are not also assigned to at least one of the programs the client has, you will not be able to see them in your client list. A supervisor needs to assign you to programs using the Set Up options.

  • How many days does the auto lock take to lock?

    • Charts are automatically locked 7 days after the activity date.

  • What’s the difference between a Pay Source and a Cost Center?

    • Pay Source refers to the entity or program which will be paying for the visit/services to the client (e.g., Medicare, Medicaid, ABC Grant). For those visits/services provided by the agency without reimbursement by a funding source of some sort (such as some disease control services), many agencies identify “County” as the Pay Source.
    • Cost Center refers to the administrative unit within your agency charged with overseeing time spent for that visit/service. This could be a specific program (NFP, First Steps, etc.) or a larger unit (PH Nursing, Disease Control).

  • How can we create a family chart?

    Different agencies have different approaches to creating a family chart:

    • Some agencies chart on more than one family member on a single care plan (e.g., mom/baby), opening the chart to one family member only (usually an adult).
    • A more common and better approach is to open separate charts for each family member (e.g, mom and baby each have their own chart), but to link those records through the use of a common identifier through the chart number. For example, Mom’s record could be numbered AB1234-1 and the infant’s record could be identified as AB1234-2. The advantages of using a common family chart ID number (AB1234) is that you can easily find all the records for individual family members and can add additional family members in the future prn, while allowing each family member to have his/her own personalized care plan. This permits measurement of client outcomes much more accurately and clearly.

  • What is the difference between office versus location?

    • The office identifies where the agency serving the client is located. For example, if your agency serves 3 cities and has one office in each city, then the Office could be identified by the city name. The location identifies where the services are performed for the client. For example, if you visit them in their home, or at a nursing home. Those are locations.

  • Where do I list the forms or tests that I did for a client?

    Nightingale Notes allows agencies and clinicians a variety of options to record tests administered (e.g. Denver II), forms completed (e.g. agency nutrition questionnaire), pamphlets handed out (e.g., SIDS prevention), and similar items:

    • You can upload your scanned documents, tests, assessments or lab values to your client in the Files tab located in either Client Details or Activities. You are able to store Files up to 10MB in size and any file type.
    • Custom tabs can be created on the Activity Details or Client Details screens by administrators in the Setup screens (Setup/Agency/Custom Tabs and Fields). You can create up to 10 Custom tabs per screen; each tab can contain an unlimited number of fields.
    • Documentation of any tests administered, questionnaires completed, teaching material left, etc. can also be done in the charting screens as Interventions under the appropriate problem. These can be added on a client-by-client care plan basis by the clinician (by clicking on New Intervention) or can be added to the agency care plan itself by administrators in Setup (Setup/Agency/Pathways).

  • When is it okay to unlock/revise charting versus adding an addendum?

    • Generally speaking, it is okay to unlock/revise charting if an error is discovered immediately or a very short time after charting (same day) and before the record has been printed out/signed (for agencies who maintain a hard copy record). Otherwise, it is strongly advised that the clinician add an Addendum Activity, describing the error in the Activity summary.
    • Keep in mind that printed reports show the date that the report (such as a Visit Report) was printed. If a report shows a print date days after the contact was made, that can raise legal “red flags” if the chart should be brought into any legal proceedings.

  • Can we enter more than one Diagnosis code?

    • Unlimited diagnosis codes may be entered on the Client Admission tab. The first diagnosis entered is the primary. All subsequent diagnoses are considered as secondary. Even though Nightingale Notes allows you to enter an unlimited number of diagnoses, the electronic claim file can only use the first 8.

  • Locking and Unlocking Charting – manual vs. automatic, who can unlock charts?

    • Whether a chart is locked manually or automatically, only a person with Supervisor privileges to Activities can unlock a chart.

• Omaha System/Charting

  • Do I need to follow all of my client’s Actual Problems? Are Actual problems always a higher priority than Potential Problems?

    • No. An Actual problem may not necessarily be a high priority one for you to follow—perhaps the client is taking care of it himself or another provider is working on it.
    • You may also find that a Potential Problem (e.g., a teen mother with many risk factors for poor parenting) may be the highest priority problem that your client has.

  • How many problems do I need to identify for a client?

    • Don’t over-identify problems—more is not necessarily better! Some areas of concern can be addressed as targets under more-inclusive “umbrella” problems such as Pregnancy, Postpartum, Caretaking/parenting, Growth and development, etc. (If needed, go back to the slides covering targets to see a good example of this) You need to be VERY FAMILIAR with the target list to do this well.
    • Don’t under-identify problems, either. If the client has very discrete, un-related problems, they shouldn’t be combined under one problem label as it will be difficult or impossible for you to accurately measure outcomes.
    • BONUS! When you start charting in CHAMP, you will be using pathways that pre-load problems and interventions for different client types. Depending on your client, you may need to delete or add problem or interventions to fit your client’s unique needs and characteristics.

  • I can’t choose between two problems for my client. How do I choose?

    Often the best way to decide which problem(s) to choose is to look at the signs/symptoms listed for each problem you are considering:

    • Which set of signs/symptoms best describe your concerns and which can you plan interventions for?
    • Which problem allows you to best measure changes in KBS to show you have had an impact?

    For example, a client with a colostomy may have inflammation of the skin surrounding the stoma. This is really a Skin problem, not a Bowel function problem—the signs and symptoms for Skin fit what you are describing and what you are taking action on.

  • I have added a problem and charted some and now cannot delete the problem.

    • Once you have charted on a problem you may not delete that problem. You first have remove all charting including any intervention notes and problem details. Only then can you delete the problem entirely.

  • If I added a pathway, started charting on it, and then realized I added the wrong one is there a way for me to delete that pathway so I can add the right one?

    • To remove a pathway you first need to remove all documentation from the problems and interventions for that pathway.

  • How do I decide if my client has an actual problem, a potential problem or a health promotion problem?

    • In simple terms, an Actual problem is one for which the client is currently displaying signs/symptoms. A Potential problem is one for which the client has risk factors, but currently does not have any signs or symptoms. A Health Promotion problem is one for which the client has neither actual signs/symptoms or risk factors, but education is appropriate or requested (example: a client asks for information about exercise classes available in his community).

  • The Care Plan for my client’s problem in the User’s Guide doesn’t match my client exactly. Now what?

    • The User Guide’s sample care plans give only one possible example of KBS ratings, care plans, etc. for each problem. Your client may or may not match up exactly—that’s fine, just choose what may fit for your client and discard what does not.

  • When do I use the Intervention category of Treatment and Procedures?

    • Most public health field programs use this category infrequently, if at all.. It is designed for documenting hands-on care such as catheter changing, insertion of an IV, specimen collection, etc. However, if you do actually perform a hands-on procedure such as giving a PPD in the home, it may be used.

  • My client is an infant—how can I do a KBS rating on him?

    • If your client is an infant, child, or dependent adult, the Knowledge and Behavior ratings will refer to the caretaker. The Status rating will refer to your client. You can indicate the caretaker’s name in your notes so that anyone reading your chart will know who you rated.

  • Most of my clients are low-income. Should I always identify Income as a problem?

    • Not necessarily. Let’s face it—many of our clients are low income when we find them and they’re low income when we leave them–that’s not something you can usually do something about. What we usually can do as practitioners is to help families with some of the common effects of being low income–lack of access to health care, poor nutrition, etc. Those may be the issues to focus on, not income itself. In other words, if the PHN/clinician goes out and makes referrals to nutrition or health care programs for low-income clients, then she’s more directly impacting poor nutrition and health care access problems, not income. But if you are referring a client to AFDC, consumer credit counselors, budget management classes, food stamps, etc., then those would be appropriate to follow under Income.

  • What do I do when I can’t decide which rating to choose for my Assessment KBS rating?

    • Check the sample care plan guide in the User’s Guide for examples of KBS ratings for the problem you are working on. If you’re still in doubt (e.g., is it a 2 or a 3?), go with the lower number.
    • Another way to decide is to think of your worst case client and your best case client and then decide where this client falls between the two.

  • What about problems I might want to discuss with the client in the future?

    • Your charting is a SNAPSHOT of what you assessed and did on that day, not what you may do in the future. In your charting you may include plans to assess/discuss certain issues later, but these possible areas shouldn’t be identified as problems in your care plan yet.

  • When do I use Adequate versus Health Promotion?

    • Adequate is used when the client has no signs/symptoms of the problem, has no risk factors, and expresses no interest in increasing his/her knowledge about the problem. The clinician never enters Interventions on a problem rated as Adequate, so it is also unnecessary to enter KBS ratings.
    • Health Promotion is similar to Adequate in that the client has no signs/symptoms of the problem and has no risk factors. It differs from Adequate in that the client expresses an interest in increasing knowledge or behaviors about the problem (such as a client interested in learning what a heart-healthy diet consists of as they are concerned that their neighbor recently died of a heart attack). The clinician enters Interventions and KBS ratings on Health Promotion problems visits.

  • How do I use another clinician’s care plan?

    If you want to use an existing care plan created by another clinician, simply select the last activity for which that care plan was used on the client’s Activity list [which can be accessed by clicking on the Activities icon next to the client’s name on the Clients (Search) screen].

    • Click on the Copy icon.
    • This will open a New Activity screen with the other clinician’s care plan available to you to use and modify prn.

  • Entering a client from admission to discharge—how do we close a client out in NN?

    Closing a client to services in Nightingale Notes is an easy process:

    • After entering any closing interventions on each problem that was open to follow-up, the clinician should enter closing KBS ratings and a closing date under the problem Details. Even if a client is being closed due to inability to locate, closing KBS ratings and a closing date should be entered.
      1. The clinician should enter a closing Activity Summary on the Activity Details screen.
      2. The clinician enters a Closing date and Closure reason for closure on the Discharge tab under Client Details. S/he may also add a Discharge note.
      3. The clinician changes the Case status to Closed on the Name and address tab under Client Details.

• Computer Related

  • I keep indicating to my computer to save my user name and password but every time I log into NN it doesn’t save that information.

    • In order to protect client data and be HIPAA compliant, Nightingale Notes will not allow your browser to save your username and password.

  • No Display?

    Check the following items:

    • Is your monitor turned on?
    • Is your computer turned on?

  • Browser shows no web pages?

    Please check the following items:

    • Does every site you try not work or is it only some sites?
    • Did it work yesterday? What changed?