Platform
One therapy record, in three layers.
Bedside documentation usually fails because the forms do not know about each other — a chart is filled in under a prescription that has since changed, and nothing records it. Assessments and flowsheets here never stand alone. Each belongs to one order set and inherits its context.
The three layers
01 — ORDER SET
The prescription
- Diagnosis, allergies, weights, vascular access
- Modality, machine, filter
- Solutions, flow rates, anticoagulation
- Laboratory schedule and maintenance orders
- Signatures
02 — ASSESSMENT
The shift
- Systems examination and haemodynamic status
- Access, dressing state, lines reversed
- Filter number, day and discontinuation reason
- Line and circuit safety checks
- Ultrafiltration, pressures, labs, anticoagulation
03 — FLOWSHEET
The hour
- 07:00 to 06:59, in the patient's timezone
- Twenty-four hourly columns
- Fluid balance, intake and output
- Circuit pressures and anticoagulation
- Per-hour nurse initials and sign-off
Order chains
A changed prescription does not rewrite yesterday.
- Continue all orders — no new order set; existing records stay linked
- Change sections — modality, solutions, anticoagulant or labs
- A change forks a new order, tagged with what moved
- Records under the previous order become read-only
- Therapy day number derived by walking the chain to its root
Why records lock
Editable while live. Read-only once history.
- Editable only while the source order is still active
- Assessments — twelve hours from the documented time
- Flowsheets — a backfill window set per deployment
- Finalised on the nurse signature; physician signature optional
- Reopening a finalised sheet is itself audited
What the software calculates
The nurse enters observations. The sheet does the arithmetic.
Hourly fluid balance on paper is a column of additions performed between other tasks, and one slip propagates for the rest of the day.
Entered
- Effluent, pre-filter dilution, post-filter volume, dialysate
- Urine, emesis, drains, stool, other output
- Nasogastric, blood products, intravenous, oral intake
- Desired outcome per the medical order
- Four circuit pressures
Calculated
- Patient fluid removal
- Additional output, then total output
- Total intake, then hourly fluid balance
- Replacement to give, then actual net balance
- Cumulative balance, carried across hours and shifts
- Transmembrane and delta pressure
Every derived cell is marked as derived, so nobody has to guess which numbers were typed and which were computed.
Work the record does on its own
Checks carried forward
The flowsheet's nursing checks band is filled from the active order and the latest matching-shift assessment, not copied by hand onto every sheet.
Changes marked in place
Where an order changed mid-day, the timeline marks the hour and names the sections that moved.
Gaps surfaced
Each patient carries flags for unlinked records, stale links and missing AM or PM assessments — visible while they can still be closed.
Saving that keeps up
Flowsheet edits draft locally as they are typed. Order sets and assessments autosave on an interval each organisation sets.
Configuration
The unit's form, not ours.
A form that cannot be adjusted gets worked around on paper. Order-set forms are built from a schema an administrator edits directly, with a live preview beside the editor.
What can change
- Section order, layout and labels
- Machine, filter and fluid options
- Which fields appear, and which are read-only
- Measurement units and validation ranges
- Item numbering, derived automatically
What cannot
- Patient identification and signature blocks
- Citrate and calcium sliding scales
- The heparin dosing scale
- Anything feeding print, reports or signatures
Frozen after sign-off
Once a department agrees its forms, the configuration is frozen. Unfreezing is a separate, higher-privilege action.
Next