Transcript Document

COMPUTERIZED
PROVIDER ORDER ENTRY
PROVIDER-COMPREHENSIVE GUIDE FOR TRAINERS
CME INFORMATION
St. Peter’s Hospital is accredited by the Medical Society of the State
of New York to provide continuing medical education for
physicians.
St. Peter’s Hospital designates this live educational activity for a
maximum of 2 hours AMA PRA Category 1 Credit (s) ™.
Physicians should only claim credit commensurate with the extent
of their participation in the activity.
Disclosure:
Speaker has no conflicts of interest in relation to this talk.
This talk has not been commercially supported.
TABLE OF CONTENTS
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Introduction
Objectives
Policy & Procedures
Census Set Up
Access Patient Data
Allergies
Patient Factors
Worklist Management
Orders Tab Overview
Searching for Orders
Signing Orders
Active Orders Display
Order Detail Form Review
Med Student Order Entry
Ordersets
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Order Modification
Personal Favorites
Shopping Cart
Clinical Checking
Hand On Practice Ordersets
Order Tips
Departmental a la carte ordering
Medication Order Entry (simple)
Medication Order Entry (complex)
Adding Patient Problems
Preliminary Cause of Death
Benefits of CPOE
Telephone/Verbal Order Process
Downtime Process
Hands on Practice a la carte
INTRODUCTION
• What is CPOE?
• Computerized provider order entry is the process of entering medical orders into
Soarian electronically by a licensed provider.
• Go-Live – June 11, 2013
• Hospitalist (medicine ordersets/a la carte)
• All RNs/Ancillaries that currently accept telephone/verbal orders
• Go-Live June 12, 2013
• Cardiology (order sets/ a la carte)
• All other providers encouraged to use CPOE a la carte ordering
Units excluded from Live
• Hospice
• NICU
OBJECTIVES
The learner will
• Become more proficient with Soarian EHR regarding
order placement of medications, labs, imaging and
use of Ordersets
• Understand the patient safety benefits of CPOE
• Understand CPOE policies and procedures
• Understand how CPOE impacts use of Soarian
• I.e Worklist Management (orders to be co-signed/orders
approaching expiration)
• Management of active orders
• Downtime process
POLICY AND PROCEDURES
• Allergies, height and weight must be entered before
a provider can enter patient orders
• Generally nursing will enter this information but you will be
trained on how to complete this function
• Medical Students will be able to enter CPOE orders
however the orders are NOT ACTIVE until they are
co-signed by their supervising provider
CENSUS SET UP
• To set up your census select Search then
Coverage Tab
• Your assigned group will display on the left
• Place a check in the box, add to Selected
Coverage, Save & Close
CENSUS SET UP
• Select Include Coverage Patients from drop down menu
• This census includes all of your hospitalized patients (inpatient,
outpatient, and ED)
WORKLIST MANAGEMENT
• Your Worklist is populated from patients on your census
• The Worklist contains Alerts, Orders to be Signed, Orders Approaching
Expiration, Consultations, and New Results associated with your patients
• The orders associated with these items can be easily managed from the
Census page using your Worklist
ACCESS TO PATIENT DATA
• Click this ICON to launch into Patient
Record (default view is all results)
• Click on patient name for open census
display
• Click this ICON to access Orders Tab
ALLERGIES
• Allergies must be completed before a patient order can be entered
• If you attempt to place an order and Allergies have not been entered you will receive
this message
• Click Close
REASSESS ALLERGIES
• Reassess Allergies displays in the patient header for new patients and at every new visit
• From the Charting tab click on Allergies
• The Reassess Allergies window displays, then Select No Change or Update to enter
Allergy information and click Save
REASSESS ALLERGIES
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You must click the verify button
A message window will open indicating Allergies verified
Click ok to complete
At anytime you can view the history by clicking the View Allergy History button
The Allergy history will display in the window
ENTERING NEW ALLERGIES
• Click on Charting tab
then Allergies
• You can enter new
Allergies one of two
ways
• Select from common
Allergies menu and from
here you will be taken to the
Allergy reaction window OR
• Type the Allergy in the
search box and from here
you will be taken to the
Allergy selection window
• The allergy name will
appear in the Search
Results, click the allergy
then click the arrow
• The allergy will move to
Selected Results
• Then click Add
ALLERGY REACTION WINDOW
• To complete Allergy details click on the Reactions drop down
menu and select the reaction
• Severity will auto populate
• Click Save
• The Allergy will display on the screen
• You must click the verify button
• A message window will open indicating Allergies verified
• Click ok to complete
REVISING ALLERGIES
• From the Charting tab click on Allergies
• Select the Allergy that needs to be revised
• To revise Allergies click the Status drop down menu and select either not active or
marked in error
• Click Save
PATIENT FACTORS
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• It is essential for height and weight to be completed
with every patient visit
• In most cases this information will be entered by the
nurse
• If this information has not been entered by the nurse
you may complete
• Click on Charting tab (1), Assessments (2), then
Patient Factors (3)
PATIENT FACTORS
• Enter Height, Weight
and How Weight
Obtained
• Select the double
arrow box to convert
into a different unit of
measure, then click ok
• The status will default
to Complete
• Sign using the pen in
the lower right corner
ORDERS TAB OVERVIEW
• The Orders screen is made up of two main sections
• Current Orders and
• Unsigned Orders
• The left side of the screen is the
Current orders
• The Current orders display will default
to Active Orders Since Registration
• From this section orders can be
discontinued, renewed, completed
and co-signed
• The right side of the screen is
the Unsigned Orders
• This section will list orders that
have been entered for a
patient but have not been
signed electronically
TO ACCESS ORDERS
• From the Orders Tab
• Click on Add Order
ORDERABLES PAGE OVERVIEW
Search box
Tabs to narrow search
results
• From this screen you can place orders
several ways:
• Favorites Pick List- under Common Tab, displays
orders in categories
• All available CPOE Ordersets are located in
CPOE Ordersets Tab
• Searching
SEARCHING FOR ORDERS
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Enter the order in the search field and click corresponding tab (All/Meds/Labs)
Search using a minimum of 4 characters, more characters = more direct hit
The search results will be listed to the right of the screen
Click on the box of the order
Click Add to Order Session
SEARCHING FOR MULTIPLE ORDERS
• You can search for multiple orders at one time
• There must be a space between the orders
SIGNING ORDERS
Sign
Here
• After clicking “Add to Order Session” the orders will move to the
Unsigned Orders screen on the right hand side
• Prior to signing orders review and make any necessary changes
• The tab at the bottom right hand side of the screen is where orders are
signed off
ACTIVE ORDERS DISPLAY
• After orders are signed they will move to the left hand side of the screen
• All Active Orders Since Registration will display here
ACTIVE ORDERS DISPLAY SORT OPTIONS
• From Active Orders
• Click the Arrow to change sort options
• Note options for Since RegistrationReverse Chronological-displays active
orders by date OR Past 3 Days-Reverse
Chronological
DISCONTINUING AN ORDER
• From the Active Orders display click on the box
next to the order to be discontinued
• A green check mark will appear then click on
Discontinue
DISCONTINUED ORDER
• The Discontinued order moves to the Unsigned
Orders screen
• The Discontinued order must be signed by the
provider to be effective
• After signing the order moves to the Active
Orders display
• The order displays in gray and will remain
there for 1 hour
• Hover over the order to see details
RENEWING MEDICATION ORDERS
• This ICON indicates a medication order is approaching expiration
• To Renew orders from the Active Order display click on the box of the
order to be renewed
• A green check mark will appear
• Click Renew
• The order will move to the Unsigned Orders screen
• The order must be signed by the provider to be effective
RENEWED MEDICATION ORDER
• After signing the Renewal order will move to the Active Orders display
• Both the original order and the renewal order will be listed
• Once the original order reaches the stop date and time it will become a
completed order and will no longer be listed in Active Orders
• The Renewal order will remain on the Active Orders display
• The order will be validated by pharmacy and verified by the RN in MAK
ORDER DETAIL FORM REVIEW
• During order entry you may be prompted to complete required fields on an Order
Detail Form prior to signing off the orders
• Required fields are Bold for easy identification
• Some required fields will default in information
• Note Priority default is Routine and can be changed
• If the required field is not valued it will turn “Pink” when attempting to sign the
order
• In this example when ordering a Chest X-Ray the Reason for Request and Patient
on Telemetry is required
ORDER DETAIL FORM REVIEW
• If you attempt to place the order without completing the required information this
message will appear reminding you to check that the information has been
entered correctly
MEDICATION ORDER DETAIL FORM
GENERAL REVIEW
• If you need to change a medication order, open the order
detail form to modify
• ONLY Frequency, Priority, Start Date and Duration can be
modified
• Do NOT modify dosage and route
• If needed information can be typed in the Clinician Directions
field
MEDICAL STUDENTS ORDER ENTRY
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A Target Co-Signature is required for all orders entered by Medical Students
Session Defaults can be set from the Orderables Page OR Unsigned Orders screen
Orders will not be Active until co-signed by supervising provider
Do not discontinue or renew orders from Active Orders, you will receive an error message
Click on ellipsis to search for provider name
ORDERSET GUIDING PRINCIPLES
• Ordersets are a grouping of predefined (means
fewer clicks) convenience orders for a specific
disease or condition
• Every patient should have an admit orderset
• Admit ordersets contain patient status, activity, diet etc…
• For Core Measure diagnosis use Admit orderset plus
disease specific orderset
• I.e. (Admit Medicine + Pneumonia)
• I.e. (Admit Cardiology + Heart Failure)
• All patients must have a patient status order and
VTE prophylaxis assessment/orders
ORDERSET GUIDING PRINCIPLES
• Ordersets may have orders that are pre-checked
• Prechecks can be deselected
• Utilizing a disease specific orderset does not label a
patient with that diagnosis or condition
• Once the orders are entered the association with
the orderset name is lost
• When ordering from an orderset click “Add to Order
Session” these orders will remain on the Unsigned
Orders screen and will enable searching for “a la
carte” or “ad hoc orders”
• Please remember to review and sign orders
CPOE ORDERSETS
• Medicine related ordersets are listed here
• Other CPOE specialty ordersets can be found on this screen
• Click the black arrow to expand the nested ordersets
FOUNDATION ORDERSETS
• Foundation Ordersets are located in “Other”
• VTE Prophylaxis Medical and Surgical can be found here or in
an Admit orderset
USING AN ORDERSET
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Click on the black triangle to expand
the order set to see the details
• There are some mini ordersets
within a larger order set
• Some items are prechecked
• If you do NOT want the item you
must deselect the checkmark
USING AN ORDERSET
• If you want to order an item that is prechecked, you must place a checkmark in
the mini orderset header checkbox
• You will receive this message if you do NOT
place a checkmark in the mini orderset
header checkbox
USING AN ORDERSET
• Remember to use the scroll bar to see the entire order set
• This notation indicates the End of Order Set
• Clicking “Add to Order Session” moves the orders to the Unsigned Orders screen
USING AN ORDERSET
• Evidence links and notes may be displayed within ordersets
• Local Evidence links contain St. Peter’s specific policies, procedures and/or
standards of care
• If you clink on any of these links you will be directed to source documents
MODIFYING AN ORDER FROM UNSIGNED ORDERS
SCREEN
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Click on the words of the order to be modified
Order Detail Form will open to enter modifications
In this example the IV rate was changed from 75mL/hr to 100mL/hr
Click Apply
• Modified order on Unsigned Orders Screen
• Sign orders to complete
REMOVING ORDERS FROM UNSIGNED
ORDERS SCREEN
• ALL orders need review by the provider prior to signing off
• If an order needs to be removed, check the box of the order that is no longer needed & click
remove
• The order will be removed from the Unsigned Orders Screen
CREATING PERSONAL FAVORITES FROM
UNSIGNED ORDERS SCREEN
• From the Unsigned Orders screen, check the box of the order you would like to Add to
Personal Favorites
• Click Add to Personal Favorites
• You will receive this message, Click OK
• The order will be added to your Personal Favorites
• Adding Personal Favorites must be done prior to signing the orders
• Your Personal Favorites are only visible to you
PERSONAL FAVORITES MANAGEMENT
• From Orders tab click on Add
Order
• Click Personal Favorites tab
• Place a checkmark in the box of
the order to be used
• Click Add to Order Session
• The order will move to the
Unsigned Orders screen
• Sign order to complete
• To collapse or expand Personal
Favorite categories use these
ICONS
• To remove a Personal Favorite
• Place a checkmark in the box of the
order to be removed
• Click on the “X” to remove
UNSIGNED ORDERS SCREEN IS MY SHOPPING
CART
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From Orders tab click on “Add Order” to return to the Orderables Page
You can enter additional orders from order sets, personal favorites or a la carte searching
Place a checkmark in the box of the order then click “Add to Order Session”
You can fill your shopping cart (add orders to Unsigned Orders screen)
Review ALL orders, make any necessary changes and “check out once” by signing
to complete
TYPES OF CLINICAL CHECKING
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Therapeutic Duplicate
Generic Duplicate
Allergy
Adult Max Dose
Pediatric Max Dose
Drug Drug Interaction
Pregnancy Precautions
Lactation Precautions
Geriatric Precautions Level 1 (age 75 and over)
Pediatric Precautions Level (up to age18)
A more comprehensive explanation of
clinical checking with examples can be
found in your training packets
ORDERSET HANDS ON TIME
• Medicine/Cardiology Practice
• 1 Admit Medicine OR Admit
Cardiolgy
• Plus VTE Prophylaxis Medical
• Plus 1 Disease specific
• For example Admit Medicine &
Heart Failure
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Admit Order sets and can also
be found in “Other” CPOE
orderset category)
• Surgery practice with
Foundation Ordersets
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VTE Prophylaxis Surgical
Analgesics Foundation
Bowel Care Foundation
IV Fluids
Antiemetics
PATIENT STATUS ORDER TIPS
• All patients need a status order (inpatient, observation, outpatient)
• If the patient’s status changes during hospitalization use “change patient status
order”
• All status orders require Attending Physician and Diagnosis
• To search for the Physician name click on the box with ellipsis
• In the Search field enter Physician name and click search
• Select the name from Search Results and click Add
RESUSCITATION STATUS ORDER TIPS
• Resuscitation orders can be found in Admit Ordersets or in Favorites List under
Code Status
• If patient is a DNR remember to order See MOLST on Chart, this serves as a
communication order for all clinicians
• The above in an example of a complete DNR order
CONSULT ORDER TIPS
• Consult orders can be found in Ordersets or in the Favorites List
under Consults
• When ordering the order detail form will open to complete the
order requirements
• Enter consultants name (not group) and reason for consult
• Priority defaults to routine
STAT OR URGENT CONSULT TIPS
Call
placed
• If a consult is needed Stat or Urgent:
• Change the priority from Routine to Stat or Urgent
• Stat or Urgent consults must be called by the ordering provider
• After the call is made please check off call placed to indicate call
has been made
PHYSICIAN LOOK UP FOR STAT OR
URGENT CONSULTS
• To obtain the consultant’s phone number:
• From the Order Detail Form click on Physician Name Search
• A Doctor Lookup window will open
• The search can be done by Last Name, Specialty, or Group
PHYSICIAN LOOK UP FOR STAT OR
URGENT CONSULTS
• Here is an example of the physician search results
• This telephone number can be used to make the phone call
• This number will not populate the order detail form
ROUTINE CONSULT ORDER TIPS
• For Routine consult orders only:
• After the order is signed the active order display will have 2
orders
• A Consult Physician order
• A Consult Follow Up order for IA’s/Nursing-to place call to
consultant
• Providers do not need to call routine consults
DEPARTMENTAL A LA CARTE
ORDERING
PART 2
LAB ORDERS
• Can be entered from several different pathways
• From an orderset
• From Favorites picklist
• Searching a la carte or ad hoc
• From Orderables Page click on the Labs tab to limit the search
• All lab orders default to Routine priority
• Routine does not mean the next morning
• Routine is the next draw time
• Routine draw times are as follows:
• - 04:00, 07:00, 10:00, 13:00, 16:00, 19:00, & 22:00
• AM Labs= 4am draw
• Morning Labs orderset is available
for convenience ordering of AM labs
TIMED LAB ORDERS
• Select the Timed priority for orders such as troponins
• Completing the “How Often” “Every” and “For” fields as shown above will time the
troponin orders every 8 hours for 3 times
RADIOLOGY ORDERS
Do Not Order
from Outpatient
Services
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From Favorites Picklist, Click on Radiology
Open the INPATIENT Orderset for a list of available services
DO NOT select order for Outpatient services
Outpatient Services appear like this
RADIOLOGY ORDERS
• All Angio, CAT Scan and MRI services should be
ordered using the relevant “Consult” Order
• For example:
• CT of Abdomen
CT Abdomen Consult
• Order Detail form will always open to complete
required field “Reason for Request”
CARDIOLOGY ORDERS
• From Favorites Picklist click on Cardiology
• If you want a specific cardiology group to read an
Echo or EKG you must specify that information in the
instructions field
• Order Detail form will always open to complete
required field “Reason for Request”
DIETARY ORDERS
• From Favorites Picklist, Click on Nutrition
• Oral diet order detail form will open for customization
• When placing a new diet order Discontinue previous diet order from Active Orders
TUBEFEEDING ORDERS
• From Favorites Picklist, Click on Nutrition, click on black triangle to expand Tube Feedings
• The Order Detail Form will open to enter tube feeding specifics
• If the patient needs an Oral Diet or NPO order it MUST be entered separately
• Oral Diet & NPO orders cannot be entered from Tube Feeding diet order
NURSING ORDERS
DRESSING CHANGES
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From Favorites Picklist, Click on Nursing
Look under Dressing and Bandage category
Select Drsg Changes: @@
Complete How Often and Every fields
Enter dressing details in the Instructions field and click “Add to Order Session”
NURSING ORDERS
FREE TEXT
• For any order that requires communication to
nursing (i.e.) Call Dr. Smith with results
• Search “Free Text”………
• Select Free Text Nursing Order
PT/OT & SPEECH ORDERS
• From Favorites Picklist, Click Rehab Services
• Audiology, PT, OT, and Speech orders are listed
• PT/OT/Speech Language Pathology Eval & Treat, Activity as Tolerated orders do NOT require
any additional information
RESPIRATORY ORDERS
• In the CPOE Orderset tab under “Other” use the Respiratory Foundational
Order Set to order any Respiratory Services except for invasive ventilator
MODIFYING AN ORDER FROM ORDERABLES PAGE
(A LA CARTE ORDERS ONLY)
• From Orders tab click on Add Order
• The Orderables page will open
• Click on the words of the order, the order
detail form will open
• For example, the priority of this order can
be modified to Stat
• Click “Add to Order Session”
• The order will move to the Unsigned
Orders screen
• Once all orders have been moved to the
Unsigned Orders screen, remember to
close or “X” out of the Orderables page
• Orders cannot be signed off if the
Orderables page is open
• Complete final review of orders on
Unsigned Orders screen and sign to
complete
MEDICATION ORDER ENTRY
• Medications can be ordered in 4 ways
• (orderset, medication picklist, searching, or admission
medication reconciliation)
• However you decide to order a medication, they all function
the same way
• Medications are predefined with dosages, routes, and
frequencies (this means less clicks)
• ONLY Frequency, Priority, Start Date & Duration can
be changed
• ****Dosage and Route should NOT be changed due
to dispensing issues***
• Some medication order detail forms will open for you
to make necessary changes
• After changes are made Click Apply
MEDICATION ORDER ENTRY USING
PICKLIST
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From Favorites Picklist click on Medications to see Therapeutic Drug Classes
Each class listed is an orderset
Click on the black triangle to expand the predefined medication orders
To order the medication click on the checkbox next to the medication order
A checkmark will be placed in the box and click “Add to Order Session”
MEDICATION ORDER ENTRY USING
SEARCHING
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Medications can be ordered by searching with the Generic or Brand name
In this example Lasix was entered into the search field
Click on Meds tab
Options for IV, Oral Tablet and Solution are shown
IV ORDER ENTRY USING SEARCHING
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To search for large volume IV’s enter “Solutions” in the search field
Types of Solutions are listed in mini ordersets
Expand the ordersets for predefined orders
The orders have been predefined with rates of 75, 100, or 125 mL/hr
MEDICATION PROTOCOL ORDERS
• Medication protocol orders can be found by searching on the Generic or
Brand name of the drug
• In this example Heparin and Coumadin were entered in the Search field
• Choosing one of these orders will mirror our current paper process
NON-FORMULARY MEDICATIONS/
THERAPEUTIC SUBSTITUTIONS
• You can search for any medications
• If it is not on St. Peter’s Formulary you will see this autosub symbol in the
medication pick list along with the P & T Formulary Substitution
• Note the active order created on the patient will contain the formulary
medication
COMBINATION MEDICATION ORDERS
• Combination medications contain 2 separate
predefined medication orders
• When discontinuing please remember to
discontinue both medication orders if
needed
MEDICATION ORDER DETAIL FORM
GENERAL REVIEW
• If you need to change a medication order, open the order
detail form to modify
• ONLY Frequency, Priority, Start Date and Duration can be
modified
• Do NOT modify dosage and route
• If needed information can be typed in the Clinician Directions
field
EAR & EYE DROP ORDER DETAILS
• When placing order for Ear or Eye drops
• The Order Detail Form will open
• Select the appropriate Route (specific to these orders only)
• Click Order & Finish
TOPICAL ORDER DETAILS
• When placing order for Topicals
• The Order Detail Form will open with message to enter “Apply To”
information
• Enter Site of Application in the Clinician Directions
• Click Order & Finish
ANTIMICROBIAL ORDERS
TREATMENT OF INFECTION
• When ordering Antimicrobials for Treatment of Infection this order detail form will open
for you to complete the requirements
• This form is needed for the Antimicrobial Stewardship Program
• This form will display in the Medication Specialty Orders category in Active Orders
• The Antimicrobial that is ordered will display in Medication or IV category
ANTIMICROBIAL ORDERS
SURGICAL PROPHYLAXIS
• When ordering antimicrobials for Surgical Prophylaxis the drug order will be
sent to pharmacy for appropriate dosage calculation
• This order detail from will open for you to complete the requirements
• This form will assist with documentation of compliance for SCIP measures
• This form will display in the Medication Specialty Orders category in Active
Orders
• The Antimicrobial that is ordered will display in Medication or IV category
COMPLEX MEDICATION ORDER ENTRY
PREDEFINED INSULIN SLIDING SCALE
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Search “Insulin” click Meds
Insulin Sliding Scale predefined orders are available
Select Insulin and “Add to Order Session”
The medication will move to the Unsigned Orders Screen
Click the black triangle to expand order details for review prior to signing off
COMPLEX MEDICATION ORDER ENTRY
BUILD YOUR OWN INSULIN SLIDING SCALE
• From Insulin Sliding Scale order set locate MD Fill In
• Select Insulin and “Add to Order Session”
• The Order Detail Form will open to enter sliding scale information
ENTERING INSULIN SLIDING SCALE
DETAILS
To delete a row
from the table
click here
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Enter Insulin dosage and sliding scale range in the table provided
Click here to add a new row
Complete Notify Physician field
Add any Clinician Directions if needed
Click Order & Finish
COMPLEX MEDICATION ORDER ENTRY FOR
TAPERS
• Search “Prednisone” for predefined scheduled orders & taper starting at 40mg over 15
days
• Search “Medrol” to order dose pack protocol
• Pharmacy will enter individual orders
COMPLEX MEDICATION ORDER ENTRY FOR
TITRATES
• For Titrate orders search using the drug name (i.e. dopamine)
• Select appropriate medication order
• The Order Detail Form will always open for review and modification
COMPLEX MEDICATION ORDER ENTRY FOR
TITRATES
• Review Titration Instructions
• These instructions have been pre-populated with standard titration directions
• To modify instructions, highlight the specific area, delete and enter your changes
SYSTEM REQUIREMENT FOR WEIGHT
BASED MEDICATIONS
• If a weight has not been entered on a patient you may receive this error message
• This is not a problem with the order
• A weight needs to be documented in Soarian
FREE TEXT MEDICATION ORDER
• If you are not able to find a medication when searching OR you need to indicate “May
Take Own Medications”
• Type “free text” in the search field and click meds
• The free text medication order detail form will display
• Complete the form with drug name, dosage, frequency and any other details that are
needed for a complete medication order
• All free text medication orders will be evaluated to determine if a predefined medication
is needed
“NO” … MEDICATION ORDERS
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To order a “No” medication order
Type “No” in the search field and click on “meds”
Select appropriate order
This is a communication order for Pharmacy and Nursing
Orders with a specific medication will enable duplicate checking
Orders with a general category (i.e. No Narcotics) will NOT trigger duplicate checking
IV BOLUS ORDER ENTRY
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Type “Solutions” in the search field and click Meds
Pick the solution
Open the order detail form
Select Bolus and enter volume and duration
CHANGE IV RATE
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To change an IV rate type “Change” in the search field and click Meds
Select Change IV Rate order
The order detail form will open
Enter IV solution type and new rate information in the Clinician Directions
ADULT TPN ORDERS
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Search TPN then click Meds
Note there are 2 pre-selected orders that are required to process the order
Place a checkmark in the header of the orderset & click Add to Order Session
Adult TPN Medication Specialty Order form will open
Complete the details
Click Order & Finish
Review orders on Unsigned Orders screen and Sign to complete
ADULT TPN ORDERS
You will see two orders for TPN:
1. The order for the TPN rate and duration
2. The order details for the solution contents are
found in the medication specialty order display
ADDING A PATIENT PROBLEM
MEANINGFUL USE REQUIREMENT
• To ADD a Patient Problem Click on Clinical Summary tab
• Go to Problems section, lower right hand corner and click on + sign
TO SEARCH PATIENT PROBLEM
• Type the problem in the search field and click search
• Check the appropriate problem from the list
• Do NOT choose problems with prefix of POC
• Click Add then OK
REVISING THE STATUS OF A PROBLEM
• From Clinical Summary Problems section, click on the words of the problem
• The Problem Update screen will open, click Update
• Update the status, click Apply and then OK
COMPLETING PRELIMINARY CAUSE OF DEATH
ASSESSMENT MEANINGFUL USE REQUIREMENT
• Complete Assessment on all expired patients
except Hospice Inpatients
• From Charting tab, click on Assessments
• Click on Preliminary Cause of Death
• Complete Assessment details
• Sign as Complete
BENEFITS OF CPOE
• Supports access to patient data
• Orders are processed more quickly
• Don’t have to look for chart
TELEPHONE/VERBAL ORDER
DEFINITIONS
Telephone Orders
• Telephone orders may be taken when:
• The provider is out of the hospital
• The provider is on site but scrubbed in a procedure
• The provider is on site but engaged in a patient care activity they
cannot easily stop or put on hold
Verbal Orders
• Verbal orders may be taken when:
• The provider and receiver of the order are in a procedure area or a
critical care unit and the provider is engaged in a patient care
activity s/he cannot stop to enter an order electronically or in
writing.
• The provider and receiver of the order are in an emergency
situation
• Code
• Rapid response
TELEPHONE ORDER EXPECTATIONS
If the provider is on site and not scrubbed in a procedure, or not
engaged in a pt. care activity they cannot stop, or not in an
emergent situation:
• The provider will enter the order electronically themselves, or
• The provider will write the order on a physician/provider order
sheet
If the provider is out of the hospital:
• The provider will enter the order electronically if remote access to
a computer is available, or
• The provider will give a telephone order when remote access to
a computer is not available
The Provider/Attending Physician/Practice Group is responsible for
countersigning, with date and time, the telephone order within 48
hours in Soarian system
VERBAL ORDER EXPECTATIONS
• Are face to face when the provider is present
• These orders should be limited to times when:
• The provider and receiver of the order are in a procedure area or
a critical care unit and the provider is engaged in a patient care
activity s/he cannot stop to enter an order electronically or in
writing
• The provider and receiver of the order are in an emergency
situation
• Code
• Rapid response
• The licensed professional accepting verbal orders must write down the
complete order, then read it back including the patient’s name for
verification from the physician/provider who gave the order
• In emergency situations where it may not be feasible to write the order and
read it back, it is acceptable to repeat back the complete order for
verification from the physician/provider
• The Provider/Attending Physician/Practice Group is responsible for
countersigning, with date and time, the verbal order within 48 hours in the
medical record
DOWNTIME PROCESS
• All patient care orders will be written on a
physician/provider order sheet during the system
downtime
• When the system returns, all active orders with
future occurrences are back loaded into the system
by IA’s or Nursing
HANDS ON PRACTICE TIME
• Medicine & Cardiology
• Enter the following orders:
Blood Gas Analysis, CBC and Chest Xray
• CT Chest Consult
• EKG
• ECHO
• Oral diet-with the modifiers
• Carb controlled
• 2 Gram Sodium
• No Caffeine
• Free text nursing order-”call Dr. Smith
with potassium results”
• PT eval and treat
• CIPAP
• Search “solutions” to order IV fluid of
your choice
• Insulin Aspart sliding scale ACHS
• Cefazolin 1 gram IV Q6H
• Lasix 40mg orally BID
• Change IV rate
Enter Patient Problem of your choice
•
• Surgical
• Enter the following orders:
• CBC, Comprehensive, Blood Gas
Analysis and Chest X-ray
• MRI Abdomen Consult
• NPO Diet
• Free text nursing order-”Reinforce
dressing as needed”
• D/C nasogastric tube
• PT eval and treat
• O2 2L/NC
• Search “solutions” to order IV fluid of
your choice
• Insulin Regular sliding scale ACHS
• Search “antimicrobial” enter post-op
surgical prophylaxis order
• Lortab 5/500 2 tabs Q4H PRN Mild
Pain
• Change IV rate
Enter Patient Problem of your choice
QUESTIONS