1. Family & Community Medicine Start

2. OB PowerPlan Favorites This module shows: How to create a PowerPlan Favorite The orders to select on the OB Triage PowerPlan The orders to select on the OB Labor Admit PowerPlan The orders to select on the OB Post Partum PowerPlan How to access and use a favorite PowerPlan How to use Add to Phase to add an order How to use View Excluded Components to add an order (this shows all the orders you did not select) What to order when a patient is positive for Group B Strep Things to remember when ordering The abbreviation SP at the end of an order name indicates the order is a Sub Phase containing a group of orders. Next

3. Click in the checkboxes of the orders you want to be pre-selected on your PowerPlan favorite. The Physician Care Team order will not retain a provider’s name so it cannot be saved as a favorite. After selecting the orders, click on the Save as My Favorite button. Creating a PowerPlan Favorite Next

4. Either keep the existing name of the plan or create a new plan name. Do not use a patient name in the plan name. Click OK to complete saving the plan to your favorites. Creating a PowerPlan Favorite Next

5. OB PowerPlans Family and Community Medicine Three OB PowerPlans used by FCM providers OB Obstetric Triage OB Labor Admit OB Post Partum Use the following information to create PowerPlan favorites for the three OB PowerPlans. The following are commonly selected orders from the OB PowerPlans. The PowerPlans can be customized depending on the individual patient needs or provider preferences by unchecking pre-selected orders and/or checking any order not already selected. Next

6. OB Obstetric Triage PowerPlan Favorite Use the following recommendations to create a favorite for the OB Obstetric Triage PowerPlan. Keep all of the pre-selected orders in the OB Obstetric Triage PowerPlan and do the following: Select Vital Signs per Protocol Never use Advance Diet as Tolerated SP. Always keep Urinalysis (Reflex Microscopic) selected. Next

7. OB Obstetric Triage PowerPlan Favorite Next Admitting Service is Family Medical Care but it will not stick when plan is saved as a favorite. Select Vital Signs per Protocol. Do not select Advance Diet as Tolerated SP.

8. OB Obstetric Triage PowerPlan Favorite Next This sub-phase is used infrequently, only when you are evaluating a patient with pre-eclampsia. All of the lab orders are in the sub-phase and already selected. Uncheck any order not needed when using this sub-phase. The OB Pre Eclampsia Lab SP is only used for patients with this condition so you may not want to include it in your plan favorite. An option for including this sub-phase in a favorite PowerPlan is to save two OB Obstetric Triage PowerPlans in your favorites with descriptive titles; The plan saved without the Pre Eclampsia SP, OB Obstetric Triage PowerPlan, and a second favorite including the sub-phase, OB Obstetric Triage PowerPlan Pre Eclampsia.

9. OB Obstetric Triage PowerPlan Favorite Next After selecting the recommended orders on the OB Obstetric Triage PowerPlan, save the plan as a favorite. Either keep the existing name of the plan or create a new plan name. Do not use a patient name in the plan name.

10. OB Labor Admit Favorite Use the following recommendations to create a favorite for the OB Labor Admit PowerPlan. These are orders that are commonly added to the already pre-selected orders. Uncheck Nurse to Nurse Communication in the Communication section. In Laboratory section, select Urinalysis (UA) and Type & Screen (the CBC is already preselected for you). In Consults section, select Anesthesiology. Do not select the OB PreOp SP and the OB Post Partum CS SP, these are only used by OB. Select the OB Post Partum After Delivery SP. Next

11. OB Labor Admit Favorite Next Admitting Service is Family Medical Care but it will not stick when plan is saved as a favorite. Uncheck Nurse to Nurse Communication in the Communication section.

12. OB Labor Admit Favorite Next Select NPO from the Diet section. Select Notify Physician from the Nursing Care section.

13. OB Labor Admit Favorite Next Every patient must have an IV. Select Insert PIV from the IV Solutions section and one of the following: Both Lactated Ringers (LR) orders, or Change IV to Saline lock

14. OB Labor Admit Favorite Next Select the OB Post Partum After Delivery SP (this is so nurses can administer pitocin and care for the patient until the patient arrives in the Post Partum unit). Do not select the OB PreOp SP and the OB Post Partum CS SP, these two SPs are only used by OB.

15. OB Labor Admit Favorite – OB Post Partum After Delivery Sub Phase Next The OB Post Partum After Delivery SP - check everything except NPO and acetaminophen. Click on Return to OB Labor Admit.

16. OB Labor Admit Favorite Next In Laboratory section, check Urinalysis (Reflex Microscopic) and Type & Screen. In Consults section, check Anesthesiology (for patients that want an epidural). After selecting the recommended orders on the OB Labor Admit PowerPlan, save the plan as a favorite and remember to name the plan something generic (i.e. OB Labor).

17. OB Post Partum PowerPlan Favorite Use the following recommendations to create a favorite for the OB Post Partum PowerPlan Select Code Status (this order was default selected in other plans) Uncheck Nurse to Nurse Communication In Nursing Care section: Select Apply Ice Pack Select Sitz Bath In IV solutions, select: Change IV to Saline Lock with Routine Flush Oxytocin In PRN meds: Select lanolin, glycerin, and benzocaine Select Post Partum PRN Pain Meds for Non APS pts SP (Non Anesthesia Pain Service Sub Phase) Meds checked in the Non APS pts SP are Percocet and ibuprofen. Change if patient is allergic. If patients are Rh negative, use the SP for Rhogam. Keep the items checked in this plan Next

18. OB Post Partum PowerPlan Favorite Next Check Code Status Uncheck Nurse to Nurse Communication in the Communication section

19. OB Post Partum PowerPlan Favorite Next In the Nursing Care section also select: Apply Ice Pack Sitz Bath

20. OB Post Partum PowerPlan Favorite Next In IV solutions, select: Change IV to Saline Lock with Routine Flush Oxytocin In PRN meds: Select lanolin, glycerin-witch hazel topical, and benzocaine topical Select Post Partum PRN Pain Meds for Non APS pts SP

21. OB Post Partum PowerPlan Favorite Next Keep defaulted selections on the OB Post Partum PRN Pain Meds SP In Laboratory section: Keep the Hematocrit order selected Select Rhogam Post Partum SP if patient is Rh negative

22. OB Post Partum PowerPlan Favorite Next Keep all of the defaulted selections on the OB Post Partum, Rhogam Post Partum SP Click on Return to OB Post Partum. After selecting the recommended orders on the OB Post Partum PowerPlan, save the plan as a favorite.

23. When ordering OB PowerPlans, use the favorites to save time and effort Favorites are found in the star icon on the Add Order window Click on the star icon to access your favorite plans and individual orders Using a PowerPlan Favorite Next

24. Using a PowerPlan Favorite Next Click on My Favorite Plans to see your list of PowerPlan favorites

25. Using a PowerPlan Favorite Next Click on a plan to select it for ordering Click the Done button to close the Add Order window Select any additional orders needed for the patient Either Initiate or put in a planned state (Orders for Signature) as needed

26. Things to Remember Don’t ever use Merge View in OB. Check to see if you are on the correct FIN before placing a PowerPlan. When saving a plan as a favorite, select only those orders that are used a majority of the time. Review the plan and make sure that the defaulted orders (and your saved favorites) match the care that is needed for the patient. Uncheck orders that do not match the needs of the patient. Next

27. Things to Remember Initiating a PowerPlan means that you intend for the plan to be put into use for the patient immediately. Putting a PowerPlan into a planned state means that the patient is not ready for the orders in the plan at this time (i.e.. Patient not admitted yet, patient not post partum yet). If adding orders to a PowerPlan use the +Add to Phase button. Do not use the +Add button on the far left side of the screen. If a PowerPlan has been initiated, select the plan in the View window so the orders display on the right. Then use the +Add to Phase button to add orders to the plan. Orders added to the plan using the +Add to Phase button will be discontinued when the plan is discontinued. Orders added individually outside the plan will not be discontinued when the plan is discontinued. Next

28. Adding an Order to a PowerPlan Next Don’t use the +Add button when adding an order to a PowerPlan. Click on +Add to Phase and then select Add Order to add an order to a PowerPlan.

29. Group B Strep Next If a patient is positive for Group B Strep, select all three penicillin G potassium medications listed when completing the Medications section of the OB Labor Admit PowerPlan. The first two listed penicillin G potassium medications are loading doses. The third penicillin G potassium medication is the scheduled dose for every four hours.

30. Placing Orders on a Future Visit If a patient is scheduled to have an induction and a visit number (FIN) for the induction visit exists orders can be placed on the future FIN and put in a planned state. You must be on the induction visit (FIN). Use the Labor Admit PowerPlan to create the orders for the patient’s visit on the future FIN. Do not Initiate the orders. Put the PowerPlan in a planned state (click Orders for Signature instead of Initiate). When the patient arrives at the hospital a nurse will initiate the orders. Next

31. Initiating Pitocin If you have already initiated the OB Labor Admit PowerPlan and later decide to initiate pitocin, use View Excluded Components to add the pitocin orders to the OB Labor Admit PowerPlan. Open the patient’s chart to PowerOrders. In the View window, click on the initiated OB Labor Admit PowerPlan so that the plan displays in the window on the right. Click on the light bulb icon to View Excluded Components. Next

32. Initiating Pitocin After clicking on the light bulb icon, checkboxes appear next to all orders not selected when the plan was originally initiated. Click on the checkbox next to Initiate Pitocin Protocol and oxytocin (oxytocin/LR 20 units/1L IV Sol). One order allows the nurse to get a bag of premixed Pitocin and the second order tells the nurse how to run the Pitocin IV. Next

33. Initiating Pitocin Initiate Pitocin Protocol and oxytocin now have a light bulb icon. Click on the Orders For Signature button and on the next screen click on the Sign button. The pitocin orders will be active and part of the OB Labor Admit plan. Next

34. VTE Order in the OB Post Partum PowerPlan If you choose to uncheck the VTE Prophylaxis order in the OB Post Partum PowerPlan you must add an order to Ambulate Patient. Next Click on the +Add to Phase button and select Add Order. Type Ambulate in the search field and select the Ambulate Patient order. Complete the order details. The Ambulate Patient order is now part of the plan.

35. Click the Exit button to close the module. Exit