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PROVIDER-COMPREHENSIVE GUIDE FOR TRAINERS COMPUTERIZED PROVIDER ORDER ENTRY.

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Presentation on theme: "PROVIDER-COMPREHENSIVE GUIDE FOR TRAINERS COMPUTERIZED PROVIDER ORDER ENTRY."— Presentation transcript:

1 PROVIDER-COMPREHENSIVE GUIDE FOR TRAINERS COMPUTERIZED PROVIDER ORDER ENTRY

2 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.

3 TABLE OF CONTENTS 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 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

4 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

5 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

6 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

7 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

8 CENSUS SET UP Select Include Coverage Patients from drop down menu This census includes all of your hospitalized patients (inpatient, outpatient, and ED)

9 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

10 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

11 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

12 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

13 REASSESS ALLERGIES 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

14 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

15 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

16 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

17 PATIENT FACTORS 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) 1 2 3

18 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

19 ORDERS TAB OVERVIEW 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 The Orders screen is made up of two main sections Current Orders and Unsigned Orders

20 TO ACCESS ORDERS From the Orders Tab Click on Add Order

21 ORDERABLES PAGE OVERVIEW 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 Search box Tabs to narrow search results

22 SEARCHING FOR ORDERS 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

23 SEARCHING FOR MULTIPLE ORDERS You can search for multiple orders at one time There must be a space between the orders

24 SIGNING ORDERS 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 Sign Here

25 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

26 ACTIVE ORDERS DISPLAY SORT OPTIONS From Active Orders Click the Arrow to change sort options Note options for Since Registration- Reverse Chronological-displays active orders by date OR Past 3 Days-Reverse Chronological

27 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

28 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

29 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

30 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

31 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

32 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

33 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

34 MEDICAL STUDENTS ORDER ENTRY 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

35 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

36 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

37 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

38 FOUNDATION ORDERSETS Foundation Ordersets are located in “Other” VTE Prophylaxis Medical and Surgical can be found here or in an Admit orderset

39 USING AN ORDERSET 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

40 USING AN ORDERSET If you want to order an item that is pre- checked, 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

41 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

42 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

43 MODIFYING AN ORDER FROM UNSIGNED ORDERS SCREEN 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

44 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

45 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

46 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

47 UNSIGNED ORDERS SCREEN IS MY SHOPPING CART 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

48 TYPES OF CLINICAL CHECKING 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

49 ORDERSET HANDS ON TIME Surgery practice with Foundation Ordersets VTE Prophylaxis Surgical Analgesics Foundation Bowel Care Foundation IV Fluids Antiemetics Medicine/Cardiology Practice 1 Admit Medicine OR Admit Cardiolgy Plus VTE Prophylaxis Medical Plus 1 Disease specific For example Admit Medicine & Heart Failure (VTE Prophylaxis Medical is in Admit Order sets and can also be found in “Other” CPOE orderset category)

50 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

51 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

52 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

53 STAT OR URGENT CONSULT TIPS 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 Call placed

54 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

55 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

56 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

57 DEPARTMENTAL A LA CARTE ORDERING PART 2

58 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

59 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

60 RADIOLOGY ORDERS 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 Do Not Order from Outpatient Services

61 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”

62 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”

63 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

64 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

65 NURSING ORDERS DRESSING CHANGES 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”

66 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

67 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

68 RESPIRATORY ORDERS In the CPOE Orderset tab under “Other” use the Respiratory Foundational Order Set to order any Respiratory Services except for invasive ventilator

69 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

70 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

71 MEDICATION ORDER ENTRY USING PICKLIST 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”

72 MEDICATION ORDER ENTRY USING SEARCHING 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

73 IV ORDER ENTRY USING SEARCHING 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

74 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

75 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

76 COMBINATION MEDICATION ORDERS Combination medications contain 2 separate predefined medication orders When discontinuing please remember to discontinue both medication orders if needed

77 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

78 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

79 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

80 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

81 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

82 COMPLEX MEDICATION ORDER ENTRY PREDEFINED INSULIN SLIDING SCALE 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

83 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

84 ENTERING INSULIN SLIDING SCALE DETAILS 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 To delete a row from the table click here

85 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

86 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

87 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

88 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

89 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

90 “NO” … MEDICATION ORDERS 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

91 IV BOLUS ORDER ENTRY Type “Solutions” in the search field and click Meds Pick the solution Open the order detail form Select Bolus and enter volume and duration

92 CHANGE IV RATE 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

93 ADULT TPN ORDERS 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

94 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

95 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

96 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

97 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

98 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

99 BENEFITS OF CPOE Supports access to patient data Orders are processed more quickly Don’t have to look for chart

100 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

101 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

102 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

103 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

104 HANDS ON PRACTICE TIME Medicine & Cardiology Enter the following orders: Blood Gas Analysis, CBC and Chest X- ray 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

105 QUESTIONS


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