January 2012 Inpatient Pharmacy Order Processing 1

Learning Objectives Explain the difference between inpatient and outpatient medication orders Explain why inpatient and outpatient medication orders must be different Discuss best practices in inpatient pharmacy 2

Inpatient versus Outpatient Differences between inpatient and outpatient patients: Outpatients take their meds and leave: They receive multiple days supplies Then they ask for refills Inpatients are residents of the facility: Medications are administered by nursing Nursing normally has access to meds needed for one day Many more controls and higher risk of errors 3

Inpatient versus Outpatient Outpatient orders are converted to prescriptions: Set days supply with refills Patients are in control See provider when its time to renew Ask for refills Inpatient orders contain no days supply: Are open ended but may automatically discontinue if policies require Are printed on nursing MAR so accuracy and clarity are crucial Utilize a team approach to assure patient safety 4

RPMS Inpatient Order Processing Two menus: IV and Unit Dose IV can also be used for Outpatient IVs Unit Dose has same core functionality The difference is in the reports available Both menus will be used because they use different reports to manage workload 5

IV Menu CRL Change Report/Label Devices (IV) CIR Change to Another IV Room (IV) Drug Inquiry (IV) IOE Inpatient Order Entry IPF Inpatient Profile Barcode ID - Return and Destroy (IV) Label Menu (IV)... Manufacturing List (IV) Order Entry (IV) Profile (IV) REPorts (IV)... RETurns and Destroyed Entry (IV) SUPervisor's Menu (IV)... SUSpense Functions (IV)... Update Daily Ward List (IV) Ward List (IV) 6

Example (not a real patient) Select PATIENT: ABEL,DEVIN JOE M ** SENSITIVE ** WW Patient Information Jul 27, :12:31 Page: 1 of 1 ABEL,DEVIN JOE Ward: MEDICAL HRN: Room-Bed: Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________) Sex: MALE Admitted: 06/11/09 Dx: Last transferred: ******** Allergies/Reactions: No Allergy Assessment Inpatient Narrative: Outpatient Narrative: Enter ?? for more actions PU Patient Record Update NO New Order Entry DA Detailed Allergy/ADR List IN Intervention Menu VP View Profile Select Action: View Profile// View Profile SHORT, LONG, or NO Profile? SHORT// 7

NO ORDERS FOUND FOR SHORT PROFILE. Enter RETURN to continue or '^' to exit: Patient Information Jul 27, :17:55 Page: 1 of 1 ABEL,DEVIN JOE Ward: MEDICAL HRN: Room-Bed: Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________) Sex: MALE Admitted: 06/11/09 Dx: Last transferred: ******** Allergies/Reactions: No Allergy Assessment Inpatient Narrative: Outpatient Narrative: Enter ?? for more actions PU Patient Record Update NO New Order Entry DA Detailed Allergy/ADR List IN Intervention Menu VP (View Profile) Select Action: Quit// NO 8

Select DRUG: LISINOPRIL 10MG TAB U/D CV800...OK? Yes// (Yes) Available Dosage(s) 1. 10MG 2. 20MG Select from list of Available Dosages or Enter Free Text Dose: 1 10MG You entered 10MG is this correct? Yes// YES MED ROUTE: ORAL// PO SCHEDULE TYPE: CONTINUOUS// CONTINUOUS SCHEDULE: QDAY// 0900 [ENTER] ADMIN TIMES: 0900// 0900 SPECIAL INSTRUCTIONS: START DATE/TIME: JUL JUL STOP DATE/TIME: NOV NOV PROVIDER: JACOBSEN,JACOB// SELF MED: 9

ACTIVE UNIT DOSE Jul 27, :23:37 Page: 1 of 2 ABEL,DEVIN JOE Ward: MEDICAL HRN: Room-Bed: Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________) (1)Orderable Item: LISINOPRIL TAB Instructions: (2)Dosage Ordered: 10MG (3)Start: 07/27/11 09:00 (4) Med Route: ORAL (5) Stop: 11/04/11 23:59 (6) Schedule Type: CONTINUOUS (8) Schedule: QDAY (9) Admin Times: 0900 (10) Provider: JACOBSEN,JACOB DURATION: (11) Special Instructions: (12) Dispense Drug U/D Inactive Date CM-LISINOPRIL 10MG TAB U/D 1 + Enter ?? for more actions ED Edit AC ACCEPT Select Item(s): Next Screen// 10

ACTIVE UNIT DOSE Jul 27, :29:14 Page: 2 of 2 ABEL,DEVIN JOE Ward: MEDICAL HRN: Room-Bed: Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________) + (7)Self Med: NO Entry By: ALLEN,MICHAEL Entry Date: 07/27/11 17:23 (13) Comments: ORDER NOT VERIFIED Enter ?? for more actions ED Edit AC ACCEPT Select Item(s): Edit// AC NATURE OF ORDER: WRITTEN//...transcribing this active order..... Pre-Exchange DOSES: Select DRUG: Select IV TYPE: PIGGYBACK. Select ADDITIVE: CEFTRIAXON CefTRIAXone (The units of strength for this additive are in GM) Strength: 1 GM Select ADDITIVE: Nature of order: Verbal, Telephone – Self Explanatory Service Correction – If something needed fixing on the order *Written – When working from a signed sheet of orders Policy – When working from protocols (covered by policy) * Counts against provider for Meaningful Use 11

Select SOLUTION: SODIUM CHLORIDE 0.9% INJ. 100 ML INFUSION RATE: 30 INFUSE OVER 30 MIN. MED ROUTE: IV// SCHEDULE: Q24H 1200 ADMINISTRATION TIMES: 1200// REMARKS: OTHER PRINT INFO: START DATE/TIME: JUL (JUL 27, STOP DATE/TIME: AUG PROVIDER: JACOBSEN,JACOB// Orderable Item: CEFTRIAXONE INJ,SOLN Give: IV Q24H [1] MEDICALSURGICAL 07/27/11 ABEL,DEVIN JOE CefTRIAXone 1 GM SODIUM CHLORIDE 0.9% INJ. 100 ML Dose due at: ________ INFUSE OVER 30 MIN. Q24H 1200 RETURN TO IV ROOM IN 24 HOURS MADE BY __ ___ TIME____ 1[1] Start date: JUL 27, :00 Stop date: AUG 6, :59 Is this O.K.: YES// YES NATURE OF ORDER: WRITTEN// 12

Dose due at: ________ INFUSE OVER 30 MIN. Q24H 1200 RETURN TO IV ROOM IN 24 HOURS MADE BY __ ___ TIME____ 1[1] Start date: JUL 27, :00 Stop date: AUG 6, :59 Is this O.K.: YES// YES NATURE OF ORDER: WRITTEN// W 1 Label needed for dose due at... 07/27/ : Next delivery time is 1100 *** Action (PB) P// PRINT V1180 [1] MEDICALSURGICAL 07/27/11 ABEL,DEVIN JOE CefTRIAXone 1 GM SODIUM CHLORIDE 0.9% INJ. 100 ML Dose due at: ________ INFUSE OVER 30 MIN. Q24H 1200 RETURN TO IV ROOM IN 24 HOURS MADE BY __ ___ TIME____ 1180[1200] 13

Questions? 14