Quick Order Setup

Learning Objectives Become familiar with the steps used to create and modify Quick Orders Identify the various namespaces used to identify service category orders (e.g., RA-radiology, PSO-Outpatient meds, etc) Examine options to be completed when creating a Quick Order Review various menu models and design on paper the menu type that will be used for your facility Using your design, perform the steps for creating a Menu for orderable items

Managing Quick Orders

Order Menus

Creating a Menu Select ORDER MENU: ORZM OUTPT QUICK ORDERS// ORZM NEW MENU Are you adding 'ORZM NEW MENU' as a new ORDER DIALOG? No// Y (Yes) Do you wish to copy an existing menu? YES// NO DISPLAY TEXT: New Menu DESCRIPTION: No existing text Edit? NO// y YES Test Menu COLUMN WIDTH: 40 MNEMONIC WIDTH: 2 PATH SWITCH:Y ENTRY ACTION: <<<<<< not used EXIT ACTION: <<<<<< not used

Adding an Item Using the Add option, any quick order created can be placed on the menu. Type the row and column to place the quick order on the menu. Add: menu Menu Items ITEM: PSOZ AMOXICILLIN 250MG TID ROW: 5 COLUMN: 1 DISPLAY TEXT: MNEMONIC

Naming Convention for Quick Orders NamespaceDepartment RARadiology LRLab PSOOutpatient meds PSJInpatient (Unit dose) meds PSIVIV meds PSOXZOutpatient Meds for ePrescribing GMRCConsults ORCPRS (Nursing Orders)

Name Spacing BE CONSISTENT Menu Generic Order Lab Order Outpatient Pharmacy Order IV Order Inpatient Pharmacy Order Radiology Order

Laboratory Quick Orders Select QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ CALCIUM TODAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: LAB LABORATORY

TYPE OF QUICK ORDER: ? Choose from: ACTIVITY ALLERGIES CONDITION CONSULTS DIAGNOSIS DIET ADDITIONAL ORDERS DIET ORDERS EARLY/LATE TRAYS GENERAL RADIOLOGY IMAGING INPATIENT MEDICATIONS IV MEDICATIONS LABORATORY NURSING OUTPATIENT MEDICATIONS PRECAUTIONS PROCEDURES SUPPLIES/DEVICES TUBEFEEDINGS UNIT DOSE MEDICATIONS VITALS/MEASUREMENTS

Laboratory Quick Orders Select QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ CALCIUM TODAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: LAB LABORATORY NAME: LRZ CALCIUM TODAY// DISPLAY TEXT: Calcium Today VERIFY ORDER: y YES DESCRIPTION: Calcium level done for outpatients for today ENTRY ACTION: Lab Test: CALCIUM Collected By: SP Send patient to lab SP Send patient to lab WC Ward collect & deliver LC Lab blood team Collection Sample: BLOOD// Collection Date/Time: TODAY (MAR 23, 2004) How often: ONCE ONCE

Review Order Lab Test: CALCIUM Collected By: Send patient to lab Collection Sample: BLOOD Specimen: BLOOD Collection Date/Time: TODAY How often: ONCE (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO// Auto-accept should not be used for quick orders. Orders that are auto- accepted do not display to the provider for final review and are a potential source of error.

Lab Schedule ONCE must be setup as a laboratory administration schedule. Lab menu option is LRZM LAB TESTS Select ADMINISTRATION SCHEDULE: ONCE ONE-TIME NAME: ONCE// TYPE OF SCHEDULE: ONE-TIME//

Quick Orders - Radiology Select QUICK ORDER NAME: RAZ ELBOW XRAY Are you adding 'RAZ ELBOW XRAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: IMAGING NAME: RAZ ELBOW XRAY// DISPLAY TEXT: Elbow Xray VERIFY ORDER: Y DESCRIPTION: No existing text Edit? NO// Select one of the following imaging types: ANGIO/NEURO/INTERVENTIONAL GENERAL RADIOLOGY ULTRASOUND Select IMAGING TYPE: general RADIOLOGY

Quick Orders - Radiology Radiology Procedure: 14 ELBOW 2 VIEWS Procedure Modifier: History and Reason for Exam: No existing text Edit? No// Category: Is this patient scheduled for pre-op? NO// Date Desired: TODAY// Mode of Transport: Is patient on isolation procedures? Urgency: ROUTINE//

Review Order Radiology Procedure: ELBOW 2 VIEWS Date Desired: TODAY Urgency: ROUTINE Submit request to: X-RAY (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Quick Order – Outpt Meds NAME: PSOZ AMOXICILLIN 500MG BID 7D Replace DISPLAY TEXT: Amoxicillin 500mg bid 7 days Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// Y Amoxicillin 500mg BID outpatient for 7 days ENTRY ACTION: Medication: AMOXICILLIN CAP,ORAL // Complex dose? NO// Dose: 500MG// The dose should have been set up by pharmacy Route: ORAL// Setup by pharmacy

Quick Order – Outpt Meds Days Supply: 7// Quantity (CAP): 14// Refills (0-11): 0// Schedule: BID// Pick Up: WINDOW// Priority: ROUTINE// Comments: No existing text Edit? No// (No) Select ADMINISTRATION SCHEDULE:

Review Order Medication: AMOXICILLIN CAP,ORAL 500MG Instructions: 500MG ORAL BID Days Supply: 7 Quantity (CAP): 14 Refills (0-11): 0 Pick Up: WINDOW Priority: ROUTINE (P)lace, (E)dit, or (C)ancel this quick order? PLACE// P Place to save quick order

Special Med Quick Orders Clinic Meds (In-House Meds) –Pick up is ADMINISTERED IN CLINIC –Status is ASAP or STAT, not DONE CII Prescriptions –Entered as usual. Hardcopy printed for signature Prescriptions for outside pharmacies –Make orders just like meds on formulary. It is printed as an RX It is ePrescribed Prescriptions received from outside providers –Must be entered into RPMS/EHR. User may have to edit Drug File

Review the Order Medication: CEFTRIAXONE INJ,SOLN 1GM/VIAL Instructions: 1 GRAM 1GM/VIAL INTRAMUSCULAR Q12H Days Supply: 1 Quantity (VL): 1 Pick Up: ADMINISTERED IN CLINIC Priority: STAT (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Quick Order – Inpatient Meds Select QUICK ORDER NAME: PSJZ LISINOPRIL 20MG QD NAME: PSJZ LISINOPRIL 20MG QD Replace DISPLAY TEXT: Lisinopril 20mg QD// VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: LISINOPRIL TAB // Complex dose? NO// Dose: 20MG// Route: ORAL// Schedule: QD// Give First Dose NOW? NO// Priority: ROUTINE// Comments: No existing text Edit? No//

Review the Order Medication: LISINOPRIL TAB Instructions: 20MG ORAL QD Priority: ROUTINE (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO// Meds should NEVER be auto-accepted

Quick Orders – IV Meds Select QUICK ORDER NAME: PSIVZ D5W WITH 30KCL NAME: PSIVZ D5W WITH 30KCL Replace DISPLAY TEXT: D5W 1000CC with 30KCL Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// ENTRY ACTION:

Quick Orders – IV Meds Solution: DEXTROSE INJ,SOLN // Additives: 1: POTASSIUM CHLORIDE INJ,SOLN 30 MEQ 2: Can add multiples Select (1-2) or to continue: Infusion Rate: 75 Schedule: Priority: ROUTINE// Provider Comments: No existing text Edit? No//

Review the Order Solutions: DEXTROSE INJ,SOLN 1000 ml Additives: POTASSIUM CHLORIDE INJ,SOLN 30 MEQ Infusion Rate: 75 ml/hr Priority: ROUTINE (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Nursing/Generic Quick Orders Nursing Quick Orders rely on “Orderable Items”

Manage Orderable Items Select Order Menu Management Option: OI Manage orderable items OI Enter/edit orderable items QO Enter/edit QO restriction SR Search/replace orderables Select Manage orderable items Option: OI Enter/edit orderable items Type of Orderable: NURSING Select ORDERABLE ITEMS: CATHETER Are you adding CATHETER' as a new ORDERABLE ITEMS (the 3499TH)? No// Y (Yes) NAME: CATHETER//

Create a Nursing Quick Order TYPE OF QUICK ORDER: NURSING NAME: ORZ FOLEY CATHETER// DISPLAY TEXT: Foley Catheter to Drainage VERIFY ORDER: DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Patient Care: CATHETER Instructions: Empty Foley Catheter to drainage bag q shift Start Date/Time: NOW// Stop Date/Time: T+7 (FEB 24, 2007)

Review the Order Patient Care: FOLEY CATHETER Instructions: Empty Foley Catheter to drainage bag q shift Start Date/Time: NOW Stop Date/Time: 7 DAYS FROM TODAY (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Generic Orders Select ORDER DIALOG NAME: ORGXZ RESTRAINTS NAME: ORGXZ RESTRAINTS// DISPLAY TEXT: RESTRAINTS// SIGNATURE REQUIRED: ORES// VERIFY ORDER: YES// ASK FOR ANOTHER ORDER: DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: EXIT ACTION: VALIDATION: ADDITIONAL TEXT: DISPLAY GROUP: NURSING// Select PROMPT: ? Answer with ITEMS, or SEQUENCE Choose from: 1 OR GTX ORDERABLE ITEM Orderable Item, e.g. RESTRAINTS 2 OR GTX WORD PROCESSING Can use TIU Template Fields 3 OR GTX START DATE/TIME 4 OR GTX STOP DATE/TIME You may enter a new ITEMS, if you wish Type a Number between.1 and 999.9, 1 Decimal Digit Select PROMPT: Auto-accept this order? NO//

Quick Orders - Consults Select QUICK ORDER NAME: GMRCZ PHYSICAL THERAPY NAME: GMRCZ PHYSICAL THERAPY DISPLAY TEXT: Physical Therapy Consult VERIFY ORDER: YES// DESCRIPTION: Quick order for physical therapy consult Edit? NO// ENTRY ACTION: Consult to Service/Specialty: PHYSICAL THERAPY// Consult Type: Reason for Request: No existing text Edit? No// N (No) Category: OUTPATIENT// Urgency: ROUTINE// Place of Consultation: Consultant's Choice// Attention: Provisional Diagnosis:

Review Order Consult to Service/Specialty: PHYSICAL THERAPY Category: OUTPATIENT Urgency: ROUTINE Place of Consultation: Consultant's Choice (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Order Sets Select ORDER SET NAME: LRZ DIABETIC TESTS ORDER SET NAME: LRZ DIABETIC TESTS ORDER SET Replace DISPLAY TEXT: Diabetic Yearly tests Replace DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: EXIT ACTION: ORDER SET COMPONENTS: 1 LRZ HGBA1C OUTPT 2 LRZ LIPID PANEL 3 LRZ TSH OUTPT Select COMPONENT SEQUENCE#:

Quick Order Restrictions

Quick Order Wizard Wizard can be most useful when creating large number of similar Quick Orders (e.g. many dose variations of a medication) Quick Order Wizard requires a “special” EHR VueCentric Template for the CAC since it should not be on the regular template CAC still has to use roll-and-scroll RPMS to place Quick Orders on menu

Lab using Quick Order Wizard

Lab and Quick Order Wizard Name of quick order Name the User sees Click to have user verify Enter description

Lab and Quick Order Wizard Enter Lab Test Specimen and sample may default Urgency Collection Type –Date/time –How often –How long

Select QUICK ORDER NAME: LRZ MAGNESIUM NAME: LRZ MAGNESIUM// DISPLAY TEXT: Magnesium// VERIFY ORDER: YES// DESCRIPTION: Test Quick Order Wizard Magnesium Edit? NO// Lab Test: MAGNESIUM// Collected By: Send patient to lab// Collection Sample: BLOOD// Collection Date/Time: TODAY// Urgency: ROUTINE// How often: ONCE// Indication:// Indication ICD9:// Lab Test: MAGNESIUM Collected By: Send patient to lab Collection Sample: BLOOD Specimen: BLOOD Collection Date/Time: TODAY Urgency: ROUTINE How often: ONCE Indication:

Problem: Ordering a Med to be given in Clinic If only a Pharmacy Order is used, how is Nursing notified to give? If only Nursing Order is used, Medication is not processed in Pharmacy package

Pharmacy Order (“real” Medication) Priority: ASAP, or STAT Pickup: Clinic Med Tab: Yes Health Summary: Yes Allergy Check: Yes Drug interaction: Yes Nursing Order (text only) Allergy Check: No Drug interaction: No Med Tab: No Health Summary: No Generic Order (text only) Free text entry of order Allergy Check: No Drug interaction: No Med Tab: No Health Summary: No Comparison of Order Types used to order a Medication Order checking: No Verification: No

Solution: Order Set containing both Pharmacy and Nursing Orders NURSING QUICK ORDER: ORZ ALBUTEROL NEB RX Give an Albuterol Neb Treatment in Room #. Use 0.25ml/3ml Saline PHARMACY QUICK ORDER: PSOZ ALBUTEROLNEB RX TWO TYPE ORDERS IN ONE SET: Nursing orders: one and Pharmacy Orders: one Med Tab: Yes Health Summary: Yes Allergy Check: Yes Drug interaction: Yes Meds administered in clinic are generally billed using J-Codes, not through POS.

Questions and Discussion