GSMC CPOE Physician Faqs October 15, 2015

GSMC CPOE Physician FAQs October 15, 2015

Table of Contents

October 15, 2015 Updates: 1. Why do I keep seeing orders for my signature that I did not create?  When ordering an Initiate Protocol, there will be various orders that are reflexed from the protocol. The example below is the “Initiate PO Potassium Protocol” – This protocol will initiate various orders for PO Potassium that are based on the patient’s serum potassium levels. These individual orders are each sent to the patient’s eMAR for the nurse to administer.

 These orders will go to your queue for you to sign as an order due to the initial order for the protocol. You can

see what will be included in a protocol you plan to order by clicking the small P that is in the yellow box .(See screen sample below)

1 GSMC CPOE Physician FAQs October 15, 2015

2. What is the process and what are the protocols for ordering restraints?  Restraints for violent behavior for all nursing units except Pediatrics are defaulted to Q4. Violent restrains for Pediatrics is defaulted to Q2.  All non-violent restraint orders are set to ONCE when ordered for every unit at GSMC.  Physicians should reorder the Violent Behavior Restraints Q4 or Q2. Please note, a new order for violent restraints is required.  Screen samples for restraints are included below. There are two options for ordering restraints—a restraint order, and a restraint order set.

Restraint Order

Restraint Order Set

3. How do I enter a one-time medication order in CPOE?  Medications ordered for single dose administration have defaults in the drug dictionary that have “One -Time” and “Once” defaulted in. The frequency and status fields CAN be changed to “Scheduled” or “PRN” and the medication will not fall off of the eMAR. Below is a screen shot illustrating this process.

Leave the Frequency as Once.

Change the SCH column – click on the existing entry of ONE, and change to PRN or SCH or STA. This will cause the order to remain on the eMAR until the nurse documents on it.

4. What is the correct process and use of the system for Blood Bank Type and Screen orders?  TYPE AND SCREEN - No product is automatically ordered/made ready when you order a Type and Screen. See instructions and screen shots below.

1. Order test

2. Select priority

3. Edit Date and Start Time, if desired

5. What is the correct process for ordering blood?  This order is to get product made ready for the patient.

1. Order product – the product order will automatically reflex any required blood bank testing, like the type, screen, and cross-match when it’s ordered in lab. This type of reflex will not be seen in OM during the ordering process as it will happen within lab. Note: Other required testing, like a hemoglobin, platelet count, or INR is NOT automatically order.

2. Select Priority

3. How many units? a. If only 1 unit for today and now should be made ready, and there are no special instructions needed, select next.

b. If more than 1 unit should be made ready, or to edit the start time, or provide special instructions, select edit

4. Whenever product is ordered, the order to transfuse the product is automatically reflexed. This message will appear alerting the user the reflex has happened. Click Close

5. Do you want to transfuse NOW? a. No. If the order to transfuse is not desired at this time, simply uncheck the reflex Transfuse order.

b. Yes. Select the red edit for the transfuse order b.i. Edit the quantity of units to be transfused, if desired b.ii. Edit the start date/time if desired b.iii. Indicate the reason for transfusion b.iv. Indicate the volume to transfuse, if appropriate

6. What is the correct process for ordering a transfusion? ORDER TO TRANSFUSE:

This is the order to transfuse the product once it is ready.

7 GSMC CPOE Physician FAQs October 15, 2015  If the order to transfuse was deselected at the time the product was ordered, it must be ordered individually to initiate the transfusion process. 1. Use in the following ways: a. If the product was only ordered, but not infused b. Total units have not been transfused for this patient

2. Select the priority

3. Select edit for the transfuse order – reason for transfusion is required. a. Edit the quantity of units to be transfused, if desired b. Edit the start date/time if desired c. Indicate the reason for transfusion d. Indicate the volume to transfuse, if appropriate

This list of reason for transfusion follows the long text description visible on the screen. Select from the list or simply type the associated number shown on either screen.

TRACKING:

There are a couple of places to easily see the associated lab results and the number of products ordered versus transfused. The product summary screen under the blood bank results section is one of the best places to see this information.

Why a product order may show as cancelled.

The cross-match specimen/testing is good for 72 hours. Any products ordered during that 72 hours have to be added to that specimen to be able to issue the product. Due to Meditech functionality, adding a new order to an existing order automatically isn’t possible. So when there is a valid existing specimen the blood bank tech will “move” the new order to the existing order; by cancelling the new order and adding it to the existing order. Even though the new order may be cancelled, it is still technically the written order.

General CPOE Questions 1. How do I order IV fluids and IV antibiotics? In attempt to make ordering easier, the following sets have been developed by pharmacy.

1. Under orders, new sets, select IV FLUIDS

A list of all available IV fluids will be available to choose and edit as desired.

2. To order IV Antibiotics, under orders, New Sets, select ANTIBIOTICS IVPB. Choose the antibiotic desired and edit if needed.

2. How do I make a medication order STAT in MEDITECH?  NOW orders in MEDITECH by protocol are orders to be delivered within two hours. For a STAT order with a protocol of delivery within 15 minutes, the order should be entered into MEDITECH as a NOW order and verbal communication with the nurse that the order is to be delivered STAT.

3. I see an order in my eSign queue called “Pharmacy Correction”. What is this?  Pharmacists review and verify all medication orders. If a pharmacist identifies a medication problem in an order —for example, a compound entered incorrectly—it will be cancelled and reordered with an order source called “Pharmacy Correction”. All orders must be eSigned by physicians and this order will be in your eSign queue for signature.

4. Is it necessary to continue a consult order when transferring a patient?  When transferring a patient each order is either continued or stopped. Since the consult order was previously entered the consulting physician has been contacted. Stopping the order is appropriate and does NOT stop the consult. Continuing the order will result in an additional contact to the consulting physician because it will be viewed by the system as a new consult order.

5. When is it appropriate to use nursing communication within MEDITECH?  Nursing communication should be used for communication to the nurse for things like family communication, desired communication to the physician about blood pressure changes, etc. Discharge orders, transfer orders and medication orders cannot be communicated via the Nursing Communication function.

Telephone Orders 1. When is it acceptable to call in a telephone order?  Telephone orders are acceptable when:

 The physician is in a sterile environment, involved in a case, etc.

 The physician does not have access to a computer

 It is a call from the hospital to the physician requesting orders in the middle of the night

 If there are more than 5 individual orders, physicians are encouraged to enter the orders via CPOE

 Full Admission Order Sets as telephone orders are discouraged

2. When I call in an order, will the nurse put it in CPOE while I am on the phone?  It is preferred for the nurse to enter the order directly into the computer while the physician is on the line

 Per policy, orders are to be read back to the physician when taken by the nurse

3. When are verbal or written orders acceptable?  While we encourage online use of CPOE whenever possible, we recognize there are times that are appropriate for verbal orders. These include:

 The physician is in a sterile environment or involved in a case

 The hospital is experiencing computer downtime

Transfer Orders Process 1. When should I use the MEDITECH transfer orders process?  When patients move from an outpatient area like Same Day Surgery or PACU, and are to be admitted as an inpatient or observation patient, the transfer orders process should be used.

2. What is the correct sequence for using transfer orders?  Use the transfer orders first to stop medications / services as appropriate. Then add general admit orders for the patient. Do not click on submit until you have addressed all previous orders and entered any new orders, new meds or new order sets for the patient.

3. I completed the transfer orders process and my new orders disappeared. What happened?  Always stop medications and services first within the transfer orders process BEFORE you add new orders or sets. If new orders or sets are created first and then services cancelled, the new orders will be cancelled. DO NOT click on submit until you have addressed all previous orders and any new orders, new meds, or new order sets.

4. Following are instructions and screen prints for the transfer orders process. TRANSFER ORDERS – Physician Driven:

1. Transfer orders used any time a patient is:

a. Sent from PACU to a Post Op Unit

b. Transferring the patient from one level of care to another (ICU to IMC, IMC to Med/Surg)

2. ALWAYS do the Transfer Orders portion before entering any other orders, or reconciling home meds. Failure to Transfer Orders first will result in lost orders!

3. Go to Orders Tab (right of screen) and Click Transfer Orders (top of screen).

15 GSMC CPOE Physician FAQs October 15, 2015 4. The first thing that will be required is which unit to transfer the patient to. If the patient already has an admit o

The Admit Patient may have already been completed with the Admission.

If the Patient was NOT previously admitted, the Admit portion will be requested for completion.

16 GSMC CPOE Physician FAQs October 15, 2015 5. Each item will automatically be stopped. The items can be left at a Stopped Status or changed to Continue. This can be done by individual order or all items within the category.

6. If placing new orders, new medications, or order sets DO NOT click SUBMIT. Scroll back up to top and place new orders by click on new orders, new meds, or new sets.

7. Reconciliation of medications that the patient has taken at home are to be reviewed during the transfer of the patient as well. This is indicated when the Reconcile button is Red. See below:

Discharge Process 1. What is the CPOE process for discharging a patient to another care facility like Select Specialty, Home Health, etc.?  The discharge process is the same using CPOE whether a patient is discharged home or to another care facility. If there are additional requirements for the care facility, these are handled outside of the CPOE process and will be handled by the discharge nurse.

Printing Prescriptions 1. What is the process for printing prescriptions at discharge?  The physician discharge process has a step that prints the patient’s prescriptions on prescription paper for the physician’s signature. To be a valid prescription, it must be manually signed by the physician.

 Each patient care area / unit has a designated printer or printer drawer on the copy machine that is dedicated to housing the “safety/security” prescription paper – this is where all scripts will print. All prescription printers start with RX for the printer name.

Medication and Allergy Conflict Checking 1. I’m getting a lot of pharmacy medication conflicts. What can I do about this?  Duplicate drug classes interactions have been turned off in the system (for example, multiple drugs in the Opiate classification). Physicians can turn off other specific drug interaction checking by patient or across their patients when they receive the interaction alert. When you receive the interaction message, click the button to turn off the interaction for this patient or for all patients.