Transcript 30_Quick Orders

Quick Orders and Order
Menus
Orders Package
• The Orders package in RPMS provides a
number of functions including:
– Ability for users to enter, process, and discontinue
electronic orders
– Control who can act on orders with OR keys
– Order checking
– Delayed release of orders (inpatient using ADT)
– Auto-discontinue orders (inpatient using ADT
Order Keys
• ORES – Assigned to providers who are
authorized to independently write orders
(typically physicians, nurse practitioners,
physician assistants, podiatrists etc.).
• ORELSE – Assigned to users who are
authorized to take and release verbal and
telephone orders from providers who hold the
ORES key, or who can enter policy orders
(typically registered nurses, pharmacists).
Order Keys (cont.)
• OREMAS – Assigned to users who
transcribe written orders into RPMS-EHR
(typically only given to inpatient ward clerks).
• A user must hold only one order key or they
will not be able to process any orders at all
• You can check to see if users hold multiple
order keys with this menu: ORD > KEY >
CHK
Order Management
• RPMS-EHR provides management of orders on
the Orders Tab.
• The Orders Tab provides the ability to add, change,
discontinue, and print.
• The Orders Tab allows EHR users to sort by
column headings or customize the view of orders
displayed.
Orders Tab
Medication Order Management
• It is recommended that all prescriptions be entered
and managed on the Meds tab.
• The Meds tab provides a better overview of
medications.
• The Meds tab provides easy access to the change,
renew, refill, or discontinue actions for effective
management of medications.
Medications Tab
Note that not all levels are available for all parameters, but only those
that make sense for that particular item.
Order Entry
•
New orders are entered into RPMS-EHR
via order menus.
•
Order menus are organized groupings of
quick orders and other menus.
•
Order menus can be customized to
meet local needs.
•
Usually, order menus are created with
groups of similar quick orders.
Order Menus
• Order menus should be designed by target
end users, not by package informaticists
(i.e., by physicians who will enter orders,
not by pharmacists, laboratory information
specialists, or radiology technologists).
• Once designed, order menus are built by
package informaticists.
Order Menu
Quick Orders
• Quick Orders are electronic orders with
ALL the data elements correctly
preconfigured.
• Order menus are organized groupings of
quick orders to make provider order entry
more convenient and efficient.
Quick Orders
• Well designed order menus and quick
orders provide the clinician with proper
choices and helpful information, and
promote entry of correctly formed electronic
orders.
• Incorrectly entered electronic orders
require additional work to clarify and correct
and may delay or impede patient care.
Quick Order Dialog
Quick Order Creation
• While order menus should be designed by
end user clinicians, the quick orders and
order menus should be built by package
informaticists to ensure that they are
correctly constructed.
Quick Order Creation
• Quick Orders should not be built by CACs
or Informaticists from another discipline
who do not have the knowledge
background for that package.
• In other words, only a pharmacy
informaticist should build pharmacy quick
orders, and only a laboratory informaticist
should build laboratory quick orders, and
so on.
Orderable Item Creation
• Prior to creating a quick order, the orderable item to
be used must already exist.
• The process of adding a new drug to the drug file
creates a new orderable item.
• The process of adding a new test in the laboratory
file creates a new orderable item.
• The process of constructing a new exam in the
radiology-nuclear medicine procedure file creates a
new orderable item.
Orderable Item Creation
• If the order is for nursing or patient care,
then the orderable item must be created
manually using this menu:
OIC
Create/Modify Orderable Items
Create a Nursing Orderable Item
Create a Nursing Orderable Item
• Recommendation is to create nursing orderable items in
ALL CAPS.
• Keep nursing orderable items general so they can be reused in multiple quick orders (e.g. WOUND CARE vs.
TELFA 4x4)
RPMS Namespacing
• Software packages in RPMS have
designated namespaces
• It is recommended that quick orders for
RPMS-EHR utilize the recognized
namespaces
• Use of namespaces aids in the future
management of these quick orders by local
informaticists and by area and national
helpdesk staff.
Naming Convention
Naming Convention
• Conventions for quick orders and menus:
– Namespace + Z = Quick Order
– Namespace + ZM = Menu
– Namespace + ZSET = Order Set
– Use IP to differentiate Inpatient Orders (esp.
Lab and Nursing)
Naming Convention
• Additional suggested namespace:
PSJIVZ for IV piggybacks to differentiate
from oral unit dose and IV fluids
Naming Convention
• Examples:
ORZ WOUND CARE
PSOZ ATENOLOL 25MG DAILY
PSJZ CARVEDILOL 6.25MG BID
LRZ HGBA1C
RAZ FOREARM 2 VIEWS
ORZ IP COLD PACKS
[Outpatient Nursing]
[Outpatient Med]
[Inpatient Med]
[Laboratory]
[Radiology]
[Inpatient Nursing]
PSOZM DIABETES MEDS
LRZM
ER LABS
RAZM
RADIOLOGY
ORZM
IP RESPIRATORY
[Outpatient Pharmacy Menu]
[Laboratory Menu]
[Radiology Menu]
[Inpatient Nursing Menu]
ORZSET COLONOSCOPY PREP
[Order Set]
Quick Order Construction
• From the standard RPMS-EHR
Configuration Master Menu:
ORD > MNU > QOC
Quick Order Types
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Activity
Consult
Imaging
Inpatient Medications
IV Medications
Laboratory
Nursing
Outpatient Medications
Quick Order Types
• There appear to be other Order Types
available of: Diet and Vital/Measurements,
but these should not be used.
• The Dietetics Package is not an IHS
supported package.
• These Vital/Measurements orders point to the
VA Vitals package and not the IHS
Measurements File.
Creating Quick Orders
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
SP
WC
LC
Send patient to lab
Send patient to lab
Ward collect & deliver
Lab blood team
Collection Sample: BLOOD//
Collection Date/Time: TODAY
How often: ONCE ONCE
(MAR 23, 2004)
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//
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//
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: OUTPATIENT
Is this patient scheduled for pre-op? NO//
Date Desired: TODAY//
Mode of Transport: AMBULATORY
Is patient on isolation procedures?
Urgency: ROUTINE//
Review Order
---------------------------------------------------------Radiology Procedure: ELBOW 2 VIEWS
Category: OUTPATIENT
Date Desired: TODAY
Mode of Transport: AMBULATORY
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
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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
• Prescriptions for outside pharmacies
– Make orders just like meds on formulary. (If med is
not in Drug File, then use a med called OUTSIDE RX,
until Pharmacy adds to Drug File). Provider fills in
data, and it is printed as an RX
• Prescriptions received from outside providers
– Must be entered into RPMS. User may have to edit
Drug File
Review 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 Orders - Nursing
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: N+7
Review Order
----------------------------------------------------------------Patient Care: FOLEY CATHETER
Instructions: Empty Foley Catheter to drainage bag q
shift
Start Date/Time: NOW
Stop Date/Time: 7 DAYS FROM NOW
-----------------------------------------------------------------
(P)lace, (E)dit, or (C)ancel this quick order? PLACE//
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
Problem:
Ordering a Med to be given in Clinic
• If only a Pharmacy Order is used, how is
Nursing notified to give the med?
• If only Nursing Order is used, Medication
is not processed in Pharmacy package
Comparison of Order Types used to
order a Medication
Pharmacy Order
(“real” Medication)
Nursing Order
(text only)
Priority: ASAP, or STAT
Pickup: Clinic
Allergy Check: No
Drug interaction: No
Free text entry of
order
Allergy Check: Yes
Drug interaction: Yes
Med Tab: No
Health Summary: No
Order checking: No
Verification: No
Med Tab: Yes
Health Summary: Yes
Generic Order
(text only)
Allergy Check: No
Drug interaction: No
Med Tab: No
Health Summary: 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
Allergy Check: Yes
Drug interaction: Yes
Med Tab: Yes
Health Summary: Yes
Bill through POS or J-Codes
Hands-on Exercise
1. Create nursing orderable item and
nursing quick order for ???
2. Create laboratory quick order for ???
3. Create outpatient med quick order for ???
4. Create radiology quick order for ???
Questions and Discussion