cpoe training hs

Computer Provide Order Entry

WELCOME2/8/12

Medication Administration Check 2005 Emergency Dept Tracking Board 2005

Enterprise Documentation Management Jan 2008

Soarian Clinical Team (eDocumentation) June 2008 Soarian Financials June 2009

EHR SOARIANSoarian Common Clinicals (Orders) June 2008

Computer Provider Order Entry August 30, 2011 Memorial Forms Catalogue 2007

Soarian Clinical Access (Results) 2007

CPOE Chartin g

Time Line ePhysicians68

68 Urology Surgeo Ortho ns OB/Gyn

ALL

22 MP PHS S Psy ch 24

34 Intensivists Neonatolog ists 24 Cardiologis YFWC ts CWF Peds 23 Pediatricia ER 34 M ns

10 Oncologist Nephrologi s sts 10

8/309/14 9/27 10/4 10/1 10/1 10/2

1/10 1/17 1/24

2/1

Class ContentComputer Provider Order Entry (CPOE) Physicians and other providers will place orders on all their patients In house and remote access

The Physician will need your help!!Learn the effects of CPOE in the Clinical Process for Nursing, The Ancillaries, and the Unit Secretary

Its a Hybrid World

Soarian is the List of Orders Unit Secretary role

Pharmacy - Validation MAK Verification

OAW (Order as Written)

Soarian Acknowledgement STAT Orders

Learn to place orders through the Physician account

Order Sets Pick Lists Individual Orders

Conflicts Discontinues Min/Max

Worklist Patient Data Form Search for Orders

Functions Packaged vs. Pre-defined Formulary Non-Formulary

IVsMedications

Free TextOrders to be Signed Orders Reaching Expiration Revising/Discontinuing Medications

Learn the differences between a physician's account and Nurse or Unit Secretary account

Patient Census Coverage

Group Individual

Outpatient Census Specialty Census Floor Census

Impact on Nursing, Unit Secretaries, and AncillariesPatient Adm itted to YVM H

Hybrid Environm ent CPO E vsHardcopy O rders .

Physician Signs into Soarian to review ALL orders

Physician Enters orders in Computer

Unit Secretary M onitors orders and com municates imm ediate needs to appropriate staff

Places orders into eKardex

Nurse signs into Soarian and reviews worklist for new orders

Verifies Med O rders in M AK (with Order as W ritten and ) acknowledges all orders in Soarian

STAT orders will be called to unit by the Physician AND an alert is sent in Soarian to Nurse and Unit Secretary

CPOE

Physician O rder Type

Hard Copy


Physician writes orders

Chart flagged for new orders

Unit Secretary or RN enters into Soarian .

Scans Hard Copy to Pharm acy using PDM

ALL Orders only found in Soarian. Clinicians must be aware whether a CPOE physician or Paper Order Physician, emphasize emphasize emphasizePatient Admitted to YVMH Physician Signs into Soarian to review ALL orders Physician Enters orders in Computer Unit Secretary Monitors orders and communicates immediate needs to appropriate staff Places orders into eKardex

Changes to the Nurse and Unit Secretary ProcessP y ic nS n in h s ia ig s to S a ntore ie A L o ria v w L o e rd rs

CO P E

P y ic nO e h s ia rd r Tp ye

Hybrid Environment CPOE vs. Hardcopy Orders


Verifies Med Orders in MAK (with Order as Written) and acknowledges all orders in Soarian


H rdC p a oy

CPOE

Physician Order Type

Hard Copy




Unit Secretary or RN enters into Soarian.

Scans Hard Copy to Pharmacy using PDM

P y ic nS n in h s ia ig s to S a ntore ie A L o ria v w L o e rd rs

Changes to the Nurse and Unit Secretary ProcessUnit Secretary Monitors orders and communicates immediate needs to appropriate staff


Patient Admitted to YVMH




Unit Secretary Monitors orders and communicates immediate needs to appropriate staff





CPOE


Hard Copy






Unit Secretary will set up Personal Census to cover ALL patients on unit(s) of responsibility .

Changes to the Nurse and Unit Secretary ProcessClick to edit Master text styles Second level Third level Fourth level Fifth level

Setting Personal Census for 3W Icon, Change time, assign all patients,






Move to 3E


Click Personal Census icon, make sure time is right, move all 3E patients


Now ALERTS are based on Personal Census. Work list is now functioning for both units Illustration Test 2 Validation has no alerts


Dr Olden places order for Lasix 80 mg IV STAT


ALERT shows on census view and Worklist Unit Secretary notifies appropriate staff

Pharmacy Review Pending

Nurse needs to go into Soarian to view exact order. Once the nurse starts acting on order, should be in MAK by the time of Administration. Can chart it through Pharmacy Pending Review). Workflow - Physician places order STAT Order goes directly into Pharmacy System. At the same time ALERT to Soarian notifying Nurse and Unit Secretary. STAT order goes to top of Pharmacists screen Pharmacy validates Viewable in MAK for nurse to verify and administer

Changes to the Nurse and Unit Secretary Process

The Nurse MUST clear ALL STAT Medications ALERTS in Soarian manually The ALERT for STAT Diagnostics or Patient Care Orders, are cleared by acknowledging the order The Unit Secretary at NO time should clear the ALERTS, EXCEPT for the STAT Med ALERT. It is role based. It will not remove the ALERT from the Nurses account The Unit Secretaries responsibility is to notify the appropriate staff member of the ALERT There will be times the Nurse notices the ALERT before the Unit Secretary. The Nurse can go ahead and follow the process and remove the ALERT

Orders Acknowledgement by the Nurse

Orders to be Acknowledged in Soarian

ONLY Non-Medication Orders (Patient Care Orders, Rads, Labs, etc)Is the order appropriate for the care of the Patient?

Look at Order Detail

Ordering Physician is a physician caring for patient Time appropriate (i.e. Change dressing timed appropriate) Look at mode of transport on radiology. Is it appropriate?

Check for Duplicates. Is it appropriate?

Compare with the eKardex and update the eKardex as needed Verify Medication Orders in MAK using Order as Written (OAW)

Order Checking by Unit Secretary

Orders in Soarian

Check ALERTS for STAT Orders (Every 15 minutes)

Must Refresh screen every 15 minutes Communicate to Appropriate Staff Member Physician Ordering Remote should call all STATS to Unit

Monitor for New Orders

Keep track of Physicians on Unit Monitor Patients for new orders Check with Physician before physician leaves unit Physician should update secretary on any patient that has new orders

Compare with the eKardex and update the eKardex as needed Updated CPOE Physician List Will be Provided

Changes to the Nurse and Unit Secretary ProcessVerifies Med Orders in MAK (with Order as Written) and acknowledges all orders in Soarian (Minus medications)



Patient Admitted to YVMH









CPOE

Nurse Only


Hard Copy







Titrate parameters show up blank. Titration will be listed under DIRECTIONS Medication will be verified with Order as Written (OAW) NEW ICON DR in front of medication indicates the


Order as Written is exactly how the physician wrote the Order. If Pharmacist uses substitute or alters order in any way, the alteration will show up in OAW. I.e., Nexium for Protonix. Substitution will be listed.


Patient A dmitted to YVMH

H ybrid Environm ent CPO E vsHardcopy O rders .


Physician Enters orders in C omputer




Verifies Med Orders in MAK (with O rder as W ritten and ) acknowledges all orders in Soarian

STAT orders will be called to unit by the Physician AN D an alert is sent in S oarian to N urse and Unit Secretary

CPOE



Hard Copy






Changes to the Nurse and Unit Secretary ProcessPhysician writes orders Chart flagged for new orders Unit Secretary or RN enters into Soarian. Scans Hard Copy to Pharmacy using PDM

Hybrid Environm ent CPO E vsHardcopy Orders .Patient Adm itted to YVM H


P hysician Enters orders in Co m puter

Unit Secreta ry M onitors orders and com m unicates im m ediate needs to appropriate staff

Places orders into eKa rdex

Nurse sig ns into Soarian and reviews w orklist for new orders

Verifies M ed Orders in M AK (w ith Order as W ritten an d ) acknow ledges all orders in Soa rian

STAT orders w ill be called to unit by the Ph ysician AN D an alert is sent in Soarian to Nurse and Unit Secretary

CPO E

Physician Order T ype

Emphasize again ALL orders are in Soarian

Hard C opy

Physician Signs into Soa ria n to review ALL orders



Un it Secretary or RN e nters into Soarian .

Scans H ard Co py to Pharm acy using PD M

Changes to the Nurse and Unit Secretary ProcessAll telephone orders, order revisions to protocols, etc. will be done on Hardcopy by Nurse

Patient Adm itted to YVM H

H ybrid Environm ent CPO E vsH ardcopy O rders .

Physician Sig ns into Soarian to review ALL orders

Physician Enters orders in Com puter

Unit Secretary M onitors orders and comm unicates imm ed iate needs to appropriate sta ff



Verifies Med Orders in MAK (with Order as W ritten and ) acknowledges all orders in Soarian


CPO E


Hard Copy






Placing Orders Using CPOEClick to edit Master text styles Second level Third level Fourth level Fifth level

Click on order icon


Two primary ways to sort active orders


CLICK +ADD ORDER


Picklists for Physicians are different then Nursing and Unit Secretary screens

Picklist

Picklist

Labs in AM Picklist

Picklist

STAT Rx Medication Picklist

General Admission Order SetClick to edit Master text styles Second level Third level Fourth level Fifth level

When starting an admission Med/Surg will routinely go to Adult General Admission Orders


When placing an order(s) make sure to fill out Session Detail Do not fill in priority when using the Order Sets. It will change the Pre-set priority on all orders within the order set. Only use priority when entering single orders or several orders with the same priority.

Placing Orders Using CPOEClick to edit Master text styles Second level Third level Fourth level Fifth level Physician will check orders appropriate to patient care If theres an arrow next to any display, open it up to see what is in the sub set. Must check main title box in order to make part of order session

Admit to/Transfer toThe Order Detail will open on the Admit To screen. Service is where the patient is being admitted to Patient Status (In patient or Outpatient) Condition Critical, Stable, Guarded, Unstable, etc. Code Status Primary/Secondary Diagnosis (Editable Fields)

Click to edit Master text styles Second level Third level Fourth level Fifth level Information from Registration

Placing Orders Using CPOE Alerts for conflicting Orders will Click to edit Master appear before the physician signs text styles Second level and activates the order. Third level level There is a Model issue with some FourthFifth level ALERTS repeating IGNORE IT

Placing Orders Using CPOE Once signed, orders to edit Master text styles Click go directly to pharmacy, lab, level Second rad, etc. The ALERTS go Third level away Fourth level Fifth level

Searching for Medication Orders Using CPOEClick to edit Master text styles To search for a Second level particular order, type in Third level the first few letters. Fourth level Example here is looking Fifth level for Promethazine.

Click on Meds if looking for a Medication, Labs, if looking for Lab, or All if looking for a

Searching for Medication Orders Using Packaged CPOE MedicationClick to edit Master text styles Second level Third level Fourth level Fifth level Predefined Medication

Two types of Orders - Pre-Defined, specific, fully automated - Packaged, Order Detail screen must be filled out Dose, Frequency, priority,

Example of Packaged Medication Order detailClick to edit Master text styles Second level Third level Fourth level Fifth level

Example of Packaged Medication Order detail and all the fields that must be filled in

Placing Orders Using CPOEClick to edit Master text styles Second level Third level Fourth level Non-Formulary Fifth level Search gives a much broader Search. It searches the Data Bank in Pharmacy and will bring up the entire list, not just what we have in Pharmacy. It does bring the Medication up in Packaged Form because thats what

Communication OrderClick to edit Master text styles Second level Third level Fourth level An order the physician Fifth level can use to communicate tasks to the nursing staff is a Patient Care Order called Communication. Once found through the Search, click on the name of the order which will bring up the

Communication OrderClick to edit Master text styles Second level By going into the Order Third level Detail and putting in the Fourth level specific instructions under Fifth level Order Comment

Communication OrderClick to edit Master text styles Second level Third level Fourth level Fifth level It will show up as a Patient Care Oder with the information typed into the Comment Field

Weight Base DosingClick to edit Master text styles Second level Example of Weight Third level Based Auto Fourth level calculation. Once a Fifth level weight is recorded, the weight will migrate into the Dosing Weight Field. If the medication is weight based, the dose will be autocalculated. If the weight has not yet been recorded, the physician can

Weight Base DosingClick to edit Master text styles Second level Third level Fourth level Fifth level

How the weight based medication displays before signing. Note the mg/kg/dose in the order.

Order Sets Not in SoarianClick to edit Master text styles Second level Third level Fourth level Fifth level Order Sets not in Soarian. The Search will bring up (2) sub orders. The Primary Order reads One is to notify the nurse that its found it the paper chart Two is a Hyperlink to the paper order set.

Order Sets Not in SoarianClick to edit Master text styles Second level Third level Fourth level Fifth level

The physician prints it out from here and places on the chart.

Placing IV Orders Using CPOEClick to edit Master text styles Search for IVF and Second level ALL IV solutions will Third level come up. Fourth level Fifth level

Placing IV Orders Using CPOE

Make sure the rate is correct

Medication BolusClick to edit Master text styles Second level Third level Fourth level Fifth level

Medication Bolus First Search for medication

Medication Bolus

With Weight Base Dosing, Calculation is done for you ( MUST HAVE A

Medication BolusClick to edit Master text styles Second level Third level Fourth level Fifth level

Remember, this will place an ALERT on the Secretarys and Nurses Worklist. Follow that procedure The icon Mortar and Pestle indicates the order originated in Pharmacy. The Rx icon indicates validation by Pharmacy. The ^ symbol means there was an EDIT.

Add Order to FavoritesClick to edit Master text styles Second level Third level Fourth level Fifth level

If medication is one that is used frequently by the physician Before Activating an order or signing


Once the physician starts a list of Personal Favorites This new tab shows on the Order


Any instructions the physician has added to the order will stay within the Favorites

Continuous Medication Drip with TitrationClick to edit Master text styles Second level Third level Fourth level Fifth level This is where the titrate detail is filled in. This is actually the Directions element in Pharmacy/MAK.

Continuous Medication Drip with TitrationClick to edit Master text styles Second level Third level Fourth level Fifth level When hovering it looks like the Titration has not been filled in. Must go to the Order Detail

Using Free Text Orders in CPOEUsing Free Text Orders in CPOE Type in zz or vdjbvggdfogbsj and click on Meds. It will bring up the free text field. Click on middle arrow. Place Medication/IV in top window. Must type in entire order Medication, amount, route, frequency, priority. Discourage use!!

Type in WILD and click LAB if sending an order to lab. Above method goes to Pharmacy.

Placing Orders Using CPOE

ALERT will display. Pharmacy cannot Clinically check because of the Free Text.

Revising Medication Orders Using CPOEClick to edit Master text styles Second level Third level Fourth level Fifth level

When Revising an Order, revise liquids, IVF, etc. Tabs must be handled differently.


If dose is changed on a tab


It works off the Tablet. Be certain this is what is needed. Otherwise, Discontinue the order and place a new order for the dose.

Revising Orders Using CPOE

Parenterals, Elixirs, and IVFs can be revised. Emphasize when revising a tablet its working on the tablet, not the strength.

Discontinuing an OrderClick to edit Master text styles Second level Third level Fourth level Fifth level

To Discontinue an order simply check the box next to it and click discontinue.

Discontinuing an Order

A reason does not need to be inputted at this time. That might change in the near future do to regulations. Click OK to bypass this field

Discontinuing an Order

Example of Discontinued Medication. Simply sign at this point

Placing STAT Orders Using CPOEClick to edit Master text styles Second level Third level Fourth level Fifth level

When placing a STAT order make sure Priority is set on Order Detail

Placing STAT Orders Using CPOEClick to edit Master text styles Second level Third level Fourth level Fifth level

Once signed, it sends the ALERT to both the Unit Secretary and Nurses Worklists

Orders to be Signed by PhysicianClick to edit Master text styles Second level Third level Fourth level Fifth level

Orders to be Signed by Physician will show up on the Worklist. Simply check the box and Click

Orders Approaching ExpirationOrders Approaching Click to edit Master text styles Expiration Check the Box and sign IF the order Second level is to expire. Clicking on the order Third level itself will take the user to the order Fourth level screen. This allows to order the same Fifth level thing OR a substitute of some type.

The Physicians Account

Click to edit Master text styles Second level Third level Fourth level Fifth level

The Physicians Account Displayed next to the physicians name is YVMH. This is because Soarian is an Enterprise Program. If there were multiple Hospital in the enterprise, they would ALL be listed. Clicking on YVMH allows the physician to view the census in that Hospital.

The Physicians AccountClick to edit Master text styles Second level Third level Fourth level Fifth level

The main Browser to the physicians account is found in the middle of the screen

My Patients Only

Displays patients in the census that are either registered to the physician Or Manually added by the physician

Include Coverage Patients

Displays patients in the census that are either registered to the physician or a physician in a particular coverage group Or Registered to a specific list of physicians

Nurse Station Patients

Lists patients on a particular unit Or Lists patients on several units

Patient Service Selections

Lists patients registered to a particular service Or Lists several services and the patients registered under the services

Outpatients

Displays patients in the census that are either registered to the physician And Manually added by the physician Or Displays patients in the census that are registered to physicians in a particular coverage group Or Registered to a specific list of physicians Or Lists patients registered to a particular service Or Lists several services and the patients registered under the services

Adding Patients or Subtracting Patients to My Patients OnlyClick to edit Master text styles Second level Third level Fourth level Fifth level

The Search menu is the set up for each filter type. Searching by Unit is the best way if looking for an inpatient. It is making sure the user is on the right encounter


May search by encounter number if the account number is known.


Three Ways Physician can add patient to census OR Notify Registration to add Physician as a Once the Patient is found and the record is entered, an icon appears on the left upper corner of the screen. This allows the physician to addrelationship with the patient to the census view. Make certain this is what is needed. If added and then account stays on the census, the patient moves to the outpatient environment on discharge. This can bog down the patient Outpatient view and if the amount exceeds 500 patients, the outpatient view will not display.

Adding Patients to My Patients Only as Consult or other physician places physicians name on accountClick to edit Master text styles Second level Third level Fourth level Fifth level

Adding Patients to My Patients Only as Consult or other physician places physicians name on account. Physicians name can be viewed through Demographic hyperlink.


Adding Patients or Subtracting Patients to My Patients OnlyRemember, stress must remove from census upon discharge or Outpatient accounts becomes too large to access. If Out Patient census gets that large IS must be involved. This icon removes the patient if the physician used the MANUAL adding of the patient. The MANUAL adding does not place the Physicians name on the accountClick to edit Master text styles Second level Third level Fourth level Fifth level


If the Physician added the patient using the CONSULT or OTHER CAREGIVER This icon appears.


The Physicians name stays on the Demographics, BUT displays the Stop Date

My Coverage GroupClick to edit Master text styles Second level Third level Fourth level Fifth level

Go to the Search window and click on the Coverage tab. When the Physician first sets up the Coverage group their group should be already in the left-hand part of the window. The user simply checks the box, clicks the arrow in


If the user wants the Coverage to be specific to certain members, CLICK the (+) next to the coverage group. ALL the members names will appear. Click the box(es) next to the name and move them over to the right side. Click Save


The user can SEARCH for any group. Click the radio button next to All Coverage


The user can SEARCH for any user. Click the radio button next to All Users, type in a search, click search.


Nurses Station ViewClick to edit Master text styles Second level Third level Fourth level Fifth level

Nurses Station View Go to Search screen. Click on Location and Service Tab. (CLICK) Click on plus next to Nurse Station.

Nurses Station ViewClick to edit Master text styles Second level Third level Fourth level Fifth level

Click on YVMH.

Nurses Station View

Check Boxes next to units listed with number and letter only.

Nurses Station View

Once the unit appears in the window under nurse station click Save and Close

Nurses Station View

Patient Census View

Patient Service is done exactly the same way. CLICK the (+) next to Patient Services.

Patient Census View

Choose the Service

Patient Census View

Once the Service appears in the window, click Save and Close.

Patient Census View

Combined Census View

COMBINED Specialty Click on Service, then desired Nurse Station Click on the Arrow in the middle of the Screen, Once it appears on the right, Click SAVE AND CLOSE.

Combined Census ViewClick to edit Master text styles Second level Third level Fourth level Fifth level

Outpatient CensusClick to edit Master text styles Second level Third level Fourth level Fifth level

Setting up Outpatient View. Once the other views are set up, Outpatients can be viewed by the above dropdown. Make sure they set it up for days before and days after.

Discharged PatientsClick to edit Master text styles Second level Third level Fourth level Fifth level

Discharged Patients are the same way. Use the dropdown for desired view, can either use number of days or the calendar setting. Click SAVE and CLOSE.

Discharged PatientsClick to edit Master text styles Second level Third level Fourth level Fifth level

SummaryReviewed the Impact on the Workflow of the Nurse and Unit Secretary Reviewed placing different Medication Orders Reviewed the Differences Between the Nurse/Unit Secretary Account and the Physician Account

cpoe training hs

Documents

soarian stat orders

med orders

new orders unit secretary

orders functions

hardcopy orders nurse

individual orders conflicts

pdm unit secretary

unit secretary processclick