CPOE/POMProvider OrderProvider Order ManagementManagement

Training ManualTraining ManualApril 2006April 20061st Edition1st Edition

Table of ContentsChapter 1: Identify a Patient via the “Rounding Routines”

Chapter 2: Review Patient’s Orders/Single Screen

Chapter 3: Entering Procedures

Chapter 4: Preview/Edit

Chapter 5: Order Sets

Chapter 6: Medication Ordering

Chapter 7: IV Ordering

Chapter 8: Non-Formulary Medications

Chapter 9: View/Change

Chapter 10: Renew/Repeat

Chapter 11: Hold and Resume

Chapter 12: D/C

Chapter 13: Undo

Chapter 14: Transfer

Click Sign Order to electronically sign your orders.

Note the details that display at the bottom of the screen for the order you are signing.

Review Patient’s Orders/Single Screen

This is POM. Providers come here to enter and edit patient orders.

Patient Header

The patient header appears in a light green color. The information in this screen may not be edited.

Light green background in POM always indicates view only and may not be edited!

Allergies will be noted in the header. Allergies within a bracket denote the allergy has not yet been verified by the pharmacy.

For example: This patient has a verified allergy to Amoxicillin. The patient states she also has an allergy to PCN, but until this is verified in the computer by a pharmacist, crosschecking of the medication won’t occur and you will be prompted with this error message.

Changing Selection CriteriaThe orders listed on the Review Orders Screen can be changed using these three cells:

The cell representing the selected view will be dark blue, while the other cells will be a lighter blue. Unlike the light green preview screen, the light blue cell may be selected and the information edited.

Current: The criteria for Current Orders will be all active orders, as well as those that have been completed within 2 days. If you wish to see more or less days worth of completed orders, you can change that in your Preferences button.

All: The All button will display all orders for this admission.

Session: The session button will list all orders that have been entered or edited during the current session.

Notice the status of the order in the session cell is green for NEW order.

Changing Sort Criteria

When entering the POM Review Orders screen, the sort will always default to Category.

Navigating the Single ScreenThe cells that contain a heading description are called physician heading cells.

The physician heading cells may be collapsed or expanded. To expand click on the “+” and to collapse click on the “–”.

Example: Radiology is expanded and therefore the provider can view the radiology tests.

Example: Respiratory is collapsed, therefore no orders are in view, however the number indicates there are 4 orders that may be viewed.

The number after the heading indicates the number of orders that appear beneath the heading.

The Orders cell sorts the orders in alphabetical order. Note physician headings no longer appear.

The Pri (priority) cell sorts priorities as routine or stat. Routine orders do not display a priority.

The Date/Time cell sorts orders according to the most current date/time to the least current.

The Status cell will display the order’s current status alphabetically.

The Stop cell defines the stop date for any order placed. The order will flag the stop date in red, 24 hrs before and after the stop date.

The My Cell will be populated with an “*” if the user is the ordering provider.

Active status indicates the procedure or medication is currently in process.

Canc? Status indicates a cancellation request to that dept. It is now the dept’s responsibility to cancel the order and make sure it is not already in process.

UnvPHA status indicates that the pharmacy has not yet verified the orders.D/C status indicates that

the order has been stopped. Notice the stop date is in red.

Order Statuses

Other Statuses that may apply

Cancel status indicates an order that was never in process.

Complete status indicates an order that has been completed.

The Review/PCI button will bring the provider to their PCI table of contents menu for the selected patient.

This will bring the provider to the home.caregroup.orgWebsite. You can add websites in Preferences.

website.

The Allergies button will display additional allergy information.

The Back button returns the provider to the previous PCI screen.

Entering Provider Orders

Procedures

The Procedures button is where the provider comes to enter all orders. Any order, other than medications and IV’s, may be placed through this screen.

Some procedures that might be found by clicking on the Procedure button include:

Labs, Diet, Radiology, Nursing Interventions and Consults.

Entering a ProcedureWhen a provider selects the Procedures button, they will first be brought to a listing of their Favorite Procedures, if Favorites are defined.

Once you see this screen the provider may check each of the intended procedures by single clicking on the box. The provider may multi-select additional orders.

As you can see the screen is named in the top left hand corner of the screen.

This is followed by the # of selected procedures for this session.

To shorten the lookup, the provider may choose the appropriate category heading to see the list of procedures in that category.

Procedures can be added to or removed from a provider’s Order Favorites by highlighting the item and clicking the Add to Favorites or Remove Favorites respectively.

The Favorites list allows the providers to quickly access tests or treatments that they commonly perform.

If the order the provider needs is not defined as a Favorite, click on the Any Order button.

How to order a procedure not included under Favorites

The Any Order lookup offers the provider a lookup of every procedure to which they have access.

Begin typing your procedure in the Search On window until it appears.

Once the procedure appears highlight the order & click Select.

Helpful HintsIf looking to enter a diet order, spell the word diet and all diets will appear.

If ordering an x-ray, define the body part in the search box and available x-rays will appear.

When ordering an ultrasound preface the search with “us”.

If a procedure is prefaced with an “**” it denotes that this procedure is commonly ordered.

Favorite/Lookup Screen

The Favorite Procedure screen will display the Preview/Edit button on the side whereas the Any Order screen displays the Preview/Edit button on the top.

No matter how the provider chooses their orders, the PREVIEW/EDIT button must be selected to view the orders prior to Done.

Favorite Procedure Any Order

Preview/Edit Screen

Columns have clickable cells with dropdown menus. No dropdown indicator will appear on this screen. A gray cell will indicate that it is ‘clickable’. If the cell is white, there is no information available.

The Preview/Edit screen will allow the provider to review all orders prior to completion.

Any heading highlighted in green may not be edited.

When an order is selected it will be highlighted in a dark blue color. This order may now be viewed for details.

The priority of an order will always default to a routine status. To change the priority to stat click on the light blue/grey box.

Stat will always default to today and now.

Only Military time can be used!!

Click on the dark gray header to make the same edit for all of the procedures simultaneously.

For ex. If you would like to change the priority of all labs to stat, click the dark grey cell once, or the light grey cell, to change each lab individually.Enter B,

L, or D for diet orders

A Series Order allows a provider to order a procedure more than once.

For example: A provider can order a daily CBC x 7 days, rather than 7 individual orders.

When placing a Series Order, the provider will indicate the direction/frequency with which the order should be performed, and for how long.

Quantity allows the provider to order a certain amount of an order.

Example: 2 would be chosen as the quantity for units when entering blood products.

Details will include questions associated with the selected order along with instructions written by provider as “free text”. Medication orders will display dose, route, directions and start date/time.

View requires the user to see the text associated with the order.

Available may be viewed to see the details of the order.

Req means there is a required field that needs to be answered before completion of the order. The light green highlighted box will display what is required.

Notice when this screen displays after clicking Preview/Edit, it has all of the procedures checked off. If the provider decides they do not want to order a selected item, they may remove it by clicking on the box to deselect it, then click Clear Unchecked to remove it from the screen.

The provider may click on the Add More button to return to the lookup menu to select more order sets, meds/IV’s or procedures, then, click Preview/Edit and it will return you to this menu for review.

Order Sets

Order Sets consist of a group of predefined orders. These may include orders from any category.

After the provider selected an order set and clicked Preview/Edit they will be defaulted to this screen where they can select or deselect other orders prior to clicking Done.

Before clicking Done, the provider must click on the Req or View to complete the order.

After selecting the orders, the provider will view the orders prior to submitting them.

Note that all orders entered in this session are flagged in green as New in the status cell.

Now it’s time to click the Submit button.

After clicking Submit the provider will be prompted with this Session Summary screen. This screen is designed to be the final view before electronically signing the order set.

The Password will be the same as your current meditech password.

The Pin will be your dictating number.

Favorite Single OrdersAs previously discussed, orders may be saved as a favorite order set. If you routinely order a single procedure, a list of single Favorites may be created.

Highlight the order.

Click Add to Favorites.

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Medication OrderingClick on the “Medications/IVs button to select a medication order.

The system will bring you into your list of Favorite Medications/IVs.

Highlight the medication with the correct form, then click on the “Select” button.

The system will bring you into a lookup of pre-defined order strings.

Order strings are comprised of the information in a prescription. They include the following: Dose, Units, Route, Directions, and Start/Stop Date & Time.

Highlight the order string that corresponds to the correct dose/route/directions.

If you do not see the exact order string, highlight the closest one and edit the appropriate fields by clicking on the drop down arrows.

Anything that has a drop down arrow may be clicked to edit.

IMPORTANT: Always view the light green box when building an order string.

If you order the string on a regular basis, click the Add to Favorites button to have it display under your list of favorite medications.

Users can edit any of the above fields on a medication order by clicking on the drop down arrow.

Click on the Dose/Units drop down box to edit the dose of the medication

A list of available doses appear in the box. If the desired dose is not available, select Other to type in the desired dose.

Anytime you see the word “Other” in POM, it indicates free text.

Dose instructions can be used when a med does not have an easily quantified numeric dose (one drop in each eye, etc.)

Remove the dose of 80 and type 325 in the dose prompt.

Clicking on the Route drop down box allows you to select a different route of administration.

Clicking on the Directions drop down box allows you to select a different direction.

Click on the scroll bar to move down through the list of directions to find the appropriate one. Select Other to free text in the direction if you do not see the one needed.

Click on the PRN box if the medication is ordered as needed. The PRN reason must be selected by clicking on the appropriate symptom from the drop down box.

Click on the Start drop down box if you want to enter a start date & time other than Today and Now.

Important: Military time is used for orders entered in POM.

Click on the Stop drop down box to add or edit the stop date associated to a medication order.

You can either define a stop date and time or the total # of doses to be administered.

Click on the Inst drop down box to define Special Instructions. Special Instructions allow the provider to enter any free text comments associated with the order. They will cross to Pharmacy and will be available for the nurses to view.

Notice that the light green box now has <see Instructions>. In addition, an “*” appears in the drop down box to inform the user that there is information contained in the special instructions box. To view this information, click on the drop down box containing the “*”.

Anytime a drop down box contains an “*”, always click on it to see the additional information.

Administration Criteria can be used when the dose of medication to be administered depends on a particular condition. Let’s look at the Insulin Sliding Scale below:

Administration Criteria can be defined as a part of the original order string. When this happens, the “*” will appear in the Admin Criteria box and the green box above will contain <see Admin Criteria>.

If you want to create your own administration criteria, click on the drop down box. The following fields may be edited:

Condition Dose/Route/Rate Instruction Treatment Text

Once you’ve defined the conditions, you can click one of the following buttons:

Click on this button to save the criteria as a favorite so it can be used again.

Erases the information entered above.

Files the admin criteria with this order string only.

Returns the user to medication ordering string. The admin criteria is not associated.

A Taper Schedule can also be attached to a medication order. Notice the “*” appears next to the Taper drop down box. In addition, (Taper) also appears in the light green screen.

Taper schedules may also be created “on the fly”.

Once the user clicks on the Taper drop down box, they are presented with the following screen:

The user can edit the fields that have drop down boxes: Dose, Directions, Days and Hours.

If the user does not want to specify “Days” or “Hours”, they can select the <None> option.

When you are finished creating your order string, click on the Done button to accept the order.

If you selected the incorrect medication, Click on the Cancel button to return you to the medication lookup.

Interactions and Conflicts

When ordering Medications/IV’s, the system will perform interaction and conflict checking on the selected order and patient. The following types of conflicts and interactions may occur:

Interactions: Conflicts:

Allergy/Averse Drug Reaction (ADR) Duplicate

Drug-Drug Interaction

The system will present the user with a Conflict screen like the one below:

The type of conflict will display. In this example, the conflict message is a Duplicate.

Users can click the Details button to view additional information.

Click on the Cancel button to return to the medication lookup if you’ve selected the incorrect medication.

Click on the Replace button to order a different medication as a result of the conflict message received.

“OOPS”

Once the conflict has been viewed, the user can click the Override button.

It is required that the user select a reason for why they are overriding the conflict message. If the reason is not listed, select the Other option to free text in the reason. The information selected here will be stored electronically with the order.

IV OrderingClick on the Medications/IVs button to select an IV order.

The system will bring you into your list of Favorite medications/IVs.

Begin typing the IV fluid. The system will perform a search to find the medication.

Highlight the desired IV medication by clicking on it. Click on the “Select” button to choose it.

The system will bring you into a lookup of pre-defined order strings.

Order strings are comprised of the information in a prescription. They include the following: Dose, Units, Route, Directions, and Start/Stop Date & Time.

Highlight the order string that corresponds to the correct dose/rate/route/directions.

If you do not see the exact order string, highlight the closest one and edit the appropriate fields by clicking on the drop down arrows.

Select Other to free text in a different dose/rate

Notice there are different prompts that can be edited for IV orders: Additives, IV Fluid and Alt IV.

Click on the Additives drop down to select a medication additive.

Alternating IV’s are not used.

Click on the IV Fluid drop down to edit the existing IV Fluid.

Prior to clicking on the Done button, review the light green screen above to verify the medication order. Once complete, click on the Done button.

Non-formulary Medication Orders

If the provider is unable to find the medication because it is not included in the pharmacy formulary, users may click on the Non-Formulary button.

Important: Allergy and interaction checking are not performed on non-formulary medications.

Note: Any question that includes an “*” is a required field.

Free text the medication name under the Medication prompt. The Dose is also entered in as free text. The remaining prompts have drop down arrows, allowing the user to select from a menu.

The Justification button may be invoked to see the information entered regarding why the medication has been ordered as a non-formulary.

When you are finished ordering the medication, click on the Done button.

After the order has been filed, the flag (NF) will appear before the medication name to denote a non-formulary item.

To override an interaction/conflict, follow the same procedure as for medications.

View/Change

Highlight the order to be viewed or changed and click the View/Change button.

The View/Change button allows users to view existing orders and make any necessary changes.

The bubble denotes there are details to be viewed.

Highlight the order with the bubble, click View/Change.

Note the details listed.

When a user enters the View/Change screen, the system will default to the Details cell.

The Details cell includes the following information:

•Status

•Hold Date/Time

•Resume Date/Time

•Instructions

•Label Comments

•Taper Schedule

•Administration Criteria

If the user is presented with any conflict messages during the order process, they will display under the Conflicts cell. Notice the Duplicate Comment entered is also available here.

Notice: The Administrations cell is white (indicating there is no information available). This cell is not in use at this time. Information will be available once the online MAR is implemented.

The Results cell displays lab tests associated to the medication order. A yellow flag will be used to denote an abnormal value. If no results are available, the Pending status appears.

If there are no lab tests attached to the order, the Results cell will appear in white, indicating that there is no information to display.

The Providers cell will display data, specific to all providers associated with the order, along with electronic signature information. If another user entered the order for a provider, they will be identified as well.

The History cell will display information pertaining to the audit trail (history of events). In the example above, the order was entered in POM on 10/25 at 1019 by MD-MARTHA.

Now that you’ve viewed an order, lets make some changes.

Here is where you make the appropriate changes by clicking on the dropdown boxes.

The transition screen will only appear if making changes to the direction prompt.

If the edited order is intended to begin at a time other than now, click the Change Effective button to determine the date/time the change should be initiated.

Note the green CHANGE status.

Note that the new directions appear on the session summary.

How to Change a Diet OrderProviders may Change a Diet Order without having to D/C the previous order!

Click the

Click All, unless the diet you want to select is listed under My Favorites.

Use

to select a diet.

The date & time will default to today and now unless otherwise edited.

Note the change in diet along with the start time for this order is in the green highlighted area.

Note the Change status is in green for House diet. Now click Submit for completion!!

Click OK

How to Change a Nursing Order

The View/Change button allows the following information on a Nursing order to be edited:

Directions/Frequency Instructions&

Click on the Directions

Use the Enter key to move the cursor down to the next open date field.

Fill in the date that change will be initiated. You may type “T” for today and “N” for now so the date and time will default to today and now or choose another specified time.

In the Directions field you may click type or type in the new directions .

Click OK

To change the Instructions:

This is where you may enter or edit Instructions.

D/C OrderThe D/C button will cancel or send a cancel request.

Highlight the order and Click D/C.

Time & Date will default to Today & Now unless edited.

Note the order now has a D/C status.

When a lab or diet is D/C’d, this dropdown window will appear for the provider to click on the appropriate reason.

When D/C’ing a Nursing order the status will change to Complete without prompting the Reason box.

Undo

The undo function allows the user to undo any changes prior to submitting them. Changes that are made in the Review Patient’s Orders screen are not actually filed until the Submit button is selected.

To undo an order, highlight the order entered and click Undo.

Undo may be done to any orders with a status in green.

TransferThe Transfer button is used to transfer orders to another location. The provider may also use this function to enter new orders, stop orders or continue orders.

The new orders will not take effect until the patient is received in the new location by a nurse.

The provider will complete the appropriate transfer information.

In this example, Paxil is the only order eligible to be transferred.

The provider can click on the existing order to continue the order throughout patient transfer. Then click Done.

This is where the provider may choose additional orders to take place in the new location.

Just highlight an order set and you will be automatically prompted to the appropriate order screen, If no further orders are needed, click Done.

Note: The Session Summary screen separates the New transfer orders from previous continued orders.