EHR Inpatient Quick Orders March 2010

Inpatient Quick Orders Naming Conventions/Recommendations: PSJ = Inpatient Unit Dose Meds PSJIV = IV Piggybacks PSIV = IV Fluids/Infusions Add a “Z” to the end to denote local quick orders Add an “M” to the end to denote a menu

Type of Quick Order Nomenclature/ Namespace Uses Inpatient Medications OR Unit Dose Medications PSJZUnit Dose Inpatient Medications OR Unit Dose Medications PSJIVZIVPB’s IV MedicationsPSIVZIV Infusions IV Fluids

Inpatient Med Quick Orders (PSJ) Majority of things fall under this category Unit dose oral meds Creams, Eye Drops, single injections, etc

Things to think about Remember, quick orders are made from Orderable items Think about how the order will display on the computer generated MAR (ie “1 tablet” vs “5/325mg”) Dosages available controlled in drug file – marked as “I” or “O” or both IV File Clean-Up Communication with Providers

Quick Order Menu EHR – BEH – ORD – MNU – QOC Order Menu Management ACT Create/Modify Actions DIS Enable/Disable Order Dialogs GEN Create/Modify Generic Orders LST List Primary Order Menus MNU Create/Modify Order Menus OIC Create/Modify Orderable Items PAR Menu Parameters... PMT Create/Modify Prompts PRI Assign Primary Order Menu PRT Convert Protocols QOC Create/Modify Quick Orders QOR Create/Modify QO Restrictions SET Create/Modify Order Sets SRC Search/Replace Components SRO Search/Replace Orderables

TYPE OF QUICK ORDER: ? Answer with DISPLAY GROUP NAME Do you want the entire DISPLAY GROUP List? Y (Yes) Choose from: ACTIVITY ALLERGIES CONDITION CONSULTS DIAGNOSIS DIET ADDITIONAL ORDERS DIET ORDERS DIET ORDERS(WR) EARLY/LATE TRAYS GENERAL RADIOLOGY IMAGING INPATIENT MEDICATIONS IV MEDICATIONS LABORATORY NURSING OUTPATIENT MEDICATIONS PRECAUTIONS PROCEDURES SUPPLIES/DEVICES TUBEFEEDINGS UNIT DOSE MEDICATIONS VITALS/MEASUREMENTS

Type of Quick Order Unit Dose and Inpatient Medications behave the same. Just pick one and go with it IV Medications type behaves very differently

Unit Dose or Inpatient Med

IV Medication

IV Piggybacks – Which Type? The TYPE of quick order for IV Piggybacks is Inpatient Medications

Why? Providers want to order schedules for these drugs –Cefazolin 1gm IVPB Q8H – Ertapenem 1gm IVPB Q24H Pharmacist will finish the order and add: –Rate of Infusion –Solution for the Additive –Other Print Info

Why? (cont…) In the order dialog for IV Medications type of quick orders, there is no schedule, only a rate Don’t want ordering providers changing which fluid the piggyback is in

PSJIVZ CEFAZOLIN 1G Q8H

IV Medication

PSJZ Lisinopri10mg daily

Time out to talk about Drug File Implications of what Pharmacy Packages the drug is marked for Implications for how the dosages are marked – I, O, or Both Individual UD drug file entries?

Pharmacy Packages O - Outpatient –if you use the drug for outpatients U - Unit Dose –Anything besides IV that you use in inpatient (creams, eye drops, etc) –Must be marked as this in order to make an inpt quick order from the drug I - IV –Just items that are additives or solutions

Examples Floxin Otic drops Outpatient Unit Dose Hydrocortisone cream Outpatient Unit Dose Cefazolin 1gm Vial Outpatient Unit Dose IV

Separate Drug File Entries Do you order unit dose medications from the manufacturer? If yes, then you’ll have a separate drug file entry –Lisinopril 10mg –Lisinopril 10mg UD

Two Entries Lisinopril 10mg tab –Marked for Outpatient –Dosages marked for Outpatient only Lisinopril 10mg UD tab –Marked for Unit Dose –Dosages marked for Inpatient only Both entries tied to same orderable item – LISINOPRIL TAB

One Drug File Entry If you unit dose a bulk medication yourself for inpatient use: Will only be one drug file entry, marked as –Outpatient –Unit Dose Dosages will need to be marked I and O

Dosages By marking the dosages for either Inpatient, Outpatient, or Both, you control which dosages you have to choose from in different packages

Back to Quick Orders “Inpatient/Unit Dose” Type of Quick Orders –majority of quick order building “IV Medications” Type of Quick Orders –This happens after IV Files are cleaned up and marked accurately (See PDM Presentation) –Standardized IV Pre-Mixes (NS, NS w/20mEq of KCL, D5W, etc.) –Standardized IV Infusion List (P&T approved?)

PSJIVZ CEFAZOLIN 1G Q8H

PSIVZ INSULIN DRIP

Order Sets Order Menu Management ACT Create/Modify Actions DIS Enable/Disable Order Dialogs GEN Create/Modify Generic Orders LST List Primary Order Menus MNU Create/Modify Order Menus OIC Create/Modify Orderable Items PAR Menu Parameters... PMT Create/Modify Prompts PRI Assign Primary Order Menu PRT Convert Protocols QOC Create/Modify Quick Orders QOR Create/Modify QO Restrictions SET Create/Modify Order Sets SRC Search/Replace Components SRO Search/Replace Orderables

Common Combos EX: Promethazine IM/PO/PR Make a quick order for each Put together in a set

PSJZ PROMETHAZINE PO/PR/IM NAME: PSJZ PROMETHAZINE 25MG PO/PR/IM Replace DISPLAY TEXT: Promethazine 25mg PO/PR/IM q6h prn Replace DESCRIPTION: No existing text Edit? NO// ORDER SET COMPONENTS: 1 PSJZ PROMETHAZINE 25MG TAB 2 PSJZ PROMETHAZINE 25MG SUPP 4 PSJZ PROMETHAZINE 25MG IM Select COMPONENT SEQUENCE#:

Mix of orders Can be a mix of orders: medication, lab, generic, nursing, ect…

Menus Consider organizational structure Same as outpatient vs something new? Additional categories for inpatient “All other meds…” options

Building Menus Order Menu Management ACT Create/Modify Actions DIS Enable/Disable Order Dialogs GEN Create/Modify Generic Orders LST List Primary Order Menus MNU Create/Modify Order Menus OIC Create/Modify Orderable Items PAR Menu Parameters... PMT Create/Modify Prompts PRI Assign Primary Order Menu PRT Convert Protocols QOC Create/Modify Quick Orders QOR Create/Modify QO Restrictions SET Create/Modify Order Sets SRC Search/Replace Components SRO Search/Replace Orderables

Menus Naming convention –Add an “M” to denote menu –Consider “…” in display text to denote link to menu Column width –for 2 columns = 40 –For 3 columns = 27 Path switch – probably “yes”

All other meds… For Outpatient Meds –PSO OERR For Inpatient Unit Dose/non IVs –PSJ OR PAT OE For IVs (Additives and Solutions) –PSJI OR PAT FLUID OE