1. Rationale: A significant finding from the Joint Commission – when multiple medications are ordered to treat the same indication (e.g. Pain, Nausea, Constipation) for various reasons, there is the potential for medication administration errors to occur. Vanderbilt is adopting the Joint Commission recommendation to limit the use of concurrent prn medication orders that treat the same indications. Limiting PRN Meds that Treat the Same Indications Effective 2/1/2016

2. Expected pop-up when the comments “PRN” & either “Pain, Nausea, or Constipation” are identified in multiple orders The provider is expected to: Modify the comments with distinct indications OR Discontinue duplicate therapy The provider is expected to: Modify the comments with distinct indications OR Discontinue duplicate therapy Better choices of distinct indications Duplicate Comments Clinical decision support pop-up box appears when “done” is clicked in the HEO order entry session

3. Modify – allows the user to change the PRN order comments DC – allows the user to discontinue the medication Click Continue to save changes and return to HEO/Wiz Click Reset All to undo changes to start over Modify & Discontinue Continue to Save Changes & Reset All

4. 1. To continue without making changes click Continue 2. An override reason is required **The override box will appear when the continue button is clicked and no changes were made** 1 1 2 2 Continue Without Making Changes & Override

5. Separate tables display when there are duplicate indications for different medications 1.Pain 2.Constipation 1 1 2 2 New orders display in blue font Existing orders display in black font to match the HEO/Wiz profile color scheme Separate Tables for Different Meds Blue & Black Fonts Identify New and Existing Orders

6. Orders with the word “protocol” in the comments will be excluded from screening For consistent matching of key words, the search will ignore the first word of the comment if it is “PRN” or “FOR”.  Example. “For pain” and “pain” = duplicate comment match Lastly,