1. Inpatient EHR Pharmacy Quick Orders Carla Stearle, PharmD W.W. Hastings Indian Hospital Tahlequah, OK April 22, 2008

2. Pre-Quick Orders IV File Clean-Up Quick Orders: based on orderable items in drug file Pharmacist should be involved in creating quick orders and/or review them upon completion Outpatient quick orders will not work for inpatient medication ordering –Must start from the beginning! Communication with providers

3. Types of Medications Quick Orders Inpatient Medications –Unit Dose Medications Amlodipine 5mg U/D, ondansetron 4mg IVP PRN Routes: Oral, ophthalmic, otic, nasal, inhalation, rectal, topical, subcutaneous, intramuscular, and intravenous push –IVPB’s i.e. cefazolin, vancomycin, ranitidine –IV Fluids/IV Infusions “Admixtures” Within drug file: “Used in IV Fluid Order Entry?”: Set to YES NS 1000mL; NS 1000mL with 20mEq of KCl Morphine Drip; Insulin Drip

4. Name of Quick Order Nomenclature/ Namespace Uses Inpatient Medications PSJZUnit Dose Inpatient Medications PSJIVZIVPB’s IV MedicationsPSIVZIV Infusions IV Fluids

5. Unit Dose (PSJZ) Quick Order Metformin 500mg U/D PO BID

6. Multiple Route Order Set Promethazine 25mg IV/IM Q6H PRN Nausa/Vomiting

7. EHR Order Set Display

8. EHR Order Set Display (cont.)

9. IVPB Quick Order Cefazolin 1gm IVPB Q8H

10. EHR Order Display

11. IV Fluid Quick Order Sodium Chloride 0.9% (1000mL) @100mL/hr

12. EHR Order Display

13. IV Infusion Quick Order (PSIVZ) Regular Insulin 1 unit/mL in D5W 100mL IV (titrate to effect)

14. EHR Order Display

15. Putting Quick Orders on Menus………

16. Ordering Medication Electronically Ordering of medication electronically by provider Completion of pending order by pharmacist

17. Completion of Pending Orders by Pharmacist……

18. Lessons Learned Standardize all IV Infusions Communicate with medical staff Use Data Objects as much as possible Dosing Charts for certain medications Order Sets (i.e. CAP, Chest Pain, etc…) Large Volume IV Fluids –Set default rate?

19. Unanswered Questions??? Ordering a TPN electronically Outside Medications –Transfer from outpatient? –Enter as Patient Supply? Less Common routes for medication administration –Peg tube, NG Tube Truncation of Special Instruction/Provider Comments Field Medication Reconciliation