1. SmartChart Dofetilide (Tikosyn) Order Management Effective: February 14, 2012

2. Under Favorites CPOE Cardiology 4 New Dofetilide (Tikosyn) Order Sets Click Black Arrow to expand set

3. *Initial Therapy Order Set Summary of Flow Checkmark appropriate orders: Admission info EKG (if not done in past 24 hrs) Nomogram (already pre-checked) Starting Tikosyn Dose based on Cr Cl Electrolyte Correction prior to therapy Lab Orders Click Enter information in Order Detail Forms that present: Nomogram Order Detail Form (enter the QTc value) Tikosyn Order Detail Form (enter Enter DEA# or License#) Sign See screen prints on next slides.

4. Initial Starting Dose based on Creatinine Clearance click checkbox for dose: 0.5mg, 0.25mg, or 0.125mg

5. Continued (Select Lab Orders)

6. Nomogram – Automatically Opens Provides instructions for Nursing: Physician-entered baseline QTc Interval QTc monitoring & dose adjustment instructions Electrolyte Correction prior to Initial Therapy Before Discharge Instructions See screen print on next slides.

7. Enter Baseline QTc interval

8. Nomogram (continued)

9. Must enter DEA# or State License#

10. Last Step Sign Initial Therapy Orders

11. If patient is Admitted on Tikosyn * Use Maintenance Therapy Order Set Enter the Dose, DEA or State License#, Est. Cr Cl See screen print on next slides.

12. Click Dose Dropdown Enter DEA # or State License # Enter estimated Cr Cl ___mL/min

13. Last Step Sign Maintenance Therapy Order

14. To Make a Dose Adjustment *Use Dofetilide (Tikosyn) Dose Adjustment REMINDER: Discontinue Previous Order

15. Last Step Sign Dose Adjustment Order

16. Discharge with Tikosyn Click Discharge Order 7 day Take Home Supply Pharmacy will dispense a 7 day supply so patient has time to obtain from a retail pharmacy. See screen print on next slides.

17. Under Directions Enter the ___mg and ___hours

18. Last Step Sign Discharge Orders