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EHR Inpatient Quick Orders

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.

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EHR Inpatient Quick Orders

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  1. EHR Inpatient Quick Orders March 2010

  2. 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

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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Unit Dose or Inpatient Med

  9. IV Medication

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

  11. 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

  12. 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

  13. PSJIVZ CEFAZOLIN 1G Q8H

  14. IV Medication

  15. PSJZ Lisinopri10mg daily

  16. 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?

  17. 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

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

  19. 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

  20. 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

  21. 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

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

  23. 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?)

  24. PSJIVZ CEFAZOLIN 1G Q8H

  25. PSIVZ INSULIN DRIP

  26. 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

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

  28. 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#:

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

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

  31. 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

  32. 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”

  33. 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

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