OB PowerPlan Favorites

1. OB PowerPlan Favorites Family & Community Medicine Start

2. OB PowerPlan Favorites • This module shows: • How to create a PowerPlan Favorite • The orders to select on the OB Triage PowerPlan • The orders to select on the OB Labor Admit PowerPlan • The orders to select on the OB Post Partum PowerPlan • How to access and use a favorite PowerPlan • How to use Add to Phase to add an order • How to use View Excluded Components to add an order (this shows all the orders you did not select) • What to order when a patient is positive for Group B Strep • Things to remember when ordering • The abbreviation SP at the end of an order name indicates the order is a Sub Phase containing a group of orders. Next

3. Creating a PowerPlan Favorite • Click in the checkboxes of the orders you want to be pre-selected on your PowerPlan favorite. • The Physician Care Team order will not retain a provider’s name so it cannot be saved as a favorite. • After selecting the orders, click on the Save as My Favorite button. Next

4. Creating a PowerPlan Favorite • Either keep the existing name of the plan or create a new plan name. • Do not use a patient name in the plan name. • Click OK to complete saving the plan to your favorites. Next

5. OB PowerPlans • Family and Community Medicine • Three OB PowerPlans used by FCM providers • OB Obstetric Triage • OB Labor Admit • OB Post Partum • Use the following information to create PowerPlan favorites for the three OB PowerPlans. • The following are commonly selected orders from the OB PowerPlans. The PowerPlans can be customized depending on the individual patient needs or provider preferences by unchecking pre-selected orders and/or checking any order not already selected. Next

6. OB Obstetric Triage PowerPlan Favorite • Use the following recommendations to create a favorite for the OB Obstetric Triage PowerPlan. • Keep all of the pre-selected orders in the OB Obstetric Triage PowerPlan and do the following: • Select Vital Signs per Protocol • Never use Advance Diet as Tolerated SP. • Always keep Urinalysis (Reflex Microscopic) selected. Next

7. OB Obstetric Triage PowerPlan Favorite • Admitting Service is Family Medical Care but it will not stick when plan is saved as a favorite. • Select Vital Signs per Protocol. • Do not select Advance Diet as Tolerated SP. Next

8. OB Obstetric Triage PowerPlan Favorite • This sub-phase is used infrequently, only when you are evaluating a patient with pre-eclampsia. • All of the lab orders are in the sub-phase and already selected. Uncheck any order not needed when using this sub-phase. • The OB Pre Eclampsia Lab SP is only used for patients with this condition so you may not want to include it in your plan favorite. • An option for including this sub-phase in a favorite PowerPlan is to save two OB Obstetric Triage PowerPlans in your favorites with descriptive titles; The plan saved without the Pre Eclampsia SP, OB Obstetric Triage PowerPlan, and a second favorite including the sub-phase , OB Obstetric Triage PowerPlan Pre Eclampsia. Next

9. OB Obstetric Triage PowerPlan Favorite • After selecting the recommended orders on the OB Obstetric Triage PowerPlan, save the plan as a favorite. • Either keep the existing name of the plan or create a new plan name. • Do not use a patient name in the plan name. Next

10. OB Labor Admit Favorite • Use the following recommendations to create a favorite for the OB Labor Admit PowerPlan. These are orders that are commonly added to the already pre-selected orders. • Uncheck Nurse to Nurse Communication in the Communication section. • In Laboratory section, select Urinalysis (UA) and Type & Screen (the CBC is already preselected for you). • In Consults section, select Anesthesiology. • Do not select the OB PreOp SP and the OB Post Partum CS SP, these are only used by OB. • Select the OB Post Partum After Delivery SP. Next

11. OB Labor Admit Favorite • Admitting Service is Family Medical Care but it will not stick when plan is saved as a favorite. • Uncheck Nurse to Nurse Communication in the Communication section. Next

12. OB Labor Admit Favorite • Select NPO from the Diet section. • Select Notify Physician from the Nursing Care section. Next

13. OB Labor Admit Favorite • Every patient must have an IV. • Select Insert PIV from the IV Solutions section and one of the following: • Both Lactated Ringers (LR) orders, or • Change IV to Saline lock Next

14. OB Labor Admit Favorite • Select the OB Post Partum After Delivery SP (this is so nurses can administer pitocin and care for the patient until the patient arrives in the Post Partum unit). • Do not select the OB PreOp SP and the OB Post Partum CS SP, these two SPs are only used by OB. Next

15. OB Labor Admit Favorite – OB Post Partum After Delivery Sub Phase • The OB Post Partum After Delivery SP - check everything except NPO and acetaminophen. • Click on Return to OB Labor Admit. Next

16. OB Labor Admit Favorite • In Laboratory section, check Urinalysis (Reflex Microscopic) and Type & Screen. • In Consults section, check Anesthesiology (for patients that want an epidural). • After selecting the recommended orders on the OB Labor Admit PowerPlan, save the plan as a favorite and remember to name the plan something generic (i.e. OB Labor). Next

17. OB Post Partum PowerPlan Favorite • Use the following recommendations to create a favorite for the OB Post Partum PowerPlan • Select Code Status (this order was default selected in other plans) • Uncheck Nurse to Nurse Communication • In Nursing Care section: • Select Apply Ice Pack • Select Sitz Bath • In IV solutions, select: • Change IV to Saline Lock with Routine Flush • Oxytocin • In PRN meds: • Select lanolin, glycerin, and benzocaine • Select Post Partum PRN Pain Meds for Non APS pts SP (Non Anesthesia Pain Service Sub Phase) • Meds checked in the Non APS pts SP are Percocet and ibuprofen. Change if patient is allergic. • If patients are Rh negative, use the SP for Rhogam. Keep the items checked in this plan Next

18. OB Post Partum PowerPlan Favorite • Check Code Status • Uncheck Nurse to Nurse Communication in the Communication section Next

19. OB Post Partum PowerPlan Favorite • In the Nursing Care section also select: • Apply Ice Pack • Sitz Bath Next

20. OB Post Partum PowerPlan Favorite • In IV solutions, select: • Change IV to Saline Lock with Routine Flush • Oxytocin • In PRN meds: • Select lanolin, glycerin-witch hazel topical, and benzocaine topical • Select Post Partum PRN Pain Meds for Non APS pts SP Next

21. OB Post Partum PowerPlan Favorite • Keep defaulted selections on the OB Post Partum PRN Pain Meds SP • In Laboratory section: • Keep the Hematocrit order selected • Select Rhogam Post Partum SP if patient is Rh negative Next

22. OB Post Partum PowerPlan Favorite • Keep all of the defaulted selections on the OB Post Partum, Rhogam Post Partum SP • Click on Return to OB Post Partum. After selecting the recommended orders on the OB Post Partum PowerPlan, save the plan as a favorite. Next

23. Using a PowerPlan Favorite • When ordering OB PowerPlans, use the favorites to save time and effort • Favorites are found in the star icon on the Add Order window • Click on the star icon to access your favorite plans and individual orders Next

24. Using a PowerPlan Favorite • Click on My Favorite Plans to see your list of PowerPlan favorites Next

25. Using a PowerPlan Favorite • Click on a plan to select it for ordering • Click the Done button to close the Add Order window • Select any additional orders needed for the patient • Either Initiate or put in a planned state (Orders for Signature) as needed Next

26. Things to Remember • Don’t ever use Merge View in OB. • Check to see if you are on the correct FIN before placing a PowerPlan. • When saving a plan as a favorite, select only those orders that are used a majority of the time. • Review the plan and make sure that the defaulted orders (and your saved favorites) match the care that is needed for the patient. • Uncheck orders that do not match the needs of the patient. Next

27. Things to Remember • Initiating a PowerPlan means that you intend for the plan to be put into use for the patient immediately. • Putting a PowerPlan into a planned state means that the patient is not ready for the orders in the plan at this time (i.e.. Patient not admitted yet, patient not post partum yet). • If adding orders to a PowerPlan use the +Add to Phase button. Do not use the +Add button on the far left side of the screen. • If a PowerPlan has been initiated, select the plan in the View window so the orders display on the right. Then use the +Add to Phase button to add orders to the plan. • Orders added to the plan using the +Add to Phase button will be discontinued when the plan is discontinued. • Orders added individually outside the plan will not be discontinued when the plan is discontinued. Next

28. Adding an Order to a PowerPlan Don’t use the +Add button when adding an order to a PowerPlan. Click on +Add to Phase and then select Add Order to add an order to a PowerPlan. Next

29. Group B Strep • If a patient is positive for Group B Strep, select all three penicillin G potassium medications listed when completing the Medications section of the OB Labor Admit PowerPlan. • The first two listed penicillin G potassium medications are loading doses. • The third penicillin G potassium medication is the scheduled dose for every four hours. Next

30. Placing Orders on a Future Visit • If a patient is scheduled to have an induction and a visit number (FIN) for the induction visit exists orders can be placed on the future FIN and put in a planned state. • You must be on the induction visit (FIN). • Use the Labor Admit PowerPlan to create the orders for the patient’s visit on the future FIN. • Do not Initiate the orders. Put the PowerPlan in a planned state (click Orders for Signature instead of Initiate). • When the patient arrives at the hospital a nurse will initiate the orders. Next

31. Initiating Pitocin • If you have already initiated the OB Labor Admit PowerPlan and later decide to initiate pitocin, use View Excluded Components to add the pitocin orders to the OB Labor Admit PowerPlan. • Open the patient’s chart to PowerOrders. • In the View window, click on the initiated OB Labor Admit PowerPlan so that the plan displays in the window on the right. • Click on the light bulb icon to View Excluded Components. Next

32. Initiating Pitocin • After clicking on the light bulb icon, checkboxes appear next to all orders not selected when the plan was originally initiated. • Click on the checkbox next to Initiate Pitocin Protocol and oxytocin (oxytocin/LR 20 units/1L IV Sol). One order allows the nurse to get a bag of premixed Pitocin and the second order tells the nurse how to run the Pitocin IV. Next

33. Initiating Pitocin • Initiate Pitocin Protocol and oxytocin now have a light bulb icon. • Click on the Orders For Signature button and on the next screen click on the Sign button. • The pitocin orders will be active and part of the OB Labor Admit plan. Next

34. VTE Order in the OB Post Partum PowerPlan • If you choose to uncheck the VTE Prophylaxis order in the OB Post Partum PowerPlan you must add an order to Ambulate Patient. • Click on the +Add to Phase button and select Add Order. • Type Ambulate in the search field and select the Ambulate Patient order. • Complete the order details. The Ambulate Patient order is now part of the plan. Next

35. This concludes the OB PowerPlan Favorites module for Family & Community Medicine Residents. Click the Exit button to close the module. Exit