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Quick Orders and Order Menus Quick Orders and Order Menus

Orders Package • The Orders package in RPMS provides a number of functions including: Orders Package • The Orders package in RPMS provides a number of functions including: – Ability for users to enter, process, and discontinue electronic orders – Control who can act on orders with OR keys – Order checking – Delayed release of orders (inpatient using ADT) – Auto-discontinue orders (inpatient using ADT

Order Keys • ORES – Assigned to providers who are authorized to independently write Order Keys • ORES – Assigned to providers who are authorized to independently write orders (typically physicians, nurse practitioners, physician assistants, podiatrists etc. ). • ORELSE – Assigned to users who are authorized to take and release verbal and telephone orders from providers who hold the ORES key, or who can enter policy orders (typically registered nurses, pharmacists).

Order Keys (cont. ) • OREMAS – Assigned to users who transcribe written orders Order Keys (cont. ) • OREMAS – Assigned to users who transcribe written orders into RPMS-EHR (typically only given to inpatient ward clerks). • A user must hold only one order key or they will not be able to process any orders at all • You can check to see if users hold multiple order keys with this menu: ORD > KEY > CHK

Order Management • RPMS-EHR provides management of orders on the Orders Tab. • The Order Management • RPMS-EHR provides management of orders on the Orders Tab. • The Orders Tab provides the ability to add, change, discontinue, and print. • The Orders Tab allows EHR users to sort by column headings or customize the view of orders displayed.

Orders Tab Orders Tab

Medication Order Management • It is recommended that all prescriptions be entered and managed Medication Order Management • It is recommended that all prescriptions be entered and managed on the Meds tab. • The Meds tab provides a better overview of medications. • The Meds tab provides easy access to the change, renew, refill, or discontinue actions for effective management of medications.

Medications Tab Note that not all levels are available for all parameters, but only Medications Tab Note that not all levels are available for all parameters, but only those that make sense for that particular item.

Order Entry • New orders are entered into RPMS-EHR via order menus. • Order Order Entry • New orders are entered into RPMS-EHR via order menus. • Order menus are organized groupings of quick orders and other menus. • Order menus can be customized to meet local needs. • Usually, order menus are created with groups of similar quick orders.

Order Menus • Order menus should be designed by target end users, not by Order Menus • Order menus should be designed by target end users, not by package informaticists (i. e. , by physicians who will enter orders, not by pharmacists, laboratory information specialists, or radiology technologists). • Once designed, order menus are built by package informaticists.

Order Menu Order Menu

Quick Orders • Quick Orders are electronic orders with ALL the data elements correctly Quick Orders • Quick Orders are electronic orders with ALL the data elements correctly preconfigured. • Order menus are organized groupings of quick orders to make provider order entry more convenient and efficient.

Quick Orders • Well designed order menus and quick orders provide the clinician with Quick Orders • Well designed order menus and quick orders provide the clinician with proper choices and helpful information, and promote entry of correctly formed electronic orders. • Incorrectly entered electronic orders require additional work to clarify and correct and may delay or impede patient care.

Quick Order Dialog Quick Order Dialog

Quick Order Creation • While order menus should be designed by end user clinicians, Quick Order Creation • While order menus should be designed by end user clinicians, the quick orders and order menus should be built by package informaticists to ensure that they are correctly constructed.

Quick Order Creation • Quick Orders should not be built by CACs or Informaticists Quick Order Creation • Quick Orders should not be built by CACs or Informaticists from another discipline who do not have the knowledge background for that package. • In other words, only a pharmacy informaticist should build pharmacy quick orders, and only a laboratory informaticist should build laboratory quick orders, and so on.

Orderable Item Creation • Prior to creating a quick order, the orderable item to Orderable Item Creation • Prior to creating a quick order, the orderable item to be used must already exist. • The process of adding a new drug to the drug file creates a new orderable item. • The process of adding a new test in the laboratory file creates a new orderable item. • The process of constructing a new exam in the radiology-nuclear medicine procedure file creates a new orderable item.

Orderable Item Creation • If the order is for nursing or patient care, then Orderable Item Creation • If the order is for nursing or patient care, then the orderable item must be created manually using this menu: OIC Create/Modify Orderable Items

Create a Nursing Orderable Item Create a Nursing Orderable Item

Create a Nursing Orderable Item • Recommendation is to create nursing orderable items in Create a Nursing Orderable Item • Recommendation is to create nursing orderable items in ALL CAPS. • Keep nursing orderable items general so they can be reused in multiple quick orders (e. g. WOUND CARE vs. TELFA 4 x 4)

RPMS Namespacing • Software packages in RPMS have designated namespaces • It is recommended RPMS Namespacing • Software packages in RPMS have designated namespaces • It is recommended that quick orders for RPMS-EHR utilize the recognized namespaces • Use of namespaces aids in the future management of these quick orders by local informaticists and by area and national helpdesk staff.

Naming Convention Naming Convention

Naming Convention • Conventions for quick orders and menus: – Namespace + Z = Naming Convention • Conventions for quick orders and menus: – Namespace + Z = Quick Order – Namespace + ZM = Menu – Namespace + ZSET = Order Set – Use IP to differentiate Inpatient Orders (esp. Lab and Nursing)

Naming Convention • Additional suggested namespace: PSJIVZ for IV piggybacks to differentiate from oral Naming Convention • Additional suggested namespace: PSJIVZ for IV piggybacks to differentiate from oral unit dose and IV fluids

Naming Convention • Examples: ORZ WOUND CARE PSOZ ATENOLOL 25 MG DAILY PSJZ CARVEDILOL Naming Convention • Examples: ORZ WOUND CARE PSOZ ATENOLOL 25 MG DAILY PSJZ CARVEDILOL 6. 25 MG BID LRZ HGBA 1 C RAZ FOREARM 2 VIEWS ORZ IP COLD PACKS [Outpatient Nursing] [Outpatient Med] [Inpatient Med] [Laboratory] [Radiology] [Inpatient Nursing] PSOZM DIABETES MEDS LRZM ER LABS RAZM RADIOLOGY ORZM IP RESPIRATORY [Outpatient Pharmacy Menu] [Laboratory Menu] [Radiology Menu] [Inpatient Nursing Menu] ORZSET COLONOSCOPY PREP [Order Set]

Quick Order Construction • From the standard RPMS-EHR Configuration Master Menu: ORD > MNU Quick Order Construction • From the standard RPMS-EHR Configuration Master Menu: ORD > MNU > QOC

Quick Order Types • • Activity Consult Imaging Inpatient Medications IV Medications Laboratory Nursing Quick Order Types • • Activity Consult Imaging Inpatient Medications IV Medications Laboratory Nursing Outpatient Medications

Quick Order Types • There appear to be other Order Types available of: Diet Quick Order Types • There appear to be other Order Types available of: Diet and Vital/Measurements, but these should not be used. • The Dietetics Package is not an IHS supported package. • These Vital/Measurements orders point to the VA Vitals package and not the IHS Measurements File.

Creating Quick Orders Creating Quick Orders

Laboratory Quick Orders Select QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ Laboratory Quick Orders Select QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ CALCIUM TODAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: LABORATORY

TYPE OF QUICK ORDER: ? Choose from: ACTIVITY ALLERGIES CONDITION CONSULTS DIAGNOSIS DIET ADDITIONAL TYPE OF QUICK ORDER: ? Choose from: ACTIVITY ALLERGIES CONDITION CONSULTS DIAGNOSIS DIET ADDITIONAL ORDERS DIET ORDERS EARLY/LATE TRAYS GENERAL RADIOLOGY IMAGING INPATIENT MEDICATIONS IV MEDICATIONS LABORATORY NURSING OUTPATIENT MEDICATIONS PRECAUTIONS PROCEDURES SUPPLIES/DEVICES TUBEFEEDINGS UNIT DOSE MEDICATIONS VITALS/MEASUREMENTS

Laboratory Quick Orders Select QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ Laboratory Quick Orders Select QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ CALCIUM TODAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: LABORATORY NAME: LRZ CALCIUM TODAY// DISPLAY TEXT: Calcium Today VERIFY ORDER: y YES DESCRIPTION: Calcium level done for outpatients for today ENTRY ACTION: Lab Test: CALCIUM Collected By: SP SP WC LC Send patient to lab Ward collect & deliver Lab blood team Collection Sample: BLOOD// Collection Date/Time: TODAY How often: ONCE (MAR 23, 2004)

Lab Schedule • ONCE must be setup as a laboratory administration schedule. • Lab Lab Schedule • ONCE must be setup as a laboratory administration schedule. • Lab menu option is LRZM LAB TESTS Select ADMINISTRATION SCHEDULE: ONCE ONE-TIME NAME: ONCE// TYPE OF SCHEDULE: ONE-TIME//

Review Order ------------------------------Lab Test: CALCIUM Collected By: Send patient to lab Collection Sample: BLOOD Review Order ------------------------------Lab Test: CALCIUM Collected By: Send patient to lab Collection Sample: BLOOD Specimen: BLOOD Collection Date/Time: TODAY How often: ONCE ------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Quick Orders - Radiology Select QUICK ORDER NAME: RAZ ELBOW XRAY Are you adding Quick Orders - Radiology Select QUICK ORDER NAME: RAZ ELBOW XRAY Are you adding 'RAZ ELBOW XRAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: IMAGING NAME: RAZ ELBOW XRAY// DISPLAY TEXT: Elbow Xray VERIFY ORDER: Y DESCRIPTION: No existing text Edit? NO// Select one of the following imaging types: ANGIO/NEURO/INTERVENTIONAL GENERAL RADIOLOGY ULTRASOUND Select IMAGING TYPE: general RADIOLOGY

Quick Orders - Radiology Procedure: 14 ELBOW 2 VIEWS Procedure Modifier: History and Reason Quick Orders - Radiology Procedure: 14 ELBOW 2 VIEWS Procedure Modifier: History and Reason for Exam: No existing text Edit? No// Category: OUTPATIENT Is this patient scheduled for pre-op? NO// Date Desired: TODAY// Mode of Transport: AMBULATORY Is patient on isolation procedures? Urgency: ROUTINE//

Review Order -----------------------------Radiology Procedure: ELBOW 2 VIEWS Category: OUTPATIENT Date Desired: TODAY Mode of Review Order -----------------------------Radiology Procedure: ELBOW 2 VIEWS Category: OUTPATIENT Date Desired: TODAY Mode of Transport: AMBULATORY Urgency: ROUTINE Submit request to: X-RAY -----------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Quick Order – Outpt Meds NAME: PSOZ AMOXICILLIN 500 MG BID 7 D Replace Quick Order – Outpt Meds NAME: PSOZ AMOXICILLIN 500 MG BID 7 D Replace DISPLAY TEXT: Amoxicillin 500 mg bid 7 days Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// Y Amoxicillin 500 mg BID outpatient for 7 days ENTRY ACTION: Medication: AMOXICILLIN CAP, ORAL // Complex dose? NO// Dose: 500 MG// The dose should have been set up by pharmacy Route: ORAL// Setup by pharmacy

Quick Order – Outpt Meds • • • Days Supply: 7// Quantity (CAP): 14// Quick Order – Outpt Meds • • • Days Supply: 7// Quantity (CAP): 14// Refills (0 -11): 0// Schedule: BID// Pick Up: WINDOW// Priority: ROUTINE// Comments: No existing text Edit? No// (No) • Select ADMINISTRATION SCHEDULE:

Review Order -----------------------------Medication: AMOXICILLIN CAP, ORAL 500 MG Instructions: 500 MG ORAL BID Days Review Order -----------------------------Medication: AMOXICILLIN CAP, ORAL 500 MG Instructions: 500 MG ORAL BID Days Supply: 7 Quantity (CAP): 14 Refills (0 -11): 0 Pick Up: WINDOW Priority: ROUTINE -----------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// P Place to save quick order

Special Med Quick Orders • Clinic Meds (In-House Meds) – Pick up is ADMINISTERED Special Med Quick Orders • Clinic Meds (In-House Meds) – Pick up is ADMINISTERED IN CLINIC – Status is ASAP or STAT, not DONE • Prescriptions for outside pharmacies – Make orders just like meds on formulary. (If med is not in Drug File, then use a med called OUTSIDE RX, until Pharmacy adds to Drug File). Provider fills in data, and it is printed as an RX • Prescriptions received from outside providers – Must be entered into RPMS. User may have to edit Drug File

Review Order --------------------------Medication: CEFTRIAXONE INJ, SOLN 1 GM/VIAL Instructions: 1 GRAM 1 GM/VIAL INTRAMUSCULAR Review Order --------------------------Medication: CEFTRIAXONE INJ, SOLN 1 GM/VIAL Instructions: 1 GRAM 1 GM/VIAL INTRAMUSCULAR Q 12 H Days Supply: 1 Quantity (VL): 1 Pick Up: ADMINISTERED IN CLINIC Priority: STAT --------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Quick Orders - Nursing TYPE OF QUICK ORDER: NURSING NAME: ORZ FOLEY CATHETER// DISPLAY Quick Orders - Nursing TYPE OF QUICK ORDER: NURSING NAME: ORZ FOLEY CATHETER// DISPLAY TEXT: Foley Catheter to Drainage VERIFY ORDER: DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Patient Care: CATHETER Instructions: Empty Foley Catheter to drainage bag q shift Start Date/Time: NOW// Stop Date/Time: N+7

Review Order --------------------------------Patient Care: FOLEY CATHETER Instructions: Empty Foley Catheter to drainage bag q Review Order --------------------------------Patient Care: FOLEY CATHETER Instructions: Empty Foley Catheter to drainage bag q shift Start Date/Time: NOW Stop Date/Time: 7 DAYS FROM NOW --------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Quick Orders - Consults Select QUICK ORDER NAME: GMRCZ PHYSICAL THERAPY DISPLAY TEXT: Physical Quick Orders - Consults Select QUICK ORDER NAME: GMRCZ PHYSICAL THERAPY DISPLAY TEXT: Physical Therapy Consult VERIFY ORDER: YES// DESCRIPTION: Quick order for physical therapy consult Edit? NO// ENTRY ACTION: Consult to Service/Specialty: PHYSICAL THERAPY// Consult Type: Reason for Request: No existing text Edit? No// N (No) Category: OUTPATIENT// Urgency: ROUTINE// Place of Consultation: Consultant's Choice// Attention: Provisional Diagnosis:

Review Order ------------------------------Consult to Service/Specialty: PHYSICAL THERAPY Category: OUTPATIENT Urgency: ROUTINE Place of Consultation: Review Order ------------------------------Consult to Service/Specialty: PHYSICAL THERAPY Category: OUTPATIENT Urgency: ROUTINE Place of Consultation: Consultant's Choice ------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Order Sets Select ORDER SET NAME: LRZ DIABETIC TESTS ORDER SET Replace DISPLAY TEXT: Order Sets Select ORDER SET NAME: LRZ DIABETIC TESTS ORDER SET Replace DISPLAY TEXT: Diabetic Yearly tests Replace DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: EXIT ACTION: ORDER SET COMPONENTS: 1 LRZ HGBA 1 C OUTPT 2 LRZ LIPID PANEL 3 LRZ TSH OUTPT Select COMPONENT SEQUENCE#:

Quick Order Restrictions Quick Order Restrictions

Problem: Ordering a Med to be given in Clinic • If only a Pharmacy Problem: Ordering a Med to be given in Clinic • If only a Pharmacy Order is used, how is Nursing notified to give the med? • If only Nursing Order is used, Medication is not processed in Pharmacy package

Comparison of Order Types used to order a Medication Pharmacy Order (“real” Medication) Nursing Comparison of Order Types used to order a Medication Pharmacy Order (“real” Medication) Nursing Order (text only) Priority: ASAP, or STAT Pickup: Clinic Allergy Check: No Drug interaction: No Free text entry of order Allergy Check: Yes Drug interaction: Yes Med Tab: No Health Summary: No Order checking: No Verification: No Med Tab: Yes Health Summary: Yes Generic Order (text only) Allergy Check: No Drug interaction: No Med Tab: No Health Summary: No

Solution: Order Set containing both Pharmacy and Nursing Orders NURSING QUICK ORDER: ORZ ALBUTEROL Solution: Order Set containing both Pharmacy and Nursing Orders NURSING QUICK ORDER: ORZ ALBUTEROL NEB RX Give an Albuterol Neb Treatment in Room #. Use 0. 25 ml/3 ml Saline PHARMACY QUICK ORDER: PSOZ ALBUTEROLNEB RX TWO TYPE ORDERS IN ONE SET: Nursing orders: one and Pharmacy Orders: one Allergy Check: Yes Drug interaction: Yes Med Tab: Yes Health Summary: Yes Bill through POS or J-Codes

Hands-on Exercise 1. Create nursing orderable item and nursing quick order for ? ? Hands-on Exercise 1. Create nursing orderable item and nursing quick order for ? ? ? 2. Create laboratory quick order for ? ? ? 3. Create outpatient med quick order for ? ? ? 4. Create radiology quick order for ? ? ?

Questions and Discussion Questions and Discussion