CPOE WORKFLOW

1. CPOE WORKFLOW REVIEW OF WORKFLOW AND ORDER ENTRY PROCESS IN THE SNF

2. outline • In this presentation , we will be reviewing how the CPOE system can work in conjunction with your facility’s workflow. We will be reviewing, alerts, draft/draft recommended, new admission process, re-admission process, order category , HOA exceptions times, proactive facility formulary, and using search order reports.

3. ALERTS NURSING CORE TEAM • Alerts provide an overview of unit or by facility order activity • Can use as a reconciliation for meds expected to arrive from the pharmacy • Can use as a back-up to ensure lab and consults orders were processed • Dietary- Can run daily before each meal to capture diet changes • SW- Can view new advanced directives orders, psychology orders • Rehab- Can view new evaluation's

4. Alerts Facility does have the option in security to decide the “ Alert” look back period. Recommend at least 3 to 4 days incase of a Holiday weekend. After viewing “ Alert” the type will turn from green to black, so user can see what they have already viewed

5. By selecting “ Diet” , user has ability only to see diets

6. View of Advanced Directives

7. Alert types Alerts also has many other “ look-ups”. For HL7- can see changes from Pharmacy or orders sent to draft., Discontinued orders, drug conflicts and more. Alert viewing is set in Security by role

8. Alerts cycle renew MD Cycle Renew dates is also located in the alert button. Can run by date range, unit, PCP. And lets MD know who did last Monthly. Remaining days if in red indicate that Renewal is late.

9. Draft Orders • Best practice for Facility's is to check for Draft orders at least 3 times per shift, when arriving, mid-shift and before exiting. • Depending upon facility’s P/P, non-nursing departments can enter their recommendations into draft ( OT, PT, ST, and Dietary) • HL7 messages, back from Pharmacy can also arrive into draft

10. Resident specific- When a resident is selected and has either draft or draft recommended orders, the draft button will be pink.

11. Draft by unit Can search Draft by one unit or all units. Shows number of drafts per resident and type of draft. By clicking on the number, it will open to the draft order(s) by category.

12. Here we are viewing a draft recommendation from an ancillary department , dietary is recommending a diet change

13. User can also run a search order report by unit and a complete description of actual draft order can be obtained. This can actually become the call sheet when contacting MD.

14. Note that a draft or draft recommended order can be edited, deleted or confirmed. Consider a progress note be written if deleting with a reason MD not approving.

15. notifications Notifications button is where the MD goes to co-sign orders. Most states have a regulatory time period in which this action has to happen. Also noting of orders or a second sign by nursing.

16. For 2nd note or signer, you can click on order details to see full “ label” of the order.. You can then proceed by clicking note on the bottom of the “ label”

17. New Admission • New Admission templates can be developed as per facility’s Admission process. These template orders are a reminder to Admission staff what is the minimum requirement that each facility foresees for every admission. Examples are OT/PT and ST evaluation, Diet orders, Activity Level, Immunizations ( Flu and Pneumovac ) , and PPD testing.

18. Add Allergy One Level one screen, double click on Allergy , located on the bottom of the screen

19. Add Allergy After selecting the allergy, click save then OK, then close

20. Assign orders Go to Service button and select “ Assign Order Set”

22. Admission templates ( side note) Admission template are developed in the templates. Templates is accessed via the launcher

23. Assigned orders will go to draft, user will then select each draft order, some draft can be directly confirmed, others will need to be edited to add information as per MD order

24. For this example the Oxygen order was in draft, but needed more information specific for the resident, user would edit and enter necessary information then confirm

25. As each order is confirmed, profile will show status as active

26. Order types: examples for new admission and interim orders

27. Short term order For transcribing a short term orders, you must changed the number of days by “ For” . If set-up in security , the number of days will also print in ext.sig. . More important it will d/c off profile at the end date

28. One time order For “ one-time “ orders, choose by “ Type” one time, pop-up will ask to specify the start date, after date is selected, order will expire on midnight of that day

29. Stat order For STAT order, STAT is located in the frequency/dir area. Will expire at midnight

30. Order with administration time change MD may order a drug daily, but not want the time scheduled by the facility, example here shows 9am, but MD wants 2pm

31. schedule User would like the schedule button, click on time, in the case 9:00am, choose time ordered and then click ok and save

32. Schedule Time change Notice that when a time id changed for administration, it will show in red on the label

33. Drug with a parameter To add a parameter, for this example will be a B/P, again after selecting a frequency , go to schedule, this time you will identify the parameter by check in the inc box before and after

34. Drug with parameter Here you will have to set the parameter, click in “TO” box under parameter, add parameter number and write action

35. Drug with parameter Overview before clicking save

36. Parameter label Example of Label before confirming. Note: Do not write parameter in ext.sig. , this is a free text area

37. Sliding Scale order for Blood Sugar When adding a sliding scale order for Blood Sugar, in the quantity area, check Blood Sugar Sliding Scale to be assigned

38. Sliding Scale Parameter We will need to go to the schedule area after selecting frequency

39. Parameter for SS Check by “BS” , click in boxed to the left to start building SS, and in action number of units ordered

40. Parameter ss template For facility's that have programmed SS template, click on BOLD BS Sliding Scale ( templates)

41. Parameter Template Facility can have more then one template, select on right, and will see template on left, click OK

42. Parameter ss SS will appear in label, review then confirm

43. Every other day Select frequency and go to schedule in this example we will be ordering MOM every other Night.

44. Every other day schedule Go to schedule, select schedule of days , what date you want every other night to start

45. RE-ADMISSION • For Re-Admission(s) and to use copy prior order feature in the Service button, you must first set in Security System Parameters, Facility Level, Category orders

46. Copy Prior orders Order will go to draft, carefully review each draft order, either delete, edit or confirm Not recommended for residents that have been out of the facility for an extended time.

47. Copy Prior orders

48. Copy prior orders • After selecting prior stay, these order(s) will go into draft, user will then either edit, confirm or delete.

49. Facility formulary ( Negative Formulary) • Is a Proactive approach for cost savings, facility is able to set-up their facility formulary in the Formulary manager. Depending upon Administration, each role will either have permission to override or not. • All users will be able to view the preferred therapeutic alternative for the medication on the formulary. • Formulary manager is located in Optimum EMR>SET-UP>FORMULARY EDITOR>SEARCH NEG DRUG>SELECT>CLICK COVERAGE>CHECK NEG PART-A BOX>LOOK-UP THERAPUTIC ALTERNATIVE • Note: Resident payer source is entered in Financials

50. Formulary editor