Inpatient EHR Pharmacy Quick Orders

1. Inpatient EHRPharmacy Quick Orders Carla Stearle, PharmD W.W. Hastings Indian Hospital Tahlequah, OK April 22, 2008

2. Pre-Quick Orders • IV File Clean-Up • Quick Orders: based on orderable items in drug file • Pharmacist should be involved in creating quick orders and/or review them upon completion • Outpatient quick orders will not work for inpatient medication ordering • Must start from the beginning! • Communication with providers

3. Types of Medications Quick Orders • Inpatient Medications • Unit Dose Medications • Amlodipine 5mg U/D, ondansetron 4mg IVP PRN • Routes: Oral, ophthalmic, otic, nasal, inhalation, rectal, topical, subcutaneous, intramuscular, and intravenous push • IVPB’s • i.e. cefazolin, vancomycin, ranitidine • IV Fluids/IV Infusions • “Admixtures” • Within drug file: “Used in IV Fluid Order Entry?”: Set to YES • NS 1000mL; NS 1000mL with 20mEq of KCl • Morphine Drip; Insulin Drip

5. Unit Dose (PSJZ) Quick Order • Metformin 500mg U/D PO BID

6. Multiple Route Order Set • Promethazine 25mg IV/IM Q6H PRN Nausa/Vomiting

7. EHR Order Set Display

8. EHR Order Set Display (cont.)

9. IVPB Quick Order • Cefazolin 1gm IVPB Q8H

10. EHR Order Display

11. IV Fluid Quick Order • Sodium Chloride 0.9% (1000mL) @100mL/hr

12. EHR Order Display

13. IV Infusion Quick Order (PSIVZ) • Regular Insulin 1 unit/mL in D5W 100mL IV (titrate to effect)

14. EHR Order Display

15. Putting Quick Orders on Menus………

16. Ordering Medication Electronically • Ordering of medication electronically by provider • Completion of pending order by pharmacist

17. Completion of Pending Orders by Pharmacist……

18. Lessons Learned • Standardize all IV Infusions • Communicate with medical staff • Use Data Objects as much as possible • Dosing Charts for certain medications • Order Sets (i.e. CAP, Chest Pain, etc…) • Large Volume IV Fluids • Set default rate?

19. Unanswered Questions??? • Ordering a TPN electronically • Outside Medications • Transfer from outpatient? • Enter as Patient Supply? • Less Common routes for medication administration • Peg tube, NG Tube • Truncation of Special Instruction/Provider Comments Field • Medication Reconciliation