CPOE/POM

1. CPOE/POM Provider OrderManagement Training Manual April 2006 1st Edition

2. Table of Contents Chapter 1: Identify a Patient via the “Rounding Routines” Chapter 2: Review Patient’s Orders/Single Screen Chapter 3: Entering Procedures Chapter 4: Preview/Edit Chapter 5: Order Sets Chapter 6: Medication Ordering Chapter 7: IV Ordering Chapter 8: Non-Formulary Medications Chapter 9: View/Change Chapter 10: Renew/Repeat Chapter 11: Hold and Resume Chapter 12: D/C Chapter 13: Undo Chapter 14: Transfer

3. Click Sign Order to electronically sign your orders. Note the details that display at the bottom of the screen for the order you are signing.

4. Review Patient’s Orders/Single Screen This is POM. Providers come here to enter and edit patient orders.

5. Patient Header The patient header appears in a light green color. The information in this screen may not be edited. Allergies will be noted in the header. Allergies within a bracket denote the allergy has not yet been verified by the pharmacy. For example: This patient has a verified allergy to Amoxicillin. The patient states she also has an allergy to PCN, but until this is verified in the computer by a pharmacist, crosschecking of the medication won’t occur and you will be prompted with this error message. Light green background in POM always indicates view only and may not be edited!

6. Changing Selection Criteria The orders listed on the Review Orders Screen can be changed using these three cells: The cell representing the selected view will be dark blue, while the other cells will be a lighter blue. Unlike the light green preview screen, the light blue cell may be selected and the information edited. Current: The criteria for Current Orders will be all active orders, as well as those that have been completed within 2 days. If you wish to see more or less days worth of completed orders, you can change that in your Preferences button. All: The All button will display all orders for this admission. Session: The session button will list all orders that have been entered or edited during the current session.

7. Notice the status of the order in the session cell is green for NEW order.

8. Changing Sort Criteria When entering the POM Review Orders screen, the sort will always default to Category.

9. Navigating the Single Screen The cells that contain a heading description are called physician heading cells. The physician heading cells may be collapsed or expanded. To expand click on the “+” and to collapse click on the “–”. The number after the heading indicates the number of orders that appear beneath the heading. Example: Radiology is expanded and therefore the provider can view the radiology tests. Example: Respiratory is collapsed, therefore no orders are in view, however the number indicates there are 4 orders that may be viewed.

10. The Orders cell sorts the orders in alphabetical order. Note physician headings no longer appear. The Pri (priority) cell sorts priorities as routine or stat. Routine orders do not display a priority. The Date/Time cell sorts orders according to the most current date/time to the least current. The Status cell will display the order’s current status alphabetically. The Stop cell defines the stop date for any order placed. The order will flag the stop date in red, 24 hrs before and after the stop date. The My Cell willbe populated with an “*” if the user is the ordering provider.

11. Order Statuses Active status indicates the procedure or medication is currently in process. Canc? Status indicates a cancellation request to that dept. It is now the dept’s responsibility to cancel the order and make sure it is not already in process. UnvPHA status indicates that the pharmacy has not yet verified the orders. D/C status indicates that the order has been stopped. Notice the stop date is in red.

12. Other Statuses that may apply Cancel status indicates an order that was never in process. Complete status indicates an order that has been completed.

13. The Allergies button will display additional allergy information. The Review/PCI button will bring the provider to their PCI table of contents menu for the selected patient. This will bring the provider to the home.caregroup.org Website. You can add websites in Preferences. The Back button returns the provider to the previous PCI screen. website.

14. Entering Provider Orders The Procedures button is where the provider comes to enter all orders. Any order, other than medications and IV’s, may be placed through this screen. Procedures Some procedures that might be found by clicking on the Procedure button include: Labs, Diet, Radiology, Nursing Interventions and Consults.

15. Entering a Procedure When a provider selects the Procedures button, they will first be brought to a listing of their Favorite Procedures, if Favorites are defined.

16. Once you see this screen the provider may check each of the intended procedures by single clicking on the box. The provider may multi-select additional orders. As you can see the screen is named in the top left hand corner of the screen. This is followed by the # of selected procedures for this session. To shorten the lookup, the provider may choose the appropriate category heading to see the list of procedures in that category.

17. Procedures can be added to or removed from a provider’s Order Favorites by highlighting the item and clicking the Add to Favorites or Remove Favorites respectively. The Favorites list allows the providers to quickly access tests or treatments that they commonly perform. How to order a procedure not included under Favorites If the order the provider needs is not defined as a Favorite, click on the Any Order button.

18. The Any Order lookup offers the provider a lookup of every procedure to which they have access. Begin typing your procedure in the Search On window until it appears. Once the procedure appears highlight the order & click Select. Helpful Hints If looking to enter a diet order, spell the word diet and all diets will appear. If ordering an x-ray, define the body part in the search box and available x-rays will appear. If a procedure is prefaced with an “**” it denotes that this procedure is commonly ordered. When ordering an ultrasound preface the search with “us”.

19. Favorite/Lookup Screen Favorite Procedure Any Order The Favorite Procedure screen will display the Preview/Edit button on the side whereas the Any Order screen displays the Preview/Edit button on the top. No matter how the provider chooses their orders, the PREVIEW/EDIT button must be selected to view the orders prior to Done.

20. Preview/Edit Screen The Preview/Edit screen will allow the provider to review all orders prior to completion. Columns have clickable cells with dropdown menus. No dropdown indicator will appear on this screen. A gray cell will indicate that it is ‘clickable’. If the cell is white, there is no information available.

21. The priority of an order will always default to a routine status. To change the priority to stat click on the light blue/grey box. Stat will always default to today and now. Any heading highlighted in green may not be edited. Click on the dark gray header to make the same edit for all of the procedures simultaneously. For ex. If you would like to change the priority of all labs to stat, click the dark grey cell once, or the light grey cell, to change each lab individually. When an order is selected it will be highlighted in a dark blue color. This order may now be viewed for details. Enter B, L, or D for diet orders Only Military time can be used!!

22. A Series Order allows a provider to order a procedure more than once. For example: A provider can order a daily CBC x 7 days, rather than 7 individual orders. When placing a Series Order, the provider will indicate the direction/frequency with which the order should be performed, and for how long.

23. Quantity allows the provider to order a certain amount of an order. Example: 2 would be chosen as the quantity for units when entering blood products. Details will include questions associated with the selected order along with instructions written by provider as “free text”. Medication orders will display dose, route, directions and start date/time. View requires the user to see the text associated with the order. Available may be viewed to see the details of the order. Req means there is a required field that needs to be answered before completion of the order. The light green highlighted box will display what is required.

24. Notice when this screen displays after clicking Preview/Edit, it has all of the procedures checked off. If the provider decides they do not want to order a selected item, they may remove it by clicking on the box to deselect it, then click Clear Unchecked to remove it from the screen. The provider may click on the Add More button to return to the lookup menu to select more order sets, meds/IV’s or procedures, then, click Preview/Edit and it will return you to this menu for review.

25. Order Sets Order Sets consist of a group of predefined orders. These may include orders from any category.

26. After the provider selected an order set and clicked Preview/Edit they will be defaulted to this screen where they can select or deselect other orders prior to clicking Done. Before clicking Done, the provider must click on the Req or View to complete the order.

27. After selecting the orders, the provider will view the orders prior to submitting them. Note that all orders entered in this session are flagged in green as New in the status cell. Now it’s time to click the Submit button.

28. After clicking Submit the provider will be prompted with this Session Summary screen. This screen is designed to be the final view before electronically signing the order set. The Password will be the same as your current meditech password. The Pin will be your dictating number.

29. Favorite Single Orders As previously discussed, orders may be saved as a favorite order set. If you routinely order a single procedure, a list of single Favorites may be created. 1 Highlight the order. Click Add to Favorites. 2

30. Medication Ordering Click on the “Medications/IVs button to select a medication order. The system will bring you into your list of Favorite Medications/IVs.

31. Highlight the medication with the correct form, then click on the “Select” button. The system will bring you into a lookup of pre-defined order strings. Order strings are comprised of the information in a prescription. They include the following: Dose, Units, Route, Directions, and Start/Stop Date & Time.

32. Highlight the order string that corresponds to the correct dose/route/directions. If you do not see the exact order string, highlight the closest one and edit the appropriate fields by clicking on the drop down arrows. Anything that has a drop down arrow may be clicked to edit.

33. IMPORTANT: Always view the light green box when building an order string. If you order the string on a regular basis, click the Add to Favorites button to have it display under your list of favorite medications.

34. Users can edit any of the above fields on a medication order by clicking on the drop down arrow. Click on the Dose/Units drop down box to edit the dose of the medication A list of available doses appear in the box. If the desired dose is not available, select Other to type in the desired dose.

35. Anytime you see the word “Other” in POM, it indicates free text. Dose instructions can be used when a med does not have an easily quantified numeric dose (one drop in each eye, etc.) Remove the dose of 80 and type 325 in the dose prompt.

36. Clicking on the Route drop down box allows you to select a different route of administration. Clicking on the Directions drop down box allows you to select a different direction. Click on the scroll bar to move down through the list of directions to find the appropriate one. Select Other to free text in the direction if you do not see the one needed.

37. Click on the PRN box if the medication is ordered as needed. The PRN reason must be selected by clicking on the appropriate symptom from the drop down box. Click on the Start drop down box if you want to enter a start date & time other than Today and Now. Important: Military time is used for orders entered in POM.

38. Click on the Stop drop down box to add or edit the stop date associated to a medication order. You can either define a stop date and timeor the total # of doses to be administered. Click on the Inst drop down box to define Special Instructions. Special Instructions allow the provider to enter any free text comments associated with the order. They will cross to Pharmacy and will be available for the nurses to view.

39. Notice that the light green box now has <see Instructions>. In addition, an “*” appears in the drop down box to inform the user that there is information contained in the special instructions box. To view this information, click on the drop down box containing the “*”. Anytime a drop down box contains an “*”, always click on it to see the additional information.

40. Administration Criteria can be used when the dose of medication to be administered depends on a particular condition. Let’s look at the Insulin Sliding Scale below:

41. Administration Criteria can be defined as a part of the original order string. When this happens, the “*” will appear in the Admin Criteria box and the green box above will contain <see Admin Criteria>. If you want to create your own administration criteria, click on the drop down box. The following fields may be edited: Condition Dose/Route/Rate Instruction Treatment Text

42. Once you’ve defined the conditions, you can click one of the following buttons: Erases the information entered above. Click on this button to save the criteria as a favorite so it can be used again. Returns the user to medication ordering string. The admin criteria is not associated. Files the admin criteria with this order string only.

43. A Taper Schedule can also be attached to a medication order. Notice the “*” appears next to the Taper drop down box. In addition, (Taper) also appears in the light green screen. Taper schedules may also be created “on the fly”.

44. Once the user clicks on the Taper drop down box, they are presented with the following screen: The user can edit the fields that have drop down boxes: Dose, Directions, Days and Hours. If the user does not want to specify “Days” or “Hours”, they can select the <None> option.

45. When you are finished creating your order string, click on the Done button to accept the order. If you selected the incorrect medication, Click on the Cancel button to return you to the medication lookup.

46. Interactions and Conflicts When ordering Medications/IV’s, the system will perform interaction and conflict checking on the selected order and patient. The following types of conflicts and interactions may occur: Interactions: Conflicts: Allergy/Averse Drug Reaction (ADR) Duplicate Drug-Drug Interaction

47. The system will present the user with a Conflict screen like the one below: The type of conflict will display. In this example, the conflict message is a Duplicate. Users can click the Details button to view additional information.

48. Click on the Replace button to order a different medication as a result of the conflict message received. Click on the Cancel button to return to the medication lookup if you’ve selected the incorrect medication. “OOPS”

49. Once the conflict has been viewed, the user can click the Override button. It is required that the user select a reason for why they are overriding the conflict message. If the reason is not listed, select the Other option to free text in the reason. The information selected here will be stored electronically with the order.

50. IV Ordering Click on the Medications/IVs button to select an IV order. The system will bring you into your list of Favorite medications/IVs.