PowerPlan: Managing Orders and Care Plans

1. What is a PowerPlan? A PowerPlan is a care-planning tool that allows you to manage orders as they relate to a pre-defined plan of care. PowerPlans define decisions, activities and expectations for a specific problem. The plan serves as the primary catalyst for a number of activities such as orders, diagnostics and medication administration executed by the care team. PowerPlans are commonly grouped together for the purpose of completing specific clinical pathways. The PowerPlans in FirstNet are created based on the Existing Clinical Pathways already used at CHKD.

2. Accessing PowerPlans A PowerPlan is accessed from PowerOrders in the same way individual orders are accessed. Once you have clicked on Enter the name of the plan you wish to display in the ‘Find’ window and select the appropriate PowerPlan or Click the ED PowerPlans folder to display all available ED PowerPlans.

3. Section of PowerPlans The sections of the PowerPlan are laid out in order similar to a physician’s pre-printed paper order sheet. Each section heading is colored blue to help identify the beginning of a new section.

4. Preselected Orders The checkmarks on the left are preselected orders for your PowerPlan. You can select additional orders or deselect by unchecking the preselected orders.

5. Navigating a PowerPlan There are several ways to navigate down the PowerPlan. • One way is to collapse each section after completing it by clicking on the minus symbol next to the section. • You can also navigate down the PowerPlan by clicking the scroll down bar on the right.

6. Medication Section • The medication section of the PowerPlan will display the most commonly used medications for the selected plan. • The Order sentences for each medication are displayed as a list on the right. • A drop down arrow is displayed when there are additional commonly used order sentences for that medication. When selecting a Medication you may be prompted to select the appropriate pharmacy type for the medication selected. You can select Additive or Medication.

7. Order Sentences Order Sentences are commonly entered values defined for an orderable. When an order is placed, select one set of details without having to enter each value separately. Select the order sentence closest to the values needed and then modify if necessary.

8. Dosing Calculator When choosing a medication that is a Weight Based medication, the Dosing Calculator will automatically open and display the information the dose was based on. Click the Apply Dose button to apply the calculated dose. This section displays the available dose forms and is display only.

9. Standardized Dose Important! If standardized dosing is available for a medication, the Apply Standard Dose button will be available for selection.  When the Dosage Calculator gives the option of  “Apply Standard Dose” vs. “Apply Dose” ALWAYS select “Apply  Standard Dose.” As with pharmacy, prescribers should choose the standardized dose unless clinical conditions warrant.

10. Dosing Calculator When choosing a medication that is Weight Based, the Dosing Calculator will automatically open and display the information on which the dose was based. If needed, the Dosing Calculator can be accessed at anytime by clicking the “Open Dose Calculator” icon on the Details window toolbar.

11. Decision Support Alerts Decision Support Alert Window will display if medications ordered for your patient are contraindicated. The example below displays a duplicate alert. To override the alert select the reason from the Override Reason Drop down menu. Or You can select to remove the new order based on clinical judgment. Double click on the Interaction Information hyperlink to display additional information about the reason for the alert.

12. Removing an Order If an order has been entered in error it can be removed prior to selecting Sign. Highlight the order in the navigator window, right click and select remove. When the order is removed, it no longer appears within the patient record because it was never submitted. Important Note: After an order has been signed and submitted, it cannot be removed using the Remove option. If the order is no longer needed once signed, cancel or cancel / reorder must be selected.

13. Evidence Right clicking on the plan and selecting Evidence will display the paper view of the plan Right click anywhere to Print

14. Merge View The Merge View icon can be used to review active orders adjacent to pending PowerPlan orders. Click on the appropriate PowerPlan from the Navigator window and then Click Merge View icon. NOTE: When you have finished viewing the plan you may want to click the Merge View icon again to restore your plan to the original view.

15. View Excluded Components The View Excluded Components Icon (light bulb icon) allows you to view the components of the PowerPlan that were not originally selected. Once in this view you can select additional items within the plan to add them. To select additional components: Click on the appropriate PowerPlan from the Navigator window. Click the View Excluded components icon. Click the check box beside the component/orders to add Complete the Ordering Physician window if applicable Complete any needed details for the order Click Orders for signature Click Sign Click the Refresh Button The additional orders you selected will now be included as part of the selected PowerPlan.

16. Discontinue Icon The Discontinue Button opens up the discontinue window where selected components of the PowerPlan can be removed.   In the Keep column you can select the items you wish to keep to remain as part of the plan. Deselected items will be discontinued from the PowerPlan. • To discontinue the PowerPlan Orders: • 1. Click on the Discontinue Button. • Click on the items in the Keep column you wish to keep • Note: Any items not selected will be discontinued from the plan. • 3. Select the OK button • 4. Enter the reason for discontinuing the • components • 5. Complete any needed details for the order • 6. Click Orders for Signature • 7. Click Sign • 8. Click the Refresh button

17. Add to Phase The Add to Phase button on the Orders tool bar allow you to add additional orders to a previously entered PowerPlan that were not originally part of that plan.  • To add an additional order to a PowerPlan that was not included complete the following steps: • 1. Click on the appropriate PowerPlan from the Navigator window. • 2. Click Add to Phase and select Add Order. • 3. Enter the order name in the Find field. • 4. Click Search. • 5. Click the desired order. • 6. Click Done. • 7. Complete order details. • 8. Click Sign. • Click the Refresh button to refresh. • Note: If you select the Add button the order will not become part of the plan. • You must use the Add to Phase button to include the order as part of the selected PowerPlan.

18. This concludes thePower Plans LessonYou are now ready to proceed to the Next Lesson