Provider Order Management
MAGIC
Best Practice Recommendations:
Building Computerized Physician Order Entry
Please click on a
topic below to review dictionary building best practice
recommendations.
Admit
to Service: Transfer to 5W; Admit to ICU; Designate Service
MEDITECH workflow process: This is entered in POM as a nursing order and doesn’t interface to any other application. It is simply an informational order to nursing that allows them to plan and begin nursing care. The nurse would acknowledge receipt of the order, but does not need to document against it.
MEDITECH building process: An OE procedure is built with a CDS attached. The CDS has a comment-type query or group response depending on the number of possible responses.
Rationale: Building this as a single order allows the physician to more quickly find this when ordering it outside of an order set. Entering a default response within an order set makes this a viable option in that scenario as well.
MEDITECH workflow process: This is entered in POM as a nursing order and doesn't interface to any other application. It is simply an informational order to nursing to allow the nurse to plan and begin nursing care. The nurse would acknowledge receipt fo the order, but does not need to document against it. As an alternative, or in addition to the above, users can document the problem on the Problem List in the electronic chart.
MEDITECH building process: An OE procedure is built with a CDS attached. The CDS has a comment-type query, which allows the physician to free-text an entry.
Rationale: Building this as a single order allows the physician to more quickly find this when ordering it outside of an order set. Entering a default response within an order set makes this a viable option in the scenario as well.
Condition: Unsatisfactory, Good, Satisfactory, Serious, Critical
MEDITECH workflow process: This is entered in POM as a nursing order and doesn’t interface to any other application. It is simply an informational order to nursing, allowing them to plan and begin nursing care. The nurse would acknowledge receipt of the order, but does not need to document against it.
MEDITECH building process: An OE procedure is built with a CDS attached. The CDS has a "pointer" type query to the MIS Condition Dictionary. When this is documented during the ordering process, the information does not pass to the OE Administrative Data screen and the nurse must re-document. We recommend defaulting the most appropriate response during the building process.
Rationale: Building this as a single order allows the physician to more quickly find this when ordering it outside of an order set. Defaulting a response within an order set makes this a viable option in the scenario as well.
Activity: Ambulate as Tolerated
MEDITECH workflow process: This is entered in POM as a nursing order and doesn’t interface to any other application. It is simply an informational order to nursing, allowing them to plan and begin nursing care. The nurse would acknowledge receipt of the order, but does not need to document against it.
MEDITECH building process: An OE procedure is built with a CDS attached. The CDS has a group response-type query, which allows the physician to select an entry. We recommend adding a comment-type query to the CDS, as well, to allow the physician to add additional information if needed.
Rationale: Building this as a single order allows the physician to more quickly find this when ordering it outside of an order set. Defaulting a response within an order set makes this a viable option in the scenario as well.
Diet Orders: Regular, 1500 calories diabetic
MEDITECH workflow process: This is entered in POM and doesn’t interface to any other application. It is simply an informational order to nursing that allows them to plan and begin nursing care. The nurse would acknowledge receipt of the order, but does not need to document against it. Dietary reports are printed to notify dietary of the patient’s diet.
MEDITECH building process: Diets are built as individual entries in the OE Dietary Procedure dictionary. Each diet has its own entry. During the ordering process, the physician designates the start date.
Rationale: Building individual diets streamline the managing process by allowing use of the auto-complete feature by completing of one diet when a subsequent diet is ordered. The type-ahead feature allows the physician to easily find the diet.
For all IV's and Medications ordered in POM, all drugs will need to be set to "Y" for "Orderable by OE" in the drug dictionary. POM searches for medications based on the ID Display Name defined in the OE QuickScript dictionary. The ID Display Name can be set up based on Specific, Generic, or General name (we recommend Generic). The parameter controlling how the ID Display Name is associated is defined in the OE parameter "Load POM Display from PHA _________ Name."
1. Basic
Medication Orders
The most common medication order strings are built in the OE
QuickScript dictionary. If there are multiple drugs with
different strengths, but the same generic name, these drugs would
be given the same ID Display Name in the OE QuickScript
dictionary. For an example: ACET325 and ACET500: both are given
Acetaminophen as an ID Display Name. When the physician places a
med order, they choose Acetaminophen, the route, and then choose
the appropriate string by strength.
2. Large Volume IVs
The most common medication order strings are built in the PHA
Order String dictionary. The mnemonic of the IV components
will need to be entered in the OE QuickScript dictionary and
given an ID Display Name. If the IV can be used as a "component,"
the component string is entered in the OE QuickScript dictionary.
A component allows the provider to build the IV "on the fly"
or switch out the fluid on a pre-defined string.
3. Taper Orders
The most common medication
order strings are built in the OE QuickScript dictionary. In the
OE QuickScript dictionary the order string is created. On page
two of the order string, the taper schedule can be pre-defined.
4. Range Orders
These types of orders would be built as zero-dose strings in the
OE QuickScript dictionary. In the Dose Instructions box, the
first line will show as the dose in POM. For an example:
Acetaminophen 500mg would have a zero-dose with Dose Instructions
of 1-2 tabs. When selecting the string, the provider will just
see Acetaminophen 1-2 tabs.
5. Titrate
The most common medication order strings are built in the OE
QuickScripts dictionary. Titrate is handled through the use of a
CDS or Text-type admin criteria. The admin criteria is associated
to page 8 in the Drug dictionary. A titrate direction is defined
in the MIS Direction dictionary, made available in POM, and has
an associated trigger screen as Titrate. In the OE QuickScript
dictionary the order string is created with the direction of
Titrate and the admin criteria is associated.
6. Admin Criteria
Admin criteria can be defined as a table, text or CDS format. The
admin criteria are attached to the drug in the PHA Drug
dictionary. When creating an order string in the OE QuickScript
dictionary or the PHA Order String dictionary, the admin criteria
can be associated or can be associated when ordering the
medication.
7. TPNs
Create a drug representing the TPN in the PHA Drug dictionary.
Define CDS admin criteria outlining specifics needed for the TPN.
Attach the admin criteria to the drug in the PHA Drug dictionary.
In the OE QuickScript dictionary, create an order string and
associate the admin criteria.
8. Compounds
Flag each ingredient in the
PHA Drug dictionary as a component. In the PHA Order String
dictionary use the compound order type, name the compound, and
associate the appropriate ingredients.
9. Weight-based
dosing (Med & IV)
For Med weight-based dosing, define the order string in the OE
QuickScript dictionary as mg/kg, etc. IV weight-based dosing
prior to 5.6 SR2 is not availbale, but weight-based weights are
available. As a work-around, the order string would be defined as
mg/kg for the additive in the OE QuickScript dictionary and the
physician would order it without a carrier. PHA would then
associate the carrier when verifying the order.
10. PCA
For drugs that can be entered as PCA, admin criteria should be
used. Admin Criteria can be defined as a table, text or CDS
format. The admin criteria are attached to the drug in the PHA
Drug dictionary. When creating an order string in the OE
QuickScript dictionary or the PHA Order String dictionary, the
admin criteria can be associated, or it can be associated by the
physician during the medication ordering process.
Meditech Workflow process: The order is entered in POM by the physician. The physician does not need to complete any queries designating who will collect the specimen. On the status board, the nurse sees the UNC flag, collects the specimen, clicks on the uncollected flag on the status board, and indicates the specimen has been collected; the order then transmits to lab with a status of collected.
Meditech Building Process: The “Collected by Nurse” and “Hold Specimen in OE” queries are attached in the OE parameters. They are then attached to the LAB category or LAB procedure CDS as auto-file queries. These queries cannot exist on the physician screen.
The process for individual lab orders and lab orders within a set is the same.
Rationale: By following this process it allows the physician to easily place a lab order, without having to know the nursing or lab process for collecting the specimen. This process also eliminates an STO order.
Meditech Workflow Process: The functionality of linked medication orders within sets is available. When building an order set, one or more medication orders within a set can be linked together. When ordering the set, the physician receives a message indicating the two medications are linked.
Meditech Building Process: In the MEDITECH order set dictionary, select two or more medication orders which to link.
Estimated Creatinine Clearance & Other Pharmacy-Related Rules
Meditech workflow process: When ordering medications, providers have the ability to view the patient’s Estimated Creatinine Clearance value so that the medication dosage may be evaluated appropriately. The ability to display other pieces of information during the ordering process can be accommodated as well.
Meditech building process: A rule would be created and attached to the drug in the drug dictionary, if the rule is specific to that drug. Rules can also be attached at the parameter level, in which case the rule would be evaluated for any pharmacy type order.
MEDITECH workflow process: This is entered in POM as an order. Depending on the type of consult ordered, the requisition prints to a designated department. The consulting physician is notified of the consult via the Desktop notification or via a phone call from a nurse/unit clerk. In some cases, the ordering physician may not know the name of the consulting physician. In this instance, the provider would select ‘Provider on Call’ and the nurse/unit clerk would determine the appropriate physician.
MEDITECH building process: Separate consult orders would be built in the OE Procedure dictionary for each department, i.e. Dietary, Psychiatric, and Cardiology. A CDS is attached with queries for Consulting Physician (set up as a pointer-type query to MIS Provider dictionary), Reason for Consult (a free-text query), and Other (a free-text query).
Rationale: The building of separate orders by department allows physicians to easily find the appropriate order and also allows for multiple orders per set. The Consulting Physician and Reason for Consult queries allow for notifications to be sent to the Physician Desktop.
Meditech workflow process: This would be entered in POM as an RT order. Respiratory Therapy reviews the order by using either the OE process orders by category or the status board routines. The RT would then collect the specimen, enter the order and send the specimen to be processed.
Meditech building process: This would be built as an OE procedure within the Respiratory category.
Meditech workflow process: There are multiple ways in which vital signs orders can be handled. If Vital Signs are considered a protocol order at the organization, a physician would not place an order. The nurse would initiate a plan of care, including this intervention. The frequency would also be determined by the protocol. If vital signs need to be ordered by a physician, the order would be entered in POM. The frequency can default in and/or the physician can define the frequency at the time of ordering. It is important to evaluate which process is most appropriate for your organization as having multiple processes can result in duplicate interventions on the patients’ worklist.
Meditech building process: If the vital sign order has to be initiated by the physician the vital sign intervention would need to be removed from all NUR care plans. The vital sign intervention would need to be set up with an OE category and procedure in the NUR intervention dictionary. If the physician needs to capture the direction when placing the order, the Directions Req'd field would need to be set to Y in the OE Procedure dictionary. If the vital sign order was part of an order set, the organization can pre-define the direction.
Meditech workflow process: The administration of oxygen would be ordered in POM. When ordering oxygen therapy, the physician has the option of ordering a flow rate, method of delivery and Sa O2 parameters.
Meditech building process: Administer oxygen is built as an OE procedure within the Respiratory category. A CDS containing appropriate queries is attached at the procedure level. The order can be viewed by nursing on the status board or by the RT within Process Orders Routine or the status board.
Meditech workflow process: This would be entered in POM as a NUR order that does not interface to any other application. After the physician places the restraint order in POM, it will transmit to the NUR application for the nurse to acknowledge and complete.
Meditech building process: Restraint orders are built as an OE procedure with a renewable period defined and the order is associated to a non-interfacing category.
Physicians can set up renewable notifications in the PWM Access dictionary. When the order is up for renewal the physician receives the notification on their Desktop and is able to invoke the renew function in POM. However, if the restraint order has a CDS associated in the OE Procedure dictionary we recommend the physician use the repeat function since renewing does not display the CDS.
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PCA
(Patient Controlled Analgesia)
Meditech workflow process: This would be entered in POM as
an order set. Located within the PCA Order Set would be a
procedure that directs the user to the hospital's policy manager
for specifics of the PCA Order Set. The order set would also
include the various medications that are available to be ordered.
The final order found in the PCA Order Set would be the
Respiratory Therapy order for O2/SAT.
Meditech building process: The Adult PCA Order Set
procedure order would be built under a non-interfacing category
with a customer-defined screen attached. Once the order is pulled
into the order set, the comment query included on the
customer defined screen would tell the user where to look for
more information regarding the Adult PCA Order Set. An example
would be: "The Adult PCA Order Set was used, refer to Policy
Manager."
The medication orders would be built in the Order Set dictionary
and would include Dosing Instructions similar to: "Document
changes in pump settings/wastes in the PCA intervention."
These comments then flow to the eMAR for the nursing staff to
review with the order. The medication orders would use the
category of Pharmacy and flow to the interfacing department of
Pharmacy.
The Respiratory Therapy order for O2/SAT would have a category of RT and flow to the
interfacing department of Respiratory Therapy. The O2/SAT
procedure order would include a customer defined screen that
would include queries to modify the order. Examples of such
queries would be:
Per RT Protocol
Cont. Pulse OX Ordered
SATS=
Liter Per Minute
cc's Per Minute
FIO2%
Oxygen
Equipment
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