Quick Orders and Order Menus

Orders Package

• The Orders package in RPMS provides a number of functions including: – Ability for users to enter, process, and discontinue

electronic orders

– Control who can act on orders with OR keys

– Order checking

– Delayed release of orders (inpatient using ADT)

– Auto-discontinue orders (inpatient using ADT

Order Keys

• ORES – Assigned to providers who are authorized to independently write orders (typically physicians, nurse practitioners, physician assistants, podiatrists etc.).

• ORELSE – Assigned to users who are authorized to take and release verbal and telephone orders from providers who hold the ORES key, or who can enter policy orders (typically registered nurses, pharmacists).

• OREMAS – Assigned to users who transcribe written orders into RPMS-EHR (typically only given to inpatient ward clerks).

• A user must hold only one order key or they will not be able to process any orders at all

• You can check to see if users hold multiple order keys with this menu: ORD > KEY > CHK

Order Keys (cont.)

• RPMS-EHR provides management of orders on the Orders Tab.

• The Orders Tab provides the ability to add, change, discontinue, and print.

• The Orders Tab allows EHR users to sort by column headings or customize the view of orders displayed.

Order Management

Orders Tab

Medication Order Management

• It is recommended that all prescriptions be entered and managed on the Meds tab.

• The Meds tab provides a better overview of medications.

• The Meds tab provides easy access to the change, renew, refill, or discontinue actions for effective management of medications.

Medications TabNote that not all levels are available for all parameters, but only those that make sense for that particular item.

Order Entry

• New orders are entered into RPMS-EHR via order menus.

• Order menus are organized groupings of quick orders and other menus.

• Order menus can be customized to meet local needs.

• Usually, order menus are created with groups of similar quick orders.

Order Menus

• Order menus should be designed by target end users, not by package informaticists (i.e., by physicians who will enter orders, not by pharmacists, laboratory information specialists, or radiology technologists).

• Once designed, order menus are built by package informaticists.

Order Menu

Quick Orders

• Quick Orders are electronic orders with ALL the data elements correctly preconfigured.

• Order menus are organized groupings of quick orders to make provider order entry more convenient and efficient.

Quick Orders

• Well designed order menus and quick orders provide the clinician with proper choices and helpful information, and promote entry of correctly formed electronic orders.

• Incorrectly entered electronic orders require additional work to clarify and correct and may delay or impede patient care.

Quick Order Dialog

Quick Order Creation

• While order menus should be designed by end user clinicians, the quick orders and order menus should be built by package informaticists to ensure that they are correctly constructed.

Quick Order Creation

• Quick Orders should not be built by CACs or Informaticists from another discipline who do not have the knowledge background for that package.

• In other words, only a pharmacy informaticist should build pharmacy quick orders, and only a laboratory informaticist should build laboratory quick orders, and so on.

Orderable Item Creation

• Prior to creating a quick order, the orderable item to be used must already exist.

• The process of adding a new drug to the drug file creates a new orderable item.

• The process of adding a new test in the laboratory file creates a new orderable item.

• The process of constructing a new exam in the radiology-nuclear medicine procedure file creates a new orderable item.

Orderable Item Creation

• If the order is for nursing or patient care, then the orderable item must be created manually using this menu:

OIC Create/Modify Orderable Items

Create a Nursing Orderable Item

Create a Nursing Orderable Item

• Recommendation is to create nursing orderable items in ALL CAPS.

• Keep nursing orderable items general so they can be re-used in multiple quick orders (e.g. WOUND CARE vs. TELFA 4x4)

RPMS Namespacing

• Software packages in RPMS have designated namespaces

• It is recommended that quick orders for RPMS-EHR utilize the recognized namespaces

• Use of namespaces aids in the future management of these quick orders by local informaticists and by area and national helpdesk staff.

Naming Convention

Naming Convention

• Conventions for quick orders and menus:

– Namespace + Z = Quick Order

– Namespace + ZM = Menu

– Namespace + ZSET = Order Set

– Use IP to differentiate Inpatient Orders (esp. Lab and Nursing)

Naming Convention

• Additional suggested namespace:

PSJIVZ for IV piggybacks to differentiate

from oral unit dose and IV fluids

Naming Convention

• Examples:

ORZ WOUND CARE [Outpatient Nursing]

PSOZ ATENOLOL 25MG DAILY [Outpatient Med]

PSJZ CARVEDILOL 6.25MG BID [Inpatient Med]

LRZ HGBA1C [Laboratory]

RAZ FOREARM 2 VIEWS [Radiology]

ORZ IP COLD PACKS [Inpatient Nursing]

PSOZM DIABETES MEDS [Outpatient Pharmacy Menu]

LRZM ER LABS [Laboratory Menu]

RAZM RADIOLOGY [Radiology Menu]

ORZM IP RESPIRATORY [Inpatient Nursing Menu]

ORZSET COLONOSCOPY PREP [Order Set]

Quick Order Construction

• From the standard RPMS-EHR Configuration Master Menu:

ORD > MNU > QOC

Quick Order Types

• Activity

• Consult

• Imaging

• Inpatient Medications

• IV Medications

• Laboratory

• Nursing

• Outpatient Medications

Quick Order Types

• There appear to be other Order Types available of: Diet and Vital/Measurements, but these should not be used.

• The Dietetics Package is not an IHS supported package.

• These Vital/Measurements orders point to the VA Vitals package and not the IHS Measurements File.

Creating Quick Orders

Laboratory Quick Orders

Select QUICK ORDER NAME: LRZ CALCIUM TODAY

Are you adding 'LRZ CALCIUM TODAY' as a new ORDER DIALOG? No// Y (Yes)

TYPE OF QUICK ORDER: LAB LABORATORY

TYPE OF QUICK ORDER: ?Choose from: ACTIVITY ALLERGIES CONDITION CONSULTS DIAGNOSIS DIET ADDITIONAL ORDERS DIET ORDERS EARLY/LATE TRAYS GENERAL RADIOLOGY IMAGING INPATIENT MEDICATIONS IV MEDICATIONS LABORATORY NURSING OUTPATIENT MEDICATIONS PRECAUTIONS PROCEDURES SUPPLIES/DEVICES TUBEFEEDINGS UNIT DOSE MEDICATIONS VITALS/MEASUREMENTS

Laboratory Quick OrdersSelect QUICK ORDER NAME: LRZ CALCIUM TODAY Are you adding 'LRZ CALCIUM TODAY' as a new ORDER DIALOG?

No// Y (Yes)TYPE OF QUICK ORDER: LAB LABORATORY NAME: LRZ CALCIUM TODAY//DISPLAY TEXT: Calcium TodayVERIFY ORDER: y YESDESCRIPTION: Calcium level done for outpatients for todayENTRY ACTION: Lab Test: CALCIUM

Collected By: SP Send patient to lab SP Send patient to lab WC Ward collect & deliver LC Lab blood team

Collection Sample: BLOOD//Collection Date/Time: TODAY (MAR 23, 2004)How often: ONCE ONCE

Lab Schedule

• ONCE must be setup as a laboratory administration schedule.

• Lab menu option is LRZM LAB TESTS

Select ADMINISTRATION SCHEDULE: ONCE ONE-TIMENAME: ONCE//TYPE OF SCHEDULE: ONE-TIME//

Review Order-------------------------------------------------------------

Lab Test: CALCIUMCollected By: Send patient to labCollection Sample: BLOODSpecimen: BLOODCollection Date/Time: TODAYHow often: ONCE

------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE//Auto-accept this order? NO//

Quick Orders - RadiologySelect QUICK ORDER NAME: RAZ ELBOW XRAY Are you adding 'RAZ ELBOW XRAY' as a new ORDER DIALOG? No//

Y (Yes)TYPE OF QUICK ORDER: IMAGINGNAME: RAZ ELBOW XRAY//DISPLAY TEXT: Elbow XrayVERIFY ORDER: YDESCRIPTION: No existing text Edit? NO//Select one of the following imaging types: ANGIO/NEURO/INTERVENTIONAL GENERAL RADIOLOGY ULTRASOUNDSelect IMAGING TYPE: general RADIOLOGY

Quick Orders - RadiologyRadiology Procedure: 14 ELBOW 2 VIEWSProcedure Modifier:History and Reason for Exam: No existing text Edit? No// Category: OUTPATIENTIs this patient scheduled for pre-op? NO//Date Desired: TODAY//Mode of Transport: AMBULATORYIs patient on isolation procedures?Urgency: ROUTINE//

Review Order----------------------------------------------------------

Radiology Procedure: ELBOW 2 VIEWSCategory: OUTPATIENTDate Desired: TODAYMode of Transport: AMBULATORYUrgency: ROUTINESubmit request to: X-RAY

----------------------------------------------------------

(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Quick Order – Outpt MedsNAME: PSOZ AMOXICILLIN 500MG BID 7D ReplaceDISPLAY TEXT: Amoxicillin 500mg bid 7 days ReplaceVERIFY ORDER: YES//DESCRIPTION: No existing text Edit? NO// Y Amoxicillin 500mg BID outpatient for 7 daysENTRY ACTION: Medication: AMOXICILLIN CAP,ORAL //Complex dose? NO//Dose: 500MG// The dose should have been set up by pharmacyRoute: ORAL// Setup by pharmacy

Quick Order – Outpt Meds• Days Supply: 7//• Quantity (CAP): 14//• Refills (0-11): 0// • Schedule: BID// • Pick Up: WINDOW// • Priority: ROUTINE// • Comments:• No existing text• Edit? No// (No)

• Select ADMINISTRATION SCHEDULE:

Review Order----------------------------------------------------------

Medication: AMOXICILLIN CAP,ORAL 500MGInstructions: 500MG ORAL BIDDays Supply: 7Quantity (CAP): 14Refills (0-11): 0Pick Up: WINDOWPriority: ROUTINE

---------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE// P Place to save quick order

Special Med Quick Orders

• Clinic Meds (In-House Meds)– Pick up is ADMINISTERED IN CLINIC– Status is ASAP or STAT, not DONE

• Prescriptions for outside pharmacies– Make orders just like meds on formulary. (If med is

not in Drug File, then use a med called OUTSIDE RX, until Pharmacy adds to Drug File). Provider fills in data, and it is printed as an RX

• Prescriptions received from outside providers– Must be entered into RPMS. User may have to edit

Drug File

Review Order

---------------------------------------------------- Medication: CEFTRIAXONE INJ,SOLN 1GM/VIAL

Instructions: 1 GRAM 1GM/VIAL INTRAMUSCULAR Q12H Days Supply: 1

Quantity (VL): 1

Pick Up: ADMINISTERED IN CLINIC

Priority: STAT

----------------------------------------------------

(P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Quick Orders - NursingTYPE OF QUICK ORDER: NURSINGNAME: ORZ FOLEY CATHETER//DISPLAY TEXT: Foley Catheter to DrainageVERIFY ORDER:DESCRIPTION: No existing text Edit? NO//ENTRY ACTION: Patient Care: CATHETER Instructions: Empty Foley Catheter to drainage bag q shift Start Date/Time: NOW// Stop Date/Time: N+7

Review Order-----------------------------------------------------------------

Patient Care: FOLEY CATHETERInstructions: Empty Foley Catheter to drainage bag q shift Start Date/Time: NOWStop Date/Time: 7 DAYS FROM NOW

----------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Quick Orders - ConsultsSelect QUICK ORDER NAME: GMRCZ PHYSICAL THERAPYNAME: GMRCZ PHYSICAL THERAPY DISPLAY TEXT: Physical Therapy Consult VERIFY ORDER: YES//DESCRIPTION: Quick order for physical therapy consult Edit? NO//ENTRY ACTION:Consult to Service/Specialty: PHYSICAL THERAPY//Consult Type:Reason for Request: No existing text Edit? No// N (No) Category: OUTPATIENT//Urgency: ROUTINE// Place of Consultation: Consultant's Choice// Attention: Provisional Diagnosis:

Review Order

------------------------------------------------------------Consult to Service/Specialty: PHYSICAL THERAPYCategory: OUTPATIENTUrgency: ROUTINEPlace of Consultation: Consultant's Choice

------------------------------------------------------------ (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Order SetsSelect ORDER SET NAME: LRZ DIABETIC TESTS ORDER SETNAME: LRZ DIABETIC TESTS ORDER SET ReplaceDISPLAY TEXT: Diabetic Yearly tests ReplaceDESCRIPTION: No existing text Edit? NO//ENTRY ACTION:EXIT ACTION:ORDER SET COMPONENTS: 1 LRZ HGBA1C OUTPT 2 LRZ LIPID PANEL 3 LRZ TSH OUTPTSelect COMPONENT SEQUENCE#:

Quick Order Restrictions

Problem: Ordering a Med to be given in Clinic

• If only a Pharmacy Order is used, how is Nursing notified to give the med?

• If only Nursing Order is used, Medication is not processed in Pharmacy package

Pharmacy Order(“real” Medication)

Priority: ASAP, or STATPickup: Clinic

Med Tab: YesHealth Summary: Yes

Allergy Check: YesDrug interaction: Yes

Nursing Order(text only)

Allergy Check: NoDrug interaction: No

Med Tab: NoHealth Summary: No

Generic Order(text only)

Free text entry of order

Allergy Check: NoDrug interaction: No

Med Tab: NoHealth Summary: No

Comparison of Order Types used to order a Medication

Order checking: No Verification: No

Solution: Order Set containing both Pharmacy and

Nursing Orders

NURSING QUICK ORDER: ORZ ALBUTEROL NEB RXGive an Albuterol Neb Treatment in Room #. Use 0.25ml/3ml Saline

PHARMACY QUICK ORDER: PSOZ ALBUTEROLNEB RX

TWO TYPE ORDERS IN ONE SET:Nursing orders: one and Pharmacy Orders: one

Med Tab: YesHealth Summary: Yes

Allergy Check: YesDrug interaction: Yes

Bill through POS or J-Codes

Hands-on Exercise

1. Create nursing orderable item and nursing quick order for ???

2. Create laboratory quick order for ???

3. Create outpatient med quick order for ???

4. Create radiology quick order for ???

Questions and Discussion