CPOE updates

As you are using CPOE, there are a few tips that can help with ease of use. If you need further assistance with any of the below, you may call extension 2763.

• Old notes cleared by corporate — Multiple pages of notes prior to CPOE have been cleared by Corporate.
• Preferences — These may be set for your covering list and your initial default screen.
• Tap and go — please make sure that the person before you logged off and that you are the one logged in.

Documentation

Below are some helpful tips for documentation and working with notes, including:

• Delete a note —
  • If note has not been signed (temporary, pending or draft status), select the note, click "Edit/Amend" then click "Cancelled." Submit and PIN.
  • If note has been signed, enter an addendum stating reason (wrong patient, etc.), then contact the advanced clinicals department (extension 2763) for further direction.
  • Med list — Options for importing into PDoc (meds – scheduled and PRN options)
  • Pending notes — How to find and access for signature (how to access a pending note).

Orders

When making an order, your first move is to change the level of care, followed by the admission status to either inpatient, outpatient or observation. Other tips for making orders include:

• Blood cultures – One order will order two sets automatically. The default priority is routine, but you may change it if needed.
• Enter name for consult — Do not combine the two methods, simply choose one of the following:
  • Option one — N\ at least the first two letters of the physician's last name.
  • Option two — Remove N\ and enter the mnemonic of the physician.
• Echo after hours — The process is unchanged. Continue to the page or call the on-call technician.
• Initiate "Hold/Resume" — A "Resume" time is now mandatory when the "Hold" function is utilized. This is a patient safety issue. Registered nurses (RNs) do not have access to the "Hold/Resume" function, they must DC the current order and enter a new order.
• Order sets default to open — If desired, this can be changed in your preferences from the desktop screen.
• Patient’s own medication (med) — This may be entered as the med's name. Complete all fields to complete the order.
• Prechecked items – These are not mandatory. You may uncheck them.

Order sets

When making order sets, you may encounter one of the below notices:

• Duplicate lab orders on hemodialysis order set — This means that a second set of Dialysis orders for subsequent days was created.
• Revisions and updates to order sets — This means that many revisions have been made to numerous order sets. Call extension 2763 for assistance with requests.

Orders status updates

As the CPOE program has been updated over time, there are certain order processes and commands that have changed, while others have stayed the same. Here are some of the most important to know.

• “Add to specimen in lab” — This has either been removed or is no longer a mandatory field.
• Blood transfusions:
  • Option one — Order the product. If the order is to "Give Now," the transfusion indication screens will appear automatically for completion. The product may be ordered, but held or pending surgery. A transfusion order will be required to give the product. The blood bank will not release the product without the transfusion order/indications completed.
  • Option two — Order transfusion of product being held (product already ordered), then select "Transfusion Order" to access the order and indication screens.
  • Consent remains on paper to allow for patient/family signatures.
• Body fluid — Continue to use the paper order form until an order set is built.
• Donor breast milk — This has been added to the list of feeding methods available for "Nursery."
• New orders created:
  • Cardiac chair is an option under “Activity”
  • DC M1 Hold
  • Diet: NPO after MN
  • Free Water (flush for tube feeding)
  • Images to disc – if you need CDs from Radiology
  • Liver + Renal panel (type either "Liver," "Renal" or "Comp" to access)
  • PCP PCR
  • Trach Wean
• PICC line — order "PICC LINE PLCMT OVER FIVE YRS," as it is the only PICC line with "Interventional Radiology" as the category.
• Time for lab orders:
  • "AM” added to drop down box on lab orders.
  • Routine — This means that it was drawn within an hour of the entered time (may be a little longer with routine morning labs).
  • Stat — This means that it was drawn within 15 minutes.
  • Timed — This means that it was drawn within 15 minutes, either before or after the entered time.
  • Urgent — Similar to stat, but this is rarely used. Either stat, timed or routine is preferred.
• Tissue specimens — Continue to use the "Body Fluid" order form until an order set is built.
• Urine source — This has been pre-populated to “Random” in order to reduce mandatory clicks. It may be edited in the comment field or by nursing or lab personnel.

Meds/fluids

When dealing with meds or fluids, there are several processes that are beneficial to know, including:

• Changing med route (IV to PO, etc.) — The initial order must be DC’d and a new order placed for the new route.
• Edit titration parameters — You may edit within "Administration Criteria." To view the pre-populated parameters, be sure to select the string for titration.
• Electrolyte order set — The pharmacy will automatically DC the order if the patient’s creatinine is less than 1.5 since that is the criteria for utilizing the order set.
• Meds vs. fluids — It has been requested that plain IV fluids also be listed under "Medications." At this time, we are unable to do this. Plain IV fluids are listed under "Fluids." IV fluids with a medication are listed under "Medications."
• “Pick a Med String” — Always select a string for medications, then edit. It will minimize the fields you have to complete before filing.
• qHS and qDay options — These are not approved abbreviations. Select "Bedtime" or "Daily."
• Topical medications — The application site is no longer required.

For additional information and helpful tips on issues resolutions, visit our clinical review and discharge pages.