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CPOE - Computerized Physician Order Entry


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CPOE is now a requirement for ARRA. This talks about the items that need to be focused on for CPOE implementations. It is geared towards MEDITECH, but the ideas can be used for any EMR system. Check out the excelhcg youtube channel for a video presentation.

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CPOE - Computerized Physician Order Entry

  1. 1. MEDITECH CPOE Excel Healthcare Group
  2. 2. Dictionary Review At least make considerations and have a style guide to follow when making these changes
  3. 3. Order Sources eMAR Quick Charge Ramifications: If the order source is defaulted into PHA, then that order source will also default into the Quick Charge routine for nurses.
  4. 4. Review OE Procedure Dict • Naming conventions: Orderable name descriptions should be spelled out completely since it is the legal name. However when appropriate, in many name descriptions it makes more sense to use the industry-standard abbreviation or acronym. Computerized Axial Tomography Scan of Head is the legal name for the orderable commonly known as Head CAT scan but CT is the known “Industry Standard”. Example: CT Head wwo Cont Example: CT Chest Abdomen Pelvis w Cont
  5. 5. Review Pharmacy Med Dict • Trade Name field should be formatted as: • Injectable and Bulk (If more than one concentration is available) [Trade name] + [drug concentration] + [dose form] • All others: [Trade name] + [dose form] • Add special identifying information at end of the name (i.e. PEDS, OR, ER, etc) • Express suffixes that are part of the brand name (SR, SA, CR) within both the generic name and brand name. Suffix should immediately precede the dose form. • (Example: Metoprolol Succinate 12.5 mg XL Tab ). • Combination medications should contain strength of items at end of name • Example: Dyazide 50/25 Cap • If more than one trade name for product, add additional trade names to Generic Equivalent field.
  6. 6. Review Pharmacy Med Dict • Pharmacy - Generic Equivalent • Generic Equivalent can be used to add additional generic or trade names, using naming convention described above for Trade Name field. • Trade names that you enter at the Generic Equivalent prompt appear in lookups that are sorted by trade name. • Utilize Generic Equivalent field for any Automatic Therapeutic Interchanges. • Example: Add “Atorvastatin Auto Sub to” as a Generic Equivalent for • Simvastatin, if Simvastatin is automatically substituted for Atorvastatin.
  7. 7. Order Strings • Review the format of the order strings first • MEDITECH recommends using Joint Commission and ISMP standards when building the frequency schedules, example: use “daily” instead of “qd”. • Medication orders should include common order strings. (* Morphine might have many order strings, with variation in both dose and route) • • • • Morphine Inj 1 mg IVP every 4 hours PRN Morphine Oral Liquid 2 mg PO q2hp Morphine PCA 50 mg/ 50mL 50 mg IV ONCE ONE Morphine 30 mg IR PO Q2h2 SCH • Frequency - The most common frequency is the default on the order selection screen. • *Note in Zynx all Frequencies are displayed and are not separated by Category use. Frequencies should be standardized when possible.
  8. 8. Evidence Based Order Sets Both of these vendors are approved by MEDITECH: • Provation • Zynx
  9. 9. Reflex Order Sets There are three types of reflex orders you can build: 1. Suggested Order 2. Pre-requisite 3. Linked Meds
  10. 10. CPOE Training We suggest grouping all the same type of clinicians into a training to make it relevant to their practice.
  11. 11. Provider Training • Explain process for Direct Admit and ED to Inpatient, if pertinent to provider practice • Place single medication order and protocol Order Set • Add a single order to favorites and create a specialty folder for it • Explain difference with CPOE telephone orders/Verbal Order, Written and Protocol • Place an order for a consult, Diet • Complete a Transfer & D/C an old Order Set • Enter admission orders • Adjust the Admission orders (register as, etc.) • Initiate & Sign Order Sets – demonstration and explain difference of the two
  12. 12. Provider Training • Complete Medication Reconciliation – Admission, Transfer • Discontinue orders, discontinue O/S or complete • Complete Discharge Process – discharge order, Depart, D/C med rec • Resolve order conflicts – alerts • Demonstrate Proper Hand off/Chart Check • Explain Downtime Process • Physician Desktop – how are orders are signed or refused • Discuss process around your specialty area….as pertinent (ex. ED, Med/Surg, Oncology, OB, NICU and processes)
  13. 13. Nursing and Clinicians • • • • • Train on Single Orders, Order Sets (O/S), any Order Sets related to their specialty, Transfusion O/S, TPN O/S, Admit to venue Order Sets, identifying statuses O/S and how to discontinue if you have too many Home Medications on the Med Rec when they print. Emphasize looking to Initiate Order Sets when patients arrive from the Physician‟s office, ED or the OR once the location is updated by Registration in the computer and looking for a completed admission med rec or transfer if it pertains to the circumstance. Train on Transfer orders (service or bed location), Transfer Med Reconciliation (where to find all the med recs if completed before sending a patient anywhere) Identify and train on the Med Rec process for the outpatient areas Train on where to find orders. • • • • Discuss with ED & PACU – Process for discontinuing their O/S phase of orders before patient goes to department or completing to obtain a „completed‟ status for the O/S. Surgery areas & ED must be proficient on use of the eMAR. Discuss looking for Provider Orders, and the use of „Notify Physician‟ orders • • • • • For example: Where do I find my consults (case management, PT/OT, dietician) now that paper is gone? Example: Provider Order – notify physician when pt arrives to department (nurse can complete this one time order when task is complete) Example: Notify physician if pt. BP <100 is continuous order (nurse does not complete since it is continuous and each nurse needs to see this order) Discuss Discontinuing orders/Order Sets within the proper workflow Discuss receiving telephone or verbal orders Discuss receiving telephone calls related to admission orders and med reconciliation process for telephone orders
  14. 14. Nursing and Clinicians • Discuss Downtime process for CPOE with clinicians, what their role is during a downtime and where to find information, as well as what has to be placed back in the computer once the application is back up. • Discuss Status of Order Sets – physicians may have entered one twice, know to review both and call the doc to cancel one that is hanging out there. • Discuss importance of Documenting Home Medications correctly the first time in the OR,ED, Admission so the physician does not receive an error message when doing reconciliation and so that the meds print correctly for discharge. • Discuss the importance of using the proper „Order Source Type‟ when placing orders • Discuss what to do if a nurse orders a med as „Written‟ that should have been a „Telephone order‟ that will need a physician signature in the messaging. • Discuss the more complicated process if the order is entered, and completed with the wrong Order Source Type. Discuss how to change or adjust as needed. • Discuss readiness (day or night) to take orders if calling a physician: computer on, in patients chart ready to take orders. Ideal is for physician to enter orders themselves, but you always want to be prepared. Be collaborative rather than rigid.
  15. 15. Ancillary Departments • • • • • • • Discuss Downtime process for CPOE with ancillary department and their role for CPOE during a downtime. Discuss how to look at a chart and review Discuss any virtual beds needed for ED, and Rehab areas with registration if the facility does not already have the process in place. If patient is in a virtual bed and an order set is initiated it will go to the department the patient is expected to go to versus if not in a virtual bed, it will fire the O/S orders to the Outpatient department. Discuss with the auditors and registrars where to find order sets, and how to look up orders on charts now that there is no paper. Walk through a typical workday where each would use paper and identify where in the computer it will now reside. Discuss with Pharmacists use of the messaging for communication Discuss with Pharmacist Physician Order Management (POM) Order entry to assist physicians and troubleshoot the POM side of ordering medications and online med rec entry. Discuss with Pharmacists when to use the appropriate order source type so that proper routing to the ordering physician inbox can occur. This is also important for CPOE statistics.
  16. 16. Contact us or 770-918-9083