Dr.Cantral James Anderson,M.D.

Managing Patient Care Using

CPOE (Computerized Physician Order Entry)

for Physicians Session 1

February 2008

Medical Informatics Physician Education Program February 2008 Page 2 of 90

CPOE Education

Table of Contents Introduction....................................................................................................................4 Navigating the Orders Tab............................................................................................4

Adding an Order .....................................................................................................................4 Using the View Navigator Column........................................................................................5 Setting Order Default View/Filters ........................................................................................7

To Filter Orders in View.......................................................................................................................7 To Use Advanced Filters.....................................................................................................................7 To Customize the Columns in the View.............................................................................................8 To Review Orders Details..................................................................................................................10 To Interpret Orders Display ..............................................................................................................10

Ordering with Order Sets ............................................................................................13 Rationale for Standardized Order Sets............................................................................................13 To Locate a Common Order Set.......................................................................................................14 To Order Using the Find Window.....................................................................................................17 To Complete Missing Details............................................................................................................19 To Place an Individual Order Using Order Sentences ...................................................................21

Using Order Commands/Right Click Functions........................................................22 To Review the Order Command Menu.............................................................................................22 To Modify an Order ............................................................................................................................23 To Copy an Order...............................................................................................................................24 To Cancel/Reorder .............................................................................................................................24 To Suspend an Order ........................................................................................................................25 To Resume a Suspended Order .......................................................................................................25 To Cancel or Discontinue an Order .................................................................................................25

Placing and Processing Orders .................................................................................27 To Place an Order for a Physician ...................................................................................................27 To Process an Order from a Medical Student.................................................................................29 To Process an Order from a Nurse Practitioner or Physician Assistant .....................................31

Creating and Organizing Your Favorites Folders .....................................................32 To Navigate Through Favorites Folders..........................................................................................32 To Set Up Favorites ...........................................................................................................................32 To Add Orders to the Favorites Folders..........................................................................................33 To Delete, Rename or Remove an Order from Your Favorites Folder .........................................35

Understanding the Soft Stops ....................................................................................36 To Respond to a Soft Stop................................................................................................................36

Entering Lab Orders ....................................................................................................37 To Enter a One Time Lab Order........................................................................................................37 To Enter One Time Lab for a Specified Date/Time .........................................................................38 To Enter One-Time Lab STAT Order ................................................................................................38 To Enter a Time Limit/Stop Date for the Order ...............................................................................39 To Enter AM Lab Orders....................................................................................................................39 To Enter Peak and Trough Orders ...................................................................................................39 To Enter Nurse Collect Lab Orders..................................................................................................39

Entering Radiology Orders .........................................................................................40 To Modify Radiology Order During a Procedure ............................................................................40 To Change to the Actual Procedure.................................................................................................40

Entering Diet Orders....................................................................................................42 To Delay Diet ......................................................................................................................................42 To Order NPO at Midnight.................................................................................................................43


CPOE Education

Managing Medication Orders Using oneChart ..........................................................44 Viewing the MAR Summary.................................................................................................44

To View the MAR Summary ..............................................................................................................44 To View the Medication Status and Documentation ......................................................................45 To Change the MAR Summary Display ...........................................................................................46 To Change Your Default View...........................................................................................................48 To Use MAR Summary Primary Icons .............................................................................................48

Navigating the Electronic MAR (Medication Administration Record) .............................49 To Review Medications .....................................................................................................................50 To Use MAR Filters ............................................................................................................................51 To Modify the MAR View ...................................................................................................................52 To Review Order Details....................................................................................................................53 To Recognize Differences with eMAR .............................................................................................54 To Document Administration of a Medication ................................................................................54 To Correct a Medication Not Displaying Correctly.........................................................................55 To Unchart a Medication Administration.........................................................................................56 To Reschedule a Single Dose...........................................................................................................57 To Reschedule All Medication Doses..............................................................................................58 To Void a Medication.........................................................................................................................59 To Order First Dose STAT.................................................................................................................59 To Resolve Medication Errors ..........................................................................................................60

Navigating the Meds Tab .....................................................................................................61 To Sort by Columns...........................................................................................................................61 To Change View .................................................................................................................................62 To Change Medications on the Medications Profile ......................................................................62 To Add Unknown Meds .....................................................................................................................64 To Modify Home Medications ...........................................................................................................65 To Discontinue a Home Medication .................................................................................................65 To Convert a Home Medication to an Inpatient Medication ..........................................................66

Preparing Discharge Prescriptions............................................................................68 To Perform Medication Reconciliation at Discharge .....................................................................68 To Convert Inpatient Medication(s) to a Discharge Prescription..................................................68 To Convert Inpatient Medication(s) to a Discharge Prescription..................................................69 To Convert Historical (Home) Medication(s) to a Discharge Prescription...................................71 To Write a Discharge Prescription for a New Medications(s) .......................................................71 To Print Prescriptions .......................................................................................................................74 To Add/Remove Prescriptions to Your Favorites/My List .............................................................75

Performing Medication Reconciliation ......................................................................78 To Reconcile at Admission, Transfer or Discharge .......................................................................78 To View Suspended Medication on the eMAR................................................................................80 To Suspend and Resume for Surgical Procedures........................................................................80 To Transfer to Another Level of Care ..............................................................................................81

Entering Orders for Discharge ...................................................................................83 Handling Alerts ............................................................................................................84

To Respond to an Allergy Alert ........................................................................................................84 To Enter the Missing Weight ............................................................................................................86 To Order a Non-Formulary Medication ............................................................................................87 To Resolve a Duplicate Order Alert .................................................................................................89


CPOE Education

Introduction Computerized Physician Order Entry (CPOE) is a component of oneChart (included in Cerner PowerChart) that provides the physician and his/her representatives an electronic method to assist in managing patient care. The CPOE function allows orders to be entered directly into the oneChart/Cerner system from any location such as a computer within the hospital, in the physician’s office or in the physician’s home. CPOE impacts patient care by:

• Reducing the time it takes to receive and respond to an order.

• Reducing errors secondary to illegible handwritten orders and handwritten discharge prescriptions.

• Improving error avoidance through systems alerts notifying the practitioners of patient allergies, drug to drug interactions and duplicate order entry.

Navigating the Orders Tab The Orders tab is the primary location for placing and managing orders. The main features of the Orders tab include adding orders, navigating through orders, and organizing the order views.

Adding an Order

1. Click the + Add (Add Order) icon on the Power Orders tab. A drop down menu will appear that includes Add Orders and Add Allergy.

2. Click Add Order (Alt + R). The Add Order window for that patient opens.


CPOE Education

Using the View Navigator Column

The View navigator column contains:

• Orders for Signature –display of all orders requiring signature. You can review, modify or remove orders that you have placed prior to signing.

• Allergies –displays recorded allergies for the patient and allows you to modify an

allergy. If an allergy has a plus sign (+) in front of it, click the + and the reaction symptoms will be listed for review.

• Problems and Diagnoses –problems and diagnoses recorded from prior encounters

and the current encounter are listed for review. If the Problem or Diagnosis has a plus sign (+) in front of it, click the + and the onset date will be listed.

• Orders –categories of orders available. Each category has a gray box in front of it. If

the gray box contains a check mark and the title is bolded; there are orders entered in this category. If a check mark is not in the box and the title is not bolded; orders do not exist for this category.


CPOE Education

To reduce the number of categories displayed on the right side of the view, click on the check mark ( ). However, if orders are added to a removed category later, you will not be able to see the orders. Be careful not to remove categories.

NOTE: If you accidentally left click the box in front of a bolded category (indicating there are items in that category) with a check mark, click the blank box to restore the category. The check mark will reappear and the category will show on the view on the right

• Reconciliation History –currently not available for use at this time.

• Related Results – provides a review of pertinent vital signs, weight and lab results

when placing selected orders or highlighting an order that has already been placed.


CPOE Education

Setting Order Default View/Filters The Power Orders display defaults to All Orders 5 Days Back for all orders in any status (ordered, discontinued canceled, completed, etc). You can click the drop down menu to change orders display in Power Orders.

To Filter Orders in View With the patient’s chart open to the Orders tab,

1. Click on the Display window drop down menu above the Order Profile Spreadsheet to view filter options:

• All Medications (all statuses) • All Non-medications (all statuses) • All Orders (all statuses) • All Orders 5 Days Back • Completed Orders • Future Orders • Suspended, Incomplete, and On Hold Orders Only

2. Click the filter you wish to apply. 3. Click Save. 4. Click OK.

To Use Advanced Filters 1. Click the Ellipsis box next to the Display window. The Advanced Filters

window will display filter options. 2. Click to select or deselect desired statuses. Highlighted Statuses are the ones

you will be saving. 3. Click Save. 4. Click OK.

NOTE: It is RECOMMENDED to check the box: Show individual instances for continuing orders. This enables you to view continuing order instances such as “LAB QAM Collect” order.


CPOE Education

To Customize the Columns in the View

1. Click Customize View on the right side of the display.

The Customize View window will open.

To add columns you wish to see to your orders display: 2. Click on the Available columns choices (on the left of the

screen).to highlight your preferences.

Organize order of columns

Further select sort order/ criteria


CPOE Education

3. Click Add button in the center between the columns. Your

selections will appear on the Selected columns list on the right. 4. To Remove columns from the orders display, click the Selected

columns item, then click the Remove button in the center between the columns.

5. To organize Selected columns, click the item to highlight it and

click the up and down arrows on the right side of the window.

6. There are options under Select how you want to group & sort

orders at the bottom of the window that allow you to select a primary criteria then a secondary criteria Using the arrow, click your preference. in the Sort orders drop down box

7. Click Ascending or Descending button to set the order for selected criteria.


CPOE Education

To Review Orders Details On the right side of the orders display, there will be three distinct columns of order information:

• Order Name • Status • Details

To the left of the Order Name, gray boxes display with and without check marks followed by icons.

To Interpret Orders Display

1. Look for the Gray Box – If the order is in an active status, a check mark ( ) will be in the gray box. If the order is not in an active status, such as completed, discontinued or canceled, a check mark will not be present in the box.

NOTE: If you click a box that has a check mark, it removes the check mark and

the system will strike through the order and open the Discontinue window. If this happens unintentionally, right click on the order and select Reset. The discontinue actions will cease.

2. Review the Icons – Some of the orders will have icons to the right of the gray

box. These icons indicate specific information about the order. Common icons include:

1. Eye Glasses – This icon indicates the order is pending nurse review. 2. Tablet with Writing – This icon indicates there is reference text available. To

obtain the reference text, right click and select

reference information.


CPOE Education

3. Mortar and Pestle indicates the order is for pending pharmacist verification.

4. Caduceus – This icon indicates the order is either a verbal or telephone

order that needs to be cosigned. 3. Read the Order Name – This will be the name and/or the synonym for the order.

Synonyms have been placed on orders to provide common terms physicians use to place orders. Drug names display the generic name first then the brand name where appropriate.

4. Review the Status –The progress of the order will be labeled in one of the following categories:

• Order - This status indicates that the order details need to be completed. Sign

the order when details are complete. located bottom right)

• Processing - After you sign a new order, the order status of Processing displays. Click As Of…to refresh/update the system. The status of the order will change to Ordered.

• Ordered/Scheduled/Pending Collection - An order that has been entered successfully and signed has a status of Ordered/Scheduled/Pending Collection.

• Completed – A task has been completed or a specimen has been collected and resulted.

• Discontinued – The order has been stopped.

When the Cancel/Discontinue action is taken on an order with a frequency or interval, the status will display as discontinued if the procedure or medication has been administered at least once. (For a medication order, the drug interaction checking continues for Discontinued orders for their defined time-frame. This time-frame is determined by the drug half-life.)


CPOE Education

• Canceled – The order has been stopped. When the Cancel/Discontinue action is taken on an order with frequencies or intervals, the status will display as canceled if the first instanced was never administered. (No drug interaction check is performed on order with the status of Canceled.)

NOTE: Any order can be stopped immediately by taking the Cancel/Discontinue action. (Certain conditions may cause the status of some order to go to Discontinued rather than Canceled.)

• Suspend - Orders that have a frequency associated with them can be suspended and later resumed, e.g. Patient sent to surgery will have their medications/diet order suspended. Upon their return the order can be resumed.

5. Review the Details – This area will contain the specific information for that

order. Examples of information you may expect to locate in this column include:

Date, Time, Frequency, Duration, Reason for Exam and Transportation Mode.

Dose, Form, Route etc.


CPOE Education

Ordering with Order Sets Order Sets (or Care Sets) are similar to the pre printed paper Standardized Orders Sets, Care Tracks and Protocols currently in use. An Order Set is multiple individual orders grouped together that are considered pertinent for a diagnosis or procedure.

Rationale for Standardized Order Sets Methodist Healthcare will maintain an electronic library of standardized Order Sets published by department/clinical specialty and approved by the Quality Committee of the Medical Staff. Order Sets will also be available through the downtime processes for printing from computers designated at PCLA.

NOTE: Some of the order sets will include CMS required documentation.

Physicians participated in all Order Set development. A Physician Champion for each specialty approved each Order Set in oneChart.


CPOE Education

To Locate a Common Order Set 1. Click Add Order icon. The Add Order window will open.

The window will open with five standardized folders available for order selection. These folders are:

• Care Sets • Medications • Laboratory • Diagnostic Tests • Continuous Infusion.

Each of these folders contains common orders and cannot be changed. 2. Left click on a folder to open it. The folder label is highlighted and underlined. The

contents of the folder will appear.

3. Click on the order you wish to enter. Your selection will also be highlighted. 4. Enter the Details requested. Required Details will be bold. 5. Click on the Order detail and the Detail values will appear in the panel on the

right. 6. Click on the correct Detail value.


CPOE Education

NOTE: If you accidentally click an order, the selection can be removed before signing the order.

Some order sets will contain “nested” order sets. A nested order set is a protocol or order set included within another order set.

As example, the Post CV Surgery Diltiazem Atrial Fibrillation Protocol orders are included as an option to select with the CABG Post Op orders.


CPOE Education

Some orders require documentation for CMS compliance. Compliance documentation has been added to these specific order sets. If documentation is needed for an order associated with CMS indicators, the documentation will display after the entry of the order set.


CPOE Education

To Order Using the Find Window 1. Type the diagnosis, procedure name or first few letters of the order in the Find

box. The system will automatically search for matches.

2. Locate the correct order set and left click on the order to select it.

To narrow the search use Starts With or Contains and the Search Within functions. It is recommended that you set the Search Within field to ALL, broadening the search.

3. Click the Order Set you wish to use. The Order Set will open with some if not all of the orders pre-checked. The pre-checked orders were determined through the physician review process, designating an order that is needed 80% of the time as common. Some orders may be required by JCAHO or CMS for compliance.


CPOE Education

4. Review the orders and order sentences in the order set. Select (by left clicking on

the box in front of the order) or deselect (removing the check mark in the box) the orders you want to place from the order set.

5. Once an order is selected, the specific order details for that order in the order set should be reviewed and modified.

6. Modify the order if necessary. As the orders in the order set are selected, the order details will appear in the lower portion of the screen in the Order details tab.

Details that may be modified include:

• Frequency: How often?? Frequency, if specified, generates continuing orders. If no frequency is specified, the order is a ONE TIME order.

• Duration: Numerical value – when an order will start and end

• Duration Unit: Unit of measure; minutes, hours, days. Duration and Duration Unit work together to create a stop time for child orders (i.e. when an order will end or automatically D/C)

• Collection Priority: When the lab is to be collected after the order is placed. Collection priority when the lab is to be collected can be specified.


CPOE Education

Routine STAT (STAT priority requires a call by physician to the unit

and/or nurse to alert the associate of the STAT order) MECH Routine MECH Stat Timed Study

Some of the order details may be required. The required order details will be highlighted in yellow. The view will default to the first required order detail.

NOTE: Completion of required fields is necessary to sign the order.

7. Click OK when the modifications are complete.

To Complete Missing Details If any required fields are excluded when the order set details are completed, oneChart will prompt the user to fill in Missing Required Details. An information window will appear listing the number of required fields remaining. Items missing details will be marked with an icon with a white X in a blue circle. A button at the bottom of the screen will indicate how many Missing Required Details need attention.

1. Click the First Detail button to show the first missing required field. oneChart will present the orders that have missing required order details.

2. Complete the highlighted fields. 3. Click OK.

oneChart will default back to the Add Order window. 4. If you are finished placing orders, click Done, located in the right lower corner.

oneChart will default back to the Orders Tab display.


CPOE Education

NOTE: If an order was entered in “Error”, right click on the order prior to signing the order and select Remove.

5. On the Orders tab, click Sign in the right lower corner. 6. Click the As Of button located at the top of the screen to refresh the orders

display view.


CPOE Education

To Place an Individual Order Using Order Sentences If an Order Set does not include all necessary orders, you can place individual orders. To place a simple order:

1. With the patient’s chart open to the “Orders” tab, click the +Add button.

2. Type the order name in the Find blank. 3. Click the Search button. The Search within field defaults to ALL. If you

want to search by a specific category use the down arrow to select. 4. Click the order. 5. Click the appropriate Order Sentence if this window displays. The order

sentence chosen will automatically fill in the order details. 6. Click OK. 7. Click Done. 8. Complete any Order Details. You may change the order details at this

step.

NOTE: Any yellow field is a required field.

9. Click Sign. 10. Click the As Of… button.


CPOE Education

Using Order Commands/Right Click Functions To Review the Order Command Menu There are a number of actions that can be taken on an order once it has been placed. To display the menu:

1. Open patient’s chart. 2. Right click on the Order. 3. The Menu will display with the following options:

• Modify – Modifies an existing active order.

NOTE: Modified orders maintain original start/stop date and time; system retains history. (Next medication dose scheduled at next scheduled time).

• Copy – This function will duplicate the order. This function should be used on a discontinued or completed order.

• Cancel/Reorder – This function should be used on an active order. The original order will be canceled and a new order with a new start date and time will be established. It is not recommended for Pharmacy or Lab orders; system DOES NOT retain history of the order.

• Suspend – Allows you to put an existing signed order (Medication or Diet) order on hold. Use the Resume function to place a suspended order back in an active status.

• Cancel/DC – Allows you to cancel a one-time existing signed order or discontinue a continuing order.

• Void (In Error) – Used to remove an order that was entered in error on the wrong patient. If the order was for a CBC, for example, and the lab was drawn and resulted; the status of the order will be Void with Results.

• Order Information – Gives details, additional information, history etc. about the order.


CPOE Education

To Modify an Order To modify an existing order while maintaining the original date and time, complete the following steps:

1. Open the chart to the Orders tab, 2. Right-click an order with the status of “ORDERED”.

3. Click Modify. 4. Select the detail/values you wish to modify.

5. When finished, click Orders for Signature.

6. Click Sign.

7. Click As Of….

NOTE: A Modified order maintains its original start/stop date and time. This function should be used when changing the dose, frequency or route of the medication order.


CPOE Education

To Copy an Order A quick and easy way to reorder a test and still have the ability to make order detail modifications are to Copy a previously ordered test. Only use Copy for orders already completed or discontinued, to avoid duplications. To use the Copy function:

1. With the patient’s chart open to the Orders tab, right-click an existing order.

2. Click Copy. 3. The date defaults to Today and Now. Make any necessary adjustments. 4. When finished, click Orders for Signature. 5. Click Sign. 6. Click As Of…

To Cancel/Reorder Cancels the original existing order and places a new order with a new date and time.

1. With the patient’s chart open to the Orders tab, right click an order

2. Click Cancel/Reorder. 3. Complete details for canceled order and new order. 4. When finished, click Orders for Signature. 5. Click Sign. 6. Click As Of…


CPOE Education

To Suspend an Order To suspend an existing medication or diet order, complete the following:

1. With the patient’s chart open to the Orders tab, right click an existing medication order

2. Click Suspend from the drop down menu. 3. When finished, click Orders for Signature. 4. Click Sign. 5. Click As Of…

To Resume a Suspended Order To resume an order that has been suspended:

1. With the patient’s chart open to Orders tab, right click on the Suspended order.

2. Click Resume from the drop down menu. 3. Click Orders for Signature. 4. Click Sign. 5. Click As Of…

To Cancel or Discontinue an Order To cancel a one-time existing signed order or discontinue a continuing order, complete the following steps:

1. With the patient’s chart open to the Orders tab, right click an existing order

2. Click Cancel/DC. 3. Verify the defaulted date/time.


CPOE Education

4. Click Discontinued Reason if you wish to add one.

5. Enter a reason. 6. When finished, click Orders for Signature. 7. Click Sign. 8. Click As Of…


CPOE Education

Placing and Processing Orders Care providers other than the physician will place orders in the medical record. These care providers will include the Nurse, Respiratory Therapist, Pharmacist, Radiology Technician, Physical Therapist and Dietician. The orders will be placed as a telephone or verbal order. Steps to place an order in OneChart are similar for each care provider. When orders are placed by a provider other than the physician, there will be an additional step in the ordering process.

To Place an Order for a Physician 1. With the patient’s chart open to the Orders tab, click on the +Add tab.

2. Click the order.

3. The Ordering Physician screen will display. Enter Physician Name,

Physician Number and Communication type.


CPOE Education

NOTE: Step #3 is the only step that is different when the order is entered by someone other than the physician. If multiple physicians with similar names are found, you will see an additional display “Provider Selection.”

4. Complete the Order Details.

5. Click Sign. The telephone or verbal order(s) will be

routed to the physician’s inbox for his/her signature.

6. Click As Of…to refresh the display.

NOTE: When a telephone or verbal order is given, the physician is encouraged to stay on the telephone or in nursing unit until the order is entered and the RN has read back the order as required by JCAHO. This will also allow the physician to respond to any alerts without the RN having to call the physician back to resolve any issues with an order.

NOTE: When orders are placed by the nurse, pharmacist, respiratory therapist or the

physician’s privately employed rounding nurse, these orders will always be telephone or verbal orders.


CPOE Education

To Process an Order from a Medical Student Orders placed by a Medical Student will not be acted upon until signed by the supervising physician. The orders will remain in an “On Hold, Medical Student (On Hold)” status until approved with the signature from the supervising physician. The Cap icon will display to the left of the order.

The supervising physician or resident will need to cosign the orders. This may be done directly from the Orders tab. 1. Highlight the order(s) that need to be cosigned. (You may hold down the shift key

and press the left mouse to highlight a section of orders to cosign.) 2. Right click and select Cosign (No Dose Range Checking).


CPOE Education

3. The orders will display for review. If correct, you may click the box in the bottom

left to check Select All. Click the Cosign button at the bottom of the view.

Once the orders are cosigned, the Cap icon will be removed and the status of the order will change to Ordered (Scheduled).

NOTE: If the supervising physician or resident does not agree with the order the medical student has placed, the order may be modified directly from the Orders tab or from the Inbox.

To change the order from the Orders tab:

1. Right click on the order. 2. Click modify. The order detail window will open for modification. 3. Change the details. 4. Click Sign.


CPOE Education

To Process an Order from a Nurse Practitioner or Physician Assistant Orders placed by Nurse Practitioners and Physicians Assistants will be acted upon immediately and will not be routed to the inbox for physician cosign. It is the supervising physician’s responsibility to assure compliance with order review and monitoring.


CPOE Education

Creating and Organizing Your Favorites Folders Favorites Folders contain commonly used orders that you have customized, saved and organized. These saved versions are not automatically updated when there are formulary changes etc. However, they will serve you well in providing advantages in caring for your patients. Some advantages to setting up Favorites include:

• Accessed only by you. This helps eliminate the error that is possible using shared folder when you are not sure what might have been changed by another provider.

• Expedites and simplifies the ordering process. If you use many orders in a standard manner, you can click and order rapidly using your personalized orders.

• Order details can be modified per patient at the time of placing the order. You can have easy flexibility to better meet individual patient needs.

• Easy to create and delete. You will learn the basic steps, have help in creating your base set and then be able to maintain your own folders.

To Navigate Through Favorites Folders At the Add Order display menu, there are four Icons below the Find box of the Add Order Display.

Up Arrow on the far left provides navigation back to your previous folders view. HOUSE icon - displays your selected “home” folder STAR icon - displays all Favorite Folders CARET or down arrow icon - displays “Organized Favorites” FOLDER icon displays the “home” folders

To Set Up Favorites To set up and organize Favorites Folders:

1. Open the Orders tab.

2. Click on the +Add tab. 3. Click the caret to display Organize Favorites drop down menu Organize.


CPOE Education

4. Select Organize Favorites. 5. Click Create Folder.

6. Name your folder. The words New Folder will be highlighted. You may type your

preferred name in this highlighted field.

7. Click Close.

To Add Orders to the Favorites Folders 1. With the patient’s chart open to the Orders tab.

2. Click on the +Add tab. 3. Search for the desired order and complete the order details. 4. BEFORE signing the order, right click. 5. Click Add to Favorites.

6. Highlight and click the folder in which the Favorite will be placed.

NOTE: You can customize selected orders(s) from an Order Set and save it to

the Favorites Folder, but you CANNOT customize an entire Order Set and save it. You can save Generic Order Sets in your Favorites Folder and set it as your HOME folder


CPOE Education


CPOE Education

To Delete, Rename or Remove an Order from Your Favorites Folder 1. From the +Add Order window, click the Caret icon. 2. Click Organize Favorites from the drop down menu.

3. Highlight the folder you want removed. 4. Click Delete, Rename or Remove. 5. Click Close.


CPOE Education

Understanding the Soft Stops To Respond to a Soft Stop A Soft Stop is when an order has an automatic discontinue date and time (according to policy) that triggers a reminder to the provider. The Physician must renew the order or discontinue it to clear the hour glass notification. The order will continue until the order is renewed or discontinued. An example of an order that will automatically have a Soft Stop applied is the respiratory treatment orders.

After 72 hours, the Soft Stop icon (yellow hour glass) will display to the left of the order name on the Orders tab. This icon indicates that the order must be renewed per policy.


CPOE Education

Entering Lab Orders The Lab has set times for Routine collection of specimens. When you specify Routine, the order will be executed on the standard schedule. Routine is the proper priority for Once orders in which the lab test does not need to be drawn at a specified time. If you wish a test to be drawn at a specific time or collected with a frequency, specify the test as a Time Study.

To Enter a One Time Lab Order (to be drawn based upon the Lab’s Routine collection times/policy):

1. Select the Lab Order from the Add Order search display 2. Select the appropriate order sentence from the window e.g. T;N, Routine

T = today N= Now

3. Select specimen type e.g. Blood, etc 4. Review order details:

• Collection Date/Time = keep today’s date and current time.

• Collection Priority = Routine.

• Frequency = how often? (Example 1x, TID) An order is considered a one time order….IF you do not enter a frequency detail value.

• Duration / Duration Unit = how long? Works together to set when an order will end

• Specimen Type = Blood, Urine, etc.

• Nurse Collect = Yes or No • Collected? Status = Yes or No

5. Click Sign. 6. Click As Of…


CPOE Education

To Enter One Time Lab for a Specified Date/Time 1. Click Lab Order from the Add Order search display. 2. Select the Priority of Time Study.

3. Change the Collection Date and Time to the date and time the lab is to be drawn. 4. Click Specimen Type, e.g. Blood. 5. Frequency and Duration and Duration Unit will remain blank. 6. Click Sign. 7. Click As Of… to refresh the view.

To Enter One-Time Lab STAT Order

1. Click Lab Order from the Find search window. 2. Click the order sentence (blood, STAT). 3. Verify Order Details are correct. 4. Collection Date/Time = can keep defaulted to today’s date and current time. 5. Collection Priority = STAT 6. Frequency, Duration and Duration Unit = BLANK. 7. Click Sign. 8. Click As Of…

NOTE: For all STAT Orders, a phone call must be placed by the provider.


CPOE Education

To Enter a Time Limit/Stop Date for the Order In order to enter an order that will be drawn with recurring frequency and on a specified time frame, complete the frequency, duration and duration unit to set a time limit/stop date for the order:

1. Click the Lab Order from the Add Order search display. 2. Click the appropriate order sentence from the window list. 3. Verify Order Details:

• Collection Date/Time = Date to begin; set to the time lab should be drawn.

• Collection Priority = Time Study.

• Frequency = q24H, q12H, q8H, q4H, QDay, QOD as examples.

NOTE: Any lab with a frequency must have a priority of time study.

• Duration = number needed

• Duration Unit = day, dose, hr, min, month, occurrence, sec, week, year

To Enter AM Lab Orders When placing an order for lab in the AM:

• The collection date should be changed to tomorrow’s date.

T+1 = tomorrow

• The collection time should be changed to 0400 • The priority should be routine.

To Enter Peak and Trough Orders The physician will place an order for the Peak and Trough level. The nurse will then place another order verifying the time the level should be drawn.

To Enter Nurse Collect Lab Orders When lab is ordered, an order detail of Nurse Collect should be reviewed and changed if appropriate. Depending upon the patient’s location in the hospital, this field will default. If the patient’s location is in the Emergency Department or Critical Care, the nurse collect field will default to “Yes” for a nurse collect of the specimen. If the patient is in any other area of the hospital, the nurse collect will default to “No” for nurse collect.


CPOE Education

Entering Radiology Orders 1. With the patient’s chart open to the Orders tab, click +Add button. 2. Click Add Order. 3. Search for the order or select from your Favorites folder. 4. Click on Reason for Exam (this is a required field)

5. Select option from drop down menu

6. Complete or change any fields as necessary 7. Click Sign. 8. Click As Of… to refresh view.

To Modify Radiology Order During a Procedure With or Without Contrast is a common modification to an order that is determined by the Radiologist or through a discussion with the original ordering physician. Consulting the ordering physician is not mandated. If the procedure is changed to include contrast, the Radiology Technician will modify the order to include the contrast. The revised order will include a Comment containing the Radiologist Name and Reason for the change.

NOTE: Additional details the Ordering Physician wishes to share with the Radiologist can be typed in the Comments section. However, the contents in this section are not visible in the order itself. Do not put order specifications in the Comments.

To Change to the Actual Procedure If the patient is critical or in a life threatening situation, the Radiologist will contact the ordering physician for confirmation of further study. Further study or a change in the original order, such as a change of this procedure from abdominal to abdominal pelvic exam, will be determined by the patient’s condition. The additional order can be placed by the Radiology Technician under the name of the original ordering physician.


CPOE Education

If the patient is not critical or in a life threatening situation, the original procedure ordered will be performed and the Radiologist will include recommendations in his/her dictated report. The original ordering physician should then order further study if deemed necessary after reading the recommendations in the report.


CPOE Education

Entering Diet Orders The patient should have only one active diet order at a time.

1. With the patient’s chart open to the Orders tab, click +Add button. 2. Click Add Order. 3. Type Diet or the specific diet name in the Find field. 4. Click the diet preferred. 5. Make any detail modifications.

i. 6. Use Order details and Detail values or use Order Comments tab to add any

additional comments for dietary.

7. Click Sign. 8. Click As Of… to refresh the view.

To Delay Diet oneChart includes an order to delay a patient’s diet. The order details include start and stop delay diet date and time. The nurse will monitor the patient’s care to be aware when the patient should be placed back on a diet. The nurse will pursue an order for resumption of the diet. The physician may also discontinue the delay diet order before the stop delay diet date and time on the original order is reached.

NOTE: If changing diet, CANCEL the current diet order and enter a new diet order.


CPOE Education

To Order NPO at Midnight The physician will place an NPO when appropriate. Enter the specific date and the time as 2359. Do not enter the time of 0000 as the system will not accept this time.

The nurse will monitor the patient’s care to be aware when the patient should be placed back on a diet. The nurse will pursue an active diet order for the patient. The physician may also place an order for an active diet when appropriate.


CPOE Education

Managing Medication Orders Using oneChart

oneChart provides medication information and order management through several methods. The three primary views of medication administration are the MAR (Electronic Medication Administration Record or eMAR), Meds (includes the Medication Profile) and the MAR Summary. These are tabs available in the Patient’s Electronic Medical Record.

Viewing the MAR Summary The MAR Summary provides a listing of medications that have been ordered, times administrations are due and the actual time medication was administered to the patient.

To View the MAR Summary 1. Open the patient’s electronic medical record. 2. Click the MAR Summary tab.

The Mar Summary will open.


CPOE Education

The patient’s medications will be listed in the left column of the screen, divided into the categories of:

• Scheduled (The row color will be Blue)

• PRN (The row color will be Green)

• Continuous Infusion (The row color will be Blue) The medications will display in alphabetical order within the category. The columns displayed to the right of the medications listed defaults to 4-hour intervals.

To View the Medication Status and Documentation The Medications detail displays in color coded status:

• Blue – Current or future medication dose

• Green – PRN medication dose

• Gray – Canceled or discontinued medication

• Red - (with an Alarm Clock icon)– Past Due Dose

PRN


CPOE Education

• Yellow –Current date and time interval column Documentation on medications administration will display as follows:

• If the medication has been administered, the block will document the dosage and time administered.

• If the medication was charted as not given or not done, this will display in the time block and if documented, a reason will display.

• If the medication is for pain, the pain intensity will be documented. • The time and volume started will display for intravenous fluids.

To Change the MAR Summary Display

1. Click Compass icon, left of Search Criteria bar. 2. Click Change Properties, Intervals or Navigate to.

. Change Properties opens the MAR Summary Properties window that includes tabs for changing:

• Date Range (from and through date plus column time intervals)

• Filters (selection or deselection of scheduled, PRN and Continuous meds plus Inactive orders)

• Options (selection or deselection of IV rate change, bolus, infusion volume documented and site change)

NOTE: Changing Properties keeps settings for the current patient only.

The MAR Summary display defaults to the Time View to a maximum of 12 hours in four-hour increments.


CPOE Education

Change Interval - Allows selection of time intervals for the medication columns. The

time columns will default to an every 4 hour view.

Navigate To - Moves Scheduled Meds, Unscheduled Meds, PRN or Continuous Infusions to the top of the view.


CPOE Education

To Change Your Default View 1. On the menu bar click Options.

2. Click Change Defaults. The Mar Summary Defaults window will open. 3. Modify any of the following Default Settings can be set and maintained for your

login only and will be the same from patient to patient: a. Minimum Hours Back b. Minimum Hours Forward c. Column Time Intervals d. Each Day Begins At e. Font Size

4. Click OK.

To Use MAR Summary Primary Icons

Eyeglasses - order is pending nurse review.

Mortar and Pestle - order is pending pharmacist review.

Ringing Alarm Clock - medication administration is past due.

Yellow Delta – mediation has been modified.

Push Pin - a pharmacy comment has been entered.

Yellow Hourglass- medication needs to be reordered.

Pharmacy Refused Order- red exclamation point.


CPOE Education

Navigating the Electronic MAR (Medication Administration Record) The MAR provides an alphabetical listing of the medications ordered, times due and administered to the patient. The MAR and MAR Summary provide essentially the same information. The MAR presents this information in a slightly different format. The MAR provides a Time View and Therapeutic View of the patient’s medications. To view the medication administration record:

1. Open the patient’s chart. 2. Click the MAR tab. The Time View if the default view.

The categories in the Time View include:

• Scheduled - Scheduled frequency medications. • Unscheduled - On-Call (Vaccines) and Per Parameter (not scheduled used for a

specific condition) medications. • PRN - PRN meds with time given • Continuous Infusions - Continuous IV administration

• Future - Future scheduled medications

• Discontinued - Discontinued medications and time of administration. Includes: Discontinued Scheduled, Discontinued Unscheduled, Discontinued PRN and Discontinued Continuous Infusions.

The Therapeutic Class View arranges medications in drug categories, e.g. Cardiovascular.

3. Click the Therapeutic Class View at the bottom of the Navigator column. The medications will be reorganized by drug type.


CPOE Education

4. Click the plus (+) to the left o the category to view the medications listed in that category and the related status.

To Review Medications The medications on the MAR will display as on the MAR Summary using the same color coding for status:

• Blue – Current or future medication dose

• Green – PRN medication dose

• Gray – Canceled or discontinued medication

• Red – Past Due Dose (will display red, one hour after administration time)

The same icons with the same meanings appear on the MAR as on the MAR Summary:

Eyeglasses - order is pending nurse review.

Mortar and Pestle - order is pending pharmacist review.

Ringing Alarm Clock - medication administration is past due.

Yellow Delta – mediation has been modified.

Push Pin - a pharmacy comment has been entered.

Yellow Hourglass- medication needs to be reordered.

Pharmacy Refused Order- red exclamation point.


CPOE Education

To Use MAR Filters The first time the MAR is opened, the oneChart user must apply filters for the MAR view. If this is not done the medication names and times of administration will not appear on the MAR display.

To set the filters for the MAR display:

1. Click Option on the top menu bar and 2. Click Filters.

The Order Filters window opens.

3. Click each check box so that all categories will appear on the MAR.


CPOE Education

4. Click OK. The filters will be applied and the medications with time of administration will display.

To Modify the MAR View Scroll Bar - Use the scroll bars on the bottom or on the right side of the window to view administration times.

Date Range - To change your Clinical Range to different time/dates: (see top light blue bar)

1. Right click the Date Range Bar.

2. Click Set to Today or to Change Search Criteria (adjust the date & time).

3. Click OK.


CPOE Education

To Review Order Details The medications column displays the medication’s name and order details including frequency, date and time. To view order info:

1. Right click on the selected order. 2. Click Order Info.

3. Click the Details tab to view order details. 4. Click the Comments tab to view any text comments. 5. Click the History tab to view order history, including modification and

statuses. 6. Click the Results tab to view order results on the flowsheet. 7. When done, click the X on the upper right corner of the Order Information

window


CPOE Education

To Recognize Differences with eMAR Clinical information currently documented on the paper MAR will not be viewed on the oneChart eMAR. This information will be available to view on the Lab and IView tabs. The clinical information that will not be viewed on the eMAR includes:

Heart Rate (Digoxin) INR (Warfarin) Heart Rate and/or Blood Pressure (Beta Blocker) Blood Pressure (Nitrol Ointment) Potassium level (Intravenous KCL) Glucose level (Sliding Scale Insulin) APTT (Heparin)

Only in specific circumstances will Physicians document Medication Administration. There are a few medications that may only be administered and documented on the eMAR by ED Physicians and Anesthesiologists.

To Document Administration of a Medication 1. Enter an order for the medication. 2. Double click on medication task to be administered in eMAR.


CPOE Education

3. The MAR charting window will open.

To Correct a Medication Not Displaying Correctly When a medication administration task is being signed as given, the fields of dosage, volume, diluents or route on the medication administration window may be changed. The information changed will display on the administration line. This should only be done with a PRN medication when the dose should be divided. If the medication information is not displaying correctly in the medication administration window:

1. Click the Orders tab. 2. Right click on the medication in error. 3. Click Modify. 4. Select the detail/values you wish to modify. All items highlighted in yellow are

required,

5. When finished, click Orders for Signature.

6. Click Sign.

7. Click As Of….

8. Sign the administration of the medication by clicking the green ( )check mark (upper left hand corner)


CPOE Education

The screen will return to the MAR display.

The time block on the MAR will display with a check mark and the word Complete.

Once As Of… is clicked, the Auth/Verified will display under the time block, indicating the administration of the medication.

NOTE: The nurse can open the medication administration task and change the Performed By name to the physician. This is not recommended but can be done in emergency situations.

Medications may only be back charted for 48 hours. If a nurse or physician omits to document the administration of a medication, the proxy function may be used

To Unchart a Medication Administration 1. Click on the MAR tab. 2. Right click on the completed medication task. 3. Click Unchart. 4. Type the reason that the medication is being uncharted. 5. Click Sign.


CPOE Education

The task is placed back on the MAR and In Error is displayed below the medication to indicate that it was uncharted. If the medication task is completed at a later time, the Auth/Verified will display to the right of In Error display.

To Reschedule a Single Dose 1. Click on the MAR tab. 2. Right click on a blue medication task and 3. Click Reschedule This Dose.

The Reschedule window will open.

4. Change the Rescheduled date and time. 5. Click a Rescheduling reason from the drop down list. 6. Click OK.


CPOE Education

To Reschedule All Medication Doses 1. Click on the MAR tab. 2. Right click on the Medication Name.

3. Click Reschedule Medication Times. 4. Change the medication times appropriately.

NOTE: If a single dose of medication is rescheduled, please note the subsequent medication due times will not change. If it is too close to the upcoming administration time, omission should be considered

NOTE: This option will allow rescheduling of all medication administration times. The selection of Reschedule Medication Times is also an option from the Orders tab, as long as the medication name is used with the right click function.


CPOE Education

To Void a Medication 1. Click the Medication section on the Navigator Bar of Orders tab. 2. Right click on the medication order.

3. Click Void in error.

The system will place a line through the medication and the status will be void. 4. Click the orders for signature

5. Sign the order. 6. Click the As Of… button.

To Order First Dose STAT

Select STAT in the order detail of Pharmacy Order Priority (order details will show as above). When ordering First Dose as STAT, a red exclamation mark (!) shows on the MAR.

NOTE: This may only be performed on medications with an hourly frequency.


CPOE Education

To Resolve Medication Errors ISSUE SOLUTION Medication dosage, route or frequency not displaying correctly on the MAR

Modify the original medication order on the Orders tab.

Medication order placed on the wrong patient and administered.

Void the original medication order on the Orders tab.

Medication ordered on correct patient but administered to wrong patient

MD notified, error documented on clinical note with a subject of Medication Admin.

Patient is off of the unit at the time of scheduled medication

Reschedule the medication administration time if appropriate.

Accidentally signed off the wrong medication

Unchart the administration of the medication

Medication ordered incorrectly but signed off anyway

Unchart the administration of the medication and Modify the medication order. Sign off the corrected medication order on the MAR.


CPOE Education

Navigating the Meds Tab With the patient’s chart open, click on the Meds tab. The Medication Profile is displayed. In the Medication Profile there are four categories/folders of medication information:

Name Contains

Medication(s) Being Given – Current: Inpatient Medications ordered on the current admission/ encounter in active order status.

Medication(s) Being Given – Past Medications discontinued during the current admission/encounter or automatically by the system when a patient is discharged..

Prescription(s)/ Home Medication(s) – Current:

Home medications entered by the nurse or verified by the nurse for the current admission/encounter. Home medications that were entered on previous admissions will also display in this folder. The nurse will verify the status of these home medications with each admission.

Prescription(s)/ Home Medication(s) - Past

Home medications the patient has taken and reported on an admission in the past.

To Sort by Columns

1. Click on the column header Name to sort the medications in alphabetical order. 2. Click again to reverse the sort.


CPOE Education

You may also sort by Provider, Start, Last Given, etc.

To Change View

Click the Change View button (top right) to display the Medication View listing all meds together (current, past, inpatient and home).

To Change Medications on the Medications Profile The nurse will add the patient’s home medications to the Prescriptions(s) Home Medications when admitting the patient. If you review these medications and recognize errors or omissions, you may Add Medications by Hx (History), Modify Home Medications, or Discontinue Home Medications. .

To Add Medications by History (Home Meds):

1. Right-click on Prescription(s)/Home Medication(s). 2. Click Add Medication by Hx (History). 3. Type in medication name.


CPOE Education

4. Click the Product button.

5. Click Search. 6. Click on a medication from the list. 7. Click on an available choice of common Rx (form, route, frequency, and dose. 8. Click Select to display the medication in the Easy Script prescription and

Scratch Pad areas. (SHOW Rx and Scratchpad areas). 9. Return to the Search field and continue to enter the name of another

medication until all home meds have been entered. 10. If all meds are correctly entered, click the Sign Orders button and the

additional orders will display in the medication profile.


CPOE Education

After the nurse enters the Home Medications to the Prescription(s) Home Medications, a validation status of the home medications will be entered and display:

Validation Complete – All home medications verified and entered. Validation Incomplete – List incomplete but awaiting medication information Validation – No Home Medications Validation – Unable to Obtain after all avenues exhausted NOTE: As the Validation Status changes, the status will be updated.

To Add Unknown Meds There are times when a patient is taking a home medication that you cannot identify. To document the unknown medications:

1. Right-click on Prescription(s)/Home Medication(s). 2. Click Add Medication by Hx (History). 3. Type in Unknown. 4. Click the Product button. 5. Click Search and the Unknown medication categories will display. 6. Click on one of the unknown medication selections. 7. Click Select to display the medication in the Easy Script prescription. 8. Click on the word <NONE> next to the COMMENTS and 9. Enter the description of the unknown medication eg:“little pink pill”.

NOTE: A Paper Clip will appear on the Scratchpad. Place the cursor over the Paper Clip to view Comments

10. Click Sign Orders and the additional unknown medication(s) will display in the medication profile.

11. Click the As Of button to update the Meds tab view.


CPOE Education

To Modify Home Medications At times you may want to modify or complete a home medication entry.

1. Right-click on a medication located in Prescription(s)/Home Medication(s) under the Current folder.

2. Click Modify. 3. To modify, click in the field and change the information.

4. Click Sign Orders.

5. Click As Of… The modified order displays on the Medication Profile.

To Discontinue a Home Medication 1. Right-click on the medication you wish to discontinue on the Prescription(s)/Home

Medication(s) under the Current folder. 2. Click the Cancel/DC.

The Cancel/DC Order window opens.

3. Double-click the Comments < > to enter a reason for discontinuation (e.g... “Pt

reports that she has not taken Plavix for the last 2 months”).


CPOE Education

4. Click Sign. 5. Click the As Of…to refresh your view.

NOTE: The order no longer displays in the Current Folder. It has moved to the Past Folder under Prescription(s) Home Medication (s)

To Convert a Home Medication to an Inpatient Medication Upon admission the nurse will document current home medications in the Prescription(s) Home Medications. If you want to administer any of those current home medications as an inpatient medication, you may convert the home medication to an inpatient medication. To Convert a Home Medication to an Inpatient Medication:

1. Right click one or multiple home medications. 2. Select Convert to Inpatient Medication Administration. 3. Click a formulary match. 4. Modify/complete order details and review.

5. Click OK.


CPOE Education

6. Click Sign. 7. Click As Of…

NOTE: Converted order(s) will display under Medication(s) Being Given in the Current folder.


CPOE Education

Preparing Discharge Prescriptions To Perform Medication Reconciliation at Discharge If the Physician calls in scripts and documents them in a note or if he/she gives the patient handwritten scripts on a personal script pad, the RN should update Medication Profile, as is the current practice, in preparation for discharge.

To Convert Inpatient Medication(s) to a Discharge Prescription To expedite the discharge process, use the Convert to Prescription option. It is not required that the physician use Easy Script to generate the discharge prescriptions, but it is recommended. There are three ways to prepare a discharge prescription:

• convert an inpatient medication, • convert a historical medication, and • enter a new prescription.

When using one of these three methods you will see the following view.


CPOE Education

As you complete a prescription in one of these three ways, you can see your prescribed medications at the bottom of the view with the details.

To Convert Inpatient Medication(s) to a Discharge Prescription To expedite the discharge process, use the Convert to Prescription option. It is not required that the physician use Easy Script to generate the discharge prescriptions, but it is recommended.

1. Open the patient’s chart to the Meds tab. 2. Click Medication(s) Being Given – Current folder.

3. Right click a single order. 4. Click Convert to Prescription. The prescription view/ Easy Script Prescription

Pad will open.

NOTE: This Easy Script view will act as your prescription pad. Anything you enter on this view appears on the printed prescription.

For convenience you may wish to keep Quick sig checked on the prescription view. When Quick sig is unchecked the dose, route and frequency columns are separated and each has its own drop down list from which to select. With Quick sig checked, the dose, route and frequency are grouped (as in the sample above) for that medication and the most common appears in the drop down list. Checking Short list will limit the drop down display to the most commonly used dose, route and frequency. To see a full range of choices, uncheck both Quick sig and Short lists.


CPOE Education

5. Complete the required fields marked in RED such as:

• Disp/Supply: Free text a number between 1-999 or a description such as 1Cap, 1Unit, 1Tube, etc.

If a wrong value is entered, a drop down list displays.

6. Click the appropriate option. 7. Press ENTER. 8. Specify Refill by clicking to the right of the field label. 9. Click the number of refills from the drop down list or type in the number in gray

blank. 10. Specify the Stop Day. If duration is specified, the stop day is automatically

calculated.

If not, click the Stop Date field to display an arrow 11. Click on the arrow and use the calendar to make your selection. 12. To print the prescription, prior to signing, change the Routing Option and/or click

to include an Educational Leaflet. Specify English or Spanish version of the leaflet.

13. Click Convert.


CPOE Education

14. Click As Of… to refresh the view.

NOTE: Inpatient medications that are not converted to prescriptions are automatically discontinued upon discharge.

To Convert Historical (Home) Medication(s) to a Discharge Prescription 1. Open the patient’s chart to the Meds tab. 2. Click Prescription(s)/Home Medication(s) Current. 3. Highlight medication. 4. Right click. 5. Click Duplicate/DC.

6. Check for correctness on Easy Script Prescription Pad. 7. Uncheck Historical Rx on the right bottom of the Easy Script Prescription Pad.

8. Prior to signing, you may opt to print the prescription by changing the Routing Option and/or include Educational Leaflet by selecting that option.

9. Click Sign. 10. Click As Of …. 11. Medication will now have an Rx instead of Hx.

To Write a Discharge Prescription for a New Medications(s) 1. Right click on the Medication Profile located on the main menu toolbar. 2. Click on Prescribe.

3. Click on the Search area at the top left of the window.


CPOE Education

4. Click the Product button.

5. Enter the name of the medication (or the first 4 letters) in the Search field. 6. Click the Search button or press the Enter key.

7. Highlight the appropriate medication. 8. Click the Select button or press the Enter key. 9. Enter/Verify the following fields as appropriate:

• Dose

• Frequency

• Instructions

• Comments

• Route

• Duration

• Indications

The fields in RED are required.

10. Click on the Refill field if desired. 11. Click on the appropriate number. 12. Click on the Prescribe field to choose the Provider prescribing the medication


CPOE Education

13. Prior to signing, you may choose to print the prescription by changing the

Routing Option and/or include Educational Leaflet. 14. Click Sign Orders on the bottom right hand side of the screen or the button

located on the main menu toolbar. 15. Click the As Of… .


CPOE Education

To Print Prescriptions

The default setting is to Print Rx. To prevent printing a prescription, click Document (don’t print) Rx. The default printer must be used. The physician must personally print all Schedule II medication prescriptions. The nurse will be able to print all other prescriptions. State law requires the physician’s handwritten signature on all prescriptions. NOTE: Only certain printers will have the appropriate paper to print a prescription. These

printers have a designated paper drawer containing the required tamper proof paper. When prescriptions are printed ahead of discharge, they will be attached to the discharge documents ready for physician signature.

If the option to print the prescription was not chosen when the medication was converted or created as a discharge prescription, you may print at a later time.

1. Highlight the discharge prescription medication. 2. Right click. 3. Click Print Rx. –

NOTE: All prescriptions must have actual signature before giving to patients.


CPOE Education

To Add/Remove Prescriptions to Your Favorites/My List 1. From the Easy Script Prescription Pad display, click the Product button. 2. Enter the name of the drug. 3. Click Search.

4. A list of drugs will display. Double click the appropriate drug. The drug selected

will display in the Easy Script window. 5. If necessary, modify the drug information. 6. Look at the Rx list below the Easy Script pad and the drug will be displayed. 7. Right click 8. Click Add to My List.

The medication will now display under the tab, My List, located on the left upper corner of the Easy Script window.


CPOE Education

To Use My List The My List tab in the Orderable Selection pane contains a list of favorite Medications and their associated order sentences, which are unique to each oneChart user.

1. Click the My List tab in the Orderable Selection pane.

2. Review the list of available medications. 3. Select the medication you want. (Add additional details such as number to

dispense and number of refills, as well as any customary instructions you use to save a personalized favorite that can provide a complete order in one click.)

4. Click Select. oneChart displays the order sentence in the Prescription Pad.


CPOE Education

To Remove a Medication from My List 1. Click the My List tab. 2. Highlight the medication to be removed.

3. Right click. 4. Click Remove.

To Print an Education Leaflet 1. Complete prescription as normal. 2. Click on Leaflet. 3. Click English or Spanish from the drop down list. An education leaflet will

automatically print with the prescription.


CPOE Education

Performing Medication Reconciliation Medication Reconciliation is performed at admission, transfer to another level of care and discharge. Medication Reconciliation is required prior to prescribing inpatient medications, upon transfer or prescribing discharge medication. Medication Reconciliation allows the physician to make the best decisions regarding the medication regime. Prescriptions called into the patient’s pharmacy or handwritten on a prescription pad will also need to be added to the historical medications record in oneChart. This step is important to maintain a complete record of the patient’s discharge medications and provide medication reconciliation proof.

To Reconcile at Admission, Transfer or Discharge To perform medication reconciliation upon admission, transfer and at discharge: Open the Meds tab to review the current inpatient and home medications. The medications will be listed in the Medication(s) Being Given and Prescription(s) Home Medication current folders.

Suspend and Resume Orders When a patient is administered general anesthesia, the review of the patient’s active orders is required post procedure. Use oneChart Suspend and Resume functions to complete this review and action. General Information - Suspend and Resume

• The Order Details of the original order will be retained with the suspend action.

• Once an order is suspended, it will remain suspended until an order action is taken.

• Order actions that can be taken on a suspended order: o Review. o Cancel/DC. o Resume.

• Only active orders may be placed in a resume status.

• The suspend and resume order actions in PowerChart are not passed to the Lab (PathNet.)


CPOE Education

• Groups of like orders can be suspended together if all highlighted. Others should be suspended on an individual basis..

• If the order has a duration in the order detail and is suspended, once resumed, the count will start over.

Orders that can be suspended include: Orders that cannot be suspended include:

1. Medication Orders with a continuing frequency

1. Orders with a Once frequency

2. PRN Medication 2. Medications with a frequency of Once

3. Continuous Intravenous fluids 3. All Lab

4. Diet Orders 4. All Radiology

5. Orders with tasks –

Examples include:

• Home Medication History

• Pneumococcal Administration Screening

• Admission – Adult task

• Physician Consult

• Oxygen Saturation – Spot Check

6. Orders from Consults –

Examples include:

• Rehab Return Visit

• RT Treatment

• ET Follow Up

• PICC Follow Up

• Ancillary Courtesy Evaluation

• Case Manger/Social Worker Follow Up


CPOE Education

To View Suspended Medication on the eMAR • Suspended medication orders maintain one row on the eMAR.

• The administer task will be dithered (grayed out).

• Suspended medication orders will display in the original category on the

eMAR if the filters are set to display suspended medications.

• If a medication is ordered every four hours and is suspended at 0801, oneChart will leave the task for the 0800 medication and suspend the following doses.

• Orders not needed at transfer can be canceled.

To Suspend and Resume for Surgical Procedures 1. The nurse from critical care, floor or Same Day Surgery (SDS) will place orders in a

suspend status and complete any patient care orders possible. 2. Once the procedure is completed, the Anesthesiologist will place a post anesthesia

care set. This care set will be completed or canceled/discontinued prior to the patient’s departure from PACU.

3. The surgeon should open the orders tab and place the post operative order set.


CPOE Education

4. The orders view should then be changed to view the suspended orders. The surgeon should then right click and resume those orders that should be continued post operatively, modify or discontinue remaining orders.

• Right click suspended medications.

• Click Resume.

5. If there are suspended orders the surgeon does not feel are appropriate for him/her to resume, a nursing communication order should be entered to consult the physician responsible for these orders. The appropriate physician should then continue, modify or discontinue the designated order(s).

6. The nurse on the receiving unit will review and implement the post operative orders.

To Transfer to Another Level of Care 1. The physician places an order for transfer to another level of care.


CPOE Education

2. Click on the Meds tab and perform Medication Reconciliation. Review all active inpatient medications and current home medications.

3. Click on the Orders tab to manage the patient’s orders. 4. To focus on current orders only, the physician may change the order display to list

only active orders.

5. The active orders in all categories should be reviewed to determine if appropriate to

continue once the patient has transferred. 6. Action is not required on the orders that should continue without modification. 7. The appropriate right click action (e.g. modify, cancel/reorder, cancel/DC) should be

taken on any order that requires modification. 8. The nurse should review the patient care orders and complete all orders that have

been implemented and will not be continued after transfer.

9. The nurse on the receiving unit will review and implement the transfer orders. 10. If the transfer is delayed, the orders should be reviewed for any modifications.


CPOE Education

Entering Orders for Discharge When it is time to discharge the patient, the physician should complete the following steps:

1. Place an order for discharge.

2. Click on the Meds tab and complete discharge medication reconciliation. 3. Convert medications for discharge from the current inpatient and home

medications using Easy Script.

4. Prescribe any new medications for discharge using Easy Script.

5. Print Schedule II prescriptions. (The nurse will be unable to print these.) The physician must sign the prescriptions for the Schedule II medications.

6. Place additional discharge orders/instructions utilizing the discharge

instructions and discharge planning orders.


CPOE Education

Handling Alerts To Respond to an Allergy Alert When you order a medication to which the patient is allergic, if the allergies have been recorded in the electronic medical record, the Discern Alert for that allergy will display. If the patient has no allergies recorded when a medication is ordered, the alert displays with the message “There are no recorded allergies on the patient. Please obtain allergies.” To update allergy information:

1. Click OK on the Discern Alert. 2. The Order screen displays. 3. Click +Add tab and click Add Allergy to enter the allergy.


CPOE Education

The Drug Alert shows the Status of the allergy, the Type allergy, the Severity of the allergy and if an Override has been entered related to the allergy and the ordered medication. Drug Incompatibility/Interaction Discern Alert When a medication is ordered that is not compatible with other medications that are current, a discern alert will display alerting this possible adverse effect. The option to cancel the order or override the discern alert is available. Weight Discern Alert When a medication is ordered on a patient, the Weight Not Charted alert will display if an actual weight has not be recorded on the patient. Meds orders can still be placed but physician is cautioned that dose range checking cannot occur. It is a soft stop, not a hard stop, so orders can be placed if they need to be. If the physician knows a weight and wants to chart it they can do so. You can enter the weight by clicking on Chart Weight. Certain medications require an entered weight before you can complete order.


CPOE Education

To Enter the Missing Weight 1. Enter the weight in kilograms 2. Select the method of weight

3. Click green check mark to Sign. Non – Formulary Alert When a medication is ordered that is not included in the Methodist Formulary, an alert will display. If a physician selects a non-formulary medication that is in the medication catalog, you will be required to chart a reason for ordering a non-formulary medication. If you receive the message to pick a reason for using a non-formulary drug, consider changing meds to one on formulary. If you continue with the non-formulary choice, you may receive a call from pharmacy to confirm your selection.


CPOE Education

To Order a Non-Formulary Medication 1. Click Add Order for non formulary med. 2. Click OK. oneChart will open Order details for entry of the non formulary drug.

3. If you do not choose to enter the formulary medication option, instead of selecting

that option, the user should just click OK. 4. Enter a Pharmacy Formulary Override Reason by clicking the selection under

Detail values.


CPOE Education

The screen will then return to the order search window allowing you to make another selection.


CPOE Education

To Resolve a Duplicate Order Alert When orders are placed that are currently active for the patient, the system will display the Duplicate Order alert. Click Order Anyway, Remove, Cancel/DC or Modify. An example when you would want to Order Anyway is to order a lab for now and repeat it in the morning. Remove deletes the most recent order. Cancel/DC removes earlier orders. Modify gives you the opportunity to change order details.


CPOE Education

Dr.Cantral James Anderson,M.D.

Documents

individual order

order sentences

order commandsright

suspended order

standardized order sets

order default viewfilters

common order set

order command menu