Ordering Specific Medications Any medication can be ordered individually. These can be searched by either the brand or generic name. NOTE: The search field setting of either starts with or contains can alter search results. Ordering Specific Medications (con t) All order sentences following the word Reference:*** ***Pediatric Dosing Below*** as displayed in the following image, are Pediatric specific. ***Neonatal Dosing Below*** as displayed in the following image, are Neonatal specific. Ordering medications in Ordersets are disease or indication specific. Complicated medication orders (requiring labs, monitoring, etc.) should be ordered through the Orderset: Any fields with an asterisk (*) are required. Required fields that are not complete will be highlighted in yellow. Once all yellow fields are completed, the order can be signed and processed. Best Practice: To place a completed medication order, six items are needed: Drug Dose Dose Unit Route Frequency Indication Medication Order Entry Dose Calculation Dose calculation may be required for specific medications and for weight based dosing. The dose calculator will only open when the medication has been configured as requiring a weight-based dose. Further detail available on Weight Based Dosing QRC. Multiple orders can be placed at one time, then click the Sign button. Best Practice: When placing orders, choose the appropriate order sentence the order sentences will generally have 5 out of 6 fields completed. If the specific order sentence isn t available, the closest sentence can be picked and the specific details modified.
Page 2 Making Changes on Medication Orders Existing on the Profile Active medication orders can be modified by right-clicking on the order and selecting Modify from the drop-down menu. Fields on a medication that should NOT be modified: Dose Unit Drug Form Route of administration If changes need to be made to any of the above, the order should be discontinued and a new order placed.
Page 3 IV Fluid Ordering Continuous Medications When ordering IV fluids, select the most appropriate order sentence. Note that there are two tabs: Details specific to the order (Start, Stop, Route, etc.). Details specific to the infusion contents and the rate. Update details accordingly on supplemental tabs. Additional details can be added to the infusion instructions. Continuous Infusions A starting rate and indication will be required to start a continuous infusion. This may default from the order sentence or be a required field. DO NOT change either the volume or additive dose (these fields may be locked). If a change needs to be made to the concentration, the order should be discontinued and a new order placed. When changing an IV Infusion Rate, right-click and select Modify. Modify the rate to display correctly in Intake and Output.
Page 4 Special Scenarios TPN (Orderset to be added for labs and placeholder order) actual ordering of components to remain on paper. PCA s Ordering driven through Ordersets. Chemotherapy Remains a paper order process. Investigational Drugs Remain a paper order process. Insulin Orderset Some medication orders are associated with a sliding scale dosage. An example is insulin. To view or modify the sliding scale dosage associated with a medication order, complete the following steps: Taper Dosing Orders (con t) 2. The Dosing Calculator will open allowing the user to enter taper details and calculate steps. There are four main sections: Start Taper Details Planned Regimen Order Details. 3. Click the Calculate Steps button and the Planned Regimen section is filled in along with the details. NOTE: The final dose cannot be zero. 1. Click the +Add icon on the Orders tab from the menu. 2. Type Insulin in the Find field and click the Search button (binoculars). 3. Select Insulin Therapy Subcutaneous Adult found in the Search results window. 4. Click Done. 5. Click the box to select Appropriate Order. Insulin Type Fingersticks 6. Complete the order details by entering the dose. 7. Click Orders for Signature. 8. Click Sign. 9. Click Refresh. Change to Insulin Frequency, Change BGT Frequency Change to BGT Frequency, Change Insulin Frequency Aerosol Treatment 1. Order Aerosol Treatment AND Order the Medication. If Aerosol Treatment frequency is Modified, Modify Medication Frequency. If Medication for Aerosol Treatment frequency is Modified, Modify Aerosol Treatment frequency. Taper Dosing Orders A physician may order a medication with a tapering dose. After placing an order for Prednisone, for example: 1. Click on the Taper Dosing icon. Within the Taper Details section, you have an option to choose whether you need to create a set of orders that have reducing or increasing doses. The default unit for each increasing or reducing dose comes from the unit of measure selected in the Start section. The default within the taper dialog box is Reduce. You may also increase or reduce by a defined percentage. If reducing or increasing by a percent, make sure you select whether you want to reduce or increase by a percent of the previous dose or by a percent of the starting dose. 1. Once all the required fields are filled out in the Taper Details section, the Calculate Steps button is enabled. 2. Click Calculate Steps. Taper Details
Page 5 Planned Regimen and Order Details 3. Carefully review the schedule of the calculated taper steps. May need to change frequency. If customization is needed, you can add or remove taper steps by selecting the plus or minus signs to the right of the last row in the Planned Regimen. 2. Once details of the taper regimen are finalized, click OK. Medication Clinical Decision Support (mcds) Alert Window (con t) 1. The Medical Clinical Decision Support (mcds) has 3 separate sections in the alert pop-up window. A. Allergy B. Drug/Drug C. Duplicate Therapy Note: Additional information can be found on the Medication Clinical Decision Support (mcds) Alert Window QRC. The taper regimen is added to the orders scratchpad. 3. Click the Sign button. To view the contents of the entire taper, you must select the plus sign to the left of the taper name. Planned Regimen and Order Details Modifying Tapers 1. Each order within the taper regimen is eligible to be modified. 2. Right-click on a taper regimen and select Modify. The Details window displays allowing you to make any necessary modifications. 3. Click the Orders for Signature button when all changes are made. Medication Clinical Decision Support (mcds) Alert Window The Medication Clinical Decision Support (mcds) Alert window provides you with alerts and warnings concerning medication you are ordering for the patient. When a Decision Support alert window opens, you must take action before you can proceed. Such actions include removing the new order, removing the order already on the patient s chart, or entering an override reason.