Epic EMR Project Training Summary Documents
When to Sign vs Sign & Hold Orders
Sign, Sign & Hold, Phases of Care, Pending
When entering orders and order sets in Epic, it will be important to choose the correct option for signing or signing and holding orders. When an order is entered and details are completed and accepted, orders will be Signed, Signed and Held, or Pended. Phases of care is a new concept that is related and will provide several advantages to assure that orders are released and acted upon at the appropriate time and location.
/Signing Orders
· Signed orders are active in the system and are released immediately.
· Sign your orders when they need to be acted upon or administered based solely upon the instructions in the order or at the current time.
/Signing & Holding Orders
· Sign and Hold orders will not be listed among active orders and are held to be released at an appropriate time.
· Signing and holding an order will require a reason, unless using a navigator med rec section that defaults to sign and hold. See the Category Select screenshot below for the possible reasons for signing and holding orders. The most common reason will be related to transferring a patient.
· Orders and order sets can be defaulted to Sign & Hold in some navigator Medication Reconciliation and Orders activities, such as in the Transfer navigators, where orders will need to be released upon the patient’s arrival on the receiving unit.
/Phases of Care
· A Phase of Care is a “tag” on an order which can indicate the “time” when orders should be released relative to a given procedure or admission, discharge, or transfer activity.
· It can notify downstream staff that a med is to be administered (or order carried out) at an ambiguous, “future time”.
· Phases of Care can provide pharmacy dispensing logic when patients are NOT transferred to procedural areas and need meds dispensed in those areas.
· Physicians can “sign” various orders and, based on the phase of care to which the orders are assigned, the system can automatically sign or sign and hold the orders until such time as they are needed.
/Using Phases of Care
· From the perspective of the clinician, much related to Phases of Care will be done in the background or automatically assigned in Epic. Orders in Order Sets for procedures will be assigned the appropriate phase of care and signing those order sets will result in the orders being held for the phase of care defined.
· The most common time that physicians will interact with phases of care directly will be when additional orders are placed on an order set with a phase of care assigned. When this happens, a screen like the one below will appear.
You will have to decide whether the additional order (Ceftin in the example above) should be signed and released now, or if it should be signed and held for the phase of care for other orders in the set, or perhaps for another phase of care.
· If the order needs to be signed and released immediately, just check the box next to that order in the Sign column.
· If the order needs to be held for a particular phase of care, check the boxes next the order in the columns for Sign & Hold and for the Phase of Care.
/Pend Orders
· Pended orders are not active in the system. Pend orders when you are unable to complete your work or you are not ready to sign or sign and hold orders.
· Orders that are open and not yet signed will be automatically pended if your session times out. If you select the pend option rather than signing your orders. You will be prompted for a reason.
· If you attempt to log out of the system with incomplete orders you will get a message like the one below:
· If you need to step away from your workstation momentarily, but hold your work, you can use the Secure option in the Epic pull down menu at the upper left corner of the screen and not have to pend your orders. They will pend automatically, however if you do not return before the session times out.
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