Key Points for Care-Set Order Entry
1. “Review current orders for the patient prior to new order entry to avoid duplicate orders”
Avoiding duplication of any process in business is the corner stone of efficiency; the same is true with order entry. Duplicate orders can cause confusion among staff, incur extra expense of time and money, and can cause error that may cause harm to the patient.
Know that when ordering a single lab, for example a K+, the test may be part of an ordered profile like “Lytes” or a “Comprehensive metabolic profile”. Order entry staff needs to know what individual studies the group profiles contain. Occasionally, an order is intended to repeat, i.e. there is a daily cbc ordered and a new order for cbc now and at 10 PM. Choosing the “Order Anyway” option on the duplicate order screen communicates to the lab not to cancel the other ‘like’ orders.
2. “Understand the how the laboratory computer system (SunQuest) interfaces or communicates with PowerChart to avoid unintended canceling of duplicate lab orders.”
With Lab orders, the SunQuest Lab system will automatically cancel new orders coming in that duplicate an existing one. Therefore, if a user entering a new order puts in a duplicate, the lab system cancels it. If the user then sees the previous order and goes back and cancels it (the old order) no lab order will exist for the patient because the new one was canceled by lab. This could adversely affect the patient’s outcome.
3. “Follow the correct sequence to cancel orders: discontinue the old/sign, then order the new/sign.”
If there is a lab order that needs to be canceled, such as duplicate or one entered in error, first cancel the existing order and SIGN it. If the order is a recurring order, both the parent order and any children orders that have not been completed need to be cancelled and signed before the new order is placed.
If it is realized after a new order is placed that another order already existed, cancel both orders (the old and the new), sign them, and then place the new order. If you go back and cancel the “old one” no orders will remain active for the patient.
When the Duplicate Warning screen pops up, pay attention to it. You can remove the order you are placing from this screen and then return to the Matrix order tab to cancel and sign the existing order.
4. “Know the definitions for the order details of Priority (routine, time/dated, stat and now) and of Frequency (once, on-going or recurring –like daily, bid, or q8h, timed/dated for specified times, or department or facility set times etc).”
A Priority of Routine is on the next regular rounds or opening in a given department.
A Priority of Timed/dated indicates a specified time for a test or study to be done is given.
A Priority of Stat is urgent, life threatening, top priority, right away. (For lab: within 10 minutes)
A Priority of Now is ASAP (for lab: within 30 minutes) Department response times fluctuate.
There are several Frequency detail options available to choose from; a PowerChart Order Entry class includes specific discussion regarding these choices and provides reference material for users. Understanding Frequency detail is essential prior to order entry. Departments using only Care-set order entry have correct Priority and Frequency selections built into the department care set(s). Should the need arise to order outside the care set(s)used, the department can contact IS to add the additional orders to the care set or contact Cerner Education for further education regarding order entry.
NOTE: for rare orders selected outside the care set:
a. Use only the priority of Stat, Now, and time-dated.
b. Use only the Frequency of once.
5. “Know how to use filter settings for accurate viewing and review of entered orders.”
On the Orders page several pre set views are available in the drop down next to the display field. Users can view for example; All Orders All Statuses, All Active Orders (does not include future, canceled, or completed orders), or Completed Orders (only orders that have been done), etc. Custom views may also be built to accommodate the viewer’s preference and to include Continuing Orders.
Pre-set options:
To set Custom Filters and Settings
1. Click the Ellipsis button next to display drop down.
2. Click New at the bottom of the Advance Filters window.
3. Type the name of custom list in the display field.
4. Check the desired boxes for order statuses to view.
5. Check the “Show individual instances for continuing orders” under Miscellaneous.
6. Click Save.
6. “Know your unit’s process for calling or paging departments with orders.”
Page or call the order-receiving department for all STAT and NOW orders (except those that auto-page).
Monitor response time on Auto-paged orders; call or page if there is a delayed response time.
Check with your manager, charge-nurse, and unit clerk preceptor for department specific calling or paging guidelines.
During downtime instructions for calling and paging are given in the published in the IS GroupWise communications.