USD 2012- Message Center Orders “Message Center” is an electronic center in which physicians, PAs, or NPs, can log in to perform tasks such as electronic signature of documents, approving and cosigning of orders, and management of electronic messages. “POE VORB/TORB” Orders: When a nurse enters an order with the Communication type “POE VORB/TORB,” it will travel to the Message Center “inbox” of whatever provider is listed in the Physician name section of the order. This communication type should ONLY be used when a new order is received via verbal communication with the provider. “Per Protocol/Policy/Existing Order”: When a nurse enters a nursing order or acts on a previously written conditional order (using the Physician name “Nurse, Use Per Protocol”), the Communication type “Per Protocol/Policy/Existing Order” shall be used. These messages do NOT travel to a provide message box. This type of order should ONLY be used when a nurse has a legal authority to institute the order, based on nursing scope of practice, a written policy or protocol, or an existing written order with conditional treatment. “POE Cosign” has some specialty applications, but is used at this time by maternity only on a regular basis. “VORB/TORB Non-POE”: Is not used by nurses at MMC. “Written/Fax”: Communication type would be used when a patient presents as a direct admit with written orders that need entering into Powerchart. The most common errors from nursing staff during order entry are related to: Incorrect selection of the ordering provider’s name Problem: This sends the order for authentication to the inbox of a provider who may have no knowledge of the patient and may not have given/authorized the order. The result is the nurse taking action on an un-validated order. Solution: Use caution, especially when multiple providers exist with similar last names (ex. Smith) or when the provider has a last name that could be confused for a first name (eg., Thomas MD, Steven), to ensure the verbal order the nurse enters gets to the correct provider for electronic authentication/validation. Incorrect selection of the communication type Problem: Orders the provider did not technically write or need to authenticate are routed to their inbox for authentication/validation. Solution: Be sure you know when a provider authentication is required. For example, a general diet order is entered by the nurse based on a previously entered order from the physician to Advance Diet as Tolerated. The new general diet order can be entered using Nurse as the Physician name and using “Per Protocol/Policy/Existing Order” as the communication type. If it is entered using the name of the provider and POE VORB/TORB, the provider is presented with orders he/she does not need to sign and will likely not sign the order. Incorrect linking of the name and communication type Problem: When “Nurse, Use Per Protocol” is used with any communication type other than “Per Protocol/Policy/Existing Order”, the order will go to the “Nurse” Message Center Inbox that nurses do not monitor. The orders are not authenticated by a provider and remain in this inbox until Medical Records contacts the staff member and/or unit manager to investigate and rectify the mistake. Solution: When “Nurse, Use Per Protocol” is entered as the Physician name the ONLY communication type that should be used is “Per Protocol/Policy/Existing Order”. Order Communication Type Examples Order To Be Entered: Based On: Use Provider Type: Use Communication Type: Any New Physician Orders entered by RN Verbal conversation Physician Name POE VORB/TORB Diet- Full Liquids (as an example) The existing active order: “Advance diet as Nurse, Use Per Protocol Per Protocol/Policy/Existing Order “Blood Cultures if Temp…” Nurse, Use Per Protocol Per Protocol/Policy/Existing Order Nursing- KCl Oral Electrolyte Replacement The existing “Electrolyte Replacement Orders” Nurse, Use Per Protocol Per Protocol/Policy/Existing Order Nursing- Heparin Reorder Protocol An active order: “Heparin Protocol MMC” Nurse, Use Per Protocol Per Protocol/Policy/Existing Order Discontinuing any Old or Duplicate Orders Completed status of order tolerated” Blood Culture (Blood Culture x 2) The conditional order: Use Complete if it is an option. Complete does not require an ordering name/communication type.