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.