Intro to order entry

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Introduction to Order Entry
Order Entry Lesson 2
Objectives
Following completion of this lesson you will be able to:
. Describe the Order Management process
. Identify which orders are entered via Meditech Order
Management
. Demonstrate how to enter individual orders using the By
Procedure button
. Describe how to properly enter Order Information
. Describe the difference in DIET orders and other types of
orders
. Show how to file an order and explain what happens when
an order is filed
Meditech Order Management
• The Meditech Order Management system delivers patient care
orders electronically to the department or patient care service
from which an intervention or service is being requested.
• Meditech Order Management will be used for many things,
among them to enter physicians’ orders for patient care. Orders
are transmitted through the Meditech system and appear at the
department from which you are requesting service. For
example, an order for physical therapy will appear in the
Physical Therapy Department where it will be scheduled as a
request for service.
Meditech Order Management
• All written physician orders are entered into Meditech
EXCEPT for medication and IV orders. Medication
and IV Orders are transmitted by fax to the
Pharmacy.
Let’s review the patient selection process as we learn to access the
Order Entry routine from PCS. First, we will select our practice patient,
Mr. Red, by clicking on his name.
Now that the correct patient is highlighted and we assume we have
already entered in the patient’s allergies and patient data, we will click
on the Orders link to begin the ordering process.
Before you may enter an order, you must choose the Ordering Provider
from a list of eligible providers at GBMC. Be careful to choose the
provider who wrote or telephoned the orders, which may not necessarily
be the Attending Physician. You can search for a provider by typing
his/her last name in the Ordering provider box. We will now type Davis in
the Ordering Provider box.
Now that Dr. Davis’ last name is in the Ordering Provider box, we will
click on the Save button or press the Enter key on the keyboard.
This will open a list of all the doctors in the hospital with the first or last
name of Davis. We will click on the doctor we wish to select and his or
her name will be entered in the Ordering Provider Box and we will then
advance to the Order Entry screen. We will click on Alan Davis now.
This is the Main Order Entry screen. Our patient has just been admitted
and doesn’t have any orders yet. Let’s discuss how the screen is
arranged.
At the top of the screen, you will see the list of current orders for the
patient. Our patient does not have any orders entered yet.
Just below the current orders list will be the selections used to enter
orders. The Orders button will allow you to enter one order at a time.
The Sets button (highlighted presently for our patient), will open a list of
possible order set choices on the screen (seen here in the middle of the
screen). The Meds button is grayed out. All medication orders must be
faxed to pharmacy and are not entered through Meditech.
The Favorites, Category, and Name options highlighted here can be
used to change the way orders are sorted on the screen. We will learn
more about these options later in this tutorial.
There are two ways to enter orders: individually or in sets. We will learn
to enter order sets later. Let’s start by learning to enter individual orders
using the Orders button. We will now click on Orders.
We want to order a CBC for our patient. We will begin to type the procedure
name, CBC, in the Search box at the top of the screen. The list of procedures
will be shortened with each letter that you type.
The CBC with differential is the second procedure on the list. We can select it
by double-clicking on the entry. Let’s see what happens when we do that.
The CBC has been selected, as evidenced by the indicator in the
middle of the screen that now says “1 Selected Items.” Always
monitor this indicator to keep track of the orders you have selected.
Although, you have chosen the order you want to place, it has not yet been
transmitted to the Lab for processing. There are several more steps you
must take to submit the order. It is possible to select several orders at a
time from this page. When you have entered all of the orders you plan to
submit, you will click on the Edit button at the bottom of this page to enter
in the exact details for each order. We will click on Edit now.
This is the order detail screen for the CBC order. This is where we will enter
details about the order, such as its priority, when it is to be performed, and
special instructions.
REQUIRED
OPTIONAL
Now we must fill in the order detail section of the screen. Any required
fields are shown with an asterisk next to the question. Optional fields will
not have an asterisk.
The first question we must answer is the order’s priority – whether Routine,
Stat, or Urgent. Fields with pull down arrows like this one have multiple
selections. You may enter the mnemonic of the selection if you know it, or
look up the answer from a list. We will now click the drop down arrow.
Any drop down boxes on the order details screens will also allow you to
type the mnemonic for what you are searching for in the white box at
the top pf the drop down screen and the answers will narrow below
based on your typing.
In this case, we will make our selection from the list by clicking on our
choice. Since we want the Routine selection, we will click on it and it will
fill into the selection box for us.
The Date field is automatically filled with today’s date when you are entering
an order. We can change the date if we need to or accept the date as it is
given by pressing Enter.
The doctor ordered the CBC to be performed now, and in the Time field there
is a short cut to tell the system that the order is to be performed now. We
have typed N for now, and the system will automatically fill in the current time
for you once you press Enter or move to the next field.
The next section is asking if the order is a series order.
Because most orders are for single events, the system
offers a default answer of N for No here. We will press the
Enter key to accept the answer as it is given.
Meditech has skipped the rest of the series questions, because we
said our order was not a series order. The cursor has moved to the
label print question.
You can tell that an answer to this question is required because it has an
asterisk next to it. This questions will determine where the specimen labels
will print. If you answer Yes to this question, the labels will print on the unit; if
No, they will print in the Lab.
Details about when you should print the labels in the Lab appear on the
screen for reference. You only print the labels to the lab if you want the
lab to draw the sample on phlebotomy rounds. Phlebotomy rounds
occur every 2 hours from 7am – 9pm. There are specific cut off times
for ordering specimens. There will be more information later in this
tutorial about cut off times for you.
Now we have filled out all of the necessary sections of the order details
screen and we will save our selections by clicking on Save.
Now that the details have been entered, the order is ready
for submission. The status “New” will appear in green,
which is a reminder that the order has not yet been saved.
To submit the order, we will click on the Save button.
Before the order submission is completed, Meditech always gives you a
chance to change your mind in case you have entered an order in error.
For this you could use the Return to Screen function which allows you to
return to the order to correct any entries or discard the order entirely.
To save the order and transmit it to the Lab, you will click on one of the
File buttons. If you are finished with this patient and want to leave
order entry and go back to PCS, you will click File and Exit. We want
to refresh the screen and add more orders to this patient, so we will
click on File and Refresh.
Our CBC is now saved and the order has been sent to the lab.
We have learned how to enter a single order. Next we will learn how to
enter two or more orders for a single submission. Again, we will initiate
the orders by clicking on the Orders button.
We need to order a BUN. We will
type BUN in the Search box now.
We will now select the correct order by
double clicking on it.
We can now see “1 Selected Items” in the middle of the screen. Now
we can enter our second order for a serum creatinine. To do this, we
will begin typing “CREAT” in the Procedures box.
We must be careful to choose the correct Creatinine test from
the list. We will double-click on the one we want now.
The selected orders counter is increased by one, indicating
that we have two orders on our list to submit. We will now
click on Edit to fill in the details for these 2 orders.
Here is the information section of the BUN order. You learned about using
mnemonics as a short cut in the last lesson. Since you now know the
mnemonic for a routine priority is R, you can type that instead of using the
drop down arrow to choose the priority. We will type R then press Enter.
The date field defaulted with the current date, but the order is for a BUN
for tomorrow morning. As a shortcut, we have removed the date and
typed T + 1. T stands for today, T + 1 means tomorrow, and so on.
We need to enter a time for the specimen to be drawn in the
morning. This order will be drawn by the lab phlebotomist on
morning rounds, so the appropriate time to enter is 4 AM. Entering
0400 will ensure that the labels print out at the appropriate time and
the specimen is collected on schedule.
What happens if you enter a phlebotomy collect order after 4:00 am - say, at
5:00 am? If the specimen is to be drawn by the lab, then the specimen will go
the NEXT MORNING draw collection list – the specimen will not be drawn until
the following morning. This is why it is so important to be familiar with the cut
off times for entering orders in Meditech. Lets take a look at some.
Ordering Cut Off Times
Phlebotomy Draw Times
Order Must be in Meditech by:
Morning Draws 0500-0800
Before 0400
Rounds 9am, 11am, 1pm
3pm, 5pm, 7pm
30 Minutes Before Round Time
Round at 9pm
Cut off time is 7:30pm
* Note: Any orders put in after cut off times will
be drawn on next phlebotomy round.
Stat Tests
• In order for pharmacy to collect a
STAT specimen, the unit must page
STAT phlebotomy (Pager #158)
• All blood draw labels for STAT tests
should be printed out on the unit.
Now that we have filled in our Time, the Series order question again defaults
to N for no, so we will accept that answer by pressing the Enter key.
Once again, Meditech skips the Series Information Questions because we
said the order wasn’t a series order. We will now fill in where we want our
label to print. The specimen is to be drawn by phlebotomy. We will enter N
to print this label in the lab.
If, as in our earlier scenario, it is now 5:00am and you want to enter an
order for blood to be drawn by the Lab this morning, you may elect to
enter Y here. If phlebotomy has not yet made morning rounds on your
unit, you may print the labels on your unit and place them in the morning
draw folder of the Lab Stats/Rounds book. Phlebotomy will collect the
labels before making round on the unit and draw the blood for you.
We will click on Save now to save this order and move on to the
Creatinine order.
The order detail screen appears for the Creatinine order, just as it did for
the BUN order. We have filled in the values for you. We will save the
entries by clicking on the Save button.
Remember that, as long as the “New” status appears in green, the orders
are ready, but have not been submitted. We will now Save these new orders.
We have more orders to enter for this patient, so we will
choose the File and Refresh option.
We will now learn how to place a new type of order – a series order. We
will begin by using the ordering process we have already learned. We
need to order a chest x-ray for our patient.
When finding procedures for diagnostic imaging, a good rule of thumb is
to search for the part of the body being imaged – in this case, the chest.
We will begin to type “Chest” and the possibilities will appear.
When searching for diagnostic imaging orders, always review
the Category column to make sure you have the appropriate
radiologic procedure selected.
Now we will select the Chest PA and Lateral using the
techniques we have learned. We will double click on
the correct row now – and then click on the Edit button.
The first questions on the Chest PA and Lateral order detail screen ask for
priority and date. We can see that these are required because the questions
appear with an asterisk beside them. We have filled these in for you.
For Radiology Orders, we do not enter a time in the Time details box. This is
because radiology will take patients as they can squeeze them in with their
regularly scheduled patients. Certain units (particularly critical care) may
enter in a time when ordering portable x-rays. You will learn more about this
on your unit, if appropriate.
What makes this order unique is the fact that it is a series order. The
physician has requested a chest x-ray each day for 3 days. We must
first change the letter N in the Series box to a Y.
When you type a Y in the Series box, it allows you to enter additional
series details below in the Series Information section of the screen.
The directions field is where the frequency for the series order is entered.
The directions that are found in the drop down menu are mostly intended
for respiratory and nursing procedures. The best way to enter the
frequency/directions for a radiology series order is to type them directly
into the box using appropriate system recognized frequencies. Let’s take
a look at some of these.
Examples of Directions/Frequencies
Abbreviation
Translation
DAILY
every day
Q2D
every other day
Q4H
every 4 hours
QAM
every morning
QS
every shift
Q15M
every 15 minutes
0000-2359
specific military time
MO, TU, WE, TH, FR, SA, SU
specific days of the week
Complex directions:
QD17 - every day at 5pm
MoWeFr - every Monday, Wednesday and Friday
[email protected],1230,17 - every other day at 8:00, 12:30 and 17:00
We have typed the DAILY frequency so that the x-ray will be done
once a day.
The stop date that will determine how many chest x-rays are ordered.
Here we have entered T+2 (today plus two more days) to set the stop
date for three days from now.
After you enter the Stop Date, you will notice the Count field has
automatically generated the total number of tests that are ordered. This
number must match with the number of procedures the physician has
ordered.
Note that the number of procedures that the count reflects is driven by the time
of day that the order is placed. Consider the following examples of orders placed
for procedures that occur at 9:00am:
Order entered at:
7:00 am
7:00 pm
Stop Date:
T+2
T+2
Count:
3
2
If the count does not reflect the number of procedures you are expecting, you
can change the Stop Date or Stop Time, which is automatically entered as 23:59
for you, until you get the number you require.
The reason for the test is another required field. This is a free text
field that must contain something in order for you to submit the
order. This is important information that the radiologists and
technicians need in order to perform the test properly and receive
reimbursement from insurance companies. Let’s take a look at
some approved and not approved radiology reasons.
Radiology Reasons
Acceptable Reasons
Unacceptable Reasons
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Any SYMPTOM related to the
study being ordered (ex –
Pain-foot, swelling-left leg)
Chest Pain
SOB
Vent Dependent
Trauma paired with reason for
the trauma (ex - Trauma-fell
from 20 ft, leg pain)
Any relevant cardiac history for
chest x-rays
Pre-op should include surgery
name and anything to do with
chest (ex - hx smoking, hx CHF)
Post op should include any
relevant chest symptoms
Pre-admission
Doctor Ordered / MD order
R/O
Altered Mental Status
Vent (by itself)
Trauma (by itself)
Follow Up
Repeat
All
PCKR in am
No Reason entered
For radiology orders, you will also have to specify whether or not
the patient has a discharge pending. Here we have selected No,
and can now Save our answers to the order details questions by
clicking on Save.
Once again, the “New” status in green reminds you that the order is
ready to send, but still needs to be submitted. We will click on Save
now.
We have more orders to enter for this patient, so we will choose the
File and Refresh option.
The Review Orders screen reflects all of the orders we have
placed so far. Take a moment to review the list. Note that the
three chest x-ray orders appear sequentially in the Radiology
category on the list of orders.
Because diet orders are entered slightly differently from all other
orders, we’ll experiment by ordering a diet now. We will start the
ordering process as we have for each of the other orders, by
typing the order we are searching for in the Search box.
Diet orders can always be located by typing DIET in the
procedures search box, as we have done here. Another thing
we can do to narrow our list of orders to Dietary-only is by
clicking on the Category button.
Clicking on Category will open a drop down list where you can
select which category of orders you would like to see on the
screen. We will now click on Dietary to select this group of
orders.
Now, all we are seeing on the screen are Dietary orders. If we ever
wanted to change the category or remove the category that we had
selected previously, all we would have to do is click on Category again,
and click on Clear to allow all order types to appear in our selection list.
Our 1800 calorie ADA diet appears on the screen near the top because
it starts with a number. We will select the 1800 calorie ADA diet from the
list now by double-clicking on it.
We can see the “1 Selected Items” displayed in the middle
of the screen, indicating that we are ready to enter the
details for our order. We can now click on Edit.
For diets, the first section will always be filled out for you. Notice the
priority has been left blank. This is because diets do not have a priority.
The date will default to today’s date. This is the date you wish the diet to
start. If you want the diet to begin some time in the future, you can
change the date.
The biggest difference between a diet order and other types of orders is in how
you fill in the Time field. Diets are timed by B, L or D – for Breakfast, Lunch or
Dinner. The next possible meal will default in. You can also choose the meal
when the diet is to take effect and enter the appropriate initial letter here.
We can also see the admission reason which was captured from the admitting
screens when the patient was registered. This information is automatically filled
in for you and helps the Dietary Department to properly assess the patient’s
dietary needs.
The next question on the diet detail screen asks whether this is the Primary Diet.
You should always type in a Y for Yes because, in our ordering system, each
patient can have one (and only one) diet.
Our patient needs a low sodium diet. The Diet 2 and 3 fields are for the second
and third diet options, such as the low sodium request on this order. We will click
on the Diet 2 drop down arrow to see some examples of secondary diet options.
Every diet that is a primary diet can also be a secondary or third diet, so the list
is long. To see more choices or to find the cancel option of the Diet 2 choice list,
you can scroll through the list using the arrows or scroll bar.
The low sodium diet that we are looking for appears further down the
list. We will choose it by clicking on the entry – and it will be filled into
the Diet 2 box for us.
Now we have chosen the 1800 calorie ADA primary diet and the secondary diet
that includes a low sodium provision. The doctor has also ordered a fluid
restriction for our patient.
The fluid restriction is what is known as a modifier. We can open the list of
modifiers by clicking on the down arrow to the right of that field.
The 1200 cc Fluid Restriction modifier appears second on the list. We will
select it by clicking on it and it will fill into the Modifier box for us.
We have entered all of the information that we need to on the Order Details
screen – the primary and secondary diet, and the modifier fluid restriction.
Notice there are also drop down fields for Supplements and Tube Feedings, if
they are appropriate for your patient.
Now we can click on Save to save these details for our diet.
This diet order is ready to file. We will click on Save to process the order.
We will select File and Refresh now.
Our list of orders has grown again, now reflecting the Diet order that was
just placed. Diet orders appear in the “Nutrition” category on the Current
Order list. This category is currently hidden. We can click on the plus
sign to the left of the category title to see its contents.
With the category “Nutrition” expanded, you can see the most
recent order placed.
You have gained proficiency in placing individual orders of several
types. In the next order entry lesson you will learn how to order
groups of orders called order sets, and how to enter nursing orders
that automatically transfer to PCS for documentation.
If you wanted to return to PCS and document now, you could click on
Record List and it would take you back into PCS.
Summary
. All physician orders are entered via the Meditech Order
Management system except for IV and Medication orders, which
get faxed to pharmacy.
. The priority field is where you indicate the level of urgency of
the order
. A quick way to enter the date of an order is to accept T for today,
T +1 for tomorrow, etc.
. All orders are entered using military time on a 24 hour clock
. Questions with asterisks are required and must be
completed before the order can be submitted.
. To place individual orders, click on the Orders button
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