8.1 Quick Orders Script We are going to create one of each type of Quick Order and place those on the menu. Note: We strongly encourage that Package Informaticists build and maintain Quick Orders for their respective packages (i.e. a Pharmacist should maintain Pharmacy, Laboratorian should maintain Lab, etc.), but it is useful for a CAC to understand how each type of Quick Order is made. This knowledge can be helpful to the CAC to communicate issues with the Package Informaticist. So in summary Nurse’s should not build Pharmacy Quick Orders, Pharmacists should not build Lab Quick Orders, and so on. Having made this point, let’s look at each type of Quick Order. Creating Quick Orders From the RPMS-EHR Configuration Master Menu: ORD> MNU > QOC Outpatient Medication Namespace: PSOZ Create/Modify Quick Orders Select QUICK ORDER NAME: PSOZ YOURNAME AMOXICILLIN 250MG TID Are you adding 'PSOZ YOURNAME AMOXICILLIN 250MG TID' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: OUTPATIENT MEDICATIONS NAME: PSOZ YOURNAME AMOXICILLIN 250MG TID Replace DISPLAY TEXT: Amoxicillin 250mg PO TID VERIFY ORDER: y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: AMOXICILLIN CAP,ORAL Complex dose? NO// Choose from (or enter another): 1 250MG $0.002 2 250MG $0.003 3 500MG $0.005 4 500MG $0.036 5 500MG $0.004 6 1000MG $0.072 7 1000MG $0.008 Dose: 1 250MG $0.002 Route: ORAL// ORAL Schedule: TID//TID 21 CAPSULES PER BOTTLE Patient Instructions: - UNTIL ALL TAKEN FOR INFECTION Include Patient Instructions in Sig? YES// Chronic Med?// NO Dispense as Written?// Days Supply: 10 Quantity (CAP): 30 Refills (0-11): 0 Pick Up: WINDOW Pharmacy:// SureScripts Pharmacy Information Edit? No// (No) APSP REFILL REQUEST entry// Priority: ROUTINE// Comments: No existing text Edit? No// (No) Indication:// Indication ICD9:// ----------------------------------------------------------------------Medication: AMOXICILLIN CAP,ORAL 250MG Instructions: 250MG ORAL TID Patient Instructions: - UNTIL ALL TAKEN FOR INFECTION Days Supply: 10 Quantity (CAP): 30 Refills (0-11): 0 Pick Up: WINDOW Priority: ROUTINE ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Auto-accept this order? NO// <Enter> IV Medication Namespace: PSIVZ Select QUICK ORDER NAME: PSIVZ YOURNAME D5W .45NS W/20MEQ KCL 1000ML Are you adding 'PSIVZ YOURNAME D5W .45NS W/20MEQ KCL 1000ML' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: IV MEDICATIONS NAME: PSIVZ YOURNAME D5W .45NS W/20MEQ KCL 1000ML Replace DISPLAY TEXT: D5W .45%NS w/20meq KCl 1000ML VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Solution: DEXTROSE 5% IN 0.45% NS--1000 ML INJ,SOLN Additive: POTASSIUM 1 POTASSIUM ACETATE INJ,SOLN 2 POTASSIUM CHLORIDE INJ,SOLN 3 POTASSIUM PHOSPHATE INJ,SOLN CHOOSE 1-3: 2 POTASSIUM CHLORIDE INJ,SOLN (Units for this additive are MEQ) Strength: 20 Another Additive: Infusion Rate: 75 Schedule: Priority: ROUTINE// Provider Comments: No existing text Edit? No// (No) ----------------------------------------------------------------------Solutions: DEXTROSE 5% IN 0.45% NS--1000 ML INJ,SOLN Additives: POTASSIUM CHLORIDE INJ,SOLN 20 MEQ Infusion Rate: 75 ml/hr Priority: ROUTINE ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO// 1000 ml Unit Dose Quick Order Namespace: PSJZ Select QUICK ORDER NAME: PSJZ YOURNAME ATENOLOL 25MG QAM Are you adding 'PSJZ YOURNAME ATENOLOL 25MG QAM' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: INPATIENT MEDICATIONS NAME: PSJZ YOURNAME ATENOLOL 25MG QAM Replace DISPLAY TEXT: Atenolol 25mg PO QAM VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: ATENOLOL TAB Complex dose? NO// Choose from (or enter another): 1 12.5MG 2 25MG $0.141 3 50MG 4 100MG Dose: 2 25MG $0.141 Route: ORAL// ORAL Schedule: QDAY// DAILY Give additional dose NOW? NO// Priority: ROUTINE// Comments: No existing text Edit? No// (No) ----------------------------------------------------------------------Medication: ATENOLOL TAB Instructions: 25MG ORAL DAILY Priority: ROUTINE ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Auto-accept this order? NO// <Enter> IV Piggyback Medication Namespace: PSJIVZ Select QUICK ORDER NAME: PSJIVZ YOURNAME CEFTRIAXONE 1GM IVPB x7D Are you adding 'PSJIVZ YOURNAME CEFTRIAXONE 1GM IVPB x7D' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: INPATIENT MEDICATIONS NAME: PSJIVZ YOURNAME CEFTRIAXONE 1GM IVPB x7D Replace DISPLAY TEXT: Ceftriaxone 1Gm IVPB X 7 Days VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: CEFTRIAXONE INJ,SOLN Complex dose? NO// YES [Required so we can limit to 7 Days] Choose from (or enter another): 1 1GM/1VIAL $5.111 2 1GM/1VIAL $5.277 3 2GM/1VIAL $10.421 4 4GM/2VIAL $20.842 5 250MG/1VIAL $65.5 6 500MG/2VIAL $131 Dose or Rate: 1 1GM/1VIAL $5.111 ...OK? YES// Route: INTRAMUSCULAR// IV PIGGYBACK Schedule: Q12H How long: ? Enter the length of time over which this dose is to be administered as '4 HOURS', '7 DAYS', '2 WEEKS', or '1 MONTH'. How long: 7 DAYS And/then: Give additional dose NOW? NO// Priority: ROUTINE// Comments: No existing text Edit? No// (No) ----------------------------------------------------------------------Medication: CEFTRIAXONE INJ,SOLN Instructions: 1GM/1VIAL IV PIGGYBACK Q12H FOR 7 DAYS Priority: ROUTINE ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Auto-accept this order? NO// <Enter> Imaging Quick Order Namespace: RAZ Select QUICK ORDER NAME: RAZ YOURNAME CHEST PA AND LAT Are you adding 'RAZ YOURNAME CHEST PA AND LAT' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: IMAGING NAME: RAZM YOURNAME CHEST PA AND LAT Replace DISPLAY TEXT: Chest PA and Lat VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Select one of the following imaging types: CT SCAN GENERAL RADIOLOGY ULTRASOUND Select IMAGING TYPE: GENERAL RADIOLOGY Common General Radiology Procedures: 1 ABDOMEN 3 OR MORE VIEWS 20 ORBIT MIN 4 VIEWS 2 ABDOMEN-KUB 21 PELVIS & HIPS CHILD 2 OR MORE VIEWS 3 CALCANEOUS 2 VIEWS 22 PELVIS 1 VIEW 4 CHEST 2 VIEWS PA&LAT 23 PELVIS 3 OR MORE VIEWS 5 CLAVICLE 24 SCAPULA 6 DEXASCAN 25 SHOULDER 2 OR MORE VIEWS 7 FACIAL BONES, LESS THAN 3 VIEWS 26 SINUSES 3 OR MORE VIEWS 8 FEMUR 2 VIEWS 27 SKULL 4 OR MORE VIEWS 9 FINGER(S) 2 OR MORE VIEWS 28 SPINE CERVICAL MIN 4 VIEWS 10 FOOT 2 VIEWS 29 SPINE LUMBOSACRAL MIN 2 VIEWS 11 FOREARM 2 VIEWS 30 SPINE LUMBOSACRAL MIN 4 VIEWS 12 HAND 1 OR 2 VIEWS 31 SPINE THORACIC 4 OR MORE VIEWS 13 HIP 1 VIEW 32 SPINE THORACIC AP&LAT&SWIM VIEWS 14 HIPS BILATERAL 4 OR MORE VIEWS 33 TEETH FULL MOUTH 15 KNEE 2 VIEWS 34 TIBIA & FIBULA 2 VIEWS 16 KNEE 4 OR MORE VIEWS 35 TM JOINT UNILAT O&C MOUTH 17 MAMMOGRAM BILAT 36 TOE(S) 2 OR MORE VIEWS 18 MAMMOGRAM UNILAT 37 WRIST 2 VIEWS 19 NASAL BONES MIN 3 VIEWS Radiology Procedure: 4 CHEST 2 VIEWS PA&LAT Procedure Modifier: History and Reason for Exam: No existing text Edit? No// (No) Category: ? Choose from: I INPATIENT O OUTPATIENT C CONTRACT S SHARING E EMPLOYEE R RESEARCH Enter the category of the patient for this exam. Category: <Leave Blank, System will determine automatically by Patient’s Location> Is this patient scheduled for pre-op? NO// Date Desired: TODAY// Mode of Transport: ? Choose from: A AMBULATORY P PORTABLE S STRETCHER W WHEELCHAIR Enter the transportation mode of the patient for this exam. Mode of Transport: AMBULATORY Is patient on isolation procedures? Urgency: ROUTINE// ----------------------------------------------------------------------Radiology Procedure: CHEST 2 VIEWS PA&LAT Date Desired: TODAY Mode of Transport: AMBULATORY Urgency: ROUTINE Submit request to: X-RAY ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Auto-accept this order? NO// <Enter> Lab Quick Order Namespace: LRZ Select QUICK ORDER NAME: LRZ YOURNAME GLUCOSE TODAY Are you adding 'LRZ YOURNAME GLUCOSE TODAY' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: LAB LABORATORY NAME: LRZM YOURNAME GLUCOSE TODAY Replace DISPLAY TEXT: Glucose Today VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Lab Test: GLUCOSE 1 GLUCOSE BLOOD GLUCOSE 2 GLUCOSE, 24 HR URINE 24 HR URINE GLUCOSE 3 GLUCOSE, BLOOD BLOOD GLUCOSE 4 GLUCOSE, FLUID FLUID GLUCOSE 5 GLUCOSE, RANDOM RANDOM GLUCOSE Press <RETURN> to see more, '^' to exit this list, OR CHOOSE 1-5: 1 BLOOD GLUCOSE BLOOD GLUCOSE SEND TO LAB - Means the patient is ambulatory and will be sent to the Laboratory draw room to have blood drawn. WARD COLLECT - Means that either the physician or a nurse will be collecting the sample on the ward. LAB BLOOD TEAM - Means the phlebotomist from Lab will draw the blood on the ward. This method is limited to laboratory defined collection times. IMMEDIATE COLLECT BY BLOOD TEAM - Means the phlebotomist from Lab is on call to draw blood on the ward. This method is available during times defined by Laboratory. SP Send patient to lab WC Ward collect & deliver LC Lab blood team I Immediate collect by blood team Collected By: SP Send patient to lab Collection Sample: BLOOD// Collection Date/Time: TODAY (AUG 17, 2011) How often: ONCE ONCE 1711 Indication:// Indication ICD9:// ----------------------------------------------------------------------Lab Test: BLOOD GLUCOSE Collected By: Send patient to lab Collection Sample: BLOOD Specimen: PLASMA Collection Date/Time: TODAY How often: ONCE ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Note that when making Lab Quick Orders, you may need to make separate sets/menus for the different collection types: Lab Collect, Immediate Collect, Ward Collect, Send Patient to Lab. Consult Quick Order Namespace: GMRCZ Create/Modify Quick Orders Select QUICK ORDER NAME: GMRCZ YOURNAME RESPIRATORY CONSULT Are you adding 'GMRCZ YOURNAME RESPIRATORY CONSULT' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: CONSULTS NAME: GMRCZ YOURNAME RESPIRATORY CONSULT Replace DISPLAY TEXT: Respiratory Consult VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Consult to Service/Specialty: RESPIRATORY Consult Type: ? Enter the type of consult you wish to have done at this service Consult Type: Reason for Request: No existing text Edit? No// (No) Category: ? Choose from: <Leave Blank, System will determine automatically by Patient’s Location> I INPATIENT O OUTPATIENT Enter if the service rendered will be on an inpatient or outpatient basis. Category: Urgency: ROUTINE// Place of Consultation: Attention: Provisional Diagnosis: ----------------------------------------------------------------------Consult to Service/Specialty: RESPIRATORY Urgency: ROUTINE ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Auto-accept this order? NO// <Enter> Nursing Quick Order Namespace: ORZ This is a “simple” Nursing Quick Order. In the next section we will work on more complex orders by building a Generic Order. In the previous examples, we built Quick Orders using pre-existing Orderable Items. These Orderable Items exist, because they were created in each Package when that Package was configured. You can’t create a Quick Order until an Orderable Item exists. For Nursing Quick Orders, there is no prior set up. Therefore you must create the new Orderable Item before making the new Nursing Quick Order. Using the RPMS-EHR Configuration Master Menu: ORD > MNU > OIC (Create/Modify Orderable Items) MEDSPHERE DEMO HOSPITAL RPMS-EHR Management Version 1.1 Create/Modify Orderable Items Type of Orderable: NURSING Select ORDERABLE ITEMS: ORAL CARE Are you adding 'ORAL CARE' as a new ORDERABLE ITEMS (the 4033RD)? No// Y (Yes) NAME: ORAL CARE// <Enter> Select ORDERABLE ITEMS: <Enter> Type of Orderable: <Enter> Now that we have the Orderable Item, we can create the Quick Order. ORD > MNU > QOC Order Menu Management ACT DIS GEN LST MNU OIC PAR PMT PRI PRT QOC QOR SET SRC SRO Create/Modify Actions Enable/Disable Order Dialogs Create/Modify Generic Orders List Primary Order Menus Create/Modify Order Menus Create/Modify Orderable Items Menu Parameters ... Create/Modify Prompts Assign Primary Order Menu Convert Protocols Create/Modify Quick Orders Create/Modify QO Restrictions Create/Modify Order Sets Search/Replace Components Search/Replace Orderables Select Order Menu Management Option: QOC Create/Modify Quick Orders Create/Modify Quick Orders Select QUICK ORDER NAME: ORZ YOURNAME ORAL CARE BID Are you adding 'ORZ YOURNAME ORAL CARE BID' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: NURSING NAME: ORZ YOURNAME ORAL CARE BID Replace DISPLAY TEXT: Oral Care BID VERIFY ORDER: Y YES DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Patient Care: ORAL CARE Instructions: Provide Oral Care Twice a Day Start Date/Time: NOW// <Enter> Stop Date/Time: [This prompt is Optional] ----------------------------------------------------------------------Patient Care: ORAL CARE Instructions: Provide Oral Care Twice a Day Start Date/Time: NOW ----------------------------------------------------------------------(P)lace, (E)dit, or (C)ancel this quick order? PLACE// <Enter> Auto-accept this order? NO// <Enter> Creating a Quick Order Menu At this point we have created a Quick Order of each type. Let us put them on a menu so we can see them. First we will create an Order Menu, then we are going to place the Quick Orders on the menu. From the RPMS-EHR Configuration Master Menu: ORD > MNU > MNU MEDSPHERE DEMO HOSPITAL RPMS-EHR Management Create/Modify Order Menus Select ORDER MENU: ORZM YOURNAME ORDER MENU Are you adding 'ORZM YOURNAME ORDER MENU' as a new ORDER DIALOG? No// y (Yes) Do you wish to copy an existing menu? YES// n NO DISPLAY TEXT: Yourname Order Menu... DESCRIPTION: No existing text Edit? NO// COLUMN WIDTH: 27 MNEMONIC WIDTH: PATH SWITCH: Y YES ENTRY ACTION: EXIT ACTION: Version 1.1 Menu Items Text or Header Add: MENU ITEM Add: MENU ITEM Menu Items ITEM: PSOZ YOURNAME AMOXICILLIN 250MG TID ROW: 2 COLUMN: 1 Row DISPLAY TEXT: MNEMONIC: ITEM: PSIVZ YOURNAME D5W .45NS W/20MEQ KCL 1000ML ROW: 4 COLUMN: 1 DISPLAY TEXT: MNEMONIC: ITEM: PSJZ YOURNAME ATENOLOL 25MG QAM ROW: 6 COLUMN: 1 DISPLAY TEXT: MNEMONIC: ITEM: PSJIVZ YOURNAME CEFTRIAXONE 500MG IVPB x7D ROW: 8 COLUMN: 1 DISPLAY TEXT: MNEMONIC: ITEM: RAZ YOURNAME CHEST PA AND LAT ROW: 3 COLUMN: 2 DISPLAY TEXT: MNEMONIC: ITEM: LRZ YOURNAME GLUCOSE TODAY ROW: 5 COLUMN: 2 DISPLAY TEXT: MNEMONIC: ITEM: GMRCZ YOURNAME RESPIRATORY CONSULT ROW: 7 COLUMN: 2 DISPLAY TEXT: MNEMONIC: ITEM: ORZ YOURNAME ORAL CARE BID ROW: 9 COLUMN: 2 DISPLAY TEXT: MNEMONIC: ITEM: <Enter> Placing the Quick Order Menu onto EHR At this point we would like to place this menu so it is available to someone using EHR. There are two possible methods, Inpatient or Outpatient. You site is using one or the other, it doesn’t matter which since this does not actually designate the menus as Outpatient-only or Inpatient-only-only. You do not use both at the same time. Menu Placement Method 1 (Inpatient): Method 1 - Accessing via RPMS-EHR Configuration Master Menu: ORD> MNU> PAR> INP MEDSPHERE DEMO HOSPITAL RPMS-EHR Management Write Orders List (Inpatient) Version 1.1 Write Orders (Inpatient) may be set for the following: 1 2 2.3 2.7 3 4 User Location Service Division System Package Enter selection: 3 USR LOC SRV DIV SYS PKG System [choose from NEW PERSON] [choose from HOSPITAL LOCATION] [choose from SERVICE/SECTION] [MEDSPHERE DEMO HOSPITAL] [DEMO.MEDSPHERE.COM] [ORDER ENTRY/RESULTS REPORTING] DEMO.MEDSPHERE.COM --- Setting Write Orders (Inpatient) Select Sequence: Select Sequence: ? for System: DEMO.MEDSPHERE.COM -- Sequence -------10 20 30 40 50 70 80 90 100 Value ----PSJ OR PAT OE PSH OERR PSO OERR PSJI OR PAT FLUID OE LR OTHER LAB TESTS RA OERR EXAM GMRCOR CONSULT OR GXTEXT WORD PROCESSING ORDER ORZM YOURNAME ORDER MENU <Add you new menu here> Method 1 (alternate) - Accessing via XX General Parameters: Select General Parameter Tools Option: EP Edit Parameter Values --- Edit Parameter Values --Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST Write Orders (Inpatient) ORWOR WRITE ORDERS LIST may be set for the following: 1 2 2.3 2.7 3 4 User Location Service Division System Package Enter selection: 3 USR LOC SRV DIV SYS PKG System [choose from NEW PERSON] [choose from HOSPITAL LOCATION] [choose from SERVICE/SECTION] [MEDSPHERE DEMO HOSPITAL] [DEMO.MEDSPHERE.COM] [ORDER ENTRY/RESULTS REPORTING] DEMO.MEDSPHERE.COM --- Setting ORWOR WRITE ORDERS LIST Select Sequence: ? Sequence -------10 20 30 40 50 70 80 90 100 for System: DEMO.MEDSPHERE.COM --- Value ----PSJ OR PAT OE PSH OERR PSO OERR PSJI OR PAT FLUID OE LR OTHER LAB TESTS RA OERR EXAM GMRCOR CONSULT OR GXTEXT WORD PROCESSING ORDER ORZM YOURNAME ORDER MENU <Add you new menu here> Menu Placement Method 2 (Outpatient): Method 2 - Accessing via RPMS-EHR Configuration Master Menu: ORD> MNU> PAR> OUT MEDSPHERE DEMO HOSPITAL RPMS-EHR Management Write Orders List (Outpatient) Menu for Write Orders List may be set for the following: 2 4 5 7 8 User Location Service Division System Enter selection: 8 USR LOC SRV DIV SYS System [choose from NEW PERSON] [choose from HOSPITAL LOCATION] [choose from SERVICE/SECTION] [MEDSPHERE DEMO HOSPITAL] [DEMO.MEDSPHERE.COM] DEMO.MEDSPHERE.COM Version 1.1 --- Setting Menu for Write Orders List Order Dialog: ORZM MAIN MENU// for System: DEMO.MEDSPHERE.COM ---- Once we have determined that this is the Master Menu, you can add additional menus or Quick Orders to this menu using the normal menu edit options Method 2 (alternate) - Accessing via XX General Parameters: Select General Parameter Tools Option: EP Edit Parameter Values --- Edit Parameter Values --Select PARAMETER DEFINITION NAME: ders List ORWDX WRITE ORDERS LIST Menu for Write Or ORWDX WRITE ORDERS LIST may be set for the following: 2 4 5 7 8 User Location Service Division System Enter selection: 8 USR LOC SRV DIV SYS System [choose from NEW PERSON] [choose from HOSPITAL LOCATION] [choose from SERVICE/SECTION] [MEDSPHERE DEMO HOSPITAL] [DEMO.MEDSPHERE.COM] DEMO.MEDSPHERE.COM --- Setting ORWDX WRITE ORDERS LIST Order Dialog: ORZM MAIN MENU// for System: DEMO.MEDSPHERE.COM --- Note: If your site is using Method 2 (Master Menu), regardless of how your Master Menu is configured, the display in the EHR GUI will only have one Column. The GUI will ignore Spaces between items. If you need/want a space between items, you should make a “dummy” menu (e.g. ORZM BLANK) with display text of three spaces and then place this menu between items to force the space to display. Now after using the “Toggle Display” option: Finally here is our new menu we have been building in RPMS: And here is the same menu in RPMS-EHR GUI: Of course in a real system we would not jumble these Quick Orders together in this fashion.