Tippy - Modifying Orders

Tippies can be quickly adopted with immediate workflow benefits...

• Modifying Orders

In the inpatient context, when wanting to change an order, use the "Modify" button (click the below camera icon for a screenshot). Modify allows you to change the dosage, frequency, and/or administration instructions, and using this function may reduce the BPAs you encounter during the ordering workflow. Note that, for medication orders, the formulation must remain the same (injectable concentration, tablet, oral liquid, etc.), and Modify should not be used when trying to order a non-standard medication (see this previous Tip for details). 

In the ambulatory context, there is not a Modify button; instead, to change an ambulatory order, use the "Reorder" icon. This will discontinue the current order and place a new one.

Medication Ordering Tip - STAT vs. First Dose

Pharmacy tips alert prescribers to common medication ordering challenges and solutions.

STAT vs. First Dose

Challenge: When entering a medication order, how can you ensure your patient has the first dose scheduled immediately?

Context: While selecting the "STAT" button in the order composer ensures your order goes to the top of the pharmacy verification queue, selecting the STAT button alone does not ensure that your patient's first dose will be scheduled right away. STAT indicates priority only, not the dispense time or administration time. And, because Connect Care uses SMAT (standardized medication administration times), unless you also indicate the desired time for the first dose, the timing of the first dose will default to SMAT, which may be a few hours away. 

Solution: To ensure that your patient has a dose scheduled immediately, click the "Include Now" button in the "First Dose" field of the Frequency selection, as well as the "STAT" button in the Priority section. If you select "As Scheduled" in the First Dose field plus STAT, you will get a yellow warning to update your desired start time (click on the camera icon to see the screenshot). 

For more information:

• Tip: Medication Scheduling and SMAT
• Manual: Medication Orders  

Medication Ordering Tip - Non-Standard Medication

Pharmacy tips alert prescribers to common medication ordering challenges and solutions.

Non-Standard Medication

Challenge: When a prescriber cannot find the exact medication that they want to order, how can the medication order be placed?

Context: Users may think trying to modify or add comments to another medication order that is similar is an appropriate way to place an order for a medication they cannot find. However, if this is done, there is a risk that these modification requests may be missed by nursing or pharmacy, resulting in dispensing of the wrong product.

Solution: Whenever you are not able to find the exact medication order that you want:

• Search for the "Non Standard Medication" order, using the term "non-standard".  
• Fill out the required free-text fields and add any additional requests to the "Note to Pharmacy" section of the order. 
• A pharmacist will then review and modify the order to something we can provide, or contact you to suggest an alternative.

For more information:

• FAQ: How can "non-standard" medications be ordered?
• Guide: Using Non-standard Medications in Practice
• Manual: Medication Orders  

Medication Ordering Tip - Weight-Based Dosing

Pharmacy tips alert prescribers to common medication ordering challenges and solutions.

Weight-Based Dosing

Challenge: When ordering medication dosing based on weight (e.g., mg/kg), the system will prompt you to enter a weight but will allow you to sign the order with no weight entered. However, a number of issues occur when a weight is not entered when the order is placed, including delays in order verification and delayed patient care. 

Context: In accordance with the AHS Medication Orders Policy and Procedures, all weight-based orders require a weight to be entered into the system at the time the order is placed. This is to ensure that all workflows within the system can be carried out as intended, without extraneous workload and workarounds placed on certain healthcare providers. 

Solution: In urgent situations where the patient’s actual weight is not known or recorded yet, consider changing the order dosing unit to an absolute dose (e.g., mg) and then calculate the dose manually. Otherwise, an estimated weight must be entered, to allow Epic to calculate the appropriate dose; the order can be modified if needed once the actual weight is known.

When using an estimated weight, in the order composer, enter the estimated weight under the "Order-Specific" weight type. This weight will only be applied to that particular order.  

For more information:

• Tip: Weight-Based Orders
• Manual: Medication Orders  

Medication Ordering Tip - Understanding Dose Rounding and Dose Banding

Pharmacy tips alert prescribers to common medication ordering challenges and solutions.

Dose Rounding and Banding

Challenge: When prescribing certain medications, or for certain age groups, clinicians may find limited options for specifying a medication dose and wonder what the constraints are about or how to overcome them if clinically justified.

Context: Medication order composers can help prescribers by reflecting how pharmacies and/or medication administrators must work with medication preparations.

• Dose rounding may be imposed to ensure a that a practically measurable drug dose (considering equipment available to nursing) can be prepared and administered. Rounding constraints cannot be overridden, however choosing a different product/concentration may help. 
• Dose banding guides, when present, reflect how some products are supplied and used when weight-adjustments are needed (e.g., mg/kg). Banding guides can be overridden.

Solution: Prescribers who need to override dose banding guides can order the desired medication as discrete dosing units (e.g., mg). 

• Guide: Dose Banding and Rounding
• FAQ: Dose Banding FAQ and Examples
• Manual: Medication Orders  

eSafety Alert - Dosing vs. Recorded Weight

eSafety alerts highlight CIS phenomena that require particular attention...

• Note Dosing vs. Recorded Weight

Some orders (particularly for neonates, infants and children) are adjusted to patient weight.

The latest recorded weight (vitals) may reflect hydration, edema or other clinical factors. A medication dosing weight can be declared at admission (and periodically updated) to assure appropriate adjustments despite weight fluctuations.

Hovering over the vitals section of the Patient Storyboard allows a quick check to see if a dosing weight has been specified.

Be careful when ordering weight-adjusted medications. The default selected weight may not be best for the clinical circumstance. Explicitly select the weight to be used in calculations.

This eSafety alert is particularly important to Pediatrics, NICU, PICU contexts.