AMBULATORY MANUAL
Reference Guide
Ambulatory Manual
TABLE OF CONTENTS
INFORMATION SECURITY AND CONFIDENTIALITY .................................................................................... 5
AMBULATORY ORGANIZER ...................................................................................................................... 6
UNDERSTANDING THE INFORMATION DISPLAYED IN EACH VIEW ................................................................................7
Selecting Providers to be displayed ........................................................................................................8
Color Status Bar ......................................................................................................................................9
Appointment Time ..................................................................................................................................9
Patient ....................................................................................................................................................9
Appointment Details ...............................................................................................................................9
Notes.......................................................................................................................................................9
Calendar View Details ...........................................................................................................................10
Open Items View Details .......................................................................................................................10
Opening a Patient Chart .......................................................................................................................10
INTRODUCTION ...................................................................................................................................... 11
ACCESSING ORDERS WORKSPACE......................................................................................................................12
Placing an Order from My Favorite Order in the Ambulatory Summary .............................................13
ORDERS WORKSPACE LAYOUT ..........................................................................................................................14
CUSTOMIZING FILTERS ON MEDICATION LIST TAB ................................................................................................15
ADD ORDER WINDOW ....................................................................................................................................16
ADDING ORDERS ...........................................................................................................................................18
ADDING ORDERSETS .......................................................................................................................................19
SAVE ORDERSET ELEMENTS AS FAVORITES ..........................................................................................................20
SUB-PHASES (NESTED) ORDERSETS ...................................................................................................................21
MEDICATION ORDER ENTRY/MEDICATION DOSE CALCULATOR ...............................................................................22
ADDITIONAL ORDERSET FUNCTIONALITY .............................................................................................................23
ORDER INFORMATION.....................................................................................................................................24
CLINICAL DECISION SUPPORT: ORDER ALERTS/WARNINGS.....................................................................................24
Patient level Alerts ................................................................................................................................24
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Ambulatory Manual
Order level Alerts ................................................................................................................................. 25
DUPLICATE ORDER ALERT ............................................................................................................................... 25
DISCERN ALERTS ........................................................................................................................................... 26
DRUG-ALLERGY ALERT ................................................................................................................................... 27
OVERRIDING AN ORDER RELATED ALERT ............................................................................................................ 27
ORDER ACTIONS .................................................................................................................................... 29
ADDING AN ORDER TO AN ORDERSET (ADD TO PHASE) ........................................................................................ 30
ORDERING EXCLUDED COMPONENTS ................................................................................................................ 30
MODIFYING ORDERS ...................................................................................................................................... 31
DISCONTINUING SINGLE ORDERS ...................................................................................................................... 31
DISCONTINUING AN ORDERSET........................................................................................................................ 31
VOIDING ORDERSETS ..................................................................................................................................... 33
VOIDING SINGLE ORDERS................................................................................................................................ 33
PLACING AMB CHARGES WITH AN ORDERSET..................................................................................................... 34
Adding Charges .................................................................................................................................... 34
APPENDIX .............................................................................................................................................. 35
ORDERS ICONS AND INDICATORS ...................................................................................................................... 35
CANCEL AND REORDER ................................................................................................................................... 37
AMB FOLDER STRUCTURE .............................................................................................................................. 38
Labs: ..................................................................................................................................................... 39
Adult Disease Based ............................................................................................................................. 39
IN WHAT FOLDER ARE MY CHARGE ORDERSETS? ................................................................................................ 39
Adult Path ............................................................................................................................................ 39
Peds Path ............................................................................................................................................. 40
Women’s Health/FP Path ..................................................................................................................... 40
Specialty Clinics Path............................................................................................................................ 40
4
Information Security and Confidentiality
INFORMATION SECURITY AND CONFIDENTIALITY
When dealing with computerized health care records, specific confidentiality and security issues must be
followed to protect the patient. There are increasing HIPAA and Joint Commission regulations that dictate
how these records are handled.
•
When signing on to PowerChart use your own User Name and Password, do not share.
•
When you open a chart for the first time, you will be asked to identify your relationship to the
patient, for example primary RN, consulting physician, etc.
•
The application keeps an audit trail, or record, of who enters each chart and when. PowerChart
records who signed into the chart and who documented each piece of information in the Chart.
•
Do not leave the computer while still signed on.
•
Do not access any charts that do not apply to your current job and caseload.
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Ambulatory Organizer
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AMBULATORY ORGANIZER
Topics in this Unit:
Understanding the information in
each view
Selecting Providers to be displayed
Color Status Bar
Appointment Time
Patient
Appointment Details
Notes
Calendar View Details
Open Items View Details
Opening a Patient Chart
6
The Ambulatory Organizer provides a simple and
comprehensive view of your schedule as a physician. It
provides a snapshot of the current day's appointments,
which includes appointment times, patient information,
appointment details, and patient status.
This section also covers how you can add additional care
providers to see a broader perspective of patient
appointments. Colored status indicators and visual clues
notify you of pertinent information.
Ambulatory Organizer
UNDERSTANDING THE INFORMATION DISPLAYED IN EACH VIEW
1.
When viewing the My Day view (today’s appointments), you can select up to five providers at
one time. If only one provider is currently displayed on the My Day view, then a timeline is
available to the far right side which mimics Calendar view behavior. The My Day view displays
the appointment details both face up and when the pointer is positioned over data.
1.
When viewing the Calendar view, you can select one provider at a time for viewing a single day
or a week of data.
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2.
When viewing the Open Items view, you can select one provider at a time for viewing the
unfinished reminder tasks for the past seven days.
SELECTING PROVIDERS TO BE DISPLAYED
If the user signed into the Ambulatory Organizer is also a resource (resource configuration is performed
by the system administrator), their name will be displayed at the top of the Patients for: menu list and
will already be selected (indicated by a check mark).
Complete the following steps to select the providers you want displayed:
1.
To add a new resource, select the Add Other option in the Patient’s Menu.
2.
Search for, and select the name of another resource.
3.
Click in the box to the left of the name to indicate you want to see their appointment details at
this time.
4.
Click Apply.
5.
•
The window closes and populates the selected Resources data in the view.
•
The provider can deselect themselves by removing the check mark so their appointment
details are not displayed, but they cannot delete themselves from this menu.
To prevent a resource from being displayed from this menu, select the gray X to the far right of
their name, and then click Apply.
Note: If you are a resource, you cannot remove yourself from the
menu.
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Ambulatory Organizer
6.
Once resources have been added to the menu, they will be visible between the different views.
You may add as many resources to the menu; however, you will only be able to select a
maximum of 5 in the My Day view at any one time.
•
7.
The same thing applies to the Open Items view.
In addition, each view is independent of the others, meaning that each view will display the
resources that you last selected to be displayed.
•
If you remove a resource from the list, however, it is removed from all views. There is only
one list, but the list allows different selections for each view.
COLOR STATUS BAR
The color of the status bar on the far left indicates the status of
the appointment.
APPOINTMENT TIME
The Appointment Time column displays the appointment time
(the time will be displayed in the My Day view, in red text, when
double booked). If more than one provider’s schedule is
displayed, the provider names will be displayed under the
appointment time.
PATIENT
The Patient column displays the patient name, age, and gender.
Position your mouse on a patient name and a pop-up box is
displayed with the Patient Name, MRN, FIN, DOB, and Phone Number.
APPOINTMENT DETAILS
In the Appointment Details column, the appointment type is displayed. In the Status column, both the
status of the appointment (including how long since the appointment was placed in this status) and the
patient’s location are displayed.
NOTES
The Notes column displays Reason for Visit and Chief Complaint data, as well as temporary comments.
To the left of the Reason for Visit information, a folder icon is displayed indicating whether
temporary comments exist for this appointment.
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Temporary comments provide a nurse or provider the ability to share information to other staff viewing
this appointment. Temporary comments are specific to this
appointment, today. They do not become part of the chart and go
away from Ambulatory Organizer at midnight when this appointment
(with any unfinished reminder tasks), rolls to the Open items view.
CALENDAR VIEW DETAILS
The Calendar view displays a single provider's schedule for a day or a week interval. The Calendar view
displays the appointment details both face up and when the pointer is positioned over data.
OPEN ITEMS VIEW DETAILS
The Open Items view displays unfinished tasks for a single
provider, from yesterday through the past seven days since the
appointment.
The Open Items view displays the appointment details both face
up and when the pointer is positioned over data.
The appointments are divided into three sections: Yesterday, 2 Days Ago, and More Than 2 Days Ago.
Positioning the pointer over the Note Not Started, Note Saved, or Charge
Not Started item then selecting the text will open the charge entry or
note entry section of the Chart.
The charge or note can be finished and the Ambulatory Organizer will
show these items as complete.
In addition to completing tasks through these reminder links, tasks can
also be completed automatically by completing specific charges for which
the reminder tasks will then be displayed as complete.
OPENING A PATIENT CHART
There are multiple ways to open a patient's chart:
10
1.
Click on the patient's name in the My Day view, Calendar view, or the Open items view.
2.
Selecting the reminder tasks in the My Day view or the Open Items view will open directly to the
corresponding component of the chart (i.e. Orders for a charge item or Clinical Folders for a note
item.)
Introduction
INTRODUCTION
Topics in this Unit:
Accessing Orders Workspace
Orders Workspace layout
Customizing Filters on Medication
List tab
Add Order Window
Adding Orders
The Orders workspace allows you to place orders for your
patients, as well as modify, view, filter and cancel. You can
place a single order or multiple orders simultaneously, as
well as grouped collections known as Ordersets.
This section covers the basic order entry processes and
support tools including departmental order folders,
Ordersets and clinical decision support in the form of
order-related alerts.
Adding Ordersets
Save Orderset Elements as Favorites
Sub-Phases (Nested Ordersets)
Medication Order Entry/Dose
Calculator
Additional Orderset Functionality
Order Information
Clinical Decision Support: Order
Alerts/Warnings
Patient Level Alerts
Order Level Alerts
Duplicate Order Alert
Discern Alerts
Drug-Allergy alert
Overriding an Order Related Alert
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Introduction
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ACCESSING ORDERS WORKSPACE
There are several ways to access Orders, a few are mentioned below:
12
1.
From within PowerNote, navigate to Impression & Plan>select the Orders sub-section>click
Include Orders or Order Profile>Click Add from the Order
Catalog that displays.
2.
From within PowerChart, click Orders from the Menu.
3.
Ambulatory Summary. Rapid access to your personal order favorites is available for review and
quick order entry. The My Favorite Orders is divided into 2 categories (Favorites and Folders).
a.
You can either click on one of the folders or click an individual order.
b.
Click on the drop-down arrow to change the order filter from Ambulatory to Ambulatory
Meds as Rx. (Inset image)
c.
If you have built favorite
folders in the Order section of
the chart, you can access and
use them here.
d.
Click on the desired folder to
open it.
e.
Click on the Order button next
to the order you’d like to
place.
f.
The selected order(s) will be
added to the Orders for
Signature section and using
the drop-down to view
options for Dx Table, Modify
and Sign.
g.
Click on the Remove button to
remove the order from the
Orders for Signature section.
h.
When signing your orders
from My Favorite Orders, you must associate a diagnosis to an order. (See grey text in image
on next page.)
Introduction
PLACING AN ORDER FROM MY FAVORITE ORDER IN THE AMBULATORY SUMMARY
To quickly place an order for a prescription, charge, lab/rad test, etc. complete the following steps:
1.
Browse each category and select the respective orders.
•
2.
Click the Orders for Signature icon.
•
3.
The selected order’s label will change color to grey as well as add the order to the
scratchpad.
The Diagnosis Table scratchpad will display.
Select the desired primary diagnosis for each order from the diagnoses already on the encounter
by clicking in the box that they intersect in.
•
Additional diagnoses can be selected and they will be ordered in the sequence they were
selected.
4.
Once finished selecting diagnoses, click the Save button.
5.
If you are done placing all orders, click the Sign button.
•
Medications will print by default.
•
If you want to send to a pharmacy instead, go to the Orders | Charges or Medication section
of the chart and complete the order there.
6.
New orders can also be entered from this view by searching for the desired order.
7.
Click on the Add button.
•
The order search field will display.
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ORDERS WORKSPACE LAYOUT
14
Introduction
CUSTOMIZING FILTERS ON MEDICATION LIST TAB
1.
Click on the blue Displayed: All Active Orders |Inactive … link.
2.
Change the display to All Medications (All Statuses) using the drop-down list.
3.
Place a checkmark on the order statuses you want to see.
4.
Click Save As button.
5.
Name your new Filter and click OK.
•
6.
If you do not see a particular Order, click on the Show More Orders…
link.
The same is done to view all other orders from the profile list:
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Introduction
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ADD ORDER WINDOW
The Add Order window is used to locate and select new orders for the patient. Below gives a quick
overview of the window:
1.
The Type filter allows you to further define the search criteria by defining the type of orders that
you are seeking, which is either: All Orders, Document Meds by Hx and Discharge Meds as Rx.
Note: See Appendix for AMB Folder structure.
2.
16
This area (zoomed right) contains access in order to aid in ease of navigation and utilizing
favorites
a.
Moves up a folder level from the current folder.
b.
Displays contents in Home.
c.
Displays contents in Favorites
d.
Allows access to organize your favorites, such as
adding, deleting, moving, renaming etc…
e.
Displays AMB folders.
Introduction
3.
1
Orders can be grouped and listed inside Departmental Folders. (This is the most efficient display
to use). Folders can be created by going to Organize Favorites as discussed in step 4.
•
Departmental folders have been established for AMB clinics.
•
4.
5.
Tip: You can save a departmental
folder, or personally created folder as
your home folder by right-clicking the
folder and selecting Set as Home
Folder.
Orders without an icon preceding them are single orders. Orders with an
2
collection of orders known as an Orderset.
This area is available to be used to add a new Dx being addressed at this visit and/or choose
appropriate Dx for Orderset.
•
6.
Problems and Dx are discussed in detail in the AMB Provider Manual.
This area is available to be used to add a new Problem/Dx being addressed at this visit.
•
7.
icon indicate a
Problems and Dx are discussed in detail AMB Provider Manual.
After clicking to select an order (be careful not to double-click), click Done to close the Add Order
window, and begin to work in the Order Details pane.
1
A Departmental Folder is a main folder which contains subfolders (defined by area) in which the provider can locate
quickly and efficiently.
2
An Orderset is a group of orders under a single title designed to support a procedure or a process. This tool allows
you to manage orders, outcomes and interventions as they relate to a predefined plan of care. Examples include
Nursing care plans and NHIQM quality measures.
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Introduction
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ADDING ORDERS
3
When a single order is placed, you will be taken to the scratchpad (shown below) which contains a top
and bottom pane that is related to the order chosen. The bottom pane contains the following three tabs:
1.
Details: The details pain displays details that need to be entered concerning the order. Required
order details are always highlighted yellow.
o
3
Use the letter ‘t’ (for today) in any date field to automatically apply the current date.
Similarly, enter ‘n’ (for now) in any time field to enter the current time.
2.
Order Comments: Order comments are entered on this tab and will carry over to the order
profile.
3.
Diagnosis: The Diagnosis tab has a required field (indicated by the
before signing.
4.
Finally, after all data has been appropriately entered, the Order can be signed by clicking on the
Sign button.
5.
Multiple orders can be selected from the Add order window and each will display in the top
pane.
) and must be completed
The ‘scratchpad’ is the nickname for this window. It is presented as a location to properly set up and
identify all appropriate orders and actions prior to signing.
18
Introduction
ADDING ORDERSETS
An Orderset is a group of orders under a single title designed to support a procedure or a process.
Kaleida Health has established a standard “look and feel” for provider Ordersets. There is also a standard
name naming convention. Details of the naming convention and Orderset composition may be found in
the Appendix.
All Ambulatory Ordersets are prefaced by AMB. This allows you to easily sort and find Ordersets. The
name of the Orderset is designed to be self-explanatory, i.e. it is not necessary to open the Orderset to
understand its purpose. A complete list of all AMB Ordersets may be found in the Appendix.
The orders contained within an Orderset are arranged in standard sections that allow you to quickly select
the orders necessary for the patient. Virtually all orders within the Ordersets are complete, that is, all
required information has been pre-entered. Some orders are also pre-selected for you. Ordersets can be
“nested” within larger Ordersets (ie VTE Prophylaxis, Empiric Antibiotic therapy). These are referred to as
sub-phase Ordersets. Orders placed as part of an Orderset stay together and can be discontinued
individually or as a group (by Orderset).
After finding and selecting an Orderset from the Add Order window the following will display:
•
The list of items that have been predefined as part of the Orderset and are displayed pre-selected.
These can individually be de-selected as
part of the Orderset as needed. Some
that cannot be de-selected have been
defined by KH as mandatory. Additionally
sub phases may be part of the Orderset.
Once all selections have been made, click
the Orders for Signature button to
continue to the scratchpad.
•
•
See Orderset Sub Phases on page 21
for additional information in this area.
(Scratchpad view 1) This is the view of the
scratchpad after clicking the Orders for
Signature button. Note the Order Details tabs
at the bottom are collapsed and hidden from
view by default. The tabs can be made visible by
either clicking on an order itself from the top
pane, or by clicking the triangle icon to
maximize the space.
•
Items can be removed or added at this
point as well. See page 19 for more information.
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Introduction
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(Scratchpad view 2) Each order within the Orderset should be completed as applicable. The blue
X symbol will display for any
order that is missing required
details.
After order details have been
completed, click the Sign
button to sign the order.
•
•
Once signed, any orderrelated alerts will be
displayed. The provider will
need to manage any alerts
before the Orderset can be
submitted.
Note: All AMB Ordersets will initiate on sign. This means that all orders within the Orderset will
become active once the provider has managed any alerts, completed all required order elements and
signed the Orderset.
SAVE ORDERSET ELEMENTS AS FAVORITES
After selecting all components of the Orderset and the details have been entered/edited, the user can
save the elements of the Orderset as their Favorite.
1.
20
Click the Save as My Favorite button.
•
Saving an Orderset as your Favorite will
save all edits you’ve made to the plan.
•
Input a unique name for your Orderset
and click OK.
•
The Orderset will be saved in the My
Favorite Plans folder, denoted with the
date it was saved to favorites.
•
If an order is updated by the system, the
system will fire a warning that there are
updates to a saved order. You will have to
re-enter your criteria into a new order (or
Orderset respectively) and re-save to your
My Favorite Plans.
Introduction
SUB-PHASES (NESTED) ORDERSETS
Ordersets that are nested within another Orderset are referred to as sub-phase Ordersets and are
indicated by this
icon. Sub-phase Ordersets are used to allow providers flexibility in managing orders
for diverse patient conditions without adding to the length and complexity of the Orderset, (i.e. Empiric
antibiotic selections by source for
sepsis). Sub-phases are also used to
accommodate standard groups of
orders (ie AMB meds in office).
1.
To include the sub-phase, click
the check box to select it in the
Orders for Signature window.
•
As soon as the Sub-Phase is
selected, the Orders for
Signature window changes in
appearance, but keep in mind, it is still
the same window (as denoted by the
Order for Signature button [3]). This
window is now drilled down to only
display the detail of orders [2] within the
Sub-Phase. Also the sub-phase is in an
Initiated Pending status in the Navigation
pane [1]. This view provides a
convenient and flexible method for
placing complex orders and making
modifications as dictated by the clinical
needs of the patient.
2.
Return to the standard Orders for Signature view by clicking the Return to … button.
3.
There are pre-checked icons that have a grey
background to them (pre-selected). These are
required for the orderable and cannot be
unchecked.
4.
After identifying the correct orders, you have the option
to modify the associated order sentences by clicking the drop-down menu.
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Introduction
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MEDICATION ORDER ENTRY/MEDICATION DOSE CALCULATOR
Dose calculation may be required for specific medications and for weight-based dosing. The dose
calculator will only open when the medication has been configured as requiring a weight-based dose.
The dose calculator functions appropriately for weight-based mass dosing, but does not for weight-based
volume dosing (mL/kg). The calculator will NOT open for weight-based volume dosing. The provider will
have to manually calculate the volume dose/rate and enter this into the order.
1.
The documented dosing weight is used by the dose calculator. It can be changed from within the
dose calculator if an “adjusted” weight is required. This adjusted weight will ONLY affect the
particular medication being ordered and will NOT update the dosing weight.
•
Final Dose (#4 on dosage calculation) = calculated dose; automatically calculated
from the current dosing weight.
•
Standard dose (#5 on dosage calculator) = medications that have a maximum
dose – in that case, click Apply Standard Dose. (This will be dithered unless
there is a standard dose available.)
2.
Select the medication to include in the Orders for Signature window.
3.
If/when the Pharmacy Type dialog box opens, select Medication > OK.
4.
22
•
The Dosage Calculator window opens.
•
Any medication that will need calculations is noted with an icon.
Click Apply Dose or Apply Standard Dose as applicable.
•
The Dosage Calculator closes and the Orders for Signature window is
open and completion of the remaining tasks for the Orderset can be resumed.
•
The Nursing MAR and the medication profile will populate with the ordered medications.
•
The pharmacy and laboratory systems receive the orders placed.
Introduction
ADDITIONAL ORDERSET FUNCTIONALITY
Adding the following Orderset:
Notice the pre-checked Immunization orders (these can be unchecked, however, not appropriate). Please
choose the following orders:
When choosing the Influenza orderable (this is a sub phase – an Orderset nested within an Orderset) and
takes you to that sub phase.
Note: This icon
reminders.
is located on the top and is designed for the staff placing the order for direction and
Clicking on the notepad icon
will lead a user to the policy or materials that can be printed.
By hovering over the icon, you can click on the blue hyperlink and the user will be directed to the
evidence based materials (in this case it will take you to the Consent form).
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Introduction
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ORDER INFORMATION
Use Order Information to view detailed, in-depth information about an order or Orderset components.
1.
Right click the order you wish to see additional information on.
2.
Select Order Info from the shortcut menu.
•
Alternatively you can simply double-click the order.
•
The Order information dialog box is displayed. It contains several tabs of distinct types of
information about the selected order.
•
You can view validation information
regarding who reviewed an order and
whether it was rejected, as well as
detailed additional information such as
the start date/time of continuing order
instances, the ID of an order or Orderset
template, the department mnemonic, and
accession number.
CLINICAL DECISION SUPPORT:
ORDER ALERTS/WARNINGS
There are two basic types of order-related alerts:
•
Patient-level alerts – alerts which are tied
to the patient, (ie Latex allergy)
•
Order-level alerts – alerts which are tied
to the specific order being placed (ie
duplicate order alerts, Drug-Drug
interaction alerts and Drug-Allergy alerts).
•
These are described in detail below. Order-related alerts are exposed to the ordering provider
after the order has been submitted (signed) and must be addressed before the order can be
completed. You can also proactively check alerts by selecting the Check Alerts button once you
have selected an Orderset. Order-related alerts can be overridden by the ordering provider.
These alerts are explained below and the process how to handle each one.
PATIENT LEVEL ALERTS
Latex allergy – the alert displays when the patient chart is opened to notify the provider that the patient
has a documented latex allergy.
Height/weight/allergy – not documented – height/weight and allergies must be documented and/or
reviewed at each patient encounter. If this has not been done at the time of the order entry, this alert
will be displayed when the patient’s chart is opened.
24
Introduction
Free-text allergy - this alert will display when the patient’s chart is opened if a free-text allergy has been
documented. The alert is intended to ensure the ordering provider is aware that no drug-allergy checking
will be performed.
ORDER LEVEL ALERTS
Height/weight/allergy not documented – height/weight and allergies must be documented and/or
reviewed at each patient encounter. If this has not been done at the time of order entry, this alert will be
displayed at the time of order entry.
No serum Creatinine – this alert will display for certain medication orders requiring renal function
adjustment if no serum Creatinine has been documented. The alert displays at the time of order entry.
Excipient allergy alert – this alert will display if the patient has a documented allergy to certain common
excipients, (ie fish and calcitonin). The alert displays at the time of order entry.
DUPLICATE ORDER ALERT
Occasionally a Duplicate Order Alert is displayed after signing the order. This alert indicates that you are
attempting to order something that has already been ordered.
1.
Make the appropriate action selection at the bottom of the window. The options are explained
below:

Order Anyway – Allows the duplicate order to be placed.

Remove – Cancels the new order.

Modify – Lets the provider change the new order.
2.
Repeat step one as many times as necessary until there are no more duplicate orders.
3.
Click the OK button; after the window closes be sure to also click Refresh to refresh the screen.
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Introduction
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DISCERN ALERTS
When placing orders, if there is pertinent information missing on a patient (example: Height and Weight
or Allergy information) either it has not been entered or updated for the visit, you will receive a Discern
Alert that needs to be addressed prior to placing the
order.
1.
Click Enter Data to open the HT/WT/Allergies form.
2.
Fill in required missing fields and Sign form by
clicking on the green checkmark.
•
3.
26
You are returned to the Order Entry window.
Complete the Order.
Introduction
DRUG-ALLERGY ALERT
Drug-allergy alerts will be presented to the ordering provider at the time of order signature if there is a
documented allergy (allergy and/or adverse effect.) The decision support window will open and present
the information that has been documented for the allergy. The provider may remove the order that has
prompted the alert or override the alert.
•
Drug-drug Interaction Alert: Drug-Drug interactions are defined by the Multum database used
by the Pharmacy at Kaleida Health. There are several levels of drug-drug interactions. The only
level that will prompt an alert to the ordering provider is Major Contraindicated. (Note that the
Pharmacy will see both Major and Major Contraindicated drug-drug interactions). The alert will
be presented at the time of order signature and the decision support window will contain all
pertinent information. The provider will have the option of removing the order, modifying the
current orders or overriding the alert.
OVERRIDING AN ORDER RELATED ALERT
1.
Make the appropriate action selection at the bottom of the window. The options are explained
below:
•
Order Anyway – Allows the duplicate order to be placed.
•
Remove - Cancels the new order.
•
Modify – Allows the provider to change the new order.
2.
Repeat step one as many times as necessary until there are no more duplicate orders.
3.
Click the OK button; after the window closes to be sure to also click Refresh to refresh the
screen.
4.
Click in the Override Reason drop-down and select the reason you are overriding.
27
Introduction
(Rev 1/31/2014)
5.
Click Continue.
•
You can also click the Remove New Order button located in the bottom right corner.
•
You are returned to the Orders window.
6.
Click Orders for Signature (this adds selected orders to the scratchpad for final review)
7.
After completing all required fields, click Sign.
8.
Click the Refresh button to refresh the existing orders.
•
28
The orders submitted in the previous steps should now display with a status of Ordered.
Order Actions
ORDER ACTIONS
Topics in this Unit:
Adding an Order to an Orderset
(Add a Phase)
After having a thorough understanding of Orders Basics in
the previous unit, some orders that have already been
placed may require additional actions, e.g. modification,
discontinuation, etc. This section describes the
functionality to support Order Management.
Ordering Excluded Components
Modifying Orders
Discontinuing an Orderset
Voiding Ordersets
Voiding Single Ordersets
Placing AMB Charges with an
Orderset
Added charges
29
Order Actions
(Rev 1/31/2014)
ADDING AN ORDER TO AN ORDERSET (ADD TO PHASE)
It is possible to add additional individual orders to an existing Orderset. Note: This can be done prior to
signing or added to an active/initiated Orderset.
1.
In the navigation pane on the left, highlight the Orderset you wish to add an additional order to.
2.
Click Add to Phase.
•
3.
Options in the drop-down are: Add Order…, Add
Outcome/Interventions…
Click Add Order.
•
The Add Order search window displays.
4.
Select the AMB Request for Services
folder.
5.
Click the AMB Request for Ancillary
Services order.
6.
Click Done
•
The new Order is added to the order
profile and displays the Details
window.
7.
In the Ancillary Services Requested dropdown, select Physical Therapy.
8.
Select a Diagnosis to associate with this
order.
•
9.
Note: Required fields are denoted with either *bolded text or may be highlighted yellow.
Click the Sign button.
ORDERING EXCLUDED COMPONENTS
Complete the following steps to order excluded components:
1.
Click the View Excluded
Components button to view
orders that were not
selected within an Initiated
Orderset.
2.
Place a checkmark in front
of the component(s) you
want to order.
•
30
Once selected, the
checkbox will have the excluded icon in its place.
3.
Once all excluded orders are selected, click Orders for Signature button.
4.
Click Sign.
Order Actions
MODIFYING ORDERS
The details of individual orders can be modified.
1.
From the Orders workspace, right-click the order, and select Modify from the displayed shortcut
menu. (This opens the scratchpad).
2.
Make the desired changes to the order (i.e. change the dose).
3.
Click Orders for Signature.
4.
Sign the order.
5.
Click the Refresh button.
•
The order displays in the workspace with the new modified parameters.
DISCONTINUING SINGLE ORDERS
Discontinuing an individual order OR an order from within an Orderset.
1.
Highlight the Order and check the Quick Discontinue button.
•
2.
The Details window will display.
Enter a reason that the Order or Orderset is being
discontinued if required by positions/policy.
•
The Details window will display.
•
Once an Orderset has been discontinued, the status will change to Discontinue Pending.
Note: If discontinuing an Orderset (from within the
navigation page, see image below), the discontinue reason
is applied to all the orders in the Orderset; unless specified
to ‘keep’.
•
3.
Once an Orderset has been discontinued, the
status will change to Discontinue Pending.
Click Sign and the Refresh button.
•
The order or Orderset becomes discontinued.
31
Order Actions
(Rev 1/31/2014)
DISCONTINUING AN ORDERSET
1.
From the Navigation pane, right-click the desired Orderset then select Discontinue from the
shortcut menu.
•
2.
Review all orders that are to be
discontinued, click to select any
orders you wish to keep (exclude
from the discontinue process).
3.
Select the appropriate discontinue reason from the drop-down. (This reason will apply to all
orders within the set that are being discontinued – if required by position/policy).
4.
If the Discontinue was chosen in error AND the void has not yet been signed, the provider can
right-click over the Orderset that is in the Discontinue Pending status and click Revert
Discontinue.
•
32
The Discontinue window displays and assumes all orders within the set should be
discontinued, as they are not
selected in the Keep column.
This will bring the Orderset back to initiated status.
Order Actions
VOIDING ORDERSETS
If an Orderset was placed in error (for example, on the wrong patient), it should be voided instead of
canceled or discontinued.
1.
From the Navigation page, right-click the desired Orderset, then select Void from the shortcut
menu.
•
The Orderset
moves into a Void
Pending status.
2.
Click Orders for
Signature button.
3.
Click the Sign button.
4.
Click the Refresh
button.
•
The Orderset is now in a Void (deleted) status.
VOIDING SINGLE ORDERS
Similarly, if a single order was placed in error, it should be voided instead of canceled or discontinued.
1.
From the Orders workspace on the right, right-click the desired order, then select Void from the
shortcut menu.
•
2.
3.
The Order/Orderset moves in Void status.
In the following order, click the Orders for Signature >Sign>Refresh buttons.
•
The Orderset is now in a Void (deleted status, and depending on the display filter selection;
it may or may not be visible in the Orders Workspace.
•
If VOID is chosen in error for that Orderset
If Void was chosen in error AND the Void has not yet been signed, the provider can right-click
over the Orderset that is in the Void Pending status and click Revert Void.
33
Order Actions
(Rev 1/31/2014)
PLACING AMB CHARGES WITH AN ORDERSET
1.
Providers will add the clinics charges at the end of their visit. This can be done various ways:
•
From within PowerNote > Orders
•
Orders
•
•
Depart
Ambulatory Summary mPage> My Favorite Orders
Note: All of the above methods are driven to Orders.
For some specific Ordersets the charges are built into the
Orderset. The charges can be placed now or they can be placed
at a later time during the visit from the Charges Orderset.
ADDING CHARGES
1.
After completing and signing the note, click the Orders
Add button.
2.
Select a Diagnosis and then click on Appropriate Charge Orderset.
•
3.
An electronic charge ticket displays.
To charge for office visits, click in the checkbox to select Amb Visit Chgs.
4. The modifiers key is visible; with
the drop-down arrow, choose the
appropriate modifier when necessary. If
the modifier is not viewable, you will need
to right-click over the order to choose the appropriate option.
5.
Click the OK button.
•
The Visit levels charge screen displays.
6.
Select the appropriate visit charges for the date
of service.
7.
Click the OK button.
8.
Review your charges, and if correct, click the
Sign button.
9.
If not correct, right‐click on the charge and
select Remove.
•
Your charges will be in a Processing Status.
10. Click the Refresh button.
34
•
Your charges are now showing as Completed.
•
When entering charges after the visit, be sure to change the date to the date of the
encounter.
Appendix
APPENDIX
ORDERS ICONS AND INDICATORS
Icons are located in various places on the screen and provide easy access to orders functions. Toolbar
buttons access additional functionality.
Orders for Signature---Displays a list of the current orders in the Order Profile window that
require a signature.
Sign - Signs all orders currently displayed in the Order Profile window and sends them from
Order status to Processing status.
Missing Required Details - Click this button and the system takes the user to the next missing
detail in the order entry format. As each missing and required detail is addressed, the system
updates the number displayed on the button. The button serves as both a count of the
missing details and a mechanism to locate them.
Add - Click to add an order, an Allergy or home medication history. The appropriate window is
displayed.
Expand and Collapse (Clinical Category) - A plus sign indicates that the item (clinical category)
can be expanded. The minus sign means that the item is expanded and can be collapsed. Click
either symbol to toggle between views.
Expand and Collapse (Details Pane, Orders Navigator) - Click the up arrows to expand or
collapse the detail screen.
Active and Inactive Orders - A check mark indicates that the order is currently active. To
inactivate an order, click the check mark to remove it. This action may cause a dialog box to be
displayed requiring a reason for discontinuing the order. Orders that are in a final status, such
as Completed or Discontinued, do not display check marks because they are no longer active.
Order Details Not Complete Indicates that there are required order details that have not been completed for the
orderable.
Orderset - Indicates a care set orderable in the orders search window.
Clinical Calculator - Launches the clinical calculator
Dose Calculator - Launches the dose calculator.
Medical Student Cosign - This icon indicates that medical student cosign is required for the
order. Add to mar summary section pg 12
35
Appendix
(Rev 1/31/2014)
Nurse Review - This icon indicates that nurse review is required.
*Phase (Initiated) -*Indicates a phase in a plan. The yellow Phase icon indicates that it has
been initiated.
Phase (Completed) - Indicates a phase in a plan. The gray Phase icon indicates that it has been
completed.
Physician Cosign - This icon indicates that physician cosign is required for the order.
Physician Cosign Refusal - This icon indicates that the physician has refused to cosign the
order.
Reference Text - This icon indicates that reference text is associated to the order.
Renew Indicator - Hard Stop Policy - A red hourglass with a lock signifies a hard stop, meaning
the order will be stopped when its expiration time is reached. A user must intervene to
continue this order.
Renew Indicator - Soft Stop Policy - A yellow hourglass is displayed for an orderable defined
with a soft stop associated with it, meaning that it is recommended that the order be
discontinued when the stop time is reached, but the system will not automatically stop the
order.
Rx Verify Indicator - The Rx prescription icon means that the order is subject to pharmacy
review and has not yet been reviewed by a pharmacist.
Rx Refusal Indicator -Indicates that a pharmacist has rejected the order.
Taper Dosing- Opens the Taper Dose Tool
Advanced Medication Management---Open to review medication schedule
Sliding Scale - Opens the Sliding Scale dialog box.
Check Interactions-Button shown top, indicator shown bottom.
Check Interactions completed previously.
Merge View- Allows proactive duplicate checking.
Initiate - Activates plan orders, outcomes, and interventions
Discontinue - Discontinuation of Plan.
Add to Phase – Allows order, Outcome and Interventions to be added quickly.
36
Appendix
CANCEL AND REORDER
The Cancel and Reorder action allows the user to quickly cancel and reorder an order. The order item
selected is canceled, and a new order is placed. The user can then select the new order and modify
details prior to signing. (This can only be done on individual orders, not Ordersets.)
1.
From the Orders workspace, right-click the order and select Cancel/Reorder from the displayed
shortcut menu.
•
The scratchpad displays the new order in the top pane and the Order Details tab below is
ready to be populated with any information, as needed.
•
The original order displays at the top of the scratchpad in the Discontinue status.
2.
Make the applicable changes in the Details tab as necessary.
3.
In the following order: click Orders for Signature > Sign >Refresh buttons.
4.
The new order is an Ordered status and depending on the display filter selection, the
discontinued order may or may not be visible in the Orders workspace.
37
Appendix
(Rev 1/31/2014)
AMB FOLDER STRUCTURE
Face-up there are folders for each type of AMB clinic as well as additional Ordersets/single orders that are
used by each type of clinic.
Example(s): AMB Adult Orders will contain additional sub
folders with all charges, lab orders (both provider requisitions
and staff orderables), disease based Or Sdersets and the
additional orders that are ‘face up’ on the home folder.
Charges:
38
Appendix
LABS:
ADULT DISEASE BASED
IN WHAT FOLDER ARE MY CHARGE ORDERSETS?
ADULT PATH
39
Appendix
(Rev 1/31/2014)
PEDS PATH
WOMEN’S HEALTH/FP PATH
SPECIALTY CLINICS PATH
Note: Charges are built in your Orderset
40