CPOM TRAINING Page 1
Physician Training For CPOM Patient list columns, Flag Management, Icons Icons added for CPOM: Columns added: Flags New Orders: GREEN - are general orders. RED means STAT orders included Order Rec: GREEN means it needs to be done RED means it s overdue To Sign: GREEN means there are orders that need signed RED you must sign Page 2
Signature Manager If you have orders or documents that need to be signed, Signature Manager displays when you log in. If you don t sign them at that time, an Alert fires - as to why you are not signing now. You can also access Signature Manager by clicking the flag If you want to Refuse to sign an order, highlight the order and click - You will be asked to give a reason why you are refusing to sign. Page 3
Entering Orders General Order entry worksheet design Session Type: Standard (default session type) Allergy Details: Page 4
Browse/Manual Entry: Start of Browse assists you in finding orders. To use Manual Entry If you need to check something in the chart before submitting your orders, you can Hide Worksheet so you do not lose your work. To return to Order Entry, click the Leaving this patient s chart, however, gives you a warning that you have un-submitted orders. Page 5
You can Suspend the Session if you get called away. However, if you don t submit the orders in a timely fashion, the computer logs you off and all previous work is lost. Admission Orders require you to enter an Admitting Diagnosis (if it hasn t already been added). This automatically takes you to the Health Issue Manager. Page 6
This is also where other Health Issues (including a Discharge Dx) can also be entered: You can also access the Health Manager from the Toolbar: Required Fields: Some order forms have required fields they display with a RED asterisk *. A Conditional Order is available to enter a specific condition that must be met before the test is to be done. The Nurse activates the order when the condition is met. Page 7
If the test is to be STAT at the time it s activated change it in the Collection Priority/Time box. Some Conditional fields display because they are controlled by the system. For example: X-ray, CT, MRI, and MRA tests ordered for females between the ages of 12-55 activate a required field to be completed regarding their pregnancy status (Yes / No / Unknown). If the patient is male, or the female is outside the age bracket the field is not displayed. Lab order can also be conditional. Some fields have optional fields where you can Select one of the choices. Or use one of these choices or think of your own Page 8
Repeat Orders: Orders can be repeated: Hourly / Daily / Weekly You decide when to start & how often: - The defaults for occurrences are 2 but can be changed to meet your needs. Below is the icon you will see that indicates there are more than one order with this item. Parent or original order. / Repeated orders follow and appear when they have been told to repeat. Most forms also have a free text area where you can write additional instructions (if desired). Page 9
Sometimes you ll see checkboxes which allows you to select more than one option. Other times you can see circles that allow only one choice: Lab order entry Some lab items will require a specimen source and location to complete the order. Frequencies are designed to list appropriate options for that item. Medication Order Entry Page 10
As you type, possible choices appear (sometimes less is more). Therapeutic substitutions are configured in SAC for items that are non-formulary at CMH. Medication forms default with options that complete the necessary fields to complete an order. Not all substitutions are a 1-1 for dosages. As seen below. To Override a Reason: You must offer a reason. TPN Order Entry: Page 11
Add Modify additives: Orders tab and order management Sequence of categories > o Chart Selection This chart or All Available Charts o Date Range From: To: or Use the QuickPick Page 12
o Display Format o Filters Status / Priority Order Selection Page 13
Department - (No Department Filter) is the Default But this can be customized for your best use: Dispense Type: Or Customized: Page 14
o Display Styles: Or Customized: o You can set your Filters to also display additional Views: Page 15
SETTING UP PREFERENCES FOR ORDER ENTRY: From the MENU BAR click Preferences the select ORDER ENTRY: Set the Default of your choice Page 16
If you want the Option of either Starting the Browse with your own frequently used Order Set category, follow the example below. Example: Click Add New > Order Sets > Cardiology > Apply Hit Apply to keep going or OK to close. Don t forget to Set as Default Once defaulted, it will stay this way until you change your Preferences again. Page 17
SETTING UP YOUR FAVORITES: You can save Order Sets that you use frequently to your Favorites From the Order Entry Worksheet, type in the Order Set Highligh the selection you want to save Click the Add to Favorites button to the right. It saves it & allows you to keep going Once you close and switch to My Favorite Sets your list appears You can also make this your Default list You can also re-arrange your list how you want it to appear by using the Move Up or Move Down button. Page 18
ORDER MODIFICATION: Not all orders can be modified. From the Orders Tab, find the Order you want to modify and highlight it. Next right click on the order. Your options appear in an active state. If the options are grayed out, they may not be modified. Modifying an order for tube feedings or mechanical Vent Order Modification can only be done on a select few orders. Tube feedings and Ventilators Page 19
If the item is designed to allow modification the requested by will be active. *Note: The Start Date and Start Time are grayed out and cannot be changed. The active fields are available for modification. Creating preferences in the options panel allows for you to build filters that are specific to your needs. It s done only once and each time after you create it the item is available for you to use. Page 20
You can build as many or as few you need to collect the data necessary to make your review of patient data specific to your needs. Order Set There are different types of order sets to accommodate efficient order entry. Admission, Common (i.e. Labs and Rads), Therapeutic substitution, Pre/Post op, Procedure, and Disease Form design and how to interact with the columns. You can create a list of favorites that will display each time you launch the order entry worksheet. Relevant results will provide you with the most recent results for specific tests that are related to the order sets. Order sets will display only the results that are relevant to the type of set you are working with. Health Issue Management (Problem list) can be perform from the Tool bar icon or from within the admit order in the Admission Order sets The following health issue types will stay on the chart from visit to visit: o Pt Problem, Pt Medical Hx, Pt Surgical Hx, The following health issue types will only be active for this visit: o Admitting Dx, Discharge Dx, Other Dx, and Chief Complaint o The Top Admitting and Discharge diagnoses have been created for you but you can also create a favorites list as well. Evidence links are provided in the order set to allow you to include them into your orders. Page 21
Selecting the E in the grid will take you to articles related to the topic. Red asterisk indicates required fields that need to be addressed before the order can be submitted. The order sets are set up to have the same grid sequence from one order set to another. Columns on the grids are also consistent from one order set to another. Existing paper order sets have been built in the system to allow for you continue to have the orders you need in a group to expedite order entry. Page 22
Orders that are pre checked do not require any actions by the user to initiate the order If you do not want this order to be on the patient just select the check and remove it except for Evidence and quality indicators. Typing in the signs and symptoms in the box provided on the form Typing in the signs and symptoms in the box provided on the form Page 23
This will populate all of the x-rays that you order. If you have a different reason for ordering an exam, make sure to select the column for the signs and symptoms and modify. The headers in each lab section let you know what priority is pre selected for the items in that grouping. Note the icon beside the repeat orders. This is the indication that the repeat criteria have been set (daily x3 days). You can open the lab item and modify the repeat criteria if needed. Note some of the grids have folders at the bottom that allow for ordering items outside of what is on the order set. Once you select the order(s) you will be able to come back to the order set. Page 24
When possible the medication grid will have complete orders for you to select. If there are multiple options you can select the column and pick/type in the desired amount/option. The communication order Call MD For allows you to type in the special instructions. In some order sets this can be pre-filled out. Pre-configured Special Instructions for Call MD for: Page 25
The CMH VTE order set will take you to another order set to select items and then those items will become a part of this set for this patient. Page 26
On the order entry worksheet you can review and make modifications to an order before submitting it. You can hide a worksheet to protect the patients from someone else seeing the information if your attention is drawn away from entering orders. You can suspend the session if necessary if called away from order entry If you do not submit and the computer logs off due to inactivity you will lose the information you were working on. Page 27
Reauthenticate This action prevents someone else entering data into the chart under your log in. Authentication is required for both documentation and order entry This action gives you one more review to make sure you are entering the orders on the correct patient Verbal/Telephone The physician s role in the future will be for them to perform order entry when possible. Page 28
When not possible for the physician to enter the order the nurse will take a verbal/telephone order that will prompt you to sign via Signature manager at your next log in. The nurse will require you to be on the phone while they are putting the order/orders in to SAC. This will allow the nurse to read you any alerts that are fired during the order entry process. Suspend/UnSuspend Page 29
Un-Suspend You will also be able to modify the suspend date depending on the patient s condition. You can un-suspend at any time Managing Alerts Page 30
View Actions This will allow you to keep the order you just selected and discontinue the order that is currently on the patient to maintain one diet order on the patient at a time. Drug Interaction View Actions Page 31
Warning messages in order browse Order Reconciliation Manager Order Reconciliation types Page 32
Admission This workflow will allow you to review home medications the patient is taking Continue the medication while the patient is hospitalized Modify dose/frequency during hospitalization Review and Reconcile but not continue the medication during this hospitalization Working through each medication Page 33
Access to order entry icon from this pathway to allow for ease of use Transfer Allow for all orders to be reviewed not just medications. DC/Reorder allows for you to change the orders at time of transfer Home medications can be reviewed again with the transfer since may now be appropriate for the patient. Because patients can be transferred more than once, this type of Reconciliation can be performed several times Pre-transfer orders include: Active orders including suspended orders Orders with their status automatically changed to suspended or discontinued upon transfer Orders discontinued/canceled or completed 24 hours prior to transfer Post-transfer orders can include: Orders placed after the transfer was made Orders placed prior to the transfer but maintained after the transfer & before reconciliation took place (i.e., - an order that was automatically suspended upon transfer but then was unsuspended from the Orders tab) Page 34
Discharge You can enter the order to discharge and any discharge orders at this time. The order session will be Discharge so the orders are not acted on while the patient is still an in patient The list of current medication will allow you to continue these as a home medication Icons available on the items to expedite the reconciliation process. Discharge meds includes all orders entered in the Discharge session type. Creating a list of medications that the patient needs to take upon discharge includes: o Reviewing current inpatient orders & deciding what should be continued upon discharge o Reviewing the list of home meds & deciding what should be continued upon discharge o Entering new discharge orders o Entering new prescriptions Identifying Discharge Reconciliation Triggers include: o Discharge Order A catalog item configured as a discharge order (When it s placed, a requirement generates & allows you to perform a reconciliation BEFORE the patient is discharged o Discharge Event When the patient is actually discharged (either from within Sunrise or through an ADT), a requirement is triggered based upon the rules configured which prompts you to perform a reconciliation after the patient is discharged Page 35
Page 36
The Reconciliation Document Page 37
Rx Writer From the ORM module you can access Rx Writer and create your prescriptions while doing discharge reconciliation. By right clicking you will be given a menu to create a new prescription. The modify prescription screen will already have the information from the order that the script is tied to. Verify the details of the order making sure the instructions and quantity are correct. You can also access Rx Writer from the Icon on the tool bar by selecting this Icon Check the orders that you want to write prescriptions for. Then select the prescription icon The list of medications will be displayed. Check the item(s) that you need prescriptions for. Select the down arrow to open the options. Select the Rx item to open the prescription screen. Fill in the number of days and the system will calculate the quantity needed. Select add to list. The next item that is checked will display, repeat filling in the number of days, and modifying the instructions if needed. To modify you will need to select the edit button above the instructions pane. Once you have completed the list then you can review and submit. On this screen you have the opportunity to preview, edit the script before printing or delete. As you can see here the first item was deleted which is now scored through. Page 38
Also note on this screen shot that the system has taken the 15 day quantity and created the Rx End Date. You can add a memo to a medication so that the next time you write a prescription the Sigs, Memo is available for your review Once you select the add memo the dialog box opens for your to type in your message.. This is where the informaiton can be reviewed. In this same function you have the opportunity to review the pharmacology of the item and print out education material for the patient. The education material is written in 6 th grade level English and you also have the option to print it in Spanish. Page 39
Discharge Planning Page 40
This order can be placed at any time during the stay in preparation for discharge. Discharge Order set Page 41
The discharge order can be made conditional so that the discharge order will become active only when a specific condition is met. (An example would be that it s ok to discharge if Protime is greater than 1.5) Once the lab result is back nursing would then activate the discharge order. Page 42
Meeting Core Measure The grids that are measured for the admitting diagnosis for the patient at discharge will activate requiring a response for the appropriate grids. Currently the core measures that are being evaluated by this order set are Stroke, Congestive Heart Failure and Acute Myocardial Infarction Physician Progress note Initial assessment setting up defaults for physical exam and negatives Page 43
Daily progress Page 44
You can set up my normal for ROS for negatives then once pulled in can be modified to reflect the changes noted for this patient Page 45
Can retrieve the most recent note and modify for changes noted Page 46
Can retrieve the current health issues add to note and also add new health issues This screen allows you to pull into this note the results for the most recent images taken Page 47
For patients that have received blood or are on a mechanical ventilator The note contains the necessary document for certification of Inpatient admission This last section displays the necessary documentation to support subsequent visits Page 48
You have the ability to individualize the progress note based on your practice or to a specific disease. You can only have one template If a CDIS query is done for your patient the Case Manager will add this to a progress note and require for you to sign it which will allow for you to edit the document and respond to the query. Icon functions within a note. The Preview allows for the reading pane to be either at the bottom, right side or not at all. Page 49
Acronym expansion set up once can copy from another user so groups can set up standards This feature is case sensitive so for ease of use we recommend that the Acronym be created using lower case. You have the ability to individualize the progress note based on your practice or to a specific disease. You can only have one template Clinical Summary -this has not changed but let s reviews. NOTES: Page 50
Page 51