Introduction to Order Entry

1. Introduction to Order Entry Order Entry Lesson 2

2. Following completion of this lesson you will be able to: . Describe the Order Management process . Identify which orders are entered via Meditech Order Management . Demonstrate how to enter individual orders using the By Procedure button . Describe how to properly enter Order Information . Describe the difference in DIET orders and other types of orders . Show how to file an order and explain what happens when an order is filed Objectives

3. Meditech Order Management • The Meditech Order Management system delivers patient care orders electronically to the department or patient care service from which an intervention or service is being requested. • Meditech Order Management will be used for many things, among them to enter physicians’ orders for patient care. Orders are transmitted through the Meditech system and appear at the department from which you are requesting service. For example, an order for physical therapy will appear in the Physical Therapy Department where it will be scheduled as a request for service.

4. Meditech Order Management • All written physician orders are entered into Meditech EXCEPT for medication and IV orders. Medication and IV Orders are transmitted by fax to the Pharmacy.

5. Let’s review the patient selection process as we learn to access the Order Entry routine from PCS. First, we will select our practice patient, Mr. Red, by clicking on his name.

6. Now that the correct patient is highlighted and we assume we have already entered in the patient’s allergies and patient data, we will click on the Orders link to begin the ordering process.

7. Before you may enter an order, you must choose the Ordering Provider from a list of eligible providers at GBMC. Be careful to choose the provider who wrote or telephoned the orders, which may not necessarily be the Attending Physician. You can search for a provider by typing his/her last name in the Ordering provider box. We will now type Davis in the Ordering Provider box.

8. Now that Dr. Davis’ last name is in the Ordering Provider box, we will click on the Save button or press the Enter key on the keyboard.

9. This will open a list of all the doctors in the hospital with the first or last name of Davis. We will click on the doctor we wish to select and his or her name will be entered in the Ordering Provider Box and we will then advance to the Order Entry screen. We will click on Alan Davis now.

10. This is the Main Order Entry screen. Our patient has just been admitted and doesn’t have any orders yet. Let’s discuss how the screen is arranged.

11. At the top of the screen, you will see the list of current orders for the patient. Our patient does not have any orders entered yet.

12. Just below the current orders list will be the selections used to enter orders. The Orders button will allow you to enter one order at a time. The Sets button (highlighted presently for our patient), will open a list of possible order set choices on the screen (seen here in the middle of the screen). The Meds button is grayed out. All medication orders must be faxed to pharmacy and are not entered through Meditech.

13. The Favorites, Category, and Name options highlighted here can be used to change the way orders are sorted on the screen. We will learn more about these options later in this tutorial.

14. There are two ways to enter orders: individually or in sets. We will learn to enter order sets later. Let’s start by learning to enter individual orders using the Orders button. We will now click on Orders.

15. We want to order a CBC for our patient. We will begin to type the procedure name, CBC, in the Search box at the top of the screen. The list of procedures will be shortened with each letter that you type.

16. The CBC with differential is the second procedure on the list. We can select it by double-clicking on the entry. Let’s see what happens when we do that.

17. The CBC has been selected, as evidenced by the indicator in the middle of the screen that now says “1 Selected Items.” Always monitor this indicator to keep track of the orders you have selected.

18. Although, you have chosen the order you want to place, it has not yet been transmitted to the Lab for processing. There are several more steps you must take to submit the order. It is possible to select several orders at a time from this page. When you have entered all of the orders you plan to submit, you will click on the Edit button at the bottom of this page to enter in the exact details for each order. We will click on Edit now.

19. This is the order detail screen for the CBC order. This is where we will enter details about the order, such as its priority, when it is to be performed, and special instructions.

20. REQUIRED OPTIONAL Now we must fill in the order detail section of the screen. Any required fields are shown with an asterisk next to the question. Optional fields will not have an asterisk.

21. The first question we must answer is the order’s priority – whether Routine, Stat, or Urgent. Fields with pull down arrows like this one have multiple selections. You may enter the mnemonic of the selection if you know it, or look up the answer from a list. We will now click the drop down arrow.

22. Any drop down boxes on the order details screens will also allow you to type the mnemonic for what you are searching for in the white box at the top pf the drop down screen and the answers will narrow below based on your typing.

23. In this case, we will make our selection from the list by clicking on our choice. Since we want the Routine selection, we will click on it and it will fill into the selection box for us.

24. The Date field is automatically filled with today’s date when you are entering an order. We can change the date if we need to or accept the date as it is given by pressing Enter.

25. The doctor ordered the CBC to be performed now, and in the Time field there is a short cut to tell the system that the order is to be performed now. We have typed N for now, and the system will automatically fill in the current time for you once you press Enter or move to the next field.

26. The next section is asking if the order is a series order. Because most orders are for single events, the system offers a default answer of N for No here. We will press the Enter key to accept the answer as it is given.

27. Meditech has skipped the rest of the series questions, because we said our order was not a series order. The cursor has moved to the label print question.

28. You can tell that an answer to this question is required because it has an asterisk next to it. This questions will determine where the specimen labels will print. If you answer Yes to this question, the labels will print on the unit; if No, they will print in the Lab.

29. Details about when you should print the labels in the Lab appear on the screen for reference. You only print the labels to the lab if you want the lab to draw the sample on phlebotomy rounds. Phlebotomy rounds occur every 2 hours from 7am – 9pm. There are specific cut off times for ordering specimens. There will be more information later in this tutorial about cut off times for you.

30. Now we have filled out all of the necessary sections of the order details screen and we will save our selections by clicking on Save.

31. Now that the details have been entered, the order is ready for submission. The status “New” will appear in green, which is a reminder that the order has not yet been saved. To submit the order, we will click on the Save button.

32. Before the order submission is completed, Meditech always gives you a chance to change your mind in case you have entered an order in error. For this you could use the Return to Screen function which allows you to return to the order to correct any entries or discard the order entirely.

33. To save the order and transmit it to the Lab, you will click on one of the File buttons. If you are finished with this patient and want to leave order entry and go back to PCS, you will click File and Exit. We want to refresh the screen and add more orders to this patient, so we will click on File and Refresh.

34. Our CBC is now saved and the order has been sent to the lab. We have learned how to enter a single order. Next we will learn how to enter two or more orders for a single submission. Again, we will initiate the orders by clicking on the Orders button.

35. We need to order a BUN. We will type BUN in the Search box now.

36. We will now select the correct order by double clicking on it.

37. We can now see “1 Selected Items” in the middle of the screen. Now we can enter our second order for a serum creatinine. To do this, we will begin typing “CREAT” in the Procedures box.

38. We must be careful to choose the correct Creatinine test from the list. We will double-click on the one we want now.

39. The selected orders counter is increased by one, indicating that we have two orders on our list to submit. We will now click on Edit to fill in the details for these 2 orders.

40. Here is the information section of the BUN order. You learned about using mnemonics as a short cut in the last lesson. Since you now know the mnemonic for a routine priority is R, you can type that instead of using the drop down arrow to choose the priority. We will type R then press Enter.

41. The date field defaulted with the current date, but the order is for a BUN for tomorrow morning. As a shortcut, we have removed the date and typed T + 1. T stands for today, T + 1 means tomorrow, and so on.

42. We need to enter a time for the specimen to be drawn in the morning. This order will be drawn by the lab phlebotomist on morning rounds, so the appropriate time to enter is 4 AM. Entering 0400 will ensure that the labels print out at the appropriate time and the specimen is collected on schedule.

43. What happens if you enter a phlebotomy collect order after 4:00 am - say, at 5:00 am? If the specimen is to be drawn by the lab, then the specimen will go the NEXT MORNING draw collection list – the specimen will not be drawn until the following morning. This is why it is so important to be familiar with the cut off times for entering orders in Meditech. Lets take a look at some.

44. Ordering Cut Off Times Phlebotomy Draw Times Order Must be in Meditech by: Morning Draws 0500-0800 Before 0400 Rounds 9am, 11am, 1pm 30 Minutes Before Round Time 3pm, 5pm, 7pm Round at 9pm Cut off time is 7:30pm * Note: Any orders put in after cut off times will be drawn on next phlebotomy round.

45. Stat Tests • In order for pharmacy to collect a STAT specimen, the unit must page STAT phlebotomy (Pager #158) • All blood draw labels for STAT tests should be printed out on the unit.

46. Now that we have filled in our Time, the Series order question again defaults to N for no, so we will accept that answer by pressing the Enter key.

47. Once again, Meditech skips the Series Information Questions because we said the order wasn’t a series order. We will now fill in where we want our label to print. The specimen is to be drawn by phlebotomy. We will enter N to print this label in the lab.

48. If, as in our earlier scenario, it is now 5:00am and you want to enter an order for blood to be drawn by the Lab this morning, you may elect to enter Y here. If phlebotomy has not yet made morning rounds on your unit, you may print the labels on your unit and place them in the morning draw folder of the Lab Stats/Rounds book. Phlebotomy will collect the labels before making round on the unit and draw the blood for you.

49. We will click on Save now to save this order and move on to the Creatinine order.

50. The order detail screen appears for the Creatinine order, just as it did for the BUN order. We have filled in the values for you. We will save the entries by clicking on the Save button.