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02/14/2017 MD -- Order Entry policy update - Duplicate orders

From: "Michele Durda"

To: "Pharmacists"

Sent: Tuesday, February 14, 2017 8:15:49 AM

Subject: Order Entry policy update - Duplicate orders

Due to some medication omissions related to orders being erroneously discontinued as duplicates by HCAs or nurses, the Order Entry policy has been updated regarding HCA management of duplicate orders. The policy previously instructed them to identify duplicate orders, mark the paper order as a duplicate ("duplicate" with red ink in the margin), and discontinue any orders identified as duplicates in the EMR. The updated policy instructs HCAs to strictly transcribe medication orders and avoid interpretation. HCAs should only discontinue medication orders that are specified to be discontinued by the prescriber order. This includes discontinue orders or orders specifying a change (change, increase, decrease). HCAs are being educated about the policy update beginning today in their February meetings. You may start seeing an increase in the number of duplicate orders that you will need to discontinue. However, this change is being made to address an important safety issue. Duplicates are much easier for the pharmacist to identify than discontinuation errors. Please let me know if you have any questions or concerns.

Updated Order Entry policy:

    * For non-medication orders, if there is a duplicate order, indicate the order is duplicate by writing the word “Duplicate” with red ink in the margin. ( Example: Patient has order for CBC daily in EMR and physician writes CBC in AM). The nurse verifies order as a duplicate when completing Nurse Review of orders. Before a new non-medication order is transcribed into the EMR, the current orders are to be reviewed to see if the order duplicates a current order or possibly cancels a previous order.

    * For medication orders, potential duplicate orders are reviewed and managed by the pharmacist. The HCA or nurse discontinues a medication order in the EMR if a provider order indicates that the order is to be discontinued. Orders interpreted as discontinue orders include discontinue orders and orders indicating a change (change, increase, or decrease). Medications are not administered prior to pharmacy verification of the order, unless emergent or the provider is physically present.

        * [ Ex. 1: Current order for lisinopril 5 mg PO daily and new Provider order to “Increase lisinopril to 10 mg PO daily”; HCA/nurse discontinues previous lisinopril 5 mg order and enters new order for lisinopril 10 mg]

        * [ Ex. 2 : Current order for lisinopril 5 mg PO daily and new Provider order for “lisinopril 10 mg PO daily”; HCA/nurse leaves previous lisinopril 5 mg order in the system and enters a new order for lisinopril 10 mg and the pharmacist reviews and manages the duplicate order]

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Michele Durda, Pharm.D.

Medication Safety/Drug Utilization Pharmacist Huntsville Hospital