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09/21/20 jh Summary: Verifying anticoagulant drips, t-subs, ordered as, IV to PO
September 21, 2020
From: "Joseph Ho" <joseph.ho@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Cc: "Physician Help Line" <4doc@hhsys.org>
Sent: Monday, September 21, 2020 9:49:06 AM
Subject: Summary: verifying anticoagulant drips, t-subs, ordered as, IV to PO
Greetings Cerner Masters!
Much of this information was distributed in recent huddles, but here is some added detail and a summary:
- Please read the linked tip sheet at the end of this sentence about verifying anticoagulant drips, bolus orders, and discontinuations. There was an incident where providers switched the Heparin drip PowerPlans for a patient, but inadvertently left parts of the old PowerPlan active because they only discontinued the initial drip order instead of the entire PowerPlan. If you have the opportunity we highly encourage entering good catches like this into Quantros so we can identify gaps in provider education! Click the following link: Additional Tips when verifying anticoagulant drips
- Please continue to evaluate t-subs and report mismatches during verification. The tip sheet on t-subs has been updated to emphasize the two-step comparison. Note: the statin T-sub example is among those fixed due to your contributions; some of these half tab/multiple tab examples are especially tricky: ALWAYS check the Therapeutic Interchange details!
- There are many things to keep in mind about order modification, but please remember among them is the “Ordered As” field. This field is what controls what is seen on the PowerChart-side (MAR, Medication List, Reconciliation). In the screenshot below the Product was updated on modification to clonidine 0.1 mg/24 hr patches, but the Ordered As was left as 0.2 mg/24 hr. These problems can be avoided by Void and manual re-entry, but we understand that has its own pitfalls.
- IV to PO. More information will be coming about IV to PO conversions. There doesn’t seem to be a perfect method, but we appreciate your input and the following table shows some things you will want to consider:
|
Void and manually re-entry |
Order modification |
|
Always an option |
Not really an option for IVPB (e.g. Keppra, Levaquin)
Most useful for switching things like Protonix |
|
Pros
More likely to have correct route for product
Avoids appearance on MAR Summary of different route administrations
Avoids errors in updating Ordered As
|
Pros
Faster
Can preserve MAR tasks and durations |
|
Cons
Slower
Relies on user to pick correct product on re-entry
Relies on user to enter appropriate start date/time (and duration, order comments if applicable) on new order
Can get distracted and forget to void old order or enter new one |
Cons
Can forget to change route
Can forget to change to the correct product
Can forget to update the Ordered As
Can lead to modify issues: 1. outstanding tasks with a different route (e.g. Protonix, Lasix) 2. Pyxis to NIP problems (nurse can still pull product from Pyxis even though it has been modified to an NIP product)
Gives the appearance on the MAR Summary that the patient has been getting the new route the whole time |
Thank you all for your hard work and continued reporting to PharmIT and via Quantros! Please let me know if you have any questions or feedback about this information.