The Grand Healthcare System

Navigating the Orders Tab Quick Reference Guide

This screen contains items required to navigate the Orders tab.

Documenting Orders

From the Orders tab in the resident chart, you can review the resident's orders, enter New orders, create Batch Updates, and view resident specific Reports.

From the Orders tab you can:

• Create a New Order.
• Batch Update allows you to update multiple orders at one time.
• View the Last Order Review and Next Order Review. Order Review dates shown are based on configuration.
• Search for specific orders using the filters. 

Actions contains specific functions depending on the status of the order. 

• View the order without making changes. 
• Update the existing order.
• Discontinue to discontinue that order.
• Hold to put that order on hold.
• Strike Out remove incorrect order.
• Files to attach documents to orders.
• Confirm to review and confirm the accuracy of orders before it can appear in the eMAR.
• Progress Note to add a progress note for that order.
• Messages to view messages for that order.
• Order Audit Report to access audit information.

hints and tips

Warnings and icons notify you of important information related to each order. Hover over or click the icon for more information.

Click + next to the Order to see Supply information and Additional Information. 

Click column headers to filter Orders by that column. The red triangle indicates how the list is sorted (ascending or descending)

The Order Entry window is where you enter individual orders for a resident.

To open the Order Entry window, go to the Orders tab of the resident's chart, click New or select the order template using the search bar.

This window contains multiple sections that are required to complete each order:

Order Details - order information including Order Category, Ordered by, ordered item (medication name, diagnostic test, diet type), order type and route of administration.

• Some fields depend on the Order Category selected. All MEDICATIONS must go under the pharmacy category. 
• Scheduling Details - timing, frequency, indications for user, date range and directions. Some schedules can be combined in a single order for efficiency.

Routine - orders that are needed routinely for specific date range or indefinite period of time. Can have multiple routine schedules per order.

Source Details - Complete the fields as required.

Permanent Medication Source - Select option. Select House Stock if you have the medication on hand and do not need refills from the pharmacy.

Inventory on Hand - Appears when Pharmacy is selected as the source. Select if medication is already available but future refills will be needed from the pharmacy.

Pharmacy - Select option. Appears when Pharmacy is selected as the Permanent Medication Source. For IMM, if the selected pharmacy is non-integrated, you need to generate the Pharmacy Requisition and fax to the non-integrated pharmacy to receive the medication.

Note to Pharmacy - Type note. For example “First dose taken from emergency kit”. Do not use to communicate STAT orders. You need to communicate STAT orders directly to the pharmacy. This appears on the Order Audit report and the Pharmacy Requisition report.

Orders Procedure 

1. From the Resident’s chart, click the Orders tab 
2. Click the New button 
3. Enter the Order Date, date in which the prescriber provided the order 
4. Select Pharmacy from the Order Category  
5. Select the Communication Method by which order was communicated by the Prescriber. For e-prescribe enabled facilities if you are the prescriber or an agent of the prescriber the Prescriber/Agent entered option will be active and selected by default.  
6. Select prescriber from the Ordered By magnifying glass icon look-up. “Last prescribed by:” will default to the last medical professional used. If you are the medical professional entering the order you name will auto populate here. 

1. Library should default to pharmacy formulary.  
2. Enter the prescribed Medication. Predictive texting should begin to display results as you type. Select the desired medication from the options.  

Check the Dispense as Written (DAW) checkbox if medication should be dispensed by the pharmacy exactly as it was written informing the pharmacy that no substitutions can be made i.e. brand name medication. 

1. Select the appropriate Order Type which determines the administration record the order will appear and other reporting filter capability. This field may be auto populated based on the class of the medication you selected from the library. 
2. Select the Route of Administration. Pick list is filtered based on the medication you selected from the library; If you do not see the option you are looking for, click the 

show all link. 

Scheduling Details if Routine Schedule is selected 

1. Record a Location upon Administration (displays based on route selected) uncheck box if you do not want to be prompted to record Location of Administration in eMAR. 

Enter the Dose or Admin Quantity by typing and selecting unit of measure (filtered by medication selected, click the show all link for more options). If you check Alternating Dose checkbox enter in the two sets of fields that display.  

1. Apply To text field displays instead of “Dose or Admin Quantity” fields based on route 

i.e. topically. Type in prescribed location of administration. 

1. Select Frequency to be administered. If desired frequency is not available, select other and type label. 
2. Select Schedule Type. 
3. Select Facility Time Code. 
4. Click the magnifying glass icon to select any Related Diagnosis, for which the order is being prescribed, select the diagnoses check box(es), and Click Update. If the diagnosis is not in existing list of medical diagnoses list, click the Create New Diagnosis button or report to MDS department based on your facilities policy. 
5. Type in Indications for Use; or click the magnifying glass icon to select and Update.   
6. Type in any Additional Directions that you need to communicate. 
7. Select who the order will be Administered By (will default to clinician )
8. Alter Start Date if the prescriber specified, alter start time as needed. 
9. Modify End Date from Indefinite to Duration or Specified Date, if applicable.
   1. Pass Time(s) will display based on Time Code selected; alter as needed. 
   2. Beside each pass time to select for any pre-administration data that needs to be recorded. Go to Supplementary Documentation: Click on ADD. Choose Wt (weight), Resp (respirations), BP (blood pressure), Temp (temperature), Pulse (pulse), BS (blood sugar), O2 (oxygen saturation), lab results, etc. Click Update. 
      • If selected Custom Prompt, enter 5 characters max title i.e. “pain” for a pain scale prompt. 
      • Enter “AMT” for an amount prompt i.e. Supplement or residual amount ( for enteral feeds)
   3. Admin Notes: Enter Pass Time specific direction in the text field to the right, as needed to be read by administrating nurse.

If you are ordering a controlled substance with EPCS, orders entered into PointClickCare will be the actual orders to dispense. 

• For schedule 2 controlled substances: the order is only good for 30-day supply, No refills. To get the next 30-day supply, the Prescriber needs to enter &/or sign a new order. 
• With schedule 3 / 4 Rx: must have a new order entered at least every 6 months.  If the order was entered prior to EPCS being enabled, will need to discontinue the order and enter a new order when the next fill is needed, to start the electronic prescription. Then reorders may be processed up to the number of refills specified in the order. 

**The previous order must be discontinued. You would not use the "update" link to create a new order from the old order because that will bring the RX number forward from the previous order.

Under Scheduling details, you will have to indicate the quantity and depending on the type of controlled substance the number of refills needed from pharmacy.

Source Details if Pharmacy is selected 

1. Select Permanent Medication Source from the drop-down. Will default to Pharmacy and Pharmacy will show default pharmacy’s on file name.
2. If temporary supply available check Inventory on hand 

Type any Note to Pharmacy if applicable 

Note Medical Professionals

Medical professionals will be taken to another window where they will be prompted to e sign the order. Click on the box next to the medication name and the click on electronically sign. If it is a controlled substance you will have to click on ready to sign then check to box next to the medication name will appear.

If you successfully pass the authentication check you will return to the resident’s Order Listing.  For medical professionals if you’re ordering a controlled substance you will be prompted to add your device token id in addition to your password. 

Other Scheduling Details

PRN - orders that are only as needed for specific date range or indefinite period of time. Can have multiple PRN schedules per order. (Reassessment may be required)

• One Time Only - orders that are needed one time only or during a specific date range. Alert: This schedule will appear on the administration record as of the specified start date and will remain until administered or the schedule's end date.

Titration - orders that are required to change dosing over a specific period of time. The system will automatically calculate dates for you.  

STAT - orders that are needed immediately. 

• Source Details - information about the source or provider of the item ordered (pharmacy, in-house stock, provider lab used for Laboratory testing). Not all orders entered contain this section. 
• Order information shows on the right side of the window as the Order Details, Scheduling Details, and Source Details sections are completed. Order Summary - a summary of the order, this is what shows on the medication block in the eMAR.

• Formularies - indicates if the order is found in a category of formulary types. Hover over icons to see Pharmacy, Medical Professional, Facility Favorite or Payer. Formulary name is listed and Y or N indicates if the formulary contains the order.

• Additional Information - shows Alerts such as Black Box Warnings, Drug Interactions, Dose Checking, Overdose warnings, Drug Allergy Alerts or if Dose Checking is unavailable. Click alert for more information.

NOTE TO SELF- When transferring out a resident put all orders on hold for 24hrs. Once resident is admitted discontinue orders on HOLD.

House Stock Order Tips

When entering orders, it is best practice to use the suggested order templates. This will save you time when entering orders and will also help you identify house stock supply of medication from you Pharmacy supply. The system does this by automatically defaulting all your in-house supply to house stock down below in your source details. Pharmacy will not be alerted of these orders and therefore will not dispense these items. 

Example 

1. Enter name of medication. Bisacodyl

2. Click on desired Order template: Bisacodyl (Dulcolax) EC 10mg PO Daily for Bowel Management. This will auto populate the rest of the order. (Facility Time Code maybe required).  
3. Scrolled down to your Source Detail: Permanent Medication Source will default as House stock.