PCA PRESCRIPTON/ORDER AND PUMP CHANGES ALLSCRIPTS TO EPIC

[Pages:4]PCA PRESCRIPTON/ORDER AND PUMP CHANGES ALLSCRIPTS TO EPIC

Type of PCA Allscripts PCA Orders

Epic PCA Orders

Comments

Name of dose patient gives self:

All PCA Order Patient demand is called demand

Sets

dose.

Patient demand is called patient demand bolus (sometimes just demand bolus and sometimes just patient bolus).

CAUTION. In Sapphire pump `bolus' does not only refer to the doses that clinicians administer. Be clear in your orders/discussions.

All PCA Order First setting in PCA prescription

Sets

parts of order set is the demand

dose

First setting in PCA prescription parts of order set is the continuous rate

CAUTION. The initial PCA order and any upward and/or downward titration orders all start with the continuous rate. Make sure you do not put in a patient demand bolus as the first parameter by accident.

All PCA Order Sets

Main PCA order and Clinician Boluses will have default settings that are the most common for that order set (i.e. basic, advanced, restricted) but the prescriber can override the default settings if clinical status warrants.

Same as Allscripts

All PCA Order Has Hour maximum of mg/mcg per Hour Max now determined by #

Sets

hour

patient demand boluses per hour

Due to functionality of Sapphire pump changing to a max # patient boluses per hour

All PCA Order Continuous Rate: Continuous rate

Sets

is added into the hour limit

Do NOT add continuous rate into hour limit. Only determine limit by the number of times a patient can receive a demand bolus.

Since hour limit is now determined by the number of times a patient can receive a patient demand bolus, there is no way to add the continuous rate into the hour limit.

Use caution when putting in a continuous rate!

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Type of PCA Allscripts PCA Orders

Epic PCA Orders

Comments

All PCA Order Sets

Documenting the Hour Limits: Allscripts completes the arithmetic to determine max mg/mcg per hour

Does NOT do the arithmetic. You will need to determine max # patient boluses by dividing the lockout time into 60 min and then deciding if you want that number of patient boluses or less and then indicating in the "Maximum # boluses" order. Ex: lockout 6 min, the maximum # of patient demand boluses can be 10 or less. Lockout 8 min, maximum # of patient demand boluses is 7 or less. YOU choose.

Epic functionality does not allow for the arithmetic to be automatic. Prescriber must complete the arithmetic for almost every parameter that requires arithmetic be performed.

Advanced and Restricted PCA (not Basic) Order Sets

Nighttime ONLY continuous infusion--present but never used as it was not known it was there

Nighttime ONLY continuous infusion. If desired will order `0' in the main order, for continuous infusion, and then order the separate (part of the order set) Nighttime Only continuous infusion. It will need to be ordered for subsequent nights at the time you place your PCA order. You can order for up to 7 nights in a row. It will always be from 10p to 6a

If you do not want 7 days' worth of nighttime infusion you can hit the `remove' button on the remainder of the nighttime infusion orders.

Advanced and Restricted PCA Order Sets

Loading Dose Clinician bolus

Loading Dose clinician bolus. If you choose to have a larger clinician bolus for the first hour of PCA usage to help patient reach an effective systemic level use this order.

Same as Allscripts. Use only if needed. If regular clinician bolus will suffice do not need Loading Dose Clinician bolus. BOTH Loading dose and `regular' clinician boluses can be ordered so do order both if needed. RN will only use one or the other. Loading dose is only in effect for first hour of patient using the PCA.

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Type of PCA Allscripts PCA Orders

Epic PCA Orders

Comments

Basic PCA Order Sets

PACU only Clinician Bolus

PACU only Clinician Bolus

All PCA Order First Adjustment for Inadequate

Sets

Relief 1+ hours from initiation of

PCA

First Adjustment for Inadequate Relief 1+ hours from initiation of PCA

Same as Allscripts except for hour maximum as described above.

Advanced and Restricted PCA Order Sets

Second adjustment for inadequate relief

This order is only completed if prescriber feels it will be beneficial for the patient. It is not a required order. Second adjustment for inadequate relief

Same as Allscripts except for hour maximum as noted above

Advanced and Restricted PCA Order Sets

Sedation without respiratory compromise. General Nursing mPOSS >/= 2 or RASS 10 per minute. This order is mandated and requires the prescriber to place downward titration orders for patients who are drowsy but do not yet require the PCA be turned completely off.

Same as Allscripts

Like the Loading Dose, in the Advanced order set, this enables the prescriber to give the patient larger and/or more frequent clinician boluses while the patient is in PACU. BOTH PACU clinician bolus and `regular' clinician bolus can be ordered so do order both if both needed. RN will only use one or the other, not both. "PACU only" clinician bolus is no longer active when the patient leaves PACU. Remember to complete all the parameters, making sure to put `0' in the first line, which is continuous infusion, unless a continuous infusion is wanted and available in that order set. And remember to do the arithmetic for the maximum patient demand boluses based on lockout interval. May prescribe exact number or may prescribe less than 60 min/lockout interval minutes.

Advanced and Restricted order sets allow for a 2nd upward titration, if it will be beneficial to the patient. It is not a required order.

If ordered, remember to complete the arithmetic for maximum # of patient demand boluses.

If any concerns that the patient has mitigating diagnoses/factors and you, as a prescriber, would want the PCA turned off even with RR > 10/min you can put in all 0's to the order so the RN would, in effect, turn off the PCA.

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Type of PCA Allscripts PCA Orders

Epic PCA Orders

Comments

All PCA Order Adjuvant Agents. In Allscripts

Sets

Medications for nausea/vomiting

ordered automatically

In Epic the prescriber can choose to order medications for side effects such as nausea, vomiting, severe itching. If desired click on the indicated box and then choices (i.e. N/V or pruritus) will be available for each of the indicated side effects.

Many of these medications are also ordered by primary service so only need to add these medications if not otherwise ordered and discussed with primary service.

All PCA Order Sets

A change in order is needed. In Allscripts, the entire order must be discontinued and reordered if the patient requires an unplanned for change in PCA prescription

In Epic you can modify a part of the order. You do not have to redo the entire order.

Only a prescriber with security rights to the specific type of order set can modify the order. For example, if a patient has Advanced PCA, only a prescriber with Advanced PCA or Restricted PCA can modify the order. A prescriber with only Basic PCA security rights will not be able to modify the order for the given PCA.

All PCA Order Sets

Discontinue PCA. In Allscripts once a part of the PCA order is discontinued a query comes up asking if you would like to d/c other orders and then the prescriber can choose those he/she wants to discontinue.

In Epic you need to know the `keystone' order for an order set to discontinue the entire order set at one time. The `keystone' order for any PCA order in Epic is the main PCA order. That is the part of the order set in which the prescriber first orders the continuous rate, demand bolus, lockout time and maximum # patient boluses per hour.

In Epic when the `keystone' order is discontinued all the other orders will also come up with a `button' to modify or discontinue. However, at the top of the order will be a button that says: Discontinue All. You can then determine if you wish to discontinue all or some of the related orders.

If the PCA order itself has been modified then the order set will not be able to be discontinued all at once. Each order will need to be discontinued individually.

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