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Hi all, Two questions for the POM Community; my questions are also
related to an EMAR environment: 1. How have you handled discussions on what
happens when Pharmacy incorporates a “cosmetic/minor” change to the
original POM order? (This equates to the intent of
the order not changing but some manual intervention has been incorporated
to the original order) Possible change may include: Re-formatting or adding
dose instructions, re-formatting or adding admin criteria, or changing the drug
form because the wrong order string was selected by the Physician. We have heard that some sites create an Order Source called “PC - Pharmacy Correction” which
is set to not queue for the ordering Physician to Electronically Sign. We have tried to implement this solution but it is
challenging to define when the “PC -
Pharmacy Correction” should be use. We want to use “PC - Pharmacy Correction” in
situations when “the intent of the order does not change”
but it is difficult to really define what “the intent of the order
does not changing” really means. Each discipline (Pharmacy,
Nursing, Physician) doesn’t want to make an unintentional error and not
have people be alerted so the end result, in the name of “safety“, is that “PC - Pharmacy Correction” is
sparingly used and the original Order Source called “CPOE” is not
changed causing orders to be queued to the original physician to be
Electronically Signed which lets the Physician know that some change in the
order has taken place. This also introduces more interesting challenges
whereas the audit trail detailing what has been changed in the system for the
Physician to review is often not very clear, difficult to interpret, and not
Physician friendly. 2. Do your Nurses cross check the POM Medication Orders that
appear in EMAR against anything and
is there any reason for this to be done? (i.e. A Paper report or
Order Sheet generated from the system) Here lies the root of the question. There always is a
mixture of POM orders and Written orders. So at any given time the
medications that appear on the EMAR are a mixture of orders. For the
written orders, the Nurse compares the physical written order sheet to what
appears in EMAR to see if there are any missed medications or transcription
errors from Pharmacy. The Nurse currently doesn’t have any physical
piece of paper to compare the POM Medication order to what appears in
EMAR. In an ideal world the POM order from the Physician is entered
perfectly and Pharmacy doesn’t have to do anything except verify the
order. But what happens when the Pharmacy has to make a “cosmetic/minor” change to the original
CPOE order?” Even though the intent of the order hasn’t changed
should Nursing be aware that the original order that the Physician entered has
actually been changed? And in what mechanism should this be done?
We could use the MEDITECH POM Order Sheet but is this practical? There
would be so many single pieces of computer generated Order Sheets to look
through.) I think I secretly embedded 100 questions in my 2 original
questions. Any and all feedback would be appreciated. Regards, Tim Wong Ph: 978-287-8069 [EMAIL PROTECTED] Tim Wong CPOE Project Leader Ph: 978-287-8069 [EMAIL PROTECTED] |
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