Order Medications—Continuous Drips

1. For applicable delivery routes such as IV Bolus Plus Infusion, the Loading Dose window opens automatically.  See Ordering a Loading Dose.
   The loading and maintenance dosing for a single medication can be ordered on the same form. The two are separated for transmission to the pharmacy system, with a one-time (x1) frequency for the loading dose. You must delete both orders before signing to prevent ordering the medication. See Deleting Orders.

2. Type a value or range for the continuous dose.
   For range dosing, as needed PRN administration is not allowed, and a "Titrate to" description is required. See Ordering medications.

3. If available, select a flow rate or Other.

4. For inpatient orders, if the order does not have to be filled by pharmacy because the patient will be using medications from home, click to check Use Home Supply; May Self Admin; May Require Form. This is checked automatically for pumps.

• If this medication is available on formulary at the MGH pharmacy, you must provide a reason for using a supply from outside the hospital. Allowing patients to take medications brought from outside of MGH bypasses all bar code based safety checking, which is used by the MGH electronic Medication Administration Record (eMAR). You may be contacted by a pharmacist to re-order the medication if it is available from MGH formulary.

1. if prompted, type your reason for allowing the patient to take a medication from outside the hospital.

2. Click OK (ALT+O).

• Orders with Use Home Supply; May Self Admin; May Require Form are flagged <POM>.

5. Select a fluid. If Other, press TAB and type a description, then click OK (ALT+O).

6. Select a Start Time or Other.

7. If needed, type a number for the duration (hours).

8. To indicate as needed medication (not available for taper or sliding scale administrations):

1. Click to check PRN (ALT+P). To edit , click .

2. When prompted for a reason, for MGH sites only, click More Info to access the MESAC site for information on effective and safe medication management.

3. Click the associated checkbox to select one or more reasons. Reasons are listed alphabetically.

4. For reasons needing delimiting values (such as temperature), type to describe the clinical requirements. Less than (<) and greater than (>) symbols are allowed.

5. For Other, type a description. Use pre-defined reasons rather than the Other option whenever appropriate.

6. Click OK (ALT+O).

9. If needed, select a line or Other for the site.

10. To note reasons for holding the medications, type in the Hold if field.

11. To describe parameters for titrating the administration for effect, type in the Titrate To field.

12. Type instructions as needed.

For selected intrathecal (IT) medications, the titrate to and instructions field are pre-filled with required information from the Chronic Pain Service.

11. Click OK (ALT+O).