At 5:00 a.m. on the day after an IV Fluid order has started on an inpatient or ED care unit, Order Entry activates the IV Renewal reminder function. First, the patient's Order Status field displays the IV Rewrite flag. Second, when an Attending, House Officer, Nurse Practitioner, or Physician Assistant starts to write routine or special (transfer, pre-admission, or rewrite) orders, a list of current active IV Fluid orders requiring renewal is displayed. The list also includes the date and time each order was signed (if a routine order) or activated (if a special order), and the current eMAR administration status for each order as available.
To put off the decision to a later time, click Defer (ALT+D).
You cannot defer action on an IV Renewal if you want to write special orders. These include transfer, pre-admission, and rewrite orders.
If you continue to defer the decision, the IV order or orders requiring renewal will automatically be inactivated at 6pm.
To display details of an order, including the renewal history when applicable,click to select the order, then click Zoom. To return to the list, click Close.
To review the MGH inpatient clinical policy for intravenous fluids, click More Info. IV fluids are described in section 3.12.
To rewrite or actively discontinue the IV order or orders requiring renewal:
Click the corresponding checkbox for each order on the list to indicate what to do: Continue, Discontinue, or Decide/Edit Later. You must select an option for each order on the list.
Click Continue (ALT+O). The Orders For This Session scratch pad opens. The IV Rewrite Session is listed as a new order.
When prompted, sign the order(s) to renew or discontinue the IV fluids.
IV Rewrite sessions that result in renewed or discontinued orders generate a general care order. The IV Rewrite general care order lists each IV fluid order that was continued or discontinued along with pertinent signature information.
IV fluids that are continued remain active; a new order is not generated. Pharmacy review and approval is not required, but the patient's order status does include the Pending flag to alert the RN that there is an order needed RN review. The order detail includes a renewal line: Renewed by [Authorized provider full name] at mm/dd/yyyy hh:mm:ss AM/PM. The zoom detail for IV fluids that are renewed more than once includes the following: Last Renewed by [Authorized provider full name] at mm/dd/yyyy hh:mm:ss AM/PM, Renewed [n] times.
IV fluids that are selected to discontinue generate a D/C order the same as the routine process for discontinuing an order.
All orders written in this session are routine, and active on signing. If you received the IV Renewal Reminder when starting a Special Orders session such as Transfer or Pre-Admission, the special orders still have to be written. Click the appropriate Special Orders button to start the session.
IV orders that are continued are included in the IV Fluid renewal process along with all new orders.
IV orders that are not addressed by 6 p.m. expire at that time. Expired orders are removed immediately from both the pharmacy systems and the eMAR.
See also: Ordering IV Fluids.