MGH Provider Order Entry (POE) is a comprehensive integrated system for placing a variety of tests, exams, and conditions into inpatient records. Use Order Entry to record allergies and write, edit, and discontinue orders. Write day-to-day orders individually, or select from system-designed or personal order sets and templates. Use special sessions for pre-admission, post-operative, transfer, and discharge orders.
Allergies—Allergy orders entered into POE are stored in the Partners Enterprise Allergy Repository (PEAR). The PEAR also stores and provides allergy records from other Partners sites, and from the outpatient LMR (Longitudinal Medical Record). The record persists outside of the patient's current orders.
Writing Orders—All authorized clinicians can write orders into the system. Some order types, including chemotherapy and total parenteral nutrition (TPN), are restricted.
The person who enters orders must sign to save the order. Routine orders are active on signing. See Writing Routine Orders or the basic process, and Overview of Order Types for links to more specific instructions.
Orders for admission can be written in advance. These orders must be activated in a separate step for use in the inpatient care unit. See Working with Pre-Admission Orders.
Orders for transfer to another care until can be written 24 hours in advance. These orders must be activated in a separate step for use in the new care unit. See Working with Transfer Orders.
Orders for chemotherapy—pre-admission, inpatient, and ambulatory—are all available via Order Entry. See Overview of Chemo Order Entry.
Clinicians can resume an order session if interrupted before signing. See Resuming Order Sessions.
If required by policy, providers can rewrite active orders. The rewrite process allows a provider to review all active orders, select which to continue and which to discard, and then add orders as needed. On signing the rewrite, all current orders are inactivated, and replaced by duplicates of the orders that were continued, as well as any orders added to the rewrite session. See Rewriting Orders.
Handling Orders—Once orders are written, there are several processes required to put them into use:
The patient's order status is displayed in the far right column of the Unit Census Monitor (UCM), the list of patients who have been admitted to the care unit. See Overview of Order Status Codes.
An MD, NP, PA, or CNM must cosign some verbal orders. See Cosigning Orders.
OCs, OAs, or RNs transcribe orders to the appropriate forms or call the appropriate service to forward the order. See Transcribing Orders.
RNs and NPs review all orders and sign them as they're taken off. See Reviewing Orders (RN).
House staff on medical units can review orders written by attendings. See Acknowledging Attending Orders.
Viewing and printing—Orders can be viewed and printed by any authorized clinician or operations staff member. See:
Automatic requisition printing—Once the orders are activated,the requisitions for radiology exams and diagnostic studies are also available to the applicable department. (Requisitions for radiology exams that will be performed by Obstetrics do not print in the Radiology department.)
Food and nutrition—All orders for food and nutrition transmit electronically to the dietary system.
POE Queue—Some departments, including physical therapy, occupational therapy, and other consult services, can generate daily lists of orders for processing. When an order is processed via the queue, the date and time the order was received is logged in the order detail, along with the name of the person who received it.
Emergency Department Orders—Order Entry has been modified for use in the Emergency Department. When started from the EDIS Treatment Area Board, the write function creates orders for use in the ED only. Any order written in the main ED is flagged <ED order only> in its summary display, and "Attention clinicians: This order is for Emergency Department use only" in its detail (zoom) display. Orders flagged for use in the ED only should not be used outside the main emergency treatment areas. See Overview of Orders For ED and ED Observation Patients.
ED to Admit Orders—ED to Admit special sessions are written for patients who are being admitted as inpatients from the main Emergency Department (ED) treatment areas. The process allows the ordering provider to review the active orders in the ED, and indicate which should be re-ordered for the admission. ED to Admit orders are similar to transfer orders. However, when orders are re-ordered for inpatient use, each is checked automatically to determine if the ED parameters such as start time, dosing, fluid, and so on, translate exactly to those available for inpatients. If needed, the inpatient form opens for you to complete the order for inpatient care; these orders are flagged as <updated to>admit order<from>ED order. When a patient has ED to Admit orders, the Order Status includes the ED to Admit flag. (See UCM - Order Status Codes.)
Activation of ED to Admit Orders—ED to Admit orders written from an ED treatment area must be activated on the inpatient unit when the patient arrives. When a patient has ED to Admit orders, clinicians writing new inpatient orders are prompted to either activate the ED to Admit orders or to inactivate all orders previously written in the main ED. Inactivating active ED orders does not affect the ED to Admit session; it remains awaiting activation, and the patients order status still includes ED to Admit.
ED to Admit orders written from an inpatient care unit are active on signing.
Tools—In addition, Provider Order Entry provides a number of tools for ancillary functions:
Printing orders for the medical record
Reviewing the decentralized pharmacy queue
Reprinting pharmacy orders
Creating QA reports
Building order sets, templates, and chemotherapy regimens and protocols