While routine, emergency department and observation orders are usually active when signed, there are additional types of orders that remain inactive until they are deliberately called up and activated. These inactive orders, which are essentially "waiting in the wings" until needed, include pre-admission, day of procedure, transfer, post-operative, ED to admit, and new inpatient chemotherapy orders.
Preadmission sessions allow a provider to write orders for a patient who is currently not listed on an inpatient unit. These can be written for admission to ED observation or to an inpatient care unit. When the patient is admitted the new orders are ready to activate. See Overview of Pre-Admission Orders.
Transfer and post-operative orders are written by checking off the existing active orders that will be carried forward, then adding new orders for future use. Any orders that aren’t carried forward are discontinued when the transfer or post-op orders are activated. Until the patient arrives on the unit or in the PACU, transfer and post-op orders should remain inactive, unavailable for transcription or RN review. See Overview of Transfer Orders, Overview of Post-Op Surgeon Orders, and Overview of Post-Op Anesthesia 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. Any orders that aren’t carried forward are discontinued when the ED to Admit orders are activated. Until the patient arrives on the inpatient care unit, ED to Admit orders should not be activated. Doing so discontinues all of the ED orders, which may still be needed while the patient remains in the ED. See Overview of ED to Admit Orders.
Some orders are not affected by the activation of transfer, post-op, ED to Admit, or non-chemo pre-admission orders:
Chemo orders are always carried forward and never discontinued when a set of ED to Admit, transfer, post-op, or non-chemo pre-admission orders is activated.
Allergy orders are stored in the Partners Enterprise Allergy Repository (PEAR) as soon as they're signed. Allergies are not inactivated when ED to Admit, transfer, post-op, or non-chemo pre-admission are activated.
The Order Status flags for special orders indicate what type they are—Pre-Admit (with the admission date), Transfer, Post-Op, ED to Admit, or NICO (with the chemo treatment date). If a medical student writes the orders, they are flagged for cosign, and can't be activated until that's done. Once special orders are activated, the Order Status changes to Pending, indicating that there are new orders.
When a pre-admission or new inpatient chemo order session contains both chemotherapy agents and other non-chemo orders, the two types are split into separate groups for activation. The non-chemo orders can be activated by any authorized clinician. Only RNs and pediatric NPs can activate the pre-admission or NICO sessions containing chemo. Overview of Chemotherapy Pre-admission Orders and Overview of Chemo Activation.
See also: