What Orders Must Be Cosigned: Orders entered in Order Entry by any of the clinicians listed below must be cosigned by an MD.
Nurse (RN)
Medical student
Medical student orders are inactive unless cosigned
Pharmacist (clarification orders)
Physical therapist
Respiratory therapist
In addition, the following clinicians can mark an order session to require cosign when appropriate:
Nurse Practitioner (NP) or other advanced practice nurse
Physician Assistant (PA)
Clinical Nurse Midwife (CNM)
Who Can Cosign: Clinicians must select a name from the MGH provider list to assign cosign. Providers who are authorized to cosign include MDs, NPs, and PAs. If the clinician who enters a verbal or clarification order assigns it to the wrong provider for cosign, that clinician can change the name. See Changing the Provider For Cosign (Fix Wrong MD).
Finding Orders Assigned to You For Cosign: Providers who are authorized to cosign can access their list of patients with orders assigned to them for cosign in three (3) ways:
With "No Patient Selected" in the CAS (as when you first log on), or with a patient selected who does not have a Cosign order status, click Cosign.
With a patient selected who does have a Cosign order status, click Cosign. Click View My List of Patients on the Cosign Pending Sessions list.
When prompted to cosign overdue orders, click Yes. See Cosigning Orders.
Cosign Notification: Accreditation requirements include cosign of all verbal, approved exception, and clarification orders within 24 hours of those orders being signed. To encourage compliance, the Order Entry system monitors all orders assigned for cosign. If you do not cosign orders assigned to you within six (6) hours, you will be prompted to do so the next time you log on to Order Entry.
Click Yes when prompted to display your list of patients for cosign. All Orders, overdue or otherwise, are listed.
The first time you are prompted to cosign overdue orders, you can defer for six (6) hours. You will have to provide a reason for doing so.
If you do not cosign the orders assigned to you within six (6) hours of deferring at the prompt, you will be prompted again each time you log on to Order Entry. You can continue to defer, but you will have to provide a reason for doing so each time.
To prevent the cosign notification, clear your list of sessions to be cosigned. See Cosigning Orders.
Clearing Your List: All of the orders assigned to you must be signed off to clear your list. You have the option to decline cosign if you must. Do not decline an order because it has already been carried out—cosign does not create another order. Each order must be declined individually, and you must provide a reason for declining for each order. For inpatient orders, you should notify the clinician who entered the order that you have declined cosign; at present, there is no automatic method for doing so. If you decline ambulatory orders, the clinician who entered the orders will receive an email that you have declined cosign.
Medical student orders: You can edit or delete, but not decline, orders written by medical student. See Cosigning Orders.