What Do You Want To Do?

1. Click a blue folder on the left to open a template.

2. Select or deselect orders from the template as needed, then click OK (ALT+O). See Ordering From a Template.

1. Right-click anywhere on the orders list, or click Additional Orders (ALT+A).

2. Click the order type you need.

3. If needed, click the appropriate button to open a specific order form. (This is not needed for Consults, IV Fluids, or Laboratory.) Click Add (ALT+A) to open the medication order form.

4. Complete the order form and click OK (ALT+O).

5. If needed, click Close (ALT+C) to return to the Surgery Post-OP Orders scratch pad. The new order is listed here.

When the PAML is in progress, ready for review, or reviewed, the heading for the post-op orders list includes the note "There is a Pre-Admission Medications List."

• Open the medication orders list:

  1. Right-click anywhere in the post-op order list.

  2. Click Medications.

• Select orders from the PAML

  Medications on the PAML with planned action on admission to continue or substitute should be included in the active medication orders. Active meds are listed on the left.

  1. If the PAML is not displayed, click the vertical + PAML Meds + button to the right of the list.

  2. To display details of a PAML medication record:

  • Click the line for the order to see details in the summary area beneath the lists.

  • To view details in a larger area, click Zoom (ALT+Z). Click Close (ALT+C) to return to the list.

  3. For more information, hold the mouse pointer over the object for a moment:

  • To display the entire text of a line

  • To display the full text of an abbreviated Planned Action on Admission (PAA)

  • To display a key to all of the PAA abbreviations (PAA column heading)

  4. Click for the medication in the PAML to start the order.

  Parameters for the new medication are carried forward to the medication order form as available from the PAML source and applicable to the planned action on admission. Depending on the situation, you may have to search for the medication, and include all of the parameters for the order. If possible, the medication name, route, dosing, and frequency of administration may be pre-filled. You can edit as needed.

  5. Complete the order—see following procedure.

  Medications that have been added to the active medications list from the PAML on the right are displayed with a checkmark.

  "Order Initiated From PAML Medication" is included in the detail information of the order.

• Complete the order as applicable.

  1. 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 Pt. To use home supply.

  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 Pt. To use home supply are flagged <POM>.

  2. To indicate as needed medication:

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

  2. When prompted, click the associated checkbox to select one or more reasons. Reasons are listed alphabetically.

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

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

  3. Select a Start Time (Today, Stat, In AM, On Call to OR/CATH, or Other).

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

  5. Type the number of days or total doses in the Duration field, then click an option to select the units.

  Duration is not definable for x1 medications.

  Duration for defined Repetitive Order medications is set automatically, and cannot be edited. The options of Weeks/Months is available only for these medications.

  Total doses are calculated automatically from the selected frequency and number of days when provided.

  6. Type instructions as needed.

  7. Enter the name of the approving MD if the use of the medication is restricted. The Approval by field appears only when required in the following circumstances:

  • Infectious Disease Approval of Restricted Antibiotics

  • Heart Failure Group or EP (Electrophysiology) Approval of Restricted Medications

  • Restricted Mediations For Neonates

  If you are awaiting approval of nighttime antibiotic orders (written between 8 pm and 8 am):

  1. Click Search Approval.

  2. Select Will Contact ID in the AM (MGH) or Temporary Pharmacy Approval (DFCI).

  3. Click OK.

  Once you obtain approval, enter the name of the approving MD as follows:

  1. Type at least one letter of the last name. To include more information, follow this with a comma (,), and one or more letters from the first name (no spaces).

  2. Click Search Approval. The Providers list opens, displaying any names that matched your input.

  3. Click to select a name.

  4. Click OK.

  8. Click OK (ALT+O).

• Click to access KnowledgeLink..

• Click Exit (ALT+E) to close KnowledgeLink.

• Click Pop Out (ALT+P) to open KnowledgeLink in a separate window from the CAS.

• Toggle between Order Entry and KnowledgeLink by clicking the icons in the taskbar.

• Click to close the KnowledgeLink window.

• To write additional orders:

• Writing Post-Op Orders From a Template

• Writing Additional Orders

• To display details of an order, click to select its line, then click Zoom (ALT+Z). Click Close (ALT+C) to return to the orders list.

• To change an existing order:

1. Click its line in the orders list.

2. Click Edit (ALT+E).

3. The form for the order opens; make changes as needed. See Editing Orders.

4. Click OK (ALT+O).

• To delete an order:

1. Click its line in the orders list.

2. Click Delete (ALT+D). To undo this action, click Restore (ALT+R).

Once you sign a deletion, you can't use Restore—the order must be rewritten.

Surgery post-op sessions that include orders written by medical students must be cosigned by an MD before the orders can be activated. Cosign can be carried out through either the UCM Cosign function or this, the Post-OP Surgeon function.

1. Click Cosign (ALT+C) on the upper left of the Post-Op orders template list.

2. Click Cosign Orders (ALT+O).

3. Click Sign (ALT+S).

4. When prompted, type your signing key, then click OK (ALT+O).

• To view order details, click to select the order, then click Zoom (ALT+Z). Click Close (ALT+C) to return to the list.

• To make changes before signing (only on orders entered by med students), click Edit (ALT+E). The form for the selected order opens; edit, then click OK (ALT+O).

5. Repeat the process for every line on the Cosign Sessions list.

6. Click Close (ALT+C).