Writing post-op orders—The main purpose behind the MGH Order Entry Post-Op Anesthesia function is to reduce the need for verbal orders to the post-op nursing staff. For compliance with requirements of the JCAHO, as well as legal purposes, a physician must cosign all verbal orders. Anesthesiologists can now write orders for post-op care in a couple of minutes, eliminating the potential for a backlog of orders to be cosigned.
Order Entry has been enhanced to allow anesthesiologists to write orders for post-operative care quickly and easily in the PACU or SDSU. The most common anesthesia orders for these post-op care units, as well as epidural pain management orders and patient-controlled analgesia orders, have been recreated as electronic templates in Order Entry.
The Post-Op Anesthesia function opens the surgery orders template player, which lists the anesthesiology order templates: PACU, SDSU, and Epidurals. Each set of post-op orders is written in a session that you, another anesthesiologist or advanced practitioner, your medical student, or a surgeon can add to until the session is activated in the PACU. See Writing Post-Op Anesthesia Orders.
Reconciling medications—As part of the process of medication reconciliation, you can reference the pre-admission medications list (PAML) from the Surgery Orders Template Player. See Checking the PAML.
Activation of orders—Post-op orders are special in that they are inactive until the nurse in the PACU or other post-op care unit activates them. When the post-op orders are activated, any previous orders that were not included in the post-op session are inactivated.
Additional post-op orders—If post-op orders are written more than eight (8) hours after a set of post-op orders has been activated, the Post-Op function will create a new order session. The assumption is that the patient is returning to the OR. The new orders are inactive on signing. When activated, the new orders supersede the previous set of active post-op orders.
Post-op orders started within eight (8) hours of activation trigger a prompt to indicate whether to add to the active post-op orders, or (if the patient has returned to surgery) start a new post-op session.
If you choose to add to the active orders, the new orders are active on signing. These orders print automatically in the PACU, as long as the patient is still there.
If you choose to start a new post-op session when prompted, the new orders are inactive on signing. When activated, the new orders supersede the previous set of active post-op orders.
Writing pre-admission—Post-op orders can be written in advance for patients who have yet to be admitted as inpatients. Simply access the patient record using Patient Lookup, as you would for a Pre-Admission session. See Selecting Patients for more information.
Cosigning when required—Orders written by medical students must be cosigned before a post-op session can be activated. This is also true for post-op orders flagged as needing cosign when written by a Physician Assistant, Nurse Practitioner, or Certified Nurse Midwife. Even if a surgeon, anesthesiologist, or surgical resident adds orders to the post-op session and signs it, the "cosign required" orders must be cosigned for any of the orders to be used. The Cosign function is accessible from the Surgery Orders template player as well as the main Unit Census Monitor (UCM). See Cosigning Orders From the Post-Op Anesthesia Scratch Pad.