$TXT Created by RUSSELL,JOEL E at CPRS27.FO-SLC.MED.VA.GOV  (KIDS) on Tuesday, 08/03/10 at 13:47
=============================================================================
Run Date: OCT 18, 2010                     Designation: OR*3*330
Package : OR - ORDER ENTRY/RESULTS REPORTING  Priority: Mandatory
Version : 3       SEQ #282                      Status: Released
                  Compliance Date: NOV 18, 2010
=============================================================================

Associated patches: (v)OR*3*307    <<= must be installed BEFORE `OR*3*330'

Subject: FIX REVIEW/SIGN ORDERS PROBLEM INTRODUCED BY OR*3.0*307

Category: 
  - Routine

Description:
============

 Note:  This patch can only be installed at sites running CPRS.
  
 This patch is being issued primarily in response to Patient Safety Alert
 AL10-09 "Anticoagulation Management Software Allows Release of Unsigned
 Orders."
  
 This patch resolves the following problems:
  
 1. After installing Veteran's Health Information Systems and Technology
 (VistA) Anticoagulation Management software (referenced as OR*3*307), a
 problem occurs within the Computerized Patient Record System (CPRS) in
 which unsigned orders may be inadvertently released by a nurse, based on
 the setting of the 'OR UNSIGNED ORDERS ON EXIT' parameter for that user.
 Prior to exiting the patient's CPRS chart, the system displays the
 patient's verbal/telephone/policy unsigned, unreleased orders and
 unsigned, unreleased orders entered by other users such as medical
 students. The nurse is then unable to uncheck any of the orders and, upon
 entry of their electronic signature code, releases all of the orders
 including those orders not intended for release. Orders entered by a
 medical student and released by a nurse, prior to approval by a physician,
 may result in the patient receiving care not intended to be given by the
 physician. This patch will assure that ORELSE key holders are only shown 
 their own unsigned orders on the Review/Sign Changes dialog, regardless of
 the OR UNSIGNED ON EXIT parameter setting.
  
 2. Additionally, when the nurse (i.e., ORELSE key holder) exits the
 patient's CPRS chart, the system again displays all unsigned orders and
 the nurse is unable to exit the patient's CPRS chart, unless either 'Hold
 Until Signed' is selected or a forced reboot of CPRS is initiated by the
 CTRL-ALT-DEL keyboard sequence. When the nurse re-enters the patient's
 CPRS chart, the orders have been released, but the nurse may not realize
 the orders have been released. The nurse may enter a duplicate
 verbal/telephone/policy order, which may result in an adverse event (e.g.,
 duplicate x-ray). This latter problem is particularly troublesome in
 locations where nurses are routinely required to release verbal orders to
 their respective services.
  
 3. During development of this patch, it was discovered that ORELSE key
 holders would only be presented with the Review/Sign Changes dialog for
 their own INR and CBC orders placed through the Anticoagulation Management
 Tool if they held the PROVIDER key in addition to ORELSE, or if the OR
 UNSIGNED ORDERS ON EXIT parameter was set to ALL UNSIGNED ORDERS. The
 intended functionality is for the ORELSE key holder to be allowed the
 opportunity to release (as verbal/telephone/policy), mark signed on chart,
 or hold until signed any INR or CBC orders which they had placed using the
 Anticoagulation Management Tool, upon returning to CPRS and either
 refreshing patient data, selecting a new patient, or exiting the chart.
  
 4. As noted in Remedy Ticket 394447, notifications for unsigned INR &/or 
 CBC orders placed using the Anticoagulation Management Tool were not 
 being sent, if the user held the ORES key. This has also been corrected.
  
  
 PATIENT SAFETY REFERENCE
 ========================
 1694, 1701, 1706, 1720
  
 RELATED CQ'S
 ============
 None
  
 RELATED Remedy Tickets
 ======================
 393077  394637 item #2 only
 393541  394911
 394374  397297
 394447
  
  
 INSTALLATION INSTRUCTIONS:
 ==========================
 This patch should be loaded during non-peak hours to minimize disruption
 to users.  Installation will take less than 1 minute.  Users may remain
 on the system.
  
   1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu.
  
   2. From the Kernel Installation and Distribution System Menu, select
      the Installation menu.
  
   3. From this menu, you may elect to use the following options
      (when prompted for INSTALL NAME, enter OR*3.0*330):
         a.  Backup a Transport Global
         b.  Compare Transport Global to Current System
         c.  Verify Checksums in Transport Global
  
   4. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//'
      respond NO.
  
   5. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and
      Protocols? NO//', respond NO.

Routine Information:
====================
The second line of each of these routines now looks like:
 ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[Patch List]**;Dec 17, 1997;Build 2

The checksums below are new checksums, and
 can be checked with CHECK1^XTSUMBLD.

Routine Name: ORAM
    Before: B73547514   After: B75504293  **307,330**
Routine Name: ORWOR
    Before: B36027702   After: B39244307  **10,85,132,141,163,187,190,
                                           215,243,307,330**
 
Routine list of preceding patches: 307

=============================================================================
User Information:
Entered By  : RUSSELL,JOEL                  Date Entered  : APR 15, 2010
Completed By: SERVICE,JOHN                  Date Completed: SEP 14, 2010
Released By : STOKER,ELAINE                 Date Released : OCT 18, 2010
=============================================================================


Packman Mail Message:
=====================

$END TXT