# Local Order Checking

CPRS has several local order checks that occur during the ordering process.

Local Order Checks

These nationally released order checks are available on a local CPRS system:

· Allergy-Contrast Media Interaction

· Allergy-Drug Interaction

· Aminoglycoside Ordered

· Biochem Abnormality For Contrast Media

· Clinical Reminder Live

· Clinical Reminder Test

· Clozapine Appropriateness

· Critical Drug Interaction

· CT & MRI Physical Limitations

· Dangerous Meds For Pt > 64

· Dispense Drug Not Selected

· Drug Dosage

· Duplicate Drug Class Order

· Duplicate Drug Order

· Duplicate Opioid Medications

· Duplicate Order

· Error Message

· Estimated Creatinine Clearance

· Glucophage-Contrast Media

· Glucophage-Lab Results

· Lab Order Freq Restrictions

· Missing Lab Tests For Angiogram Procedure

· No Allergy Assessment

· Order Checking Not Available

· Polypharmacy

· Recent Barium Study

· Recent Oral Cholecystogram

· Renal Functions Over Age 65

· Significant Drug Interaction

Note: All of these order checks are exported disabled at the system level. IRMS can then turn them on for individuals or teams, as determined by the site. IRMs, Clinical Coordinators, individuals, or services can also disable individual order checks, if they choose to.

Several parameters that each site controls determine how these order checks behave.

Order Check On Acceptance Dialog

For medication orders, if a possible problem is found, CPRS displays the order check window, such as seen below when the user selects Accept:

When accepting a medication order, order checks are performed to identify potential problems

The Order Checking dialog separates the text for each order check, numbering each using the 1 of 3, 2 of 3, format. If an allergy assessment has been done, the Perform Allergy Assessment button will be inactive.

Order Checks Dialog on Signature Actions

If the clinician chooses to sign the order, CPRS displays the following dialog:

Order Checks dialog shows the full text of the order check. In this example, an item labeled “Checks marked with **** require reason for override” in red text and with blue description text would require a justification for overriding it.

This dialog displays each medication or other item that had an order check in a separate section. Each item will have a check box allowing the user to check any orders that should be canceled at this point. Under the order text, the order checks are displayed, the most serious order checks are listed first. Those that need a justification for overriding the order check are displayed first, with the “Checks marked with **** require reason for override” in red and are displayed with blue descriptive text in the body of the order check. To accept these orders, the clinician must enter an override reason.

This dialog displays each medication or other item that had an order check in a separate section. Each item will have a check box allowing the user to check any orders that should be canceled at this point. Under the order text, the order checks are displayed, the most serious order checks are listed first. Those with High Clinical Danger Level items are displayed first, labeled as high danger, and colored blue. To accept these orders, the clinician must enter an override reason to justify accepting the order.

Whether the order check requires the clinician to enter a justification depends of how each site has set the Clinical Danger Level for each order check. For example, the Pharmacy package determines if an interaction is critical or significant. Each site then determines whether the provider must enter a reason for override by setting a Clinical Danger Level in CPRS for the Critical Drug Interaction and Significant Drug Interaction order checks.

Another example would be allergy assessments. If the site has the No Allergy Assessment order check set as an order check that requires an override reason and the patient does not have an allergy assessment, then the order will require a justification for override. If the site has No Allergy Assessment as a moderate order check, CPRS does not require the clinician to enter an override reason. As an alternative, the user can perform an allergy assessment immediately by selecting the Perform Allergy Assessment button.

When a user enters an override reason, the reason for override is sent with the orders to ancillary packages so that the information is available to their users.

The dialog also has a View Monograph button. The button will not be active unless there is a drug-drug interaction. Selecting the See Monograph button will send the user to a monograph about the drug or drug class to help the provider with additional information. If there is more than one kind of drug, the Monographs for Order Checks dialog will display a dropdown list with the choices for the various kinds of medications.

Related topics

Order Checking Overview

Site-Defined Clinical Reminder Order Checks

Order Checking Remote

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders