# Using the Unified Action Profile View

Note: The United Action Profile (UAP) is not currently available, but will be available soon. Sites will be notified when this feature becomes available.

The Unified Action Profile (UAP) view on the Orders tab displays existing inpatient and outpatient medication orders from the local site on a single page. Using this view, a clinician can record decisions for all orders assigned to a patient to ensure that the correct medication orders are continued for the patient upon discharge.

Previously, when preparations were made to discharge a patient, the clinician had to switch views from inpatient to outpatient medication forms. The UAP enables the clinician to review all medication orders at one time. This view simplifies order reconciliation and reduces the time and effort required from the clinician when making decisions on each active inpatient and outpatient order.

## Understanding UAP Sorting

The UAP view sorts medication orders by medication name, with inpatient orders, outpatient orders, and non-VA medication (Documentation) entries grouped together. This grouping is essential for medication reconciliation when preparing a patient for discharge. UAP sorting is based on the name of the first orderable item from the Orderable Items file (#101.43). However, subsequent changes to the order can disrupt this rule and alter the way that the order is sorted by UAP.

The Order Text field (#100.0081) in the Order file (#100) is a word processing field that is generated when an order is created. Additional Order Text fields are added each time the order is modified. When working with an order in CPRS, the content of the most recent Order Text field is displayed. UAP checks the first line of the Order Text field against the orderable item name. If this check detects that the first line of the Order Text field does not match the orderable item name, then the order is sorted based on the first line of the most recent Order Text field.

For example, a clinician places an order for “DIAPER TABBED MISCELLANEOUS BRIEF, TRANQUILITY SMARTCORE SMALL #2311.”

This item is retrieved from the Orderable Items file and saved in the Order Text field when the order is placed. During processing, the Pharmacist changes the order to “BRIEF, TRANQUILITY SMARTCORE SMALL #2311” and this update is saved as a new entry in the Order Text field. During sorting, UAP performs a check and detects that the Orderable Item name and the first line of the most recent entry in the Order Text field are not the same and sorts the item based on the Order Text field entry (i.e., “BRIEF, TRANQUILITY SMARTCORE SMALL #2311”). If an order is modified by a pharmacist during prescription processing, then the order is marked with an asterisk (“*”) when displayed in CPRS. In the UAP view, this asterisk is hidden when displaying orders to preserve the alphabetical sorting critical to the reconciliation process.

Infusions are sorted alphabetically by the first orderable item identified as an additive in the Orderable Items file; solutions are ignored for the purpose of sorting. The display of Infusion orderable items is reorganized based on the additive used for sorting. This supports alphabetical sorting by a meaningful additive in the UAP but does not change the original order of items in the ORDER file (#100).

## Configuring UAP

Before UAP can work as designed, some setup is required. First, Write Delayed Orders must be configured for the DISCHARGE event.

Note: To perform the following actions, the DISCHARGE event must be active and Copy Active Orders for Discharge Release Events must be disabled.

Refer to the CPRS Technical Manual: GUI Version for details.

To configure the Write Delayed Orders feature for the Discharge event:

1. From the CPRS Orders tab, select Write Delayed Orders. The Release Orders window displays.
2. Select the Delay release of new order(s) until radio button.
3. Select DISCHARGE from the Event Delay List.
4. Adjust the Effective Date if necessary and then select OK.

Write Delayed Orders button displays the Release Orders window

Note: If the provider has an NPI, it will not display on the screen above.

The view changes to the Delayed DISCHARGE Orders view. The Discharge Patient (Delayed DISCHARGE) dialog box displays with DISCHARGE as the selected event.

Discharge Patient (Delayed DISCHARGE) dialog box

Note: If the provider has an NPI, it will not display on the screen above.

5. Select a Discharge Type (e.g., REGULAR) and then click Accept Order.

The Delayed Discharge order displays on the Orders tab. The Service column displays the service “A/D/T” after the order is configured. The Delayed Discharge order remains unsigned until after the UAP review decisions are completed and all medication orders for the patient are ready to be signed.

Unsigned Delayed Discharge Order

Note: To perform the following actions, the UAP view must be turned On by a CAC or OI&T staff member. If UAP is not displayed in the View menu, then the feature is turned Off. Refer to the CPRS Technical Manual: GUI Version for details.

## Reconciling Medications Previous to Patient Discharge

Note: The previous steps must be completed before this reconciliation section.

To use the UAP view to reconcile all inpatient and outpatient medications when preparing a patient for discharge:

1. Select Unified Action Profile (UAP) from the View menu.

Unified Action Profile (UAP) option displays on the View menu

The Unified Action Profile view is displayed and ready for you to take action on each inpatient and outpatient medication.

Unified Action Profile on the CPRS Orders tab

Note: If the provider has an NPI, it will not display on the screen above.

Example: Infusion Orders – ALL SERVICES view vs. UAP view

The following Infusion order is displayed in the ALL SERVICES view. The asterisk indicates that the order was changed by the pharmacist.

The ALL SERVICES view displaying the Infusion order with the asterisk and list of orderable items

In the UAP view, the Infusion order components are intentionally reorganized for sorting purposes to facilitate medication reconciliation. The asterisk is hidden; the first orderable additive item in the ORDER file, INSULIN, is listed first and the Infusion is displayed in the medication list accordingly. The solution (DEXTROSE) is ignored for sorting purposes.

UAP displaying the Infusion order without asterisk and sorted by first orderable additive item

2. Right-click on a medication order and then select an available reconciliation action from the popup list.

The UAP view on the orders tab. Above the service column, text showing that UAP is being viewed, a context menu shows actions that can be taken, and the Reviewed column shows actions taken.

Note: Infusion orders cannot be continued, changed, or renewed using UAP because CPRS does not convert inpatient infusion orders to an outpatient order when preparing for discharge. To prevent issues with discharge medication orders, these options are grayed when performing UAP medication reconciliation for an inpatient Infusion order.

3. Complete required information in the secondary window that displays when a reconciliation action is selected. Not all selected actions will display a secondary window.

Selecting certain actions, such as Change, will open the Copy Orders window. When this window displays, the Delay release of copied orders radio button is selected by default. Select DISCHARGE from the list of suggested events, and then select OK.

The copy orders dialog

## Copy Orders Window

When DISCHARGE is selected, the view automatically reverts to Delayed Discharge Orders. Additional secondary windows, such as Outpatient Medications, open for configuring the Delayed Discharge medication order.
The decision made for each inpatient and outpatient medication is displayed in the UAP “Reviewed” column. Information regarding whether an order was reviewed using the UAP, and who last reviewed it, is added to the order record in the Orders file (#100) in VistA.

Note: When a reconciliation action is canceled before it is complete (for example, if you click Cancel in the Copy Orders window), then no decision is recorded for the selected medication. The action is briefly displayed in the UAP “Reviewed” column, but after processing the display toggles back to the UAP view, the UAP “Reviewed” column is cleared, and no decision is recorded in VistA.

The UAP Reviewed column shows the decision made for a medication

Note: If the provider has an NPI, it will not display on the screen above.

After completing the UAP review, use the Discharge Meds view to see a complete list of outpatient medications prescribed for the patient at the time of discharge (refer to Using the Discharge Meds View).

## Using the Discharge Meds View

The Discharge Meds view on the Orders tab displays a list of the remaining active outpatient orders after medication decisions are recorded in the Unified Action Profile (UAP) view (refer to Using the Unified Action Profile View.). It displays the orders that will be released with the patient upon discharge. While the UAP provides the ability to review and make decisions about all inpatient and outpatient medications, the Discharge Meds view enables a clinician to see the full list of medication orders from the local site still prescribed for the patient after the UAP review is completed.

To use the Discharge Meds view of all prescribed medications for a patient being discharged:

1. Select Discharge Meds from the View menu on the Orders tab.

2. Review the information for each medication displayed on the Discharge Meds Review pane. Verify the dosage, quantity, Start/Stop date, and Status for each outpatient medication prescribed for the patient being discharged.

Related Topics

Viewing Orders

Changing Views on the Orders tab