# Ordering Inpatient Medications (Simple Dose)

Ordering medications now uses two dialogs in the ordering process and eliminates the dispense drug prompt. Inpatient medication orders now require a valid schedule. If users do not find the appropriate schedule in the list, they can choose to create a day-of-week/administration time schedule using the new Schedule builder. This feature also works for renewing, copying, and changing inpatient medication orders. The procedure for ordering medications is described below.

Note: Because a valid schedule is required, if you attempt to modify an existing medication order that does not have a valid schedule, you will receive a message box stating that and will have to enter a valid schedule.

CPRS now requires a unique match in the Medication, Dosage, Route, and Schedule fields for inpatient medications before CPRS will auto-select an item from the list. For inpatient medications, the Medication and Schedule fields must be an item from the list, but the Dosage and Route can be a free-text entry (the route must be in the MEDICATION ROUTES file #51.2). If the desired schedule is not on the list, the user can build a day-of-week/administration time schedule using the Schedule Builder.

CPRS displays unit dose routes based on the following rules:

1. If a default medication route is defined in the orderable item file, CPRS displays only the default medication route for the Unit Dose orderable item in the medication route selection list.
2. If there is no default medication route defined for the orderable item, CPRS displays all possible medication routes for the dosage form to the provider for selection.
3. If there is only one possible medication route, it will be used as the default.
4. If a medication route name or its abbreviation is not included in the selection list, a user may type it in.

Also, medications that are not in the formulary display in the list with the letters "NF" after the name or synonym, which is also displayed. CPRS checks for non-formulary dosages (e.g., the VA formulary may not have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary orderable items (e.g., the VA may not carry a specific kind of allergy medication).

New Clozapine Requirements

Select the link above to view the new requirements. CPRS now prevents the user from renewing outpatient and inpatient Clozapine orders.

To write a new Inpatient Medications order, follow the se steps:

Note: If the user attempts to order inpatient medications for an inpatient from an outpatient location, CPRS discontinues the order process and returns the user to original Orders or Meds tab display.

1. Select the Meds tab and select Action | New Medication.

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Select Orders tab and bring up the Inpatient dialog by selecting the appropriate item under the Write Orders box.

2. Locate the desired medication or medication quick order.

Note: CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

3. Select the quick order or medication name. Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

The lab results for the most recent lab test associated with the selected medication are displayed in the Information field, if an associated lab test was performed within the last 365 days.

Note: A CAC or ADPAC will need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab results display at a site.

To view associated lab results for Quick Orders, a TIU OBJECT must be inserted into the Quick Order. For more information, refer to the Text Integration Utility (TIU) Clinical Coordinator & User Manual. This functionality will work for generalized Quick Orders only (orders assigned to Order Menus). It is not currently implemented for personal Quick Orders.

The lab results functionality will not work properly for multi-divisional facilities or any sites that use different lab test names at different sites, as only one lab test name can be associated with each drug. To successfully implement this functionality, all facilities/divisions that share a VistA system must use the same name for each monitored lab test.

Note: CPRS now uses a look up from Pharmacy to check if the selected medication is a controlled substance that will require the signature of a provider with a DEA or VA number. A message will appear to the provider "Provider must have DEA# or VA# to order this medication". Before an order for a controlled substance can be entered, the provider selected for the encounter must be able to sign the order. You may need to exit the dialog, change the provider, and then reenter the dialog.

Click here to see the inpatient medication selection dialog .

4. In the Dosage field, select or type a dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character "^" may not be entered in the Dosage field. Also, the associated cost of the drug is displayed to the right of the dosage.

Note: CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

Once a dosage is selected, any lab test results displayed in the Information field are replaced by the National Standard Orderable Item information.

5. In the Route field, enter the appropriate route (a default route may have been set up) by either selecting one from the list or typing in a valid route.

6. Select a schedule or if the schedule you want to use is not in the list, locate the Other (you can also click the Non-Standard? link and then click OK on the dialog that displays) entry and select it. If you selected Other, use these instructions to create a customized schedule .

Note: See the second inpatient Medication Order dialog for a simple dose .

When the user selects a schedule, the administration times may display under the "Give additional dose now" text. The administration times will display if they have been defined for the ward or if there is a default as long as the order is not a PRN order.

7. If you selected an existing schedule, skip to step 8. If you selected OTHER, the Order with Schedule ‘OTHER’ dialog appears. Take the following steps:

a) Select one or more checkboxes by the appropriate days of the week.

b) If the schedule requires specific administration times skip to steps c and d. To select a schedule from the list, highlight the schedule and select Add.

Note: Users can assign either a schedule from the list or specific administration times, but not both. Also, because the user is specifying days of the week and a schedule, the list will contain only schedules less than 24 hours (for example, Q36H will not be in the list).

c) To use a specific administration time, select the hour and minutes (if the user only selects the hour, the minutes will default to zero) and select Add.

d) Repeat step c until you have entered all required administration times.

Warning: The administration times in the Schedule field apply to each day of the week that is listed, such as TU-TH-SA@08002000, for example. To create a schedule such as TU@0800 TH@2000, users would have to enter two separate orders using the complex medication order dialog. Also, users may not enter a schedule that only has administration times and PRN but no days.

e) If you make a mistake while selecting an administration time or schedule, do one of the following to remove it:

- For a single administration time, highlight the hour and minutes in the Set Administration Time fields and select Remove (so to remove 08:00, you would have to select that time in the Set Administration Time fields not in the Schedule text box.)
- To remove the schedule, highlight the schedule and select Remove.
- To remove the entire schedule and begin again with step a, select Reset.

f) Review the Schedule field.

g) When you have the correct schedule, select OK.

8. Select PRN if necessary.

Note: When selecting the PRN checkbox, the quantity and say supply are zeroed out and will need to be adjusted manually. If the checkbox was accidentally selected, de-selecting it corrects the quantity and day supply.

9. Enter an Indication. If indications have been set up, there will be items in the drop-down list, the most common indication on top. If no indications have been set up, you can type an indication.

10. Add comments (optional).

11. CPRS displays the date and time of the expected first dose if it can determine one. (For example, CPRS cannot show an expected first dose for "on call" or schedules with PRN. On the complex tab, it will not try to determine an expected first dose after a THEN because the first item must be completed.) If you want to give an additional dose now, select to place a check in the "Give additional dose now" check box.

Note: Make sure the "Give additional dose now" and the regular order with the original schedule you entered do not overmedicate the patient. "Give additional dose now" is not available for ONCE, ONE-TIME, or NOW orders. It is also not available for delayed orders.

When you select the Give additional dose now check box, CPRS creates two new orders.

a. The dosing schedule and priority are set automatically for each order. The first order is scheduled for immediate administration (NOW) and is assigned the priority ASAP. The second order is given the priority ROUTINE and will be administered following the dosing schedule that you defined. A warning displays that is similar to the following example.

Note: If your site does not use the priority ASAP, then an alternative priority (for example, STAT) will display in place of ASAP.

b. Check the warning message to ensure that the orders you created are what you expected. If the orders are acceptable, then click OK. If not, click Cancel to clear the Give additional dose now check box.

12. Select the drop-down arrow and select a Priority .

a. When Give additional dose now is selected, the Priority field is automatically set to ASAP (or a site-specific alternative). If you select a value for the Priority field before you select the Give additional dose now checkbox, a message notifies you that the selected priority will be changed to the “Give additional dose now” priority settings.

b. The default value of ASAP can be changed by selecting a different value from the Priority field before submitting the order. If the Priority field is empty when the order is submitted, it will revert to the default values for “Give additional dose now.”

13. Select Accept Order .

Note: If you do not complete the mandatory items or if the information is incorrect, CPRS sends a message that tells you that the information is incorrect and shows you the correct type of response.

14. (Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o To proceed, select Accept Order.

o To stop the ordering process and return to the dialog, Cancel Order.

15. Enter another medication order

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select Quit .

Note: The order must be signed before it is sent to pharmacy. You can either sign the order now or wait until later.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)