# Ordering Complex Clinic Medications

CPRS enables providers to place complex Clinic Medication orders. These orders must be placed from a clinic location. CPRS will ask you to confirm that you are placing a Clinic Medication order. You will also have to change the encounter location to an appropriate clinic. For outpatients, you will be prompted if no encounter location has been defined yet and then asked to confirm that you want to order Clinic Medications. For inpatients, you will be asked to confirm that you want to order Clinic Medications first and then prompted for an appropriate clinic location.

In a complex dose order, the user must define specific characteristics for the order. Because the dose can affect the quantity, for example, changing certain fields may cause the quantity field to either recalculate or reset to zero to force the user to enter the quantity.

To order complex Clinic Medication orders, use the following steps:

1. Select the Orders tab.
2. From the Write Orders pane, select Clinic Medications.

   Note: Depending on how menus are set up at your particular site, you may need to select a different option from the Write Orders pane. Many sites have customized the items in the Write Orders pane. Check with your CAC (or the person who manages information resources at your site) if you have trouble locating the Clinic Medications item.

   Note: The following prompts will be slightly different based on the patient’s location. You will be asked to verify that you want to write Clinic Medications and to ensure that the encounter location is a clinic location

3. If prompted, enter the appropriate clinic for the encounter information. This will generally happen with an outpatient that does not yet have an encounter defined.

   You can use an existing appointment if one exists or create a new one. To use Clinic Medications, you must enter a location that was previously defined clinic. If you chose a clinic location, you will see this dialog.

   This dialog is to ensure that the user knows they are about to enter Clinic Medications.

4. To continue ordering Clinic Medications, select Yes and continue to the next step. To stop the Clinic Medications process, choose No.
5. (Conditional) If the patient’s current location is not a clinic, you will be asked if you want to change the patient’s location.
6. In the Clinic Medications dialog, locate the medication name or quick order name in the list box by typing characters in the Medication field

   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.

7. Select the quick order or medication name using the mouse or keyboard.

   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

   Note: If the selected medication is a controlled substance that requires the signature of a provider with a DEA or VA number, the DEA# Required dialog appears. CPRS allows orders for controlled substances only when selected providers are able to sign the orders. You may need to exit the Medication Order dialog, change the provider selection, and then reenter the dialog.

   You must have a DEA# or VA# to order certain medications
   Note: CPRS requires a patient have a valid address if the selected outpatient medication is a controlled substance that requires the signature of a provider with a DEA number. For outpatient controlled substances, CPRS displays a message – “Controlled substance prescriptions require a patient address. Please contact administrative support to update patient address information.” if the patient does not have a valid address. The contact information in the display may be customized using the Enter/Edit Missing ZIP Code Message option in the GUI Parameters menu.
   Controlled substance prescriptions require a patient address

8. Select the Complex tab.

   Note: After you begin a complex dose medication order, you must remain on the Complex tab until you finish the order. If you switch to the Dosage tab, CPRS clears all complex dosages and you will be forced to start again.

9. Select the Dosage field and select the appropriate 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. (The associated cost 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.

10. Enter a Route by either selecting one from the list or typing in a valid route.

    When the user selects a regular schedule that does not have PRN, the administration times may display in the Schedule column. The administration times will display if they have been defined for the ward or if there is a default

11. If you selected an existing schedule, skip to step 13. If you selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take the following steps:
    1. Select one or more check boxes by the appropriate days of the week.
    2. 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. If launched from the Complex tab, the Day-of-Week Schedule builder does not display one-time schedules in the schedule list. 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).

    3. 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
    4. 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@0800-2000, 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.

    5. 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
    6. Review the Schedule field.
    7. When you have the correct schedule, select OK.

       The Order with Schedule ‘OTHER’ dialog allows you to enter a customized day-of-week and/or administration-time schedule. The user can enter specific administration times or select a schedule from the available list.

12. If necessary, select PRN.

    PRN will display in the schedule field if the PRN checkbox is checked or if the schedule is defined in the Pharmacy files as a PRN schedule
    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.

13. Select the Duration field and select the amount of time that the patient should use the specified dose.
14. In the then/and field, select the appropriate conjunction for the order.

    Note: The conjunction “Then” requires a duration to be added.

15. Select the next row in the Dosage field and type or select 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. (The associated cost is displayed to the right of the dosage.)

16. CPRS fills in the Route and Schedule fields. You can change the values in these fields if necessary.
17. Select a duration and a conjunction (then or and) except on the final row

    Note: Your site’s IRM staff may have specified rules governing the status of inpatient medication orders when patients are transferred from one ward or service to another. It may have also specified the number of days an inpatient medication order remains active. Please check with your site’s IRM staff for information about these rules.

18. Repeat steps 15-18 until you have completed the complex dose.

    Note: You can also add or remove a row in the complex dose. To add a row, select the gray area in front of the row and select Add Row (CPRS places the new row above the selected row). To delete a row, click the gray area in front of the row you wish to delete and select Delete Row.

19. Enter an Indication. If indications are defined, they will display in the drop-down list for you to select or you may type in an indication.
20. Add comments (optional).

    The date and time that the patient is scheduled to receive the first dose of the medication appears under the Comments field. (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.)

21. If you want the patient to receive an additional dose now, select the Give additional dose now check box. If you select the check box, the Give Additional Dose Now for Complex Order warning dialog box appears, as shown below.

    This graphic shows an example of the Give Additional Dose Now for Complex Order warning.

    When you select the Give additional dose now check box, CPRS creates two new orders. Depending on your version of CPRS, the order priority and dosing schedule may be set automatically or may require manual adjustments. The pop-up messages displayed will also vary.

    The dosing schedule and priority are set automatically for each order. The first order is scheduled for immediate administration (NOW) and is assigned a priority of ASAP (or a site-specific alternative). The second order is given the priority ROUTINE and follows the regular dosing schedule that you defined when placing the order.

    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.

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

    Warning displayed when “Give additional dose now” is selected

22. Check the orders and then select OK to close the warning dialog.
23. Choose a priority from the Priority drop-down list.

    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.

    CPRS displays a notification that “Give additional dose now” overrides any previously selected priority

    The default value of ASAP can be changed by selecting a different value from the Priority field before submitting the order.

24. Select Accept Order.

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

25. (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.
    - To proceed, select Accept Order.
    - To stop the ordering process and return to the dialog, Cancel Order.

26. Enter another medication order.

    -or-

    select Quit.

27. When you select Quit, if the patient is in inpatient, CPRS changes the patient’s location back to where the patient was before changing to the clinic.

On the Orders tab, CPRS displays Clinic Medications in the Clinic Medications display group, with the clinic location in the Location column.

Related topics

Clinic Medications (Overview)

Ordering Simple Clinic Medications

Sorting the Medications View

Changing or Copying Clinic Orders