Unit Dose Tutorial

Order Entry: Detailed Steps

Introduction

Typically, the order entry process will carry you through several steps. Most of the steps are bypassed following selection of an ingredient because automatic/preset default values are commonly utilized. As a result, most orders can be entered by completing 1 or 2 fields!

Since we cannot be sure whether your system or drug formulary options have been set up yet, your order entry process may include greater or fewer steps than this documentation portrays. Refer to Formulary Setup and Option Settings for more information on order entry defaults.

The basic order entry steps are:

  1. Select one or more ingredients.
  2. Adjust the quantity-per-ingredient, or dose (strength), or per (volume) values if necessary. 
  3. Enter the route of administration if a default one is missing.
  4. Enter a SIG if no default SIG is provided.
  5. Adjust the default start or stop date/time if needed.
  6. Exit the order to automatically prompt for: (a) print labels and/or (b) initiate starter doses.

Note

To skip to any Order Entry Help Topic in this tutorial, click the desired link below.

Order Entry Help                                                            

Learn More About

Unit Dose Order Entry

For the first example, we’ll enter a unit dose medication order for "FUROSEMIDE 40MG TAB". We use the term unit dose to refer to any non-compounded item that would typically be dispensed via a medication cassette. We do not intend the term to refer to unit dose packaging. Therefore, a unit dose order could be for tablets, capsules, ampules, vials, cream/ointment tubes, patches, suppositories, etc. 

Note

Ingredient Selection

  1. Begin by typing the letters "FUROS". As you type, the drug list will match the characters you have typed and subsequently reduce the length of the list. Eventually, by continuing typing, you will see the target drug on the list.
  1. Use your mouse or up/down cursor control keys to highlight the desired item. 
  1. Once the item is highlighted, you can press ENTER to select it, or double-click on the item with your left mouse button. The program will then create a second (blank) ingredient field (i.e., in case you want to add a second ingredient).
  1. In this case, we do not want a second ingredient. You can press the ENTER key to skip to the next field or use your mouse to click on the next desired field (e.g., typically the route or SIG/directions for use).

Dosage Fields

Each ingredient in the order is associated with one or more "dosage" fields: 

  1. "quantity-per-dose" (the "quantity per dose" value is usually "1")

  2. "dose"   (the optional "dose" field is usually a strength value)

  3. "per"  (the optional "per" field is usually the volume of the solution) 

Editing any one of these dosage fields automatically adjusts the other two dependent values proportionately. For example, if you were to edit the Furosemide "40MG" dose to "80MG", the quantity-per-dose would increase from 1 to 2, indicating 2 x 40MG tablets per 80MG dose.  

Notes

Route of Administration

If your formulary record for "FUROSEMIDE 40MG TAB" has an assigned route, it will appear automatically and the program will focus the cursor on the SIG. If not, the cursor will focus on the route. If you need to select a route, you can enter "PO" and the program will match your entry to the "PO" route in the list box; or use your up/down cursor control keys to choose the route from the list. Press ENTER or double click on the selected route.

If a route is not listed, you can leave it blank and include it in the SIG/directions for use. The program does not require a route. 

Tip

Would you like to know more about?

Assigning a route to an item in the Formulary

How to add routes to IP's current list

SIG Entry (Directions for Use)

The program will focus on the SIG field after the route has been assigned. You may also use your mouse to focus on this field. In some cases, a pre-built, default SIG will already be present. In our example we’ll enter one ourselves.

  1. Type the SIG as "1 TABLET QD". (SIGs such as "1 PO QD", "1 QD", "QD", "DAILY", "1 DAILY", "1 PO DAILY", "1 TAB PO DAILY" and similar common variations could also be used).
  1. Press the <Tab> key to have the program initiate the SIG’s intelligent scheduling features. The SIG field has built-in intelligence and can perform several additional steps for you. It recognizes a wide variety of directions, including those that you can pre-define yourself.   

The program will automatically:

Note

Check the Order after "Tabbing" from the SIG

This is a good point to check the order and make any adjustments that may be necessary. The start/stop date/time, administration schedule, order type, fill method, and MAR status should be reviewed as discussed below.

Start Date/Time, Stop Date/Time, Stop Quantity, and Scheduled Doses for Today and Tomorrow

Start by examining the start date/time, the stop date/time and stop quantity. These refer to the actual dates medication administration begins and stops, whereas the "order date/time" is the date/time you entered the order into the computer. The program automatically "rounds" these times according to the system option settings you have in place.

Using our option settings, the program rounded the start/stop times forward to an even "12:00". If these start/stop dates/times are incorrect, you can click on them and edit them, without having to enter the entire field again. When you are done modifying a start/stop date/time, be sure to press the <Tab> key to initiate the "intelligent rescheduling" process once again.

As part of the order review process, you should also check the scheduled doses of administration for today and tomorrow. The order detail screen gives you a summary of these doses as shown below.

One way to change the administration times for today/tomorrow is to edit the order start date/time and/or stop date/time to include earlier/later doses (then press <Tab> when done editing!). Other ways will be discussed later on.

Another way to add a scheduled dose "on the fly" is to select the <Add a dose> button. The program will present the current date/time as a default dosage administration time. In most cases, the default can be used indicating an additional dose will be given now: e.g., "08/07/2003 12:45"). If desired, the date/time can be edited back to reflect when an earlier dose would have actually been scheduled (e.g."08/07/2003 10:00"). This feature is commonly used when it is likely the nurse will want to give a dose before the next regularly scheduled dose would be due, to record a scheduled dose that was given while the pharmacy was closed, or for a similar reason.

MAR Status, Fill Method, Par level/Doses, and Doctor

Other fields that should also be reviewed are shown below.

The MAR status controls where the order will be printed on a medication administration record (MAR). The drop down list includes options for the "SCHEDULE" section, or the "PRN" section of the MAR. Another option is "DON’T LIST" which would cause the order to NOT be included anywhere on the MAR. This last option is used for orders that are for "pharmacy eyes only". (e.g., "DAILY PROFILE FEE").

The MAR status is normally determined by your SIG entry. If "PRN" or "AS NEEDED" appear anywhere in your SIG, the program assumes a "PRN" MAR status. Otherwise, "SCHEDULED" is the program’s choice. You can also pre-set this field for specific drugs by specifying their formulary record default.

The Fill method controls how the order is dispensed and charged. The drop down list includes "AUTO FILL" and "DEMAND FILL" options. The program assumes "Auto fill" orders will be dispensed and charged according to the schedule of administration. For example, a "QID" order would have 4 doses per day dispensed and charged. On the other hand, "Demand fill" orders are only dispensed and charged when you tell the program to do so. When you print a "fill list" (or pick list), the program will (depending upon options), automatically charge/dispense "Auto fill" orders, but will not do so for "Demand fill" orders. When you print batch IV labels (to be discussed later), "Auto fill" IV orders have labels printed/charged, but "Demand fill" IV orders do not.

The Fill method is normally determined by your SIG entry. If "PRN" or "AS NEEDED" appear anywhere in your SIG, the program assumes a "DEMAND FILL" method. Otherwise, "AUTO FILL" is the program’s choice. You can also pre-set this field for specific drugs by specifying their formulary record default.

The Par Level/Doses field is usually only of value for "DEMAND FILL" orders. It serves as a reference point for persons refilling medication cassettes so they know how many (doses) are usually placed in the cassette.

The ordering Doctor should also be verified. This will normally be the same (admitting/attending) doctor who appears at the top of the patient profile portion of the screen. If another doctor placed the order, please alter this field before exiting the order. Many reports and statistics are dependent upon the proper selection of the "ordering" doctor.

Note

Order Status

This order status field shows the current status of the order. After entering a new order, the order status will be "ACTIVE", "DISCONTINUED" or "INACTIVE". If you have proper authorization, your orders will be "active" upon completion (usually pharmacists). Otherwise, they will be "inactive". Inactive orders must be "verified" by a pharmacist (or other staff with the proper security level) before they can appear on MARs, batch IV print runs, and the like.

If someone DC’s the order (e.g., a one-time order), it will appear with a "discontinued" status and a date in the "DC Date" field. Orders that are DC’d without the higher security level will be in a "DC’d-Inactive" status and will be subject to review as well. The "discontinued date" field may contain a different date than the "stop date" field.

One additional order "status" that is used by some facilities is the "HOLD" status. Most facilities will DC an order rather than put it on hold.

Order Type

The order type controls how the program will process this order, especially for batch printing processes such as fill (pick) lists and batch IV labels. Although the program contains many order types (and allows you to define additional ones) all order types must fall into one of three main groupings:

  1. Unit Dose – these orders appear on fill (pick) lists, but are excluded from IV batch label printing processes. If labels are printed for these orders, they use a "unit dose" label format. You can be prompted to dispense/charge "starter" doses for these orders if you choose this option.
  2. IV – these orders are included in IV batch label printing processes, but do not appear on fill lists. If labels are printed for these orders, they use an "IV" label format. You can be prompted to print/charge "starter" labels for these orders if you choose this option.
  3. Floor stock - these orders are not included in IV batch label printing processes, or listed on fill lists. They are filled/charged on a "demand" basis by default. You do not get starter dose/label prompts for floor stock orders.

Select an order type that is most descriptive of your order. In this case, the basic "Unit dose" order type is best. If you do not specify an order type before exiting the order, the program will prompt you for it.

When You Are Done With Entering the Order

At this point, most users are ready to enter another order or go back to the patient’s profile. You can tell Ascend-I.P. what you want to do next by clicking on one of these command buttons: At <Profile> or <New Order> or <Select>

The "Profile" option tells the program you are done entering orders for this patient and want to return to the patient profile screen. The "New Order" option lets you add another order for this patient. The "Select" option lets you choose another patient. With any of these choices, the program will finish any remaining steps on the current order before proceeding with your command. In our case, select the "Profile" option.

Notes

Starter Doses

For unit dose orders, the program may be configured to ask you how many "starter" doses you want to dispense. Starter doses will also include any scheduled dose records that were created via the <Add a dose> button during order entry. If a fill list (i.e., pick list) is used to refill medication carts, then this value should be the number of doses to last the patient up until the next effective fill (pick) list period begins. If the fill list has already been printed today (and no "catch up" list will be printed later), you may also need to dispense/charge the doses needed to last through the next fill list period. The screen will display the order ingredients, and the number of units per dose (e.g., 1 tablet per dose in this case). It will also show you which of the scheduled doses (if any) have been charged. In this example, if you want to dispense the 01/12/2000 20:00 dose you could accept the default "1" dose value. If you wanted to also dispense the 01/13/2000 08:00 dose (assuming no catch-up list will be printed), you would enter "2" starter doses instead. This order entry option can be configured "on" or "off" under the "Utilities" à "Options" menu.

Warning

If you use a "Catch-Up fill list, you should not need to over-ride the default starter dose value as suggested by the program. If you do, you might end up dispensing the same scheduled dose two times (i.e., once as a starter dose and again when the catch-up list is filled). Since Ascend-IP cannot "double-charge" the same scheduled dose, this double-dispensed dose will only be charged once (Net: 2 dispensed, 1 charged). Later on, when the "extra" dispensed dose is returned to stock, if it is then "credited", the net result will be 1 dispensed but 0 charged!!!!  When the program is configured properly, it will display the appropriate number of starter doses to last up to the next fill period...the catch-up list will include the doses from that point forward.

Labels

After specifying the number of starter doses for your unit dose order, the program can ask you for unit dose labels. The default value is one label. For unit dose orders, label printing is independent of charging/scheduling. Therefore, you can print one or more unit dose labels and this has no effect on the charges for unit dose orders.

If you want the label to display a different "amount sent" value, just edit the amount shown. This would be necessary, for example, if you were replacing a missing dose. This order entry option can also be configured "on" or "off" under the "Utilities" --> "Options" menu.

Order "Type" and "Route" Defaults Set Automatically in the Formulary

Upon finishing an order, the program will also check if a default order type (and route) has been set for the medication. If not, the program will display a message box window and ask you if it is "Ok" to set the displayed defaults for you. In general, if the medication is usually given (i.e., 80% or more) by this route and/or as this order type, let the program set the formulary default for you. If not, you should either (a) change the default, or (b) click the check box at the bottom of the window box to prevent the program from setting these defaults.

This check/message occurs only once for each item in your formulary that lacks these defaults. Therefore, after a few weeks of program use, these messages will disappear. If you change your mind later on, you can go to the formulary record and alter the defaults. An example of the message appears below.

Clinical Checking and Interventions

The program also performs several "clinical checks" including allergy, drug interaction, duplicate therapy and food-drug interaction checking. If one or more potential problems are discovered, the program will display them.

The results are displayed in a "Clinical review" window. There are fields for the category, problem, action, outcome, time spent/saved, cost savings and who reviewed the problem. These fields can be used for documentation purposes. Many of the fields have user-defined drop down lists for you to choose from. Under the lists, text boxes may be used for "free text" to more clearly describe the problem/action/outcome if desired. The fields can be entered/edited at any time during or after the patient’s stay. These records are kept with the patient’s record indefinitely.

The check box should be checked when the "Clinical review" documentation has been completed for a particular intervention. This can be done at order entry time, order verification time, or at any time later on. The program tracks incomplete Clinical reviews and notifies you of this in various parts of the program. To review the next one, if any, use your mouse to select it from the summary list.

You can also add your own Clinical review records by clicking on the "New" button on this screen, or by using the "Clinical" menu on the main profile screen. These would normally include interventions or events that you want to document such as calls made to the physician to change therapy, a missing medication, an adverse drug reaction, and so forth.

Next New Order or Profile Screen

Depending upon the button you chose from the order screen earlier ("Profile" or "New Order"), you will either return to the patient’s profile, or a blank order entry screen will appear ready for you to enter the next order.

IV Order Entry: IV Piggybacks

Many of the steps to enter a new "IV" type of order are the same as entering a "Unit dose" type of order. We will refer back to the unit dose instructions in that case. If you already have the order screen up, ready to enter a new order, go to the next section of this documentation. Otherwise, from the patient’s profile screen, select to enter a new order (see "Initiating a New Order" on page 1).

Selecting the First Ingredient

In general, for "IV piggyback" type orders you would select the drug first, then the solution as the second ingredient. This has the advantage of allowing the program to automatically select a solution that has been pre-assigned to the drug, where possible. For large volume solutions, most users prefer to select the solution first and the ingredients, if any, afterwards. Since we’ll do an IVPB order first, select "CEFAZOLIN 1GM INJ" or something similar, as your first ingredient (see "Ingredient Selection" on page 2).

Selecting the Solution

After you have selected your first ingredient and pressed <Enter>, the program will do one of two things:

  1. Create the next blank ingredient line ready for your selection.
  2. Automatically enter the next item, typically the default solution assigned to the first ingredient.

In your case, if #1 occurs, select "D5W 50ML" (or however you have it listed in your formulary) as the next ingredient. Otherwise proceed to the next section.

Dosage Fields

Each ingredient and solution in the IV order is associated with one or more "dosage" fields: 

  1. "quantity-per-dose" (the "quantity per dose" value is usually "1")

  2. "dose"   (the optional "dose" field is usually an additive strength value)

  3. "per"  (the optional "per" field is usually the volume of the IV solution) 

Editing any one of these dosage fields automatically adjusts the other two dependent values proportionately. For example, lets assume you do not stock CEFAZOLIN 2GM vials, and only 1GM vials are available. Therefore,  if you edited the CEFAZOLIN dose from 1GM to 2GM, the quantity-per-dose would increase from 1 to 2, indicating 2 x 1GM were used for each 2GM dose.  Editing a large volume D5W "1000ML" to "500ML" would change the quantity per dose from "1" to "0.5"  (Note: most financial systems can't handle a fractional billing quantity as in the last example. Therefore the quantity billed is usually rounded up to an even number).

Route of Administration

How to?

SIG Entry (Directions for Use)

Typical SIG entries for IVPB orders include the interval (e.g., "Q6H", "500MG Q12H", "Q8H X 5 DAYS", "Q24H X 2 DOSES", "NOW", "STAT", "X 1", and etc.). For our IVPB order, please enter "Q8H X 5 DAYS". When you have entered the SIG, please press the <TAB> key to initiate order scheduling.

Check the Order after "Tabbing" from the SIG

So far, your IVPB order should look similar to the example shown below. This is a good point to stop and check the order. You can use the <Add a Dose> button to create additional scheduled doses if needed. 

Start Date/Time, Stop Date/Time/Quantity, and Scheduled Doses for Today and Tomorrow

Start by examining the start date/time and the stop date/time/quantity. These refer to the actual dates IVPB administration begins and stops. The program automatically "rounds" these times according to the system option settings you have in place.

In this case, you should see the program set the stop date/time in accordance with your directions (i.e., stop in 5 days). If these start/stop dates/times are incorrect, you can click on them and edit them, without having to enter the entire field again. When you are done modifying a start/stop date/time, be sure to press the <Tab> key to initiate the "intelligent rescheduling" process once again.

As part of the order review process, you should also check the scheduled doses of administration for today and tomorrow. The order detail screen gives you a summary of these doses. One way to change the administration times for today/tomorrow is to edit the order start date/time and/or stop date/time to include earlier/later doses (then press <Tab> when done editing!). Other ways will be discussed later on.

IV Interval and Rate

These fields are not required for proper handling of an IV order. However, if you want them to appear on the IV label, be sure to enter them. The interval field may be completed:

  1. automatically using your SIG entry (directions for use) e.g., "Q8H". Proper recognition of the interval from the SIG is dependent upon the administration times definition table (see "Utilities" à "Options" à "Administration times")
  2. manually, if left blank (not recognized on schedule table), or if an earlier entry is incorrect.

The rate field may be completed:

  1. automatically via the (optional) default IV rate which was pre-selected for this drug in the formulary (see "Utilities" à "Formulary" à Select your drug à "Defaults tab" à "IV rate")
  2. automatically via the default system-wide IV rate (see "Utilities" à "Options" à "Order entry tab" à "Default rate for IV piggybacks")
  3. automatically via your SIG entry (directions for use) e.g., "125ML/HR". This usually pertains to large IVs only, not to IVPB orders.
  1. manually, if left blank, or if an earlier entry is incorrect.

MAR Status, Fill Method, and Doctor

Other fields that should also be reviewed are shown below.

The MAR status controls where the order will be printed on a medication administration record (MAR). For our IVPB order, this should be "SCHEDULE".

The Fill method controls how the IVPB order is dispensed and charged. For our IVPB order, this should be "AUTO FILL". The program assumes "Auto fill" IV orders will have IV labels printed and charged according to the schedule of administration. For example, our "Q8H" order would have 3 labels (scheduled doses) batch printed and charged per day. "Demand fill" IV orders do not print when batch IV labels are printed.

The Par Level/Doses field can be ignored for IV order types. It has no effect on IV scheduling, charging, labels, and etc., for IV orders.

The ordering Doctor should also be verified. If another doctor placed the order, please alter this field before exiting the order. Many reports and statistics are dependent upon the proper selection of the "ordering" doctor.

Order Status (see page 5 for details)

Order Type

The "IV Piggyback" order type may have been pre-assigned to the "CEFAZOLIN" record in the formulary. If not, select the "IV Piggyback" type for your IVPB order (refer to page 5). A variety of other IV order types are built-in to the program. The user can create and use new ones if required.

We recommend that all drugs that will be primarily administered via IV piggyback have their "Order type" default preset to "IV piggyback" in the formulary record. Assignment of default solutions to these IVPB drugs also saves time during order entry. Order entry for IVPB orders will proceed more smoothly this way.

If you will be making extensive formulary or option changes based upon order types, please contact Hann’s On Software first to discuss your plans. We don’t want you making time consuming changes unnecessarily.

When You Are Done With Entering the Order

At this point, you can tell Ascend-I.P. what you want to do next by clicking on <Profile> or <New Order> or <Select>.

In all cases, the program will finish any remaining steps on the current IVPB order before proceeding with your command. In our case, select the "New Order" option.

If you have not specified an order type before exiting the order, the program will prompt you for it. The program will ask you "Is this a unit dose order?" In this case, say "No" and then pick the "IV Piggyback" order type from the drop down list.

Print "Starter" IV Labels

Before moving on to the next order, the program will prompt you for "starter" IV labels/doses.

Starter labels/doses will also include any scheduled dose records that were created via the <Add a dose> button during order entry. Print the number of IV labels (i.e., doses) you need to last up until the effective time for the next scheduled batch IV print job. If the beginning of the batch effective period has already been reached today, you may need to print enough doses (labels) to last through to the next batch period date/time. In either case, this number is usually calculated for you automatically, once the system has been set up. "Catch-up" batch IV print jobs (if available, and if used) may eliminate the need to print starter IV labels at order entry time.

Avoid over-riding the default starter doses value as suggested by the program. If you do, you might end up printing two labels for the same scheduled dose (i.e., once as a starter dose and again when a batch of IV labels is printed). This could result in too many IV solutions being prepared. When the program is configured properly, it should display the appropriate number of starter doses to last until the beginning of the next batch effective period.

Your "Options" settings will control whether you charge for these doses as the labels are printed. In most cases, your system-wide options will be correct "as is". Otherwise, alter the "Charge for printed labels" check box if this option is not correct for this order, or for current circumstances.

If you want to create and print a label for a non-scheduled dose, or for a "demand fill" IV order, verify that the  "miscellaneous" box is checked, then edit the date/time field that will appear. If you want to charge for this "miscellaneous" dose, be sure the "Charge for printed labels" check box is checked...if not, uncheck the box.  

If you want to reprint a scheduled label/dose without charging for it, highlight the desired scheduled dose with your mouse and uncheck the "Charge for printed labels" check box. 

The following sections of the unit dose documentation (above) also apply to IV orders:

IV Order Entry: Large Volume IV Orders

Order entry for large volume IV solutions (LVP) is almost identical to IVPB orders. The main differences are:

  1. The order type should be "Large volume IV". We recommend that all large volume solutions have their "Order type" default preset to "Large Volume IV" (or "TPN Solution") in the formulary record.
  2. Furthermore, the solution volume must be specified in the formulary (i.e., in the "Per" dosage field) for the program to make volume-rate-interval calculations. This will make order entry for these large volume IVs proceed more smoothly.
  3. Ingredient selection for LVP orders usually begins with the base solution as the first ingredient, followed by additives, if any as additional ingredients.
  4. The SIG usually includes a rate or an interval (e.g., "125ML/HR", "Q12H", "80ML/hr X 3 doses", etc.)  
  5. If you enter a rate-based SIG (e.g., "125ML/HR"), the program completes the "Interval" field automatically (Volume/Rate=Interval; e.g., 1000ML/[125ML/HR] = 8HR). You can edit the interval if needed.
  6. If you enter an interval for the SIG (e.g., "Q12H"), the program does not calculate a rate. You should enter the rate in the box labeled "Rate:". This provides the user with a way of entering orders where the rate of administration does not equal Volume/Interval (e.g., LIPOSYN 500ML OVER 10 HOURS [i.e., 50ML/HR], HANG 1 BOTTLE  EVERY 24HR) 

Floor Stock Order Entry

Order entry for floor stock unit dose and floor stock IV orders is almost identical to their non-floor stock counterparts. The main differences are:

  1. The order type should be "Floor stock….". We recommend that all formulary items that will be floor stock have their "Order type" default preset to a "Floor stock…" option in the formulary record. If the item is not flagged as a floor stock order type in the formulary, you should set the order type before exiting the order. These steps will make order entry for floor stock proceed more smoothly.
  2. Floor stock items will be "Demand fill" by default upon order entry.
  3. The program will not prompt for starter labels or starter doses/charges for floor stock orders.
  4. Note: floor stock orders do not print labels during batch IV print jobs, nor do they appear on fill lists.

Reference Information

This section will explain the fields that were not covered in the Unit dose, IV, or Floor stock order entry sections or may require "extra attention".

Ingredient line fields:  "Qty/Dose",  "No Chg",  "Hide"

Qty/Dose  This value determines how many of this ingredient (usually tablets, capsules, etc.) should be dispensed/charged per dose. For example, for a TYLENOL order, "2 TABS Q4H PRN PAIN" the dosage is 2 tablets. The "Qty/Dose" field should be changed from "1" to "2" to reflect this. If the "Qty/Dose" value is greater than 1, the program will charge this quantity per dose. Charges may be incorrect if this value is not set to the proper amount. Editing an ingredient "Dose" or "Per" field values, if any, automatically adjusts the "Qty/Dose" value.

No Chg   In some facilities, laxatives, acetaminophen, etc. are provided to the patient at no charge. This check box controls whether the ingredient is charged or not. In most cases, the box should be unchecked. If the item is to not appear with the charges, check the box. You can preset this "No Chg" check box for any item in the formulary (i.e., look under the "defaults" tab for that item).

Hide  In some cases, you do not want an ingredient line to show on labels or medication administration records. For example, an "ingredient" such as "PROFILE FEE" should not appear on patient medication labels or MARs. This check box controls whether the ingredient is visible or not. In most cases, the box should be unchecked. If the item is for "Pharmacy eyes only", then check the box. You can preset this "Hide" check box for any item in the formulary (i.e., look under the "defaults" tab for that item). 

Note

Edit an Ingredient Description

To edit an ingredient description, use your mouse to click on the position you want to start editing. Then use normal word processing steps:

<Add Ingredient>, <Delete Ingredient>, Move <Up Arrow>, and Move <Down Arrow> buttons

During order entry, to add an ingredient after selecting the first ingredient, just press <Enter>. The program will create another blank ingredient line and you will select an item from the ingredient list box as you did the first time. Repeat this process for additional ingredients. To add an ingredient to this order at a later time (e.g., Verifying the order), you can create another blank ingredient line by clicking on the <Add ingredient> button. Then continue as above.

To delete an ingredient, select it with your mouse, then click on the <Delete ingredient> button.

To move an item higher up the list of multiple ingredients, select the item, them click on the <"Up Arrow"> key button. (also see "Description" below). To move an item down the list of multiple ingredients, select the item, them click on the <"Down Arrow"> key button. (also see "Description" below).

Comments

Add as many comment lines as needed. Press <Enter> at the end of the first line to generate the next line. Repeat for additional lines. Comment lines usually appear on MARs but not on labels.

Label

Add as many label lines as needed. These are usually used for warnings, reminders, and additional instructions. Press <Enter> at the end of the first line to generate the next line. Repeat for additional lines. Label lines usually appear on labels but do not appear on MARs.

Description

This is the summary description of the order that will appear on the patient’s profile. At order entry time, this field will automatically pick up the first line of your ingredient list as you exit the order. Therefore, in most cases you can skip it.

You manually add/edit the line if you would prefer a different description of the order on the profile. For example, you might change the order description from "AMINO ACIDS 3.5% 500ML" (the first ingredient) to "TPN SOLUTION".

Order number

This is a unique identifier (number) assigned to this order by the program. The program uses it to cross-reference the order to the patient, doctor, and etc.

Starting bottle

For IV orders, this defaults to bottle number "1". Subsequent printed IV labels, which contain a bottle number field, will start counting from this number. You can edit the number to "2" or more if the first dose(s) may have been given elsewhere (e.g., surgery, recovery, etc.)

Strength

This comes from the formulary "strength" field for the first ingredient. It has little use with the current version but may be used for calculations in later versions.

Volume

This is a total of the ingredient volume ("Mls" field) for the each ingredient line. Default values can be assigned in the formulary if desired. It has little use with the current version but may be used for calculations in later versions.

Control class

This is the control or DEA schedule number assigned to the item in the formulary. Typical values are "<blank>, 2, 3, 4, 5, <user defined>"

Total Charges; Total Credits; Total

These fields show the number of doses charged, credited and the net total (charged doses minus credited doses). Remember, these numbers do not necessarily equal the number of "units" (e.g., tablets, amps, etc.) charged or credited since the quantity of each ingredient per order may differ from the standard quantity of "1".

<Add a Dose>

One way to add an extra scheduled dose is to select the <Add a dose> button. The program will present the current time as the default administration time. In most cases, the default can be used "as is" (e.g., "08/07/2003 12:45"). If desired, edit the value to a true scheduled time (e.g."08/07/2003 10:00"). This feature is commonly used when the nurse wants to give a dose before the next regularly scheduled dose, or to record a scheduled dose that was given while the pharmacy was closed.

<Regenerate Schedule>

This button causes the program to regenerate the dosing schedule for the order. This might be required if:

  1. the schedule was deleted/edited and you want to restore it.
  2. a schedule was not generated originally but you want one now (e.g., you change a demand fill order to an auto-fill order).

<Schedule Maintenance>

This button brings you to the "Administration Schedule Times" screen. On this optional screen you can:

  1. edit or select alternative daily times for administration of the medication
  2. edit a dosing interval
  3. add or delete scheduled doses
  4. reschedule doses
  5. select administration days of the week

In most cases, you will not need to use this button/screen. The vast majority of initial rescheduling at order entry time is done on the main order entry screen by editing the start date/time or stop date/time. As a result of making changes in an order’s start/stop dates/times, scheduled doses for today, tomorrow and thereafter are recalculated by the program.

For example, let’s assume you enter a "BID" order at "12:00" today. Let’s also assume that "BID" is assigned "08:00" and "20:00" dosing times) the program may, depending upon option settings, schedule the first dose for later today (e.g., "20:00"), or for tomorrow, since 08:00 today has already passed. If you still want to give two doses today, you could edit the original start time from "12:00", back to "08:00" to include an "08:00" scheduled dose for today. (Note: You can set a system option that does this for you automatically if you want). This would bypass any need for using the <Schedule Maintenance> button.

Another way to accomplish "squeezing in" a dose for today would be to use the <Schedule Maintenance> button, and then use the <Add> button to enter a dose for today at any desired time. The remainder of the original dosing schedule (i.e., starting at 20:00 today) would be left unchanged.

Note: changes made in fixed administration times or in dosing intervals made on this screen will not be immediately reflected in the list of scheduled doses (i.e., "Administration times") on the left. The "Administration times" list will be updated upon selecting the "Ok" button to return to the order screen.

"Administration Schedule Times" Screen: Select alternative daily times for administration

The drop down list labeled "Schedule" lets you choose an alternative dosing schedule from your user-defined list of administration times (click on the down arrow to see the list!). In the example below, the predefined times for "BID" is highlighted for selection by the user.

"Administration Schedule Times" Screen: Edit daily times for administration

Instead of picking from a list, you can also edit or enter daily administration times directly. In the example below, the user has changed the second administration time for this "BID" order from "20:00" to "16:00" each day.

"Administration Schedule Times" Screen: Edit a dosing interval

Some orders are administered at regular intervals (e.g., every 8 hours) rather than at fixed times each day. This is usually accomplished at order entry time (i.e., on the order screen) by entering/changing the SIG (e.g., "Q8H"). For example, changing an order’s SIG from "TID" to "Q8H" would cause the program to stop using administration times assigned to "TID" and to calculate new times using the interval of 8 (which is assumed to be assigned to "Q8H").

However, this can also be done on the "Administration Schedule Times" screen by entering an interval of "8" as shown below.

If you enter an interval, the program will erase any "fixed" times that may have been present in the "Dose 1", "Dose 2", etc., "daily times" fields.

"Administration Schedule Times" Screen: <Add> or <Delete> scheduled doses

To add a dose (schedule an additional dose/administration date and time), select the <Add> button. The program will prompt you for the administration date and time. After you are done, the program will add the dose to the list. Repeat this as needed for additional doses.

To delete a dose (remove a scheduled dose from the list), select the target dose by clicking on it once from the list. Then select the <Delete> button. The program will prompt you to confirm this action. After you are done, the program will remove the dose from the list.

"Administration Schedule Times" Screen: Reschedule doses

You can reschedule an individual dose by editing the date and time on the list. Just click on the date/time and make your changes right there. If the order uses an "interval" (e.g., every 8 hours) rather than fixed times the program will then ask you if you want to reschedule the subsequent doses (i.e., when you are done editing). This is useful for rescheduling IV orders so that fewer (or more) IV labels will be printed for the next batch IV label print job. In the example below, the user has edited the "01/18/2000 20:00" dose to be given earlier at "18:00".

After selecting "Ok", the program reschedules the remaining doses (which follow the 18:00 dose) at every 8 hours as shown below.

"Administration Schedule Times" Screen: Select administration days of the week

The check boxes at the bottom of the screen (Mon, Tue, etc.) are normally all automatically checked to indicate that the drug can be administered every day of the week. If, however, your SIG includes the days of the week for administration, some days will not be checked. For example, if your "DIGOXIN 0.125 MG TAB" order has a SIG of "0.125MG on TUESDAY THURSDAY SUNDAY" then only these days will be checked.

Alternatively, you could use the <Schedule Maintenance> button and then uncheck the days you want to skip. Days that are not checked will not have doses scheduled upon exiting the screen.

<Enter Charge/Credit> [Back to the order entry screen]

This button can be used to "charge" one or more scheduled doses, to credit scheduled doses that were charged earlier, or to add miscellaneous (i.e., non-scheduled) charges/credits to the order. When you first enter the order, it is usually unnecessary to manually select this button from the order screen because the program can automatically prompt you for this information after you select the <Profile> or <New Order> options.

Charges for scheduled doses

If the medication has scheduled administration dosage times, they will be displayed in the list box. Doses that have already been charged (dispensed) will show a "Yes" under the "Charged" column. By default, the program will charge for the next uncharged doses. In the above example, by entering "2" the user will be charging for the "1/18/2000 18:00" and "1/19/2000 2:00" doses.

Credits

Credits are entered by specifying a negative number of doses (e.g., enter "-1" to credit 1 dose). By default, the program attempts to reverse the charge on "future" scheduled doses, if any. Future charges are those that have been charged to scheduled doses for tomorrow, or later. If there are no "future" charges, or if the order is not a scheduled order (e.g., a DEMAND FILL order), the program creates a separate, miscellaneous credit transaction.

"Demand-Fill" charges/credits

"Demand fill" orders, such as most "PRN" orders, do not (usually) have dosage dates/times pre-scheduled. If there are no doses scheduled for the order, the program will set up the charge screen for a "Miscellaneous" charge/credit.

Miscellaneous charges/credits

A "miscellaneous" charge or credit is one that is not tied to a specific, pre-scheduled dosage date/time. For example, if the first scheduled dose is "18:00" today but you want to dispense/charge for an earlier "04:00" dose that was given by the night supervisor, you could enter it as a "miscellaneous" charge. If you want to enter a miscellaneous charge/credit, fill in the quantity of doses you want to charge/credit, then check the "Miscellaneous Charge/Credit" box, (i.e., if unchecked). Edit the date and/or time for the transaction, if needed, and select <Ok>.

You should charge or credit for "doses", not for "units" or "quantities"

Enter charges/credits as "doses". In the previous example, let’s assume the quantity per dose had been "2" tablets rather than "1" (i.e., on the ingredient line of the order, under the "Qty" column). If so, the program would have ultimately billed the patient for 2 tablets for each of the "1/18/2000 18:00" and "1/19/2000 2:00" doses (i.e., 4 tablets total). If you then credit one dose ("-1"), the net quantity to be billed is now 2 tablets.

<Print Labels> [Back to the order entry screen]

This button can be used to print unit dose or IV labels for the order. When you first enter the order, it is usually unnecessary to manually select this button from the order screen because the program can automatically prompt you for this procedure after you select the <Profile> or <New Order> buttons. It is also unnecessary to use this button if you are printing batches of labels for one or more patients. These batch functions are more properly handled under the profile menu option, "Labels".

Unit dose labels

If the order is a "unit dose" type of order, you will be prompted for the number of unit dose labels you want (default = 1). If the "amount sent" will differ from the par level of doses set up for this order, you can edit the number. This might be useful when re-dispensing a missing dose, for example. Note: Ascend-I.P. does not "charge" when you print unit dose labels.

Charging options for printed IV labels

(Please refer to the next sample screen).

Most users choose to print and charge IV labels at the same time. If so, the "Charge for printed labels" box should be checked. You can change the option here if necessary. If you want to make a more permanent change, refer to the menu ("Utilities" à "Options" à "Order entry") section where you can choose to "charge upon dispensing" for:

  1. All orders
  2. IV orders only
  3. UD orders only
  4. Neither UD nor IV orders

Either of the first 2 options will cause the "Charge for printed labels" box to be checked by default.

Printing IV labels for scheduled doses

For scheduled IV orders, the program will print label(s) for the next uncharged doses by default. To do this, just enter the number of labels you want to print, then select "Ok". If you want to print a label for specific doses, highlight them by clicking on them with your mouse, then select "Ok".

Reprinting IV labels individually

If you want to reprint labels for specific doses, highlight them by clicking on them with your mouse, then select "Ok". If they have been charged already, they will not be charged again regardless of the status of the "Charge for printed labels" check box. The program can only charge each scheduled dose one time! If they have not been charged, they will be charged (or not charged) according to the status of the "Charge for printed labels" check box.

Printing IV labels for "Demand-fill" or non-scheduled doses

For "Demand-fill" or non-scheduled IV doses, the program will automatically check the "Print a label for non-scheduled/demand fill dose" box and enter a default "Administration date/time" in the area below it. If necessary, edit the administration date/time, and then select "Ok" to proceed.

<Cancel> [Back to the order entry screen]

This button allows you to exit an existing order without making any changes, or to stop entering a new order. If this is a new order, the program will ask you if you want to cancel it. If you answer "Yes", the order will be erased.

Order Entry Tips

The SIG field can do a lot of work for you.

Be sure the table of SIG codes ("Utilities" à "Options" à "Administration times") contains the basic codes you want the program to recognize. Examples of SIGs the program can recognize:

QD X 5 DOSES 

2 TABLETS QID X 8 DOSES 

TID X 7 DAYS 

Q12H

Q24H

Q18H (or any variation of QnnH)

Q4H X 12 HOURS 

1GM IVPB Q6H X 48 HOURS 

125ML/HR

80ML/HR X 24 HOURS 

0.25MG MON WED SAT

1 EVERY TUESDAY AND FRIDAY 

X 1  (or ONCE)

STAT (or NOW)

DAILY 

QOD

"GIVE AT" followed by any number of times separated by commas (military time format HHMM or HH:MM)  Examples: 

GIVE AT 1700 EVERY DAY  

GIVE AT 12:30, 7:30, 22:00

Sliding Scale Order Entry

You do not have to create more than one order to handle sliding scale orders. Enter each sliding scale dosage as a separate "SIG" line or "comment" line (for MARs), or as a separate label line (for labels), within one order. The SIG, Comment and Label fields can be multi-line. After entering the first line, just press <Enter> to create the next line. Be sure your MAR and/or your labels are configured to print multiple lines for these fields.

Sample sliding scale common order setup:

INSULIN REGULAR 100 UNITS/ML          (Ingredient 1)

SLIDING SCALE DOSING                      (Sig Line 1)

BLOOD SUGAR             DOSE               (Sig Line 2)

<                        0 units                   (Sig Line 3)

                          units                      (Sig Line 4)

                          units                      (Sig Line 5)

                          units                      (Sig Line 6)

                          units                      (Sig Line 7)

                          units                      (Sig Line 8)

>                        CALL DOCTOR          (Sig Line 9)

Sample order created from common order template, then edited:

INSULIN REGULAR 100 UNITS/ML

SLIDING SCALE DOSING

BLOOD SUGAR             DOSE

< 200                        0 units

201-220                     5 units

221-240                    10 units

241-260                    15 units

261-280                    20 units

281-300                    25 units

> 300                     CALL DOCTOR

 

Alternating IVs

If the base solution remains the same, but one additive (e.g., we’ll be using MVI) differs from bag to bag:

  1. Enter the order as a regular scheduled IV order.
  2. On one of the ingredient lines, or on a "Label" field line, include an appropriate entry such as "MVI to one bag daily", "MVI to every other bag", "MVI to every even bag", "MVI to every 3rd bag", etc. [The remaining instructions assume that MVI will be in one bag per day.]
  3. If an ingredient line is used (in #2 above), be sure the "No Chg" box is checked for that line. (the charge for MVI will be picked up elsewhere). Note: A formulary record can be pre-set for this purpose for common alternating ingredients such as MVI.
  4. Print any "starter" labels that may be required for this IV. Some users like to highlight (i.e., with a yellow marker) the label for the IV containing the MVI, to signal staff making the IVs.
  5. Create another scheduled order for just the MVI. No solution is needed. The SIG should be "Q24H" and the interval "24" for the MVI order. The start date/time can be set to the same administration date/time for the first IV bag that will contain the MVI.
  6. The "No Chg" box should be left unchecked so we can pick up the MVI charge with this order.
  7. Print a "starter" IV label for the MVI, if needed for the initial IVs.
  8. Attach the IV label to the prepared IV bag. Some users like to also attach the MVI label to the IV bag containing the MVI while others discard it.

If the solution alternates from bag to bag (e.g., D5W 1000ML alternating with D5/0.45%NACL 1000ML at 83ML/HR each with KCL 20MEQ:

  1. Enter a separate scheduled order for each IV solution. Note: The "Duplicate" option under the various "Orders" menus can create another order using the currently selected order as a template.
  2. The interval for each order should be doubled (for 2 alternating IVs; or tripled for 3). For example, if 1000ML IV bags are running at 83ML/Hr, the interval would normally be "12". To alternate 2 solutions at this rate, change the interval on each order to "24".
  3. The start date/times for the alternating bags should be offset by one interval. (i.e., Set the start date/time for the second IV to begin right after the first bag will be completed. Set the start date/time for the third alternating IV, if any, to begin when the second bag will be completed, and so on).
  4. If one of the alternating orders will contain an ingredient that the others will not contain (e.g., MVI), go ahead and add it as a regular, chargeable ingredient to that order only.
  5. Print any "starter" labels that may be required for each order. o also attach the MVI label to the IV bag containing the MVI while others discard it.

If the solution and or additives alternate in a non-regular pattern from bag to bag:

  1. Enter a separate non-scheduled order for each IV solution. (i.e., Make each IV order "Demand Fill")
  2. Print a label from the desired order on a "as needed" basis. (Use the IV administration date/time as the miscellaneous charge date/time).