Ordering Intermittent Clinic Infusions

Intermittent Clinic Infusion orders have many of the same required fields as continuous orders, but there are some important differences. Of course to order these infusions, the patient must be assigned a clinic location. Intermittent refers to an infusion order administered at scheduled intervals (Q4H, QDAY) or One-Time only, “over a specified period of time” (e.g., “Infuse over 30 min.”). For intermittent infusion orders, as the user selects a solution and/or additive, the items from that list are displayed to the right under Solution/Additive. For Intermittent infusion orders the only optional fields are the Comments, Infuse Over, and the Duration or Total Volume fields.

However, for intermittent orders, the Infusion Rate field changes to the Infuse Over Time field where the user enters either a number of minutes or hours. the schedule field is not available.

To order intermittent Clinic Infusion orders, follow these steps:

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

    3. 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 Infusions 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 Infusions 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.

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

    This screen capture shows the Clinic Location dialog. If the user wants to enter Clinic Infusions, they choose yes. If not, they choose no.

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


  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, change the patient’s location to the appropriate clinic.

    6. The Clinic Infusion Order dialog displays.

    This screen shot shows the Clinic Infusion Order dialog. It has numerous fields. On the upper left of the dialog are two tabs: Solutions and Additives. As the user chooses items from the lists on these two tabs, the items display on the right in a table. The table shows the name of the item as well as the Volume/Strength. The Additive Frequency field enables providers to enter which IV bag the additive the additive should be placed in: one per day, all bags, or some other instuctions the provider puts in the comments. Some of the items may be editable while others may not. Below the table with the grid is a Comments field that is optional. Other required fields include the Route (such as epidural, intravenous, and IV piggyback), the Type (Continous or Intermittent), Infusion Rate in milliliters per hour, Priority (ASAP, Routine, STAT). Next is the optional Duration or Total Volume field. Finally, the SIG field is below that and contains the order text that is created as the user selects the items in the dialog.

    The Infusion Order dialog for continuous infusion orders does not use a schedule, but it does have an infusion rate. For
    continuous infusion orders, the new Additive Frequency field enables providers to indicate into which IV bag the additive
    should be placed.

  6. Select the needed solutions from the Solutions tab.
  7. Select an additive from the list (if necessary) and edit the strength if needed. Repeat for additional additives if necessary. How users can edit the strength field will depend on the values for strength defined in the pharmacy files as follows:

    8. The solution and additives you select will appear in the Solution/Additive grid.

    Note:   To remove an additive or a solution, select the solution or additive and select Remove.

  8. Select a Route (such as intravenous, epidural, IV piggyback, etc.) If the desired route is not available, select the Other option in the list of routes to bring the expanded med route form that lists all possible IV routes.
  9. In the Type drop-down box, select Intermittent.

    10. Note:   If you change the IV Type from Intermittent to Continuous, the Schedule field becomes unavailable (greyed out) and the Infusion over Time field becomes the Infusion Rate field.

    Note:   For a definition of Continuous and Intermittent orders, select the IV Type Help link and a message box will display with a short definition of what the terms mean.

    The Informational Help Text message box shown here contains the definintions for and examples of Continuous and Intermenittent IV types.

    To help providers enter the correct type of infusion order, this dialog provides
    a definition of Continuous and Intermittent infusion orders.

  10. Select a schedule from the list or create one using the Day-of-Week schedule builder.

    11. Note:   When a user writes an intermittent infusion order with a schedule of ONCE, the following will happen in CPRS:

    Note:   When a user writes an intermittent infusion order with a schedule of On Call or a PRN, the following will happen in CPRS:


  11. If you selected an existing schedule, skip to step 14. If you selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take the following steps:
    1. Select one or more checkboxes 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.

      3. Note:   Users can assign either a schedule from the list or specific administration times, but not both.


    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.

      5. 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:

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

  12. If necessary, select the PRN checkbox
  13. Enter the number for the duration over which to infuse the medication.
  14. Move to the next field and select the unit of time (the units can be only Minutes or Hours) over which the infusion should be given.

    15. For example, you might enter 30 for the number, move to the next field, and then select minutes to define infuse over 30 minutes.

  15. Select the Priority
  16. Enter a number for the duration or total volume.
  17. Move to the next field and select the appropriate unit (liters-L, milliliters-ml, days, hours, or doses).

    18. Note:   If you change the units, the value in the Duration or the Total Volume field will be removed and you will need to enter it again. This is a safety feature to insure the patient does not receive a dangerous amount of fluid.


  18. If necessary, select the Give additional dose now checkbox.

    19. Note:   Make sure that you are careful about using give-additional-dose-now functionality. When you click the check box, CPRS creates two new orders and sends it to Inpatient Medications. 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.


  19. Enter any comments (if necessary).
  20. Review the order text at the bottom of the dialog to ensure that it is correct.
  21. If the order text is correct, select Accept Order.
  22. Review order check items and respond appropriately. If the order should not be entered because of a possible interaction, select Cancel. If the order is okay to accept, select Accept Order.
  23. To enter additional Clinic Infusion orders, repeat steps 6-19 as needed. To finish, select Quit. For an outpatient, when you select quit, the encounter location will remain with the current clinic. For an inpatient, when you select Quit, the encounter location will go back to the location where the patient was before you began entering Clinic Infusion orders

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


Related Topics

Clinic Infusions (Overview)

Ordering Continuous Clinic Infusions

One-Step Clinic Unit Dose Medication Administration

One-Step Clinic Administration for IV Medications