Local Order Checking

CPRS has several local order checks that occur during the ordering process.

Local Order Checks

These nationally released order checks are available on a local CPRS system:

· Allergy-Contrast Media Interaction

· Allergy-Drug Interaction

· Aminoglycoside Ordered

· Biochem Abnormality For Contrast Media

· Clinical Reminder Live

· Clinical Reminder Test

· Clozapine Appropriateness

· Critical Drug Interaction

· CT & MRI Physical Limitations

· Dangerous Meds For Pt > 64

· Dispense Drug Not Selected

· Drug Dosage

· Duplicate Drug Class Order

· Duplicate Drug Order

· Duplicate Opioid Medications

· Duplicate Order

· Error Message

· Estimated Creatinine Clearance

· Glucophage-Contrast Media

· Glucophage-Lab Results

· Lab Order Freq Restrictions

· Missing Lab Tests For Angiogram Procedure

· No Allergy Assessment

· Order Checking Not Available

· Polypharmacy

· Recent Barium Study

· Recent Oral Cholecystogram

· Renal Functions Over Age 65

· Significant Drug Interaction

Note: All of these order checks are exported disabled at the system level. IRMS can then turn them on for individuals or teams, as determined by the site. IRMs, Clinical Coordinators, individuals, or services can also disable individual order checks, if they choose to.

Several parameters that each site controls determine how these order checks behave.

Order Check On Acceptance Dialog

For medication orders, if a possible problem is found, CPRS displays the order check window, such as seen below when the user selects Accept:

This screen capture shows the Order Checking dialog.

When accepting a medication order, order checks are performed to identify potential problems.

The Order Checking dialog shows the order checks in a new format. The new format includes better separation of order check text and each order check is number using the format (1 of 2).

Order Checks Dialog on Signature Actions

If the clinician chooses to sign the order, CPRS displays the following dialog:

This screen capture shows the order check dialog with various order checks, including a high risk order check with colors of blue and red.

In this screen capture, CPRS displays several possible conflicts between ordered medications. Users should review each item carefully before completing the order. If an order check is larger than the cell's available space, the user can hover with the mouse to the get the full text or use the arrow keys to highlight the order check if using the keyboard or accessibility product for visually challenged users. Some order checks require an override reason. These order checks are designated by the "*Order Check requires Reason for Override" text in red and the order check text in blue.

This dialog displays each medication or other item that had an order check in a separate section. Each item will have a check box allowing the user to check any orders that should be canceled at this point. Under the order text, the order checks are displayed, the most serious order checks are listed first. Those with High Clinical Danger Level items are displayed first, labeled as high danger, and colored blue. To accept these orders, the clinician must enter an override reason to justify accepting the order.

Whether the order check requires the clinician to enter a justification depends of how each site has set the Clinical Danger Level for each order check. For example, the Pharmacy package determines if an interaction is critical or significant. Each site then determines whether the provider must enter a reason for override by setting a Clinical Danger Level in CPRS for the Critical Drug Interaction and Significant Drug Interaction order checks.

Another example would be allergy assessments. If the site has the No Allergy Assessment order check set Clinical Danger Level to High and the patient does not have an allergy assessment, then the order will require a justification for override. If the site has the Clinical Danger Level to Moderate, no reason is required.

When a user enters a high clinical danger level override reason, the reason for override is sent with the orders to ancillary packages so that the information is available to their users.

The new dialog also has a See Monograph button. The button will not be active until after the release of the first portion of the Pharmacy Reengineering project. Selecting the See Monograph button will send the user to a monograph about the drug or drug class to help the provider with additional information. If there are more than one kind of drug, the Monographs for Order Checks dialog will displays a drop-down list with the choices for the various kinds of medications.