Download open the Order Set - Warren Emergency Services

CPOE Admission Orders – ED Reference Guide
Effective January 5th, Lake Health has moved toward eliminating the use of
written orders to support our commitment to patient safety and quality of
care. The National Institute of Health reports the benefits of CPOE
include safer, more consistent patient-centered care. CPOE has improved
the efficiency of delivering healthcare which results in decrease turnaround times in the ordering process for medication management, laboratory and radiology
tests and procedures. CPOE also reduces or eliminates medications errors, transcription errors,
overlooked orders by nurses, and the need for order clarification due to illegibility. CPOE
provides immediate transmission of orders directly to the ancillary departments.
The expectation is the attending physicians will no longer
write orders; the attending will place CPOE orders.
Attending physicians may at times provide verbal orders
to a Registered Nurse and the RN will enter the CPOE
orders with the order source being a verbal order.
Of course, there are situations in written orders will be the most appropriate method for
placing orders due to a patient’s conditions.
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Code Blue or an I-Team
Other situation where time is critical to the patient outcome
Direct Admission with written orders sent with the patient
The Emergency Department nursing staff will request from the Attending Physician CPOE
admitting orders when there is an anticipated delay with bed
placement at the time of the admission. Admission orders
should be received within 2 hours of the admission order;
the ED RN can take verbal admission orders to facilitate
continuity of patient care.
Admission – Basic Set
A Basic Admission Order Set has been assigned to the ED Nurses ordering favorites.
The ED RN is able to request a
simple set of orders to facilitate
continuation of the patient care
that has been provided in the
Emergency Department. The
RN can follow the Admission –
Basic Set tree to cover the
basics; Patient Condition, Vital
Signs, Activity, Diet, IV Fluids,
Medication especially pain
medication and additional labs
or other diagnostics which can
decrease the patient’s overall
inpatient length of stay.
Order Sets
Order Sets have been developed for the inpatient orders similar to the ED Order Set but instead of
complaint driven orders the inpatient order sets are based on the patient’s admission diagnosis. The
order sets have been developed using best practice to ensure compliance with core measures and very
good patient care.
Order sets that may be utilized by the ED RN placing admission orders especially during boarding
situations include:
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Chest Pain Order Set – Low Risk
CHF Orders – Admission
Diabetic Ketoacidosis in Intensive Care
Pneumonia – Adult Order Set
Low Risk Chest Pain Order Set
1 Enter Chest Pain in
Search Engine
2 Find Chest Pain
Orders – Low Risk
3 Click on
to
open the Order Set
1
2
RN must then Select Chest Pain Order Set – Medications
then search Dysrhythmia Intervention and Add as an order.
Place a check in the box
Select Telemetry, Activity, Diet etc..
Cardiac Enzymes orders are time and the
RN must focus on the order detail
CHF Order Admission Set
1 Enter CHF in
Search Engine
2 Find CHF Orders Admission
3 Click on
to
open the Order Set
Order set includes anticipated medication
orders including; ACE, ARB, Beta Blockers,
Digoxin, and Loop Diuretics. The order sets
then display the anticipated diagnostic
testing.
REMEMBER, the nurse will have an
order to document Intake & Output. The ED Nurse is able to document the I & O from the ED
Chart view
Diabetic Ketoacidosis in Intensive Care Order Set
1 Enter DKA in Search Engine
2 Find Diabetic
Ketoacidosis in
Intensive Care Orders
3 Click on
to
open the Order Set
Special Attention needs to be
taken to the order for the BMP –
this should be redrawn at the
time of the admission order then
every as ordered.
The Anion Gap, Potassium, and
Glucose Level will dictate the
Insulin drip rate, the IVF and
Potassium Replacement.
Pneumonia Order Set
1 Enter Pneumonia in Search Engine
2 Find Adult Pneumonia Orders - InPatient
3 Click on
to open the Order Set
The Order Set includes the antibiotics and blood
cultures if not completed in the Emergency
Department
REMEMBER the Lake Health
Pneumonia Core Measure
Assessment will be on the
RN Assessment Workflow in Soarian
Clinical