Prescriptions are entered into i.CM for the currently selected patient using the Order Entry Worksheet and prescription forms. Medications, their strengths, dosages, routes, forms, administration instructions, dosage ranges and any other supporting information can be entered directly into i.CM or i.CM can be linked to external drug databases by various means.
When a medication is selected from the Order Browse on the Order Entry Worksheet, the medication is entered in the Summary window. If additional information is required, a prescription form that is typically configured based on the mediation’s route but can be tailored to the special information needs of that medication displays, prompting the user to enter the required information.
Prescriptions can be placed individually or as part of an Order Set. Order Sets are groups of orders that are commonly ordered at one time. Medications are often found as part of an Order Set. For example, enterprises often prescribe a standard set of admission or post- surgery medications or IV fluid orders. Order sets are ordered in the same way as individual orders.
Entering and Maintaining Prescriptions
The Prescribing Worksheet allows the user to enter medication orders, view information about a medication item, and modify or delete any medication in the prescription before it is submitted. Medication information is recorded in prescription forms. Medications are prescribed for patients using prescription forms that have been tailored to the specific medication route and form.
Special processing is performed based on the start time, route, frequency, duration of the medication order and patient’s current location at the time that the medication is prescribed. Conditional prescriptions may also be entered and prescriptions can be placed on hold. Special processing is also preformed based on the medication being ordered with a priority of STAT or a frequency of ONCE or PRN or based on events such as pre-op, post op or as pre-med.
After medications have been prescribed it is possible for medication orders to be reordered as a group through the multiple re-order functions. These functions make it possible to quickly extend medication coverage from previous prescriptions thus ensuring appropriate medication for patients, especially those with conditions that require long term medication.
Substitutes allowed is a special setting that tells the pharmacy that the doctor is happy for generic medication to be substituted for a brand name if they have prescribed in that manner. Typically hospitals set up their formulary with generic medications and i.CM supports synonyms such that the Brand names are translated to the generic medications. As a result most customers do not make wide spread use of the “substitutes allowed” function.
Order Review and Maintenance
The Orders chart section allows the user to review information about all types of orders, including medications for a selected patient. From here users are able to perform order maintenance functions (cancel suspend, discontinue), and to access the order entry functions. Order information can be viewed in different formats. The user can view individual orders, order sets or clinical paths.
Recording medication administration in i.CM is achieved via the Worklist Manager. Several customers now have experience with running i.CM over Radio LAN’s using tablet style PC’s or light weight notebooks with or without Citrix such that Medication Administration can be recorded as close as possible to the point where the medication is actually given to the patient.
Overdue medications are clearly labelled and it is possible to configure the Worklists such that they always open at any medication that is overdue. Medication Administration is fully supported by Clinical Decision Support (CDS). CDS can be configured to monitor various patient events that may affect the dose of a medication (blood Sugar Levels, Liver and Renal Functions tests) the results of which can be displayed to the user at the point of medication administration.
With reference to Prescription Forms and repeat prescriptions, users in add or edit mode, can enter information required to complete a prescription. In view mode, the user can view information about an existing medication and subject to the appropriate rights, modify or add information (such as pharmacy instructions) to the order for that medication. Prescription forms typically have special system defined field on them that are not typically found on any other order form.
The Worklists allow the i.CM user to view a list of medications for a patient or group of patients and to quickly indicate which medications have been administered. The general principle behind a worklist is that a medication order can generate one or more occurrences of the order based on the start time, frequency and location of the patient that must be recorded. These tasks form the basis of the worklist. For example, an order for Penicillin 500 mg PO every 6 hours (Q6H) that starts now (STAT) and ends in 10 days will eventually generate 40 occurrences allowing a single occurrence for each administration of the medication to be recorded. Medication Administration forms and Flowsheets can be displayed at the time that the user is recording administration of the medication.
Prescribing is fully supported by Clinical Decision Support (CDS). Duplicate Therapy checking, Drug Allergy, Drug- Disease, Drug – Drug, Drug- Food and Dosage Range Checking are some of the events that are monitored by CDS during the process of prescribing. If any of these events are triggered the user(s) are shown appropriate alerts/ warnings. Where the external First Databank Europe Multilex Drug Data File is integrated the clinical decision support module is underpinned by Drug – Allergy, Drug – Ingredient, Drug –
Interaction, Drug – Drug and Drug – Action-Group checking.
Validation of prescribed items by appropriate individuals is supported and validated items are clearly indicated to clinicians and staff performing drug rounds, where a prescription is amended validation is automatically cleared to allow for a further review.
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