CERNER Inpatient Medication Order Entry Tips for Providers

Department of Pharmacy
June 19th, 2014

COMPUTERIZED PROVIDER ORDER ENTRY: AD-HOC ORDERS

“Find” Field
This drop down menu
allows the prescriber to
view orders that “Start
Orderable With” or “Contains” the
text in the “Find” field.
Enter the desired order in
When using “Contains”,
the “Find” field. You may
ensure at least 3
press Enter or select the
characters are used.
Binoculars Icon to view all
existing orderables.

Choose from one of the pre-built sentences.

Do NOT use the (NONE) option.

Select desired dose

Do NOT Modify (see below)

Modifying these Review differences between

fields will result in daily/BID/TID/QID frequencies & Consider using “NOW” priority if a
stop type “Physician Q24H/Q12H/Q8H/Q6H frequencies dose is desired immediately (see
Stop” (see below). below)

Drug Form: Do NOT modify. Drug forms are set by the system to reflect what is already in stock. If there
are doubts about dosage forms, call pharmacy for questions.

Route of Administration: Do NOT modify for intravenous routes. Routes of administration serve a
specific purpose on the pharmacy end to select the correct product. Modifying this may cause the

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 CERNER Inpatient Medication Order Entry Tips for Providers
Department of Pharmacy
June 19th, 2014

system to choose the wrong product. It is best practice to “remove” the current order and re-select the
sentence with the desired route.

The following table provides a summary on the different types of intravenous routes and what their
purpose/definition in the system is:

ROUTE DEFINITION WHEN TO USE EXAMPLE

- For drug orders that are slow IV push
Medication:
(<10 minutes), where you would put - Zofran 4 mg, Soln, IV
IV Push Drug orders given in
the administration time in the “special Push
one quick push
comments” field
Intermittent: - NS Bolus IV Bolus
Any kind of Over 15 minutes
IV Bolus - Fluid (not drugs) boluses ONLY
medication given - LR Bolus IV Bolus Over
over time, anywhere 15 minutes
from 30 minutes to - Intermittent drug situations where
- Most of the pediatric
IV Syringe several hours. They the drug may be prepped in a syringe
doses
are given based on a (typically pediatric doses)
frequency, NOT - Intermittent drug situations where - Cefazolin 1 gm IV
IV Piggyback
continuously. drug is prepped in IV piggybacks Piggyback q8h
Continuous:
- For use in fluids running at specific
Given continuously - NS, IV, 125 ml/hr
IV rates
until a physician
- For use in IV drips
discontinues it

Frequency: There are major differences between Daily & Q24H, BID & Q12H, TID & Q8H, and QID & Q6H
frequencies in CERNER.

Scheduled Frequencies: The scheduled frequencies are defined by hospital policy 100.025 Medications:
Administration, Ordering, and Documentation. If an order placed sometime after this defined scheduled
time, the first dose will not be scheduled until the next defined schedule time. For example, if a daily
frequency order is entered at 11:05, the order will not start until 10:00 the next day. The prescriber
must designate the “First Dose Priority” as NOW if the first dose is desired the same day of order entry.

FREQUENCY SCHEDULED TIMES

Daily 1000
BID 1000 2200
TID 0600 1400 2200
QID 0600 1200 1800 2200

Note: Some medications have special administrations, such as warfarin (1400) and Arixtra (0900).

Interval Frequencies: A QXH frequency (interval frequency) will result in the first dose to be scheduled at
the time of order entry (unless the start time is modified) with subsequent doses scheduled every X
hours thereafter.

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 CERNER Inpatient Medication Order Entry Tips for Providers
Department of Pharmacy
June 19th, 2014

Unscheduled Frequencies: When these are used, the nurse is going to have an ongoing task on the MAR
that allows them to give the medication at any time, so it is important to communicate to the nurse
when you would like the medication given. Unscheduled includes “pre-op”, “post-op”, “post-delivery”,
“one time (unscheduled)”, “post-HD”, etc. Remember to include the duration of your unscheduled
frequency, otherwise it will default to only one dose.
Example: Zosyn 0.75 gm IV Piggyback Post-HD
Must include order duration, or the item will
fall off after 1 dose.

PRN orders: Use the drop down menu to select your reason. If you cannot find an appropriate PRN
reason, use the “Other (see comments)” reason and place your customized PRN reason in special
instructions. Note: For pain indications, please do not overlap indications.

Duration/Stop Date: There are three types of “stops”. If the duration field is left alone, it will default to
a “Soft Stop” or “Hard Stop” depending on the medication. If the duration is modified or the stop date is
modified, the stop type becomes a “Physician Stop”. Stop types are as follows:

“Soft Stop”: Orders with a soft stop will fire a renewal notice X hours prior to the stop
date/time. When the order expires, the order will remain active on the patient’s chart until an
action is taken upon it (i.e. physician renewal or discontinuation of order)

“Hard Stop”: Orders with a hard stop will fire a renewal notice X hours prior to the stop
date/time. If the order is not renewed, the order will automatically discontinue once it expires.

“Physician Stop”: Physician stop is a “hard stop” that occurs whenever the prescriber defines the
duration of the order or defines the stop date/time. The order will automatically discontinue
once it expires.

First Dose Priority: Use this drop down menu to define when the first dose shall be given. There are
three options: Routine, NOW, and STAT. Routine first doses will be scheduled as defined by hospital
policy (see frequencies). A NOW
dose will schedule the first dose to
the date/time the order is entered.
STAT priority will communicate to
the pharmacy that a dose is
needed immediately.

After selecting a NOW or STAT, go

back to the “First Dose Date/Time”
field to define whether to give the
next dose in addition to the NOW
dose or to skip administration of
the next dose altogether.

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 CERNER Inpatient Medication Order Entry Tips for Providers
Department of Pharmacy
June 19th, 2014

Note: For PRN orders, please do NOT use the NOW or STAT. When this is used, it causes confusion on
the MAR and will cause a STAT order to fire indefinitely for the nurse to give the medication to the
patient, regardless of the frequency defined.

Special Instructions: Use the “Special Instructions” field for any issue you would like to communicate to
the pharmacy (i.e. dispense oral solution, minimal fluids, dilute in NS only, etc).

COMPUTERIZED PROVIDER ORDER ENTRY: SPECIAL ORDERS

NON-FORMULARY MEDICATIONS

There are two methods by which non-formulary medications can be entered. They are as follows:

1. First, always try to search for the non-formulary item. The non-formulary items will be listed
either with a “(non-formulary)” signifier in the name OR a pop-up alert will state “Non-
Formulary.” The resulting required fields must all be accurately completed or you will receive a
call from the pharmacy.

2. Secondly, if there is no entry for the item, you may search for “Template Non Formulary” and fill
out all the required fields. Frequently ordered non-formulary medications will eventually be
entered into our database while awaiting approve by P&T for full formulary status.

Restricted Medications

Restricted medications are ordered the same way as regular medications. However, there will be a pop-
up alert that will warn you that the medication is restricted when you attempt to order. These
medications may also have a “High Alert” signifier in the name. Please review the alert message before
completing any orders on these medications. i.e. ID restricted medications require an ID consult for
scheduled orders.

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 CERNER Inpatient Medication Order Entry Tips for Providers
Department of Pharmacy
June 19th, 2014

POWER PLANS

Use the “Merge View” option to identify any duplication of orders. Duplicate orders may be
discontinued from this view.
Merge View option
allows the prescriber to
reconcile Power Plan
orders with existing
Uncheck orders.
POWER PLAN ORDERS
unnecessary
or duplicate
orders.

EXISTING ORDERS

You can right-click and

discontinue old orders if
desired.

Discontinue Power Plans when Power Plans are no longer needed. If orders within this Power Plan are
to be continued, you can opt to keep these orders active.

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 CERNER Inpatient Medication Order Entry Tips for Providers
Department of Pharmacy
June 19th, 2014

Check the boxes

if you want to
KEEP the orders
active. Do NOT
check if the
orders are to be
discontinued.

Please also note that if you keep orders from this screen but discontinue the Power Plan, any future
discontinuations of these orders will need to be done outside the Power Plan.

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