Connect Care Manual - Ordering Norms

Clinical Ordering Norms

The following norms apply wherever Connect Care is used as the record of care for a clinical activity that the order relates to ("Connect Care encounter"). Accordingly, included are situations when a prescriber generates a request from an external (e.g., home or office via computer or mobile app) setting. What matters is that the order relates to a patient's Connect Care encounter.

Computerized Provider Order Entry (CPOE)

All members of the care team rely on complete, accurate, clear and specific orders. Orders have many effects within a clinical information system (CIS). They indicate required investigations or interventions. They also coordinate care activities, assign accountability, trigger workflows and start tracking logs. Orders are tightly coupled with clinical decision supports. These guide care while alerting to potentially harmful actions.

Any second-hand (e.g., verbal or scribe or other delegated order-entry) process can isolate prescribers from decision supports and other order-dependent charting activities. Accordingly, it is essential that prescribers directly interact with the CIS when placing and managing orders.

CPOE Allowed Exceptions

There will be situations when prescribers cannot be expected to place time-sensitive orders directly and require the assistance of a qualified healthcare professional to transcribe important clinical instructions. Allowed exceptions to prescriber order-entry fall into three categories, each explained and exemplified in FAQ and Order Norms documents:

- 1. Protocolized orders
  2. Urgent verbal orders
  3. Urgent telephone orders

Note that the above table provides sample guidelines around timing that have been used at some sites. These timing guidelines will not necessarily match those developed by each unit.

CPOE Approved Exceptions

Unforeseen situations may arise where an alternative to CPOE is compellingly justified by safety and/or efficiency considerations. Such exception-cases must be described in standardized way and submitted for approval at the level of the Connect Care Executive Committee.

Form: CPOE Exception Request

Medical Scribes

Some prescriber groups may advocate for situations where "medical scribes" (extended role non-physician clinicians) could increase the productivity of prescribers with whom they are paired.

Facilitating acceptable indirect prescriber orders (real-time, with engagement of all linked clinical decision supports) may be acceptable, if implemented under an explicit scribe initiative that has been reviewed and approved by AHS (Medical Affairs). A CPOE Exception Request should be completed.

Any healthcare providers supporting prescriber-delegated real-time CIS order-entry and/or documentation must be appropriately trained, including privacy training, and certified to enter order(s) to the CIS. They can do this only if this is within their AHS-approved scope of practice and training.

- - FAQ: Prescriber Orders
  - Form: CPOE Exception Request

Resources

The following resources are intended to guide order-entry and delegation in Connect Care. A brief slide deck summarizes guidelines for telephone and verbal orders that comply with AHS and Covenant Health policies and procedures; it applies to operational (e.g., nursing and allied health professionals) and prescribing (e.g., physicians, nurse practitioners) users of Connect Care, and provides practical examples and norms based on time of day. A work package also provides additional details for interdisciplinary teams that may have additional concerns, questions or challenges regarding CPOE.