Ordering is an activity of healthcare prescribers whereby tasks are identified, allocated and timed so that investigations, medications and other interventions support patient care goals. All orders have a request component and an action component.
The Connect Care clinical information system (CIS) enables ordering of all medications, procedures, investigations and interventions available anywhere in Alberta. Understandably, orderable items may be subject to local restrictions, availability or other constraints. For the most part, the CIS is able to help with default values that are aware of the current context. Even so, orders can have great impact and therefore deserve attention to detail. The good news is that once context-sensitive details have been specified, the configured order can be saved as a personal preference with all typical settings pre-filled. Personalizing orders is one of the best ways to speed Connect Care workflows.
A variety of circumstances can make inpatient ordering more complicated. Urgent transfers – to or from emergency, critical care, operating room, dialysis, inpatient and reactivation services – can contribute to order litter in the form of duplicate, orphaned (not associated with a phase of care) or inactive orders that have not been cleared by prescribers on either side of a care context shift. Stray orders can make it harder to recognize and manage important orders. They can also bloat summative documents, such as transfer reports, that automatically pull in order lists.
Periodic “deOrderizing” should be done to find and remove inappropriate, unnecessary or misleading strays. Prescribers may be asked to do this by other healthcare team members who struggle to manage patients’ orders. Tips describe activity-based processes that can restore order to orders:
Diagnostic Imaging Orders
Diagnostic Imaging (DI) orders can present unique challenges. Clinical decision supports (appropriateness guides) may be embedded and require additional information about the indications or urgency of a requested study.
Some outpatient orders for "special" DI studies (e.g., CT, MRI) are handled differently depending upon whether the investigation will be performed at an AHS facility (with the order managed through Connect Care) or performed at a community (non-AHS) site using a non-Connect Care information system.
There may be situations in which protocolled orders are placed by non-prescribers. Allowed CPOE exceptions are addressed within Connect Care Ordering Norms, which include reference to a process for requesting new exception types. Some delegated ordering workflows have unique requirements.
Pre-operative Orders Facilitated by Surgical Medical Office Assistants
Orders for upcoming operations initially entered by surgical medical office assistants (MOAs) must be "Second Signed" by a responsible surgeon.
Excluded from this workflow are: Case Request, Admission, Gastroenterology and Referral orders.
MOAs entering orders for upcoming operations will see a pop-up alert reminding of this requirement while providing for confirmation of the intended authorizing provider.
Applicable orders will not be released (and so are not visible) until the second (surgeon) signature is placed (electronically).
Orders pending Second Signatures appear in a "review orders" section of Op Time navigators.
Responsible surgeons receive notification of orders with "Second Sign Needed" via In Basket messages, where they can be quickly signed.
Once the second signature is applied, the affected orders can be acted upon.