Procedure Orders
Procedure orders include requests for patient movement (admission, transfer, discharge, leave of absence, etc.), investigations (laboratory tests, interventions, assessments, etc.), consultations, patient alerts (e.g., Mental Health Act forms) and precautions (e.g., isolation for communicable disease risks).
Some procedure orders have unique properties, highlighted here.
Repeating Tests or Investigations
In general, single-instance tests should be ordered when addressing specific clinical questions (e.g., "Does this patient with fatigue have anemia?"). Such tests should be sequenced with other tests such that overall investigation costs are minimized.
In some circumstances, ordering repeating investigations is justified (e.g., "Is this patient's anemia worsening with chemotherapy?"). Connect Care supports ordering repeat investigations at the longest possible interval for the shortest possible time.
Add-on Laboratory Tests
Sometimes new information is needed after other blood samples have already been drawn. It may be possible to "add-on" a new test to be performed on a specimen already drawn, sparing the patient a new draw.
Complex Test Orders
Some investigations are performed on samples that may be collected in different ways (e.g., venipuncture, aspiration) from different sites (e.g., pleural, peritoneal) in different contexts (e.g., bedside, surgical, interventional radiological). Depending upon who is entering the order, and where, there can be variations in exactly how the test order must be entered to ensure timely processing by the correct laboratory service.
A "Connect Care Lab Test Order Catalogue" can help clinicians make the right order-entry choices. This is available via a "Resource Link" menu item found in the Hyperspace title bar.
Isolation and Discontinuation of Isolation
Patients can be placed on contact and/or droplet and/or airborne precautions; prescriber workflows differ between Ambulatory and Inpatient/Emergency. Each workflow is detailed in a tip sheet.
For Ambulatory, isolations are added via the Storyboard. Bedside staff remove the isolation after they have physically removed isolation precautions.
For Inpatient/Emergency, isolations can be added by prescribers by means of an "Initiate Isolation" order. A different order, "Discontinue Isolation", can be used to remove isolation precautions already in place. Discontinue Isolation orders have some unique properties. Links to relevant infection prevention and control policies are provided, together with "clinical data" links that gather key information from the chart for quick presentation in pop-ups. This information helps the ordering provider to comply with infection discontinuation requirements, including those specific to COVID-19.
Point of Care Testing (POCT)
The Connect Care initiative promotes standardization of procedure orders provincially, where this is both possible and helpful. However, some procedures are particularly sensitive to locally available equipment, expertise and other resources. This is particularly true for POCT orderables. Some settings have the relevant equipment near the bedside and others need to delegate the workflow. This can lead to confusion when prescribers seek the right intervention from among a list of available POCT orders. Prescribers should familiarize themselves with local practice, preferentially use the "facility list" tab in order search results, and save the most appropriate order as a favourite... and so reduce dependence on the precise wording in an order listing.
Spine Precautions
Patients may need to be placed on spinal precautions for a period of time or until specific conditions are satisfied. This is accomplished by using the Spinal Precautions Order Panel.
Initiate Spine Precautions
Open a patient's chart to the appropriate (usually emergency or inpatient) encounter, then open the Orders Activity and search for "spinal".
Select the "Spinal Precautions Panel" appearing in the Order Sets and Panels section.
Use the order composer and its checkboxes to select, then specify, all parameters for the needed spinal precautions. All related orders are organized and can be selected within this panel.
Save (for attending sign) or sign the orders.
Clear Spine Precautions
To clear spinal precautions, the original order needs to be discontinued and appropriate documentation needs to be completed.
In the "Orders" activity, under "Active Orders">>"Precautions & Restraints">>"Spinal Precautions", select "Discontinue".
In the "Notes" activity, create a new note and select the "Type" as "Spinal Clearance" (search for "spinal") to bring up the Spinal Clearance Documentation template. Use the provided checkboxes and text spaces to document satisfaction or requirements for spine precautions clearance.
Review Past Spinal Precautions
Previously cleared precautions can be seen in the "Summary" activity >>"Overview" tab.
Restraints
When inpatient restraints are needed, use the "Restraint as a Last Resort" order. Informed consent discussions must be documented separately from the order, within a Consent Note.