Skilled Nursing Facilities

Order Entry for Integrated Medication Management

When integrated with a pharmacy, the actual process of order entry does not change from the non-integrated process. There are special considerations/situations that you must be aware of to facilitate the best communication with pharmacy. These situations are outlined here.

  • Integration Icon - Anywhere you see the blue/green opposing arrows in the order entry screen, you know that the information next to the arrows is transmitted to the integrated pharmacy when the order is saved. Note that the information is not transmitted if the order is saved to the queue. Transmission occurs when the order is saved and added to the clinical record.

  • Permanent Medication Source - This field is important because this determines if the medication is sent from the pharmacy.

    • If the source is set to Pharmacy and the pharmacy selected is the integrated pharmacy, the New Order Message is sent and the pharmacy sends the medication.

    • If the source is set to anything other than pharmacy, such as inventory on hand, the medication is not sent.

    • If the source is set to pharmacy and the pharmacy selected is a non-integrated pharmacy, you need to generate the Pharmacy Requisition and fax to the non-integrated pharmacy to communicate the new order.

  • Notes to Pharmacy - use the Notes to Pharmacy field to communicate information like 'First dose taken from emergency supply'. Do not use to communicate STAT order. The pharmacy does not see the notes until they actually open the order message. There is no alert telling them this is a STAT order that needs processed immediately. If you have a STAT order, you still need to use you usual communication of STAT orders (phone call, fax, and so on).

  • 140 Character limit - The messaging system has a 140 character limit in the directions field. The directions field in the message is the following data: medication name (generic name if applicable), dose, schedule details, indications for use, and additional directions.

    • During order entry, if the 140 character limit is exceeded, you see a notification at the bottom of the Order Summary.

    • When you Save, you see a similar notification in the Order Review window. Note that this warning shows that the order must also be printed and faxed to the integrated pharmacy. The faxed order contains the entire directions. It is only in the integrated message that the characters are shortened.

    • The electronic message is still sent to the pharmacy with directions 'As per fax from the facility'. This prompts the pharmacy to look for the faxed order from facility with complete directions.

    • The same process takes place for a Prescriber Entered order, but in this case, you do not have a verbal/telephone order report because it was Prescriber Entered. You can print the Order Summary report because this provides the full order directions.

  • Character Limit in Notes to Pharmacy - There is a 210 character limit in the notes to pharmacy field. In each order message transmitted to the pharmacy, all of the resident Allergy and Payer information, and any notes added in the 'notes to pharmacy' in the order entry screen are included in the 'notes to pharmacy' field of the electronic message. Residents with a significant number of allergies and/or payer information can exceed the 210 character limit before any notes are added.

  • Pharmacy & Prescriber Information Required - When orders are entered, the information validates that the required information for both the prescriber and integrated pharmacy is entered into the set up. If any of the information is missing, the order cannot be saved until the information is entered.

  • Discontinuing Medications:

    • When discontinuing a single order, be sure to include the Rx number so the pharmacy can discontinue the medication.

    • When batch discontinuing orders upon resident discharge, you do not need to enter into each order, and Rx number. The pharmacy automatically receives the discharge census message and discontinues the medications in the pharmacy system. The facility does a batch discontinue and if the resident returns, they can then do a batch resume. *You need to communicate to pharmacy whether or not supplies are on hand or need sent from pharmacy.