Procedure documentationCreating Orders for Infusions

 

You use this medication order to order infusions. The order contains special screen areas for ingredients and flow rates.

An infusion consists of a solution and an active ingredient which is used to calculate the flow rate. Additional active ingredients are not possible.

Note Note

You can also create an order without an end date. The system creates an order without an end date if you do not enter an order duration or an end date for the order.

You should note that the system cannot calculate the overall quantity of an order without an end date.

When generating events the system uses the event generation horizon which is entered in the master data of the corresponding drug (Inpatient tab page). If the event generation horizon is not determined in the drug master, the system uses the value of system parameter N1MEEVTH or, if the system parameter is not maintained, a standard duration of 5 days.

See System Parameters for Medication

End of the note.

The Activate Suspended function is provided in the medication order dialog for the entry of initially suspended medication orders. This function activates a new order, as yet unsaved, while automatically setting the suspension start date to the order start and adjusting the change history accordingly.

Prerequisites

You select an infusion in the drug search or in the order.

Note Note

In Customizing, you can determine user-specific presettings for order management, to control and preset the data in the order. The system takes into account the presettings assigned to the user when creating an order.

See Maintaining User-Specific Presettings

See Order Management Tab Page

End of the note.

Procedure

  1. Select a patient in a view in the clinical work station or in the patient organizer and choose Create Order (Create Order).

    Alternatively you can create an order using a corresponding task in the documentation work station.

    You can also create a new order in the order dialog. To do this, choose Create Order (Create Order).

    Note Note

    As the order type results from the order process, the system does not support the transfer of the order type from the order template.

    End of the note.

    Depending on the user parameter N1ME_NO_DRUG_SEL you will access the drug search or the Create Order screen.

    In the drug search you can also search for order templates which you can use as a basis for the order you wish to create.

    See Finding Drugs Using Order Templates

  2. Select the infusion to be ordered in the drug search or in the input help of the Drug ID field on the Create Order screen.

  3. Enter the required data in the compressed view of the order.

    In the compressed view the system displays each order in a separate row. Depending on the user parameter N1ME_ORDGRI_OPENROW the system highlights the opened (selected) order (row) in the Compressed View.

    The system presets the following order data:

    • Depending on the user parameter N1ME_DEFOTYP the system presets the order type.

    • The system presets the standard dose, the administration route, etc. from the drug master data.

    If you create an order for an intermittent infusion, determine the individual dose for each administration time and have entered a quantity in cycle definition, the system will combine this information. The quantity entered in the cycle is used as a multiplier. In this way you can define administrations which are irregular as far as the quantity is concerned.

    Furthermore the system will also check the daily dose as a combination of the individual dose and the cycle. Note that, for this, the system will use the 24 hours before the administration time which results from the cycle as the day. The system displays a warning if necessary. The system will also display this warning if the daily dose is exceeded in the following ways:

    • by manually created new events in the order

    • by changing the dose of the events with the "Administration" purpose

    • by changing the administration time

    The system will take into account the components of an administered drug and any other valid orders which may simultaneously exist for the patient and which contain the same drug. The system will not take into account drugs with the same agents when checking the maximum daily dose.

    If you use "Dose" as the unit for the duration of the order for infusions, the system will use the individual dose entered in the order as the basis for event generation.

    Note Note

    Note that the flow rate duration of an intermittent infusion should not be longer than the smallest interval in hours defined in the cycle. Otherwise this would result in events which must be begun although the application of the previous event is not yet completed. A cumulation of flow rates would result due to the hanging of an addition bag/bottle.

    End of the note.

  4. Choose Detail (Detail) in the row of the order in the compressed view, to open this order in the Expanded View.

  5. Choose Change Drug (Change Drug), to have the system propose alternative drugs for the selected order.

    See Changing Drugs/Changing Drugs to Default

    Note Note

    Note that if you change the order description by selecting another drug in the Propose Alternatives and Propose Issue Quantity functions the system will overwrite using the drug description of the alternative.

    In such cases you should therefore use the Comment field in the order which is not overwritten by the system when alternative drugs are selected.

    End of the note.

  6. Enter the data necessary for ordering infusions on the following tab pages of the expanded view:

    • Order Tab Page

      When you create an anamnestic order, the system sets the "Anamnesis" value in the Pat. Own Medic. field for the patient's own medication. The system cannot generate events for this anamnestic order. However, this medication may be relevant for clinical interaction checks, which are only possible if an order exists.

      The system presets the organizational units on this tab page using the case. You can enter a comment for the order.

      Furthermore you can also create a check condition for the order and indicate that the prerequisite entered there must be checked before a drug can be administered.

      The Check Condition is set under the following circumstances and is no longer ready for input:

      • the Check Condition Indicator is set in the drug master

      • the PRN Medication indicator is set in the compressed view

      • the Conditional Continuous radio button is set

      • minimum and maximum rates have been defined

    • Sliding Dose Tab Page

      See Sliding Dose

    • Event Tab Page

      You can define a different fill source for the event, e.g. the drug stockroom of the care unit or outpatient clinic. In the case of intermittent infusions, this only applies to the first medication event.

      Note Note

      Choose Replace Drug for Event (Replace Drug for Event) to call the manual substitution for medication events.

      End of the note.

  7. Enter the special data for the ingredients of infusions on the Ingredients tab page.

    If you do not wish to define more than one flow rate, you do not need to toggle to the Flow Rates tab page, but can specify the flow rate in the compressed order view using the Administration Duration field.

    Generally the system will create infusions as intermittent and generate one event per planned administration. The event generation logic corresponds to the logic in the case of standard drugs. You must enter the cycle which is valid for this order.

    Note Note

    Set the Immediate Dose indicator if you wish to ensure that an additional event is created outside of the cycle times at the start of the order.

    End of the note.

    Example Example

    The patient should receive an infusion of 500ml twice daily for a duration of 10 days. The system generates a total of 20 events. For each event the patient receives 500ml.

    If you select a correspondingly short order duration and cycle, you can create an order with only one event, e.g. for PRN medication (e.g. 1000-0-0).

    In the order the ordering employee must determine a check condition for the administration.

    End of the example.

    The system displays an ingredient flagged as a solution in the ingredients table for infusions in addition to the Solution field. Note that the entry of an ingredient that is flagged as a solution is not obligatory for infusions.

    • If you do not flag any ingredient as a solution, the recipe quantity is the total of all ingredient quantities that have a unit of the volume dimension assigned.

    • If you flag an ingredient as a Solution, the system automatically calculates the solution quantity by subtracting the total of the ingredient quantities of the dimension volume from the recipe quantity.

    In the ingredient table, the system displays all ingredients of the infusion.

    The ingredients are preset from the drug master data. The concentration of the ingredients always refers to the recipe quantity (above the ingredient table).

    Note Note

    Whether you can add, remove or change ingredients, depends on whether the infusion is changeable or not. If an infusion is assigned to a Drug Category, which cannot be changed, you cannot change the ingredients and therefore the composition of the infusion.

    End of the note.

    Note Note

    If you change the recipe of a mixed drug when creating an order, the system always deletes the ordered dose of the mixed drug if you make volume-relevant changes. However, the system will not delete this if you change the dose of an ingredient which is not dosed in a unit of the volume dimension.

    End of the note.

    If you change the ingredients of a mixed drug at the time of the order, or add new ingredients, the system will create the order description according to the following rules:

    • Type of drug category (infusion, nutritional solution or compound)

    • All active ingredients or additives, separated by commas, if no active ingredients or additives exist, all other ingredients, separated by commas

    • The ingredient names (limited to 20 characters); if it is not possible to display all ingredients, the system will display three characters at the end “...” to signal that further ingredient names are contained

    You can manually overwrite the order description generated by the system in this way. You should note that the system generates a new order description if the ingredients are subsequently changed, and overwrites your manual order description.

  8. If you wish to define more than one flow rate, you enter the special data for the flow rates of infusions on the Flow Rates tab page.

    If you enter the minimum flow rate and the maximum flow rate, calculation is not active. The minimum and maximum rates must always be active as a pair.

    If several flow rates were entered for this order, the Flow Rates tab page displays the icon - (-).

  9. To add several orders, choose Add Orders Add Order (Add Orders).

    You access the drug search where you can use the corresponding functions (e.g. multiple selection) to create several orders.

  10. To activate one or more orders, select the order(s) and then choose Activate Orders (Activate Orders). See Activating an Order.

  11. To generate the events for one or more orders, select the order(s) and then choose Generate Events (Generate Events).

  12. In addition to the events which the system generates for an order, you can also manually create orders. Choose New Row (New Row) on the Event tab page, to create a new event.

  13. To activate several orders in one work step and simultaneously generate the corresponding events, select the orders in the compressed view and then choose Schedule Orders (Schedule Orders).

    See Scheduling Orders

  14. You can print the order. Choose Print Order (Print Order).

    The Print Preview screen appears.

  15. Save the order.