Procedure documentationCreating Orders for Compounds

 

You use this medication order to order compounds such as, for example, ointments, eye drops, creams, etc. The order contains a special screen area for the ingredients.

A compound can also be a mixed drug which is only ever administered, dispensed, or printed as a prescription in mixed form. You cannot define flow rates for a compound.

Furthermore, you must also decide whether a compound:

  • can be dosed precisely

  • cannot be dosed precisely (e.g. a cream)

    If a compound cannot be dosed precisely, the order is always for a complete package of the drug. As soon as this package is finished, you must request a new package. You can, of course, order several packages at once. The system rounds the entered quantity up to the nearest package.

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 a compound 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 compound 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 determine the individual dose for each administration time in an order for compounds which can be dosed precisely, 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.

    The system will check the value which results from the quantity and unit against the maximum individual dose and will display a warning where necessary. The system will also display this warning if you manually create a new event which exceeds the maximum individual dose.

    Furthermore the system also checks the combination of individual dose and cycle against the daily dose. 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 compounds which can be dosed precisely, the system will use the individual dose entered in the order as the basis for event generation.

    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.

    Note Note

    In the case of compounds which cannot be dosed precisely, the ordered dose applies to the entire order. In simplified dose definition the system automatically sets the dose according to the value (e.g. 1-0-1). If, for example, you set the values in the dose definition to 2-0-3, the system resets these to 1-0-1.

    End of the note.

    If the order start time is the same as the first event, the following system behavior results:

    • If the purpose of the order was determined as "administration" and the order start time is exactly the same as that which results from the cycle definition for the first event, the system will not generate an additional event when the Immediate Dose indicator is selected. In connection with the order duration of exactly one dose, the system sets the event time of the single generated event to the start of the order.

    • If the purpose of the order is "dispensing" or "prescription printing", the system will generate an additional event with the administration purpose, even if the time of the order is exactly the same as the first determined cycle time.

  4. Choose 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 compounds 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 compounds on the Ingredients tab page.

    • In the case of compounds which cannot be dosed precisely, the ordered dose applies to the entire order. The radio button Per Total Order is checked and cannot be changed. When generating the administration events the system assigns this dose to the first generated event, all subsequent events are not assigned a dose. As a result no drugs must be brought to the care unit from the pharmacy for subsequent events.

    • In the case of compounds which can be dosed precisely (standard compounds), you can enter the exact dose to be ordered and administered. Select whether the dose is ordered for the entire order or for each individual dose. If you select the radio button Per Individual Dose the ordered dose is used as the planned dose for each event.

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

    The ingredients are preset from the drug master data. The ingredients are calculated in the same was as for infusions (e.g. kg, BSA).

    Note Note

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

    The recipe quantity is also changeable depending on this. As soon as the recipe quantity has the indicator Fixed Recipe Quantity, it can no longer be changed. You can only continue entering the order if the recipe quantity is fixed.

    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. 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.

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

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

  11. In addition to the events which the system generates for an order, you can also manually create orders. The dose of manual events does not influence the total dose of the order. Choose New Row (New Row) on the Event tab page, to create a new event.

    In case of manually created events, you can determine the purpose of the event in the Administration, Dispensing andPrescription Printingcolumns, regardless of the purpose of the order.

    This means that, for outpatient orders (dispensing or prescription printing) you can also document an administration of the same drug, in addition to a dispensing or prescription printout, within an order. You do not need to enter two orders with differing purposes (administration and dispensing or prescription printout).

    Note Note

    When a patient is discharged, you can also use the existing orders for the administration for a prescription printout or to dispense the drug.

    End of the note.

    The system flags (manual) events where the purpose can be changed, in the Changeable Purpose column.

  12. 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

  13. To document a single administration, dispensing or prescription printout for an order for premade compounds quickly and directly from the order, select it and then choose Execute Order (Execute Order).

    See Executing an Order

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

    The Print Preview screen appears.

  15. Save the order.