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C e rn e r

Physician Reference
Guide

June 4, 2012
Important Numbers

Support The IU Health Service Desk is available 24/7 to assist you


Resources with computer related issues, including password resets.
317-962-2828
helpdesk@iuhealth.org

The Center for Physician Education provides computer


application instruction and educational services.
317-962-2222
docs@iuhealth.org

The Center for Physician Education website, located on


the Pulse page of the IU Health network, or via the link
below:

http://www.clarian.com/informatics/active/
physician_education/ v2/index.php

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Table of Contents

Overview....................................................................... 9
Introduction ...................................................... 9
Cerner Password ............................................... 9
Security ............................................................. 9
Log On and Off........................................................... 10
Introduction .................................................... 10
Remote Log On Procedure.............................. 10
Downtime Procedures .................................... 11
Log On Procedure ........................................... 13
Log Off Procedure ........................................... 13
Change Your Password............................................... 14
Introduction .................................................... 14
Procedure........................................................ 14
Access Other Clinical Systems ................................... 15
Introduction .................................................... 15
Available Systems............................................ 15
View Surgical Schedules ............................................ 16
Procedure........................................................ 16
Utilize Message Center ............................................... 17
Introduction .................................................... 17
Sign Single Telephone and Verbal Orders....... 17
Sign a Group of Telephone and Verbal Orders17
Forward Orders for Signature......................... 18
Refuse Orders for Signature ........................... 19
Cosign a Note .................................................. 19
3
Create and Maintain Patient Lists ............................... 20
Introduction .................................................... 20
Lists Used ........................................................ 20
Create a Relationship List ............................... 20
Add Patient to Relationship List...................... 23
Remove Patient from Relationship List .......... 23
Create a Query List (Report) ........................... 24
Modify a Query List......................................... 25
Safeguard Printed Patient Information .......... 26
Search for a Patient ..................................................... 27
Introduction .................................................... 27
Procedure........................................................ 27
Multiple Encounters........................................ 27
Locate the Correct Patient Encounter ............ 28
Document Chart Access.............................................. 30
Introduction .................................................... 30
Procedure........................................................ 30
View and Add Allergies.............................................. 31
View Allergies.................................................. 31
Add Allergies ................................................... 31
Navigate to Sections of the Chart ............................... 33
Introduction .................................................... 33
Manage Search Criteria on the Results Review Band 36
Move Forward or Back by One Day ................ 36
Navigate to Results ......................................... 36
View Result Details ......................................... 36
Set View Format for Current Session.............. 37
View Clinical Documentation..................................... 38
4
Four Bands ...................................................... 38
Procedure........................................................ 38
Navigate Scanned Documents ........................ 39
Create a Free-Text Clinical Note ................................ 40
Write Notes ................................................................. 41
Set Up Personal Document Types as Defaults 41
Suggested Content.......................................... 41
Procedure........................................................ 41
Create New PowerNote .................................. 43
PowerNote Views............................................ 46
Modify PowerNotes ........................................ 47
Advanced PowerNote Functions .................... 50
Computerized Provider Order Entry (CPOE) ............. 59
Customize Views ............................................. 59
The Orders Window........................................ 67
Order Entry Basics...................................................... 69
Specialty Clinical Folders................................. 69
Set Your Clinical Specialty Folder as Your Home
Folder .............................................................. 69
Basic Order Search .......................................... 70
Search for Orders............................................ 70
Enter Single Orders ......................................... 71
Modify Orders................................................. 73
Favorites Folders............................................. 74
Medication Order Frequencies ....................... 77
Standard Schedules for IU Health................... 78
Order Entry Tools ....................................................... 79
Order Sets ....................................................... 79
5
PowerPlans...................................................... 79
Medication Order Entry .............................................. 87
IV: Titratable Drip............................................ 88
IV – Heparin Nomogram and Thrombo-
stabilizer Infusions .......................................... 89
IV – TPN Adult ................................................. 89
IV – TPN Pediatric and Neonatal..................... 94
Medications: Dose Range Orders ................... 96
Medications: Hold a Single Dose.................... 97
Medications: Irrigation Orders ....................... 98
Medications: Multiple PRN Reasons............... 98
Medications: Multiple Route Orders .............. 98
Medications: Non-Formulary/ ........................ 99
Substitution..................................................... 99
Alerts ............................................................... 99
Medications: One-time STAT Doses.............. 101
Medications: STAT Doses with Ongoing Orders
....................................................................... 101
Medications: Patches.................................... 102
Medications: Taper Doses............................. 102
Medications: Taper Dose, No Existing Taper
Order ............................................................. 103
Medications: Prescriptions ........................... 104
Dosage Calculator..................................................... 112
Introduction .................................................. 112
Where to Find the Dosage Calculator........... 112
Calculation Options by Weight ..................... 113
Calculate Standard Doses ............................. 113
6
Pediatric Antimicrobial Stewardship ........................ 116
Introduction .................................................. 116
Orders ........................................................... 116
Program Goals............................................... 116
PowerPlans.................................................... 117
Organization of Antimicrobial Agents........... 117
Place Orders from a Subphase...................... 118
Locate an Antimicrobial Agent PowerPlan ... 122
Restricted Agents.......................................... 123
Medical Student Orders ............................................ 126
Overview: Medical Student Orders .............. 126
Medical Students: Order Processes.............. 126
Other Order Entry Processes..................................... 136
DNR Orders ................................................... 136
Medication Special Alerts/............................ 140
Communication............................................. 140
Transfer Order Review Note ......................... 141
Discharge Instructions (eDI).......................... 142
Glossary .................................................................... 154
Frequently Used Phone Numbers ............................. 156
IU Health Ball Memorial................................ 156
IU Health Methodist ..................................... 156
Riley Hospital for Children at IU Health ........ 157
IU Health University...................................... 158
Richard L. Roudebush VA Hospital................ 159
Wishard Memorial Hospital .......................... 160

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8
Overview

Introduction Cerner is the vendor name of the EMR system used at


IU Health. Cerner is a fully integrated EMR that is being
introduced throughout IU Health.

Cerner Your Cerner password:


Password
• Must be 6-8 alpha-numeric characters
• May contain special characters (#, &...)
• Must be changed every 90 days
• May not be the same as your previous three passwords

Security There are strict regulations that govern the use and
protection of patient information. Certain measures have
been put into place at IU Health that protects patient data
in the EMR.
• Cerner automatically logs out after 15 minutes of no
activity; however depending on the location, certain
areas may have a different automatic logout time
• Do not share passwords
• Do not allow another person access under your ID and
password
• Log out of the EMR when walking away from the
computer

9
Log On and Off

Introduction SSL is a browser-based connectivity solution that allows


credentialed physicians to access Cerner remotely. SSL
works on Windows Vista, XP, and Windows 7 operating
systems as well as on Mac operating systems.

Remote Log
On Step Action
Procedure
1. Open your web browser.
2. In the address locator bar, enter
https://sragate.clarian.org
3. Click Yes to install Juniper on your system.
4. Enter your IU Health Network ID and
password.
5. Click Enter or Sign In.
Available roles in the secure gateway display.

6. Click the Tier0 link.


The Secure Access SSL – Home page displays.
7. In the Web Bookmarks section, click the
Cerner link.
The CernerWorks applications portal displays.
8.
Click to launch Cerner PowerChart.

Continued on next page

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Log On and Off, continued

Downtime Downtime Report Access


Procedures • During a downtime period, downtime reports may be
used to view and print patient data from a designated
workstation
• Information available in the Downtime Reports folder
will display the most current patient data and will be
from 1-12 hours old, depending on the report. The unit
secretary or charge nurse will be your resource and will
be able to provide the forms and information that you
will need.

Downtime Reports Content


• The Downtime Reports folder will not contain your
personal patient list

Documentation During Downtime


• Locate paper forms for documenting during downtime
by asking the unit secretary or nurse where these
forms are kept on the unit

Continued on next page

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Log On and Off, continued

Downtime Safeguard Printed Patient Information


Procedures,
cont. Follow these guidelines for printing reports:

You Are Printing a Report You Find a Printed Report


Carefully select the correct printer If you find a report containing
from the drop-down menu. patient information on a printer,
contact the person who printed
the report.
Retrieve the printed report from If unable to contact the report
the printer immediately. owner, place the report in the
shred box.
If the report did not print, reselect If the report prints a second time,
the correct printer and attempt to contact the Service Desk at 317-
print the report again. 962-2828 and report the computer
name, location, and the name of
the printer where the report
printed.
If the report does not print after a Place the report in the shred box.
second attempt, contact the
Service Desk at 962-2828.

Continued on next page

12
Log On and Off, continued

Log On
Procedure Step Action
1. Double-click on your computer desktop.
2.
Click displayed in the Applications
window.
3. Enter your user ID (usually your dictation
number) and password into the respective
fields.

4. Click OK.

Log Off
Procedure
Step Action
1. Close all open patient charts.
2. Click to immediately disconnect from
the server.
The Exit Application window displays.
3. Select Exit and shut down the application.
Note: To suppress this message in the future,
place a checkmark in the box.

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Change Your Password

Introduction You can change your password at any time using the
following procedure.

Procedure
Step Action
1. When logged onto Cerner, click Task on the
toolbar.
2. Select Change Password from the drop-down
menu.

3. Enter your old password in the Old Password


field.
4. Enter a new password in the New Password
field.
5. Re-type your new password in the Retype
Password field.
6. Click OK.

14
Access Other Clinical Systems

Introduction Within Cerner, you can access other clinical systems used
at IU Health.

Available
Systems System Description
INPC Data repository that includes:
• Labs and documentation created
prior to the Cerner implementation
• Current information from other
health care sites around the state of
Indiana
ClinDoc • Electronic nursing flowsheet contains
data entered by nursing
• Data flows into Cerner
• It can be viewed from either ClinDoc
or Cerner
ClinSuite Tool used to facilitate the patient
handoff process between physicians
UpToDate IU Health’s source for evidence-based
clinical information

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View Surgical Schedules

Procedure
Step Action
1. Click in the links within Cerner.
2. Click the appropriate surgical area.

3. Click to begin the print process.


4. Place a checkmark in the Preview box.
5. Click Print.
6. In the next box, click Print.

The surgical schedule displays.

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Utilize Message Center

Introduction Cerner always initially opens to the Message Center


where you can:
• Sign single or a group of telephone and verbal orders
• Forward orders for co-signature
• Refuse to sign orders
• Cosign notes

Sign Single
Telephone Step Action
and Verbal
1. Click the Orders, Cosign Orders or Med
Orders
Student Orders folder.
2. Review order details for accuracy.
3. Right-click the order.
4. Select Approve from the menu.

Sign a Group
of Telephone Step Action
and Verbal
1. Click the Orders, Cosign Orders or Med
Orders
Student Orders folder.
2. Review order details for accuracy.
3. Hold the Control key down while clicking on
multiple orders.
4. Right-click anywhere WITHIN the highlighted
orders.
5. Select Approve from the menu.

Continued on next page

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Utilize Message Center, continued

Forward
Orders for Step Action
Signature
1. Select the order(s).
2. Click Forward Only.
3. Select Sign from the Additional Forward Action
list.
4. Find the provider by:
• Typing the name of the intended recipient
provider, or
• Click Search and look for the provider
5. Enter comments (up to 120 characters,
including spaces) if necessary.
Note: Comments become part of the
permanent patient medical record.
6. Click OK.

Continued on next page

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Utilize Message Center, continued

Refuse
Orders for Step Action
Signature
1. Click the Message Center Orders, Cosign
Orders or Med Student Orders folder.
2. Double-click the order you wish to refuse.
3. Click Refuse.
4. Select a reason.
5. Type a comment (up to 120 characters) if
needed.
6. Click OK or click OK and Next if you need to
refuse additional orders.
The order is routed to the refusal admin.

Cosign a
Note Step Action
1. Click the Documents folder.
2. Double-click the note requiring cosignature.
3. Review the note for accuracy.
4. Click OK to sign the note.

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Create and Maintain Patient Lists

Introduction Patient lists use defined criteria to organize patient


charts. Each patient list displays on a separate tab.

Lists Used Lists commonly used at IU Health include:


Type Description
Provider Provider Group lists are helpful if you
Group and your colleagues share a list of
patients.
Provider Groups can be created by
contacting the Help Desk at 317-962-
2828.
Relationship Relationship lists display those
patients you already have a
relationship with, such as attending
or resident.
Query Query lists display the patients of
another physician.

Create a Relationship lists are encounter or visit-based. An


Relationship outpatient relationship does not carry over into a new
List inpatient encounter.
Step Action
1. Click (List Maintenance) in the Patient
List window.
2. Click New.
3. Select Relationship.

Continued on next page

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Create and Maintain Patient Lists, continued

Create a
Relationship
List, cont.
Step Action
4. Click Next.
5. Click + to the left of Visit Relationships.

6. Click Next.
7. Place a checkmark in the box to the left of
the appropriate type of physician
relationship(s).

8. Enter a name for your new list.

9. Place a checkmark in the box to the left of


Encounter Types.

10. Place a checkmark in the boxes to the left of:


• Emergency
• Inpatient
• Observation
• Outpatient in a Bed
11. Click + to the left of Location, then click + to
the left of each appropriate location.

Continued on next page

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Create and Maintain Patient Lists, continued

Create a
Relationship Step Action
List, cont.
12. Place a checkmark in the box to the left of
each location.

13. Click to the left of Discharged Criteria.

14. Select discharged criteria.

15. Click Finish.


16. Highlight the new list in the Available lists
pane.

17. Click to move the list to the Active lists


pane.
18. Click to move your Relationship list to the
first position in the Active lists pane.
Your list is moved to the first tab in the
patient list window.
19. Click OK.

Continued on next page


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Create and Maintain Patient Lists, continued

Add Patient
to Step Action
Relationship
1. Click the patient list tab where you need to
List
add the patient.
2. Click (Add Patient).
3. Enter the patient’s last name or MRN (medical
record number).
4. Click Search.
5. Select your patient from the search results list.
6. Select the appropriate encounter from the
lower pane.
7. Click OK.
8. Click to refresh.

Remove
Patient from
Relationship
Step Action
List 1. Click the specific patient list tab where you
need to remove the patient.
2. Click the patient’s name.
3. Click (Remove Patient).
4. Click Yes to confirm.
If you have only one relationship with the
patient, the patient drops off your list. But if
you have more than one relationship with the
patient, the patient does not drop off.
5. Select the appropriate relationship.
6. Click OK.
7. Click to refresh.

Continued on next page

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Create and Maintain Patient Lists, continued

Create a Step Action


Query List 1. Click ..
(Report)
2. Click (List Maintenance).
3. Click New.
4. Select Query.
5. Click Next.
6. Select Physician List Query.
7. Change the name of the query to reflect the
physician names and locations.

8. Click Next.
9. Type the first few letters of the physician’s
name to move quickly to that area of the
physician list.
10. Place a checkmark in the box to the left of the
desired physician’s name.

11. Click Next to select locations from within the


Organizations window.
12. Place a checkmark in the box to the left of each
location.

13. Click Next.


14. Click Finish.

Continued on next page

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Create and Maintain Patient Lists, continued

Create a
Query List Step Action
(Report),
15. Highlight the new list in the Available lists
cont.
pane.

16. Click to move your new list to Active Lists.


17. Click OK.
18. Click (Execute Query) to activate the
list.
Note: Each time you use the Query list, you
must click the Execute Query icon to refresh
the report results.

Modify a
Query List Step Action
1. Click .
2. Click (Modify Parameters).
3. Modify the parameters for a query list (add or
remove a physician or location).

4. Click OK.
5. Click (Execute Query) to implement
your changes.

Continued on next page

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Create and Maintain Patient Lists, continued

Safeguard While printing of patient lists is discouraged at IU


Printed Health, please follow these guidelines if you will be
Patient printing a patient list:
Information

You Are Printing a List You Find a Printed List


Carefully select the correct printer If you find a list containing patient
from the drop-down menu. information on a printer, contact
the person who printed the list.
Retrieve the printed list from the If unable to contact the list owner,
printer immediately. place the list in the shred box.
If the list did not print, reselect the If the list prints a second time,
correct printer and attempt to contact the Service Desk at 962-
print the list again. 2828 and report the computer
name, location, and the name of
the printer where the list printed.
If the list does not print after a Place the list in the shred box.
second attempt, contact the
Service Desk at 962-2828.

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Search for a Patient

Introduction You can search for a patient by name or by medical record


number (MRN).

Procedure
Step Action
By Name
1. Type the last name of the patient in the Name
search field.

2. If multiple names display when using the name


search, highlight the correct patient name.

By MRN
1. Click the arrow to the left of the patient search
field.
2. Select MRN.
3. Enter the MRN into the search field.

Multiple • You may find that the patient has multiple encounters
Encounters that are displayed in the lower pane. Certain types of
patients may have multiple Active encounters.
• You must identify and select the correct patient
encounter. If the improper encounter is selected, your
orders and documentation will not follow the
appropriate workflow and will need to be corrected.

Continued on next page


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Search for a Patient, continued

Locate the
Correct Step Action
Patient 1. Carefully view the patient encounters in the
Encounter lower pane of the Patient Search window.
2. Search for an encounter near or on today’s
date.

3. Confirm that the encounter displays the


correct facility and nursing unit.

4. Confirm that the encounter is Active.

5. After you have located the correct patient


encounter, highlight the encounter in the
lower pane.
6. Click OK.

Continued on next page

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Search for a Patient, continued

Locate the
Correct Step Action
Patient
7. Review the patient header to ensure that you
Encounter,
cont. have accessed the correct encounter.

8. If you selected the wrong encounter, click the


location in the patient header.

9. In the pop-up window, double-click the correct


encounter.

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Document Chart Access

Introduction If you access a patient chart for any reason other than
direct patient care (e.g., research, administrative, or
accidental access) you must document why you accessed
the patient chart.

Procedure
Step Action
1. Open a patient chart.
2. If a relationship window displays, select a
relationship.
3. Click Chart on the toolbar at the top of the
screen.
4. Scroll to the bottom and select Chart
Accessed By.

5. Select Most Recent from the sub-menu.


6. Double-click in the Comment Column to the
right of your name to enable a cursor.

7. Enter the reason you have accessed the patient


chart.
8. Click Save.
9. Click Close.

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View and Add Allergies

View If allergies have been entered into the patient chart, the
Allergies name of each allergy displays in the patient demographic
bar. The list may be truncated.

To view allergy details, click the Allergy link in the patient


header.

Alternatively, you can click (Allergies band) to


view allergies.

Allergy details display as follows:

Add
Allergies Step Action
1. Click (Allergy link) in
the patient header to access allergy details.
Note: Alternatively, you can click
(Allergies band) to enter allergies.
2. Click + Add.
3. Click the + to the left of the appropriate allergy
category folder.

Continued on next page

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View and Add Allergies, continued

Add
Allergies, Step Action
cont.
4. Double-click the correct allergy name.

5. If the appropriate allergy does not display in


the folder:
a. Click the search tab.
b. Enter your search terms.
c. Click Search.
d. Double-click the correct allergy name.

6. Click the + to the left of


(Common Reactions folder).
7. Double-click the appropriate common
reaction.

8. Click OK to add the allergy to the allergy list.


9. Click OK to close the allergy list.
10. Click to refresh the screen and
display the new allergy in the patient header.

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Navigate to Sections of the Chart

Introduction Cerner uses a menu to navigate to


different sections of the patient
chart.

• Each section within the menu


is called a band
• Clicking a band moves you to
the corresponding section of
the patient chart
• In addition, the menu band can
be minimized to provide a
larger screen view

The EMR bands you may use most


frequently are described in the
following section.

Band Function
Results Displays lab results, vital signs, significant events, and
Review other pertinent information for your patient
In Patient Allows access to most of the patient data displayed in
Summary the patient chart. You can take action directly from this
band, such as adding problems, diagnoses, and orders,
and viewing physician notes and test results.

Continued on next page

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Navigate to Sections of the Chart, continued

Band Function
Rounds Displays an online view of data similar to the printed
rounds report
I/O / I • Provides advanced graphing functionality
Flowsheet • Is useful for viewing data trends over a period of time
• Displays volumes in split-screen format (flowsheet
and graph); optional split-screen display
• Default setting displays previous 24-hour totals
Allergies • Displays all allergies entered into the system
• Allows for additional allergies and reactions to be
documented
MAR Summarized medication administration over 24 hour
Summary timeframes during current encounter
Medication A record of all meds ordered for a patient, either by
List history, through online prescription ordering, or by
PowerChart order entry. Also allows for new medication
orders to be added.
Orders Provides the Order Profile for a patient—existing orders
as well as order statuses and detail information. Allows
for new orders to be entered.
2 Year
Clinical Contains notes from today to 2 years prior
Notes
72 Hr Defaults to display only notes for the past 72 hours.
Clinical Types of online documents include:
Notes • Interfaced notes dictated from other systems
• Scanned documents (display under admission date)
• Direct-entered notes (PowerNotes, intra-operative
documentation, etc.)

Continued on next page

34
Navigate to Sections of the Chart, continued

Band Function
2 Year
Displays notes by physicians and mid-level providers and is
Physician
a sub-set of clinical notes
Notes
PowerNote Allows for the use of templates to create structured notes.
Use the PowerNote band to document your online notes.
Problems
Displays problems and diagnoses entered into the system,
and
also allows for adding or editing information.
Diagnoses
Patient Info Contains demographic and case-related information
organized under sub-tabs, including list of procedures,
problems, immunizations, and visits, as well as growth
chart information, and a provider list through which you
can manage physician relationships.
Dictation Displays a combined view of Documentation and Lab &
View Diagnostic Results to assist physicians with the pertinent
data they need to complete a Dictation (for example, to
help facilitate the dictation of a Discharge Summary).
Chart Displays summarized information in window-frame layout.
Summary Includes information regarding special alerts, providers,
patient data (e.g. reason for visit, surgical cases, etc.),
medications and IVs, and patient care and ancillary orders.
Discharge Secure electronic form used for documenting custom
Instructions patient discharge instructions.
Chart Is a search engine that allows users to search for patient
Search data within the patient’s medical record. It will search for
words, phrases, and clinical concepts. It can match and
rank documents so that the most important documents
move to the top of the results list. Chart Search does NOT
include:
• Orders • Allergies
• Problems • Lab panels (currently must search
• Procedures for individual components)

35
Manage Search Criteria on the Results Review
Band

Move To move forward or back by one day at a time on the


Forward or Result Details screen, click the arrows to the right or left
Back by of the blue Search Criteria bar.
One Day

Navigate to The Navigator, located to the left of the results panel,


Results allows you to quickly navigate to results on the screen.

Click the Navigator bars to


display the selected results
at the top of the screen.

View Result Double-click any result to see more detail (reports, result
Details history, specimen information, etc.).

Continued on next page

36
Manage Search Criteria on the Results Review
Band, continued

Set View You can select a Display Format option to temporarily


Format for change how the flowsheet data displays by Table, Group
Current or List.
Session
Table
Table is the default format. It arranges results by category
along the left of the screen and by time across the top.

Group
Group format arranges results by:
• Test descriptions across the top of the screen
• Category (e.g., Vital Signs) and dates/times within the
category on the left side of the screen

List
List format arranges results in a linear list format by event
date and time.

37
View Clinical Documentation

Four Bands There are four clinical documentation bands:


• 2 Year Clinical Notes
• 72 Hr Clinical Notes
• 2 Year Physician Notes
• PowerNote

Procedure
Step Action
1. Depending on the timeframe you need to view,
click either the 2 Year Clinical Notes band or
the 72 Hr Clinical Notes band.
2. Click one of the radio buttons to sort the index
by one of the following options:
• Type
• Status
• Date
• Performed By
• Encounter
3. Double-click the needed folder to open.
4. If there are sub-folders, click the + to see more
folders or documents.
5. Double-click to open a document.
6. Use the large blue arrows to move
quickly from one document to the next or to
move between note types.

Continued on next page

38
View Clinical Documentation, continued

Navigate Scanned documents display with an additional toolbar at


Scanned the bottom of the top view pane. The following tips will
Documents help you navigate scanned documents quickly and easily:

• Documents are scanned against admission or


appointment date, not by actual date/time of
documentation

• Documents display in reverse chronological order by


patient visit date
Note: It may be helpful to sort by Encounter Type.

• Check to determine if multiple pages have


been scanned into a single entry

• Click the right arrow to move to the next page if


there is more than 1 page indicated

• Use the 4th arrow to jump to the last page

• Use magnifying glasses to zoom in (+) or out (-)

• For easier viewing, click the Fit to Page tool

• Use the rotate tools to rotate the document

39
Create a Free-Text Clinical Note

Procedure
Step Action
1. Click either the 2 Year Clinical Notes band or the
72 Hr Clinical Notes band.
2. Click (New Note).
3. Select the correct note Type.
4. Change date and time if necessary.
Note: Clinical documentation always reflects the
date and time that the note was created. If the
documentation pertains to the prior day, you
must change the date and time of the note prior
to signing the note.
5. Enter the Subject of the note.
6. Type your note.
7. Click Sign, Save, Save & Close or Cancel.

Option Function
Sign • Enters your note into the
patient’s permanent record
• Changes to the note must be
made by addending the note
Save • Saves your note before signing
• Changes can be made to the
note
Save & • Saves your note before signing
Close • Closes it so that you may
complete it at a later time
Cancel Deletes your note with no saved
record of the note

40
Write Notes

Set Up Before you enter your first PowerNote, you must set up
Personal your personal document types as defaults for your
Document specialty and author status: Staff, Resident, Fellow, or
Types as
Medical Student. All note types listed represent both
Defaults
Adult and Pediatric specialties.
Note: Medical students will not have document types by
specialty.

Suggested Suggested content for your document type list is:


Content
Type Description
IP Inpatient
OP Outpatient
Admission/H&P Note Generic
Initial Consult Note By specialty
Progress Note By specialty
Procedure Note Generic
Orders Reconciliation

Procedure
Step Action
1. Open the patient chart.
2. Select PowerNote +Add from the menu.

Note: You must click + Add and ensure that


you have opened a PowerNote to proceed.

Continued on next page

41
Write Notes, continued

Procedure,
cont. Step Action
3. Select View from the uppermost task bar.

4. Select Customize from the drop-down menu.


5. Select the Document Types tab.

6. Click to uncheck
it.
7. Select Personal Note Type List from the
Default List Type.

8. Click the appropriate Document Type in the All


Available Document Types column on the left.

9. Click > to move it to the Personal Document


Type List column on the right.
Note: You can only select one document type
at a time. However, this is a one-time set up
that will make charting commonly used notes
more efficient.
10. Click Apply.
11. Click OK.

Continued on next page


42
Write Notes, continued

Add Step Action


Templates 1. Click the Catalog drop-down arrow.
to Favorites
2. Select IUH Inpatient.
3. Click + next to Specialty (i.e., Adult).
4. Highlight the appropriate templates (e.g.,
Admission H&P, Progress Note, Consult Note,
Transfer Order Review)
5. Click Add to Favorites.
6. Scroll down and click + next to Procedures.
7. Highlight the needed procedure templates.
8. Click Add to Favorites.
Your selected templates display under your
Favorites tab.

Create New PowerNotes utilize templates to prompt for relevant


PowerNote information and can import existing data into your note.
Step Action
1. Select PowerNote +Add from the menu.
2. Select the Document Type in the *Type: field.
3. Type a clinically relevant title into the Title:
field (i.e., clinical diagnosis or symptom such as
Gastroenteritis).
Note: If no title is entered, the title will default
to the name of the template chosen (i.e.,
progress note).

Continued on next page


43
Write Notes, continued

Create New Step Action


PowerNote, 4. Proceed as follows:
cont.
• If you have created favorites, click your
Favorites tab and select a template. Skip to
Step 7.
• If you have not created favorites, click the
Catalog tab and select IU Health from the
drop-down menu. Continue to Step 5.
5. Click the + next to each folder to view its
contents.
6. Click the template that indicates the type of note
you are writing (i.e., Progress Note).
Note: Note Type and Template chosen from the
Catalog need to correspond.
7. Click OK.
The Auto Populate screen displays.
8. Check the boxes for those items that you need
included in your note.

9. Click OK.

Continued on next page

44
Write Notes, continued

Create New Step Action


PowerNote, 10. Click to expand and display the
cont.
structure of the note.
11. Click terms in each sentence that you need to
add to your note as follows:
• Single-click a term to select it by displaying
a circle around it
• Double-click a term to negate it
• A third click on a term deletes the term
from documentation
12. To enter free-text for a particular term, click
or right-click and select Comment.
13. To enter free-text at the paragraph level, click
.
14. Click Sign, Save, Save & Close or Cancel.
Option Function
Sign • Enters your note into the
patient’s permanent record
• Changes to the note must be
made by addending the note
Save • Saves your note before
signing
• Changes can be made to the
note
Save & • Saves the note before signing
Close • Closes it so that you may
complete it at a later time
Cancel Deletes your note with no saved
record of the note

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45
Write Notes, continued

PowerNote Contributor View


Views You can view a PowerNote in report format while you are
creating the note.

Step Action
1. Click the contributor icon to view the note in
report format.

2. Click the contributor icon again to return to


the PowerNote working format.

Full Screen View


You can enlarge a PowerNote to full screen format in
order to more easily view the note as it is being created.

Step Action
1. Click in the upper left corner of
the note to expand the note view to full
screen.
2. Click in the upper right corner to
reduce the screen size.

Continued on next page

46
Write Notes, continued

Modify Addend a Note


PowerNotes You can add information to your clinical documentation
by using the addend function.

Step Action
1. Click the Clinical Notes band.
2. Double-click to open the note that you need
to addend.
3. Click (Modify) or right-click in the body
of the note and select Modify.
4. Enter the additional text below *Insert
Addendum Here:.

5. Sign the note when completed.

Modify a Note
You may occasionally need to strike out incorrect
information within your note and enter the correct
information.

Step Action
1. Click the Clinical Notes band.
2. Double-click the appropriate note to open it.
3. Click or right-click the body of the note
and select Modify.

Continued on next page

47
Write Notes, continued

Modify Modify a Note, cont.


PowerNotes,
cont.
Step Action
4. Drag your cursor to highlight the incorrect
text.

5. Click (Strikethrough).
6. Enter the corrected text below *Insert
Addendum Here:.

7. Sign the note.

In Error Note
You may find that you have entered incorrect
information on a patient or written a note on the wrong
patient. Use the following In Error process to strike the in
error note from view in the EMR.

Note: Notes entered through PowerNotes or Clinical


Notes must be made In Error through the Clinical Notes
band.

Continued on next page

48
Write Notes, continued

Modify Strike the In Error Note from View


PowerNotes,
cont.
Step Action
1. Click either the 2 Year or 72 Hr Clinical Notes
band.

2. Double-click the note that was entered in


error to display the note.

3. Right-click the note and select In Error to “in


error” the existing note.

4. Type the In Error reason.

5. Click OK.
6. Either return to the PowerNotes or Physician
Notes band to write your replacement note
or select the correct patient to begin entering
your documentation.

Continued on next page

49
Write Notes, continued

Advanced Copy Paragraph or Selected Text to a New Note


PowerNote You can copy a single paragraph or selected text from one
Functions note to another.

Step Action
1. Make sure that the note you need to copy into
is open.
2. Click to minimize the new note.
3. Double-click to open the note that you need to
copy from.
4. Highlight the appropriate text that you need to
copy from the existing note.
5. Press ctrl>C on the keyboard to place the text
on the electronic clipboard.
6. Click to maximize the new note.
7. Click the area of the note where you need to
paste the new text.
8. Press ctrl>V on the keyboard to paste the text.

Continued on next page

50
Write Notes, continued

Advanced Copy to a New Note


PowerNote You can copy forward a PowerNote that you or someone
Functions, else has previously completed on a patient. The lab,
cont.
medications, and vital signs data will automatically be
updated for that date.
Note: It’s your responsibility to modify the rest of the note
to accurately reflect documentation for the date of entry.

Step Action
1. Click + Add in PowerNote band.
2. Click the Existing tab.
3. Click to highlight the appropriate note to copy
forward in the bottom pane.
4. Place a checkmark in the Copy to New Note
box.
5. Select the appropriate Document Type.
.
6. Type an appropriate Title.
7. Click OK.
8. Select paragraphs to copy.
9. Check and uncheck the appropriate items in
the Auto Populate window.

10. Complete the note by modifying data to


accurately reflect documentation for the date
of entry.
11. Click Sign.

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51
Write Notes, continued

Advanced Create a Macro


PowerNote A macro allows for quick, repeated use of a selection of
Functions, structured content where the terms have been
cont.
preselected by you and can later be retrieved and
modified as needed.

Pre-selecting the negatives in your note can improve


efficiency of documentation, allowing for you to retrieve
this macro and modify as necessary for a given patient
without having to reselect all the negatives each time but
rather allowing you to modify the necessary components.

Step Action
1. In the selected structured note, select terms
as positive or negative as needed for your
macro.
2. Right-click the appropriate paragraph or
sentence header at the level in which you
need to save your macro.
Note: You can save a macro at either the
paragraph or sentence level (e.g., Review of
Symptoms or Constitutional).
3. Select Save Macro As from the pop-up menu.

Continued on next page

52
Write Notes, continued

Advanced Create a Macro, cont.


PowerNote
Functions,
Step Action
cont.
4. Enter a Title.

Note: You may want to use the initial


paragraph/header name followed by a
descriptor to ease future retrieval (e.g., Review
of Systems – negative).
5. Click Create New.

Insert a Macro

Step Action
1. Click the M in the section of the document
where you have created the macro.

2. Select the appropriate macro from the list that


displays.

The note populates with the preselected terms


from your macro.
3. Modify the macro as needed for your particular
patient.

Continued on next page

53
Write Notes, continued

Advanced Create Auto Text


PowerNote Auto text is text developed by the user to auto-populate
Functions, sections of a note with content that is repeatedly used.
cont.
Step Action
1. Click the white space of the note until you see
your cursor.
The free-text mode becomes activated and
displays the appropriate toolbar above your
note. The toolbar contains the Auto Text icon.
2. Click (Manage Auto Text).
3. Click (New Phrase).
4. Enter an abbreviation.
Note: Start all your abbreviations with a leading
period. This is important to ensure that you are
not interrupted with a display of your auto-text
when you are typing your note (e.g., “.pyelo”).
5. Enter a description.

Note: Be sure to enter a term that will help you


know what is in your auto-text (e.g.,
“pyelonephritis”).
6. Click (Add Text).
The Formatted Text Entry window displays.

Continued on next page


54
Write Notes, continued

Advanced Create Auto Text, cont.


PowerNote
Functions,
Step Action
cont.
7. Type the relevant text (e.g., “Ciprofloxacin
500mg po bid x 10 days. Push fluids. If ongoing
fevers, chills or back pain, patient to notify.”).
8. Click OK to close the Formatted Text Entry
window.
9. Click Save and then Close.

You can also save any free-text that you have typed as an
Auto-Text as follows:
Step Action
1. Type the free-text.
2. Highlight the appropriate text and right-click it.
3. Select Save as Auto Text.

4. Enter an abbreviation.
Note: Start all your abbreviations with a leading
period. This is important to ensure that you are
not interrupted with a display of your auto-text
when you are typing your note (e.g., “.pyelo”).
5. Enter a description.

Note: Be sure to enter a term that will help you


know what is in your auto-text (e.g.,
“pyelonephritis”).
6. Click Save and then Close.

55
Write Notes, continued

Advanced Insert Auto-Text


PowerNote Step Action
Functions,
1. Click the white space of your note where you
cont.
need to type free-text.
2. Enter the first few characters of your auto-text
abbreviation beginning with the period (“.”).

Note: If you hover over the abbreviation, the


entire description displays for you.

A drop-down menu displays.


3. Double-click the auto-text you need to insert
into your note.

Drawings
You can draw on body images, annotate the images, and
insert the drawings into your PowerNote.
Step Action
1. Click next to the appropriate section.
2. Click the appropriate drawing location.

3. Click an icon in the toolbar to draw on the


image.
Note: Hover over an icon to see its function.

4. When your image has been completed, click


OK to save to the PowerNote.

Continued on next page

56
Write Notes, continued

Advanced Precompleted Notes


PowerNote Precompleted notes allow you to save a note with any
Functions, combination of terms, macros, auto-text and/or free-text,
cont.
and then retrieve it for repeated use on any patient.
Note: It is your responsibility to ensure that a
Precompleted note accurately reflects the condition and
status of the current patient.

Step Action
1. Create a PowerNote but do not sign.
2. Click Documentation in the toolbar and select
Save as Precompleted Note.

3. Enter a title for the note.

4. Click Save as New.


The note is filed in the Precompleted tab in the
PowerNotes window.

5. To use a Precompleted note, select the


appropriate note in the Precompleted tab.
6. Click OK.

Continued on next page

57
Write Notes, continued

Advanced Symbols
PowerNote Understanding the symbols that are available in
Functions, PowerNotes can help you document in more detail.
cont.
Symbol Function
(= = =) Allows you to enter numeric values such as
BP or pulse
* • Automatically repeats the affiliated
terms to allow for documentation of
differences between two sides, etc.
• If no * is present, you can manually
repeat selection of terms where there
may be a discrepancy between two sides
or two locations by right-clicking on a
term header (i.e., Capillary Refill) and
selecting Repeat
(…) • Provides additional descriptive choices
for a term in a separate display window
• Items selected from an ellipses (…) do
not immediately display but will be
included in your final note
Note: You can see your added
descriptions in the Contributor View.
+ • Signifies that additional information for
that term exists
• Additional terms can be accessed by
clicking on the symbol

58
Computerized Provider Order Entry (CPOE)

Customize BEFORE placing your first order, you MUST set up


Views
display filters and custom views on both the Orders
and Medication List bands within PowerChart. Setting
up display filters and custom views prior to placing
your first order is extremely important to ensure you
accurately interpret orders entered into Cerner.
Note: This is a one-time process. If not completed,
medication order errors may result.

Disable the Order Window Pop-Up

Step Action
1. Open the patient chart.
2. Click the Orders band.
3. Click the Options menu at the top of the
screen.
4. Click Enable Pop-up Windows for Selecting
Orderables to remove the checkmark.

Orders Band: Customize Filters, Columns, and Groups


Each order filter selection displays different data based on
the view criteria that the filter was designed to produce.

Note: The last filter setting that you used will be displayed
the next time you log in. If you change your filter view,
remember to change it back to your default setting so that
you do not accidentally overlook critical information.

Continued on next page

59
Computerized Provider Order Entry (CPOE),
continued

Customize Orders Band: Customize Filters, Columns, and Groups,


Views, cont. cont.

Step Action
1. From the Orders band, click the Displayed:
hyperlink to access the Advanced Filters
window.

2. In the Display drop-down list, click one of the


options that begins with * (asterisk) and
contains Med Student to set the filter to
display inpatient orders only.

See related note and warning on the next page.

Continued on next page


60
Computerized Provider Order Entry (CPOE),
continued

Customize Orders Band: Customize Filters, Columns, and Groups,


Views, cont. cont.

Step Action
2. In the Display drop-down list, click one of the
options that begins with * (asterisk) and
contains Med Student to set the filter to
display inpatient orders only. (continued)
Note: Home medications MUST be removed
from the inpatient medication list. The filters in
the Display list marked with an asterisk were
designed to remove home medications from
the Orders view.
Warning: DO NOT modify the radio buttons or
checkboxes in the Advanced Filter window.
This is only used to modify the Display option.
Changing these buttons may result in missed
orders.
3. From the Current menu, select Customize
View.

61
Computerized Provider Order Entry (CPOE),
continued

Customize Orders Band: Customize Filters, Columns, and Groups,


Views, cont.
cont.
Step Action
4. Move the following columns from the
Available columns pane to the *Selected
columns pane by selecting them and clicking
Add:
a. Quick Discontinue e. Status
b. Notifications f. Details
c. Type g. Ordering Physician
d. Order Name h. Last Updated By

5. Select a category in the *Selected columns


pane and click to move the item up or down
and change the display so that the order
matches the shown in Step 4.

Continued on next page

62
Computerized Provider Order Entry (CPOE),
continued

Customize Orders Band: Customize Filters, Columns, and Groups,


Views, cont.
cont.
Step Action
6. Customize the grouping of orders to create
Clinical Folders for locating and viewing existing
orders as follows:

a. In the drop-down list for Group orders by:,


select Clinical Category.
b. For Then by:, select Active/Inactive.
c. For Sort orders by:, select Order Name or
Chronological.
7. Confirm that upon completion, your Orders view
pane appears in the following order:

Continued on next page


63
Computerized Provider Order Entry (CPOE),
continued

Customize Medications List Band: Customize Filters, Columns and


Views, cont. Groups
After you have customized your Orders band, you must
also customize your Medication List band.

Step Action
1. Open the patient chart and click the Medication
List band.
2. Click the Displayed: hyperlink to access the
Advanced Filters window.

3. In the Display drop-down list, select All


Medications (All Statuses).

Continued on next page

64
Computerized Provider Order Entry (CPOE),
continued

Customize Medications List Band: Customize Filters, Columns and


Views, Groups, cont.
cont.
Step Action
4. From the Current menu, click the Customize
View link.

5. Move the following columns from the Available


columns pane to the *Selected columns pane
by selecting them and clicking Add:
a. Quick Discontinue e. Status
b. Notifications f. Details
c. Type g. Ordering Physician
d. Order Name h. Last Updated By
6. Select a category in the *Selected column pane
and click to move the item up or down and
change the display so that the order matches
the sequence in Step 5.

Continued on next page

65
Computerized Provider Order Entry (CPOE),
continued

Customize Medications List Band: Customize Filters, Columns and


Views, Groups, cont.
cont.
Step Action
7. Customize the grouping of orders to create
Clinical Folders for locating and viewing
existing orders as follows:

a. In the drop-down list for Group orders


by:, select Venue.
b. For Then by:, select Active/Inactive.
c. For Sort orders by:, select Order Name or
Chronological.
8. After you have created your filters, customized
your columns, and defined the group and sort
order for your Medications List pane, review
the screen to familiarize yourself with the
structure of the window and the location of
orders.

Note: You can click and drag column borders to adjust


your view of data in any column. If your data displays
ellipses (…) at the end, this indicates more information is
available. Hover over the data column to display the
additional information.

Continued on next page

66
Computerized Provider Order Entry (CPOE),
continued

The Orders Resize the Order Details Pane


Window
You can enlarge the Order details pane to view more
detail information or minimize the pane to view orders in
the Orders for Signature Pane.

Step Action
To enlarge the Order details pane…
1. Hover your mouse over the upper border of
the order details pane until a symbol
appears.

2. Hold down the left mouse button and drag


the window up or down to resize.
To minimize the Order details pane…
1. Click the down arrow in the upper left
corner of the pane.

2. To open the Order details pane, click the up


facing arrow in the lower left corner of the
Orders for Signature window.

Note: The Order details pane is only present when there is


an unsigned order in the Orders for Signature pane.

Continued on next page

67
Computerized Provider Order Entry (CPOE),
continued

Common Cerner uses images to denote order type, status, and


CPOE Icons other important information.

Order Type Inpatient Orders


Icons
Documented Meds by History (home meds)
Prescriptions
Ambulatory Orders
Order Additional Reference Information Order
Detail Icons
Order Details Not Complete
Dose Calculator
Order Physician Order with Pending Cosign
Review
Status Medical Student Order Cosign
Pending Pharmacy Review
Pending Nurse Review
Order Icons Order
Order Comment
Order Set
PowerPlan
PowerPlan Initiate Plan or Phase
Icons
View Excluded in PowerPlan
Discontinue PowerPlan or Phase

68
Order Entry Basics

Specialty Clinical specialty folders are available in the Orders and


Clinical Medication List bands. These folders have been populated
Folders with orders that are specific to your medical specialty.

Set Your To increase your ordering efficiency, set your clinical


Clinical specialty folder as your Home Folder so that you can
Specialty access it with one click.
Folder as
Your Home Step Action
Folder
1. Open the patient chart.
2. Click the Orders band.
3. Click + Add.
4. Click the Root Folder to view subfolders.

5. Click the appropriate subfolder to view


additional folders.

6. Right-click your specialty folder and click Set as


Home Folder.

7. Click to ensure that your specialty


folder is now set as your Home Folder.
8. To return to the Root Folder, click .

Note: If you are a resident changing specialties, you can


reselect the correct Home Folder with each rotation.

Continued on next page


69
Order Entry Basics, continued

Basic Order You can search for a single order, PowerPlan, or Orders
Search Set by the first word of the order name or by a specific
word contained in the order name. PowerPlans and Order
Sets are covered in further detail starting on page 79.

Note: You must enter at least 3 letters of the order name


to perform a Contains search. Entering too many letters
may increase the chances of misspelling your search word;
it is best to enter between 3 and 6 letters.

Search for By Order Name


Orders
Step Action
1. From the Orders band, click + Add.
2. Click the drop-down arrow to change the
Order Search criteria to Starts with, if not
already selected.

3. Enter your search word in the Search field.


A list of search results displays. Search results
may include synonyms for the same order.

4. Click the appropriate order once to select it.


Note: If you double-click, the order will be
duplicated. To remove a duplicate, right-click
and select Remove prior to signing the orders.

Continued on next page

70
Order Entry Basics, continued

Search for By “Contains”


Orders, Step Action
cont.
1. From the Orders band, click + Add.
2. Click the drop-down arrow to change the
Order Search criteria to Contains, if not
already selected.
3. Enter your search word in the Search field.
.
4. Click the appropriate order once to select it.

Enter Single Step Action


Orders 1. Search for the order.
2. Click the correct order in the search result list.
Note: For peds, it is preferable to select a
pediatric order set if available. CareSets
provide the best information for dosing and
ordering the medication in pediatrics.
3. If entering a medication order, select the order
sentence that best matches the intended
order.

The Order Details pane opens.

Note: Order details may need to be resized.

Continued on next page


71
Order Entry Basics, continued

Enter Single
Orders, Step Action
cont.
4. If displays, there are missing order
details. Click to move from
one missing detail to the next.
5. Highlight the Order detail, then complete or
change the corresponding Detail value.

6. Review all new order details in the Orders for


Signature pane.

7. Click Sign.
8. Click to refresh the screen.
Signed orders file into the corresponding clinical
category.

Continued on next page

72
Order Entry Basics, continued

Modify Use Modify to:


Orders • Adjust the rate (IV fluids, cont. infusions)
• Input stop date and time
• Add comments

Changes to the Details of a Signed Medication Order


Cancel/Reorder should NOT be used for Medication
Orders. If you need to make changes to other details of a
signed Medication Order, Cancel/DC the order and place
a new order with the corrected information.

If an order has not been acted upon and was placed in


error, you can Void it and place a new order.

Note: Always select Cancel/ DC to modify a Medication


Order unless you are modifying the:
• Rate of an IV fluid (must use modify)
• Stop date and time
• Comments

Continued on next page

73
Order Entry Basics, continued

Favorites You can create your own Favorites folders where you can
Folders store and access orders that you use frequently or orders
that are difficult to locate.

Create Favorites Folders

Step Action
1. Click the Orders band.
2. Click + Add.
3. Click the arrow by the Favorites icon.
4. Select Organize Favorites.

5. Add folders by clicking Create Folder.


Your first folder is a subfolder of the Favorites
folder.
6. To create a subfolder, highlight the parent
folder prior to clicking Create Folder.

Move Favorites Folders

Step Action
1. To move a folder to a different parent folder,
highlight the folder you need to move.
2. Click Move to Folder.
3. Select the appropriate parent folder.

4. Click OK.

Continued on next page


74
Order Entry Basics, continued

Favorites Rename Favorites Folders


Folders,
cont.
Step Action
1. To rename a folder, highlight the appropriate
folder.
2. Click Rename.
3. Type the new folder name in the text field.

Change Folder Order

Step Action
1. Highlight the appropriate folder.
2. Click to move the folder up or down.

Delete a Favorites Folder

Step Action
1. Highlight the folder.
2. Click Delete.
3. Confirm Deletion and click Yes.
4. When you are done managing folders, click
Close.

Note: Favorites Folders cannot be electronically shared with


others. One folder cannot be copied and placed into two
different parent folders. Each folder must be created
individually.

Continued on next page

75
Order Entry Basics, continued

Favorites Add Orders to Favorites Folders


Folders,
cont. You can add orders to your Favorites Folders as you write
orders. This allows you to save orders that have your
preferred order details already selected.

Step Action
1. Click the Orders band.
2. Search for the appropriate order.
3. Complete the order details.
4. Right-click the correct order.
5. Select Add to Favorites.
6. Highlight the folder where you need to save
the order.

7. Click OK.

Note: Signed orders cannot be added to a Favorites


Folder. If you have added order details, such as STAT
times, these order details will remain with the order in
your Favorites Folder.

Continued on next page

76
Order Entry Basics, continued

Medication
Order
Frequencies
Frequency Standard Administration Times
Daily 0900
QAM/ 0900/2100
QPM
At 2100
Bedtime
BID 0900, 2100
TID 0900, 1500, 2100
Four times 0900, 1300, 1700, 2100
daily
Q2 02, 04, 06, 08, 10, 12, 14, 16, 18, 20, 22,
24
Q4 0200, 0600, 1000, 1400, 1800, 2200
Q6 0600, 1200, 1800, 2400
Q8 0600, 1400, 2200
Q12 0900, 2100
Q_H The next hour after the order is written
and at the specified interval thereafter.

Note: Some medications (i.e., Warfarin) have


administration times that are non-standard.

Continued on next page

77
Order Entry Basics, continued

Standard Laboratory Order Collection Times


Schedules for Frequency Collection Time
IU Health
Daily & Default is 0600 unless there is a unit-
Every specific standard collection time (Orders
placed after 0600 will default to 0600
the Next Day)
Once Collection at the next even hour. Once is
the default frequency for ALL lab orders.
Q_H First Collection rounds to the next even
hour and the subsequent intervals are
based on the frequency chosen

Labs: Collection Priority and Results


Collection Results Definition
Priority Needed
Routine Routine Collection time = next even
hour unless there is a unit-
specific standard collection
time.
Results = routine turn-
around.
Routine Stat Collection time = next even
hour.
Results = stat turn-around.
Stat Routine Collection time = stat.
Results = routine turn-
around.
Stat Stat Collection time = stat.
Results = stat turn-around.

78
Order Entry Tools

Order Sets Order Sets are orders that are grouped together by
common use, disease, or process for ease of use.
An order set is denoted by .
Step Action
1. Select the appropriate orders within the order
set by placing a checkmark next to the order(s).
2. When all orders have been selected, click OK.
3. Sign the orders.
4. Click to refresh the screen.

PowerPlans A PowerPlan is an Order Set with added features to


optimize order entry.
• PowerPlans allow for faster planning
• All orders within a PowerPlan can be discontinued as a
group
• PowerPlans have been developed by Medical Specialty
and promote standardized order content
• A PowerPlan is indicated by

Locate a PowerPlan
Step Action
1. Click + Add on the Orders band.
2. In the Search window, search for the
appropriate Plan.

Note: If you click a PowerPlan to view the contents, the


PowerPlan remains in your Plans section. You must
remove the plan if you do not intend to use it by right-
clicking the title in the view pane and selecting Remove.

Continued on next page


79
Order Entry Tools, continued

PowerPlans, Using the Specialty and Favorites folders increases your


cont. order entry efficiency. PowerPlans and other common
orders pertinent to a given Medical Specialty have been
included in the Specialty folders.
• As you change services, set the appropriate Specialty
folder (e.g., Infectious Disease) as your Home Folder
• You can also use your Favorites folder to save any
additional orders that you may use recurrently.
PowerPlans: Place Orders

Step Action
1. Click a PowerPlan to open it.
2. Select/deselect orders from the Plan by
placing/removing a checkmark in the box next
to the order name.
Note: Order details can be completed in
several ways. To proceed with this, ensure
that the box next to the appropriate order is
checked.
3. When an order has alternate order options, a
down arrow displays. Proceed as follows:
a. Click the arrow to select alternate order
details such as dose, frequency or rates
for your orders.
b. Click the appropriate details from the
drop-down list that displays.

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80
Order Entry Tools, continued

PowerPlans, PowerPlans: Place Orders, cont.


cont.
Step Action
4. When an order does not have an arrow
option, proceed as follows:
a. Right-click and select Modify Planned
Order.
b. Complete the required details.
c. If the screen is obscured by the Order
Details, use to resize the Order
Details screen.
5. As you select/deselect orders in the
PowerPlan, review and modify the order
details as you select each order.
Note: Do not click Sign until you have
completed all your orders and their
associated details.
6. If an order is not included in a PowerPlan and
needs to be added, proceed as follows:
a. Click + Add to Phase.
b. Click Add Order.
c. Search for the order.
d. Complete the order details.
The new order is then grouped within the
selected PowerPlan.

Continued on next page

81
Order Entry Tools, continued

PowerPlans, PowerPlans: Place Orders, cont.


cont.
Orders that are added outside of a PowerPlan ( )
behave differently than those orders added within a
PowerPlan ( ).

Orders are not grouped Orders are grouped with


with the PowerPlan the PowerPlan
Orders only display in Orders display with
the Orders section of the other PowerPlan orders
view pane and not in the
PowerPlan section
Orders cannot be placed Orders can be placed in
in Planned status Planned status
Orders need to be Orders can be
discontinued individually discontinued together
when you discontinue
the PowerPlan

Note: Follow these guidelines:


• Only single orders can be added to PowerPlans using
Add to Phase
• PowerPlans and Order Sets cannot be added to a
PowerPlan and can ONLY be ordered using + Add
• + Add must be used to place an order outside of the
PowerPlan.

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82
Order Entry Tools, continued

PowerPlans, PowerPlans: Add Subphases


cont. • Subphases are subsets of orders in a PowerPlan
• DVT and PUD prophylaxis and other diagnosis-based
orders such as Pneumonia orders are built in as
Subphases of the PowerPlans
• A Subphase is indicated by
Step Action
1. Locate the appropriate Subphase.
2. Place a checkmark in the box next to the
Subphase.

3. Select the Subphase in the view pane.

4. View and enter orders within that Subphase.


5. To review ALL of your orders, you MUST
return to your main PowerPlan in the view
pane.

Note: You can also use Subphases as stand-alone orders.


For example: if your patient develops pneumonia during
a hospital stay, just search for the Pneumonia Subphase
(denoted as “mini” as opposed to “admission”), and
then use this as a stand-alone PowerPlan without having
to use a full Admission Profile.

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83
Order Entry Tools, continued

PowerPlans, PowerPlans: Planned or Initiated


cont. You have the option to leave your orders in a Planned
state or to Initiate the orders.
Planned= Orders NOT Active
Initiate= Orders ARE Active

Place a PowerPlan in Planned State


Step Action
1. After selecting the appropriate orders, click
Orders for Signature.
2. Click Sign.
3. Click to refresh.
A pending PowerPlan displays in the Plans
section of the view pane as follows:

Initiate a PowerPlan Later


Step Action
1. To initiate a PowerPlan later, highlight the
PowerPlan in the view pane.

2. Click .
3. Click Orders for Signature.
4. Click Sign.
5. Click to refresh.

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84
Order Entry Tools, continued

PowerPlans, Initiate a PowerPlan Immediately


cont.
A PowerPlan can be initiated immediately using
at the time that the orders are entered.

PowerPlans: Add Orders to an Initiated Plan

You can add orders to a PowerPlan after it has been


initiated in one of two ways.
a. You can select orders that reside in the PowerPlan
but were not initially selected, or
b. You can add outside orders to the PowerPlan

Step Action
1. Select the PowerPlan by clicking the initiated
PowerPlan name in the view pane.

2. Click (View Excluded) to check for orders


in the Plan that were not initially selected.
Note: Orders already selected display with a
checkmark.
3. Place a checkmark by those orders you need
to add to the PowerPlan.

Continued on next page

85
Order Entry Tools, continued

PowerPlans, PowerPlans: Add Orders to an Initiated Plan, cont.


cont.
Step Action
4. Conversely, you can remove orders from the
PowerPlan by removing an existing
checkmark.

5. If the needed order does not exist in the


PowerPlan, click + Add to Phase.
6. Search for the order(s) and click Done when
all orders have been added.
Note: Clicking more than once on an order
will duplicate it in the PowerPlan.
7. Review your orders and sign as usual.

86
Medication Order Entry

Order an
Immunization Step Action
/PPD
1. Select the order sentence with a frequency of
ONCE.
2. Change the Requested Start Date/Time to
tomorrow’s date at 0900, unless you have
reason to schedule otherwise.

IV – Fixed
Rate Step Action
1. Click + Add in the Orders band.
2. Type the first few letters of the fluid to be
ordered. (i.e., "Sod" for Sodium Chloride,
"Dext" for Dextrose, "Lacta" for Lactated
Ringers).
Note: You may also search using the
synonyms: D5, LR, D10, NS, ½ NS.
3. Select the correct order from list.
4. Select the correct order sentence.
5. Verify the correct diluent (e.g., Dextrose 5%)
and additive (Potassium Chloride).
6. Enter or change any missing order details.
Note: When you select the rate, the Infuse
Over detail calculates automatically.

7. Add comments, if needed.


8. Verify all information is correct and click Sign.

Continued on next page


87
Medication Order Entry, continued

IV – Fluid Step Action


Bolus 1. Click + Add in the Orders band.
2. Begin typing the name of the fluid to be bolused.

3. Select the order for the fluid that includes bolus


in the name.
4. Select the correct order sentence.
The fluid and free-text rate of “bolus” default in
the Continuous Details tab.

5. Add the volume of fluid to be infused, if less


than the size of the bag ordered.
Note: This is required for Pediatrics.

IV: Step Action


Titratable 1. Click + Add in the Orders band.
Drip
2. Search for the medication name.
3. Select the correct order from the list (drug
name + adult-titrate or peds-titrate).
4. Enter Order Comments in the continuous
details pane.
5. Complete the information for the drip order.
6. Add information for any PRN bolus orders.
Note: Pharmacy will complete the order entry.
7. Verify all information and click Sign.

Continued on next page


88
Medication Order Entry, continued

IV – Step Action
Heparin 1. Click the Orders band.
Nomogram
and
2. Click + Add.
Thrombo- 3. Type "Hep".
stabilizer 4. Select the appropriate Heparin Nomogram
Infusions /Thrombostabilizer PowerPlan.
5. Check or uncheck orders as you would any
other PowerPlan.
6. Review the Heparin drip order.
Note: The rate defaults as Per Nomogram.
7. Click Initiate and then Orders for Signature.
8. Click Sign and Refresh.

IV – TPN Ordering TPN at IU Health Ball Memorial Hospital: At Ball


Adult Memorial to order TPN, enter an order for ‘Write/Manage
TPN’ and a pharmacist and dietitian will evaluate the
patient for the most appropriate formula.

Ordering TPN at all other IU Health CPOE Facilities:

Adult Day 1/Initial Order

Step Action
1. Click + Add in the Orders band.
2. Enter “TPN” in the Search window.

Continued on next page

89
Medication Order Entry, continued

IV – TPN Adult Day 1/Initial Order, cont.


Adult, cont. Step Action
3. Select the appropriate PowerPlan: TPN
Parenteral Nutrition.
Note: Failure to select the correct order may
result in delays or incorrect formulation.

4. Select the appropriate formulation.

5. Review the orders that have been included


with the PowerPlan by scrolling down.
6. Make additional selections or changes. When
finished selecting orders, click Initiate.
Only when you click Initiate in the TPN
PowerPlan does the PowerForm appear for you
to complete.

Continued on next page


90
Medication Order Entry, continued

IV – TPN Adult Day 1/Initial Order, cont.


Adult, cont.
Step Action
7. A PowerForm opens to complete the details for
the TPN order. All highlighted fields must be
completed before you will be able to sign the
PowerForm.

8. Complete all necessary details.


• Indicate the amount of any additives to be
included in the TPN
• All required fields call for a value. If you do
not want an additive, enter zero
Note: The Comments section is for Pharmacy
Use Only. Any comments to Nursing (i.e.,
tapering rates) must be entered on the Order
Comments Tab of the TPN Order and not on
the comments section of the TPN PowerForm.

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91
Medication Order Entry, continued

IV – TPN Adult Day 1/Initial Order, cont.


Adult, cont.
Step Action
9. Click the green check mark in the
upper left corner to sign the PowerForm.
10. Volume is calculated based upon additives,
patient’s weight, etc. and is determined by
Pharmacy.
Start date and time for the order default to the
standard hang time for the facility.
11. Click Orders for Signature, Sign, then Refresh.

Note: You can review the information entered on a TPN


order at any time from the Forms band or the TPN
Therapy Analysis tab in the Results Review band.

Continued on next page

92
Medication Order Entry, continued

IV – TPN Adult Day 2 and Onward


Adult, cont.
After completing the initial TPN PowerForm using the TPN
PowerPlan, subsequent TPN PowerForms prepopulate
with the previously selected values for the additive fields.

Step Action
1. When entering ongoing daily TPN orders,
search for “TPN”.
2. Select the appropriate single TPN order and
NOT the PowerPlan or Order Set.

3. The PowerForm with the data from the


previous order displays. Modify the
PowerForm as needed.
4. Click the green checkmark in the upper
left corner to sign the PowerForm.
After signing the PowerForm, the order is
signed as usual.

Note: The TPN orders from the prior day automatically


expire at 24 hours after the standard hang time for the
facility.

Continued on next page

93
Medication Order Entry, continued

IV – TPN After completing the initial TPN PowerForm using the TPN-
Pediatric Neonatal or TPN-Peds order, subsequent TPN PowerForms
and prepopulate with the previously selected values for the
Neonatal
additive fields.

Step Action
1. When entering a TPN order, search for “TPN”.
2. Select the appropriate single TPN order, TPN-
Neonatal or TPN-Peds, and NOT a PowerPlan or
Order Set.

3. Select the correct order sentence and click OK.

Continued on next page

94
Medication Order Entry, continued

IV – TPN
Pediatric Step Action
and
4. A PowerForm opens to complete the details for
Neonatal,
cont. the TPN order. All highlighted fields must be
completed before you will be able to sign the
PowerForm.

5. On subsequent days after the initial order, the


PowerForm with the data from the previous
order displays. Modify the PowerForm as
needed.
6. Click the green checkmark in the upper
left corner to sign the PowerForm.
After signing the PowerForm, the order is
signed as usual.

Continued on next page

95
Medication Order Entry, continued

IV – TPN These guidelines apply to IV – TPN Pediatric and TPN


Pediatric Neonatal:
and
Neonatal,
• Enter any associated lab orders from your Home
cont.
folder

• The TPN orders from the prior day automatically


expire at 24 hours after the standard hang time for
the facility

• You can review the information entered on a TPN


order at any time from the Forms band or the TPN
Therapy Analysis tab in the Results Review band

Medications:
Dose Range Step Action
Orders
1. Click + Add in the Orders band.
2. Search for the medication name.
3. Select the medication order.
4. Enter the highest dose.
5. Enter the shortest frequency.
6. Open the Order Comments Tab.
7. Enter the dose range (e.g., DOSE RANGE 1-
2mg q2-4 hours).
8. Click Sign.

Continued on next page

96
Medication Order Entry, continued

Medications: In most instances, if you need to hold a single dose of a


Hold a medication (i.e., for a procedure, you will enter a Hold
Single Dose Medication Dose(s) order). Pharmacy will use this
information to communicate that the dose is to be held.

Note: Do not forget to also communicate directly with the


nurse.

Step Action
1. Click + Add in the Orders band.
2. Search for Hold Medication Dose.
The Order details window opens with the
instruction: Must Complete Order Comments.

3. On the Order Comments tab, type the name of


the medication and dose(s) to be held.
Note: Each medication must have its own hold
order.

Note: If you need to hold a medication for an


undetermined amount of time, discontinue and enter a
new order when you need to restart

Continued on next page

97
Medication Order Entry, continued

Medications: Irrigation orders can be entered either for intermittent


Irrigation or continuous Medication irrigation solutions.
Orders
• Select the order sentence with the route of
IRRIGATION when ordering to communicate that
these orders are to be used for irrigation.
• If Continuous, the Continuous Details screen will
open for entry of Rate or Infuse Over field.

Medications: A PRN medication order must include each indication


Multiple PRN that is associated with the order.
Reasons

Medications: If you are entering orders for a medication and would


Multiple like to indicate administration by more than one route
Route Orders (e.g., Tylenol orally or suppository), you need to
enter 2 separate orders: one order for the medication to
be given orally and the other for the medication to be
given rectally.

Continued on next page

98
Medication Order Entry, continued

Medications: If you enter a non-formulary medication substitution,


Non- you are presented with either:
Formulary/ a. The Physician Request for Non-formulary Drug
Substitution
form. Complete this form as indicated.
OR
b. Therapeutic Interchange Order Set with formulary
compliant medication. Select the appropriate order
from the information provided. Complete Order
details and sign.

Alerts You are presented with an alert if you order a non-


standard dose. Standard medication doses have been
approved by the System P & T Committee. If a non-
standard dose is ordered, the following alert will display:

Continued on next page

99
Medication Order Entry, continued

Alerts, To avoid receiving this alert, make sure that you:


cont.
a. Select Apply Standard Dose in the dose calculator
window when it appears.

b. Select a pre-built order sentence.

Continued on next page

100
Medication Order Entry, continued

Medications:
One-time Step Action
STAT Doses 1. Click + Add in the Orders band.
2. Search for a medication to be ordered STAT.
3. On the Order Details tab, click Pharmacy
Order Priority (on the left) and select STAT
from the Detail values list (on the right).

4. In the Frequency detail, select ONCE.


5. Review the Requested Start Date and Time.
6. If start date and time are correct, click Sign.

Medications: To enter a STAT and an ongoing dose of a medication,


STAT Doses enter two separate orders. One entry is for the STAT
with Ongoing order and the second entry is for the ongoing order.
Orders
Note: It is very important to ensure that the start date
and time of the ongoing order is appropriately spaced,
based on the ordered frequency in relation to the stat
dose.
• STAT = Medication must be administered within 15
minutes
• Now = Medication must be administered within 1
hour

Continued on next page


101
Medication Order Entry, continued

Medications:
Patches Step Action
1. Click + Add in the Orders band.
2. Search for the medication name.
3. Select the appropriate medication patch
order set.
Note: Medication patches are built into the
system as order sets because the patch
order needs to be paired with a patch
removal order. The patch removal order is
automatically checked, so it will always be
ordered.
4. Select the appropriate patch strength and
complete the order details.
Note: The patch removal order serves as a
reminder to the nurse to remove the
previous patch before placing a new one.

Medications:
Taper Doses Step Action
1. Click + Add in the Orders band.
2. Search for the medication name and select
the orderable with the term "taper" after
the order (e.g., Prednisone taper).
Order Details opens with the instructions:
Must Complete Order Comments.

Continued on next page

102
Medication Order Entry, continued

Medications:
Taper Doses, Step Action
cont.
3. In the Order Comments tab, enter your
tapering regimen (e.g., Prednisone 60mg po
daily x 6 doses, 40mg po daily x 6 doses,
etc.).

4. Click Sign.

Medications: If the medication you are ordering does not have a taper
Taper Dose, order in the system when you search for the drug name:
No Existing
Taper Order
Step Action
1. Enter "Pharmacy taper”.
Order Details opens with instructions: Must
Complete Order Comments.
2. In the Order Comments tab, in addition to
the tapering regimen, you MUST also enter
the name of the medication.
3. Click Sign.

Continued on next page

103
Medication Order Entry, continued

Medications: Enter a Prescription Order


Prescriptions
Step Action
1. Prior to your order search, change the
catalog Type to Prescriptions.

2. Search for the medication.


3. Select the prescription order sentence that
contains the correct details.
4. If you need to change a selected order
sentence, click the drop-down next to the
order name in the Details pane.

5. In the Details pane, move from one missing


detail field to the next using the Next
Missing Required Detail button or the
yellow arrow.

Note: The following symbols are used in


prescription order details:
Symbo Meaning
l
Most common
Common
Uncommon
Generic Value

Continued on next page

104
Medication Order Entry, continued

Medications: Enter a Prescription Order, cont.


Prescriptions,
cont.
Step Action
6. Select the type of therapy for the
prescription.

Note: A stop date and time automatically


calculates for Acute types of therapy.
7. For maintenance prescriptions, select the
dispense quantity (30 or 90 day supply).

8. If you need the dose calculator, click


(Open Dose Calculator).

Continued on next page

105
Medication Order Entry, continued

Medications: Safeguard Printed Patient Information


Prescriptions,
cont. Follow these guidelines for printing reports:

You Are Printing a Report You Find a Printed Report


Carefully select the correct printer If you find a report containing
from the drop-down menu. patient information on a printer,
contact the person who printed
the report.
Retrieve the printed report from If unable to contact the report
the printer immediately. owner, place the report in the
shred box.
If the report did not print, reselect If the report prints a second time,
the correct printer and attempt to contact the Service Desk at 317-
print the report again. 962-2828 and report the computer
name, location, and the name of
the printer where the report
printed.
If the report does not print after a Place the report in the shred box.
second attempt, contact the
Service Desk at 962-2828.

Continued on next page

106
Medication Order Entry, continued

Medications: Add a Prescription Printer to Favorites


Prescriptions, When you place Prescription orders within Cerner, you
cont. need to choose the appropriate prescription printer. If
you regularly print prescriptions in multiple areas, you
need to set up prescription printers in your Favorites.

Step Action
1. Click + Add and select prescriptions from
the Type drop-down.

2. Search for the medication.


3. Select the prescription order sentence that
contains the correct details.
4. Click the ellipses next to the Send To field in
the Details pane.

The Prescription Routing window displays.

Continued on next page


107
Medication Order Entry, continued

Medications: Add a Prescription Printer to Favorites, cont.


Prescriptions,
cont.
Step Action
5. In the Prescription Routing window:
a. Select Printer in *Send to.
b. Select All Pending Non-Tamperproof
Prescriptions in Apply to.
c. Select Always use the default output
destination associated with the
computer that I am using.
6. If the printer you need to use in your current
location is not already listed in the Favorites
tab, click the Other Output Devices tab and
scroll to the appropriate facility printer
location.

7. Click the + to the left of the facility. Click


again on the + to the left of the facility.
The Unit Locations display.
8. Click the Unit Location to highlight it.
Caution: Do NOT click the + next to the unit
name.
The prescription printers for that unit display
with “Rx” in the name.

Continued on next page

108
Medication Order Entry, continued

Medications: Add a Prescription Printer, cont.


Prescriptions,
cont.
Step Action
9. Right-click the appropriate printer and select
Add to Favorites.
The printer displays in your Favorites tab.

10. If you need to add additional printers:


a. Click the Other Output Devices tab
again.
b. Locate additional printers.
c. Right-click and select Add to Favorites.
11. When you have added all of your needed
printers, click OK.
12. Prior to signing the prescription, ensure that
the proper prescription printer is displayed
in the Send To box.

109
Medication Order Entry, continued

Medications: Change a Prescription Printer


Prescriptions,
cont. The last prescription printer that you used automatically
displays in the Send To box. If you are placing
prescription orders in a different location, the correct
printer must be selected.

Step Action
1. Click the ellipses to the right of the Send To
box.

2. In the Favorites tab, highlight the desired


printer and click OK.

Note: If the correct printer does not display


in the Favorites tab, follow the Add a
Prescription Printer instructions.
3. Ensure that the correct printer name
displays in the Send To box.
4. Complete and sign the prescription orders.

Continued on next page

110
Medication Order Entry, continued

Medications: Prescriptions Sent to Wrong Printer


Prescriptions,
If you routed a prescription to the wrong printer, you
cont.
are responsible for making sure that the prescription is
disposed of and not left unattended or unretrieved on
the prescription printer.
Step Action
1. Highlight the electronic prescription orders
that were sent to the incorrect printer.
Note: You can re-route multiple
prescriptions at one time by highlighting all
of the incorrectly printed prescription
orders.

2. Once the prescriptions are highlighted, right-


click the highlighted area and select Resend.
3. Select the correct printer from the Output
Devices window.

4. Click OK to reprint the prescriptions.

111
Dosage Calculator

Introduction The Dosage Calculator is available when you place


inpatient medication and outpatient prescription orders.
The Dosage Calculator is used to order weight-based
medications.

Where to The dose calculator opens automatically when you place


Find the an order that contains mg/kg, mcg/kg or other weight-
Dosage based dose calculations.
Calculator

Continued on next page

112
Dosage Calculator, continued

Calculation The Dosage Calculator provides several options for


Options by calculating correct dosing for a patient’s weight:
Weight
• Apply a Standard Dose
• Select a Rounding Rule for normalized doses
• Manually enter a Final Dose

Calculate Step Action


Standard 1. Complete the following:
Doses
a. Review Dose Values for accuracy based on
patient weight.
b. Select the appropriate Rounding Rule for
this dose.

Note: Click Apply Standard Dose, when


available.

Continued on next page

113
Dosage Calculator, continued

Calculate
Standard Step Action
Doses,
2. Using the drop-down menu, evaluate the
cont.
Rounding Rule for this medication and patient
weight.

3. Select a rounding parameter based on your


clinical judgment.
Note: In most instances, the nearest whole
number or nearest tenth is appropriate.

Continued on next page

114
Dosage Calculator, continued

Calculate
Standard Step Action
Doses
4. If the available dosing options are not
(continued)
appropriate, then type the appropriate dose in
the Final Dose field.
The mg/kg automatically calculates and the
Rounding Rule updates to Manually Entered.
5. Click Apply Dose.

115
Pediatric Antimicrobial Stewardship

Introduction Antimicrobial overuse contributes to the growing problem


of drug resistance in healthcare facilities and in the
community. Improving antibiotic use through stewardship
interventions and programs:
• Improves patient outcomes
• Reduces antimicrobial resistance
• Saves money

Orders In an effort to focus on improving antimicrobial use in


inpatient healthcare settings, orders have been developed
that incorporate antimicrobial stewardship. These
antimicrobial stewardship orders are interventions
designed to ensure that hospitalized patients receive the
right medication at the right dose, at the right time, and
for the right duration.

Program The IU Health Pediatric Antimicrobial Stewardship program,


Goals or PAS, was developed with the following goals:
• Provide optimal, evidence-based pediatric dosing for all
IV antimicrobials in order to prevent underdosing and
emergence of resistance as well as overdosing and
associated toxicities
• Reduce and or prevent the emergence of resistance
through appropriate utilization
• Manage the use of expensive antimicrobials in a fiscally
responsible manner
• Impact practice by educating providers on the
appropriate use of antimicrobials for specific indications

Continued on next page

116
Pediatric Antimicrobial Stewardship, continued

PowerPlans To facilitate the appropriate use of IV antimicrobial


agents, individual PowerPlans have been developed for
each agent. The PowerPlans assist the clinician in
determining a custom antimicrobial dose for their patient.

Antimicrobial subphases have also been inserted into


PowerPlans under the Medications header within the
PowerPlan.

Organization of The antimicrobial agents are divided into subcategories


Antimicrobial based on diagnosis. Each antimicrobial is identified by its
Agents drug name and whether it is intended for pediatrics or
neonates.

Continued on next page

117
Pediatric Antimicrobial Stewardship, continued

Place Antibiotic PowerPlans have distinct sections to aid ordering.


Orders
from a • You can generate orders based on diagnosis
Subphase
• There is also an option for one time dose ordering
• There is an option for peri-op prophylaxis ordering built
into individual plans where applicable
• Plans for certain agents may also include Restart of
Previous Established Dose and Dose Change Ordering
options
Note: With both of these options, the doses and
frequencies are left blank for the physician to fill
in the established dose or put a distinct dose in
that field if they are increasing or decreasing from
a previous dose.

Step Action
1. Select the appropriate subphase by placing a
checkmark in the box next to it.

Caution: Be careful when selecting an


antimicrobial subphase. For each agent, there
may be separate subphases for pediatric and
neonate.

Continued on next page

118
Pediatric Antimicrobial Stewardship, continued

Place Orders Step Action


from a 2. Click the selected subphase in the View pane
Subphase,
to navigate to the orders.
cont.

Note: Once inside the plan, notice the robust


dosing information provided to assist with
antimicrobial ordering.

3. If the pharmacokinetic calculations of a


patient already on an antimicrobial necessitate
a change in dosage, select the Dose Change
Ordering option and enter the new dosage
and frequency.
Caution: Be sure to adjust the start time of the
new dose and frequency. The Cerner default
start time for a “Q__H, (or interval)”
medication would be the next hour.

Continued on next page


119
Pediatric Antimicrobial Stewardship, continued

Place Step Action


Orders 4. If your patient was recently discharged and had
from a
previously received a calculated dose/frequency
Subphase,
cont. of an antimicrobial or the patient’s antibiotic was
discontinued, use the Previously Established
Dose option.
Note: In this situation, you could use the Restart
of Previously Established Dose option. Rather
than using a normalized dose, this allows you to
simply enter the order details as the dose and
frequency.
5. Once you have selected the ordering option that
applies to your patient, use the available dosing
information to make order selections.

6. At this point, you could navigate back to your


main PowerPlan and continue selecting and
deselecting orders as necessary.

Continued on next page

120
Pediatric Antimicrobial Stewardship, continued

Place
Orders from Step Action
a Subphase,
7. If a new IV antimicrobial order is being entered
cont.
within 24 hours of the patient’s admission, this
PowerForm displays. In order to complete the
antimicrobial order, provide documentation of
the prior administered doses including doses
administered at a prior hospital, en route, in
the ED, etc.

Note: In order to prevent medication variances


caused by the administration of antimicrobial
doses too close together, select groups of
medications have Prior Dose documentation
built into their plans.
8. After you complete your documentation, click
the green checkmark to save the form
and continue ordering.

Continued on next page

121
Pediatric Antimicrobial Stewardship, continued

Place
Orders Step Action
from a
9. Enter a Separate PowerPlan for a Missing
Subphase,
cont. Antimicrobial

If, while in the process of ordering a PowerPlan,


a desired antimicrobial is not included as a
subphase, you need to enter a separate
PowerPlan for this agent. Most plans can be
located by searching your specialty folder.

• There is not a subphase for every


antimicrobial agent in every PowerPlan
Note: The decision to include a
specific agent within a specific plan
was evidence-based.

• PowerPlan and Order Sets cannot be added


to other PowerPlans via the Add to Phase
button
Note: Only individual orders can be
added using Add to Phase.

Locate an Each antimicrobial agent has its own stand-alone


Antimicrobial PowerPlan. To locate an antimicrobial agent PowerPlan,
Agent search the catalog by the agent's name.
PowerPlan
Note: Remember to select the pediatric option.

Continued on next page

122
Pediatric Antimicrobial Stewardship, continued

Restricted An agent may be identified as a Restricted Agent.


Agents Restricted Antimicrobial Agents must meet utilization
criteria prior to initiation.

Note: When ordering a restricted agent at Riley Hospital,


prior authorization from the PAS team is required.

Order a Restricted Agent

Step Action
1. Once inside the Antimicrobial PowerPlan, select
and deselect orders as you normally would.

An alert fires once you attempt to initiate the


order.

Note: The restricted antimicrobial agent alert is


only in place at Riley Hospital. The remaining IU
Health facilities conducted respective review of
restricted antimicrobial orders.

Continued on next page

123
Pediatric Antimicrobial Stewardship, continued

Restricted Order a Restricted Agent, cont.


Agents,
cont. Step Action
2. When you receive the alert, either:
• Select Cancel the Order to obtain approval,
or
• Select Override the Alert if approval has
already been obtained or you are on the ID
Service
Note: If the clinician who approved the
antimicrobial is not documented, pharmacy
will page you for the information. The PAS
pager is also automatically paged when a
restricted agent is entered.
3. From within the Override Reason Form, select
from the following options:
• Prescriber is PAS Team Member
o If you are a member of the PAS Team
• Received PAS on call approval
o If you have received approval from
the PAS Team. After selecting this
option, document the PAS team
member’s name in the Additional
Freetext Override Reason field

Continued on next page

124
Pediatric Antimicrobial Stewardship, continued

Restricted Order a Restricted Agent, cont.


Agents,
cont.
Step Action
3. From within the Override Reason Form, select
from the following options: (cont.)

• Written Recommendation from ID service

o If a consultation has been completed


by ID Service and orders are being
entered based on consultation
recommendations
4. Once you have completed your
documentation, click OK to close the Override
Reason Form.
5. Click OK again to close the alert window.

125
Medical Student Orders

Overview: Orders entered by Medical Students are placed in an On


Medical Hold, Med Student status and are NOT active until the
Student supervising physician (resident or attending) cosigns the
Orders
order in Cerner.
The symbol is associated with Medical Student
orders.

Medical Student Filter View

To ensure you are able to view orders properly, you


must select an appropriate display filter on the Orders
Band. Select one of the following filters labeled:
• All Active + 1 Day Inactive + Med Student – No Home
Meds, or
• All Active + 5 Day Inactive + Med Student – No Home
Meds

Medical Medical Student: Order Entry


Students:
Order Orders entered by Medical Students are not active until
Processes
they have been cosigned by the Supervising Physician.
Orders must be routed to the Supervising Physician for
approval.

Continued on next page

126
Medical Student Orders, continued

Medical Medical Student: Order Entry, cont.


Students: Step Action
Order
1. Search for and select the first order.
Processes,
cont. 2. In the Ordering Physician pop-up window,
enter the following:
• Enter the Physician Name to whom the
order will be routed for co-signature.
The order is routed to the physician's
Inbox in Message Center.
• Leave the default as Written for
Communication Type.

Note: The Ordering Physician window will


pop-up only once per ordering session.
3. Click OK.
4. Complete the details for the order.
5. Search for and select any additional orders.
6. Click Sign.
Note: Notice that the order displays with the
status of On Hold, Med Student.

Continued on next page

127
Medical Student Orders, continued

Medical Medical Student: PowerPlan Orders


Students: Medical students can enter PowerPlan orders; however,
Order in order for the orders to be reviewed and approved by
Processes,
the Supervising Physician, the PowerPlan orders entered
cont.
by a Medical Student must always be initiated.
Step Action
1. Select the PowerPlan from the Orders search
window.
2. Enter the Ordering Physician (as with single
order entry).

3. Select the orders and ensure order details


are appropriate.
4. When all order selection is completed, you
must BOTH SIGN & INITIATE the PowerPlan.
Note: A PowerPlan must be initiated and
cannot be left in a planned status. If a
PowerPlan is left in a planned status, an alert
displays. Return to the patient chart to
initiate or void the PowerPlan.

Continued on next page

128
Medical Student Orders, continued

Medical Medical Student: Discontinue Orders


Students:
Order
Step Action
Processes,
cont. 1. Search for and select the DC Existing Order
(Medical Student Order Entry) order.

Note: For ordering efficiency, right-click the


DC Existing Order (Medical Student Order
Entry) and save to your Favorites.
2. Complete the order detail specifying the
order to be discontinued with as much
details as possible including:
• Dose
• Route
• Frequency of the order(s)

(e.g., Please discontinue the 2mg Ativan q6


order)
3. Click Sign.
The Alert below displays reminding you to
follow up with your Supervising Physician to
take the action of actually discontinuing this
order.

Continued on next page


129
Medical Student Orders, continued

Providers: Provider: Co-Sign Med Student Orders


Medical
Student Follow the steps in the table below to co-sign an order
Order
entered by a Medical Student.
Processes
Note: Use Message Center only to initially preview the
order sent by the Medical Student and to open the
appropriate Patient Chart. All actions taken on the
student's Order MUST be taken from the Orders section
of the patient chart and NOT from Message Center.

Step Action
1. While in Message Center, select Med
Student Orders from the Inbox Summary.

2. In the view pane, double-click the


appropriate order and review the details.

Note: DO NOT take any action on the order


from this screen; manage order approval
from within the patient chart.

Continued on next page

130
Medical Student Orders, continued

Providers: Provider: Co-Sign Med Student Orders, cont.


Medical
Student
Step Action
Order
Processes, 3. Click the patient name and open the patient
cont. chart.

4. Go to the Orders band and review all


existing orders on this patient.

Note: Notice that Medical Student orders


have an On Hold status and are denoted
with an icon .
5. Click Orders for Cosignature.
Note: You will be presented with both On
Hold Medical Student orders (On Hold
Orders Pending Co-Signature) and also
Verbal Orders from your colleagues (Order
Actions Pending Co-Signature) for review
prior to co-sign.

Continued on next page

131
Medical Student Orders, continued

Providers: Provider: Co-Sign Med Student Orders, cont.


Medical
Student
Step Action
Order
Processes, 6. Review all orders requiring co-signature.
cont.

7. Deselect any incorrect orders that will NOT


be co-signed.
8. Click Cosign to close the Actions Requiring
Co-Signature window and return to Message
Center.
9. Click to refresh.
The co-signed orders have been removed.

Provider: D/C Medical Student Orders

Step Action
1. While in Message Center, select Med
Student Orders from the Inbox Summary.
2. Double-click the appropriate order and
review the details.

Note: DO NOT take any action on the order


from this screen; manage order approval
from within the patient chart.

Continued on next page

132
Medical Student Orders, continued

Providers: Provider: D/C Medical Student Orders, cont.


Medical
Student
Step Action
Order
Processes, 3. Click the patient name and open the patient
cont. chart.
4. Locate the Discontinue Order under the
Other Departments section.

5. If the discontinue request is appropriate,


select the order to be discontinued and
uncheck (Quick Discontinue box)
in front of the order.
The order now has a strikethrough.
6. Sign the order as usual.
7. Click Orders For Cosignature.
8. Click Cosign to approve the original DC
Medical Student order on which you have
taken action; then close the Actions
Requiring Cosignature window.
9. Click to refresh.

Continued on next page

133
Medical Student Orders, continued

Providers: Provider: Refuse Med Student Order Co-Signature


Medical
Student Follow the steps in the table below to manage Medical
Order
Student orders that you do not want to approve.
Processes,
cont.
Step Action
1. While in Message Center, select Med
Student Orders from the Inbox Summary.
2. Double-click the appropriate order and
review the details.
Note: DO NOT REFUSE an order in the
Message Center that you do not approve of;
manage Refusal from within the patient
chart.
3. Click the patient name and open the patient
chart.
4. Click the Orders band.
5. Right-click the order that you do not want to
approve.
6. Select Void.

Continued on next page

134
Medical Student Orders, continued

Providers: Provider: Refuse Med Student Order Co-Signature,


Medical cont.
Student
Order
Processes,
Step Action
cont. 7. Enter a void reason.

8. Click Orders for Signature and complete the


signature process as you normally would.
9. Click to refresh.
The voided order has been removed.

Note: DO NOT USE Refuse for an order in Message


Center that you do not approve. You must go to the
original order, right-click and VOID this order to remove
it from the patient chart.

135
Other Order Entry Processes

DNR Orders Code Status orders can be placed by residents and


faculty/attending staff. However, all Code Status orders
that are less than Full Code orders must be cosigned by
the designated attending physician if placed by
residents. The Code Status Order Form (DNR/ Limited
Code) must be manually forwarded to the attending for
cosignature.

DNR Order Process

Step Action
1. Select the DNR order in the order entry field.

The Code Status Order Form (DNR)


PowerForm launches.

2. Complete the details within the PowerForm.

Continued on next page

136
Other Order Entry Processes, continued

DNR Orders, DNR Order Process, cont.


cont.
Step Action
3. Sign the PowerForm by clicking the green
checkmark at the top left.
An alert presents when the PowerForm is
signed.

4. Click OK to close the Alert window.


You are returned to the Orders for Signature
window.
5. Sign the DNR Order.

Note: The Code Status Order From must be manually


forwarded to the designated attending physician to be
cosigned.

Continued on next page

137
Other Order Entry Processes, continued

DNR Orders, DNR Order: Resident Forward


cont.
Step Action
1. Open the 2 Year Clinical Notes folder and
locate the Code Status Order Form you just
completed.

2. Click the Code Status Order Form so that the


note is displayed in the view pane.

3. Right-click within the note and select the


Forward option.
4. Change the Additional Forward Action
option to sign.

5. Insert the name of the attending physician


into the To: section of the window.
6. Click OK to send the request.

Continued on next page

138
Other Order Entry Processes, continued

DNR Orders, DNR: Attending Staff


cont.
When a resident places a DNR order, the Code Status
Order Form must be cosigned by the designated
attending physician. The Code Status Order Form is
cosigned in the Message Center.

Step Action
1. Within the Documents folder located in the
Message Center, identify any documents
requiring cosignature.

2. Highlight the correct document for


cosignature and double-click to open the
note.

Continued on next page

139
Other Order Entry Processes, continued

DNR Orders, DNR: Attending Staff, cont.


cont.
Step Action
3. Review the document and click OK to cosign
the note.
4. If you need to modify the note, right-click
and select Modify to make changes.
5. When the modification is complete, sign the
note.

Medication
Special Alerts/ Step Action
Communication
1. To enter exception orders (i.e., No
Heparin, No IM Injections, No ACE
Inhibitors, No Aspirin, etc.), search for the
MEDICATION SPECIAL ALERTS Order Set in
the catalog.
2. Select the appropriate exception order(s)
from the list displayed.
3. Verify start date and time in the Details
tab.
4. Click OK.

Note: By entering the exception order in the Order Set


noted above, you enable the correct Alerts to display
that effectively alert clinicians to avoid the exception
medication.

Continued on next page

140
Other Order Entry Processes, continued

Transfer This facilitates review of orders upon transferring the


Order patient from one level of care to the next.
Review Note: The transfer order review note is currently not used
Note
at all IUH facilities. Please check its use with your facility.

Open Transfer Order Review Note


Step Action
1. In the open chart, click the PowerNotes band.
2. Click + Add.
3. For *Doc Type, select Orders Reconciliation.
4. Select the Transfer Order Review template
from the IUH Inpatient Catalog.
Hint: Add this template to your Favorites.
5. Click OK.

Complete Transfer Order Review Note


Step Action
1. To review the patient’s orders, click Click here
to make changes to orders.
The Order Profile opens.
2. Review all the current orders. If no changes to
orders are needed, click Done.
3. To discontinue an order, click the checkbox to
deselect the order.
4. Click Orders for Signature, then click Sign.
5. Click to refresh.
6. To list orders to be continued in the note along
with a statement that all orders have been
reviewed, click Include Transfer Order
Summary Report.

Continued on next page

141
Other Order Entry Processes, continued

Transfer Sign Transfer Order Review Note


Order
Review
Step Action
Note, cont.
1. Click Sign/Submit.
2. If all information is correct, click Sign.

Discharge The electronic Discharge Instructions application is a


Instructions secure electronic form used for documenting custom
(eDI) patient discharge instructions.
• You can contribute to the patient discharge document
during the entire course of the inpatient stay.
• Vaccinations & TB testing information and Allergies &
Sensitivities flow into the Discharge Instructions
automatically from Cerner.
• In addition, all caregivers can access the information
after discharge to determine what information was
provided to the patient.

There are three tabs in the discharge instructions form:


• Discharge Instructions
• Medication List
• Sign & Print

Continued on next page

142
Other Order Entry Processes, continued

Discharge
Instructions Step Action
(eDI), cont.
1. Click the band to access
the eDI form.
2. Scroll down to complete the following sections
or click each link to move to the desired
section of the form.

• Patient Data
• Physicians to contact for
• Discharge Instructions Distribution
• Follow Up Visits
• Follow Up Tests
• Activity Limitations or Restrictions
• Treatment/Procedure/ Equipment
• Dietary Requirements
• Additional instructions
• Vaccinations & TB Testing
• Allergies & Sensitivities
• Final Release Info
3. Click + Add or + Edit to initially enter or edit
information.
A window pops up to allow you to enter data.

Continued on next page

143
Other Order Entry Processes, continued

Discharge
Instructions Step Action
(eDI), cont.
4. After you have entered or edited data, click
Save prior to moving to the next screen.
5. If a change must be made to an existing
section, click to make changes to the
information.
6. If you place orders for tests or labs, you must
click eSign to electronically
sign the orders.
7. If you need to add more than one test order,
click Save and Add for efficiency.
Caution: If orders for future tests or services
are placed in eDI, they will NOT result in the
scheduling of the tests or studies.
A requisition prints for each lab order when
the Final Sign & Print is completed.

Medication List
The medication list tab is used to evaluate and reconcile
current home and inpatient medications in order to create
a complete list of home medications for the patient after
discharge. When completed and printed, medications
listed on the patient instructions will be grouped into the
following categories:
• Take these medicines at home
• STOP taking these medicines
• DO NOT TAKE these medicines until instructed by your
Doctor

Continued on next page

144
Other Order Entry Processes, continued

Discharge Medication List, cont.


Instructions
(eDI), cont. Step Action
1. Verify that:
• The home medication list in Cerner
PowerChart is updated and accurate
• All new prescriptions that the patient will
be discharged with have been entered in
the orders or medication list tab (CPOE
facilities)
2. Click the Discharge Instructions band.
3. Click Medication List.
4. Move through the Home Meds list on the left
side of the screen first, marking each
medication according to the following guide:

Home Medication List Options


Action Result
Continue • Places medication into the Take these
medicines at home section of the
instructions
• Choose this option if the patient was
NOT taking this medication as an
inpatient
Modify • Click Modify if medication details must
be modified
• Changes made here DO NOT change
the medication details in PowerChart
• Changes made here file into the Take
these medicines at home section of
the instructions

Continued on next page


145
Other Order Entry Processes, continued

Discharge Home Medication List Options, cont.


Instructions Action Result
(eDI), cont.
D/C • This option places the medication into
the STOP taking these medicines
section of the patient instructions
• DO NOT D/C and then reenter an order
for the same medication; use modify
and then enter any additional
comments or instructions.
Hold • Selecting Hold requires that additional
instructions be entered in a pop-up
window
• Medications that have a Hold status
display in the DO NOT TAKE these
medications until instructed by your
Doctor section of the patient
instructions
Reviewed • Click for those home medications that
you do not want to display on the
home medication list
• If this medication is being given as an
inpatient medication and will be
continued as a home medication, click
Continue on the inpatient medication
list in order to pull in the date and time
of the last medication dose, and click
Reviewed on the home medication list.

Continued on next page

146
Other Order Entry Processes, continued

Discharge Medication List, cont.


Instructions Step Action
(eDI), cont.
5. Move through the Inpatient Meds list next,
marking each medication according to the
following guide:

Inpatient Medication List Options


Action Result
Continue • Places the medication in the Take
these medicines at home portion of
the medication instructions
• The date and time of the last
medication dose will be pulled into the
discharge instructions
• Medications can be modified in the
lower portion of the window using the
Edit icon
Hold • Holding a medication places it in the
DO NOT TAKE these medications until
instructed by your Doctor section of
patient instructions
• Additional details must be entered
Reviewed • Use this for inpatient medications that
will not be taken at home
• Medications will not display in the
patient instructions

6. Add any additional medications in the Add


Medication link under the appropriate section
(non-CPOE facilities only).

Continued on next page

147
Other Order Entry Processes, continued

Discharge Medication List, cont.


Instructions
(eDI), cont.
Step Action
7. Enter comments to clarify any med orders.
Note: Comments in the existing medication list
displayed in blue font will not populate the
discharge instructions and must be added in
the comments area.

Note: The Add Medication link under


Continue these meds should be used to enter
a home medication for which the patient will
be given a handwritten prescription (non-
CPOE facilities).
8. When all medications have been addressed,
click Patient Version to view the patient copy
of the discharge instructions and ensure that
the medication list is accurate and uses
patient-friendly language.
Note: Medication orders may change
frequently and changes made earlier in an
admission may change prior to discharge and
must be reviewed.

Continued on next page

148
Other Order Entry Processes, continued

Discharge Step Action


Instructions 9. You can click X to “reset” a medication and
(eDI), cont.
remove it from the lower portion of the
screen to the home medication or inpatient
medication list in the original state.

Note: Modifications and new medication orders


entered in the eDI form do not flow to
PowerChart; therefore, it is best to enter
modifications on the medications list tab prior
to reconciling on discharge instructions. At non-
CPOE facilities new prescriptions must be
entered in both places.

Sign & Print


The Sign & Print section is used to electronically sign the
patient discharge instructions when the patient is ready to
be released.
Step Action
1. Click the Sign & Print tab
2. Click Physician eSign to sign your name (the
person currently logged in).
3. The nurse will click Nurse eSign to sign the
RN’s name.
Note: All three sections of the discharge
instructions must be signed in order to save and
distribute the note.
4. Click Final Sign & Print.
Note: If there are medications still to be
reviewed, you must go back and address them
before you will be able to Physician eSign.

Continued on next page


149
Other Order Entry Processes, continued

Discharge Sign & Print, cont.


Instructions Step Action
(eDI), cont.
5. If you make any changes or corrections after
the Physician or Nurse eSign, click Unsign and
make the necessary changes.
6. Return to the Final Sign & Print page and click
the Physician eSign.
Note: The Nurse eSign must also be
completed.
7. If you are completing the entire eDI yourself,
you can click both Physician eSign and Nurse
eSign.
8. Click Final Sign & Print.
The name of the user currently logged in
populates the Final Sign & Print signature box.
The patient version of the discharge
instructions automatically open.
9. Click to print two copies:
• One for the patient, and
• One for the medical record
Note: The copy of the discharge instructions
for the medical record must include the
physical signature of the patient/family and
the health professional reviewing the
instructions.

Continued on next page

150
Other Order Entry Processes, continued

Discharge Sign & Print, cont.


Instructions Step Action
(eDI), cont.
10. A requisition prints for each test that was
ordered. Give these to the patient or family.

Note: It is the physician’s responsibility to review the


discharge medication instructions with the patient/ family.

Safeguard Printed Patient Information


Follow these guidelines for printing discharge instructions:

You Are Printing Discharge You Find Printed Discharge


Instructions Instructions
Carefully select the correct If you find discharge instructions
printer from the drop-down containing patient information
menu. on a printer, contact the person
who printed the material.
Retrieve the printed material If unable to contact the
from the printer immediately. discharge instruction owner,
place the material in the shred
box.
If the discharge instructions did If the material prints a second
not print, reselect the correct time, contact the Service Desk at
printer and attempt to print the 962-2828 and report the
material again. computer name, location, and
the name of the printer where
the material printed.
If the material does not print Place the material in the shred
after a second attempt, contact box.
the Service Desk at 962-2828.

Continued on next page


151
Other Order Entry Processes, continued

Discharge Favorites: Discharge Instructions


Instructions • Areas where Favorites can be added or changed are
(eDI), cont.
denoted by a
• You can view current Favorites by hovering your
mouse over the

Add Favorites

Step Action
1. Click .
2. Enter the appropriate information in the
form.

Note: The descriptive title is for your use and


does not display on the patient copy of the
instructions.
3. Click Save when completed.

Continued on next page

152
Other Order Entry Processes, continued

Discharge Modify a Favorite


Instructions
To modify a Favorite, click beside the Favorite name.
(eDI), cont.

Delete a Favorite
To delete a Favorite, click beside the Favorite name..

Replace a Favorite
To replace a Favorite that was entered into the
Discharge Instructions, select Replace.

Select Favorites
To select more than one Favorite choice, select Append.

153
Glossary

Clinical A viewer for scanned, dictated, or other documents


Notes Band sent to or generated within the Cerner system. (e.g.
operative or progress notes).
ClinDoc The application used by nursing to document patient
care data and assessments. It can be launched from
PowerChart and is the recommended view for I/Os
where implemented.
CPOE An acronym for Computerized Provider Order Entry.
Encounter A single patient interaction, such as an inpatient
admission or an outpatient visit.
Filter A filter allows the user to manipulate data views so
that only the desired groups of data display, based on
the user’s preference.
Flowsheet An electronic spreadsheet of a selected patient’s
clinical results. Within the results Review Band, any
single result can be opened to view additional details.
Examples: Lab Results, Results-72hr.
General Views in PowerChart containing information displays,
View Bands pulling together information posted in a variety of
Cerner locations. Differ from flowsheets (defined
above) in that these bands are static displays with
limited to no capability for manipulating views.
Refresh must be done manually. Examples: Diagnosis
Summary, Micro, ED Summary.
MAR An acronym for Medication Administration Record,
Summary which serves as a record of the drugs ordered
Band for/and administered to a patient. This is where
documentation of medication administration is
found. MAR Summary is an abbreviated view-only
version of the MAR.
Message The Physician default view when opening
Center PowerChart, allowing for management and
processing of orders and documents.
154
Order Provides ordering efficiency by allowing the user to
Sentence select in one click the pertinent medication order
details, including dose, route and frequency that
reflect most commonly ordered medication details.
Order Set Contains groups of orders that are related by process
or function so as to increase ordering efficiency and
support ordering best practices.
Patient List Allows the tracking of patients and can be filtered by
several criteria, including inpatient/outpatient status,
unit/location, provider relationship, and discharge
status.
PowerChart Cerner view that supports inpatient and outpatient
workflow.
PowerNote Structured clinical note created from a pre-defined
template. Allows for auto-populating, select data
within the note to expedite documentation.
PowerPlan Groups of condition-based or admission-specific
orders that allow for standardized orders based on
specialty, ordering efficiency and ease of
discontinuing orders.
Relationship The association between a healthcare provider and a
patient. Relationships can be visit-specific (such as an
admitting physician) or lifetime (such as primary care
physician). A relationship must be established
electronically with a patient before you can open his
or her chart.
Results Clinical data entered via PowerChart directly or from
an ancillary or departmental system.

155
Frequently Used Phone Numbers

IU Health Site Description Number


Ball General Main 765-747-3111
Memorial Patient Access 765-741-1073
Central Dictation 765-757-3153
Dictation Help 317-962-8501
OR Main OR 765-747-3389
SAU/PACU 765-747-4451
Rad 765-747-3236
Telemetry 765-751-2789

IU Health Site Description Number


Methodist General Main # 317-962-2000
Bed Control 317-962-9800
Central Dictation 317-962-8401
Dictation Help 317-962-8501
ED 317-962-8355
IMACS OneCall 317-944-5000
IUH 24/7 Transfer Center-Adult 877-247-1177
IUH 24/7 Transfer Center- Neo/Peds 877-447-4539
Lab- (Main) 317-491-6000
Pharmacy (Inpt) 317-962-5487
OR Main OR 317-963-6300
PACU 317-962-6500
PreOp 317-963-6260
Rad Reading-Plain Film 317-963-9342
Reading- Body/bone 317-963-9300
Reading- Neuro 317-962-2637
Techs 317-962-8306
Telemetry 317-962-3211

156
Riley Site Description Number
Hospital General Main # 317-944-5000
for Bed Control 317-944-3903
Children Central Dictation 317-962-8401
at IU Dictation Help 317-962-8501
Health ED 317-944-3936
IMACS OneCall 317-944-5000
IUH 24/7 Transfer Center- Adult 877-247-1177
IUH 24/7 Transfer Center-Neo/Peds 877-447-4539
Lab (Main) 317-491-6000
Pharmacy (Inpt) 317-948-8762
OR Main OR 317-944-8222
PACU 317-944-9943
PreOp 317-944-8634
Rad IR 317-948-6328
Reading Rooms 317-948-6343
Reading- Plain Film 317-948-6315
Reading- CT 317-948-6300
Reading -MRI 317-948-6331
Reading- US 317-948-6300
Techs 317-948-6336
Telemetry 317-962-3211

157
IU Health Site Description Number
University General Main # 317-944-5000
Bed Control 317-944-3903
Central Dictation 317-962-8401
Dictation Help 317-962-8501
ED 317-944-4705
IMACS OneCall 317-944-5000
IUH 24/7 Transfer Center- Adult 877-247-1177
IUH 24/7 Transfer Center- Neo/Peds 877-447-4539
Lab (Main) 317-491-6000
Pharmacy (Inpt) 317-944-0362
OR Main OR desk 317-944-4001
Pre-Op 317-948-5400
PACU 317-944-4088
Simon OR desk 317-948-7493
Simon Pre-Op 317-948-7100
Simon PACU 317-948-7522
Rad IR 317-944-1828
Reading- Chest 317-948-8483
Reading- Abdomen 317-944-1831
Reading- MRI 317-944-3692
Reading- Neuro 317-944-3692
Reading- US 317-948-8219
Techs 317-944-3351
Telemetry 317-944-0362

158
Richard L. Site Description Number
Roudebush General Main # 317-554-0000
VA Bed Control 317-988-2536
Hospital ED 317-988-3059
Dictate 317-988-2047
Lab Main Lab 317-988-2545
OR Main OR 317-988-2350
Pre-Op 317-988-3190
PACU 317-988-2237
Pharmacy Inpatient 317-988-2583
Radiology Techs 317-988-3173
Reading Rooms 317-988-2806
Abdomen 317-988-2806 x1
Chest 317-988-2806 x2
GI 317-988-2806 x3
IR 317-988-2806 x4
Msk 317-988-2806 x5
Neuro 317-988-2806 x6
Nuclear 317-988-2806 x7
Diagnostic 317-988-2806 x8
Telemetry 317-988-3659

159
Wishard Site Description Number
Memorial General Main # 317-639-6671
Hospital Bed Control 317-630-2233
ED 317-630-6243
Dictation 800-454-9106
Labs Main Lab 317-630-7442 x1
OR Main OR 317-630-7205
Pre-Op 317-630-8179
PACU 317-630-7030
Radiology Xray Techs 317-630-6570
Chest 317-630-6231
Abdomen 317-630-7911
Neuro 317-630-6998

160

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