VA CPRS Instructions and Tips

1. Admit Orders: Admit Order, Med Rec, Plan

a. Must be written as “Delayed Orders” (on main screen, top left “Write Delayed Orders”). Put Anticipated
Location (4A, 5D, 6D), Attending, Resident, Intern
i. Pt must have room before you can write admit orders (ED knows this – ask what floor patient is
going before seeing patient, will need location for orders); this is a strict rule for admits
ii. If patient anticipated to leave within 48hr, admit under OBS (observation)
1. This must be under the specialty as well as the location and when you sign the orders
b. Next click “Acute Care Inpt Orders” (Left hand column under “Write Orders”) and make sure the orders
are selected as delayed. Go down the list picking Dx, condition, tele orders (if needed), activity, EKG,
Diet, if DNR, Labs, DVT prophylaxis, vitals, labs
i. For vitals, order q4hr or as appropriate then under VS Parameters, choose “Call House Officer
TPR B/P Urine” and accept
ii. For labs, choose 81. Lab Order Sets -> 8. QAM Labs x3 Days (make sure to choose CBC and
DIFF); typically need CBC&Diff, BMP or CMP or renal panel, and Magnesium
c. Go to “Meds” tab and click the desired outpatient meds you want to continue in-house -> Action (top
menu) -> Transfer to Inpatient (program will go through each medicine verifying dose)
d. Sign Orders
i. Choose Orders (at very bottom tab), the actual orders will be in blue colored font. Highlight all
the orders and right-click to sign
ii. Make sure they are listed under “Delayed Orders,” will be erased otherwise with transfer
2. Admission Note
a. Click Notes (tab at very bottom) -> click “New Note” at bottom left of screen and type in “Specialty Care
Admission History and Physical note” in top blank and then select your Attending
i. Will generate note. Like MD Discharge Note, must fill all fields with asterisk or it will not let you
progress. Use text as placeholder as need be
ii. Note: This template does NOT include Review of Systems or Physical Exam and will need to cut
and paste labs and radiology as needed
iii. Write your Assessment and Plan and then sign it (or “save without signature” if you expect to
make changes)
1. If you think patient has life expectancy if <6 months, select Palliative/Hospice consult at
the bottom
2. For notes in general, once signed, you can’t alter the note till your attending has signed
3. Progress Notes
a. Click “/Templates” (is above the “New Note” tab at the bottom left)-> Shared Templates -> Specialty
Care -> Choose “Specialty Care-Daily Progress Note.” The note will prepopulate inpatient meds and note
headings only
b. Can use copy and paste
i. Template does NOT carry over LABS or PHYSICAL EXAM (must add manually)
ii. Right click and select “Save without Signature” as you go; note will not be visible to others until
signed
iii. Will need Attending’s name to sign when note is done
iv. Note: You cannot modify or addend notes once you have signed and until the Attending
addends it
4. Blood work
a. Click on “Lab Tests” for single lab orders (EX: CBC for 1 time)
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i. Order test requested. Change to Lab vs Ward collect in bottom left
b. For AM labs (CBC, CMP or BMP, Mag, etc.), choose “Lab Order Sets”
i. Will only perform for 3 days (Rule of Thumb: use call day as day to reorder AM labs)
c. Acute Care Inpt Orders
i. Can find most orders here
1. EX: 41. EKGs, 50. Diet orders, 112. IV fluids
ii. Under “100. General Nursing Orders:” CBGs, Telemetry Orders, Isolation Orders, TED hose, Foley
Orders etc.
1. For Tele orders, if you select 48 hours, you don’t have to justify why you’re ordering it
iii. Under 101. Text Only Orders can order free text orders or communicate with the nurse
iv. Misc: 90. Bowel/Bladder Care helpful in quickly finding GI prophylaxis and treatment meds
(enemas)
v. Sliding scale insulin: #111 -> #41 (will have to specify how many units to give with each CBG
range)
vi. JetNebs: #125 -> “Medication Treatments” -> “Respiratory Meds Inpatient.” For DuoNebs, will
need Albuterol and separate Ipratropium order
d. For blood cultures, will need 2 sets
i. Find “Lab Microbiology Tests” along left hand column
1. Can find many other types of cultures under this heading
ii. Find 2. Blood Culture and will need 4 separate orders
1. Under “Enter order comment,” write Aerobic for 2 of the culture orders and Anaerobic
for the other 2 cultures
5. How to review labs
a. Click Labs tab along bottom on screen
b. Can look for Most Recent labs, Cumulative Labs, Worksheet (can look for specific labs over specified
time interval), Microbiology (for cultures)
c. Ins and Outs: Reports at bottom of screen -> Health Summary (top left) -> midway down you’ll find
Intake & Output (24 vs 48 vs 72 hrs)
d. To review prior history of a lab, click the lab value itself and see trend over last several results
6. Vitals
a. Reports (at bottom) -> Vitals Cumulative (midway down left hand column)
7. Radiology reports
a. Reports (at bottom) -> Imaging (top left, 4th item)
8. How to view films
a. Tools (very top) -> Imaging Display for Windows 7 (will bring up EKGs as well); may need to move some
of the overlying windows to get to radiographic studies
9. Changing Obs to regular admit or Transfer Orders
a. If patient admitted as Observation and stayed inhouse >48 hrs; must change orders or all orders will fall
off and have to start from scratch
b. Must be written as a “Delayed Order” like a new admit order; specify your time and this time do not put
OBS in specialty or location
c. You will then need to select each item you want to carry over and “copy to new order”
d. Review all orders (in blue) and then sign. Make sure it says “Pending” when you review your delayed
orders
10. Discharge Instructions
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a. Need 5 tasks performed
i. Medicine Reconciliation
1. Click “Meds” tab at bottom, compare Inpatient vs Outpatient lists
1. To write Rx for inpatient med for outpatient use: Click on Med, click on Action
on top bar, select “Transfer to Outpatient”
i. Typically give 30d and 2 refills for most meds
ii. Will need your card to write for scheduled meds (opiates, benzos, etc.)
and your PIN
iii. Select “Window” under Pick Up tab and change Priority to ASAP then
accept order
ii. Progress Note
1. Update Plan, Disposition
iii. Dictation (look for the yellow CMTS Dictation Instructions card for complete instructions or use
instructions below)
1. Dial 1640 -> Enter 509 then your user ID (last 4 of your SSN) then # key
2. Enter Work type (1=Discharge Summary) then # key
3. Enter 9 digit patient SSN then # key. Dictation will start
1. For STAT dictation, enter 6 anytime during dictation
2. Enter 5 for dictation number – number is reported quickly. Write it down and it
to your MD discharge note
4. Note: Obs patients do not need a dictation if physically gone in under 48 hours
iv. MD Discharge Summary
1. Select “New Note” and type in “MD Discharge Instructions / Education Note.” Will open
up another screen with multiple fields that need to be filled in before you can do
anything else
1. If unsure, use any text in fields as a placeholder
2. When signed, find PCP of patient (listed at top of chart under PACT)
i. Identify as co-signer by right-clicking signed MD Discharge Note and
selected “Identify Additional Signer” and type PCP name
1. Will help update PCP of hospital course
2. Type Dictation Number clearly on top (will need for patient to be discharged)
v. Discharge Order
1. Select “Add New Order” on left side -> Select “Patient Movement” -> Select “Discharge
NOW Menu” -> Select where patient is being discharge -> Select “As ordered
previously,” “DC IV,” and DC Foley” -> Select OK. Sign order for discharge
2. To speed up d/c process, call unit clerk in AM before starting d/c process to notify
patient is leaving and how they are getting home. Once everything is done, call and give
the dictation number as well
b. Beneficiary Travel consult
1. Will need for ambulance/hired car transport for patient
2. Ask patient ahead of time if they can get a ride. If not, is better to schedule this early or
even the day before
3. Click new consult -> 5. Beneficiary Travel and fill out. Form requires pick up and drop of
locations. Ideally, complete the night before anticipated d/c
c. Beware of cutoff times and push-back
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1. Georgia War wants pt inhouse by 12p (must call Dr Gulati there for Dr to Dr; see white
boards for her number)
2. Uptown CLC wants pts inhouse by 1p (must call on call there for Dr to Dr; see white
boards for his number)
1. Try your best to get all discharge planning done the day before for anticipated
discharges; is difficulty to try to get this done the day of d/c and meet cutoff
11. Preparing Sign-out
a. Tools (very top) -> Specialty Applications -> Shift Handoff Tool -> Shift Handoff Tool
b. Log in again then find your list of patients (double click to remove patients, or click last choice on left
hand column to add patient)
c. Fill in information like what to follow up, current problems, chronic problems, and your name (right
hand side) and Print (will autosave when you input information)
d. Good habits:
i. Put down, for example, your abdominal exam if you’re asking covering team to do serial
abdominal exams or your neuro exam as primary service if asking for serial neuro checks by the
covering team
ii. Update sign-out about patients getting blood, having had procedures (chest tube placement or
removal, surgery, etc.)
iii. Include appropriate PRNs for patient (pain meds, nausea meds, etc.) or which patient shouldn’t
receive what meds
iv. Write in sign-out if patient has known weakness from prior stroke, is aphasic, blind, etc.
e. Forward your pagers appropriately once you’ve given your sign-out
i. And make sure you’re un-forwarded when you come back to work
12. Consents
a. Will be need for blood transfusions and contrast for studies
b. Start this process on a COW (computer on wheels) with a working signature pad (will need your and
patient’s signature)
c. To go Tools at the top menu -> “iMed Informed Consent” -> iMed Informed consent
i. For blood transfusion
1. When program launches, click “All Document” and type in “transfusion” and search
2. Under any of the headings, click “Basic” then look for “Blood Transfusion” and click
“Begin Consent” along right lower side of window
3. Follow prompts (decision-making capacity -> type in your name for “practitioner
obtaining consent” on top drop down -> next -> click finish when it is clickable
4. Click “OK” on next pop up and the form will generate. Read this form to the patient.
Once patient agrees, click “sign” on the right hand side, and then you sign it. Click “sign”
again after this and have the patient sign
5. Lastly, click “save to chart” and consent is completed
ii. For contrast
1. Type in “contrast” into search bar
2. Click “Diagnostic Radiology” and select the appropriate study from the list that
generates (for example, CT scan with contrast) and click “Begin Consent”
3. Follow the same steps for blood transfusion above from step 3. Under “anatomic
location and side” you will need to type in the study you want and what you’re wanting
imaged. Continue until you can click “Finish” at the bottom right hand side of the screen
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4. Read the form to the patient. Once patient agrees, click “sign” on the right hand side,
and then you sign it. Click “sign” again after this and have the patient sign
5. Lastly, click “save to chart” and consent is completed

13. How to order blood products

a. Ex: PRBC, platelets, FFP, etc
b. Under “orders” along the screen at the bottom of the menu
c. Find “Blood Bank Orders” along the left hand menu
d. Find the blood product you want to order (FFP, RBC, platelets, cryoprecipitate)
i. Along the right hand column of options, you’ll see “TAS” which stands for Type and Screen
which will need to be ordered before the blood product can be ordered
ii. In the next window, starting at the top left, make sure your desired blood product is selected.
Below it, select Modifiers if needed (leukoreduced, irradiated, washed, etc.). Under than, select
the Date/Time Wanted (can do for now, tomorrow, etc.)
iii. Next select urgency (routine, ASAP, STAT, etc.)
iv. Under Reason for Request, designate if you want the products to be transfused, held until MD
gives order, etc.
v. In the next window, choose whether you want the blood product to the held, transfused, etc.
Enter the number of products you want give (EX: 2 PRBC). Last select start time
vi. Under the “Reason for Request” window, enter your diagnosis, then why you’re giving the blood
product (for example, Red Blood Cells -> Bleeding with -> pulse >100)
vii. Scroll to the bottom of the page and enter attending name and your specialty. Click OK
viii. Click Accept Order at next window
ix. In Orders, will see your blood product order and transfusion order. Highlight and sign
x. Once infused, you will need to write a post-transfusion note
1. Go to “Notes” at the very bottom -> “New Notes” -> type in “Transfusion” to pull up
“Transfusion <Blood Bank Post Transfusion MD Note>” and complete
14. How to add yourself to the team list
a. At the top menu, click Tools -> Options
b. In the new window, select Teams/Lists
c. Find the Source Combinations Button and click it. Next select “Specialty” button and in search for the
following 3 lists:
i. For example, if starting Gold Medicine, will need the Gold list, Obs Gold list, Palliative Care Gold
list. Type in “Sp/Gold” and add then do the same for Obs and Palliative. Once all 3 entries
appear in the Combinations list, click OK
ii. Next find “Patient Selection Defaults”
1. Click Combination under “List Source”
2. Under Treating Specialty, find “Sp/Gold” and click OK
iii. Click OK when back at the Options window and should be set up
1. Go to File at the top, Select New Patient and the list should appear

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General Tips:

1. Interdisciplinary (IDT) Rounds at M-Sat at 0830 in 6C conference room

 Social Worker, Case Managers, Bed Mgmt, etc present
2. Dial 0 for operator, 3101 for inpatient Pharmacy, 3282 for ED (look for extensions list in each room)
3. For inpatient consults, placed order in CPRS: click consults tab at bottom of screen -> click new consult -> find
correct inpatient service -> fill out form and sign it after under orders. Consultants needs this order
 You will still need to call and discuss patient with the service you’re consulting
4. Physical Therapy (PT) and Occupational Therapy (OT) consults
 Orders tab at very bottom, select “Consults” on left hand column -> 63 Rehabilitative Services -> 5. Click
here for face to face consults
i. For PT: choose “Rehab Acute PT DD INPT” and write why consult is requested as well as
diagnosis in next screen
ii. For OT: choose “Rehab OT DD Consult INPT” and write why consult is requested as well as
diagnosis in next screen
iii. For Speech consult, choose 4. Audiology and Speech Pathology Consults in Consults by Service
menu
5. If you have a patient who you think will need placement, order PPD, PT and OT consults early on to save yourself
a few days of hospitalization
6. Radiology test (CXR, Ultrasounds, CTs etc.)
 Click Imaging Orders on column on left side of screen. Click Imaging at bottom left. At top left, select
“Imaging Type”
i. For portable chest X-ray, you will need to select “General Radiology.”
 Fill out Reason for Study and Clinical History and choose date
 Make sure you submit to Downtown Xray
 Will also use this order set for ultrasound of legs, transesophageal/thoracic echos, etc.
7. Limited imaging done on weekends (MRI, CT ,etc.) – will need to call appropriate department to see if they can
do it
 Any contrasted study needs to have consent from patient (on computer-on-wheels)
8. PT and OT may or may not see the patient on the weekends (alternate on weekends)
9. On-call meals provided for on-call teams on first floor past Pharmacy
 Breakfast, lunch, and dinner (be mindful of cutoff times)
10. Home O2 qualification
 Must walk patient off O2, document desat <88% and improves to >88% with O2
 Consult Pulmonology (Consults -> 62. Pulmonary Consults -> 14. Home Oxygen Initiation OUPT)
11. Ask Social Work for other consults like Non-VA Care, Home Health or Home Hospice
 Will need Face to Face note written
12. How to order cytology for pleural fluid analysis: on the left hand column, choose “Anatomic Pathology Orders”
-> “Tissue Examination SF515 INPATIENT” -> fill out and print then hand to RN so form can go with patient (if
going to IR for procedure)
13. When in doubt, make NPO for imaging
 Ultrasounds, PO and IV contrast CTs (adjust insulin accordingly if NPO after midnight)
14. Call the respective department to follow up if imaging orders have been reviewed and if they study can be
performed that day

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15. To facilitate VA ECHO readings, call ECHO lab and request it be sent to Cardiology Attending
 Echos like TTE are difficult to obtain inhouse; if urgently needed, will need to contact Cardiology
Attending for read
16. Transferring from VA to another hospital
 Multi-step process, typically takes entire day. Please confirm process with Chief of Staff (I have only
coordinated 1 transfer like this)
 Start by placing new consult -> 50. Non VA Care Coordination Consults -> 5. NON VA Care Inpatient
Consults -> 2. Non VA Care Inpatient Medical. Under justification for Non VA Care, select “VA facility
does not provide the required service.” Complete rest of the form. Will need to be approved.
 Use COW to have patient sign a transfer consent to be transferred
 Complete “Interfacility Transfer Note” under Notes section
 Will need a Discharge Order, Dictation, and Med Rec like other discharges
 Call Administrator on Duty (AoD) and Unit Clerk for assistance. Will need approval from Chief of Staff as
well
17. In general, be prepared for best prepared plans to fall apart without warning (travel doesn’t come, orders aren’t
followed, testing isn’t performed).

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