Can anyone share some references for ED nurses entering non-verified orders in the electronic record? Our hospital has recently implemented CPOE. In our ED, the practitioner's orders populate onto the patient's eMar as verified. The nurses there want to be able to enter verbal orders that will also be populating onto the eMar as verified. This was essentially their paper system; take an order from the prescriber, write it on paper, pull the med from Pyxis, administer the med, document on paper. The ED nursing directors want this ability for "emergencies" and see no difference between writing an order on paper and giving a med, versus entering one electronically and giving a med. They believe the "double check" is the prescriber's verbal order and the nurses assessment of that order. They scan the patient's name band, but not the medication. If anyone else has policies regarding this, I'd appreciate some information. From a medication safety perspective, it is a concern for me.
If you're situation described is relative to medicatinos available to ED staff via an ADC, I'd have to agree with yuor nursing management. There's little difference in the process in an ED on paper versus electronic orders. We launched CPOE in 6/11 with our ED orders "auto-verifying" so the neds can be pulled from the ADC without waiting for pharmacy review. However, we made a great push for the docs to enter the orders and verbal orders are acceptable only in very few situations.
Beyond this, I share your angst over ED medication use without pharmacy review. Literature supports the premise that it is an error-prone area of care and would benefit from pharmacist order review. Hence, the growing wave of support for ED-based pharmacists.
Thanks. I spoke with staff at ISMP and their assessment is that many facilities are trying to figure out the best approach. After talking with them and our ER staff, we are planning to define the meds/ circumstances when verbal orders and RN med entry are acceptable. We already have restrictions on high risk meds- they need to be verified by second RN before administration. I just need to figure out the best process for reviewing the RN entry and making sure it's appropriate.
The order is not verified until verified by the pharmacist. Period. It has nothing to do with double-check or triple check. When the hospital has an ED and the pharmacy is not opened 24 hours, there may be an override to move the order from the CPOE module to the MAR. The order still needs to be verified the next morning when the pharmacy opens.
This was going to be an issue for our site as well. What computer system are us using? We are using MEDITECH 5.64 and Pyxis 3500 (soon to be 4000).
An idea that was brought up was to allow nursing staff access to put in orders, but only for a specific order set that was built for a few "emergency" medications. Ultimately this was decided against. Nursing staff will be able to override the medication in pyxis and then the override order will cross over to the physicians sign queue.
