computerized order entry-what would you do?

[rnto?]

So we just got a new pharmacy/computer system. All MD orders are entered into the computer and pop up on a computerized med pass. It's pretty basic-med, dose, route, frequency, and special instructions. I received an order for IM Zofran, when I went to put it into the computer, the only option to select for injectable zofran was IV. I called the pharmacist, who told me to enter the route as IV but to clarify in the special instructions form as IM. This means it shows up as Zofran IV, and a nurse would need to read the special instructions to recognize it was not to be given IV, but IM. To me this is a med error waiting to happen, and it would involve my name since I would be the one noting the order. I have not entered the order, and am waiting for pharmacy to call back again.

[SuesquatchRN, BSN, RN]

Huh. We can enter anything in the formulary and change the sig. It would come up as Zofran IV and I could change it to Zofran IM.

Who is your super-user? Do you have anyone in-house you can ask?

[rnto?]

Well, I'm the supervisor! We don't have superusers, but I enter the most orders, so I'm pretty good at it. The pharmacist flat out told me to enter it as IV.

[SuesquatchRN, BSN, RN]

I don't really know how to advise you.

How obvious is the special instructions area?

[rnto?]

It doesn't flash big red or anything-I think it would be pretty easy to miss.

[SuesquatchRN, BSN, RN]

Can you put asterisks all over the place? I mean, there would be inx for fluids WITH an IV order, no? So they have to look SOMEWHERE.

[nurse_mo1986]

My thought on it is that if the pharmacist wants to be responsible for this HUGE potential med error, then he/she can enter it theirselves.

To me, this is a big potential waiting to happen, and I would not code it this way. Speak to the superuser of this system, and find a way to resolve it.

[diane227, LPN, RN]

I will not be the person entering medication orders into ANY system. That is the job of the pharmacist. The only way I am comfortable with a computerized system like this is when I scan the order to the pharmacy, they enter the order, I then check and verify the order with the chart when the medication gets on the mar. Pharmacy HAS TO SEE THAT ORIGINAL ORDER in order to verify that it is correct. There is no way that I am going to take full responsibility for medication order entry, especially with physicians having such horrible handwriting. If pharmacy does not see the original order there is no check and balance system.

[Emergency RN]

Tell your institution that the software vendor needs to make corrections as a part of their ongoing systems support. A few lines of code would make the choice of IV or IM available. Send a copy of your concerns to your risk management dept as well as pharmacy.

We use HMED's version of computerized ordering and charting, and they're always making changes in the interface based on identified needs.

[SuesquatchRN, BSN, RN]

What did you end up doing?

[guest2210]

The nurses can enter the order, if it's a verbal or telephone order, but it is up to the pharmacy to enter it on the MAR and to double check the order, and call the MD if there is any questions on the order itself. I am an Epic consultant and I have never seen where the nurses enter the order on the MAR.

[SuesquatchRN, BSN, RN]

We enter orders directly into the system.