[MEDITECH-L] Hold orders

[Parker Karen]

To those of you who are using Pharmacy order entry:
If a Physician writes for an order to be on hold, how does pharmacy enter that into the computer?  Currently our pharmacy discontinues that order and the Physician has to rewrite the order when they want it to restart. 

Karen Parker RN, BSN
Clinical Informatics Specialist
Meadville Medical Center
751 Liberty St
Meadville, Pa 16335
814-333-5606
kpa...@mmchs.org

[Charlie Downs]

Hold = Discontinue unless for a specified period of time such as hold AM dose, hold for 2 days, etc in which case the deactivate function is used. The physician can write an order to resume or just re-write the order if they want to re-start.

Charlie

Charles Downs Pharm.D.
Washington County Hospital
Inpatient Pharmacy
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904

---

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[Alan Miller]

That's what we do, too. In the pharmacy, we don't have access to the
nuances that are involved with "holding" medications. Hold for just
this dose? Hold forever? Hold until the lab results come back? Since
"Hold" is such an ambiguous term, it is prudent to equate it to "D/C"
until you get clarification via a "continue" etc. order.

Alan Miller, RPh
Catawba Valley Medical Center

>>> "Parker Karen" <kpa...@mmchs.org> 11/22/2006 12:14 >>>

======================================

[Bill Bowen]

We also discontinue med orders that the MD puts on hold.

 

Unless the med is being held for a certain period of time, like 2 days, then we would

restart the order at that time.

 

Bill Bowen, Staff Pharmacist

Flagler Hospital, St. Augustine, Florida

Bill....@flaglerhospital.org

Notice:  This email contains confidential or proprietary information which may be legally privileged.  It is intended only for the named recipient (s).  If an addressing or transmission error has misdirected the email, please notify the author by replying to this message.  If you are not the named recipient, you are not authorized to use, disclose, distribute, copy, print or rely on this email, and should immediately delete it from your computer system.

---

From: Parker Karen [mailto:kpa...@mmchs.org]
Sent: Wed 11/22/2006 12:14 PM
To: medit...@MTUsers.com
Subject: [MEDITECH-L] Hold orders

[Crepeau, Denise]

We are currently having this very discussion at our hospital. Is anyone using the hold function?

Thanks,

Denise Crepeau,
intelliDOT Coordinator,
Parkview Medical Center,
400 West 16th Street,
Pueblo, Colorado
intelliDOT Hotline # 3687
office (719) 584-4291

-----Original Message-----
From: meditech-...@MTUsers.com [mailto:meditech-...@MTUsers.com]On Behalf Of Charlie Downs
Sent: Friday, November 24, 2006 7:13 PM
To: Parker Karen; medit...@MTUsers.com
Subject: Re: [MEDITECH-L] Hold orders

Hold = Discontinue unless for a specified period of time such as hold AM dose, hold for 2 days, etc in which case the deactivate function is used. The physician can write an order to resume or just re-write the order if they want to re-start.

Charlie

Charles Downs Pharm.D.
Washington County Hospital
Inpatient Pharmacy
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904

----- Original Message -----

From: Parker Karen

To: medit...@MTUsers.com

Sent: Wednesday, November 22, 2006 12:14 PM

Subject: [MEDITECH-L] Hold orders

To those of you who are using Pharmacy order entry:
If a Physician writes for an order to be on hold, how does pharmacy enter that into the computer?  Currently our pharmacy discontinues that order and the Physician has to rewrite the order when they want it to restart. 

Karen Parker RN, BSN
Clinical Informatics Specialist
Meadville Medical Center
751 Liberty St
Meadville, Pa 16335
814-333-5606
kpa...@mmchs.org

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[Thompson, Jeff]

We currently Deactivate (DA) the order and then Reactivate (RA) when the doc writes to do so.  This allows us to still show the meds on our medications transfer form as held and give them a chance to order it when the patient moves around.  We also are Pyxis Profile and it shows as held there, also.

 

 

Jeff Thompson, R.Ph.

Pharmacy Informatics

Newman Regional Health

Emporia, KS 66801

Direct: 620-340-6150

 

---

From: meditech-...@MTUsers.com [mailto:meditech-...@MTUsers.com] On Behalf Of Parker Karen
Sent: Wednesday, November 22, 2006 11:15 AM

To: medit...@MTUsers.com
Subject: [MEDITECH-L] Hold orders

[Melissa Wyant]

Bill,

 

When an order is held for 2 days do you use the Deactivate and Reactivate options or do you use Copy/Edit and create a new order?

 

Melissa

 

Melissa Wyant, R.Ph.
Pharmacy Application Analyst
Information Systems
Holyoke Medical Center
575 Beech Street
Holyoke, MA 01040
Phone: 413-534-2842
Beeper: 413-755-8318
wyant_...@holyokehealth.com

>>> "Bill Bowen" <Bill....@flaglerhospital.org> 11/27/2006 10:26 AM >>>

We also discontinue med orders that the MD puts on hold.

 

Unless the med is being held for a certain period of time, like 2 days, then we would

restart the order at that time.

 

Bill Bowen, Staff Pharmacist

Flagler Hospital, St. Augustine, Florida

Bill....@flaglerhospital.org

Notice:  This email contains confidential or proprietary information which may be legally privileged.  It is intended only for the named recipient (s).  If an addressing or transmission error has misdirected the email, please notify the author by replying to this message.  If you are not the named recipient, you are not authorized to use, disclose, distribute, copy, print or rely on this email, and should immediately delete it from your computer system.

From: Parker Karen [mailto:kpa...@mmchs.org]
Sent: Wed 11/22/2006 12:14 PM

To: medit...@MTUsers.com
Subject: [MEDITECH-L] Hold orders

To those of you who are using Pharmacy order entry:
If a Physician writes for an order to be on hold, how does pharmacy enter that into the computer?  Currently our pharmacy discontinues that order and the Physician has to rewrite the order when they want it to restart. 

Karen Parker RN, BSN
Clinical Informatics Specialist
Meadville Medical Center
751 Liberty St
Meadville, Pa 16335
814-333-5606
kpa...@mmchs.org

CONFIDENTIALITY NOTICE: This email communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please reply to the sender immediately or by telephone at (413)534-2500 and destroy all copies of this communication and any attachments. For further information regarding Holyoke Medical Center's privacy policy, Please visit our Internet web site at http://www.holyokehealth.com
<<<>>>

[Roger Beverly]

We use the deactivate/reactivate routines.

Roger Beverly, PharmD
Conway Medical Center, Inc.
rbev...@cmc-sc.com

___________________________________________________________________________

Date: Mon, 27 Nov 2006 10:26:01 -0500
From: "Bill Bowen" <Bill....@flaglerhospital.org>
Subject: RE: [MEDITECH-L] Hold orders
To: "Parker Karen" <kpa...@mmchs.org>
Cc: medit...@MTUsers.com
Message-ID:

<EA6B0A15170F7A41BDD...@fh-exchange.flaglerhospital.local>

Content-Type: text/plain; charset="iso-8859-1"

Bill Bowen, Staff Pharmacist

Bill....@flaglerhospital.org

________________________________

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End of meditech-l Digest, Vol 25, Issue 32
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[Griffin, Paul]

We use HOLD as Charlie does: HOLD = DC unless there is a resume parameter given. This is hospital policy and part of the Medical Staff Bylaws.

 

Paul E. Griffin R.Ph.

Pharmacy Informatics

Emerson Hospital

(978) 287-3769

Pager 212

---

From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf Of Crepeau, Denise
Sent: Monday, November 27, 2006 6:11 PM
To: 'Charlie Downs'; Parker Karen; medit...@MTUsers.com

Subject: RE: [MEDITECH-L] Hold orders

Sent: Wednesday, November 22, 2006 12:14 PM

Subject: [MEDITECH-L] Hold orders

To those of you who are using Pharmacy order entry:
If a Physician writes for an order to be on hold, how does pharmacy enter that into the computer?  Currently our pharmacy discontinues that order and the Physician has to rewrite the order when they want it to restart. 

Karen Parker RN, BSN
Clinical Informatics Specialist
Meadville Medical Center
751 Liberty St
Meadville, Pa 16335
814-333-5606
kpa...@mmchs.org

======================================
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[Jim Fung]

We use the deactivate function for hold orders. We have a policy that deactivated order for more than 3 days old can be discontinued at the discretion of the pharmacist.

 

Jimmy Fung

Clinical Co-Ordinator

The Credit Valley Hospital

Pharmacy Dept.

(905)813-4532

jf...@cvh.on.ca

 

[Grolla, Cindy]

We decided to not use "hold" because in C/S the medications with a "hold" status still show up on the eMAR and it is not glaringly obvious that the med is on hold and we thought the nurses may give it by mistake.

 

If you put the medication at a "pending" status they do not show up on the eMAR but do show up as "pending" on the active order list.  We are planning to use this for home medications that are not started when the patient is admitted.

 

Cindy Grolla, RN
Clinical Project Leader
Phone: 507.646.1209
Pager: 507.645.1475

-----Original Message-----
From: medit...@MTUsers.com [mailto:medit...@MTUsers.com]On Behalf Of Crepeau, Denise
Sent: Monday, November 27, 2006 5:11 PM
To: 'Charlie Downs'; Parker Karen; medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders

[sda...@uhcc.com]

In general, we treat all HOLD orders as a DC. The only exception would be if the prescriber wrote to hold one specific dose, for example, before a particular test. We have been using this policy for several years, and the benefit of preventing unwanted doses far outweigh the inconvenience of having to write re-start orders.

Some things to consider: In Meditech Pharmacy, the terminology is DA (deactivated). However, the order is still "active" in the Pyxis system, so it will still show up on the patient's Pyxis profile. In Meditech PCI, the "DA" status shows up in the last column on the patient's Current Medication list, but I wouldn't count on all clinicians looking for that or even recognizing what it means if they saw it.

Steven Dailey, RPh
Pharmacist/Information Services
Union Hospital
Elkton, MD  21921

Note: This message and any attachments are intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender.

[Pivonka, Michelle]

We do not HOLD orders either. They are DC'd and entered again. This is
for every transfer to a different level of care, surgery, whatever.

Michelle Pivonka, RN
Systems Analyst
Information Services
Sinai Health System
(773) 257-6020
pi...@sinai.org
www.sinai.org

"A pessimist sees the difficulty in every opportunity; an optimist sees
the opportunity in every difficulty."
Sir Winston Churchill

-----Original Message-----
From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf
Of Amoyal, Sherryl
Sent: Monday, November 27, 2006 4:38 PM
To: Alan Miller; Parker Karen; medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders

We do not hold. I thought it was (or will be soon) a JCAHO no no. No
orders are held/ nor resumed. We DC them and they enter new Med orders
when needed.

Sherryl Gussio Amoyal
Nursing Information Systems Analyst
Telephone: 443-843-5603
Pager: 410-588-0364
Fax: 443-843-8900
Email: sga...@ex.uchs.org
Information Technology Department
Upper Chesapeake Health

-----Original Message-----
From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf
Of Alan Miller
Sent: Sunday, November 26, 2006 8:23 PM
To: Parker Karen; medit...@MTUsers.com
Subject: Re: [MEDITECH-L] Hold orders

[Jeff Lee]

We are using the hold (DA/RA) routines and they have been working for us so far.  One advantage this allows us is that meds on hold (e.g. during surgery, just indefinitely on hold) are still AC in Meditech and when we print various custom reports for physicians, med reconciliation reports, etc, these continue to display so that clinical staff don’t forget that these orders are out there and need to be reconsidered at some point.  The only kicker to this is you need to edit all your NPR reports so that there is an indication that these are ‘on hold’.  We use the status flag for this purpose. 

 

We think this is safer for patient care rather than discontinuing held orders (as we did before BMV) where physicians may ‘forget’ about orders that have been on hold and assume they are getting therapy they are not.

 

Jeff Lee
Assistant Director of Pharmacy, Support Services
DCH Regional Medical Center
809 University Blvd E.
Tuscaloosa, AL 35401
 

(205) 750-5323
jl...@dchsystem.com

The information contained in this e-mail message is confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited.

---

From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf Of Crepeau, Denise

Sent: Monday, November 27, 2006 5:11 PM

To: 'Charlie Downs'; Parker Karen; medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders

 

We are currently having this very discussion at our hospital. Is anyone using the hold function?

---

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is strictly prohibited.

[Thompson, Jeff]

Not quite accurate.  Our Pyxis 3000 handles the DA (deactivated) and RA (reactivated) correctly.  The drug shows on the patient profile at the station but shows on on hold and unavailable to take out.

 

Jeff Thompson

Newman Regional

Emporia, KS

 

-----Original Message-----
From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf Of sda...@uhcc.com
Sent: Wednesday, November 29, 2006 9:06 AM
To: Alan Miller
Cc: medit...@MTUsers.com
Subject: Re: [MEDITECH-L] Hold orders

 

[Pierson, Jeff]

Is the tab 4 part of Client Server? I am not familiar with it in Magic.
Please illuminate me as to where I can find it if it's part of Magic.
Thanks.

Jeff Pierson, RPh
Manager - Pharmacy Operations
SwedishAmerican Health System
Rockford, IL 61104

-----Original Message-----
From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf

Of Grolla, Cindy
Sent: Friday, December 01, 2006 9:15 AM
To: ke...@rphinformatics.com; Crepeau, Denise; Charlie Downs; Parker
Karen; medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders

In the PHA module the pharmacist can enter a med order and place it in a
pending status on tab 4. This places the medication in the "pending"
status. The medication does not display in the eMAR and does display on
the active order screen.

Our expectation was to have the Pharmacist enter all the home
medications that were not started at the time of admission in this
"pending" status and have the provider "change" the order to active when
they wanted the med started. This routine does not work at this point
for providers- there is a DTS out there to fix it but we may not get it
until SR4. The pharmacist can change the setting - but at this point
the provider changing it in POM does not work.

Cindy Grolla, RN
Clinical Project Leader
Phone: 507.646.1209
Pager: 507.645.1475

-----Original Message-----
From: m...@rphinformatics.com [mailto:m...@rphinformatics.com]
Sent: Thursday, November 30, 2006 10:53 PM
To: Grolla, Cindy; 'Crepeau, Denise'; 'Charlie Downs'; 'Parker Karen';
medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders

"Pending Status"? Meditech? PHA...RXM...AOM...POM...OE........where is
there a "Pending Status" for medication orders? Sounds similar to the
"Profile Med" or "Historical Med" functionality from RXM.

I'd be interested to hear back from you on this ASAP.
Thanks.



Kevin McConnell, PharmD.
Clinical Consultant
(713)480-6810
ke...@RPhInformatics.com
www.RPhInformatics.com

From: medit...@MTUsers.com [mailto:medit...@MTUsers.com] On Behalf

Of Grolla, Cindy
Sent: Tuesday, November 28, 2006 1:40 PM
To: Crepeau, Denise; Charlie Downs; Parker Karen; medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders

We decided to not use "hold" because in C/S the medications with a
"hold" status still show up on the eMAR and it is not glaringly obvious
that the med is on hold and we thought the nurses may give it by
mistake.

If you put the medication at a "pending" status they do not show up on
the eMAR but do show up as "pending" on the active order list. We are
planning to use this for home medications that are not started when the
patient is admitted.

Cindy Grolla, RN
Clinical Project Leader
Phone: 507.646.1209
Pager: 507.645.1475

-----Original Message-----
From: medit...@MTUsers.com [mailto:medit...@MTUsers.com]On Behalf Of

Crepeau, Denise
Sent: Monday, November 27, 2006 5:11 PM
To: 'Charlie Downs'; Parker Karen; medit...@MTUsers.com
Subject: RE: [MEDITECH-L] Hold orders
We are currently having this very discussion at our hospital. Is anyone
using the hold function?
Thanks,
Denise Crepeau,
intelliDOT Coordinator,
Parkview Medical Center,
400 West 16th Street,
Pueblo, Colorado
intelliDOT Hotline # 3687
office (719) 584-4291
-----Original Message-----
From: meditech-...@MTUsers.com
[mailto:meditech-...@MTUsers.com]On Behalf Of Charlie Downs
Sent: Friday, November 24, 2006 7:13 PM

To: Parker Karen; medit...@MTUsers.com
Subject: Re: [MEDITECH-L] Hold orders

Hold = Discontinue unless for a specified period of time such as hold AM
dose, hold for 2 days, etc in which case the deactivate function is
used. The physician can write an order to resume or just re-write the
order if they want to re-start.
Charlie
Charles Downs Pharm.D.
Washington County Hospital
Inpatient Pharmacy
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
----- Original Message -----
From: Parker Karen
To: medit...@MTUsers.com
Sent: Wednesday, November 22, 2006 12:14 PM
Subject: [MEDITECH-L] Hold orders

***** CONFIDENTIALITY NOTICE ***** This message contains confidential

information and is intended only for the individual named. If you are
not the named addressee you should not disseminate, distribute or copy
this e-mail. Please notify the sender immediately by e-mail if you have
received this e-mail by mistake and delete this e-mail from your system.

This e-mail contains the thoughts and opinions of the sender and does
not represent official Parkview Medical Center policy.

This communication is intended only for the recipient(s) named above,
may be confidential and/or legally privileged; and , must be treated as

such in accordance with state and federal laws. If you are not the

intended recipient, you are hearby notified that any use of this

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the message from your computer system.

[m...@rphinformatics.com]

Hey Jeff-
Definitely CS...that's why I didn't get it at first either (one of the
disadvantages of doing both Magic and CS).

Later.

Kevin McConnell, PharmD.
Clinical Consultant
(713)480-6810
ke...@RPhInformatics.com
www.RPhInformatics.com