Placing Orders - Pre-Admission Episode

Registry Setting

Use the 'Defer Activation of Orders in a Pre-Admit Episode Until Admission' registry setting to not send orders placed on a pre-admission episode to eMAR, CareConnect, Order Notifications, or RxConnect.

Note: This registry setting is not supported when any external pharmacy definitions exist for the myAvatar facility.

Place a New Order

For an end user, the order entry process when in a pre-admission episode will be identical to an admission episode, except for functionality related to the start date. 

• For all orders placed on a pre-admission episode, the start date and time will default to 01/01/2099 at 0000. 
• On-the-fly Taper/Titrate orders will increment the start date and time from 01/01/2099 as defined by the user during order entry.
• Within the Order Group pop-up screen, the Order Group Start Date and Time as well as the individual order start date and Times will default to 01/01/2099 @ 0000 and be non-editable. For any orders with a pre-defined offset within the Order Group, the dates will be adjusted accordingly. For example, an offset of one day will show as 01/02/2099.

The only order actions available in a pre-admission episode will be New Order, Discontinue, Modify, or Print (where applicable). All remaining order actions--Hold, Resume, Renew, and Reorder--will be disabled.

Any orders placed on a pre-admission episode will complete interaction checking against any pending medication orders placed via Admission Medication Reconciliation in the instance that Admission Medication Reconciliation happens prior to the physician entering the orders.

If a nurse enters verbal orders on behalf of a physician for a pre-admission episode, the orders will be marked and available for validation immediately.

When placing a new order, copying an order, or modifying an order the following items apply.

• The First Dose Date and Time are not available. 
• The start date and time and stop date and time will not be visible to the end user. 
• The First Collection will be blank and non-editable.
• Disable the options 'Give Initial Dose Now' and 'Skip First Dose' to prevent the end user from specifying a dose time before the patient is admitted.

Admission Medication Reconciliation

When any orders are placed on a pre-admission episode in this mode, any inpatient orders will be available in the Inpatient Orders Scratchpad when in Admission Medication Reconciliation. This will ensure that when doing Admission Medication Reconciliation in a pre-admission episode the user completing the reconciliation is aware of any orders placed via Orders This Episode or Orders This Admission.

Note: If a user completes Admission Medication Reconciliation prior to entering the orders in a pre-admission episode, the reconciliation history will not reflect the users knowledge of those orders.

Admit the Patient

When the patient is admitted into an inpatient system, the system will update any orders that were entered in the pre-admission episode to an order start date/time that matches the order activation date/time. There will be a button added to the Order Entry console that will activate the pre-admission orders and at this point all orders will be sent to eMAR, CareConnect, Order Notifications or HL7 Module (for example, RxConnect). The Admission Medication Reconciliation will continue to be activated manually by the nurse.

Interval orders will use existing logic to determine the first dose based on the updated order start date and time upon activation.

The system will use the time zone offset to determine the appropriate order start date and time. This means any STAT orders placed by the physician will be automatically due when orders are activated.

User/User Role-based permissions to Activate Orders

On the Order Entry User Definition and Order Entry User Role Definition forms, use the _________field  to define who is allowed to activate preadmission orders after a patient’s admission is documented in myAvatar. Users with this access will be able to select the 'Activate orders' button within the Orders console. Users without this access will see the 'Activate orders' button, but it will not be selectable.

Prevent Order Entry Until Pre-Admission Orders are Activated

If non-activated pre-admission orders are present after a patient is admitted, then the Order Search field will be locked to prevent staff from entering new orders.

Discharge a Pre-admission Episode

In the instance where a pre-admission episode is discontinued without being converted to an inpatient episode, all orders entered on the pre-admission episode will be discontinued. Changes will be required to support the discontinuation of medication orders.