Reorder Due and Renewal Due notifications
myAvatar sends notifications to Ordering and Attending Practitioners to inform them that an order medication needs to be re-ordered or renewed.
- A medication needs to be re-ordered when the existing order can no longer be renewed as authorization to the pharmacy for dispensing of the medication.
- A new order with a new prescription number needs to be created. Renew is available when the existing order has reached the end of its original duration, but no additional authorization is required.
Whether an order needs to be reordered versus renewed is determined by one of two ways, depending on whether your organization is set to send inpatient medication orders to an external pharmacy.
- When sending to an external pharmacy, this is determined by the total length of the prescription being sent to the external pharmacy, which is calculated by (Refills +1) x Days supply. This is also the Stop Date of the order.
- When sending to RxConnect, this is determined by the Maximum Eventual Order Duration. The Maximum Eventual Order Duration is defined by two different methods depending on order type or DEA Classification of drug.
Dictionary Update
- Edit Data Element #500 (Order Types) contained in the Order Entry Tabled Files file.
- The extended attribute #525 (Maximum Eventual Order Duration) can be defined with the number of days to act as the maximum eventual order duration per order type.
Registry Setting Maximum Eventual Order Duration for Controlled Substances
- This registry setting defines the total number of days that an order can be active, including renewals. No orders for controlled substances are allowed to be created that exceed these durations, nor are such orders allowed to be renewed if doing so exceeds this duration.
- The value of this registry setting must be comprised of 5 numbers separated by an ampersand (&). The first number corresponds to Order Codes that are defined as C-I controlled substances. The second piece corresponds to Order Codes that are defined as C-II controlled substances, and so on. Maximum eventual order durations specifically for controlled substances are enforced only if this registry setting is set, and if it is set, the maximum eventual order duration values are set for all controlled substance Schedules.
- If a maximum duration is defined for the Order Type that is associated with an Order Code that is a controlled substance, then the shorter of the two maximum eventual durations is enforced.
Note: Any non-medication order may also have a maximum eventual duration that require reorder vs renew. The same rules apply and the to-do is generated in the same way.
Re-order and Renewal To-Do
Every evening, the system runs a process to determine those orders which are due to expire based on the Stop Date of the order. By default, this process is scheduled to run at 1 AM in the System Task Scheduler Form. While users can adjust the time at which it runs, it should be run after midnight. As part of this process, two notifications are available in the Notifications Setup form:
- Order Entry (Renewal Due) - Any orders that can be renewed generate a renewal notice to the ordering physician.
- Order Entry (Reorder Due) - Orders that have reached their maximum order duration generate a reorder notice instead.
Organizations can configure myAvatar to send a to-do and/or pop up notification for a patient/client whose orders are due for renewal or reorder. The To-Do is presented to the Ordering Provider only. The agency can configure the notification text they wish the Practitioner to see with this re-order notification.
Note: The reorder notification requires action by the user in the Order Console. For that reason, the Order Entry (Reorder Due) notification is a notification only. Users must navigate to either the console to review and take appropriate action.
Order Notifications Setup:
Notifications (Renew and Reorder):
Order Console
Identifying orders available for Reorder or Renewal
In the order console, there are two places where users receive indications or notification that orders are due for renewal or reorder.
- Renew Notification Icon: Both orders due for renewal and due for reorder populate here. This count is updated throughout the day. For example, if an order counted in the numbers during the nightly process but expires at noon, the order is removed from the count once it is expired. This indicator is not specific to the client or patient in context, but rather any orders due to expire for which the current user has responsibility.
- Both the ordering provider and the attending physician are notified of orders that are set to expire in the Orders Console. The ordering provider only receives notifications where they are the ordering provider. However, the attending physician receives notification for any order on any of the clients or patients assigned to them.
Note: When the user clicks on the R indicator and selects a client or patient to review, all orders due for renewal populate via the filter, regardless if they are the ordering provider or attending physician for that patient. This functionality is designed to provide the user the opportunity to see all orders due for renewal as it may impact their decision making.
- Both the ordering provider and the attending physician are notified of orders that are set to expire in the Orders Console. The ordering provider only receives notifications where they are the ordering provider. However, the attending physician receives notification for any order on any of the clients or patients assigned to them.
- Order status notations: The order status notation indicates to the user the current status.
- No Renew – Use Reorder: This notation indicates that the order is still active and due for reorder vs. renewal. This notation displays until the order becomes expired.
- Reordered: This notation indicates that order is active and has already been reordered. This notation displays until the order becomes expired.
Reordering or Renewing
Once the user has identified the order to be reordered or renewed, the orders can be acted upon using the Renew or Order buttons in the console. Users can select one or multiple orders due for renew or reorder. On Reorder, if multiple orders are selected, all orders are populated to the scratchpad. If a user wishes to change any details prior to signing the order, they simply select the order and modify the details. If a user selects a single order, the order details populate and the user needs to Add to Scratchpad for final signing. In the scratchpad, the order action shows as REORDER. For orders that have reached their maximum order duration, RENEW is grayed out and no longer available as an option.
Note: Users can change any order details for the medications being reordered, however, they cannot change the medication being ordered.
All reordered medications have a start date and time one minute after the end of the order being renewed. This ensures there is no overlap or gap in the medication administration record.
For orders being renewed, the user is not able to change any of the specific order details. If any details need to be changed, the user should discontinue and place a new order. The options available at renew are:
The Renew and Reorder indications RE cleared when all the orders that triggered the notification have been addressed, or when the orders have expired. The notifications are re-generated every night, so any new orders due for expiration or orders that were not addressed result in the notification being regenerated.