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  • 1.  Use of Order Modes in Epic/Protocols

    Posted 05-08-2024 18:50
    Edited by Mallory Stroup 10-14-2025 15:38

    I am wondering if anyone who uses Epic would be willing to share their workflow and/or protocols for how they address when a provider routes a message with an order in a telephone encounter to an RN to enter in the EMR. Example: The provider sends the RN a written message in the chart for lisinopril 5 mg po BID #30 with no refills. Do your RNs enter this in the medication list? Can they send it to the pharmacy? Do they use the Order Mode "Per protocol-no co-sign required' or do they pend the order to the provider to sign off? Thanks!



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    Mallory 



  • 2.  RE: Use of Order Modes in Epic/Protocols

    Posted 05-09-2024 05:53

    I'm not understanding why the physician is sending the Rx in a message to nurse. Why isn't the Rx being sent electronically to the pharmacy? Once the Rx is sent to the pharmacy it should automatically be added to the medication list EPIC EMR's. 




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  • 3.  RE: Use of Order Modes in Epic/Protocols

    Posted 05-09-2024 07:40

    I agree with Karen The provider should be coached to just enter the order.

     This is complicated and a challenge with our providers as well.

    We have defined any order that comes via message (text, Email, secure Chat) as Verbal orders. We limit verbal orders to only emergency situations where the provider does not have access to a device to enter the order. Therefore if they are able to send a message it does not meet the requirement for accepting a verbal order.

    Our official guidance for this would be for the Nurse to pend the order to the encounter and route back to the provider for signature.

    I am not naïve and am sure our nurses are either entering as protocol or transcribed orders. 



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    Ray Snider DNP MSN RN NEA-BC
    Director Clinical Operations
    Emory Healthcare
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  • 4.  RE: Use of Order Modes in Epic/Protocols

    Posted 05-09-2024 08:06

    This would be written/transcribed, since there is record in the chart that the provider sent the message to the RN. It brings the bigger question that the other responses are also asking- if the provider was willing to take the time to write the message for the order they could have just entered the prescription themselves. Is the provider's workflow setup for them to do this, is there a knowledge gap on how to send scripts, etc...? 



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    Andrea Kelly MSN, RN, NPD-BC
    Director, Population Health
    ECU Health Physicians (formerly Vidant Medical Group)
    Greenville NC
    (252)847-3930
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    Original Message


  • 5.  RE: Use of Order Modes in Epic/Protocols

    Posted 05-09-2024 08:49

    Hi Mallory,

     

    The only allowable use of the "no-cosign required" in our system is for the flu vaccine, as deemed appropriate by CMS and our state's DPH.

    We only use "co-sign required" if using an approved nurse driven protocol for in-clinic meds only- this allows the release of the med with waiting for a provider to sign a pended order. Example: vaccines (except flu).

    Prescriptions should be pended to the provider for signature. Nurses cannot prescribe- it is outside the scope of practice for an RN or LPN.

    This workflow you described seems to add steps, as the nurse should be pending this back to the provider to sign. Provider education and 'gentle reminders' are key.

     

     

    Lisa

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  • 6.  RE: Use of Order Modes in Epic/Protocols

    Posted 05-10-2024 09:48

    I have to agree with the comments from other members. The provider should enter the medication and send it to the pharmacy. Clinical staff in our medical group can pend medication orders but cannot send any to the pharmacy (it is blocked by security access), and our providers know to send the medication to the pharmacy. We do allow the use of per protocol for RNs for a set number of protocols approved by our state's board of nursing and our quality and safety committee. Our organization does allow staff to sign non-medication orders using the order modes of telephone, written, or verbal orders. We have a pilot right now with lab orders being signed as per protocol for use during pre-visit planning.

     

    Thank you,

     

    Sharon J-J Peacock, MSN-Ed., RN, AMB-BC

    Nursing Professional Development Generalist

    Sentara Ambulatory Services Division

     

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