INP 100 Chapter 13

Which section of the Transfer Navigator must the physician use in order to reconcile all the orders for a patient?

Transfer Orders (remember this 'section' of the Transfer Navigator is a navigator unto itself).

What is a signed & held order?

A signed and held order is an order that is signed, but it is not released or made active until someone releases the orders.

What is a MAR Hold?

Epic's mechanism to notify nurses that medications might not be ready to be acted upon.

Why does someone have to confirm the patient transfer before releasing signed and held orders?

If the arrival has not been confirmed, then the orders are released and routed as if the patient was in the original unit.

How do you reconcile home medications?

In the Reconcile Home Medications section of the Med Reconciliation Navigator each medication should be marked as one of the following: Order: Medication is ordered and patient continues taking it during this admission, Don't Order: Medication is NOT ordered and the patient does not continue taking this medication during this admission (but might resume it upon returning home), Replace: Do not order this exact medication, but order a different medication in its place, or Discontinue: Medication is NOT ordered during the hospitalization.

What does it mean to have a medication on MAR hold?

It's a medication orders that was not reconciled upon transfer. The transferring physician may need to be notified to reconcile these medications.

In which section, within the Transfer Orders Navigator, does the physician place the transfer order?

New Orders

What is a cosign?

Orders needing cosign are active orders. Someone has "signed" them; they just need an authorizing provider to double-check them and give them the stamp of approval.

How do you release Signed & Held orders all at the same time?

On the Release Orders section of the Transfer navigator click the hyperlink "Click Here to Release Signed and Held Orders", the Release Orders window appears where the nurse can click the "Select All Reconciled Transfer Orders" button and then the "Release" button.

How do you release Signed & Held orders individually?

On the Release Orders section of the Transfer navigator click the hyperlink "Click Here to Release Signed and Held Orders", the Release Orders window appears where the nurse can select which orders they want to release and then click the "Release" button.

What's the difference between orders needing cosign vs. Signed & Held orders?

Orders needing cosign are active orders. Someone has "signed" them; they just need an authorizing provider to double-check them and give them the stamp of approval. Signed & Held orders are inactive until released once a patient has reached their destination unit.

Within the Transfer Orders Navigator, which section would a physician use to reconcile the orders that are currently active?

Review Current Orders

How do you place an Order to Transfer?

Select the "New Order" button on the New Orders section of the Med Reconciliation Navigator.

How do you sign & Hold orders?

Select the "Sign and Hold-Will Be Initiated by Receiving Unit" button on the Review and Sign section of the Med Reconciliation Navigator.

What happens if a physician forgets to click either Continue, Discontinue, or Modify for an order in the Review Current Orders section?

The order is automatically continued, but it appears to other clinicians as not reconciled. If the order is a medication, it will be on MAR hold.

What is it to release a signed and held order?

The orders must be manually released by the nurse on the receiving unit before anyone can act on them. If the arrival has not been confirmed, then the orders are released and routed as if the patient was in the original unit.

How do you identify medications on MAR hold?

The unreconciled medication orders are labeled [MAR Hold] in red in the Release Orders window.

True or False? A nurse has the ability to release orders individually from within the Release Orders activity.

True. The nurse would manually select the individual order(s) that need to be released, and then click Release. (This functionality would be used if an order(s) needed to be released before the transfer occurred).

How do you confirm a transfer?

Use the Unit Manager activity and drag the patient from the Incoming Transfer section to an open room and bed in the receiving unit. In the window confirming the patient's transfer, click "Transfer".

What is a transfer?

When a patient's condition changes a transfer to a higher or lower level of care may be necessary. This may require a move to another unit which is a transfer.

What's the purpose of a Transfer Orders navigator?

When a physician is transferring a patient to a different level of care the Transfer Navigator walks him through all the tasks that need to be completed.