As a common guy and macho father of 2 young boys, I tend to have an “instructions optional” attitude about putting together new kid toys and the boxed furniture my beautiful bride brings home from IKEA. One of the few times I actually did read the instructions, I ended up with extra parts in my hand and had to watch in horror as my hastily assembled TV stand came crashing down with the new 50″ HD set on top. Fortunately for our clients and their patients, I have quite the opposite approach when it comes to infusion orders and our healthcare software company.
In any business where you are dealing with medications and clinical documentation, attention to detail is not optional. In healthcare, there are instructions about almost everything, and they can’t be tossed over the shoulder or ignored without the risk of serious consequences. For the infusion nurse, the instructions always start with the physician’s order. My good friend and colleague Judy Back, RN, BSN was my mentor in the infusion business, and she taught me from day one that no nurse is worth their license if they don’t clearly read, understand, and confirm the physician’s order.
THE PROBLEM WITH ORDERS
Unfortunately, some of our most well-meaning physicians seem to think that mind reading is a viable alternative to actually reading their handwriting. I don’t want to completely blame the physicians here, after all, there are many new electronic prescription capabilities in most modern EHR’s that are supposed to cure the handwriting dilemma. The problem is that most E-Prescribing systems are designed only to prescribe common oral medications and procedures. As our own Judy Back wrote in her Take the Confusion out of Infusion Orders article last year:
“Medication, Route, Dose, Frequency, and Duration are the foundations of any medication order, but for most Specialty and Biologic medications, the orders need to contain much more information than the typical prescription pad Rx. ” – Judy Back RN, BSN
For rare infusible specialty biologics and intravenous immune globulins (IVIG), there are multiple additional and important administration and dosing instructions that are not handled completely by these e-prescribing solutions.
Many new and existing biologics have additional IV pre-medications that need to be prescribed alongside them – each with their own route, dose, and frequency. In addition, weight-based dosing, induction dosing intervals, infusion rate limits, and other critical instructions need to be provided along with the primary medication order. For the provider and the infusion nurse, these additional details make writing and understanding these orders much more complicated.
THE SOLUTION – BETTER ORDER FORMS
Back in the early 2000’s, we began to create medication specific infusion order forms for our prescribing physicians, and it made a huge impact for everyone involved in the patients’ care. These new orders included options for all the diagnosis, pre-medications, dosing, route, frequency, patient weight, and infusion rate information for a specific biologic, specialty medication, or IVIG product. These options were presented as clearly marked check-boxes or radio selection options that were easily understood whether the form was printed out and handwritten or electronically completed using free versions of Adobe Reader.
Above image: Sample partial view of a WeInfuse fillable Actemra Order Form showing clearly defined options for diagnosis, pre-medication, and dosing information.
In addition to virtually eliminating the handwriting problem, the customized forms greatly reduced the back and forth between ordering providers and the clinical teams treating their patients. For the physician, having all of the medication requirements and options clearly available on each form also helped them remember all the protocols needed for a particular therapy. For the infusion nurse, having clear and complete orders from the provider increased their confidence and reduced potential medication delivery errors when treating patients.
Physicians and nurses are not the only ones who benefit from clearly understandable order forms. There are no inexpensive biologics or IVIG products on the market today. Due to the cost of these infusion medications, nearly 100% of these prescribed specialty medications go through an intense insurance pre-authorization and verification process. This process requires the office staff to provide the insurance company representatives much of the same information that is included in the physician’s order. Having a clean and complete order means that the office staff can more quickly process the insurance’s pre-treatment requirements without having to go back and forth with the ordering provider’s office to clarify or complete the order details.
Let’s not forget that we are all still forever locked in the world of faxing and scanning in healthcare. Having a nice clean order form (with big fonts) also has the benefit of being more robust when it comes to surviving the resolution dissolving effect of going through multiple fax/scan/print cycles.
BETTER ORDERS LEAD TO BETTER PATIENT CARE
All of the above points translate directly to an improved experience and better care for the patient. Below are just some of the downstream patient care improvements that result from better orders.
REDUCED TIME to TREATMENT – if the instructions are clear and complete from the start, all processes leading up to the patient treatment move faster. The back and forth time-drain of having to find the original ordering physician and clarify or ask for a complete order will frustrate everyone involved in the process. Physicians are busier than ever these days. The time spent tracking them down wastes valuable days that delay the patients’ initial treatment and prolongs the relief they need from their symptoms.
FINANCIAL CONSEQUENCES – We said it before and it can’t be ignored – these medications are Expensive! Misunderstandings between the ordering provider, the office staff, and the insurance company can cause major headaches and have significant financial consequences for both the office and the patient. “Oops, looks like you owe $5,000 instead of $500 per treatment.” Would that frustrate you as the patient? These kinds of mistakes are what cause many tears in the eyes of patients. (Those tears can also be from the physicians crying when the high cost is theirs to pay)
MEDICATION ERRORS – We don’t like to admit it, but healthcare is not an exact science and mistakes do happen. A nurse who believes he/she is administering the medication exactly per the physician’s order is not completely at fault when the cursive “6mg/kg” and “8mg/kg” are only obvious to the physician who wrote it. It is much harder to make those mistakes with checkbox dosing options and a nice big “X” next to the physicians dosing selection. Clear communication and complete instructions lead to fewer mistakes for everyone. The consequences of mistakes in a patient’s treatment are much more significant than the destruction my new 50″ Flat Panel TV. Patients must get the right medication, at the right dosage, at the right time in order to properly treat their condition and reduce symptoms and suffering.
WEINFUSE CREATED BETTER ORDER FORMS THAT YOU CAN USE FOR FREE!
Want to get started with a better infusion order form? WeInfuse has created a number of medication-specific order forms in PDF format that you can download and use for FREE from our website. These order forms have the most common diagnosis, pre-medications, and dosing protocols for many of the biologic, IVIG, and specialty medications currently available. These order forms can be printed and filled in manually or they can be electronically completed using most free PDF viewers.
For WeInfuse customers, we customize these forms to the specific request of the customer’s protocols and providers to make the ordering process even easier on our client’s practice. These customized order forms also make it easy to intake orders into our medication-specific order intake module within the WeInfuse application.
Our current available forms can be found here: WeInfuse Order Forms
“As an infusion nurse, having a form that leaves no question as to the provider’s order is of utmost importance.” – Judy Back RN, BSN
Whether you are using a WeInfuse order form or your own practice created order forms, the importance of a clear and complete treatment order is a key component of your practice’s clinical and financial success.
If you would like to learn more about how WeInfuse can help you and your practice “Infuse Better”, please Contact Us at firstname.lastname@example.org or connect with us through our Website Here and Request a Demo.