As nurses, we want it to be correct! It must be clear, concise, comprehensive and complete. There are many new innovative technologies that have evolved over the years to improve both the accuracy and ease of prescribing medications. Electronic scripts, E-Prescribing, EMR’s and pharmacy automation systems have greatly improved a medical provider’s ability to prescribe medications rapidly and accurately to whoever needs the information to fulfill the script. Having these technologies makes our life easier and helps reduce errors, BUT……
THE INFUSION PRESCRIPTION PROBLEM
Unfortunately, electronic systems to prescribe in-office administered medications, especially biologic and specialty medications that are given intravenously or by injection under provider supervision, have still not evolved much in the healthcare system. Most current EMR and practice management systems don’t have the necessary templates to accommodate what most providers would call a complete infusion or injection order/script for these medications.
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. Many of these specialty medications have additional provider instructions specific to the medication and diagnosis and uniquely ordered for the patient for which the medication is prescribed. Most traditional EMR’s cannot provide the nurse with all the necessary information for these complicated medications in a concise manner.
Many issues exist when prescribing a biologic. The provider is concerned that the patient receives the medication as prescribed. As nurses, we are concerned about potential allergic reactions, IV access, and other existing health conditions. The provider’s order will be complex, attending to all the issues that may arise during and after the infusion.
Managing a possible reaction to some infusion medications necessitates the administration of pre-medications. For example, if a drug has significant potential to cause hypersensitive reactions, or there is a known allergic response to that drug, then a pre-medication will more than likely be ordered. Using a pre-medication may allow the patient to continue receiving the drug even though they are hypersensitive. Many of the biologic medications have recommended or provider preferred pre-medications that can reduce or eliminate the potential for adverse reactions. The pre-medications might be oral products like Tylenol, Benadryl, etc or additional intravenous (IV) pre-medications like IV Benadryl or IV Solu-Medrol. For each of these ordered pre-meds, there will be required fields for Medication, Route, Dose, etc. on the order form.
In addition to pre-medications, the provider might also choose to authorize the use of some “as-needed” or “PRN” medications to be given in the event of patient discomfort or possible infusion-related reactions. For example, a provider might choose to order Ondansetron (Zofran) 4mg IVP in the event the patient becomes nauseated during the primary treatment. Some providers also choose to include authorization for emergency medications or protocols in the event of a serious infusion/injection-related reaction.
INFUSION RATES & PATIENT MONITORING REQUIREMENTS
Like oral medications, the Frequency (Once a day, twice a day, etc) and the Duration (every other day for 7 days, etc) are critical to infusion/injection medication orders as well. For infusion/injection medications, there are often specific instructions regarding the infusion rates and volumes to be administered that can be unique to the patient based on the provider’s wishes. For example, a provider might wish to start a new patient at a slower infusion rate for their first treatment. (example: 15 ml/hr vs. 25ml/hr for the first 15 minutes or for a volume of 100ml)
Specific monitoring instructions may also be a provided for during or after the ordered treatment. Some providers may want vital signs for blood pressure checked every 15 minutes while others might want the treatment stopped altogether if the BP exceeds a specified threshold. It is common for providers to request post-infusion/injection treatment observation for some medications known to have delayed treatment reactions up to an hour or more.
LABS, DIAGNOSTIC TESTS, & CLINICAL PROTOCOLS
Manufacturer recommendations and provider preference can also play a part in the pre- or post-treatment requirements for specific medications. Some providers will give instruction for diagnostic testing (Tuberculosis (TB) screening as an example), Labs, or other clinical tasks either before or after each treatment.
INFUSION ORDERS ARE COMPLICATED
As you can see, the infusion/injection order is typically much more complex than commonly prescribed oral medications. Infusion orders require clear and accurate communication between the ordering provider and every member of the infusion patient’s care team. This is especially true when the ordering provider is providing a treatment order to an outside facility or Infusion Center that is not directly within the provider’s own practice office location.
THE SOLUTION – CLEAR, ACCURATE, & COMPLETE ORDER FORMS
Over the years we found that having accurate, clear, and complete infusion/injection orders from the ordering provider were key in our ability to efficiently and safely treat patients in the Infusion Center. If the ordering providers have the capability to create a complete medication order, this will limit the frustration and confusion for everyone involved in the patient’s care. This capability benefits the ordering provider as well so they don’t have to answer 30 questions after they write their first medication order. In addition, multiple versions of the order are less likely to get created in separate parts. Preprinted order forms also improve documentation for utilization and reimbursement purposes as they help non-clinical staff members more easily identify the provider’s intentions.
For the benefit of the ordering provider and everyone involved, WeInfuse has created standardized and customized infusion/injection preprinted order forms. These forms benefit the provider because most of the “best practice” information needed by the clinical and financial team members is printed on the form with easy to use options. Not every provider will remember to order labs with zoledronic acid for osteoporosis or that they can order IV methylprednisolone (Solu-Medrol) with Lemtrada infusion orders. The order forms benefit the office staff and infusion nurses because they can clearly understand the ordering provider’s intentions and won’t be tempted to translate or infer certain parts of the provider’s patient order.
Ordering Provider adoption of these medication-specific forms is key to updating and improving your infusion patient workflow. Be sure that any order forms used in the practice are easy to read, clearly labeled, and present concrete options for each possible choice or protocol. Having the order forms available in paper is helpful for certain providers while some will prefer an electronic or fillable format.
WEINFUSE INFUSION ORDER FORMS ARE AVAILABLE FOR FREE!
To help you get started, 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 pre-medications and protocols for many of the biologic, IVIG, and specialty medications on the market. 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 the 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
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 key to your practice’s clinical and financial success. As a nurse, having a form that leaves no question as to the provider’s order is of utmost importance.
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 at https://weinfuse.com and Request a Demo.