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Physician orders timing dating cms

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With the push to develop and deploy electronic health records (EHRs) and the need for more detailed documentation, there is a growing concern in the medical community regarding the time expended to capture information-electronic or otherwise.

No fee schedules, basic unit, relative values or related listings are included in CPT.ISMP has long been an advocate for the use of standard order sets to minimize incorrect or incomplete prescribing, standardize patient care, and ensure clarity when communicating medical orders.(1-3) Whether in electronic or paper format, well-designed standard order sets have the potential to: Enhance workflow with pertinent instructions that are easily understood, intuitively organized, and suitable for direct application to current information-management systems and drug administration devices(1-4) However, if standard orders are not carefully designed, reviewed, and maintained to reflect best practices and ensure clear communication, they may actually contribute to errors—many of which have been described in our newsletters and still occur today.In fact, the ISMP consulting team often identifies dozens of serious problems related to the content, format, and approval/maintenance of standard order sets when visiting healthcare organizations of all sizes and types.One current solution gaining popularity is the use of scribes.Scribes can provide many benefits to the practice of medicine, ultimately impacting the overall quality of healthcare delivery." by Paul Byrne, MD VII - What Happens in Rogue Hospices Medicare/Medicaid Hospice Reimbursement Cap & Hastening Death Hospice Can Use "Closers" to End Lives HMO/Hospice Intimidation to Force DNR Status and HMO Abuse Begins HMO/Hospice Nurse Causes Fatal Septic Infection Hospice Can Withhold Ordinary Treatments to End Lives Hospice Can Misinform Patients and Families to End Lives Hospice Can Ignore Your Power of Attorney and Create a New One Hospice Can Misinform Staff to End Lives A Miseducated Hospice Nurse Hospice Can Miseducate Physicians to Facilitate Ending Lives Palliative Sedation or Terminal Sedation to Hasten Death Hospice's Third Way: Quill & Byock Promote Palliative Sedation to Hasten Death Hospice: Expanding Its Turf to the Non-terminal & Hastening Their Death How Hospices Hide the Killings (HIPAA Misdirection & Hospice Fraud) VIII - Why Hospice Became the Sacred Cow of Health Care The Government Loves Hospice The Media Loves Hospice Some Surgeons and Doctors Love Hospice Hospital Administrators Love Hospice Nursing Home Owners Love Hospice Guardians Love Hospice Some Adult Children & Spouses Love Hospice The Right-to-Die/Kill Crowd Loves Hospice IX - HMO/Managed Care Approach to Hastening Death What Linda Peeno, MD Told the Congress About Managed Care Kaiser Health Plan The Nixon Administration, HMO/Managed Care and E. Because these changes are not covered by the major media in any coherent, connected way, or at all, the public has difficulty "putting a finger" on what is happening and why.

Phillips Reports that Kaiser Misinforms the Public About "Normal" Human Lab Values to Limit Treatment X - The Federal Government's Approach to Hastening Death Physician Orders Limiting Life-Sustaining Treatments to Hasten Death How Government Can Work: Involuntary Sterilization, Experimentation and Hastened Death Utilitarian Care Rationing: Health Care Reform, The Government's "Complete Lives System" and Hastened Death Government Health Care Reform Law & the former Hemlock Society (Compassion & Choices) Government Action When There is A Question of Homicide The Federal "Ethics" Used to Decide Who Lives and Whose Death is Hastened Government Rationing Health Care through Cost Effectiveness Research Government Protection of Hospice and Many Health Care Facilities Government: Controlled by Corporate Interests Corporatism and Socialism How Government Works: The Food & Drug Administration & Corporate Lobbying The Government's Conflict of Interest XI - Where We are Headed The Removal of Prolife Physicians and Other Health Care Professionals Assisted Suicide and Euthanasia May be Legalized XII - Where We're at Today The HIPAA Privacy Rule: Wall of Silence Hospice Wrongdoing May Never be Properly Evaluated Family Members are Afraid to Speak Out Thwarting Appeals to Action How Things Work: The Legal Environment for Nurses How Things Work: Typical Hospice Scenarios for Hastening Death About the Current Health Care Reform Is There An Attack Against the Pro-Life Hospices?

Mistakes and inaccuracies in the orders, such as incorrect or missing doses (e.g., magnesium sulfate 16 g instead of 16 m Eq), routes, frequencies of administration, and rates of infusion; typos; and spelling errors, particularly with drug names An exhaustive variety of medications to cover every possible scenario a patient may face (e.g., orders that include multiple analgesics by various routes, laxatives, antacids, a bedtime sedative, antidiarrheal, antiemetic, and others); we’ve previously called these “Don’t bother me” orders, which lead to crowded medication administration records and leave treatment decisions to nurses’ subjective, variable judgment Dosing guidance not provided (e.g., mg/kg or mg/m2 dose not specified along with the calculated dose, particularly for neonatal/pediatric drugs and chemotherapy; safe dose range or maximum safe doses not specified; dosing parameters for titrated drugs not provided) Critical clinical decision support information, reminders, precautions, and/or safety measures not included, such as: monitoring requirements; administration precautions; adjustments for renal impairment or age; maximum adult total dose of acetaminophen not to exceed 3 to 4 grams per 24 hours The format of standard order sets can make them easier to read and comprehend, remind staff to document pertinent information about the patient and prescribed therapy, and draw attention to important information.

Elements of format include font style and size; use of white space; adequate space for handwritten entries; arrangement of the information; prompts for information; appropriate use of symbols, abbreviations, dose designations, punctuation, and capitalization; layout and design of the orders and other important information; and directions for using the standard orders.1-4 Examples of frequently observed problems with the format of standard order sets are provided below.

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No space is provided between the drug name and dose (e.g., propranolol20 mg can be misread as 120 mg), or the numerical dose/volume measure and the unit of measure (e.g., 3Units can be misread as 30 units) Use of error-prone symbols, abbreviations, drug name abbreviations, drug name stems, undefined drug protocol acronyms, or coined names (e.g., magic mouthwash) (see ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations at: org/tools/errorproneabbreviations.pdf) Look-alike drug names listed without using standardized tall man letters to help differentiate them (see the FDA and ISMP Lists of Look-Alike Drug Name Sets With Recommended Tall Man Letters at: org/tools/tallmanletters.pdf) Lack of prompts for patient allergies with description of the reactions; actual weight (in kg or grams only); body surface area for oncology patients; diagnosis/comorbid conditions (e.g., diabetes mellitus, liver or renal impairment, behavioral health disorders, hypertension); and pregnancy/lactation status Complex order sets (e.g., TPN) that list additives in a different sequence and doses in different units (e.g., mg vs. mg/liter) than the pharmacy order entry system No prompts on neonatal, pediatric, and oncology order sets to require the prescriber to include the mg/kg or mg/m2 dose for drugs prescribed according to weight or body surface area, the calculated dose, the actual dates of administration, and the cycle number (for chemotherapy regimens) Managing the initial approval of standard order sets and keeping them current present numerous challenges to organizations.