Inpatient Decision Support

Medication Warnings

100

What is the purpose of configuring Interaction Warning Filters?

Configuring interaction warning filters allows users to see only the interaction warnings which would help them practice better medicine. The filters hide the interaction warnings which are "noise" for the providers.

200

What are the levels at which Interaction Warning Filters can be attached?

The levels, from most to least specific, are profile, provider type, provider specialty, location, service area and facility.

300

What is the difference between suppressing and filtering warnings?

Filtering hides the warnings, but a provider can still see that a warning exists. Suppressing interactions completely hides warnings.

400

What are the limitations of pop-up windows for decision support?

Pop-up warnings are very intrusive. A pop-up warning must be closed before any other actions can be taken, forcing the user to focus on the warning. In some cases, this amount of intrusiveness can cause negative reactions. For example, when a person is still learning to use the interface or when the pop-up warning does not seem useful, the user can get frustrated or annoyed. This can further decrease the effectiveness of other pop-up warnings if users learn how to habitually ignore the warnings.

500

What is the advantage of using pop-up windows for decision support?

When pop-up warnings force a user to focus on a medication safety issue which might have escaped their attention otherwise, the warning can prevent the patient from being harmed.

Alternatives

100

True or False. If I order an imaging test to see if a patient has a stomach ulcer, an Alternative can suggest the medication Nexium.

False. Procedure orders can only have alternative procedures suggested.

200

I just created a medication Alternative record for GERD medications that should appear when someone orders esomaprazole (NEXIUM) tablets. I linked it to the NEXIUM 20 MG PO CPDR medication record and set Use Alternatives to Yes. But when I order NEXIUM 20 MG PO CPDR, I do NOT see the Alternative. What could be wrong?

There are a few possibilities including: -You might have attached the Alternative to the brand name record (NEXIUM), instead of the dispensable product (ESOMAPRAZOLE) record. -You might have attached the Alternative to the medication on the outpatient fields, not the inpatient fields. -You might have only attached the Alternative to the med for a specific hospital, and the patient could be in a different hospital.

300

In an Alternative, what are two ways to provide information to the ordering user?

Use a SmartText or include a URL.

400

True or False. You must mark an Alternative as "released" before it is active in the system.

False. Alternative records do NOT need to be released. They are simply attached to a medication or procedure record. (Note that the SmartText and SmartGroup(s) attached to the Alternative DO need to be released, but if they are not then you simply won't be able to use them. The Alternative can still appear.)

500

Your've created an Alternative record to suggest formulary medications when a physician orders a prior-to-admission medication that is not on the hospital's formulary. Where must you attach this Alternative record? (Choose only one). a.) Each non-formulary medication record b.) System Definitions c.) The hospital (Revenue Location) record d.) The physician's profile

b.) System Definitions

Best Practice Advisories

100

You've been asked to create a BPA that warns users when they try to enter any order for warfarin (a medication) if there isn't an INR lab result on file in the last day. It should prompt the user to enter a single order: a ProTime-INR (a lab test). Which of the following records must you create to make this BPA happen? (Choose ALL that apply) a.) One or more BPA base records b.) One or more BPA criteria records c.) One or more Generic Rule records d.) One or more preference lists e.) One or more SmartSets f.) One or more SmartGroups

a, b and d. You don't need a generic rule, because you can search for patients with orders for warfarin or patients missing an INR lab value usign the standard criteria fields. To suggest the single follow-up order, you need to create a Preference List that contains it.

200

You've been asked to create a BPA that warns users when they try to enter any order for warfarin (a medication) if there isn't an INR lab result on file in the last day. It should prompt the user to enter a single order: a ProTime-INR (a lab test). How many BPA criteria records COULD you use to meet the needs outlined above? (Choose ALL that apply.) a.) zero b.) one c.) two d.) three

b and c. Because both criteria need to be true (order for warfarin, a missing lab value for INR), you could put them both in a single BPA criteria record. But, it's probably a better idea to create them as two separate criteria records and link them with "AND" logic in the base.

300

You've been asked to create a BPA that warns users when they try to enter any order for warfarin (a medication) if there isn't an INR lab result on file in the last day. It should prompt the user to enter a single order: a ProTime-INR (a lab test). The BPA above shoudl appear when any user selects an order that completes the criteria. The user must either accept the suggested order, or acknowledge the BPA with a reason. He has two choices: "I'll remove the order" or "INR value is recorded outside of Epic." If he chooses the second one ("INR value..."), the warning should not appear again for 24 hours. In which of the following records would you make the settings to make the above requirements happen? (Choose ONE only.) a.) BPA base record b.) BPA criteria record c.) Generic Rule record d.) Preference List e.) SmartSet f.) SmartGroup

a is the correct record. All these settings are made in the BPA base.