During my dispensary rotation, I had the opportunity to work as an extra pharmacist (still strange to think that I am a licensed pharmacist already). I was trained by some wonderful staff at BCCH and the following is my systematic approach to order entry on Centricity.
- Open the order and the corresponding patient (find by MRN) and link it!
- On the order type in the patient’s allergy status, weight, and age
- Check the dose of the medications prescribed, and if there are other old orders (not to be entered) on the script cross reference them on the patient’s file
- Enter the order and ensure the labels make sense for printing!
The following are examples of entries that I accurately transcribed onto the patient’s medical record:
1. CD is a 17 y/o 81.3 kg male with NKDA order was for a D/C of tylenol regular and to start Tylenol #3 2 tabs Q4H regularly. I first discontinued their regular tylenol and then checked their dose against pedmed for each individual component (the acetaminophen and codeine). It was entered as prescribed and I noted the following on the scanned order:
- Acetaminophen dose: 7.38 mg/kg/dose; max: 3600 mg/day
- Codeine dose: 0.74 mg/kg/dose
2. ES is an 11 y/o, 41kg, NKDA with an order for:
- Salbutamol dosing to change to 5puffs Q4H Regularly
- D/C Ampicillin (previously on file)
- Start Amoxicillin 1g TID
- I assessed the old script of Salbutamol, and found that it was previously prescribed for 10 puffs inhaled as per physician’s orders. I changed this to the new script and wrote 5 puffs for the qty, but altered the sig to “Inhale as per physician’s orders” so to limit the number of re-labeling that had to be done for the item. I had the old inhaler tubed down to be relabeled.
- For the amoxicillin, the route of administration was missing, so I wrote a clarification order for that. The dose was 73 mg/kg/day, which is not high dose (80-90 mg/kg/day), nor low dose (50 mg/kg/day). However upon discussion with one of the staff pharmacists we decided that the dose was ok as it was to ensure easier administration of two 500 mg capsules (as opposed to an extemporaneous liquid dose). The afternoon dose was sent, as the morning dose of antibiotics was administered as ampicillin.
- For the ampicillin, I noted the Rx# on the order scanned, and then proceeded to discontinue the order on the patient’s file.
3. GH is a 22 y/o, 81.6 kg, NKDA, with a new order for hydromorphone 1-3 mg PO Q4H regular with a morphine infusion and morphine PRN on file. I called the pt’s RN to confirm if the hydromorph was to be given on top of the morphine infusion and PRN, the RN confirmed this and asked for a discontinue order from the physician. I transcribed the order as written for the hydromorphone, and made a note to myself to ensure the discontinue order for morphine came through (which it did shortly after).