Home Forums Discussions Problems writing orders for an MA

Hi, I am new to AC and was wondering how do you guys give orders to staff. I was thinking ordering and "save with out printing" while in patient room with tablet pc.

these order will then go to my MA when I "forward the chart", who will execute them.

Now I find it frankly not very pretty at the bottem of the plan to have orders listed so I will need to remove them before printing a progress note for the referring physician.

Hence my question is will I be eradicating the only evidence of orders that I have. There will be no record then.

I just cant seem to get my head around to how folks order with AC. thanks in advance.

I think I agree with you. It seems to me that it would be more useful to have the orders in the past history tab than actually on the note itself. I'm not a doc though, so I may be mistaken.

yeah I dont know what to do right now. kinda waiting for some help here. you in dallas, me too!

Personally I think it is quite appropriate to have the orders you have given listed at the bottom of the plan. That also tells the lawyers, er patients, what you asked the patient to do or to have done and what your staff was asked to do for the patient. Remember...document,document,document. I actually print my patient instructions, with those orders and instructions and give them to the patient...CYA, CYA, CYA.

Leslie

Also, you can use some type of messaging system outside of AC or use the email feature within AC to give instructions to the staff that may not require recording into the chart. I use the freebie Yahoo Messenger (no patient names are ever divulged) and message staff right from the exam room. For instance, I may need a CT report or the date of the last colonoscopy and I can ask them for these without leaving the room and without the patient even knowing I am talking with my staff. The staff can then tell me when they arrive via fax into Paperport and VOILA...no wasted time.

Leslie

Leslie,

you are right. why not? just that I am an oncologist and need to send polished (as best I can) letters to the primaries. Lo and behold they dont read em anyway!

so the orders at the bottem look kinda cheesy and menuish.

Steve

I agree that they might not be appropriate for a formal consultant's letter although more and more, I tend to simply receive the consultant's office note as my "letter". This is fine with me and actually I get more information this way many times than I do with a conventional letter. For instance, many times I will get a formal letter which might say (got this one today) "I explained to the patient that we could perform a knee replacement if they feel their symptoms warrant it" but the patient heard "I do not think surgery is indicated at this time based on your symptoms". Big difference. The patient told me they could not go on like they are now and that they were ready for replacement. I sent the patient back to the consultant.

I also fax my notes on most occasions TO consultants (oncologists, cardiologists, gastroenterologists) who are also seeing patients regularly and who many times require routine or follow-up labs. If my note reflects the fact that I am already sending the patient for tests, hopefully the consultant will not send them also for the same things. Patients most of the time don't know what labs they are having done. I may see a patient the day after or the day before, say, the oncologist and they do not know what labs were drawn. It may take several days for me to receive the formal consultant's letter but a faxed note is there immediately. I know this topic is not on the validity of consultants notes but, I do believe that my notes, particularly when they include the instructions for the patient as well as the planned labs and tests, more accurately reflect what we actually plan to do than might a letter about my visit with the patient. Just my opinion.

Leslie

Ok, it seems Leslie is right.

Now, how do yall keep track of which orders have been followed through by patients? We used to keep a stack of charts that we were expecting labs, radiology, or perhaps consults on. How do yall make sure patients follow orders?

(I understand this is an insurance risk.)

Benjamin,

Excellent question, tough answer. I have tried several different methods over my 21 years in practice and have not found any sure-fire way to keep track of all the hundreds of tests/labs/referrals I order. So, I just gave up and I clearly put the onus back on the patient. Every patient gets their instructions printed out and one of the things in those instructions is that they are to call the office if they do not hear from us within 2-3 days after they have a test performed. I also tell them not to assume "no news is good news" and that they should expect to hear from us on all tests. While I am doing a Pap, I specifically tell patients to call in one week for the results and go so far as to tell them that specimens or results do get lost so that if they do not hear from us, something is wrong...not with the test results per se but with our getting in touch with them about those results. I also urge them to call any of their doctors' offices if they have not heard the results of studies done by them, even if that office told them they would call them if there was something wrong. I suppose this still leaves me open to legal scrutiny but I believe the patient must assume some of the responsibilty.

Leslie

We are using the reminder tab more and more to remind ourselves to follow up on a lab or a patient's condition. You can set a reminder tied to the patient's chart to pop up in your or your nurse's inbox at a future date. Very handy!

Wilson, is the reminder tab slow for you? I have seen it take as long as 14 seconds to pull up the first time and 4 seconds after that. I hope this is anomalous and can be fixed.

My experience is the same, the reminder tab is often very slow to load, especially the first time of the session