Treat an Inpatient Using an Outpatient Protocol (Oncology Provider) (2024)

Order a New Outpatient PowerPlan on an Inpatient Encounter

When ordering an Outpatient PowerPlan for a new cycle of treatment on an Inpatient unit, this will require the following steps:

Admission ManagementAdmission Management including completing Best Possible Medication History and Admission Medication Reconciliation

Prior to ordering a new PowerPlan for an Inpatient using an Outpatient protocol, Best Possible Medication History must be documented and the Admission Medication Reconciliation must be completed.

Best Possible Medication History

Before ordering any treatment the patient should have their Best Possibly Medication History (BPMH) completed. This can be done by a pharmacy technician, nurse, and/or physician.

See the help topic on completing the Best Possible Medication History.

Admission Medication Reconciliation

Since the patient is admitted the next logical step is to complete the admission medication reconciliation prior to any new order entry to avert having to reconcile any orders placed intended for inpatient delivery.

In the orders profile the status of reconciliation can be found in the upper right hand corner of the screen, while to access the reconciliation there is a drop down menu on the left hand side.

Within the admission medication reconciliation the provider must select which medication they may need to stop while inpatient and which to continue. Depending on the detail entered during BPMH the provider may need to add some detail prior to signing.

The reconciliation status for admission will now appear completed and the orders continued are reflected as inpatient medications within the orders profile.

See the Help topic Perform Admission Medication Reconciliation.

Add the Outpatient RegimenAdd the Outpatient Regimen

Open PowerChart and select your patient’s Inpatient encounter.

Click on theAddiconto right ofOrdersin the Menu from theProvider View.

TheAdd Orderswindow opens.

Navigate to the appropriate protocol using Order Folders or by searching for the protocol name. Click on the desired Regimen.

The Add Regimen window displays.

Choose an appropriate Estimated Start Date and click OK.

This brings you to the Regimen View.

Choose Start for the associated Pretreatment Plan, if any pretreatment labs or diagnostics are required.

NOTE: If the patient has already had all pre-treatment labs and diagnoses completed you can choose Skip and continue to step 9

In the Add Plan window that displays, the Select Visit and Start Time will default to Future Outpatient Visit.

Change to This Visit by clicking on the radio button.

Update the Date and Time as appropriate.

The default Action for phases contained within the Pretreament plan is to Order for future visit.

If these are to be performed on the current visit you may change these to Order Now.

The Pretreatment PowerPlan opens.

Customize the pretreatment orders as required.

Click Orders For Signature.

Review the orders and click Sign.

Select Start for the Cycle you are ordering.

The Add plan window opens, verify that the date and time are appropriate.

The PowerPlan defaults to Future Outpatient Visit. You may change to This Visit but you must ensure the Est. start date is accurate.

Chemotherapy, Prescription, Lab, and Diagnostic phases defaults to Order for future visit. These actions are appropriate.

The Scheduling phase action defaults to Order now. If the patient will be receiving all days of treatment during the inpatient stay this manipulation will occur from within the phase as to reduce any error of removing the scheduling orders within future cycles.

ClickOK.

You have now added the outpatient Regimen to the inpatient encounter.

Add to PhaseAdd to Phase the Communication Order Administer Oncology Treatment on Inpatient Unitto communicate to nursing and pharmacy staff that treatment is intended to be delivered inpatient

From the top of the PowerPlan:

Click Add to Phase.

Select Add Order.

Use the Search box to find the communication order.

Select Administer oncology treatment on inpatient unit order.

Click Done.

Indicate which day(s) of treatment are intended for inpatient delivery.

Click OK.

NOTE: If the PowerPlan (cycle) contains multiple days of treatment, only select the days which are going to be administered on the inpatient unit. If unsure, reassess and add to phase the order when delivery location is known.

Complete the required (yellow) fields: Cycle Number, Days of Treatment as Inpatient, and When to Proceed.

Complete the required fields.

The added order will appear with the entered details below the section Additional Orders.

Modify Pre-MedicationsModify Pre-Medications to indicate that the patient is no longer using their own supply

For best order hygiene, the Provider needs to change pre-medications from Patient to use own supply to an inpatient order. If the Provider forgets to do this, Pharmacy may modify these specifications during their review.

Modify Pre-Medications if required through the following steps:

Scroll down the Chemotherapy phase to the pre medications.

Right-click each pre-medication and select Modify.

Details for that medication opens.

Beside Use Patient Supply, change radio selection to No.

Satisfy the medication selection requirements and the treatment dosing requirementsSatisfy the medication selection requirements and the treatment dosing requirements

You will need to cancel the scheduling orders associated with the outpatient protocol for any days that the patient is an inpatient. For any days of treatment that are done as an inpatient, you can deselect the scheduling orders.

Within the Chemotherapy phase view the scheduling orders which are linked to the associated days of treatment.

Deselect the corresponding scheduling order for the treatment being received during the inpatient stay.

Note: This can be done in the scheduling section of the chemotherapy phase as well.

Prescriptions Phase ManagementPrescriptions Phase Management

If the treatment protocol contains a prescriptions phase, deselect the orders preselected in this phase at this time, as the patient will not require any prescriptions on an inpatient unit.

NOTE: The orders within this phase are defaulted to be selected as these plans are typically used for outpatients who require a prescription to take home.

Ensure you have deselected the prescriptions.

Navigate to the Prescriptions (Inpatient Use Only) phase.

Select the required medications to be delivered as an inpatient.

The Dosage Calculator opens.

Apply any rounding rules noted within the Order Comments, ensuring the final dose is accurate.

Click Apply Dose.

The Est. Start date should reflect the date you are wanting to deliver the treatment so that once activated by nursing the medication will align on the MAR accordingly.

Navigate to the Next Cycle Labs phase and add any additional labs if clinically indicated for the patient.

Click Orders for Signature .

Review all the orders selected within the PowerPlan to ensure you are not missing anything you would like to add or remove.

Once satisfied, click Sign .

Chemo CalendarChemo Calendar

In order to complete the ordering process navigate to the Chemo Calendar.

Select the Visit you would like to schedule.

The Add to Patient Treatment Calendar Window opens.

Review the defaulted date.

Ensure Send Scheduling Requests for Current Cycle (1st Radio button) is selected.

Click Sign.

You are ordering from the Inpatient Encounter (appointments are not booked to these locations) the Orders Profile Opens requesting some details of the order to be completed.

Select the Alternate Scheduling Location you would like to book the patient into for their outpatient treatments.

Click Sign.

NOTE: If you are pushing out multiple appointments you may wish to switch to the Recurring Encounter where the location is accurately reflected and you will not need to select any alternate scheduling location.

Discharge ProcessDischarge Process

When discharging the patient, the Provider will complete the Discharge Medication Reconciliation, as well as any required documentation. It is also suggested to complete a Discharge Summary Note to provide to the patient for clarity around their stay and their ongoing treatment.

Once the patient is ready to be discharged it is important to manage the medications in the discharge process accurately.

From the Orders Profile click on Discharge from the Reconciliation drop down.

The Order Reconciliationwindow opens.

If your patient requires any prescriptions pertaining to their ONCP PowerPlan treatment to continue, select Manage Plans in the upper left hand side of the window.

Navigate to the Prescriptions phase of the PowerPlan (this is where you initially unselected the orders upon order entry).

Select the prescriptions needing to be dispensed for the patient to continue taking at home.

The Dosage Calculator opens.

Satisfy the dosing requirements through applying any necessary rounding and ensuring the final dose is accurate.

Click Apply Dose.

You will be returned to the previous screen and the Details of the prescription will open, make sure to make any necessary adjustments to the following information:

Dispense: how many doses are left for the patient to take

Special Instructions: Update these to reflect what days the patient has left remaining within their treatment.

Est Start: When is the patient to take their next dose

Once the changes are reflected clickInitiate Now.

This will change the order status to Activate, and the Orders for Signature button will be highlighted at the bottom left.

Click Orders for Signature .

Click Sign.

This brings you back to the Order Reconciliation Discharge window.

The status of the order also changes to prescribed making it available within the discharged medication reconciliation.

Select to continue the patients home medications (if appropriate) and stop the medications initiated as an inpatient.

The prescription managed from within the PowerPlan will already appear as a prescription to start, if you did not update the details upon ordering you may update them at this point.

When you have completed, click Sign.

NOTE: Ensure pharmacy is aware the patient requires this prescription to be dispensed from the hospital as it is covered as part of their treatment.

Navigate to the Provider View.

Click on the Transfer/Discharge Workflow tab.

Select to create the Discharge Summary Note (once you have completed your documentation).

This note template pulls in the information about the patients medications from the discharge medication reconciliation process.

Here you can add some more details to clarify any information about the prescription for the patient, such as the Next Dose.

Once completed this documentation can be printed and provided to the patient.

Modify Existing Outpatient PowerPlans for an Inpatient setting

As the provider, your patient who is currently having chemotherapy as an outpatient needs to be admitted on the inpatient unit. You will need to modify an outpatient PowerPlan for the inpatient setting by doing the following steps:

Complete Admission Medication ReconciliationComplete Admission Medication Reconciliation to stop the medications within the Prescriptions phase of the PowerPlan. These will be ordered via the Prescription (Inpatient Use Only) phase for the length of admission.

Open PowerChart and select your patient’s inpatient encounter.

Navigate to the Orders page.

Select Admission Medication Reconciliation.

Select Do Not Continue for the medications prescribed in the oncology PowerPlan and reconcile the other medications as required.

For indepth instructions on this topic, see the Admission Medication Reconciliation Help topic.

ClickSign.

Add to PhaseAdd to Phase the Communication Order Administer Oncology Treatment on Inpatient Unit to communicate to nursing and pharmacy staff that treatment is intended to be delivered inpatient

From the top of the PowerPlan:

Click Add to Phase.

Select Add Order.

Use the Search box to find the communication order.

Select Administer oncology treatment on inpatient unit order.

Click Done.

Modify pre-medicationsModify pre-medications to indicate that the patient is no longer using their own supply

For best order hygiene, the Provider needs to change pre-medications from Patient to use own supply to an Inpatient Order. If the Provider forgets to do this, Pharmacy may modify these specifications during their review.

Modify Pre-Medications (if applicable to your PowerPlan) through the following steps:

Scroll down the Chemotherapy phase to the pre medications. Right-click each Pre-Medication.

Select Modify.

Details for that medication opens.

Scroll down the details.

Beside Use Patient Supply, displaysNo.

Order medications within the Prescription (Inpatient Use Only) phaseOrder medications within the Prescription (Inpatient Use Only) phase

If a prescription phase exists in the PowerPlan, the provider needs to order the prescription medications in the Prescription (Inpatient Use Only) phase to ensure this medication can be delivered on the inpatient unit.

Select the Prescriptions phase.

Review the orders in preparation for ordering the same medications in the Prescription (Inpatient use Only) phase.

Select the Prescription (Inpatient Use Only) phase.

Select the required medication orders and modify the details and comments as required.

You will also need to complete the details in the Dosage Calculator for any BSA based medications.

For this example, we will select the cyclophosphamide order.

TIP: If this is an order set that has been previously signed, you will need to click on the Excluded Components icon to be able to see all of the ordering options

Review the details in the Dosage Calculator, making any required modifications, add a rounding rule and Apply Dose.

Review the Details and Order Comments, and modify as required.

This may include adjusting the duration for the expected length of stay and putting in the Start Date and Time.

In the second example, we will use Dexamethasone:

Select the required dexamethasone orders (more than one order may be required depending on expected length of stay). Modify/add Details and Order Comments as required.

Select Orders for Signature .

NOTE: If you are viewing a previously excluded order , your options will be Plan for Later, Future Initiate or Order Now.Select Future Initiate so the nurse can activate the order in sequence.

Select Future Initiate.

Review the order(s) and click Sign.

Click Refresh .

Cancel scheduling ordersCancel scheduling orders

You will need to cancel the scheduling orders associated with the Outpatient PowerPlan for any days that the patient is an inpatient.

Select the scheduling phase of the PowerPlan.

NOTE:Scheduling orders can also be adjusted in the scheduling section of the chemotherapy phase.

Right click on the day of treatment that is to be given during the inpatient stay. Select Cancel/Discontinue from the drop-down list.

NOTE:It is critical that you only Cancel/Discontinue the dates for which you are confident that the patient will be treated as an Inpatient. Once the scheduling orders have been cancelled there is no way to re-establish the link to the treatment orders.

Tip: To Multi-select, hold the shift key down and click on each of the scheduling dates to be canceled.

Click Orders for Signature .

Click Sign .

Click Refresh .

Complete Discharge Medication ReconciliationComplete Discharge Medication Reconciliation to stop the in hospital version of the prescription medications and resume the take home version of the prescription medications.

When discharging the patient, the Provider will complete the Discharge Medication Reconciliation. This is where the provider will need to discontinue any inpatient orders associated with the chemotherapy PowerPlan.

Select the Discharge Reconciliation on the order page.

The inpatient order denoted by the icon for the prescription based medications will need to be discontinued and the prescribed equivalent denoted by the iconwill need to be set to continue.

Select Sign when complete.

NOTE:It is critical that you Continue the Orders within the Chemotherapy PowerPlans with future treatment dates that are yet to be administered.

NOTE:The pharmacist is meant to review the Administer Oncology Treatment on Inpatient Unit Order and then discontinue it. Should they forget this step, you will be required to clean this up in order to be able to complete the discharge reconciliation.

The Home Medications that are set to Continue will display on the Patient Discharge Handout. While you are preparing the document, you have the opportunity to add or modify any of the content within the Home Medications table.

Navigate to the Provider View.

Click on the Transfer/Discharge Workflow tab

Select to create the Patient Discharge Handout (once you have completed your documentation).

This note template pulls in the information about the patients medications from the discharge medication reconciliation process.

Here you can add some more details to clarify any information about the prescription for the patient, such as the Next Dose.

Once completed, this documentation can be printed and provided to the patient.

NOTE: You may need to repeat some of these steps more than once during a patient’s admission.

The communication order should only be added to the days of treatment that you are confident will be delivered during the admission.

Select medications in the in the Prescription (Inpatient Use Only) phase that you are confident will be administered during the admission.

Only cancel Infusion Chemo visit scheduling orders for the days of treatment that you are confident will be delivered during the admission.

How a Provider Compensates for Antiemetic’s for an Outpatient in an Inpatient setting: Post Chemotherapy Antiemetic PowerPlan

In order to compensate for the post treatment anti-emetics that are usually included in an Outpatient PowerPlan as outpatient prescriptions, a Post Chemo antiemetic module or PowerPlan needs to be added to the patients chart. This can be done in two ways:

As an Ad Hoc PowerPlan ONCP Post Chemo AntiemeticAd Hoc PowerPlan ONCP Post Chemo Antiemetic

Select Orders Page and click .

Type ONCP Post Chemotherapy Antiemetics into the search box.

The Add Plan window displays.

Confirm the Start Date and click OK.

The ONCP Post-Chemotherapy Antiemetics displays in the Order View and opens.

Select the desired medications and add details and comments as required.

Click Orders for Signature.

Click Sign.

Add Post Chemotherapy Antiemetic module through the ONCP General Oncology Admission PowerPlanPost Chemotherapy Antiemetic module through the ONCP General Oncology Admission PowerPlan

To add the Post Chemotherapy Antiemetic module through the ONCP General Oncology Admission PowerPlan. Perform the following steps:

Select Orderspage and click .

Type ONCP General Oncology Admission into the Search box.