No products in the cart.
Part 5: Data Entry & EHR Mastery (New Track)
Module 19: Meditech (Expanse) — Order Entry & Verification
19.1 Order Entry & Verification: The Meditech Workflow
Translating your core verification skills to the Meditech Expanse interface, from navigating the queue to constructing safe and effective orders.
Welcome to your operational deep dive into the Meditech Expanse pharmacy module. This is where we translate the conceptual analogy of “switching operating systems” into concrete, hands-on practice. Your fundamental clinical judgment remains your most valuable asset, but its effective application now depends on your ability to navigate a new digital landscape. We will systematically deconstruct the entire order lifecycle from the pharmacist’s perspective: from the moment an order appears in your work queue to the point of final verification. This masterclass will focus on building your confidence and competence in the core, everyday tasks that constitute the bulk of your responsibilities. You will learn the unique terminology, screen layouts, and workflow logic of Meditech, ensuring you can perform your duties as safely and efficiently as you did in other systems.
Retail Pharmacist Analogy: A New Pharmacy, The Same Gold Standard
Imagine you are an experienced retail pharmacist starting work at a new pharmacy chain. The fundamentals of your job are identical: you must ensure the right patient gets the right drug, at the right dose, with the right directions. Your clinical knowledge is completely transferable. However, the physical layout of the pharmacy is different. The controlled substance safe is in a new location, the counting machine is a different brand, the computer system has a new user interface, and the workflow for handling insurance rejections is slightly different.
Your first week is spent not re-learning pharmacology, but creating a new mental map of the workspace. You learn that “fast movers” are on the left wall, the consultation window is by the entrance, and the key for the C-II safe is held by the pharmacist-in-charge. This is precisely the process we are about to undertake. You already know how to be a safe and effective pharmacist. This section will simply give you the new “floor plan” for the Meditech environment, showing you where the digital tools you need are located so you can apply your gold-standard skills in a new setting.
19.1.1 The Meditech Triumvirate: Deconstructing the Core Modules (OE, PHA, PCS)
One of the most significant architectural differences from some other EHRs is Meditech’s use of distinct, yet interconnected, core modules. A fluid and intuitive understanding of this structure is the first step to becoming an expert user. As a pharmacist, your daily workflow will primarily exist within three of these modules: Order Entry (OE), the Patient Care System (PCS), and the Pharmacy module (PHA). Mastering the purpose of each and the flow of information between them is fundamental to navigating the system effectively.
1. Order Entry (OE) – The Source
This is the primary module used by physicians, residents, and other prescribers to create new orders. When a doctor writes an order for Lisinopril or initiates a complex chemotherapy regimen, they are working within the OE module. It contains the provider-facing tools, order sets, and preference lists. Think of it as the digital prescription pad for the entire hospital.
Your Interaction: You rarely work *in* OE directly, but you are the primary recipient of its output. Every order in your queue originates from this module. Understanding how providers build orders helps you anticipate common errors and points of confusion.
2. Pharmacy (PHA) – The Hub
This is your home base. The PHA module is the central command and control center for all pharmacy operations. It is a robust, dedicated environment that houses your verification queues, the complete medication dictionary (formulary), inventory management tools, interfaces to robotic and dispensing technology (like carousels and ADCs), and all compounding and dispensing records.
Your Interaction: This is where you spend 95% of your time. All verification, clarification, clinical intervention, and dispensing processes are managed from within the PHA module. It is your primary workspace.
3. Patient Care System (PCS) – The Destination
This is the nursing- and clinician-facing module that consolidates all aspects of bedside care. It contains the electronic Medication Administration Record (eMAR), nursing documentation, care plans, vital sign flowsheets, and lab results. It is the “front end” of patient care, providing a holistic view of the patient’s current state and treatment plan.
Your Interaction: When you verify an order in PHA, its ultimate destination is the eMAR within PCS. You will constantly access PCS in a read-only mode to perform your clinical review. This is where you go to find the “why” behind an order—to see if a PRN dose was actually given, to check vital signs before verifying a blood pressure medication, or to read nursing notes about a patient’s pain level.
The flow of a medication order is linear and logical: The provider writes a letter in the OE Post Office. You receive it, clinically review it, and approve it in the PHA Sorting Facility. The final, approved letter is then delivered and displayed for action in the PCS Mailbox at the patient’s bedside.
19.1.2 The Pharmacy Work Queue: Your Strategic Command Center
Similar to other EHRs, your workflow is driven by a central work queue, often called the “Order List” or “Pharmacist Verification Queue” in Meditech. This is the dynamic, real-time list where all new and edited medication orders land, awaiting your professional review. While the visual presentation is often more text-dense than graphical, the core principles of prioritization and strategic management are paramount. Mastering the queue is the difference between being reactive and overwhelmed versus being proactive and in control.
19.1.2.1 Simulated Meditech Queue View & Status Deep Dive
The Meditech queue is rich with abbreviations and statuses that you must learn to interpret at a glance. Let’s look at a more complex, realistic queue and decode the critical information it contains.
-------------------------------------------------------------------------------------------------- | Status | Priority | Patient Name | Location | Order | Age | MD | -------------------------------------------------------------------------------------------------- | UNV | STAT | DOE, JOHN | ED-01 | Vancomycin 1.5 g IVPB | 72Y | Dr. Chen | | UNV | STAT | DOE, JOHN | ED-01 | NS 100mL IV Flush Bag | 72Y | Dr. Chen | | UNV | ROUTINE | SMITH, JANE | 5N-512A | Lisinopril 10 mg PO | 65F | Dr. Evans | | EDT | ROUTINE | WILLIAMS, SARAH | 3S-304B | Heparin Drip (Rate Change) | 48F | Dr. Patel | | UNV | ASAP | MILLER, ROBERT | 4W-401A | Hydromorphone 1mg IVP Q4H PRN | 55M | Dr. Jones | | ACK | ROUTINE | JONES, DAVID | ICU-08 | Fentanyl Drip (ACKNOWLEDGED) | 68M | Dr. Smith | | CLA | ROUTINE | DAVIS, KAREN | 2E-210B | Ondansetron 4mg PO (CLARIFY) | 77F | Dr. Baker | --------------------------------------------------------------------------------------------------
19.1.2.2 Decoding the Meditech Statuses: A Masterclass
| Status Abbreviation | Full Name | What It Means for You & Your Action Plan |
|---|---|---|
| UNV | Unverified | This is your primary work. A brand new order that has never been reviewed by a pharmacist. You must open it, perform a full clinical review, and either verify it or send it for clarification. |
| EDT | Edited / Discontinued | High-risk queue item. An existing, active order that a provider has changed (e.g., changed a dose, rate, or frequency) or discontinued. You must verify that the change is appropriate and safe. A DC’d order must be reviewed to ensure it’s not being stopped inappropriately (e.g., stopping VTE prophylaxis). |
| CLA | Clarification Needed | This is an order you have already reviewed and found a problem with. You have sent a query to the provider and are awaiting their response. This status acts as your personal “pending” bin, reminding you to follow up if a response is not received in a timely manner. |
| ACK | Acknowledged | Low priority task. This is often a “non-pharmacist” order, like a diet change or a lab draw, that appears in the queue for situational awareness but doesn’t require pharmacy verification. Your action is simply to “acknowledge” it to clear it from the queue. Some institutions may filter these out of the main view. |
| VER | Verified | The end goal. This is the status you assign to an order once you have completed your clinical review and approved it. Verified orders are cleared from the main queue and become active on the eMAR. |
19.1.3 The Verification Process: A Step-by-Step Guide in Meditech
When you select an “UNV” order, you enter the core verification screen. This is your digital workbench. Meditech presents you with the ordered medication details alongside a view of the patient’s chart, which is often a collection of tabs or a “clinical panel” you can use to find the data you need for your review.
- Accessing the Patient’s Chart (Your Clinical Dashboard): Your first step is a full clinical review. Before you even look at the drug, you must understand the patient. You will navigate to different sections of the Meditech chart to find key information:
- The “Labs” tab or panel: Your source for the latest SCr, LFTs, electrolytes, CBC, and culture results. You must learn to look at trends, not just single values.
- The “eMAR” or “Medications” tab (often within PCS): Your definitive source for all other active medications. This is where you hunt for duplicate therapies and drug interactions.
- The “Demographics” or “Face Sheet”: This is where you must confirm allergies and, critically, find the patient’s documented weight and height.
- “Vitals/Flowsheets”: Essential for verifying vasoactive drugs, antihypertensives, and pain medications.
- Utilizing the Medication Dictionary (The Formulary Brain): The heart of building or editing an order is the “Medication Dictionary.” This is Meditech’s formulary database. When a provider orders “Vancomycin,” you must select the specific *product* from the dictionary that you will dispense (e.g., “VANCOMYCIN 1G/200ML IN NS IVPB”). This selection is a critical step that links the order to a specific inventory item, a standard concentration, a charge code, and often, a pre-built set of administration instructions. Your choice here dictates the physical product that will be made or dispensed.
- Building the “SIG” (The Order’s DNA): Frequency and Duration Tools: Meditech uses structured, menu-driven tools to build the order details. This is a key safety feature that minimizes ambiguous free-text entries.
- Frequency: You will select from a pre-defined list of standard hospital frequencies (e.g., Q8H, Q12H, DAILY). You must ensure the selected frequency makes clinical sense and that the corresponding administration times (e.g., 0800-1600-2400) are appropriate and do not conflict with other therapies or lab draws.
- Duration / Stop Dates: This is a non-negotiable field for certain drug classes. You must specify a duration for all antibiotics and controlled substances. You can set a number of doses (e.g., “for 12 doses”) or a specific stop date and time. This is a critical safety feature that operationalizes antimicrobial stewardship and prevents the unintended continuation of high-risk therapies.
- The Final Verification Step (Committing to the Record): Once you are satisfied that the order is clinically appropriate, safe, and all the details are correctly structured in Meditech’s language, you will electronically “sign” or “verify” the order. This is the moment of professional commitment. Your digital signature is appended to the order, and it is transformed from a request into an active, actionable command that is transmitted to the nurse’s eMAR in the PCS module.
Masterclass: Building a Complex Steroid Taper
Tapering doses is a common task that requires absolute precision. A missed or incorrect step can lead to significant patient harm. Meditech’s ordering tools allow you to build this complex schedule directly into a single, intelligent order string, creating a clear and unambiguous roadmap for the nursing staff.
Clinical Scenario: A patient with a severe asthma exacerbation requires a 10-day prednisone taper starting at 60 mg daily.
Building the Meditech Order: You would construct a single prednisone order with a multi-part, scheduled taper instruction in the “SIG” or details section. The system allows you to create a schedule of dose changes that will automatically update on the eMAR on the correct day. This is far superior to writing multiple, separate orders.
Medication: Prednisone 20 mg tablets
SIG / Directions:
Take 3 tablets (60 mg) by mouth daily for 3 days (Start Date: 10/04), THEN
Take 2 tablets (40 mg) by mouth daily for 3 days (Start Date: 10/07), THEN
Take 1 tablet (20 mg) by mouth daily for 2 days (Start Date: 10/10), THEN
Take 1/2 tablet (10 mg) by mouth daily for 2 days (Start Date: 10/12), THEN DISCONTINUE.
SIG / Directions:
Take 3 tablets (60 mg) by mouth daily for 3 days (Start Date: 10/04), THEN
Take 2 tablets (40 mg) by mouth daily for 3 days (Start Date: 10/07), THEN
Take 1 tablet (20 mg) by mouth daily for 2 days (Start Date: 10/10), THEN
Take 1/2 tablet (10 mg) by mouth daily for 2 days (Start Date: 10/12), THEN DISCONTINUE.
When you verify this structured order, the Meditech eMAR becomes a dynamic to-do list for the nurse. On October 7th, the task on the MAR will automatically change from “Administer 60 mg” to “Administer 40 mg.” This removes the need for human memory or manual adjustments, dramatically improving the safety and reliability of complex tapers.
