PAU Orders and
The paper PAU order set has been converted to an electronic format.
To find the order set, type “Anesthesiologist Preoperative Orders” into the search field and hit enter.
Right click on this order set so you never have to search for it again and open the order set.
Complete the usual Preoperative Orders. A number of orders will be pre-selected by default. We need to determine if the “
patient is fit for surgery”
. Notice the
exclamation point. Anything
means there is work to be done on a specific order, otherwise you will NOT be able to sign the order.
” is pre-selected in “Patient fit for surgery”. If you agree, click “
The PAU order set contains the most common consults we tend to request (copied exactly as per the paper form).
Notice that IV fluids (NaCl and D5W) are defaulted.
Do NOT unclick.
These orders state that the IV will ONLY be started if the patient is to receive an IV medication or is an insulin dependent diabetic.
You need to order a nephrology consult but this is not one of the selections in the order set. ALL outpatient consults use the prefix, “
”. You must use “
” as a keyword or you will not find this group of consults.
This brings up a long list.
Now that you know this, you may want to be more specific using, “
ambulatory referral to nephrology
” as a keyword.
Double click on the correct consult.
Complete the consult. Any field with a
MUST be completed or you will NOT be able to sign the order.
Once you have completed ALL required fields, click “
Depending on the situation, you may now be presented with a dialogue box titled, “Phase of Care”.
This is important
. Every order is intended for one or more phases of care.
You can see that “Patient is fit for surgery” is signed off for the PAU visit (Pre-Admission Testing) phase of care. The NaCl infusion (if necessary), D5W solution (if necessary) and the preop Tylenol are being HELD until the day of surgery (Preprocedure). These orders were all defaulted in the PAU Order Set (Anesthesiologist Preoperative Orders).
The system now wants to know which phase of care should be labeled for the ambulatory (outpatient) referral to nephrology. “Pre-Admission Testing” would be most appropriate.
Click on “
Remember that “PreProcedure” means day of surgery. We don’t want to wait until the day of surgery to ask for the consult. Click to highlight the Context which is the name of the upcoming surgery (in this example, “Shadow Charting Procedure”), then “Accept”
You decide that you want to order coags prior to the surgery. This can be done one of two ways. Go to Orders\ and type “inr” into search field, then enter
Select the INRPTT that is found. Because you are in a PreProcedure environment, the system should find the one for the ambulatory setting.
The INRPTT lab order will open for additional information
The expected date is blank. You could fill this out and tick the “approx.” box if you like. You can see that the order is good for one year. Notice the hard stop for “Anticoagulant”. A hard stop means that something needs to be checked in order to satisfy the requirement and allow the order to be signed.
In the Scheduled instruction box, I have typed that the order should be in force “on arrival to SDCU”.
A much faster way to accomplish this task is to have INR/PTT blood work on my preference list, thereby skipping the entire search.
Click on “Pref List”
My Preference List appears (only favourites showing) and I select INR/PTT.
I will be launched into the INR/PTT order box as previously described.
The patient is developmentally delayed and uncooperative. I decide to order midazolam prior to the surgery. Similar to above, I put midazolam into the search box.
Midaz is defaulting to:
1) no dose,
2) intravenous route
5 mg dose entered
There is no “po” dose available so click the magnifying glass and select “oral”
The frequency is once but we want to change to “On call to OR”. Use the magnifying glass.
The order will go into force tomorrow morning at 06:00 (as being ordered on May 25, 2019).
Admin instructions will ensure patient receives it on call to OR.
Specific to the PAU assessment is a tab titled, “
”. Tasks lists all the prerequisite items that must be accomplished before a patient is cleared to come to the OR. The RN is the primary “keeper of the list”.
Items currently on the list include:
Advanced directive and living will
History and Physical
Health history questionnaire
Often, additional tests or requests for information OTHER than what is included on the PAU order set will be asked for by the anesthesiologist.
In the case above, we have done several things to this point. We asked for an ambulatory consult to nephrology and some additional bloodwork-INR/PTT. Let’s say we also want some old anesthesia records from QCH.
The bloodwork should come back and be flagged if results are outside the normal range (similar to today). However, unless we inform the system that a consult and old records are requested, the patient could easily be cleared for surgery without either one. Therefore, we need to add these requests to the “
Go to “Task” and hit “+Add”
You will now see the Preference List generated for this purpose. You can see the descriptor to account for the nephrology consult (“
”) but there is currently nothing to describe the need for old anesthesia records.
In this situation, you will choose the generic, “Clearance-Other”, then Accept.
It is now important to elaborate what you mean by “other”.