Order Entry and Results Flashcards
25 cards from real Epic Skills Assessment practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Order Entry and Results flashcards as text
In a CPOE system, what is an 'orderable' vs. a 'test component'?
Answer: An orderable is what the provider orders (e.g., 'Comprehensive Metabolic Panel'); test components are the individual results it produces (Na, K, BUN, glucose, etc.)
When a provider orders a panel (orderable), the laboratory performs multiple individual tests. The components are the discrete result values returned. Understanding this distinction is important for configuring order catalogs and result displays.
What is the purpose of an 'order priority' (STAT, Routine, ASAP) in order entry?
Answer: To communicate urgency to the performing department, determining turnaround time expectations and workflow prioritization
Order priorities communicate clinical urgency: STAT (immediate, life-threatening) → ASAP (urgent but not immediately life-threatening) → Routine (standard turnaround). Labs, radiology, and pharmacy use priorities to triage their workloads.
What is a 'standing order,' and how does it differ from a 'PRN order'?
Answer: A standing order is given on a schedule (every 8 hours); a PRN order is given as needed based on specific conditions (if pain ≥4, give analgesic)
Standing orders are administered at scheduled intervals (q8h, BID, daily). PRN (pro re nata = 'as needed') orders are given when specific conditions are met, allowing nurses to administer without calling the physician each time, within defined parameters.
What is a 'reflexive test' in laboratory order management?
Answer: A test that is automatically added by the lab based on a preliminary result — e.g., if urinalysis is abnormal, urine culture is reflexed without a new order
Reflex testing automatically adds downstream tests when initial results meet specified criteria. For example, a positive hepatitis B surface antigen automatically reflexes to additional hepatitis B tests. This reduces delayed diagnosis without requiring extra provider orders.
What does 'results routing' refer to in an EHR's laboratory workflow?
Answer: The configuration determining which provider's inbox receives which results based on ordering provider, patient assignment, department, and result criticality
Results routing rules determine who receives lab, radiology, and other results in their EHR inbox. Routing considers: ordering provider, covering provider, care team role, and result criticality. Critical values are routed urgently to the responsible provider.
What is a 'verbal order' in clinical practice, and what documentation requirements apply?
Answer: An order communicated verbally by a provider to an authorized receiver (nurse/pharmacist), which must be documented in the EHR and cosigned by the ordering provider within the required timeframe
Verbal orders (VOs) and telephone orders (TOs) are placed by a provider verbally and transcribed by an authorized clinician (RN, pharmacist). The receiving clinician documents the order and reads it back for verification. The ordering provider must cosign within the organization-defined timeframe (typically 24-48 hours).
What is the purpose of a 'specimen label' in the laboratory order process?
Answer: To positively identify the specimen with patient name, MRN, date/time of collection, and test ordered, linking it to the correct order for chain of custody and result reporting
Specimen labels enable positive patient identification throughout the pre-analytic, analytic, and post-analytic phases. Mislabeled specimens can result in wrong results attributed to wrong patients — a serious patient safety event. Many facilities require two-identifier labels.
In radiology order management, what is a 'clinical indication,' and why is it required?
Answer: The clinical reason for ordering the imaging study, required to justify appropriateness, guide the radiologist's interpretation, and support insurance authorization
Clinical indication (reason for study) is required because: it guides the radiologist's interpretation, supports clinical appropriateness criteria (Choosing Wisely, ACR guidelines), is required by most insurers for prior authorization, and is legally documented in the radiology report.
What is 'order expiration' in medication management, and why do orders expire?
Answer: Orders are automatically discontinued after a defined period (e.g., controlled substances every 72 hours, antibiotics every 7 days) requiring re-evaluation and renewal to prevent indefinite continuation
Automatic stop orders (expiring orders) require providers to actively re-evaluate and re-order medications at defined intervals. This prevents indefinite continuation of medications like antibiotics, controlled substances, and blood products without clinical review.
What is a 'cumulative results' view in an EHR lab results display?
Answer: A table showing the same test results over multiple dates, allowing trend analysis and comparison of how values have changed over time
Cumulative results displays (flowsheets, trend views) show the same lab values across multiple draws over time. A clinician can immediately see a potassium trending down from 4.2 → 3.8 → 3.2 over three days and take appropriate action.
What is a 'radiology reading' workflow, and what does the 'wet read' vs. 'final report' distinction mean?
Answer: Imaging is reviewed by a radiologist; wet read is a preliminary verbal/preliminary interpretation for urgent clinical decisions; final report is the official signed interpretation
After imaging is performed, a wet read (preliminary read) provides rapid interpretation for urgent clinical needs. The final report is the officially signed, complete radiologist interpretation documented in the EHR — the legal record of the imaging interpretation.
What is the purpose of an 'order acknowledgment' in nursing workflow?
Answer: The nurse reviews and acknowledges new orders, confirming they have been seen and will be carried out, often triggering nursing tasks on the MAR or task list
Order acknowledgment by nursing (reviewing orders) is a critical safety step. It confirms orders have been received, reviewed, and are actionable. Unacknowledged orders remain flagged in the EHR until reviewed, preventing orders from being missed.
What is 'medication reconciliation at discharge,' and what must be given to the patient?
Answer: Comparing the inpatient medication list with pre-admission medications to create an accurate discharge medication list, provided to the patient and transmitted to the next care provider
Discharge medication reconciliation compares inpatient medications (new, changed, stopped) with pre-admission medications to create the complete, accurate discharge medication list. The patient receives this list as part of the AVS; it is also sent to the follow-up provider.
In CPOE, what is a 'dose range check,' and what triggers it?
Answer: An automatic check that alerts the prescriber when a medication dose is below the minimum or above the maximum safe range for the patient's weight, age, or renal function
Dose range checks compare the entered dose against pre-defined safe dose ranges (often weight-based for pediatrics, renally-adjusted for renal impairment). They fire CDS alerts when doses fall outside safe parameters, prompting the prescriber to verify or adjust.
What is a 'nurse-initiated protocol' (standing order protocol) in an EHR?
Answer: Pre-approved orders that nurses can initiate without a direct physician order when specific, defined patient conditions are met
Nurse-initiated (or nurse-driven) protocols allow registered nurses to order defined interventions (Tylenol for fever >101°F, 12-lead EKG for chest pain) without calling the physician each time, based on pre-approved criteria. They must be ordered within strict parameters.
What is the 'order of volatility' concept important in emergency CPOE situations?
Answer: Critical orders (airway, breathing, circulation) are entered and acted on first; less urgent orders follow in clinical priority order
In emergency situations, the clinical priority of orders guides their sequence: life-saving medications (epinephrine, adenosine), airway/breathing support, then cardiovascular, then diagnostic orders. The EHR urgency flags and STAT priorities support this triage.
What is the purpose of a 'pharmacy benefit manager' (PBM) check at order entry for outpatient prescribing?
Answer: Real-time verification of drug coverage, formulary tier, prior authorization requirements, and patient cost share for the prescribed medication
PBM integration at order entry allows prescribers to see the patient's formulary coverage, tier (cost) for the chosen drug, whether prior auth is required, and lower-cost alternatives — reducing prescription abandonment and improving adherence.
What does the LIS (Laboratory Information System) do in relation to the EHR?
Answer: Manages lab workflows (specimen tracking, analyzer interfaces, result verification) and transmits resulting values back to the EHR for provider review
The LIS is the specialized system managing laboratory operations: order receipt from EHR, specimen tracking (accession), analyzer instrument interfaces, QC management, result verification by lab staff, and transmission of resulted values back to the EHR.
What is 'order set maintenance,' and who is responsible for keeping order sets current?
Answer: Regularly reviewing and updating order sets to reflect current evidence-based guidelines, formulary changes, and updated protocols — typically a multidisciplinary committee including clinical informatics and clinical leadership
Order sets must be reviewed periodically (at least annually) to incorporate updated guidelines, new medications, formulary changes, and lessons learned from safety events. Clinical content ownership rests with clinical leadership, with informatics support for configuration.
In the context of clinical order entry, what is a 'one-time order'?
Answer: An order that is performed or administered once and then automatically discontinued after a single execution
A one-time (single dose) order is executed once and then automatically discontinued. Common examples: pre-procedure medications, one-time NPO (nothing by mouth) medication, or a single-dose antibiotic before surgery.