Standard+workflow+for+placing+orders+for+nursing+in+ambulatory+care+visits

 To all ambulatory care providers,

I am sending this email to clarify the standard workflow for placing orders for clinic nursing staff within ambulatory care visits. This workflow is designed to promote clear communication and consistent practice to ensure consistent, safe care.

The standard workflow for a provider to give orders to clinic nursing staff is to create a formal order in the "Meds and Orders" section in ccLink. For a nursing communication that is __not__ a medication, x-ray or lab, such as "give this patient this handout" or "repeat blood pressure before discharging patient" then there are two options:

1. create a "Nursing Communication" order in the "Meds and Orders" section in ccLink. Typing "Nurs" into the order box will bring this order up. This shows up on the MAR and makes it easy for the nurse/MA to see.

2. place this communication as a "check out note" in the "Follow Up" section as free text.

The preferred option between these two for nursing communications is currently being debated in IAC. If you have any strong feelings about either of these two options please share them with your local IAC representative. Putting an order in a progress note is not an acceptable option. It is too high risk for being overlooked within the body of the note. Verbal orders are not allowed in any setting (Hospital, ED or clinic) except in the case of an emergency such as a code blue where the provider is providing emergency care to the patient and is unable to get to a computer to place an order that needs to be carried out immediately.

Chris Farnitano, MD Ambulatory Care Medical Director Contra Costa Health Services