Epic Tip of the Week: January 3, 2020

Inpatient & Ambulatory: New CRISP In-Context v.2.0.0 User Guide

• Organization – The app is divided into the following four sections:
  • Medication Management: PDMP and Overdose information is displayed side by side. The PDMP table will include data from Maryland and neighboring states.
  • Clinical Data: Health Records (laboratory reports, radiology reports and clinical notes) and Encounters (information from Admissions, Transfers and Discharges).
  • Care Coordination: Data related to managing care including Care Team, Care Alerts and Advance Directive documents.
  • Administrative Data: Includes all data received from Claims (Medications, Procedures, Encounters and Diagnoses).
• Alerting - High priority information, now known as Patient Advisories, Care Alerts and Infection Control alerts appear in orange if a patient has an active alert. Users can click "VIEW" for additional information.
• Improved Sorting, Filtering and Searching - Data tables now support sorting, filtering and searching capabilities. Tables with > 3 columns include Column Options which allows users to hide columns that may not be of interest.
• Launching the CRISP Portal - The Launch to Portal button is in the last menu option within the menu on the left side of the screen, rather than the CRISP Portal button in the top right corner.
• The CRISP user guide

Inpatient & Ambulatory: E-Prescribing Character Limit Changes

In the Patient Sig, the character limit is expanded from 140 to 1000 characters making it easier to add longer instructions like those for tapers and ramp-up doses.

Inpatient: New Alert to Prevent Orders for Buprenorphine for Patients on Long-Acting Opioids, and Vice Versa

• Hard stop alerts will appear when a provider attempts to:
  1. order buprenorphine for a patient who is currently prescribed a long-acting opioid, or who has received one in the last 12 hours
  2. order a long-acting opioid for a patient currently prescribed buprenorphine
• User will not be able to prescribe the new medication without first completely discontinuing the previous medication. If there is no active order for the previous order, it may be necessary to go to the “signed and held” tab to discontinue the prior medication order.
• The combined use of buprenorphine or naltrexone with full agonist opioids can precipitate withdrawal. Methadone, when used in conjunction with opioids, can result in excess sedation and respiratory depression. Below are some general rules around prescribing opioids with buprenorphine, methadone and naltrexone.

References:

1. Rosado J, Walsh SL, Bigelow GE, et al. Sublingual buprenorphine/naloxone precipitated withdrawal in subjects maintained on 100mg of daily methadone. Drug Alcohol Depend. 2007; 90(2-3):261-9.
2. Silverman S, Raffa RB, Cataldo MJ, et al. Use of immediate-release opioids as supplemental analgesia during management of moderate-to-severe chronic pain with buprenorphine transdermal system. J Pain Res. 2017; 10:1255-63.
3. Roxane Laboratories, Inc. Methadone Hydrochloride Tablets, USP Package Insert. Columbus, OH: October 2006.
4. Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006; 144(2):127-34.
5. Duramed Pharmaceuticals, Inc. Naltrexone Hydrochloride Tablets, USP Package Insert. Pomona, NY: October 2013.

Inpatient: Induced CF Bacterial Culture

• In the “Cystic Fibrosis Bacterial Resp Culture” order of the Sputum Induction order panel, there is not an option to select “Induced sputum” as a Specimen Type
• Until this is resolved, please type “bronchiectasis patient” in the comment field when ordering this test

Screenshots of the above can be found here.

Epic Training Portal link

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