If you offer IV infusions to your patients, we have a special type of Alternate Plan Option that allows you to specify ingredients, infusions details, lot numbers, expirations, and will create a special type of standing order in the patient's Open Orders block.
- Add Alternate Plan Item
- Creating and Managing Alternate Plan Items (including Supplements)
- Inventory Management in Cerbo
Add a New IV Infusion to the Alternate Plan list
You can add new IV treatment formulas/ IV ordering templates to your Alternate Plan Options database under Admin > Manage... > Alternate Plan Options. To add an IV that you administer as a new prescribable/ orderable item, click the + Create New Plan Option button at the top.
- In the Alternate Plan Name field, put the name of the specific IV that you want to order/ prescribe, for example "Myers Cocktail."
- For Action Type, select IV Infusion or, if that is not an option (this is the first one you have added), select + ADD NEW TYPE or, in some instances, ALL TYPES, then type in IV Infusion into the Action Type field. NOTE you'll need to use this exact name.
- Type a Description, if desired (this would be shown on the encounter summary when the item is prescribed IF alternate Instructions/ Notes have not been saved as part of the item's default ordering profile - see below).
- Click + Add This Alternate Plan Option to save.
A pop up box will appear asking if you want to add a default profile - this would be your detailed IV formula, with the individual ingredients and amounts. Click OK for yes or Cancel for not at this time.
Set Up Default Ordering Profile
Your default ordering profile for an IV is the list of individual Ingredients, each with an Amount, Range, and Osmolarity, as well as the recommended IV treatment Frequency, Duration, and Total number of IV treatments to be ordered, plus internal Ordering Notes, and patient-facing Notes/ Instructions.
You can add the default IV formula/ ordering profile:
- When you first add the IV to the Alternate Plan Options database (see above).
- When you are adding the IV order to a patient's chart, by filling out the details that you want to be part of the default ordering profile, then checking the box at the bottom to save as default.
- Or by editing the entry in the Alternate Plan Options list, and clicking where it says "The default dosing profile (instructions, amount, brand, etc.) can be set while prescribing/ assigning this to a patient's chart or by "clicking here."
Within the default ordering profile:
- Enter each ingredient on it's own line, specifying the amount and range, if applicable, and osmolarity (if you want the total osmolarity to be auto-calculated). If you are going to be tracking ingredient-level lot numbers and expiration dates (which would be entered/ verified when the IV is administered), you will want to be careful to use uniform names for the same ingredient across all of your IV formulas.
- Add ordering notes, etc. as desired.
Ordering/ Prescribing IV Therapy to Patients
You will order IV infusions for a patient by hovering over the + sign in the blue Plan Rx/Orders/Vaccines box at the right side of an open Encounter Note and selecting Add IV Infusion. Select the IV you want, make any desired changes to the default IV formula, notes, or other information, and click Complete to add it to the plan (see screenshot above).
The information that is shared with the patient (in the Encounter Summary for the visit where the infusion was ordered, or the patient's Wellness Plan) is the name of the IV Infusion and whatever is the Notes/ Instructions field.
IV Infusions ordered within the past 6 months (or another period of time if set on a custom basis for your build) will show up in orange at the top of the patient's Open Orders block.
Administrating the IV Infusion
When the patient comes in for an IV that has been ordered for them, the person administering the IV can click on the open IV order in the patient's Open Orders block to create a new encounter note for documenting the IV administration, and pull up the IV Ordering details.
Note: by default, IV Administration notes are created as sub-notes of the encounter note where the IV was ordered. This can be changed on a custom basis so that IV Administration notes are regular, top-level notes.
The person administering the IV would verify the information in the IV Ordering details, including the ingredient Lot # and Expiration, and then click Start Drip! The IV formula and ordering information will populate into the text of the note. If vitals need to be taken during the IV administration, they would generally be taken the usual way - in the Vitals block at the right of the open encounter note. Chart Part templates can be used to quickly add the structure of any additional IV Administration chart notes, document vitals readings taken and timing, etc.
Note that the system will remember the last-entered Lot # and Expiration information by ingredient name, so if you are using the exact same name for an ingredient across all of your IVs, that lot number and expiration will only need to be updated once, the first time an IV with that ingredient is administered, each time you start a new lot.
Administering the infusion in the same note as the order
IV documentation can be placed in the same encounter note as the order by opening the open orders block (double click on the header on the right side of the encounter view) in the encounter window, and clicking on the order as you would form the patient chart.
Finishing an order
Everytime an IV is administered from an open IV order in the patient's Open Orders block, you'll see what iteration you are on in the order window:
When you have reached the final order, you'll want to remove it from the open orders block by clicking the red x on the order. If you do not, the default setting is that it will be removed after 6 months.
A note on Inventory
Inventory in Cerbo is meant to track patient-ready products, IE medications, supplements, or other products for patients (cosmetics, health foods, etc). It is not designed to track medical supplies. For that reason you cannot track IV ingredients in Cerbo inventory. If you have pre-made IV bags that you dispense as one item, that could be tracked in inventory.