Background
Definitions and Introductions
Overview
Create a Usual Scripts List
Key Points for Non-Prescribers
Key Points for Prescribers
Prescribe Medications from the Usual Scripts List (Drag & Drop OR Double Click)
Discontinue a Medication in the Usual Scripts List
End Date a Medication in the Prior Scripts List
1. Set Finished Flag in Prior Scripts List
2. Manually End-date a medication order in Prior Scripts
Prescribe a Medication that is NOT in the Usual Script List
Prescribe a Combination Product that is NOT in the Usual Scripts List
Edit a Medication in the Usual Scripts List
Prescribe ‘Ad Hoc’ Medication NOT Listed in the Formulary
Prescribe a Medication with Alternating Doses
Write a Medication Order to Administer or Dispense from the Clinic
Steps for the prescriber who orders the medication
Steps for the clinician who administers or dispenses the medication
Adjust a Dose for an Active Ongoing Medication
When the Ongoing Medication is Listed in Usual Scripts
When the Ongoing Medication is NOT Listed in Usual Scripts
Prescribe a Medication Dose that is not Listed in Formulary
Record and Sign off a Verbal and Telephone Order
For Non-Prescribers - How to Enter Medications in Usual Scripts List
Formulary Legend
Rx Entered in Error? (Steps to Delete or Cancel an Order)
When to Delete an Order (Delete Order Button)
How to Delete an Order
When to Cancel an Order ('Cancel Order' Button)
How to Cancel an Order
Formulary Updates and Replace Inactivated DIN
Resources
Background
Profile EMR uses the First Databank (FDB) formulary. From January 27, 2025 onward, the formulary will be updated on a quarterly basis.
Use this document to prescribe all medications except those requiring a Duplicate Prescription (Controlled meds). To prescribe controlled meds use the article for Controlled Prescription Form (Duplicate Rx). In addition, the patient’s usual prescription list must be kept up to date using this module.
In order to dispense or administer a medication, there has to be an active medication in the Prior Meds tab. See Administer and Dispense Medications.
Definitions and Introductions
Usual Prescription List (Rx): represents the regular, on-going medications clients are receiving. It is the primary list used for medication reconciliation purposes and must be kept up to date. Interim or short-term medications should not be included on this list.
Current Orders List: generates a prescription to hand to the client or fax to pharmacy or to record that this client has taken this medication.
Prior Prescriptions List:
- represents the chronological history of all past prescriptions entered in the EMR through the Usual Scripts or Current Order (excluding controlled meds - Controlled Prescription Form (Duplicate Rx) article).
- provides a history of medication administration and/or dispensing for a given prescription when same is documented using the medication administration or dispensing module. See Administer and Dispense Medications.
Discontinued Medications List: medications for a client that a Profile EMR prescriber has discontinued from the usual medications list
Overview
Create a Usual Scripts List
- Doing this right will make future prescribing much easier
- Non-prescribers can create or add to the Usual Scripts List because it is not a prescription – it is just a list.
- Prescribers will create the list differently than non-prescribers (see the following Key Points):
Key Points for Non-Prescribers
- For instructions on how to enter medications in the usual scripts list see section For Non-Prescribers – How to Enter Medications in the Usual Scripts List
- All meds non-prescribers enter into the Usual Scripts List should not include a quantity. This prompts prescribers to review and update the medication before it is ordered and printed.
Key Points for Prescribers
- If the drug you want to prescribe is already in the Usual Scripts list without a Quantity, it usually means it was entered by a non-prescriber. To update this entry in the Usual Scripts list, discontinue the drug and re-enter it with a quantity. This ensures that the Usual Scripts list will show your name under Entered by.
- Use Dose mg instead of tablets wherever possible – it is easier to edit these values for future dose changes.
- For Quantity use time intervals like 1 month so that it is easier to drag and drop a whole set of medications when doing repeats.
Prescribe Medications from the Usual Scripts List (Drag & Drop OR Double Click)
1. Click New Encounter
2. From the Actions Panel, select Scripts
3. Verify the prescription is entered correctly
4. If it is correct, drag and drop the desired medication from the Usual Scripts List to the Current Order list.
If it is incorrect (i.e. no quantity, client no longer taking, etc.) you would discontinue the medication. See section: Discontinue a medication in the Usual Scripts list
Note: To prescribe more than one medication at a time hold the Ctrl or Shift Key on your keyboard and click on the medications before dragging and dropping them into Current Order
5. Print the prescription (If you choose not to print the prescription at this time, you will get prompted to Process Prescription when you close the medical record)
Clicking the Print icon generates a message Checking for drug warnings… If there are severe drug interactions or allergic reactions, a warning window will display in a new pop-up window for your clinical review. The system does not prevent clinicians from printing the order; proceed as per clinical judgment.
Discontinue a Medication in the Usual Scripts List
Use these steps to discontinue a Rx if the quantity is missing or if patient is no longer taking this medication.
1. Right click and select Discontinue.
2. Click Yes to confirm, see example below.
3. Click OK to discontinue the medication.
Note: You can select the Reason from the drop down if you prefer.
Note: Discontinuing a medication from the Usual Scripts does not end-date/discontinue the medication in the Prior Scripts - see "End-date a medication Order in the Prior Scripts List"
Tip! If you would like to notify the pharmacy about a discontinued medication, there is a letter template that you can generate to fax to the involved pharmacy called Pharmacy Notification - Discontinued Medications. The letter template pulls the list of Discontinued Medications include discontinued date and reason according to the number of days you enter to look back for. Edit the letter as needed (e.g., keep only applicable pharmacy and/or delete medication rows). For instructions on how to launch a letter template, see Letter Templates in New Encounter.
Sample:
End-date a Medication Order in the Prior Scripts List
- The "Finished Flag" icon appears in the finished flag column when an order has expired or is no longer current/valid. The system will automatically end-date and set the finished flag for orders when they expire as long as the order quantity has been written as a time frequency (e.g. 2 weeks, 30 days, 3 months).
- In the event that an order is discontinued, changed or reordered prior to its scheduled end date (date the prescription is valid until) the order end-date/finished flag will need to be set manually .
- There are two ways to end-date and "set finished flag" for an order ending prior to its original expiry date: 1) Manually set the Finished Flag OR 2) Manually end-date the order.
1. Set Finished Flag in Prior Scripts List:
1. Right click on the order -> "Set Finished Flag" -> Select "Show Icon"
2. The finished flag icon will now appear in the finished flag column
2. Manually End-date a medication order in Prior Scripts:
1. Right click on the order -> Select "Open"
2. Un-tick the "auto-calculate" box
3. Enter the correct end-date of for the order in the "Expires" field -> Click Ok
4. The finished flag icon will now appear in the finished flag column
Prescribe a Medication that is NOT in the Usual Scripts List
1. Type the generic or trade/brand name (you don’t have to type the whole name) into the Current Order Rx
2. Click Enter on your keyboard OR the ellipses (…) button
3. Click the + button to see <new instruction>
Note: Meds listed in the Formulary are written in the same format and are consistent with each other.
4. Follow the numerical order below to enter Dose, Freq, Qty (these are the mandatory fields).
5. To save medication instructions for future prescribing, use the Remember feature.
6. Click OK
7. Once you see your prescription in the Current Order, click the Print icon to print the prescription
If it is an ongoing med, you can drag and drop it back into the Usual Scripts list
8. Print the prescription using the print icon shown previously. (If you choose not to print the prescription at this time, you will get prompted to Process Prescription when you close the medical record).
Clicking the Print icon generates a message Checking for drug warnings… If there are severe drug interactions or allergic reactions, a warning window will display in a new pop-up window for your clinical review. The system does not prevent clinicians from printing the order; proceed as per clinical judgment.
Prescribe a Combination Product that is NOT in the Usual Scripts List
For prescribing combination products, it may be necessary to print the Brand name on the prescription rather than the Generic name e.g. birth control pills. The EMR is set to display Generic by default.
Follow the instructions in section Prescribe a Medication that is NOT in the Usual Scripts List. Prior to Step 6, ensure you change the display to Brand name. You have two options:
Edit a Medication in the Usual Scripts List
Key Points for Prescribers
- The following functionality should only be used for medications that are not dispensed or administered. For medications that are dispensed or administered, the cleanest approach is to discontinue the medication (see section for more details– Discontinue a medication in the Usual Scripts List) and reorder it.
- If you are going to edit the medication listed in Usual Scripts, edit it before you drag it over to Current Order
- Common mistake - Editing a usual med after it’s in the Current order (prescribing window). This does not update the Usual Scripts list.
1. Right click and then click Edit
2. Type the changes in the Edit Instruction Line window and click OK to save the medication to the Usual Scripts list
3. Now drag and drop into the Current Order. The edited medication should be the same in both Usual Scripts and Current Order.
Prescribe ‘Ad Hoc’ Medication NOT Listed in the Formulary
This functionality should only be used for medications that are not listed in the Formulary as they will not generate any adverse reaction warnings.
1. Click on the Red Ad Hoc (AH) icon to see our EMR’s existing list of ad hoc medications.
2. If you find the medication you want to prescribe is listed, double click on the medication and prescribe using the steps in section Prescribe a medication that is NOT in the Usual Scripts List.
Note: You can delete medications from the Ad Hoc (AH) list if not entered correctly (Right Click and select Delete).
3. If the medication is not listed in our EMR’s ad hoc medication list, Click Blue Ad Hoc (AH) icon and a prescribing template will generate. Enter the prescription details:
4. Follow the instructions in section Prescribe a medication that is NOT in the Usual Scripts List.
Prescribe a Medication with Alternating Doses
1. If the medication does exist in the Usual Scripts list – drag and drop it into the Current Order and edit and prescribe as needed. See section for steps on how to Prescribe Medications from the Usual Scripts list
If the mediation does not exist in the Usual Scripts list – Find the medication in the formulary from the current order section
2. Tick the Only tick box.
Note: If Only is ticked, the dosage information will be excluded from the printed prescription and only the Free Text details will be included.
3, 4 and 5. Enter the dose instructions in Dose Text, Quantity, and click OK
6. Print the current order and if it needs to be entered in the Usual Scripts list, drag and drop the medication into that section.
This is the print out of the prescription:
This is how the medication will show in the Usual Script list:
Write a Medication Order to Administer or Dispense from the Clinic
Key Points for the prescriber:
- The following script writing recommendation works well with the Admin/Dispense functionality in the EMR
- All PRN medication orders must include maximum dosing frequency and clinical dosing criteria
Steps for the prescriber who orders the medication
1. If the medication exists in the Usual Scripts list – drag and drop it into the Current Order. If the order needs to be edited, do this before you drag and drop.
If you require more info - See section Prescribe Medications from the Usual Scripts list
If the medication does not exist in the Usual Scripts list – Order the medication using the formulary and the Current Order window.
2. Enter clear instructions for the clinician who dispenses/administers the medication in the Dose Text field – indicate if the medication should be dispensed or administered in addition to the other instructions (See example below)
3. Tick the prn tick box, if applicable.
4. Click OK
This is how the medication order appears in the Admin/Dispense window
Note: Transcripts appearing in Bold are not printed yet. Transcripts appearing in Blue are the ones when the client is required to fill out the Special Authority form to be covered
Steps for the clinician who administers or dispenses the medication
Key Points for the clinician who admin/dispenses:
- Always Admin/Dispense from Prior Scripts
- The medication order must be written by an authorized prescriber
- The medication order must be active and contain all the information you need to safely admin/dispense
1. Determine if the medication order exists in Prior Scripts
2. Determine if there is an existing active order by reviewing:
a. if the medication order was written by an authorized prescriber
b. the expiry date on the medication order
c. determine if the order date & quantity are not due past
3. Determine if you have all the information necessary to dispense this medication. For additional information, review BCCNM Acting with Client-Specific Orders
4. Follow the steps written in Administer and Dispense Medication.
Adjust a Dose for an Active Ongoing Medication (e.g. Testosterone)
If a prescribed ongoing medication needs to have its dose adjusted, it can be accomplished by discontinuing the current prescription and adding a new prescription.
Key Points:
- Do not use the mid-course correction functionality in EMR because it does not provide safe administering and dispensing information.
- Dose adjustment can only be done by a prescriber.
When the Ongoing Medication is Listed in Usual Scripts
1. Navigate to the Usual Scripts tab
2 and 3. Right click on the medication name and Select Discontinue.
4. Now, re-write a new prescription with the adjusted dose in the Current Order field. See section: Prescribe medications from the Usual Scripts list.
5. Drag and drop the new prescription to the Usual Scripts list.
6. View the example below to see how it will look in the usual scripts
Note: In situations where you do not need to print the prescription, you can simply press Close when prompted.
When the ongoing medication is not listed in the Usual Scripts list
When the ongoing medication has not been added in the Usual Scripts list, then you will have to work from Prior Scripts. To adjust the dose, follow these steps:
1. To view the last dose, click on the most recent script entry for that medication in Prior Scripts
2. Drag and drop the existing prescription into Current Order field. Right click and select Edit to update the dose.
3. Right click on the medication from the Current Order and select Usual Scripts list
4. Document the adjustment in the clinic encounter notes.
5. Print the script if required, otherwise you can close the medical record.
Prescribe a Medication Dose that is not Listed in Formulary
If the medication exists in the Usual Scripts list – drag and drop it into the Current Order and edit and prescribe. See section on how to Prescribe Medications from the Usual Scripts list
If the medication does not exist in the Usual Scripts list- Find the medication in the formulary from the current order section
2. Type the Dose you want to prescribe and enter the remaining information
6. Print the current order and if it needs to be entered in the Usual Scripts list, drag and drop the medication from Current Order into Usual Scripts list
This is the print out of the prescription:
This is how the medication will show in the Usual Scripts list:
Record and Sign off a Verbal and Telephone Order
See Resource section Safe Medication Order Writing: Best Practice in this article.
Key Points:
• Verbal orders are only allowable in emergent and life-threatening situations.
• Telephone orders are only allowable if the prescriber cannot reasonably attend the patient care area to enter the order in EMR.
For the non-prescriber receiving the verbal or telephone order, follow these steps:
1. Enter the prescription in the Current Order. Follow the steps in section Prescribe a Medication that is Not in the Usual scripts List.
2. Add a dose text note clearly indicating that it was a verbal or telephone order. See example below.
3. Go to the Prior Scripts tab. Follow the steps in Administer and Dispense Medication for the administration of the medication.
4. Document in Encounter notes about the situation. See example below.
5. Click on New Task in the main tool bar to create a task for the orderer to sign the order in the Encounter note. For detailed steps on how to create New Task, see Help File: Tasks
6. Enter in Subject as Sign off verbal/telephone order;
7. Change the Holder to the prescriber who gave the verbal order
8. Click Save to save the task
9. Close Encounter
For the prescriber signing off the verbal or telephone order follow these steps
1. From Work Centre, click on Tasks from Segment Bar
2. Ensure that the correct filter (view) is chosen: Pending Tasks- Me and My Groups (any PSO site I work at)
3. Double click on the task to sign off
3. From the linked task, click on the link to open the encounter
4. When the encounter window opens, enter ‘Verbal/telephone order signed off s\’. The ‘s\’ will populate your name, date and time. See the example below.
5. Once you have added in your signoff, click on the green check mark to complete the task
For Non-Prescribers - How to Enter Medications in Usual Scripts List
In situations where you are doing a best possible medication history with a client, you can enter the medications using the below steps.
1. Click on the Create New Usual Prescription icon
2. Find the medication in the formulary and enter the details as below
3. Press OK
4. This is how the mediation will appear. The blank Quantity and Last Given columns will act as a trigger for the prescribers to update the medication.
Formulary Legend
Rx Entered in Error? (Steps to Delete or Cancel an Order)
When to Delete an Order (Delete Order Button)
- Use the Delete Order button to remove an order from the Current Order List when it has been ordered in error (e.g. you have created an order for citalopram when you meant to order escitalopram, OR you have created a new encounter and created order(s) into the wrong client's medical record).
- The Delete Order button may only be used by the clinician who created the order in the original encounter, additionally users may only use the Delete Order button to delete an order within 24 hours of the order being entered into the medical record.
IMPORTANT NOTE! Prior to using the Delete Order, ensure no medication dispensing or administration records have been documented against the order; as when an order is 'Deleted' from the record so are any associated medication dispensing/administration records.
- Users who attempt to use the Delete Order button outside of the above circumstances will receive the error warning below and will be blocked from completing and actions within the original encounter.
- To exit out of the pop-up, click Close button and close out of the Edit Encounter.
How to Delete an Order
1. The Delete Order button is located in the Order Items area in the Scripts module. This button will be "grayed out" until there is an order selected to 'Delete' from either the Current Order List or the Completed Actions List (see below).
IMPORTANT NOTE! If opening an existing encounter to use the 'Delete Order' button, the order will only be visible in the Completed Actions List.
2. Once an existing order is selected, the Delete Order button will appear in red, click on the button to delete the order. Deleting the order will remove and record of same from the encounter note as well as remove the order from the client's Prior Scripts list.
When to Cancel an Order ('Cancel Order' Button)
- The Cancel Order button is used when an order has been entered and processed in error (e.g., Rx created and sent to pharmacy but incorrect dose indicated or the script was issued for the wrong client).
- The Cancel Order button may be used by clinician who entered the original order OR by an alternate clinician authorized to do so (refer to your site and practice related policies related to same).
IMPORTANT NOTE! When cancelling an order, be sure to review whether any medication dispensing or administration records have been documented against same and whether these have resulted in a medication error and require follow up.
How to Cancel an Order
1. When cancelling an order, begin by creating a New Encounter and documenting the reason for the order cancellation in the body of the encounter note
2. Navigate to the Prior Scripts list
3. Select the medication order from the Prior Scripts list to be cancelled & click the Cancel Order button.
IMPORTANT NOTE! The Cancel Order button looks the same as the Delete Order button, however is only accessible via the Prior Scripts list.
4. When an order is Cancelled, it will remain in listed in Prior Scripts list, however will be labelled as [CANCELLED] and will be italicized (see below).
Formulary Updates and Replace Inactivated DIN
The First Databank formulary is updated on a quarterly basis. During the formulary update, new Drug Identification Numbers (DINs) are added and some are inactivated. You may receive a warning pop-up when you try to prescribe an existing usual medication with an inactivated DIN.
For example:
The most common reason for a DIN no longer being available is that your prescription is linked to a formulation or size that is no longer being produced by the same company.
1. You have 2 choices.
- Choice 1 is to select Replace which will replace the old medication with the new medication that is linked to a DIN. This means you will no longer get a pop-up in the future.
- Choice 2 is to select Continue which means you do not update the medication and allows you to carry on. However, it also means that every time the med is ordered, the same pop-up will appear, until you fix it.
2. Formulary window opens
If the tablet size is incorrect, or you are not being offered any choices to choose from, then erase everything except the first part of the medication name and search again (click Rx button or hit Enter).
3. Select an alternate preparation and click new instruction
4. The previously-ordered settings carry over - review and click OK
5. Click Yes to save changes
6. Click Yes to replace Usual Script
Usual Script will be updated with the replacement (which has a different DIN).
Resources
General Resources
VCH Profile EMR Scripts Help e-learning module, covers all the major Scripts functionality
Medication Order Requirements Policy
VCH Community Medication Standard
PHSA Safe Medication Order Writing e-learning module
List of Error-Prone Abbreviations, Symbols, and Dose Designations
EMR Scripts Help Videos
- Preparing the Workspace
- Prescribing from Usual Scripts
- Discontinuing a Usual Script
- Prescribing New Medication (not in Usual Scripts list)
- Editing a Medication in the Usual Scripts List
- Prescribing Ad Hoc Medication
- Prescribing Medication with Alternating Doses
- Adjusting a Dose for an Active med
- Prescribing a Med Dose Not in the Formulary
- Editing Usual Scripts for Non-prescribers
Related Help Files
- Clinician Checklist or search for clinician checklist in the EMR Library
- Add Allergies/Adverse Reactions – Prior to adding ordering medications