Continued Care: Managing Medication Orders

Managing medication orders ensures safe and effective treatment for patients undergoing substance use disorder (SUD) and behavioral health care. This section covers the process of creating, modifying, and discontinuing medication orders in Kipu. Proper medication management follows strict state guidelines, prioritizes patient safety, and requires thorough documentation to prevent diversion and reduce medication errors. Enter medication orders in the patient’s chart, including new prescriptions and actions based on medications brought in by patient upon admission.

Required Permissions: Nurse, doctor, super admin, records admin, and users with access to Rcopia. Click here to learn more about Rcopia roles and functions. 

Best Practice Workflow Steps

Let’s review the best practice workflow to manage medication orders.  

Workflow 1: Order Placed by Physician

The prescriber navigates to the Doctor's Orders tab in the patient chart.

Workflow 1A: eRx [Rcopia]

1. Ensure that the patient’s chart is enrolled in the Prescription Portal.
2. Click Quick Orders to use pre-populated medications.
• You can also click on Custom Orders for less frequently prescribed medications.

• Note: Enter the required (*) information for medication orders, including medication name, route, dosage form, frequency, strength, units, and justification.

3. After enrolling the patient in eRx [Rcopia], select the eRx checkbox in the order template. Click here for detailed instructions on creating an eRx order in Kipu.
4. Click Change to modify the medication strength, dosage, start date, and other fields in an existing order (if needed). The system automatically discontinues the previous order and initiates a new one with the updated information.
5. Then the provider must click on Needs Signature to sign the order.
6. After submitting the order, click Prescription Portal to open Rcopia.
7. Find the medication in Rcopia.
8. After revising the medication details (if needed) click Review.  
9. Enter the required signature password and click Send.
10. Patients can view their prescribed medications in the Patient Portal.

Best Practices:  Use Quick Orders for standard and frequently prescribed medications to streamline ordering. Modify them as needed for individual patients. When using eRx, Quick Orders enable faster entry, ensure templates are ready for electronic prescription, and improve inventory management in later steps. Super admins should collaborate with providers to create protocols for quick entry of multiple medications. For example, a provider treating substance use disorder can use a predefined set of orders based on the patient’s drug of choice.

Workflow 1B: Not Using eRx (Workflow Deviation)

Orders can also be faxed to a pharmacy if necessary. 

Best Practice: eRx is the preferred medication transmission method. If the facility does not use eRx or Inventory, refills must be manually added to the order under the refills field. If the patient has exhausted all refills, create a new order in Kipu and re-submit it to the pharmacy.

1. To begin, use Quick Orders.
• You can also select Custom Orders for less frequently prescribed medications.
2. In the Doctor’s Orders tab, click on the Change button of an existing order to modify the medication strength, dosage, start date, etc. if needed.
3. Click Fax to Pharmacy to send non-controlled medications via fax. Make sure to preview the fax and confirm the pharmacy information before sending the fax.

Workflow 2: Order Placed on Physician’s Behalf

Staff members with the Nurse, Super Admin, or Records Admin role assigned to their user profile can place orders on a physician’s behalf.

Follow the same steps as described in Workflow 1A/B when placing an order on behalf of the doctor. 

1. A physician’s signature is not required for medication or action orders to appear in the MAR and Med Log, however, the order will display as pending review.
2. Enter the physician name in the Ordered By field and select the way you received the order from the Ordered Via drop-down menu. If the facility does not use eRx or Inventory, you can manually enter the number of refills in the Refills field. If the patient has exhausted all refills, create a new order in Kipu and re-submit it to the pharmacy.  
3. The physician can review and sign orders from the Physician Review tab in the Dashboard.

   Best Practices: Use Quick Orders for standard and frequently prescribed medications to streamline ordering. Modify them as needed for individual patients. When using Rcopia, Quick Orders enable faster entry, ensure templates are ready for electronic prescription, and improve inventory management in later steps. Super admins should collaborate with providers to create protocols for quick entry of multiple medications. For example, a provider treating substance use disorder can use a predefined set of orders based on the patient’s drug of choice.

Workflow 3: Discontinuing Medication Orders

Orders may need to be discontinued due to adverse reactions, changes in the patient’s condition, or completion of a medication course. Discontinuation can be done individually or in bulk from the Doctor's Orders tab. A reason and details must be provided for each discontinuation.

1. Navigate to the Doctor’s Orders tab and click Discontinue Orders
2. Select one or multiple medications to discontinue.

• Best Practice: When discontinuing multiple medications at once, only one discontinue reason is applied to all selected orders. To ensure proper documentation, group medications together if they share the same discontinuation reason. Provide a reason for discontinuation and document the ordering provider (if you are not the provider), how the discontinuation order was received, and click Submit to discontinue the order.

3. The discontinued orders pending signature appear at the top of the Doctor’s Orders tab in red with STOP before the order name. Once signed by the physician, the order moves to the All Orders section.

Best Practice: Enable notifications to stay informed of medication order changes, including new, modified, and discontinued medication orders.