In Instinct EMR, when a patient's weight is updated after medications have been ordered, a persistent alert banner appears on the Treatment Sheet and Anesthesia Sheet, prompting you to review and update active medication dosages. This feature helps prevent over- or under-dosing when a patient's weight changes during their stay.
Permissions and Draft Mode
Users with the create_draft_order permission can open and view the Review Medication Quantities screen, but cannot update quantities—the dose selection options and Confirm button are disabled. Medications remain in a draft state until a user with the approve_draft_orders permission acts on them.
Users without the order_controlled_substances permission can view the Review Medication Quantities screen, but cannot update quantities for any controlled substances.
Configure the review threshold per medication (Admin)
Admins can control how sensitive the medication review trigger is on a per-medication basis—or disable it entirely for medications where weight-based recalculation isn't clinically relevant.
Go to Admin → Inventory → Products and open the medication you want to configure.
Scroll to the Advanced Ordering section.
Click the Medication review threshold dropdown and select an option:
Never Alert — disables the review banner for this medication entirely, regardless of weight changes.
0% (always alert) — triggers the review banner for any weight change
3% / 5% / 10% (default) — triggers the banner only when the weight change exceeds the set percentage of the previously recorded weight
Custom — a text field opens for a custom number (%) to be used
Click Save in the top-right corner to save any changes made to the threshold.
Note: Changes to this setting apply to future weight updates—they do not retroactively affect an existing banner.
When does the “Medication Review Required” banner appear?
The banner displays on the Treatment Sheet and Anesthesia Sheet whenever:
A patient's weight is updated (via the patient info bar, vitals screen, or a weight order on the Treatment Sheet)
and
There are active medications on those sheets that were ordered using the dosing calculator at a previous weight.
Previously completed treatments do not trigger the medication review banner—only future (not yet administered) medications apply.
The banner is visible to all users viewing that patient's Treatment or Anesthesia Sheet until someone explicitly addresses it.
Note: If the patient's weight is changed back to its original value before the banner is acted on, the banner is automatically removed. |
How to review and update medication quantities
On the Treatment or Anesthesia Sheet, click Review Quantities in the alert banner.
The Review Medication Quantities screen opens, showing the previous weight and current weight at the top.
For each medication in the list, select either Original Dose or Current Dose:
Original Dose — keeps the dose the medication was ordered at and adjusts the quantity to match the patient's current weight.
Current Dose — keeps the originally ordered quantity and recalculates the effective dose based on the new weight.
To apply the same selection to all medications at once, use Bulk Edit to select all Original Doses or all Current Doses. You can still override individual selections afterward.
Review any medications flagged with a safety icon (❤️) — these have a calculated quantity outside the configured safe dose range and will be highlighted in red.
Select Original Dose or Current Dose to automatically calculate the intended dose, then select Confirm to save your selections. If any selected quantity falls outside the safe dose range, the button changes to Ignore + Confirm—selecting it acknowledges the out-of-range value and proceeds.
Note: The Total Dose and Quantity columns are read-only and recalculate automatically based on your selection. To use a different quantity entirely, close the medication review window and edit the medication directly on the Treatment or Anesthesia Sheet. |
Confirming medication doses clears the banner for all users.
If you need to close the modal without making changes, select Cancel—the banner will remain visible for all users. Use this when you are not the right person to confirm the medication decision (for example, a tech records the new weight but a doctor needs to review the changes).
Frequently asked questions
What is the difference between the Original Dose and the Current Dose?
Original Dose keeps the intended dose the same and adjusts the quantity to the patient's current weight. Current Dose maintains the originally ordered quantity and changes the effective dose per kilogram based on the new weight. The Total Dose and Quantity columns update in real time to reflect your selection.
What if the patient's weight changes more than once before I open the modal?
The modal displays the original weight at which each order was created, along with the most current weight on file. If different orders were placed when the patient had different weights, each line item will reflect the weight recorded when that order was created.
Which medications are included in the review?
Only medications ordered using the dosing calculator are included. Other product types, such as basic observations or monitoring, are not included.
What if a medication quantity is outside the safe dose range?
The medication is highlighted in red, and a safety icon appears next to its name. The Confirm button changes to Ignore + Confirm, requiring explicit acknowledgment before proceeding.
Can I manually enter a different quantity in the “Review Medication Quantities” window?
No—the Quantity column is read-only (not editable). To use a custom quantity, close the window and edit the medication directly on the Treatment or Anesthesia Sheet as normal.
Still need help?
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