Second Sign for Clerical/MOA Ambulatory Orders

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  • Second Sign for Clerical/MOA Ambulatory Orders 
As of April 28, 2022, orders placed in ambulatory settings by AHS clerical staff and non-AHS Medical Office Assistants (MOAs) for medications, procedures, laboratory testing, diagnostic imaging, and cardiology and surgical procedures (with some exceptions listed below) must be "Second Signed". 

With Second Sign, orders are not visible and cannot be carried out until the second signature is obtained electronically from a responsible prescriber. Once the second signature is applied, the affected orders can be acted upon.

Why is this change being made?
  • This change was reviewed by eSafety, AHS Legal, CCEC and Zone Medical Leadership, and was determined to be required for patient safety when delegating order entry to unit clerks/MOAs.
  • Compared to verbal orders needing co-sign, second sign ensures that orders entered by the ambulatory unit clerk or MOA are reviewed, approved and signed by the authorized prescriber prior to being visible in the patient chart and actionable by other healthcare providers.
  • It assists with prescriber and patient care workflow efficiency by allowing clerical staff and non-AHS MOAs, within their scope of practice, to enter certain order types on behalf of the prescriber.
  • Use of the second sign order entry workflow allows the order entry process to be transparent and auditable via reporting tools in the reporting workbench.
What else you need to know 
  • When booking urgent cases, prescribers should enter orders themselves.
  • Approved exceptions to second sign are as follows:
    • Paper orders with a wet signature can be transcribed by unit clerks and MOA’s into Connect Care, provided all order components align from paper to Connect Care format. 
    • PLEASE NOTE:  Providers with Connect Care (CC) access are expected to place orders within CC and orders submitted on paper by these providers will be returned.
    • Orders to schedule a procedure may be entered by an ambulatory unit clerk or MOA as an active order, so that scheduling/booking can proceed without need for second sign.
  • Second Sign orders can be found in the authorizing prescriber’s "Second Sign Needed" In Basket folder, which can be "favourited" to ensure visibility.
  • Order printing:
    • Orders with requisitions will not print until the second sign has been completed by the prescriber.  Upon second sign, requisitions will print to the location that the current workstation is mapped to; alternatively, prescribers can use Virtual Local Printing (VLP) to choose another destination for the order to print. Information around virtual local printing can be found in the Connect Care Manual.  
    • MOAs can use Reprint from Chart Review if additional copies of requisitions are needed.
For more information: