Transcript Document
ED Phase 3 Training for Nurses
Home Medications
• Should be documented within the Triage Screen. On the Allergies/Home Meds tab • Computer Based Trainings:
Home Meds Questions?
OM Ordering for RN’s • Order Source: Either Verbal or Med Exec Approved • Order Source of Med Exec Approved should be utilized for RN Protocol Order Sets • Order Source of Verbal should be used in emergent situation only (use your professional discretion)
Ordering IV Fluids
Select New Meds
• Select New Meds to order IV fluids
Search for IV Fluid by Name
• Search for IV fluids using the type ahead look-up.
• Place a check mark
next to the fluid
you want to order • Click
Next
to continue.
Select the Volume to Infuse
• Select the volume you want to administer • Note the
OK
is not lit • Click on the blue edit to enter the rate
Enter Rate and Units ml/hr
• Titrate defaults to No • Type in the rate • mls/hr defaults in the units field • Click
OK > Save
Order Sets
ED RN Protocols
• Click on New Sets • House sets on the left; specialty sets on the right • Click on the + to expand the ED RN Protocol sets • Check the order set (s) you need
Order Set View
• Order set expands to a pick list w/scroll bar on the right to scroll down the list • Check all the orders you need: NEW status • Note orders that have already been ordered • Click Edit all to complete required fields > OK > SAVE
Any Order
• If you need an order that is not contained in the set click on Any Order
Any Order, continued
• You can add orders, meds, or sets.
• This example shows adding a Rapid Group A Strep which was not part of the order set • The order will show at the bottom of the set under “Additional Orders”
What Stays on Paper
• Code Orders • Major Trauma • Restraints • Stroke • STEMI • Blood Product Request for Transfusion
eMAR/BMV Training Session
Agenda
• Introduction • eMAR/BMV – MAR Layout – ACK Orders from RN Tracker and MAR – Prerequisite CBT Viewing:
Introduction
• The ED Physicians will be placing order in CPOE (computer provider order entry) this will now include medication orders • RN’s will be documenting and scanning the Medications through scanning/BMV (bedside medication verification) on the eMAR (electronic medication administration record)
Medication Administration Record (MAR)
MAR Layout
Inclusion Criteria MAR Headers EMR, PCS, & OM Routine Buttons Footer Functions
MAR Headers
Clickable & Sort able
• Start/Stop • Status • ACK Status • Medication • Route • Scheduled times
Time Column
Time Column
•Scheduled times •Last administrations
Start and Stop Date and Time
Please note: Once and One Time Medication will automatically stop one minute after being ordered. This does not mean that they can not be documented against.
MAR Order Status
• • • – Active Order is active and available to administer – Discontinued Order has been discontinued – Canceled Order has been cancelled
ACK Status
– Unacknowledged – Acknowledged – Rejected
Medication Information
Jump to the next slide to review the information in the med order info cell.
Medication Order Cell
Generic Name Dose Route Frequency Schedule Trade Name Rx Number Symbols: Addl Info Give Field: How much of the dispensed dose to give.
PRN Reason
More about the Give Field on the next Slide…
MAR Symbols
Associated Data Drug Monograph Protocol Titration Special Instructions Assessment Co Signature
MAR Symbols: Clickable
• Clickable & Sortable: Symbols – Links – Co Signature – Titration
GIVE FIELD Give Ordered Dispensed
Give Field
: How much of the dispensed dose to Give to Pt ie: Give 2 Tabs of the (dispensed) 325 mg tab 2 Tabs x 325 mg (dispensed) = 650 mg (ordered)
GIVE FIELD: Split Tab Give
Give Field
: How much of the dispensed dose to Give to Pt ie: Give 1/2 Tabs of the (dispensed) 50 mg tab 1/2 Tabs x 50 mg (dispensed) = 25 mg (ordered)
GIVE FIELD Give
Give Field
: How much of the dispensed dose to Give to Pt ie: Give 6 ml of the (dispensed) 100 ml/4 ml suspension 6 ml (admin) x (100 mg/4ml) (dispensed) = 150 mg (ordered)
GIVE FIELD: Partial Injection
Give Field
: How much of the dispensed dose to Give to Pt ie: Give 2.5 ml of the (dispensed) 5 mg/5 ml Ampule 2.5 ml (admin) x (5 mg/5ml) (dispensed) = 2.5 mg (ordered)
GIVE FIELD: Multi Dose Container
Give Field
: Does not appear • Dose Instructions indicate Multi Dose Container • Order Indicates amount to administer & units as appropriate
Viewable Dates Viewable Dates • Currently: Yesterday & Today • You can manipulate the display to determine appropriate viewable date range
MAR Layout Footer Functions
• • • • • • • • •
Refresh:
Refresh new data manually
Change View:
Changes the view of data displaying on the MAR
Document
: Document an administration (manually-not using scanning) » Not Recommended!
Document Unscheduled
: Document an administration that is not scheduled
Document Assess
: Document an MAR assessment
Detail:
View the detail of the MAR Order
Manual Barcode
: Enter Medication Barcode Manually
Renewal:
Will not be utilized
Schedule Comment:
Enter a comment for a medication schedule
Medication Detail Screen
Medication Detail Panel
Includes Many Tabs of Order Information
Med Detail Info Tabs
• Detail – MAR Detail • History – Audit Trail • Flowsheet – Assessment Documentation • Associated Data – Related Queries, Labs, etc • Protocol/Taper – As Indicated • Order Detail – Audit
Medication Detail: History Tab
Order Information Audit Trail Line Items Audit Trail Detail
Medication Detail: Flowsheet Tab Flowsheet Documentation as associated to the Medication
Medication Detail: Monograph Tab Order Detail
Medication Monograph
• Viewable • Print-able • English/Spanish
Medication Detail Associated Data Tab Order Detail
Associated Data
• Query Documentation • Lab Results
Medication Detail: Protocol/Taper Tab Order Detail
Associated Data
• Query Documentation • Lab Results Protocol or Taper as Indicated
Order Detail
Order Detail Fluid Volume Info Titration Info & Protocol ACK Audit Trail
Medication Detail Panel Review
Med Detail Info Tabs
All of the info just covered, is viewable from the MAR Detail Tab
• Detail – MAR Detail • History – Audit Trail • Flowsheet – Assessment Documentation • Associated Data – Related Queries, Labs, etc • Protocol/Taper – As Indicated • Order Detail – Audit
Questions on MAR Layout?
Next, topic: Acknowledging Meds Two Methods to Ack Meds 1. RN Tracker 2. MAR
Acknowledging Orders
Two places to Acknowledge Med Orders
• MAR Ack Routine •RN Tracker Ack Routine Acknowledging Orders from the RN Tracker will Auto - Ack on the MAR!
RN Tracker ACK • To Acknowledging from the RN Tracker: – Click on the ACK prompt from your Tracker
RN Tracker ACK • List of Medication Orders and Status of Each • Place a checkmark to the left of the first Order
Review the Detail of the Order & Ack • The detail of the order will appear • Review the detail of the order by scrolling down • Next, click Acknowledge • Then, Save
Return to RN Tracker • You will be brought to the Orders Screen • Click exit to RN Tracker to navigate back
Ack on RN Tracker = ACK on MAR
Note that the orders that you acknowledged from the RN Tracker appear acknowledged on the MAR
ACK from MAR
To Ack from the MAR you must review the medication cell as well as the order detail. 1. Highlight Med 2. Review the medication cell • Five Rights 3. Click the detail tab to review the Order detail
ACK from MAR
Review all items of the medication detail screen
ACK from MAR
1.
2.
Click on the red Unacknowledged status Select Acknowledge Order
ACK from MAR
Now Med is listed with the ACK status of Acknowledged
Acknowledging Medications • Acknowledging is signing your name to the order • Obtain/Review appropriate information before signing off On MAR – Review main MAR & Five Rights • Right Patient • Right Medication • Right Route • Right Dose • Right Time – Click Detail Tab to review the Order Tab and Audit Trail • Order Source • Edits Made • Tracker (ACK Routine) – All information on one screen – Five Rights – Order Audit
ACK on Tracker
• ACK on RN Tracker = ACK on MAR • RN Tracker ACK is a true acknowledgement!
• You will acknowledge each medication order only once (MAR or RN Tracker) • It is recommended that you Acknowledge orders from the RN Tracker – Benefit: All Information on one screen
Warning:
Never
ACK Upon Admin
• Admin before ACK you will receive message “Medication has not be acknowledged” • Click Cancel and Review Order Detail!
• Never select Acknowledge and Document – You will not be presented with enough info
BMV (Bedside Medication Verification) Scanning Medications after the Physician has entered the Order and the Nurse has done the Acknowledgement
MAR Administration Screen
• Scan Patient wrist band (this will take you directly to the MAR) you will then be prompted to enter a pin to get into the MAR • Scan Medication(s) (you can scan multiple medications in one session prior to saving)
MAR Medication Administration Screen Main MAR Order info Scan List
Medication Administration Screen • MAR Order Information • Scanning Detail • Administration info – Scheduled Date – Administration Date/Time – Admin User – Administered dose – Non Admin Reason – Admin Comments Admin Date: • Date you gave med • Edit to Back Document Dose Amount of med given Edit to adjust the administered dose
Medication Administration Screen • Flowsheet Tab certain medication have a flowsheet administration assessment attached. This may contain required info. if Flowsheet appears red.
Non-Administering a Medication
• Click on the field to document an Administration • Choose Not Given you will then be prompted to enter a reason.
Titrations
How to Document a Titration
• Scan Patient • Scan Levophed • You will be brought to the titration flowsheet first • You must click to view the Protocol/Taper tab before you can save the administration (save is low lit) Dose, Rate, Start, and Volume Remaining will default upon initial admin
Titration
• Once the protocol has been viewed, you can save the administration • Click Ok • Save Summary
Titration
• To titrate (or change the rate) of the med, click on the IV bag symbol (titrate symbol)
Titration
• Here you will be prompted for the Dose • The rate will calculate automatically
Titration
• Enter the rate or dose • Increase or decrease will appear
Co-Signature
• Co-signature is indicated through the highlighted symbol
“Scan to Order/Overrides”
• In an emergent situation if a medication is need for a patient and the Physician gives a verbal order – This Medication can be pulled as an over ride from the pyxis/omnicell machine – When you scan this medication it will prompt you to enter an order in OM for this against the physicians name through the order source of Verbal – The order will then go to the physicians e-sign queue.
Scan to Order Example
Additional MAR Info.
MAR Change View
• Click change view to change the MAR display
Change View
View Dates: All due times or restrict to next due?
Number of days in the past to view schedules and admins Number of days in the past to view complete schedules Number of days in the future to view schedules and admins The field by which the MAR will sort Number of days after the med has been discontinued that you can select to view. Discontinued meds will display in active view for 24 hours after discontinued.
After 24 hours, the med can be selected to be viewed up to the number of days in the setting above.