Transcript MAK - Scott & White

Scott & White
MAK
Medication Administration Check
MAK
Scott & White Memorial Hospital
Version 1
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MAK
Scott & White Memorial Hospital is implementing Seimens MAK system. This application utilizes wireless
technology and barcodes to add an additional measure of safety to the five rights of medication
administration: right patient, right drug, right dose, right route, and right time.
Benefits of the MAK system
•
Decreases Medication Errors
Some of the most common errors in hospitals occur in the medication administration process. Poor
handwriting, incorrect transcription, and (or) as well as dispensing medications erroneously add to the
problem. This system is designed to enforce the 5 “R”s of medication administration. Medication
Administration Check is an administration system, not a documentation system. By identifying trends from
MAK reports, processes are being re-designed to help make S&W a safer hospital!
• Decreases Uncharted Occurrences
All uncharted occurrences display each time a user accesses the patient’s MAR. This helps remind the user
to document on the uncharted medications. Utilizing MAK prior to shift report to reconcile all medications
can eliminate omissions.
• Improves Charting Accuracy
Charting is done as the medication is administered. Flags for required follow-up are automatically added for
certain medications.
• Provides Online Drug Information
Drug information from the First National Drug Databank is updated quarterly. This puts the most recent drug
information in the hands of the caregivers in a timely manner.
•
Defines medication orders that require additional information.
Examples of this function are Digoxin, which prompts for a pulse, and Insulin, which prompts for a blood
sugar.
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Medication Administration Process
Medication Order
Received
Faxed to
Pharmacy
Processed by
Pharmacy
Medication
Released to
PYXIS
Follow-up
performed and
documented if
applicable
Charting completed
Medication Administered to
Patient
Medication
Delivered to
Nursing Unit
Order Verified by
RN in MAK
Medication Scanned Using
the MAK Application at the
Bedside
Patient Identified, Then
Confirmed by Barcode
Scan
Appropriate Patient
Assessment Performed
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Equipment
Mobile Workstations: MAK is loaded on each mobile workstation. The wireless carts must be taken to the
bedside when administering medications. The one exception to this is in isolation rooms. For isolation
rooms, the cart should be positioned outside of the room in the direct line of sight of the caregiver.
Barcode Scanner: The barcode scanner is a key link in the MAK safety check. These scanners are not tied
to any specific workstation. Once you sync the scanner to the cart, you may proceed in medication
administration.
Rechargeable Batteries: Each scanner has two batteries. Additional batteries are stored on each MAK
unit. S&W stongly encourages starting your shift with a freshly charged battery.
Base Unit: Each workstation has a green base unit attached to the cart. Scan the barcode on the base unit
before you log in to MAK to ensure that the scanner “talks” to the computer.
Scanner beep does not indicate a correct scan: The beep from the scanner only indicates that the
scan has been read. You must look at the screen to verify the scan was correct.
Patient ID Bracelet: Each patient’s ID Bracelet prints out with the MRN number and the case number.
The case number should be the bar code scanned to identify your patient in MAK. If this barcode becomes
unreadable, make the patient a new armband and discard the old one.
Badge: Each employee badge has a barcode on the back of the badge. This is used in the third security
step for caregiver identification. You must have your badge before you report to work.
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MOO !
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MAK
Screen
Scanner
Keyboard
Supply drawer
with lock
Brake
Basket
Height
adjustment pedal
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MAK
Original “Teal” Barcode Scanners
These wireless scanners “talk” to a certain cart by “syncing” the scanner : scan the base
unit on that cart with the scanner. These scanners can be used with any cart that has a
base unit. Change the battery at the beginning of your shift to ensure a full charge.
Trouble shooting
• Make sure all connections are in place
•Re-sync the scanner to the base unit
•Tag the old scanner. Replace the and resync the new scanner to the base unit
•Change carts and notify the Help Desk: 4-2501. They will request the scanner tag number
“Wasp” Barcode Scanners
The small black and yellow scanner is labeled with a number and can only be used with a
computer that has the corresponding label number. The wasp can be placed in a charger
that also contains a spare battery.
Trouble shooting
• Make sure all connections are in place
•Check for corresponding label numbers
•Change the battery
•Tag the old scanner, change carts and notify the Help Desk: 4-2501. They will request the
scanner tag number
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Scanning Tips
Hold scanner close to small bar codes and farther away for
large bar codes.
Move the angle of the laser (don’t “stare” at the barcode).
Change the distance between the scanner and bar code.
Turn the scanner or barcode upside down.
Click on another med and back on the med you want, then
scan.
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MAK
MAK Login
MAK is located on the Desktop of each wireless workstation as a
icon.
Once you open the application, a Login ID and Password are
required. Following the Login and Password, you will be prompted
to scan your badge.
* If you forget your password contact the Help Desk at 4-2501.
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Security
• Each MAK user is responsible for safeguarding the
security of their individual login, password and badge.
• S&W has security measures in place to keep your
information confidential. If you think someone knows
your User ID and Password, you must contact the Help
Desk at 4-2501.
• If you lose your badge, you must report it to Human
Resources so that a new one may be issued.
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MAK icon
The first time you sign in, you will
enter the Login ID in both boxes
You will then be directed to enter
your own password: make it
something you will not forget!!!
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Scan your badge.
The default is your SS# or
employee#: this will be
reported as an override.
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Click on
Location Census
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Choose your unit.
This will become a
default.
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A list of your unit
census will appear
by order of room
number.
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Hold the “Ctrl” key down
and click on all your
assigned patients.
These will be highlighted
in black.
Select “Add to Personal”.
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Next, click Cancel
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Select “Chart-Select Patient by Census” from navigator
or New Patient List
Select “Personal Census” from the New Patient
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Select All
You must choose this to
embed your patients.
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Chart - Select Patient by Census
This will bring the patient meds on screen.
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Here’s what it looks like!
The MedSummary is the
default screen if there are
orders to be verified.
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Screen Layout and Windows Functions
Title Bar: Contains the names of the user,
patient, and hospital. By double-clicking on the
title bar, the size of the window will decrease.
Repeating will make the window return to the
original size.
Minimize (-) : Removes window from view and places it on
the Taskbar.
Maximize : Returns the window to full size.
Close (X) : Closes the window and removes the application
from the Taskbar.
Column Name: Clicking
on any of the cell names
in the column will re-sort
the rows.
Scroll Bars: Both vertical and
horizontal. Move the bar or use
the arrows to scroll through the
patient window
* Right click on the screen to refresh the display.
Tabs & Buttons: Selecting tabs
“turns the pages” of the screen.
Buttons complete or request a
function.
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System Window and Terms
Patient Header: Contains
allergies, and room number.
The Log off button returns the user
to the log on screen. Any time you
leave the mobile workstation
unattended,you must log off.
Navigator:
Provides a list of options
allowing you to “navigate”
through the system.
To hide or show the Navigator: Go to Navigator and click Show Navigator or Hide Navigator.
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Screen Security
• Minimize the screen if someone approaches
you while charting.
• Never walk away from a patient screen.
o Log Out First!
o Do Not minimize or Turn off the Screen
o Others could pull the screen back up and look
at information under your ID or enter data.
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MAK List of Symbols
Order pending verification by Nurse
Order requires countersignature

Order returned to the pharmacy for clarification
One time dose not reviewed by Pharmacy
Follow-up required
Condensed text
Expanded view of text
Additional data present
Error
Discontinued Medication
You can determine what each symbol means by placing the
cursor over the icon and reading the “Tool Tip”
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This tab on the
far left is the
Active Worklist.
This is where
medication
administration
occurs.
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Rapid Allergy and Height/Weight Entry
Rapid entry of allergies and height/weight
information is more important now than it has
ever been. With a medication administration
system that performs safety checks on each
drug administration, the sooner this information
is in the computer the safer we can be as an
organization.
Enter this data quickly!
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Diagnosis Information crosses over from Invision.
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The “Lab Results” folder provides a quick view of
selected lab results.
Only the most recent lab results display.
All official lab results will always be posted in
Invision.
Abnormal lab results are noted with the yellow
triangle icon.
Go to SoftLIS for more results and detail.
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The “MED SUMMARY” Folder lists all
current medications including those that
are new or discontinued.
When a patient has new orders, the
“MED SUMMARY” is the default screen.
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Med Summary Folder
On-line verification of medication orders occurs in this folder. The order will
have the red tipped pen icon. Unverified medication orders cannot be charted
as administered.
On-line Verification
Medications should be verified as soon as possible after the order is written.
Similar to “signing off orders”, Verification produces a “signature” by the RN
proving that the order is correct as entered. On-line verification should be done
with the physician's order in hand.
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Verify Orders
Click on “Verify All” and
the system will
automatically go through
all orders pending.
If the order is correct,
select the “Verify” button.
If the order is not correct, select
the “Intervention” button
If you are unsure “Skip Order”
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Contacting Pharmacy for
non-emergent needs
Rx Message
Goes to your unit
Pharmacist
Include your ASCOM phone
number so the Pharmacist can
contact you for any questions.
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Cumulative Dose – monitors medications that
have Dose Limiting Toxicities (DLT’s) such as
chemotherapy.
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Any orders that are not verified
(Interventions) will be listed.
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Meds that have been given.
Use the scroll bar in each
section to see further
information.
Note all the buttons at the base
of the screen.
The Charted List is All Powerful!
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The Active Worklist
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Active Worklist Folder
The ACTIVE WORKLIST displays a list of current, active, and uncharted medications within a specific time range. You
can adjust this time range by selecting the expand list option on the screen. Medications due within the original time
frame display in white. Active by not yet administered medications greater then two hours display in PEACH. PRN
medications display at the bottom of the screen.
Charting Functions
The following functions are available in the ACTIVE WORKLIST folder:
 ADMIN - Medications are automatically charted as administered unless the user specifies NOTADMIN
 NOT ADMIN - Document when medications are NOT given (BEWARE!)
 BARCODE OVERRIDE - Use if there is a problem with a barcode scanning properly and it cannot be read by
the barcode scanner
 ENTER NOT ADMIN REASON - A drop-down menu is available to chart the reason that a medication is not
administered. This
field will also allow the user to document free text
 ENTER ADMIN SITE - A drop-down menu is used to document administration sites. These are typically
used for injections
 ENTER REASON - A drop-down menu is used to chart the reason a PRN medication was given
 DETAIL - Details the selected medication order
 ID PATIENT - Scan the barcode on the patient identification bracelet. MAK verifies that the right patient is
receiving the meds
 CHART - Use to complete and store charted data
 CLOSE - Closes the patient window and returns to the navigator functions
 RX MESSAGE - Allows the user to send a message to the Pharmacy
 EXPAND LIST - Allows the user to change the “date/time” window to view more data
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Active Worklist defaults to
a 3 hour view.
You can Expand List to
see your entire shift.
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Night Shift can
expand to the
next day.
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Expanded view of
Scheduled Doses
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Navigator:
Provides a
list of other
options
within the
system
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Chart – Pharmacy Review Pending
by Census
Allows you to enter verbal orders
that are STAT medications. You
become the pharmacist!
This eliminates a safety check.
These are one-time meds only.
Subsequent doses should be
entered by Pharmacy
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RX Drug Inquiry
A rapid method of obtaining up to date information
about medications.
Updated quarterly from the National Drug
Databank, the Drug Inquiry data includes
indications, contraindications, side effects, drugdrug interactions, food-drug interactions, and
education monographs in English and Spanish
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Click on “Report” to
print the information
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Print MAR/IVAR if the patient is
going to a non-MAK area such as
surgery, MRI, Interventional
Radiology, etc.
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Click Navigator – Hide
Navigator to close this
column.
Click the Maximize icon to
restore your view to full
screen.
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1.
Override Barcode
2.
Rx Message
3.
Detail
4.
Not Admin – the med
will be eliminated
from this view.
•
Do not use if the
med is on hold or
the patient is off
the floor: eg.
Surgery.
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Use for meds that
will not be given
at all: eg. Digoxin
when the pulse is
<60.
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Administration Process
• Select the name of the patient
• Select the drug you are going to administer
• Scan the medication with the barcode scanner
• If four (drug, dose, time, route) of the five rights are met, the
medication line will change to green and a green check mark will
appear next to the medication
• Repeat for each medication you plan to administer at this time
• If any of the rights are violated, a red x will appear next to the
medication and the line will turn red
• Once all medications are correctly scanned, select the ID PATIENT
button (drugs may be scanned in the hall or at the bedside)
• Scan the case number on the patients armband. MAK will determine
if you are giving the meds to the right patient.
• If no errors are present, administer the medications
• Enter any additional required data
• Select CHART
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Click on the med –
black highlight appears
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Scan the med.
The correct med will be highlighted in
green and have a green check in the
column.
A “beep” does not mean that the scan is
correct! You must SEE THE SCREEN.
If a med won’t scan, click elsewhere on the
screen, then click back on the desired med
and scan, again.
The black highlight will automatically move
to the next med for scanning. Scan the
next med.
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The wrong med = Big Red X!
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Re-Highlight and scan the proper
med.
Some medications will elicit pop-ups
with extra information.
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Insulin requires another
nurse to look at your
dosing. If it is correct, scan
their badge.
Override if no other
licensed staff: eg. Santa FE
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You must click on
“ID Patient” next.
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Do what
it says!
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An incorrect scan
would show that
red X.
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Extra boxes appear at the top of the
screen.
The system will not let you proceed until
required data is entered. (yellow box)
The system will not allow you to
progress if these are empty.
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You MUST click
“Chart” for the
medication to be
documented.
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The medications
are now on the
Charted List.
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PRN
Medications
1. Highlight the med
2. Scan the med
3. Scan the ID band
4. Enter Data
5. Chart
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Don’t
forget
Chart!
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I forgot to enter
Pain Scale and
Pain Location!
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Enter Pain Scale number and
choose the location.
You may text in a limited
number of characters.
THEN Chart!
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Now a red star and 30
minute follow-up
reminder appear.
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Click on the red star,
fill in the blanks and
Chart.
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From the Charted List, you can Revise data,
time, etc.
You can, also, document Effect, Not Admin,
etc.
You can even give a Not Admin med from this
screen.
The Charted List is all powerful!
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Now there is History behind
the Insulin NPH-dose
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Click on the blue Hx
and scroll over to
see the change.
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Override!
Pharmacy
Review Pending
And
We’ll override
the meds!
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Calculate
Choose Route
Choose Site
Date and time
Chart Reason
ID Patient
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Override
options for ID
band.
And
CHART!
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These meds show up on the
DC’d list as “one time”
without a corresponding
order in the system.
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Charting “Not Admin”
This function is utilized to document medications
that have not been administered. Meds that will
not be given or a patient refusal of a medication
would fall into this category.
Select the correct medication
Select NOT ADMIN
Enter NOT ADMIN reason
Other medications or fields?
If NO, Select chart
If YES, Continue
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PRN Medication Administration
The primary difference in PRN medication administration is use of the ‘Reason’ field. For all PRN
medication administrations you are required to enter a reason. By combining the use of the vital
signs options and the drop down box under ‘Reason’, you can document most if not all of the vital
data we used to document in progress notes.
In this example, Tylenol was ordered for a temp > 101. Charting was accomplished on this page
by adding the patient’s temperature and by citing ‘Vital sign out of parameter’ reason.
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Charting a Follow-up
All PRN medications should have a follow-up. Users can access follow-up in one of three ways. From the
navigator you can select ‘Chart Follow-up Inquiry’ or from the Active Worklist, you can select the
medication. This will be flagged with a red star icon
. After selecting the medication, a window will
pop up prompting you for the required information.
Charting follow-up can be done voluntarily from the CHARTED MEDS folder. Select the medication
occurrence. Select ‘EFFECT’ from the bottom of the screen and document the follow-up. Remember to
chart the appropriate information. If you gave a medication for pain, your assessment should include a
pain score. Don’t forget to select ‘CHART’ when you are done.
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Miscellaneous
Scanning the barcode
Always attempt to scan the barcode before you assume it does not work.
A barcode that does not work one day may work the next. Pharmacy is working on a daily basis to correct
any barcode issues.
Before you override, click on another medication and then back on the one that you want. Rescan.
Replace the armband if it does not scan.
HIPPA
Do not walk away from a screen with patient information. You can minimize if someone is speaking to you
and you stay at the ‘cow’.
If you must walk away, LOG OFF!
End of shift
Review the ACTIVE WORKLIST to confirm that you do not have any uncharted medications or any
unverified orders.
Review the CHART FOLLOW-UP INQUIRY to ensure you do not have any uncharted follow-ups.
Log out!
Downtime
Planned vs. Unplanned: paper MAR’s can be printed by the clerks from other sources.
When downtime is over, meds will be charted as administered using the barcodes to override. The revise
reason and charted reason will be documented, also.
It is imperative that you CHANGE THE CHARTED DATE AND TIME!
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Medication
Unique Situations
MAK
Situation
Action
Sliding Scale Insulin
No insulin required
Heparin Drip
Insulin Drip
Change in rate required
-From the Charted List, select the bag
of heparin or insulin that is presently
hanging
-Choose Revise
-Leave the Charted date/time as is,
the revision time will appear in MAK
-Revise Reason, drop down box to
APTT= or CS= Enter the value
-Charted Reason, drop down box to
rate increased or decreased to and
enter new rate.
Any
First dose given on a non-MAK unit
-Document the dose as ADMIN
-In the reason field, chart “Given in a
non-MAK unit”
All
Home Medications
Patient is on isolation
Patient taking home medications
-Choose Insulin
-Chart as Not Admin
-Enter CS= in “Reason”
Field
-Scan medications outside the
room.Position the cart in the doorway
to provide line of sight. Scan the
patient’s armband. Once you leave
the patient’s room wipe down the
scanner with a germicide wipe.
-Nursing charts as ADMIN
-Enter Home Med Taken in reason91
field.
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MAK
Medication Administration Record
Discharge
11/05/2003 14:22
DISCHARGE MEDICATION ADMINISTRATION RECORD
Scott and White Memorial Hospital
PAGE: 1 OF 12
PATIENT NO: 1108513
NAME: DUCK, DAFFY
DSCH LOC: 006B/060801
MED REC NO: 103843
AGE: 51Y
SEX: M
ATN DOCTOR: FRANK, DONALD A
ADMIT DATE: 10/31/2003 DSCH DATE: 11/05/2003
*** MEDICATIONS CURRENT AT THE TIME OF DISCHARGE ***
*** SCHEDULED MEDICATIONS ***
ORD# 7
CEFTRIAXONE
1 GRAM(S) = 1 VIAL
(ROCEPHIN)
IV
Q24H
Q24H
RECONSTITUTE WITH 10 ML SWFI
AND INFUSE OVER 3-5 MINUTES
START: 11/04/03 16:00 STOP:
Nrs Verified By: JAW
11/04/03 16:00 NOTADMIN JAW at: 11/04/03 16:05
Charted Reason: Dc'd by MD
Medication, instructions, and
order number
Verification and
administration information
ORD# 7 (REVISED)
CEFTRIAXONE
1 GRAM(S) = 1 VIAL
(ROCEPHIN)
IV
Q24H
Q24H
RECONSTITUTE WITH 10 ML SWFI
AND INFUSE OVER 3-5 MINUTES
START: 11/04/03 16:00 STOP: 11/04/03 16:03
Nrs Verified By: JAW
**** NO OCCURRENCES CHARTED ****
ORD# 12
ATENOLOL
(TENORMIN (EQUIV))
25 MG = 1 TAB
PO
GIVE 25 MG STAT THEN 12.5 MG Q
Q 12 HOURS
START: 11/02/03 08:04
Nrs Verified By: WIJE
11/02/03 09:00 ADMIN WIJE at 11/02/03 09:13
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Medication Administration Record - Net Access
The browser enabled MAR is viewed through Net Access. Real time entries can be reviewed
including effectiveness and associated vital signs. The view of this MAR can be expanded to
the level of detail desired.
Moving the mouse to the date and left clicking will bring up only medications administered for
that day and provide greater detail. Moving the mouse over the drug and left clicking will bring
up detailed data for individual drug administration over multiple dates.
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Problem resolution
Question or Problem with
the System
*Type of Problem*
Application Charting or
use issues
Barcode
scanner
Battery charged?
Re-sync done?
Printing
problems
Medication questions
for the pharmacist
Notify Core Trainer if available
User ID- Password
issues
Call
Pharmacy
4-3815
If unable to resolve, Contact the Help Desk at 4-2501
Help Desk 4-2501
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•The Med Summary will LOCK orders
currently being Verified by another
nurse.
•Orders requiring Verification will be
locked.
•Another user can access the Active
Worklist and administer any meds that
have been Verified.
•Orders requiring Verification will only
LOCK if the nurse signing on has the
authority to verify orders.
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•The Active Worklist will LOCK orders
requiring Verification if currently opened by
another nurse.
•You can see the User ID of that other nurse
by moving the column border. Or you can
double click on the grey area and it brings up a
box with the user and the pc they are on.
•Any Verified meds can be administered while
another nurse is Verifying new orders.
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•If another nurse is currently
administering a medication on this
patient, it will be LOCKED.
•This will prevent two users from
giving the same medication.
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•The Charted List will LOCK to
prevent two users from revising the
same charted occurrence at the same
time.
•This will not prevent another user
from accessing the Med Summary to
verify orders.
The column border
can be mover over
more to display the
ID# of the computer
being used.
•This will not prevent another user
from accessing the Active Worklist to
administer medications.
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The Chart-Pharmacy Review Pending
function will not lock or error out .
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• MAK users must Log Off the system when
charting is completed.
•This will prevent
other users from
being locked out
unnecessarily!
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• MAK users must Log Off the system when
charting is completed.
•This will prevent
other users from
being locked out
unnecessarily!
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Computer Lab
•Take advantage of the lab time to
use the Test System.
•Make sure that your ID works.
and
•“Let’s be careful out there!”
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