Transcript Time of first dose for medication orders

Time of First Dose for Medication
Orders
Start Feb 17, 2010
Background
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Feedback from clinicians using eMAR that a
new order may start immediately
First dose is the pharmacy approval time,
which may not be the appropriate time to
start an order based on the frequency
Goal is to start the 1st dose of an medication
order on an appropriate schedule
Pilot
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First dose will not be tied to the approval time
but is based on the frequency of the order
and time pharmacist processes the order
8 frequencies to be piloted—Q AM, Q PM,
AC, AC and HS, Q AM before breakfast, Q
HS, Q PM before supper, BID AC (before
breakfast and supper)
Starts February Feb 17th
Q AM, Standard Medication
Administration Time (SMAT) is 8am
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Order approved between 00:01 and 08:00,
due today at 08:00
Order approved between 08:01 and 12:00,
due today, now
Order approved between 12:01 and 00:00,
due tomorrow at 08:00
Q PM, SMAT 20:00
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Order approved between 00:01 and 20:00,
due today at 20:00
Order approved 20:01 to 00:00, order due
now
Please click here to see time of 1st dose for
the select 8 frequencies—
Time of 1st dose for 8 frequencies
Change Orders
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Becomes a new order
If the next scheduled dose of the old order is
in the future, no action needed. 1st dose of
new order will be scheduled.
If next dose on THE old order is
due/overdue, then:
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Must document “not given” on old order
Allows new order to be documented
Example
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Order Change to Lasix 40 mg po Q AM from Lasix
20mg po Q AM
Approved at 07:45am and not given yet
Lasix 20mg po due at 0800am
New 40mg order removes the 20mg dose from the to
do list
Newly ordered 40mg dose is due at 08:00
*Note due time is the actual due time of 08:00 and does
not refer to the 2 hr window of 07:00 to 09:00
Same Example Different Approval Time
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Order Change to Lasix 40 mg po Q AM from
Lasix 20mg po Q AM.
Approved at 08:15am
20 mg Dose Due at 0800, not given yet
40 mg Dose Due now
Must document not given on 20mg dose
Administer and document 40mg dose
Click on next administration time to
see future administrations
Summary of Changes
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Pilot for 8 frequencies starts Feb 17
Based on time of approval and frequency, the system will
default the first dose of an order
If the order is a change order, then the first dose will be based
on the old order:
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If there is a dose due for the old order, this must be addressed
(i.e. document “not given”) and then give the new order
If there is no dose due for the old order, then no action needed
on old order. The 1st scheduled dose on the new order becomes
the next due dose.
To customize a schedule from the SMAT, you still need to
page the pharmacist.
Case study #1
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Patient admitted from ED to Wh 10 at 20:00.
Medication orders written at 21:00 and
approved by the RPh at 22:48 for the
following
NPH Insulin Human 20 units SC Q AM.
With this new function, when would the first
dose be due?
Answer to case study # 1
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System would default the first dose to 08:00
tomorrow and then 0800 every day.
Case Study #2
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Change order is as follows
Change to Warfarin 7.5 mg PO Q PM from
Warfarin 5mg PO Q PM. Order written at
13:00 and approved at 14:34.
With this new function, when would you
expect the 1st dose to be scheduled?
Answer to Case study #2
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A change order discontinues the old order
and starts the new order. This order would be
scheduled for 20:00 tonight.
Case study # 3
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Change to INSULIN GLARGINE (LANTUS) 20
UNITS SC QAM FROM INSULIN GLARGINE
(LANTUS ) 25 UNITS SC QAM
Ordered at 09:12 and approved at 10:03.
Med was given at 07:43. When would you expect
the 1st dose of the new order?
Answer to Case study #3
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Since today’s dose was already given on the
old order, the 1st dose for the new order will
be scheduled for tomorrow
Case study 4
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Change to INSULIN GLARGINE (LANTUS)
20 UNITS SC QAM FROM INSULIN
GLARGINE (LANTUS ) 25 UNITS SC QAM
Ordered at 07:12 and approved at 08:03
Patient has not received Lantus this am
What would you expect the nurse to
administer and document?
Answer to Case study #4
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The old order of Lantus 25 units was due at 08:00.
The new order of Lantus 20 units is due at 08:03.
Both medications appear on the To do list.
RN would have to document “not given” on the old
order of 25 units as once a dose is due in eMAR it
must be addressed (ie not given, etc)
RN would administer and document the 20 units