Transcript Med Safety - The IN Group

NPR REPORTS, RULES AND
MEDICATION SAFETY
by
Steven Botwinski, R.Ph.,
Yvonne Kimura, Pharm.D.
Hao Luu, Programmer
Bruce Matthias, R.Ph.
The IN Group, Inc.
February 18, 2009
Goals:
• Demonstrate how rules, NPR reports and
customer defined screens can be used to aid
in regulatory compliance
• Demonstrate how NPR reports can be used to
increase the efficiency of clinical monitoring
JCAHO National Patient Safety
Goal 2008
Goal 3E: Reduce the likelihood of patient harm
associated with the use of anticoagulation
therapy.
Anticoagulation monitoring
• Anticoagulation protocol
 Baseline INR required (order entrypharmacist)
 Administration current INR (eMAR-nurse)
 Clinical progress (daily rounds-pharmacist)
 Performance measures (pharmacy
director)
Anticoagulation monitoring Order entry
• Baseline INR required prior to starting warfarin
• Pharmacy rule for pop up screen to warn the
pharmacist that no baseline INR has been
ordered within 24 hours
Anticoagulation monitoring Medication administration
• The medication should not be administered if
the most recent (within 24 hours) INR is
outside the acceptable range.
• eMAR rule to warn the nurse that the INR is
outside the safe range
 Display INR value
 Require action and response
•
•
Anticoagulation monitoring Clinical monitoring
• Pharmacist monitoring patient progress
 Patient response to therapy
 Potential drug interactions
 Monitoring all anticoagulants
• Use scheduled NPR report
 Screen patients
 Pertinent data (lab trends, other meds)
Anticoagulation monitoring Performance measures
• Administrative report for all anticoagulant use
 Degree of compliance
 Institutional performance trends
 Detail for follow-up as needed
• Use NPR report
 Run for specific date range
 Use data from PHA, LAB, NUR, OE
 Include heparin, enoxaparin, argatroban
and warfarin) for baseline labs and
changing renal function if applicable
Black Box Warnings
Types of Black Box Warnings
• Intervention required at order entry
• Informational for nursing
• Intervention required during therapy
• Can be a combination of the above
Black Box Warnings Intervention at order entry
• PHA order entry
• Rule with pop-up screen
• Data used from other modules to prevent over
flagging (example: female, childbearing age,
pregnant? Yes, No, or information missing)
Black Box Warnings Informational for nursing
• Information in entirety can be placed in special
instructions to be viewed by nurse in eMAR
 Advantage: no need for external printer or
separate routine
 Disadvantage: requires extra keystroke to
seen entire text or RN may not notice it is
there
Black Box Warnings Intervention at administration
• Information in entirety can be placed in Rx
comments to be viewed by nurse in eMAR
 Full text seen on Acknowledge
 Drawback: requres extra key stroke to view
full text on first screen of eMAR
Black Box Warnings Intervention at administration
• Information in entirety can be placed in admin
criteria to be viewed by nurse in eMAR
 Will pop-up automatically for viewing in
eMAR with each administration and on
acknowledge (example: use for
quinolones)
 Other potential uses: look-alike, soundalike
Vaccine Administration
Vaccine Administration
Vaccine administration requirements
• Record lot number and expiration
• Provide patient with current vaccine
information sheet (VIS)
Vaccine Administration
• Create a CDS for eMAR
 Administration query to record lot number
and expiration
 Prompt “Vaccine Information Sheet Given?
 Automatic launch to CDC website to obtain
current VIS (www.immunize.org/vis)
www.immunize.org/vis/
www.cdc.gov/vaccines/pubs/vis/default.htm
Neonatal Dose Verification and
Documentation Witness
• Dose verification and preparation verification
by a second nurse
• Alleviate need to create a separate pediatric
drug formulary
• Audit trail for policy adherence / accountability
Neonatal Dose Verification and
Documentation Witness
eMAR cosignature as part of the prescription
audit trail is a great solution…. BUT
eMAR cosignature has been an all or none
phenomena once set up in the drug dictionary….
UNITIL NOW
Neonatal Dose Verification and
Documentation Witness
Set up eMAR rule
• If patient age is <30 days, require a
cosignature for verification of dose and
preparation
• Include the cosignature as part of the Rx
audit trail
• Attach the eMAR rule at the global
Customer Defined Parameter level