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
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Titrate defaults to No
Type in the rate
mls/hr defaults in the units field
Click OK > Save
Order Sets
ED RN Protocols
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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
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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
EMR, PCS, & OM Routine Buttons
Inclusion Criteria
MAR Headers
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
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Active
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Discontinued
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Order is active and available to administer
Order has been discontinued
Canceled
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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
Titration
Drug
Monograph
Special Instructions
Assessment
Protocol
Co-
Signature
MAR Symbols: Clickable
• Clickable & Sortable: Symbols
– Links
– Co Signature
– Titration
GIVE FIELD
Ordered
Give
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
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
Includes Many Tabs of Order Information
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
All of the info just covered, is viewable from the MAR Detail Tab
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
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. Click on the red Unacknowledged status
2. 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
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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
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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
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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
The field by which
the MAR will sort
Number of days after
the med has been
discontinued that you
can select to view.
Number of days in the past to
view complete schedules
Number of days in the
future to view schedules
and admins
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.
Questions?
Time to Practice!