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 fluids using the type ahead look-up.

• Place a check mark next to the fluid you want to order

• Click Next to continue.

Search for IV Fluid by Name

• Select the volume you want to administer

• Note the OK is not lit

• Click on the blue edit to enter the rate

Select the Volume to Infuse

• Titrate defaults to No• Type in the rate• mls/hr defaults in the units field• Click OK > Save

Enter Rate and Units ml/hr

Order Sets

• 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

ED RN Protocols

• 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

Order Set View

• If you need an order that is not contained in the set click on Any Order

Any Order

• 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”

Any Order, continued

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

Footer Functions

EMR, PCS, & OM Routine Buttons

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

Schedule

Frequency

Trade Name

Rx Number

Give Field: How much of the dispensed dose to give.

Symbols: Addl Info

PRN ReasonMore about the Give Field on the next Slide…

MAR Symbols

Associated Data

Protocol

Drug Monograph

Co-

Signature

Assessment

Special Instructions

Titration

MAR Symbols: Clickable

• Clickable & Sortable: Symbols– Links– Co Signature– Titration

GIVE FIELD

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)

Ordered

Dispensed

Give

GIVE FIELD: Split Tab

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

GIVE FIELD

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

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

Medication Monograph

• Viewable

• Print-able

• English/Spanish

Order Detail

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

• Detail

– MAR Detail

• History

– Audit Trail

• Flowsheet

– Assessment Documentation

• Associated Data

– Related Queries, Labs, etc

• Protocol/Taper

– As Indicated

• Order Detail

– Audit

All of the info just covered, is viewable from the MAR Detail Tab

Questions on MAR Layout?

Next, topic: Acknowledging Meds

Two Methods to Ack Meds

1. RN Tracker

2. MAR

Acknowledging OrdersTwo 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, clickAcknowledge

• 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 MARTo 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

• 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)

Main MAR Order info

Scan List

MAR Medication Administration Screen

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?

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.

Number of days in the past to view schedules and admins

Number of days in the future to view schedules and admins

Number of days in the past to view complete schedules

Questions?Time to Practice!