McKesson Upgrade HED Education (Oct., 2013)

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McKesson Upgrade - ER 11/12
October, 2013
What is ER 11/12?
• ER is “Enterprise Release” and
11/12 is the software version. This
release will upgrade many parts of
the McKesson software used in
iCare EMR documentation. A few
of these changes will impact the
user while others will not be seen.
• Many of the changes in this upgrade
support our efforts to meet the
“meaningful use” guidelines.
Remember meaningful use goals
include using data in meaningful
ways to promote overall patient
safety and quality across the
continuum of care.
Education related to the ER 11/12 upgrade has been broken into modules.
You may be assigned more than one of these modules in HealthStream.
This module is related to changes in
eMAR, IV ADMINISTRATION, and
IV INTAKE DOCUMENTATION
This section is related to changes in
eMAR
Electronic MAR (eMAR)
The Electronic MAR (eMAR) is a “read only” view
that can be accessed through “Clinical Apps”
Go to Clinical Apps
Electronic MAR
The eMAR gives the ability to view:
• Medications (unchanged), IV fluids and medicated IV Drips (upgraded).
• Administered, Not Administered, Due, Overdue and Due in the Future medications.
• Medication details by hovering over the medication.
Clicking on administrations will take you directly to HED and
the Vitals/Meds/IO tab to administer medications.
• The eMAR can be utilized during hand off communication/report and is a quick and
easily readable view of the patient’s Medication Administration Record.
Electronic MAR (eMAR)
• REMEMBER: this is the new “read
only” view of medications, IV fluids
and medicated IV drips
• Continue on for a closer look
Electronic MAR (eMAR)
Click on the Legend
tab for an explanation
of symbols
Quick View: # of Active, Confirmed / Not
Confirmed, Overdue and Due Medications
Electronic MAR (eMAR)
Previous
Defaults to a 12 hr. view
but can be modified
Overdue
Not Given
Last Dose
Blue line
represents the
current time
Due
Due in the
Future
Electronic MAR (eMAR)
This medication has one dose that still needs to
be confirmed, one overdue dose, one dose due
Current Time
Medication order
information
Electronic MAR (eMAR)
Hovering over any blue button
(administration time) will give you
more detail
Medication location
can be viewed in the
order information
Clicking on the blue button will take
you to the Vitals/Meds/IO tab in HED
Click these buttons to scroll forward and backward through the eMAR
Electronic MAR (eMAR)
Administration bubble (enlarged view):
shows date and time of administration
Clicking on the bubble will take you to
HED  Vitals/Meds/IO tab.
Electronic MAR (eMAR)
Hovering over the
administration bubble
opens up a detail box
Dotted line = IV fluid/medication is
assumed to be running based on last
charting
Electronic MAR (eMAR)
* This dotted line should not be visible!
It indicates that the IV fluid/medication
has not been addressed *
Rate at which
IV medication
is running
IV Stopped
IV Started
Solid line = IV
fluid/medication is
running
This section is related to changes in
IV Administration
IV Administration
The most noticeable change:
“IV Admin” will no longer be used for IV Documentation
IV Administration will now be done through HED  Vitals/Meds/IO tab  IV fluids
The next few slides will show basic IV fluid administration.
The patient has IV fluid ordered: Normal Saline at 40 ml/hr.
Obtain the Normal Saline bag and tubing and enter the patient’s room.
Let’s hang the primary IV fluid.
STEPS FOR BASIC IV ADMINISTRATION
 Scan the patient’s wristband to ensure that documentation of the IV
administration is completed on the correct patient.
 Click on “Chart”, “Launch HED” and the “Vitals/Meds/IO” tab.
 Scan the IV fluid barcode.
Launch HED and
the Vitals/Meds/IO
tab
IV fluids are now
administered here. Review
the rate and select a site

Review the Physician order in HEO and program the IV Pump.
If everything is correct, scan the patient and then scan yourself.

Enter patient identifier per hospital policy.

Be sure to program the IV bag as
a primary infusion in the Alaris
pump. This is very important for
accurate I&O which will be
discussed later in this module.
The IV administration is recorded in
HED  Vitals/Meds/IO tab  IV fluids
0 = Volume infused
S= Started
Administering a Medicated Drip
Medicated drips are now documented in
HED  Vitals/Meds/IO tab  IV Med Drips
STEPS FOR ADMINISTERING A MEDICATED DRIP
The patient has an order for a Dopamine drip.
 Scan the patient’s wristband to ensure that documentation of the
IV administration is completed on the correct patient.
 Click on “Chart”, “Launch HED” and the “Vitals/Meds/IO” tab.
 Scan the medicated IV fluid barcode.

Medicated drips are now administered here
Launch HED and the
Vitals/Meds/IO tab
• Review/enter the rate or dose and select
a site
• When administering weight based
medications, if the patient’s documented
weight changes, the system will
automatically recalculate the rate
accordingly
12.75
STEPS TO FINISH THE ADMINISTRATION DOCUMENTATION
 Review the administration detail.
 If everything is correct, scan your patient and then scan yourself.
Record Med Drips
When infusing a Medicated Drip, there is now a “Record Med Drips” button.
This feature will assist you with documenting the current Medicated Drip rate.
•
•
•
•
Under IV Fluids, click “Admin”.
Review the rate and if correct click “Record Med Drips” button.
The IV rate will be documented.
Goes automatically to the Review Screen. Scan yourself.
You can record/document the
rate at which your drip is
running by using the “Record
Med Drips” button
Record Med Drips
The rate is then charted under IV Med Drips for that time.
Proper documentation of IV solutions
allows ProMedica to receive higher levels of
reimbursement for provision of care.
The Upgrade makes it much easier to document completely on all IV infusions:
• Begin time will continue to be automatically entered when solution is scanned.
• Documentation must now show the “end time” for the IV and IVPB infusions.
• Whenever a new bag is hung, always be sure that all previous bags have
been “ended” in the documentation. By not “ending” a solution, the
documentation looks as if the administration of that fluid has never ended.
IV solutions will now show up on the Care Organizer with the Medications so it will be
much easier to recognize a bag that needs to be ended.
This section is related to changes in
IV INTAKE DOCUMENTATION
Think about IV Intake in TWO DIFFERENT ways
Primary solutions
• Plain and Medicated Solutions
infused as Primary solutions on
the Alaris Pumps will continue to
be documented by the nurse as
a manual entry.
• It will be VERY important to
CLEAR the pump each time a
volume reading is recorded.
Secondary solutions
• Intermittent solutions (IVPB) will not be documented
from pump volumes.
• There are TWO ways to document secondary solutions
INTAKE.
1. Premixed solutions from Pharmacy have a patient
specific label that includes information on rate and
volume. These will SCAN into the system and will
“AUTO-POPULATE” the intake documentation.
2. Intake from ADD-Vantage and Mini-Bag Plus
solutions must be manually entered into the
Intake documentation fields.
Administering a Pre-Mixed IVPB
When administering any IVPB’s
a START and STOP time MUST be charted.
STEPS FOR PRE-MIXED IVPB ADMINISTRATION:
An order has been entered for Cefazolin 2gm IVPB every 8 hours.
 Scan the patient’s wristband to ensure that documentation of the
IV administration is completed on the correct patient.
 Click on “Chart”  Launch HED  “Vitals/Meds/IO” tab.
 Scan the med.

(This process is continued on the next few slides.)
REMEMBER: Program the IVPB medication as a
secondary infusion in the Alaris pump
• Infusing an IVPB as a secondary
solution will keep the IVPB
volume out of the total volume for
the primary solution.
• IF infusing an IVPB as a primary
solution, this volume MUST be
subtracted from the total primary
infusion volume when I&O’s are
completed.
The Projected End Time and Volume only auto populates for
premixed IVPB’s and IVPB’s prepared by Pharmacy
A volume and projected end
time will auto populate
STEPS TO FINISH THE ADMINISTRATION PROCESS:
 Scan your patient again.
 Review the administration. If correct, scan yourself.
 The IVPB administration is recorded in HED  Vitals/Meds/IO tab  All Meds
 The slide below depicts the IVPB Medication administration status as “In
Progress”.
Administration status
is “In Progress”
when in review mode
under “All Meds”
It is REQUIRED for reimbursement
to “end” the antibiotic administration in the “All Meds” Section
when the IVPB solution has infused.
 Scan the patient to verify charting is on the correct patient.
 Choose HED  Vitals/Meds/IO tab  All Meds  Admin.
 Select the “In Progress” IVPB that needs “ended”.
 Click end and edit the date and time as needed.
 Scan yourself to save the ended IVPB administration.
• Click end
• Verify the correct
fluid volume
• The projected end time will
populate, not the charting time
• Review for accuracy before saving
The volume for IVPB’s that are diluted by pharmacy or premixed
will automatically be recorded in the I & O section
After IVPB is “ended”:
•
The IVPB’s status is no
longer “In Progress” and
•
The fluid volume has been
recorded under intake
Administering an IVPB reconstituted by the Nurse:
ADD-Vantage and Mini Bag Plus
When administering any IVPB’s
a START and STOP time MUST be charted.
STEPS FOR ADD-VANTAGE AND MINI BAG PLUS IVPB ADMINISTRATION:
An order has been entered for Piperacillin 2.25gm IVPB over 4 hours.
 Scan the patient’s wristband to ensure that documentation of the IV administration
is completed on the correct patient.
 Click on “Chart”  Launch HED  “Vitals/Meds/IO” tab.
 Scan the med.

(This process is continued on the next few slides.)
REMEMBER: Program the IVPB medication as a
secondary infusion in the Alaris pump
• Infusing an IVPB as a secondary
solution will keep the IVPB
volume out of the total volume for
the primary solution.
• IF infusing an IVPB as a primary
solution, this volume MUST be
subtracted from the total primary
infusion volume when I&O’s are
completed.
The Volume does not auto-populate
for ADD-Vantage and Mini Bag Plus.
Projected End Time may auto-populate.
***IMPORTANT***
IVPB medications that are reconstituted
by the nurse (i.e. ADD-Vantage vials, Mini
Bag Plus) will NOT auto populate volumes
(and in some cases projected end times)
**Important**
AGAIN: No Volume will be
present here and a projected
end time may also not be
present
Add volume here
at the time of
administration
Failure to enter the volume infused
will trigger an override prompt:
If no volume is entered an
override reason is
required
Ending an ADD-Vantage or Mini Bag Plus
DO NOT alter this field!!
Doing so will change your medication dose!!!
• Click End
• Edit the date and time as needed
• Scan yourself to save the end time
Interrupted IVPB Administrations



The patient’s IV becomes infiltrated during
IVPB administration.
It takes 1 hour to get a new IV started, making
the administration end time 1 hour later than
projected.
Charting must reflect the accurate infusion end
time, but must also reflect the delay of one
hour.
• Mark as significant so that
reviewers are alerted to
delay infusion.
• Verify the end time is correct
• Enter a sticky note
explaining the delay when
ending the infusion
Zero Order IVPB’s
 Administering medications before they are profiled by pharmacy is highly discouraged, but
necessary in emergency situations or in certain units or facilities.
 These medications may not include volumes and will never include a projected end time.
Zero orders will not have projected end
times and may or may not include
volumes
Primary IV solution intake is now entered in
HED  Vitals/Meds/IO tab  IV Fluids  Admin
Intake Documentation of an Infusing Solution
 Check the IV pump for primary volume.
 Press Volume infused.
 Press PRI/SEC Volume button.
300
300
Make sure to clear the pump EVERY TIME you enter I&Os.
• Do Not Use “Calc” button!
• Enter the primary volume from your pump.
• Click Save.
• If everything is correct, scan yourself.
•
Enter the amount of primary fluid from
the pump
•
Once entered the remaining volume will
calculate automatically
• This is an anticipated
volume and is not accurate
• Use ONLY the pump volume
There is an order to end the Normal Saline IV
 Open IV Fluids Administration by going to HED  Vitals/Meds/IO IV fluids Admin.
 Enter Volume infused from the pump.
 Don’t forget to clear the pump EVERY TIME IV intake is entered.
Ending a Primary solution  Intake Documentation
 Change Hanging to Ended.
 Click Save and then scan yourself if everything is correct.
 The bag will be charted as Ended and the entered “volume infused” will automatically be
recorded into Intake. Don’t double enter.
300 = Volume
E = Ended
To Summarize:
 Proper documentation of IV and IVPB qualifies for higher reimbursement rates.
 Do not forget:
 The eMAR is a read-only view that provides important information during
hand-off communication.
 IV Admin will no longer be used for IV Documentation.
 Premixed and pharmacy IVPB will auto populate with projected end time and
volume infused amount, whereas Add-Vantage and Mini Bag Plus will not.
 IF infusing an IVPB as a primary solution, this volume MUST be
subtracted from the total primary infusion volume when I&O’s are
completed.
 When ending an IV infusion, click on the “end” box prior to hanging a new IV.
 Clearing the IV pump helps ensure complete and accurate I & O.
Thank you for the great care you provide
our patients every day!
Please direct questions regarding the McKesson
Enterprise Release 11/12 Upgrade to your facility’s
Hospital IT Support.
This education was created in collaboration with Clinical IT, Nursing Leadership, and the
ProMedica Center of Nursing Excellence in support of the ProMedica System-Wide
Standardization Initiative.

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