7. STW RN Session II

Report
Meditech 6.0 Upgrade
RN MedSurg and ICU
Session II
Session II Agenda
• MAR/BMV Documentation
• Daily Documentation
• Reports
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• Kardex
• Patient Passport
Medication Reconciliation Process
Home Medication Entry
Vaccine Documentation
Process Review Exercises
• Admission
• Inpatient Transfer/Hand Off
• Discharge
• Home
• Home with Services
• Transfer to SNF
• Downtime
• Go LIVE
eMAR/BMV General Info
• Acronyms
– eMAR: Electronic Medication Administration Record
– BMV: Bedside Medication Verification
• Scan Patient
• Scan Medication
• Verify 5 Rights of Med Administration
• Functions
– View Scheduled Administrations
– View Orders and Dose Instructions
– Document Med Administration
• Expected Outcome
– Reduction in Medication Administration Errors
– Improved Completeness of Documentation
– Improved Safety
MAR Overview/Acknowledge review
MAR Overview/Acknowledge review
• Explain
MAR Layout: 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: Flags when certain medications are approaching their renewal date/time
• Med Review: Will not be utilized
• Schedule Comment: Enter a comment for a medication schedule
Medication Detail Panel
Includes Many Tabs of Order Information
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
Medication Detail: History Tab
Order Information
Audit Trail Line
Items
Audit Trail Detail
Medication Detail: Flowsheet Tab
Flowsheet Documentation associated to the particular 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
Acknowledging Orders
Acknowledging Orders
Two places to Acknowledge Med Orders
• MAR Ack Routine
• Status Board Ack Routine
Acknowleding Orders from the Status
Board will Auto - Ack on the MAR!
Status Board Acknowledgement Routine
• Preferred Method of Acknowledging Meds
– Enables Acknowledging multiple meds at one time
– Review Order Detail Screen in less clicks
Status Board Acknowledgement Routine
Order Detail
1. Click Each Order to review the order detail
2. Click Acknowledge
3. Save
MAR Acknowledgement Routine
Acknowledged
Orders Acknowledged from the status board will be
acknowledged on the MAR
MAR Acknowledgment Routine
To Ack from the MAR you will 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
MAR Acknowledgement Process
Review all
items of the
medication
detail screen
MAR Acknowledgement Process
1. Click on the red Unacknowledged status
2. Select Acknowledge Order
Reject Acknowledgement
• If a medication order is incorrect, reject the order
• Place a phone call to pharmacy
• Acknowledgement may be edited as needed
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
From Status Board (ACK Routine)
• All information on one screen
• Five Rights
• Order Audit
Warning: Never ACK Upon Admin
• Admin before ACK: “Medication has not be
acknowledged”
• Click Cancel and Review Order Detail!
• Never select Acknowledge and Document
– You will not be presented with enough info
Exercise: Acknowledge from the Status Board
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Use the patient from your scan sheet
Click [Lists]
Select [Find Account]
Type Last Name, First Name
Add the Patient to your My List
From the status board click the ACK field
Find the Furosemide Order
Place a checkmark next to the Furosemide
Review the Order Detail
– Who entered the order?
– What time was the order entered?
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Once you feel comfortable with the information click acknowledge
Click Save
Click Return to the Status Board
Scan the Patient’s Wristband
Enter your Pin
Confirm that the Furosemide has been acknowledged on the MAR
BMV Scanning
BMV: Scanning
• Scanning the barcode will Automatically Locate the
Medication on the eMAR
• Multiple Medications can be Scanned and
Administered Before Saving Documentation
• Technique:
– Position scanner near the barcode
– Slowly move the scanner away from the barcode, and close
again until beep is heard
– View screen for confirmation
• If the Wrong Patient is Scanned, you will be alerted
that the account number is incorrect
• You will not be able to scan medications until the
patient’s wristband has been scanned
Exercise: Acknowledge Meds/Basic Admin
• Confirm the Header Displays “Verified”
– This indicates you have scanned the wristband
• Scan the Lasix (Furosemide) Barcode
– Confirm a barcode displays in the Medication Cell
– Confirm the admin date/time and barcode displays in the
admin time field
• Click Ok to Proceed to the Summary Screen
• From the Summary Screen review the admin
information
• Click Save
• Confirm that the Administration Date/Time displays
in black text, indicating the admin has saved to the
MAR
Administration Documentation Process
Administration Process Review
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Scan Patient’s Wristband
Scan Medication barcode
Review & Update Med Administration screen
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Review Med Protocol Information
Date/Time of Admin
Dose
Admin Comments
Assessment
Click Ok on the Admin Screen
Click Ok on the MAR to proceed to summary screen
Review summary screen for accuracy and click save
when complete
MAR Admin
Step 1: Scan Patient & Medication
• Scan Wristband
• Scan Medication
MAR Admin
Step 2: Review/Document Admin Screen
• Review & Update the Admin Screen
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Ordered dose and scanned dose
Schedule Date
Administered Dose in mg
This information can be edited as needed
• Once you have confirmed this documentation is accurate, click Ok
MAR Admin
Step 3: Review MAR
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Once you click Ok from the admin screen, you are brought back to the MAR
The Admin Date updates the Admin Cell in Green Text (Green = Pencil)
– Admin has been documented but has not yet saved to the record
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You may scan multiple medications at one time
Proceed to Summary Screen
– Document another med admin
– Proceed to the summary screen to review and save
MAR Admin
Step 4: Review Summary Screen
• Med Admin Summary Screen
• Review Admin Documentation before saving
• Confirm documentation is correct
– Click back to edit the administration
– Click save to save this to the EMR
MAR Admin
Step 5: Save the Administration
• Once the admin has been saved it will display in black text
• This confirms the administration has saved to the EMR
Administration Screen Details
MAR Administration Screen
Main MAR
Order info
Scan List
• Once the Medication is scanned, you are launched into the Admin Screen
• Medication Administration Screen
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Scan List
Admin List
Flowsheet
Protocol/Taper
Associated data
Monograph
Links
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 med was given
• Edit to Back Document
Dose:
Amount of med given
Edit to adjust the
administered dose
Medication Administration Screen
• Flowsheet Tab
– Order Info
– Scanning Detail
– Administration Assessment
Medication Administration Screen
• Drug Monograph Tab
– Order Info
– Scan Detail
– Monograph
Medication Scenarios
Split Meds
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Dose Dispensed: 10 mg tab
Dose Ordered: 15 mg
Split one tab
Administer 1.5 tabs
Split Medication
• Scanning the first tab will launch the administration screen
• Next, scan the second tab
Split Medication
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Now, the medication scanned is larger than the ordered dose
Split the second tab
And, edit the Administered dose to reflect the dose given to the patient
Meditech restricts the ability to save a dose greater than what is ordered
Split Medication
• Now the ordered dose matches the scanned dose
• Once you have confirmed the information, click Ok
Exercise: Split Medications
• Document the Lisinopril Administration
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Scan the patient’s wristband
Scan the first 10 mg tab of Lisinopril
Review the administration screen
Scan the second 10 mg tab of Lisinopril
Attempt to save
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Notice you are prevented from saving a dose greater than what is
ordered
Split the Medication
Edit the Administered dose to 15 mg
Click Ok
From the MAR Click Ok to proceed to the summary screen
Review the information on the summary screen and click
save
Bulk Meds
• Examples of Bulk items
– Creams
– Ointments
– Inhalers
– Eye drops
– Insulin (without a scheduled dose such as sliding
scale)
• The bulk items will require you to enter the
number of…..
– Applications, puffs, drops, units, etc.
Bulk Medication
• Timoptic 5 % Opth Soln (Timolol)
– Bulk Med
– Dose Instructions Indicate Dose and Units
– Dose and Units will be entered on the Admin Screen
Bulk Medication
• Indicate the Dose and Units for the first administration
• For Each Admin moving forward, the units will default
Bulk Medication
• Click Ok from Admin Screen
• Click Ok from MAR
• Click Save from Summary Screen
Exercise: Bulk Medications
• Document the Timolol Administration
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Scan the patient’s wristband
Scan the Timolol
Review the administration screen
Document the Dose
Document the Units
Click Ok from the Admin Screen
From the MAR Click Ok to proceed to the summary
screen
– Review the information on the summary screen and
click save
One Time Meds
• Once ONE = One time Med
• Medication will automatically discontinue once
the administration is documented
• Discontinued Meds fall to the bottom of the MAR
and display for 24 hours
One Time Medication
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Admin screen automatically launches the flowsheet/MAR Assessment
IV Medications require that the injection location is documented
Some Meds display Associated data
– Reviewed prior to administration
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Click Ok
From the MAR click Ok to proceed to the summary screen
Save
One Time Medication
• Once the med is documented, it auto discontinues and falls to the bottom
of the MAR
• Yellow = Discontinued
• Discontinued meds default to display for 24 hours
• Discontinued meds can be edited as needed
Multi Component
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Medications compounded in the pharmacy
Each component will be scanned separately
Verifies correct medications have been added
Scanning the first barcode will launch the admin
screen
Multi Component Med
• Notice the Cefazolin has been scanned
• Next, scan the Sodium Chloride
Multi Component Med
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Both Medications have been scanned
Confirm the information is accurate
Click Ok
From the MAR Click Ok
Then, click save from the summary screen
Exercise: Multi Component Medications
• Document the Cefazolin Administration
– Scan the patient’s wristband
– Scan the Cefazolin
– Review the administration screen
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Confirm a barcode displays with the Cefazolin
– Scan the Sodium Chloride
– Click Ok from the Admin Screen
– From the MAR Click Ok to proceed to the summary
screen
– Review the information on the summary screen and
click save
Patches
• Patch administrations will be documented on the MAR
• Utilize MAR Assessment to document:
– Location
– Removal of previous patch
– Application of New Patch
Exercise: Patch Admin
• Document Nicotine Patch Removal and Application
– Scan Patient’s wristband
– Scan Medication
– Document that you are removing previous patch and
applying a new patch to the left arm
– Click Ok
– From the MAR click Ok to proceed to summary screen
– Save the administration from the summary screen
Override Medications
• Override: Medication pulled from the
Pyxis/Accudose prior to the MD has entered
the order
• When the medication is pulled via Override
the medication will automatically flow to the
MAR
Override (.STK-MED ONE) Orders
• Override Orders are NOT Entered by the MD and
are NOT verified by Pharmacy
• Override (.STK-MED ONE) Orders display the dose
dispensed NOT the dose ordered
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Override Documentation Process
• Pull a STAT Override (before MD Order is entered)
• .STK-MED ONE Order is generated on the MAR
• Document the administration
– Scan Patient’s Wristband & Medication
– Adjust the dose as necessary to match dose ordered
– Save Administration
• Once the physician order is entered, reconcile the
scheduled time
– Document the first scheduled date/time as a Non
Administration
• Reason: Administered on override Rx
Overrides
• Displays the dose dispensed
– NOT the dose ordered
– Adjust the dose appropriately when administering
• One time order
– Automatically discontinued once admin is documented
– Next, MD will Enters the Order to justify the override
– MD Order admin time will be reconciled
– Documented as Non Administration/Administered on
Override RX
Exercise: Override Med
• Scenario
– You receive a stat order for Morphine 2 mg IV
– You pull a 4 mg IV vial
• Scan patient
• Scan Medication: Morphine 4 mg IV .STK MED-ONE
• Select the Pyxis override Morphine order (STK MED ONCE)
– In an actual scenario, you will not see the second (MD) order yet.
• Note that you removed Morphine 4 mg/ml via IM, but the order is
to give Morphine 2 mg IV
• Click on the dose to adjust the dose to 2 mg.
• Document the correct route on the assessment that appears
• Save
• Note the order turns yellow and drops to the bottom in a
discontinued status
Override Exercise: Reconcile MD Order
• Step 2: The MD has now entered the order in CPOE
• Reconcile the scheduled time as a non
administration
– Remember: This Medication Administration was already
documented on the Override RX
– Scanning will not be required here
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Highlight the 2nd Morphine order
Click “Non Admin.”
Choose Reason of “Administered on override RX.”
Save
Renewal Reminder
• Certain medications will flag for renewal
– IV Medications after 24 hours
• Reminder that the Medication is approaching it’s discontinue date/time
– A message will display upon entering the MAR
– The Renew button on the MAR will display in Red
Renewal Reminder
• The Renewal SCH/FREQ tab will flag in red if a
medication is due for renewal
MAR Functions Overview
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Edit
Undo
Non Administer
Co-Sign
Edit and Undo - Detail Tab
• Detail screen will provide the ability to edit
and undo medication administration
documentation
Medication Detail – History Tab
• Audit trail of changes made to the medication
– Acknowledgement
– Administration
– Edit/Undo Activity
• Edit/Undo Functions Available
Edit Screen
• Select the fields you wish to edit
Edit Screen
• Here, the administration time is edited and a
comment is documented
Edit – History Tab
• History displays a new edit line item with the old and new
values
• Green = Pencil
• Click Save to Save the edited documentation to the EMR
Editing Medication Documentation
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Select Furosemide
Click Detail
Find the last documented adminstration
Click Edit
Change the time of administration
Enter a new comment
Click Ok
Review the old and new value
Click Save
Undo Medication Documentation
• History screen allows you to undo documentation
Undo Medication Documentation
• A new undo line item will display
• Green = Pencil
• Click Save to save the undo to the EMR
Undo Medication Documentation
• The administration time now displays as overdue
• It is important to reconcile all scheduled admin times
Non Administration
• If a medication will not be administered, this will be
indicated with a non administration reason
• Click on the scheduled date/time and select not given
Non Administration
• Select a Non-Admin Reason
• Click Ok from the MAR to proceed to the summary screen
• Then Click Save
Exercise: Undo
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Click the Timolol
Click the Detail Function
Select the last documented administration
Click Undo
Select a Reason for Undo
Click Save
Confirm the Administration time appears on the
MAR as overdue
Exercise: Non Administer
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Click the Timolol Overdue Scheduled Time
Select Not Given
Select a Reason
Click Ok
Review the Summary Screen
Then click save
Edit/Undo – Via Admin Cell
• Edit & Undo Functions are available from the admin
cell drop down menu
• Click the Admin Date and Time, and select the
function as needed
Bedside Glucose & Insulin Admin
Blood Glucose Assessment
• Bedside Glucose Results are documented manually on the worklist
• Blood Glucose Assessment will be used to document
• This will be added to the worklist via the individualized focus of care
Problems
– Altered Glucose Metabolism
– High Risk: Altered Glucose Metabolism
Bedside Glucose Documentation
• Blood Glucose Assessment is associated to the
Altered Glucose Metabolism Problem
Co Signing Medication Documentation
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Some Medications will require a co signature (High Risk Meds ie Insulin, Heparin)
Co Signature is ONLY required when administering med (if med is not given, co signature is
not required)
Co Sign Requirement is indicated by the double pen symbol in the Medication Cell
The co-signer should witness the admin
– Co Signer Enters Name & Pin
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Click OK
Exercise: Beside Glucose, Insulin & Co-Signature
• Document the glucometer results on the worklist
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Click Worklist
Locate the Bedside Blood Glucose Assessment
Place a Checkmark in the now column
Click Document
Document the Glucose Result
Save
• Navigate to the MAR
• Document Insulin Administration
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Work in pairs and alternate witnessing the admin/co-signing
Scan the patient’s wristband
Scan the Insulin Barcode
Review associated data
Document MAR Assessment
Click Ok
Obtain Co - Signature
Save
Back Documentation
• In the (rare) and emergent event that you are unable to document a med
admin at the time the medication is given, you may back document
• Scan the patient and Scan the med (if you saved the label)
• On the Admin Screen Change the Admin date to the date the med was
given
Back Documentation
• Change the Admin Date
• You may also document an admin comment to explain why the
medication was not documented at the time of administration
Pain Med: Pain Assessment/Re Assessment
• The pain assessment will be documented for all pain meds
• Scanning the med will launch you to the flowsheet to completed documentation
• Past Pain Assessment Documentation will display from
– MAR Assessment
– Intervention Worklist Documentation
• Assess the patient’s pain
• Once the assessment is saved, a re-assessment will be triggered to be completed
60 minutes after the med administration time
Pain Med: Pain Assessment/Re Assessment
• Click Ok
• From the MAR click OK to Proceed to the summary
screen
• Save the Med Administration
Pain Re Assessment
• The administration now displays with the accurate
time the med was given
• Also, a pain assessment is now due
Status Board: Pain Re-Assessment Reminder
• Status board Next Med cell displays upcoming med
times
– Includes Re Assessment Reminders
• <Assess-Pai> Acetaminophen 650 PO Q4H PRN: Indicates the
Pain Re Assessment is due for the Rx Associated
– Click Go To MAR to launch the MAR for this Patient
Pain Re Assessment
• To document the pain re assessment, click on the
scheduled time and select to document.
Exercise: Back Documentation
1. Back document the Tylenol
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Scan the Patient’s Wristband
Scan the Medication Barcode
Document the Initial Pain Assessment
Click the Admin Screen
Change the Admin Time to one hour in the past
Document a comment to explain why you are back
documenting
Click Ok
From the MAR, click ok to proceed to the summary screen
Review the summary screen
Click Save
2. Navigate to the Status Board
3. Click the Next Med Field for this patient
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Confirm the Pain Re Assessment Is Due
4. Click [Go to MAR]
Exercise: Pain Re Assessment
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Click the Status Board Button
Click in the Next Medication Due field
Notice the <Pai Assessment> displays
Click Go to MAR
Enter your PIN
Document the Pain Re Assessment
– Click on the scheduled time for the <Assess> Line
– Select Document
– Document the Pain Assessment
– Click Save
Break
(PCA/Epidural)
• This MAR Assessment will be associated for PCA
and Epidural Meds
PCA/Epidural Assessment
• Add PCA/Epidural Assessment to the worklist
• Document pain, settings and assessment of the
effect
Exercise: PCA MAR Admin & Assessment
• Document the Morphine PCA Admin on the MAR
• Add the PCA/Epidural Assessment to the worklist
– Save
• Document the PCA Assessment
– Pain
– Assessment
– Settings
– Save
Titrations Overview
• Titrations will be documented on the MAR
• This is indicated by the word TITRATE and the IV
Pole Symbol
• Titrations are documented as unscheduled
administrations
Titrations
• Scan Patient’s Wristband
• Scan Medication Barcode
• You will receive this message:
– “No Scheduled Administrations Exist. Do an unscheduled administration
instead?”
– Click Yes
Titration – Administration Screen
• On the initial administration screen document the rate
• Based upon the order/protocol, enter the dose into your smart pump to calculate
the initial rate
• Enter this rate into the Meditech admin screen
• Click Ok
Titration - Flowsheet
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Once you enter the rate, you will launch the admin screen – flowsheet tab
Review the associated data information
The rate will default into the flowsheet from your initial administration
Next, document the dose
Click Ok
From the MAR, click ok to proceed to the summary screen
Then, click save
Titration
• Your Flowsheet documentation will update the
current dose field on the MAR
Documenting Dose Changes
• To launch the Titration flowsheet to document dose
changes click the IV Pole symbol from the MAR
ICU Flowsheet & Titrations Slide
• Upon launching the flowsheet you will document the dose and rate
• Click insert column to document multiple columns of documentation for
frequent rate changes
Clinical Panel: ICU Flowsheet & Titrations
• Displays pertinent clinical data with the titration
data to be viewed and trended
Exercise: Titration
• Document Dopamine
– Scan the Patient’s Wristband
– Scan the Dopamine Barcode
– You will be presented with a message:
• “No Scheduled Administrations Exist. Do an unscheduled administration
instead?”
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Click Yes
From the Initial Administration screen document the rate: 1 ml/hr
Click Ok
You will default to the Protocol Tab review this information
Then, click the flowsheet
Confirm the rate is correct
Document the dose
Click Ok
From the MAR click OK to proceed to the summary screen
Then click save
Confirm that the medication order cell has updated with the new rate
INSULIN Ordering and Hypoglycemic Protocol
Order Set CPOE
Insulin finger stick Protocols
Pharmacy
e-MAR
Scheduled Insulin will be ordered via the CPOE order
set “Insulin orders & Hypoglycemia”
In addition to the Glucose test, fingerstick protocol and the
insulins, the Order set has the hypoglycemia management prechecked and has the approved sliding scales pre-built.
Scheduled Insulin orders will include Blood
Glucose order and a Fingerstick Protocol
Blood Glucose frequency should match the protocol. (ACHS or Q6H)
Fingerstick Protocol #1
• ACHS (pre meals and 2200 [within 15 minutes of meals]); give correction
dose insulin AC (*Preferred for most patients*) If Blood Glucose greater
than 250 mg/dl @ 2200; give one half dose of insulin from Insulin
Correction Protocol
Fingerstick Protocol #2
• ACHS (pre meals and 2200 [within 15 minutes of meals]); give correction
dose insulin AC
• Do not administer any short-acting insulin at 2200; if blood glucose
greater than 350 mg/dl call MD
Fingerstick Protocol #3
• Every 6 hours (0600; 1200; 1800; 2400) and give correction dose insulin
every 6 hours (0600; 1200; 1800; 2400) (Appropriate for patients who are
NPO or on continuous feeds i.e. TPN, tube feeds)
The Fingerstick Glucose test is pre-checked and the prescriber
will enter the Finger Stick times based on the protocol they want
used: QID or Q6H
IF the prescriber does not select a protocol the RN will need to
follow up with the prescriber and enter the finger stick protocol
via CPOE. The insulin fingerstick protocol can be found under
New Meds by typing in insulin…
User can select the Fingerstick protocol
and submit, or edit IF required.
The fingerstick protocol will be defaulted in
the label comments
e-MAR view of the Insulin Sliding Scale, Fingerstick protocol
should be on the e-MAR and linked to the insulin sliding scale.
To document administration RN should scan patient, scan the
insulin, then…
The e-MAR will display linked sliding scale to fingerstick order.
Times should match, check linked administration to document
both insulin and fingerstick concurrently.
Both insulin administration and fingerstick are
documented concurrently if link is utilized
e-MAR Administration Summary should
include Insulin and fingerstick
Additional MAR Scenarios
• Meds with Same Barcode
• Less Than/More Than Ordered Dose
• Manual Administrations
Meds w/ Same Barcode
• If there are multiple meds with the same barcode you will be presented with the
MAR
Multi Match Screen
• From this screen you will select the order that you wish to administer against
• Examples
– Active Order and Discontinued Order
– Pyxis Override Order and Active MD Order
Less than ordered dose
The Admin will display in red text
indicating a dose less than ordered
dose was administered
• You are not prevented from saving an admin for a
dose less than the ordered dose
• You will be flagged when saving the admin
Exercise: Less than the Ordered Dose
• Document administration of Lisinopril 10 mg
– Scan the Patient’s wristband
– Scan the Lisinopril 10 mg tab
– Notice you are under by 5 mg
– Click Ok on the Admin Screen
– Confirm that you are flagged that the admin is less
than the ordered dose
– Click Ok from the MAR
– Click Save
– Notice the administered dose displays in red text
More Than Ordered Dose
• You will be prevented from saving an administration for more
than the ordered dose
• Upon clicking Ok, you will receive an error message and will
not be able to save the admin
Exercise: More than the Ordered Dose
• Attempt to administer Lisinopril 20 mg
– Scan the patient’s wristband
– Scan the Lisinopril 10 mg tab
– Confirm you have launched the admin screen
– Scan the second Lisinopril 10 mg tab
– Click Ok
– Confirm that the admin screen prevents you from
administering a dose more than what has been
ordered
Manual Admin
• Manual barcode Function
– Use if barcode is unable to be scanned
– Type the barcode number manually
• Report barcode scanning issues to pharmacy
Exercise: Manual Barcode
• Document the Acetaminophen Administration
– Scan the patient’s wristband
– Click Manual Barcode to manually enter the
Acetaminophen NDC Number
– Type: 00182844789
– Click Ok
– Complete the MAR Administration information
– Click Ok to return to the MAR
– Click OK to proceed to the summary screen
– Review the summary screen and click save
Document
• If the medication barcode is not available you may use the
document button to manually document
• This is the least favorable method, as it circumvents the
barcode scanning safety feature
MAR Management
•
•
•
•
Change View
Overdue Meds
Future Meds
Reconciling before End of Shift
Change View
•
•
MAR Default View
– Sort: Start Date/Time
– Days of Discontinued Medications Display: 24 Hours
– Days into the past to view the MAR: 5 days
– Days into the future to view MAR: 1 day
Change View provides the ability to change the MAR view
MAR Change View
• View Dates should be set to All
– Next Due will suppress important information from view
• Save to preferences will save the settings permanently
• Clicking Ok will save the settings for this session only
– Once the chart is closed, the default settings will be respected moving forward
Overdue and Future
Overdue
Future
Scheduled
Dose
• Overdue medications display in red text
• Future scheduled times display as a white cell
Exercise: MAR Management
• Click the scroll bar above the scheduled date and
time to view one day into the future
• Click Change View
• Update “Days into the Future to View MAR” to 3
Days
• Click Ok
• Now click the scroll bar to view three days into
the future
Reconciling MAR – Shift Hand Off
•
•
•
•
•
It is important to review the MAR during hand off
Any over due medications should be reconciled or communicated to the next shift
The next nurse should not be left to reconcile an overdue med
You are only able to document your own administrations
Hand Off is the best time for overdue meds to be discussed and reconciled
Break
Patient Care Reports
• Group of Meditech standard reports
• Available directly from PCS Status Board
• You may print Patient Care Reports for an
individual patient or a entire patient location
• Examples:
– Nursing Kardex
– Care Summary Report
– Active Orders Report
Patient Care Reports
• Click Patient Reports
• Place a checkmark next to the patient’s name that you wish to print the report
• Print for an floor
– Navigate to find patient by inpatient location
– Clicking in the checkmark header to select al patients
Reports Routine
• From the Patient Report Format Prompt, perform
a look up to invoke the list of available reports
Patient Reports List
• You will be provided with a list of reports to choose from
• Select the report you wish to print
Patient Reports
• Click ok to print the report
Exercise: Patient Reports
• From the status board click the patient notes routine,
click the reports button
• Place a checkmark to the left of your patient’s name
• Click Reports
• Select the Drop down arrow
• Locate and Select the Nursing Kardex
• Click Ok
• And, select preview from the print/preview screen
Patient Passport
• Found under Clinical Custom Reports on
Nursing Main Menu (at log in)
• Click on MOH Nursing Reports
– Patient Passport by Location or Patient
• Multiple Nursing Reports are found in this list
AND under the separate selection of Custom
Reports
• Follow the steps above to print a Passport for
your BMV patient
Medication Reconciliation
Medication Reconciliation Process
• Admission
– ED Admit
• ED RN Confirms/Edits Home Medications from prior visit
• ED RN Enters New Home Medications
• Inpatient MD reconciles the home med list to inpatient
medications making a decision on each med (hold, pt’s own or
continue) and adds admission orders
• Medications are verified by PHA & documented on the MAR
• Home Medication List may need to be updated during the stay
if new info is available. The RN must notify the MD that
additional info is available to reconcile
– Direct Admit
• Admitting RN confirms/edits home med list from prior visit
• Rest of the process remains the same
Medication Reconciliation Process
• Change in Level of Care
– Transferring MD uses Meditech Transfer Routine to review all orders
upon transfer
• Discharge
– MD does medication reconciliation using AOM. Resumes or
discontinues home meds and adds any new home meds
– Prescriptions printed by MD
– MD documents the Discharge Referral in PDOC
– Discharge Referral is available to print from the Reports Panel of the
EMR
– Nursing Prints the Home Med List (which includes last admins) from
any of the following
• Amb Orders
• EMR Summary Panel
• Clinical Data Screen
Home Medication List
• Home Medications will pull forward from prior visits
• For each new admission, the medication list should be reviewed by
the RN
• To begin documenting click [Edit]
Updating the Home Med List
• Upon reviewing this list, the following actions may be taken
– Medications that the patient is no longer taking - Discontinue
– Medications that the patient never took – Cancel
– Inaccurate info – Edit
– Active Medications – Confirm & document last taken date/time
– New Medications – Add to the Home Medication List (Click New)
Confirming Home Medications
• Home medications will carry forward from prior visits
• Confirm all prior home medications are accurate and document
using the confirm button
– Indicate the last dose taken when possible
Exercise: Confirming Current Home Meds
•
•
•
•
•
•
•
•
•
Click [Clinical Data Screen]
Select the [Home Medications] Tab
Click [Edit]
Find the Lisinopril Medication
Place a checkmark to the left of the Medication Name
Document the last taken date/time was yesterday at 0800
Click [Confirm]
Click [Save]
Verify the Lisinopril displays with the last confirmation
date/time as today and last taken as yesterday at 0800
Discontinuing Home Meds
• If a patient reports they no longer take a medication
– Place a checkmark to the left of the med
– Select Discontinue
– Save
Exercise: Discontinue Home Meds
•
•
•
•
Keep the Lisinopril Active
Discontinue all other Home Medications
Click Edit
Place a checkmark next to all medications (Except
Lisinopril)
• Click Discontinue
• Select Reason for DC
• Save
Entering Home Medications
• Type ahead look up to find the medication
• Provides a list of meds available
• Select the + to expand the med string selections
Home Medications – Med Strings
• Expanding the + sign will provide a list of
medication strings to select
Home Med Entry Selections
1st Tier
2nd Tier
3rd Tier
• Within the list there are three tiers/levels
– First Tier: Drug Name
– Second Tier: Drug and Strength
– Third Tier: Drug, Strength, Route, and Schedule
• Select the Third Tier whenever possible
– Provides the most information
– Less information to select on the next screen
Home Med Entry Screen
• Most information will default from the med string selected
• Edit as needed
• Enter the Last taken date/time whenever possible
Home Med Entry - Last Taken
• Once all information has been entered, click save
• And, click save from the clinical data screen
Exercise: Enter New Home Medications
1.
2.
3.
4.
5.
6.
7.
8.
9.
Click the [New] Tab
Type a new home medication
Click the + to expand the list of selections
Choose the Third Tier
Confirm all information displays in the medication entry
screen
Edit the dose
Document the last taken was this morning at 8am
Save
Save from the clinical data screen
Process Review
•
•
•
•
•
Code Status
Vaccine Assessment
MD/LIP Notification
IV Documentation
Notes
Code Status
• Code status is entered as an order
– Prior Advanced Directives Documented
– Code Status
– Code Status Limits (if applicable)
– Advanced Directives Discussed and confirmed with
EMR Summary Panel Display - Code Status and Limits
• Patient header displays Code Status
• EMR Summary Panel displays Code Status and Limits
EMR Clinical Panel Display
• Code Status/Advanced Directive Clinical Panel displays
– Code Status
– Code Status Limits
– Advanced Directives
– Health Care Proxy
Code Status Display in EMR-Review
1
2
3
1. Patient header displays Code Status only
2. EMR Summary Panel (Legal Indicators) displays Code Status and Limits
3. Clinical Panels->*Code Status/Adv Directives
Exercise: Code Status
• Use Test Patient A from your Blue Card
• Enter a code status order
– Full Code with Limits
– Limits: No Dialysis
– Save the Order
• Confirm the Code Status Displays in the patient
header
• Review the EMR Summary Panel – Legal Indicator
Tab
• Review the Code Status Clinical Panel
Vaccine Eligibility & Administration
• Upon Admission, vaccine eligibility is documented
– Age 18+ Opt Out Vaccine Assessment
• Upon saving the assessment (regardless of eligibility) the
Vaccine Assessment Order is generated
• This order generates a report to print to pharmacy
– This is NOT an order for the actual medications
• Save the Vaccine Assessment order for all patients
• Pharmacy will review this report to determine whether the
patient is eligible for vaccines
• There is a Pedi Vaccine Assessment (Age 0-17) that does
NOT send an order
– Decisions for vaccines must be made by the provider and ordered
Vaccine Assessment
• Document the Age 18+ Opt Out Vaccine Assessment
upon Admission
Vaccine Assessment
• Upon saving the vaccine assessment, the Vaccine
Assessment Order will be suggested
• Select to Order this for all patients (regardless of eligibility)
Vaccine Assessment Order
• Save the vaccine assessment order
• This will transmit an output document for pharmacy
• Pharmacy will review the report and enter the
vaccine orders as appropriate
MAR Administration – Vaccine Dates
• Document the date the vaccine is administered on
the MAR Assessment
Vaccine Dates – EMR Summary Panel
• Summary Panel (Legal Indicators)displays vaccine dates
– Updates from Age 18+ Opt Out Vaccine Assessment
– MAR Assessment
– Pulls from prior visits
Exercise: Vaccine Assessment
•
•
•
•
•
Use your BMV TEST Patient (scan sheet)
Document the Age 18+ Opt Out Vaccine Assessment
Generate the Vaccine Assessment Order
Save the Order
Document the Pneumonia and Influenza
Vaccinations on the MAR
• Review the vaccine date in the EMR Summary Panel
– Legal Indicator Tab
• Review information in the Clinical Panel “Vaccine
Info”
MD/LIP Notification
• MD/LIP Notifications should be documented on the
worklist – MD/LIP Notification Assessment
• Continue to communicate with MD – Verbal/Telephone
Admission Process Review
•
•
•
•
•
•
•
•
•
Enter Patient Allergies (Clinical Data Screen)
Review/Confirm/Enter New Home Medications
Height and Weight Assessment (Worklist)
Add a new Care Plan
Complete Admission Documentation
– Arrival to Unit/Admit or Transfer
– Admission Assessment
– Past Medical History
– Physical Assessments
– Fall/Risk/Safety Assessment
– Braden/Skin Risk Assessment
– Age 18+ Opt Out Vaccine Assessment
Individualized Focus of Care Intervention
Enter Admit Orders
Acknowledge Orders
Give Medications
Exercise: Admission Process
•
•
•
•
•
•
Use the BMV, Test Patient from the scan sheet
Enter Patient Allergies (Clinical Data Screen)
Review/Confirm/Enter New Home Medications
Height and Weight Assessment (Worklist)
Add a new Care Plan
Complete Admission Documentation
– Arrival to Unit/Admit or Transfer
– Admission Assessment
– Past Medical History
– Physical Assessments
– Fall/Risk/Safety Assessment
– Braden/Skin Risk Assessment
– Age 18+ Opt Out Vaccine Assessment
• Individualized Focus of Care Intervention
• Enter Admit Orders
• Acknowledge Orders
Daily Documentation
IV Documentation
•
•
•
•
•
Med Admin when hanging Bag – MAR
IV Insertion: IV/Invasive Line Assessment - Worklist
IV Assessment: IV/Invasive Line Assessment - Worklist
Intake: Intake and Output Assessment - Worklist
Remove of the IV Line: IV/Invasive Line Assessment - Worklist
IV Documentation:
MAR Medication Administration
• Document the IV Med Administration on the MAR
• This verifies the five rights and indicates that bag
is hanging
IV Documentation:
IV Insertion – IV/Invasive Line Assessment
• Document the IV Insertion from the Worklist
– Using the IV/Invasive Line Assessment
• Select the appropriate instance (IV/Peripheral Access or Central Line)
• Note there are 4 Sections on the IV/Invasive Line Assessment
–
–
–
–
IV/Peripheral Vascular Access Instance
Central Line Instance
Central Line Data – Insertions
AV Fistula
IV Documentation:
IV Insertion – IV/Invasive Line Assessment
• Instance is established – Location, Size, and Line Type
• Also document:
– Date, Access Use, Site Observation, etc
IV Documentation:
Assessing the Site – IV/Invasive Line Assessment
• Once the instance is established it will pull forward for
each new assessment
• Document the assessment of the line for the instance
IV Documentation:
Intake – I&O Assessment
• IV’s and IV Medications will automatically pull to the I&O
Assessment from the MAR
• The Intake amount for the med will be documented manually, based
on protocol
IV Documentation:
Removal of the IV – IV/Invasive Line Assessment
• Once the IV is removed, document the removal on the
IV/Invasive Line Assessment
– Date the line was removed, how it was removed, etc
IV Documentation:
Removal of the IV – IV/Invasive Line Assessment
• Next, inactivate the instance type to indicate the IV is
no longer inserted
• Click the instance, and select Make Inactive
IV Documentation:
Removal of the IV – IV/Invasive Line Assessment
• Gray = Inactive
• The next time the assessment is documented, this Instance
will be gray and collapsed
IV Documentation – EMR I&O Panel
• Documented Intake will be associated to the Med in the
EMR I&O Panel
• All entries total and include the balances for the time
period
Exercise: IV and I&O Documentation
• Use BMV Test Patient from the scan sheet
• Document the IV Insertion
– IV/Invasive Line Assessment
• Document Intake for Cephazolin
– Intake and Output Assessment
• Assess the IV Line indicating there is drainage from the IV
Site
– IV/Invasive Line Assessment
• Document the removal of the IV
– IV/Invasive Line Assessment
• Document assessment
• Inactivate instance type
• Review information in EMR
Exercise: Shift Hand Off
• Practice Hand Off Communication utilizing the
EMR TEST Patient
– Status Board Review
– MAR Medication Review
– M/S Hand Off Panel Review
Inpatient Transfer Exercise
• Review MAR and Reconcile overdue
Medications
• Document Arrival to Unit Admit or Transfer
Assessment
• Review M/S- Hand Off Panel when giving
report
Break
Discharge Home Process
• MD will have completed the Home Med Reconciliation and
the MD Discharge Referral
• Complete Documentation
– Outcomes
– Patient Teaching/Education
• Print MD Discharge Referral
– For additional information for diet, activity and follow up
documentation if needed
• Complete Nursing Discharge Doc and Instructions
• Print Nursing DC Instructions
• Print Home Medication List (close to discharge)
– Displays last doses of all meds to be continued
• Review all with patient
Exercise: Discharge Home
• Patient Teaching: Health Medication/Education-Teach Record
• Document: All Outcomes
• Print the MD’s Discharge Referral from Reports panel in EMR (none for today)
– Found in Reports panel of EMR
• Document: Nursing Discharge Documentation
• Generate the Discharge Instructions
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–
–
–
–
–
Click Write Note (R hand panel)
Click [Nurse]
Click [Text] (at bottom)
Select Nursing Discharge Instructions
Review the Note
Click Save
• Click Refresh EMR (note that Notes button turns red)
• Print Nursing Discharge Instructions Note
– Click Notes
– Checkmark the note
– Click View History
• To print the Instructions, click the printer icon (upper left hand corner)
– Print 2 Copies & Obtain Patient Signature
• Place one copy in the patient’s chart
• Send one copy home with the patient
Exercise: Discharge Home Con’t
• Print Home Medication Discharge List
– Click [Amb Orders]
– Click [Print] at bottom
– Click [Print Home Med List]
– Default -AOM Home Med Discharge List
– Click Print
NOTE: This can also be done from
– Clinical Data Screen
– EMR Summary Panel
• Review with patient
– MD Discharge Referral
– Discharge Instructions
– Home Medication List
Process: Discharge Home with Services
Usual Discharge Process and Documentation
PLUS:
• Add Intervention: Discharge Planning Page 2 and
Document
• Print the Discharge Page 2 Note
Then:
• Print MD Discharge Referral
• Complete Nursing Discharge Doc and Instructions
and Print
• Print Home Medication Discharge List
• Review
Exercise: Discharge Pg 2
• Add intervention: Discharge Planning Page 2
• Document
• Print the Discharge Page 2 Note
–
–
–
–
Click Write Note Routine
Select “Discharge Pg 2”
Review the Note
Click Save
• Click Refresh EMR (note that Notes button turns red)
• Print the Discharge Pg 2 Note
–
–
–
–
Click Notes
Checkmark the note
Click View History
Printer icon top left
Process: Transfer to SNF
Usual Discharge Process and Documentation
PLUS:
• Add Intervention: Discharge Planning Page 2 and Document
• Print the Discharge Page 2 Note
Then:
• Print MD Discharge Referral
• Complete Nursing Discharge Doc and Instructions and Print
• Print Home Medication Discharge List
• Case Manager will print:
– Appropriate documentation from Allscripts
• Found in Report panel in the EMR
– Discharge Pg 3 Report
• Which pulls in any Rehab documentation
• Found in Patient Care Reports (from status board)
Meaningful Use: Electronic Discharge Instructions
• Meaningful Use Measure C13
– Requires the ability to provide discharge instructions electronically (i.e. on a thumb
drive)
– Electronic Discharge Instructions should be provided upon request ONLY
• If (and only if) the patient requests their discharge instructions electronically, they
will be downloaded to a thumb drive
• Upon documenting the OB Nursing Discharge Documentation Assessment, there is
a section to indicate IF a patient requests their instructions electronically
• Within Query text, there are steps on how to download the discharge instructions
• These steps will be available on your floor as well in the event that there is a
request
Electronic Discharge Instructions: Patient Care
Reports
•To generate the instructions, use a desktop computer
•Do not use a workstation on wheels
•Steps
•Insert the thumb drive
•Click [Status Board]
•Click [Patient Reports]
•Place a Checkmark to the left of the patient’s name
•Click [Reports]
Request for Electronic Discharge Instructions
• Select *Flash/Thumb Drive MS DC Inst
• Click Ok
Request for Electronic Discharge Instructions
•
•
•
•
Click the drop down for the *Target
From the Open Window, Select My Computer
Choose the USB Disk
Name the File “Patient Discharge Instructions”
Discharge Instructions: Create a password
• Create a password with the following criteria:
– Capitalize first letter of Last Name followed by the next two letters in lower
case|Exclamation Mark| 4 digit DOB (Month and day only)
• Click Ok
• Password Example
– John Smith Birthdate: 03/04/1984
– Password: Smi!0304
Nursing Main Menu Review
•
•
•
•
PCS Status Board – Inpatient Documentation
BAR/ITS Reconciliation –Charge Entry
EDM Tracker – ED Patient Documentation
Clinical Custom Reports—Multitude of Nursing reports
including Patient Passport
Downtime
• Two types of Downtime
– Unplanned Downtime
– Planned Downtime
• Unplanned: Summit Downtime Software will be available w/MT 6.0
– Summit takes hourly snapshots of pertinent Meditech Reports
• Saves the reports to a separate server
• Provides the ability to print pertinent patient information when Meditech is
unavailable
–
–
–
–
–
Kardex
Active Orders
Downtime MARs
Last Vitals, Intake & Output
Census
• Planned Downtime: All users are alerted of the downtime, and
reports are printed directly from Meditech
• Instructions will be provided as a reference in the event that
there is unplanned or planned downtime
Downtime
• Planned Downtime
– Print the following reports from Meditech
– Nursing Kardex (nursing units)
– Unit Nursing Census (nursing units)
– Care Summary (nursing units) (when available)
– 48 Hour MAR (nursing units)
– Active Orders Report
– Pharmacy Patient Profiles (pharmacy only)
• Un Planned Downtime
– Print the following reports from Summit
– Nursing Kardex (nursing units)
– Unit Nursing Census (nursing units)
– Care Summary (nursing units)
– 48 Hour MAR (nursing units)
– Active Orders Report
– Pharmacy Patient Profiles (pharmacy only)
Go LIVE Plan
• Go LIVE is scheduled for July 1st, 2013
• An inter departmental Checklist of pre requisites will be carried out
the night before go LIVE
– An Implementation team will be on site for this pre requisite work
• Quincy Super Users
• Steward IS Analysts
• Meditech Implementation specialists
• Go LIVE Support
– Super User support will be scheduled for the first 2 weeks of Go LIVE
– An IS Command Center will be in place for the first week of GO LIVE
• Staffed with Steward IS Analysts
• Technical Support
• Meditech Implementation Specialists
• Your super users are your first line of defense and have great insight.
Be sure to know your super user.
Important Point – Editing Documentation
• Meditech allows a 3 day window to make edits to
your documentation.
• If any edits need to be made outside the 3 day
window, you will need to contact Medical Records
to request that the editing cut off flag be lifted
• Medical Records will coordinate a time for you to
meet to make the edit and will open a ticket to
request that IS Lift the Editing Cut Off Flag during
the scheduled date/time
Clinical Scenario 1 and 2 (Hand Outs)
• Use 1st test patient on your pc (not the BMV
pt) to complete the 2 comprehensive clinical
scenarios provided

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