Meditech Training Manual Emergency Department Management (EDM)

Second Edition

Jonna Bobeck BSN, RN, CEN

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Table of Contents

SECTION 1 4

WHAT IS EMERGENCY DEPARTMENT MANAGEMENT

SECTION 2 4-5

TRACKER REVIEW

SECTION 3 5-6

EDM TOOLBAR

SECTION 4 6-7

FUNCTION KEYS

SECTION 5 7-10

INTEGRATED DESKTOP TRACKER BUTTONS

SECTION 6 10-13

SIGNING INTO EDM

SECTION 7 14-20

TRIAGE

SECTION 8 21-25

VACCINE/MDRO/ALLERGIES

SECTION 9 26-44

MEDICATION RECONCILIATION

SECTION 10 45-46

VITAL SIGNS

SECTION 11 47-48

PSYCHOSOCIAL

SECTION 12 49-51

ASSIGN ROOM AND NURSE

SECTION 13 52-53

CHARTING ASSESSMENTS

SECTION 14 54-64

TREATMENT INDICATORS/INTERVENTIONS

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SECTION 15 65-83

MEDICATION ORDERING

SECTION 16 83-104

ELECTRONIC MEDICATION ADMINISTRATION RECORD (EMAR)

SECTION 17 104-106

CHANGING CHIEF COMPLAINT

SECTION 18 107-109

CHANGING STATUS EVENT

SECTION 19 110-114

DEPARTURE AND DISCHARGE DOCUMENTATION

SECTION 20 115-116

ADMISSION DOCUMENTATION

SECTION 21 117-119

DOCUMENTING ON WRONG RECORD

SECTION 22 120-121

EDITING RECORDS

SECTION 23 122-125

PATIENT’S ACCIDENTALLY DEPARTED

SECTION 24 126-139

CLINICAL REVIEW

SECTION 25 140-160

PATIENT CARE INQUIRY (PCI)

APPENDIX A 161-169

CHIEF COMPLAINTS

APPENCIX B___________________________________________________________________________________170-171

ASSESSMENT LIST

APPENDIX C___________________________________________________________________________________172-177

TREATMENT INDICATORS

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Emergency Department Management (EDM) Instructions

Section 1: What is Emergency Department Management?

EDM was implemented at Pullman Regional Hospital to improve patient care in the

emergency department. This is accomplished by improving efficiency related to

documentation. Greater efficiency can be accomplished by simplifying, streamlining,

standardizing and enhancing the documentation process through computerization of

the patient care record. Information flows easily within all setting of Pullman

Regional Hospital and other facilities within the INHS network while maintaining

patient privacy.

Section 2: Tracker Review

Prior to logging in you will be able to visualize the public tracker. After logging in you

will visualize the private tracker. To quickly view the encounter, click on the patient’s

name or click the Summary button. The encounter is a real time view of the patient’s

progress in the emergency department. It will show everything that is current and

done for the patient. You will see the patient’s name, age, chief complaint, priority,

assigned nurse mnemonic, status event, time in department, results indicator area,

integrated desktop, and tool bar.

HELPFUL HINTS:

• To quickly view the encounter, click on the patient’s name.

• To assign a room number, click on the room number located at the top left of the screen.

• To change/update the chief complain, click on the chief complaint.

• To change the status event, click on the status event.

• To view lab, radiology, ultrasound, CT and etc., click on the results indicator area.

• To sign-up to be the primary nurse, click on the sign-up button on the integrated desktop on the far right of the screen.

• To access PCI, click on the PCI button on the integrated desktop.

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• To access Clinical Review click the Review button on the integrated desktop.

• To chart Treatments click the NUR button in the results indicator area.

• Quickly access the electronic medical record by clicking the eMAR button on the integrated desktop.

The Private Tracker

Section 3: EDM Tool Bar

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The EDM tool bar is found on the far right of the screen (highlighted in red) and works as follows:

• Green check = OK or file

• Red “X” = exits you out of the current screen or pop-up

• Question mark = help

• Binoculars = look-up patient information of certain screens

• Green star/red X = session management, magic key menu

• Tools = access to a calculator

• Blue flower = special function key

• Green check all = checks all items in order sets in physician order management

• Blue arrows = up, down, back and forth in one field

• Green arrows = page up and page down

Section 4: Function Keys

• F12 = OK/file, exits and files entries

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• Shift + F12 = hot key menu/magic menu

• F11 = exits and does not file or save entries

• F10 = line feeds to erase current field

• F9 = lookup key for list of choices

• F8 = page down ( same as green arrow down)

• Shift +F8 = access on-line documentation

• F7 = page up (same as green arrow up)

• F6 = takes you back to the previous field

• F5 = auto fill

• F4 = Gives you access to “canned text”

SECTION 5: Integrated Desktop Tracker Buttons

Meditech’s Emergency Department Management (EDM) application includes a Patient Tracker

Integrated Desktop. This application gives staff a central point of data entry for documenting the

daily treatment of patients and for managing the flow of patients through the system. The EDM

system, which tracks patient test results, medication orders, and vital signs, serves as a

communication tool between physicians, nurses, and the departments with which the Emergency

Department staff interacts. Most of your documentation will be done from one of these tracker

buttons. The integrated desktop is highlighted in red below:

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TRACKER BUTTONS (INTEGRATED DESKTOP)

• Summary: Enables you to view or print out the patient’s complete EDM record for the visit. Can also click on the patient’s name or highlight the patient’s name and right arrow.

• Recpt: Not used

• Room/Staff (Rm/Staff): Let’s you assign a room and staff to a patient. Usually done by charge nurse in triage.

• Sign up: assigns you to the patient.

• Triage/Document (Trg/Doc): This will take you to the triage/documentation screen where assessments and interventions are documented.

• Reconcile: Takes you to the Medication Reconciliation screen.

• Advanced Status Event (Adv St Ev): Gives you a limited selection of status events to change to. You may also change the status event by clicking directly on it. By using the method you will get the full list of events.

• Pt Notes: Allows for general patient notes to be added to your documentation.

• Orders and Order Summary: Here you can place and view orders.

• eMAR: Takes you to the electronic medical record.

• Review: Takes you to Clinical Review

• PCI: Allows you to view specific patient care information.

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• Depart: This is where discharge functions are performed. If the patient is going home you will need to hit depart. If the patient is admitted you will depart them and update the status event.

• Comment: Allows you to type in a comment. You can do this by clicking the Comment tab or clicking under the HM in the results indicator area. When a comment is left an * will appear. Just click the * to view. To delete the comment open and delete then file. See screen shots below:

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• Trackers: Allows you to view current patients and discharged patients.

• Forms: Use to print medication reconciliation form for admitted patients.

Section 6: Signing Into EDM

There are two ways to sign in to EDM. From the computer desktop go to the icon “HCIS” and

double click on it. You will see a screen labeled MIS Directories. Choose #1 which is “live”, and

this should take you to a login screen.

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Enter your user ID and password.

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You will be taken to the EDM Main Menu. From here you choose where you want to go. To

reach the Private Tracker click on All Patients.

This will take you to the private tracker and you are ready to begin charting. If the public tracker is

already on the computer screen, simply hit right Ctrl key and proceed to login with name and

password. At this point you are ready to chart on your patient. Be sure you are charting on the

correct patient. Click on the patient you want to chart on and it will highlight blue.

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Helpful hints for charting see highlighted areas below:

• / = F9 lookup (may not use free text).

• : = Can use free text.

• ? = Yes or no question. All you have to do is type Y or N.

• + = There is text in the background. To access hit Shift + F8.

Examples in red below:

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Section 7: Triage

The first thing to be done in triage is to assign a chief complaint. To begin, select the correct

patient and click on the Trg/Doc button from the private tracker. Click the “Edit” button next to

the chief complaint field near the top of the screen.

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Hit F9 and all the accepted chief complaints come up. Choose which complaint is appropriate for

the patient. You may also type in the mnemonic. For a complete list of chief complaints see

appendix A.

Now you are ready to go to the triage screen. Under Assessments click the “+” on the left and then

on triage, go over to the Integrated Desktop on the right of the screen and click Document or just

type “D” on the keyboard. Your cursor will go to the Date, just type “T” for today. Next, the

cursor will move to the time box, type “N” for now.

You are now ready to begin the triage assessment.

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Start with answering the questions at the top of the screen (exposure, and interpreter) if applicable.

Arrived By/ and With/ are F9 look-up or you may type in the correct mnemonic. Next is your

note in the Objective/Subjective field. This is free text, when finished hit F12 to file. After you hit

F12 and file your Objective/Subjective History your cursor will be blinking in the Medical/Surgical

Hx area. Fill out Medical/Surgical Hx; this is a free text field. You must hit enter F12 to move

onto the next line. Click on Last Tetanus and record the year the last tetanus was given. Hit enter

and tab over to Immunizations Current and type “Y” or “N”. Hit enter to Last Menstrual Period

and type in date. Tab through and fill out number of pregnancies, live births, and abortions. Fill in

Primary Care Physician and use F9 to look up the correct provider. Enter or tab over to weight and

enter in LB, hit enter until you reach height and fill in each box. Enter the patient’s primary

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physician and click “OK”. Now you are back at the Trg/Doc screen. Near the bottom of the

screen is Status Event (TRG), click this button and hit Document.

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A pop-up box will appear. Hit F9 for the pop-up menu.

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Choose your new status event and Hit Ok or F12 to file.

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Lastly assign a priority. Click the Priority button at the bottom of the private tracker screen and hit

Document, a white box will appear, hit F9 to look up and assign the appropriate priority from 1 – 5.

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Section 8: Vaccine/MDRO/Allergies

Now let’s chart the patient’s vaccines, MRSA, VRE, and allergies. Highlight

Vaccine/MDRO/Allergies and hit “D” or click the Document button. Type “N” for now and this

is what the screen will look like.

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Type “Y” in the Update Allergies white box and you will be taken to the Allergy Management

screen as seen here.

Highlight each allergy listed and verify with patient and click confirm on the Verb Strip. If a new

allergy needs to be entered click “New” on right hand of the screen.

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Type in the allergy and a list will appear in large white box. Click on correct allergy and select

severity. At the bottom of the screen there is a white box labeled “Reaction”, hit the down arrow

and find appropriate reaction and click. Make sure the verified box is checked at bottom right of

the screen and file and you will be taken back to the Vaccine/MDRO screen.

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When you have finished entering the patients allergies you will be rerouted back to the

Vaccine/MDRO screen. The cursor will be automatically be blinking in the Drug Resistant

Organism History Reviewed? Box. Type “Y” and enter to fill in blanks. If the Patient has a

documented history of MRSA the fields associated with it will be auto populated. Next the cursor

will go to the Have you had the influenza (Flu) Vaccine this season/, type “Y” or “N”. Do the

same for the pneumonia box. Hit enter and fill in the white boxes as applicable. When finished

click “OK”. You will then be taken to the HOME MEDICATION HISTORY screen as seen

below. The cursor will be blinking next to the “Y” in the Update medication list? box, hit enter and

you will be taken to Medication Reconciliation.

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Section 9: Medication Reconciliation

The Medication Reconciliation screen will come up two ways. After you have finished entering

allergies in triage and click yes in the HOME MEDICATION SCREEN or when you click the blue

header in the Trg/Doc screen titled Active Prescriptions/Reported Meds. You will see the patients

name, DOB, and unit number at the top of the screen. Below the name will be documented

allergies. In the middle of the screen will be the main headers: Home Meds and Prescriptions or

Discontinued Home Meds if applicable. The large white box will have no headers if the patient

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new and no meds have been reported. From here click on Upd Med List from the Integrated

Desktop on the right.

This will open the update med list screen.

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Begin typing the home medication here. This is a type-ahead functionality and the search will

narrow down the choices of medications by the more letters that are typed. The user begins in their

Favorite List but the system will automatically go to “Go to All Meds” if the medication is not

found. As you type medications from a database of 33,000 will come up. For example, if you type

(tyl) all forms of Tylenol will appear.

In this example, tyl has been entered, narrowing the search down to medications beginning with

these three letters. Highlight by clicking with your mouse or using your arrow up/down key to

select the desired medication. Click on the Select button at the bottom of the screen when finished.

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This will take you to the screen where you can manually fill in Dose, Units, Route, and Frequency.

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You may also auto populate the correct Dose, Unit, and Route fields by clicking the blue string.

Click done when finished.

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On this same screen instructions can be typed in. For example, patients who are taking Coumadin

on Monday, Wednesday, and Friday can have that put into this section.

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The box below Instructions is Comments. This is where you want to enter the indication for the

medication. Click on the down arrow

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Click on “Get”

A pop up box will appear, choose #2 Indication for med.

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A list of indications will appear, choose what is appropriate for your patient.

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The indication will auto populate a white box when you click what you want, then click OK.

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If the entries are correct, select Done.

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After you have clicked on Done, you will be taken back to the Last Taken screen where you can

enter the date and time when the patient last took their medications.

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You may also print the Monograph of a medication simply by clicking the Monograph button.

The Monograph will appear in a pop-up box as seen below.

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You have now launched the Last Taken screen.

Click on the correct date on the calendar and enter the time the patient took their mediation. Only

enter the dose if it different than what is reported in the medication reconciliation screen. Click

“OK” when finished. You will now see you medication under the header Home Meds and

Prescriptions. Highlight the review button if all the information is correct and click Submit on the

Verb Strip, you will be taken to the Medication Reconciliation Summary screen. If your

information is correct click “OK”. If you need to make changes you can click cancel and start over.

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Finally click the Return button and you will be taken back to the Vaccine/MDRO HOME

MEDICATION SCREEN.

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Fill in the patient’s pharmacy and disposition with free text. Use the F9 key and choose what is

appropriate for the Medication history box. Type “Y” or “N” in the ASA, NSAIDS, anticoagulants

and herbal products fields. You may also free text in the large white box after the remedies. Enter

down to the Home Med Hx field and hit F9 and choose the appropriate response. Type “Y” or

“N” for pharmacy consult and a reason if need be. You may type additional comments in the white

comment field at the bottom of the screen. When finished click “OK” and you will be taken to the

Trg/Doc screen. Click on ALLERGY BAND PRINTING and type “Y”. Your allergy band will

print in triage. Be sure to apply to patient.

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The screen shot below shows what the Private Tracker results indicator area will look like when

you have completed documenting home medications:

The red HM indicates that someone verified allergies and MDROs but did not complete the meds

and checked “nursing f/u” in the drop down menu.

The green HM indicates that both the allergies/MDRO and home medication have been

completed and the nurse marked “completed” in the drop down menu.

If the area is blank neither the allergies/MDRO or home medication screens have been

completed.

HM = Nursing F/U selected on Home Med Hx Status

HM = Complete selected on Home Med Hx Status

Blank = MDRO/Vaccine Assessment not filed

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Section 10: Vital Signs

Highlight vital signs and hit “D” or click on the Document button. Type “N” for now or type in

the time the vital were assessed.

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Type in results for Temp, Pulse, Resp., BP etc. For the method, rhythm, site etc. use the F9

lookups to select appropriate response or type the mnemonic. Type in Capillary Refill, press enter.

Fill in O2 sat and press enter. Type in LPM of O2 and press enter, O2 type/ can use F9 lookup

and choose appropriate response. Type “Y” or “N” for cardiac monitor and orthostatic BP. If yes

for orthostatic BP a pop up screen will appear, fill in each field file with F12 and return to VS

screen. In the Pain? Box type “Y” or “N” and press enter. Next type in intensity from 1 – 10 and

press enter. There is a “+” outside the Intensity and Cardiac Monitor box which means there is

hidden text, to access hit F8. Location: is free text. In the field for Pain Quality/: use the F9

function key and choose appropriate response. Comment: is free text. Hit F12 to file.

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Section 11: Psychosocial

Click on Psychosocial and hit “D” or click on Document. Type “N” for now.

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Use F9 to look up and fill in Functional Impairment, Factors Affecting Ability to Learn, and Living

Arrangements. Do you feel concerned for your safety is a required field. Type “Y” or “N”. Enter

down to information obtained from: and fill in appropriate box with a “Y” or “N”. Comment field

at the bottom of the screen is free text. This may be used if a person does not feel safe and you

need to explain. Click OK or F12 to file. Select the red “X” or hit F11 to exit this screen and

return to the tracker.

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Section 12: Assign Room and Nurse

With the patient highlighted from the private tracker, click on Rm/Staff button on the right

side of the screen in the Integrated Desktop, click in the room box type in a room number or

choose from list with F9.

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If the primary nurse is known their name can be put in at this time by typing in his/her mnemonic

in the nurse box. Hit F12 to file and save. If the charge or triage nurse has not already assigned the

patient to you the first step is to signup for the patient. To do this, make sure the patient you want

is highlighted on the private tracker and then click the Sign-up button on the right hand of the

screen on the Integrated Desktop.

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Section 13: Charting Assessments

The assessments are linked to the patient’s Chief Complaint. For example, a patient with

Irregular Heart Beat will automatically generate Cardiac and Respiratory assessments. As a

reminder, to chart an assessment, there are a few things to look at. Some of the fields are free text,

designated by a “ : “. Others are look up menus designated by “ / “ hit the F9 key and this is

where you choose from a list (or type the mnemonic). When you see “ ? “ you type “Y” or “N” for

yes or no.

Click on the assessment then hit Document on the integrated desktop or type “D”.

Furthermore, you may add additional assessments or treatments for your patient by clicking the

assessment or treatment buttons. Next type “D” or click Document. A white box will appear, hit

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F9 or type the mnemonic to add assessment or treatment. From this list choose the one you want

to complete. Hit F12 to file. For a complete list of assessments please see appendix B.

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Section 14: Treatments Indicators/Interventions

With Treatment Indicators it is very important to place orders on the patient before documenting.

This will bring the documentation to the Trg/Doc screen. Place orders through Physician Order

Management (POM) by highlighting your patient and clicking the Orders button on the EDM

Tracker and then in POM. When order sets are used click on the Order Sets button instead.

Here is an example of Treatments/Interventions in POM. Most of the orders have been in place

for a while, but some new treatments will now exist. Notice the Category is EMERGENCY

DEPARTMENT and there is an “ER” or “ED” at the end of each order.

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Now let’s chart some treatment indicators. This would be interventions we do for our patient’s, for

example, IV insertion, IV removal, foley catheters, and ice packs. The physician will enter orders

which then will generate treatment indicators for the nurse. When new orders are placed the

“NUR” indicator on the Private Tracker will turn red alerting the nurse there are new treatments

ordered.

The nurse can either click on the red “NUR” or click Trg/Doc to launch the Patient

Triage/Documentation screen to view and chart his or hers treatments.

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The new treatment indicator will be highlighted in green under the blue “Treatments” header. Click

the green treatment indicator and then document to begin charting. For example, click the green

Foley Catheter and click Document.

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When finished with your charting click “OK”.

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The treatment indicator will now turn black and a “+” will appear in the left column letting the

nurse know the treatment is complete.

When all the treatments have been documented the NUR indicator will change to Green. One

exception is the IV DC. It will not trigger the indicator to change color since it will not get

documented until the end of the visit.

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Patient Summary View:

Documented interventions will show on the Patient Summary in the Treatment section.

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You may want to add treatments. To chart on a treatment that is not generated by the physician

orders, you can add an additional treatment from the treatment list, for example, bedside commode.

To do this, arrow down to, or click on Treatments so the blue treatments header is highlighted. Hit

“D” or click Document button to add treatment.

From here a white box will appear type in the mnemonic of the treatment or hit F9 to lookup.

Once the list pops up, select the treatment you want to chart on.

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Select number 9 Bedside Commode and you will automatically start charting.

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Click “OK” when finished and you will see the Bedside Commode charting is under the treatments

section in black with the “+” to the left of the column

You use the same process to add assessments. You will notice when assessments are completed and

filed they will have a “+” next to them on the left side of the screen just like the treatments. You

can click on the (+) to expand the treatments or assessments. For a complete list of treatments and

interventions see appendix C and D.

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Section 15: Medication Ordering

Medication ordering allows us to interface the ordering process with Pharmacy. This allows for

additional safety features to include Allergy and duplicate medication checking.

To access the medication order routine, highlight your patient and Click on Orders or press the

“O” key.

The Review Patient’s Orders window will open.

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The Physicians Headers Tabs are set up according to the user’s individual preferences. The

preferences are set up using the Preferences button.

The headings can be expanded to show all of the associated procedures by clicking on the + sign

next to the header. The procedures can be collapsed by clicking on the – sign.

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Placing Medication Orders

To order an individual medication, click on the Meds/Fluids button.

For Verbal Orders, the user does need to enter correct ordering provider and the Ordering

Source. It will help if the provider is assigned to the pt in the Rm/Staff routine. This will bring

the providers name to this screen automatically.

After entering past this prompt you will be taken to the Provider’s favorites if they have any set

up. Otherwise you will see the Full Formulary.

Notice the Full Formulary is highlighted along with Medications. For example, begin typing in

Motrin. Each letter you type will filter the search. Here you can see the Motrin with the (ED

Stock). This is the one you want. The Choices with (ED Stock) or * on the medications are in

the ED Pyxis. If you choose one w/o (ED Stock) or * there is a possibility it will not be available

in the ED Pyxis. You would want to call Pharmacy so they can bring this med down.

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Now you can choose how you would like this med administered, for now will choose PO.

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Now you have the option to choose the dose. In this example we will choose 400 MG.

Now you will get all the strings associated to this dose. To select, highlight and click done or

enter.

You will be taken back to the All Medication page where you can start the process over.

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If you do not want any more meds click done. This will take you back to the Review Pt order

screen.

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NOTE: The order has not been completed yet. You have to submit and file the order to

complete the process.

At this point you have several choices. You can Undo, Place more orders, go into an order set,

add non-medication orders or, if done, you can submit the order. To submit, all you need to do is

click the submit button. This will take you to a review screen.

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At this point you could click cancel and make changes if needed. Otherwise click OK to file the

order. Now you can see the order has been filed.

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Now let’s look at the tracker.

The Medication indicator acts just like the Treatment indicator. It will be RED when there are

Medication orders that have not been completed. This will turn to a RED Reverse Highlight if

not completed w/in 60 minutes. The MED indicator will change to GREEN when all scheduled

meds are given. PRN meds will show as a black PRN. Being the med is “as needed” it will not

change colors. Reverse Highlight Purple means a reassessment is overdue.

Before we go into the eMAR charting, let’s look at some other functions of medication ordering.

Editing Orders

While in the string selection you can click on the drop down arrow to change any part of the

order. To change the dose, click on the drop down next to the Dose section.

Now you can select the 50 MG or Other to edit the dose.

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Here I clicked “other”, changed the dose to 33 and added some free text dose instructions.

Now you can see the changes I made. The bubble indicates I have some Dose instructions.

When done you can submit as per the directions above.

Special Instructions

Special instructions can be placed on orders when the strings are built. They can also be added

on the fly. While in the String Selection screen, click on the Inst drop down. This will give you a

free text box.

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When done click OK. You will see the instructions as a bubble on the review order screen.

PRN medications

Some Medication strings are pre-built as a PRN. You can also change a med to PRN as needed.

To do this simply click on the PRN dropdown.

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After choosing “YES” you will want to select the PRN reason. If there is no PRN reason you

can free text the reason. Then click done.

Now you can see the PRN and PAIN for the reason. Now you can submit the order.

There is a separate indicator for PRN’s, which will not change color.

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Weight based dosing

Some medications are set up for weight based dosing. Motrin and Tylenol are good examples of

this. After selecting the medication you will se a string with the dose of MG/KG

Here the 10 MG/KG dose has been selected. Now click done or hit enter. You will see the

following:

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If the Weight in the Vital Sign screen has been completed, you will see the Weight automatically

come over. On the example above the system has automatically calculated the dose for this 70

KG pt at a 10MG/KG dose.

If you do not like that dose simply click in the box and manually change it. Being it will be

impossible to give exactly 703 mg I will decrease this to 600 and file.

Now you can see the new order of 600 MG Motrin suspension. Now all you need to do is submit

the order.

Home Packs

Home packs are defined by a (Prepack) Next to the med. You can type Prepack to see all the

available Prepacks as well.

You will want to choose the home pack dose and string when they come up.

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Now you can continue and submit the home pack and document on the eMAR.

Allergy Checking

One of the biggest advantages of using medication ordering is patient safety.

Currently the nursing staff is filing all allergies as coded. The medication ordering system in

CPOE can now evaluate these allergies and notify you if there are any interactions.

In the example below an order has been placed for a medication that the patient has allergies to.

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At this point you have several options. You can Override this allergy and order the medication,

you can cancel and start over or you can replace the order with another.

If you click on override you will get a drop down that you can select a response from.

After selecting the response you want it will take you to the string selection page.

Confirming Allergies at each visit is very important. If you do not do this, the ordering provider

will get an extra pop-up. Confirming allergies at every visit is also part of Meaningful Use.

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Reflex Orders

Some orders have other orders attached. These are called reflex orders. One example of this

would be Moderate Sedation. Let’s take a look at the Sedation order. To order sedation simply

type in “MOD” for Moderate Sedation.

After selecting the Moderate Sedation Order and clicking done you will get the following:

After clicking OK you will be taken to the Review patient Order screen. Notice there are 2 new

orders.

Now you can submit and see all 3 sedation screens under the treatment header in the Trg/Doc

section and the NUR indicator will turn back to RED.

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Section 16: Electronic Medication Administration Recored (eMAR)

Now that Medications are interfaced with pharmacy you will be documenting medications via

the eMAR.

Accessing the eMAR:

You will access the eMAR Desktop from the Tracker. You can either click on the MED or PRN

indicator or highlight the patient and click on the eMAR button.

EDM 84

The Header:

Below the acct and unit number are the wt and height. The weight is pulled from the Vital Sign

screen in EDM. When you click on this a box expands to give you detailed information

including Wt in pounds and kg and BSA.

The Header: Pt info,

Account Info, Location,

Status, Allergy

Pop up box

EDM 85

The last line on the bottom of the header is the Allergy and AdvReac fields. If you click on either

one of these it will open an information box.

The Medication Cell:

The Medication Cell area has many features that give you the ability to view information easily,

sort the data for individualized work preferences, and monitor your medications.

The right hand column (toolbar) can be used to check all medications. This will help when you

want to document the administration of multiple medications at one time. Simply click on the

green check with the “all” under it to check all medications. You can also click on the check

mark just above the other check marks to check all.

If you want to uncheck one of them simply click on the check next to the med and it will be

removed.

Additional

information

available

EDM 86

Below the patient;s allergies in the blue box on the left is the medication order ‘Start’ and ‘Stop’

times. For the ED all orders will generally be STAT or PRN. For the STAT orders you will see

the stop time as one minute after the start time. The system then shows the order as DC’d.

Click either of

these locations to

check all

EDM 87

Please do not confuse this with a canceled order. If an order is cancelled it will be removed from

the eMAR.

EDM 88

Below we can see the difference between the STAT and PRN orders. The Acetaminophen is

STAT. You can see the start and stop times along with the DC’d verbiage. The Zofran is PRN

so it will remain active for the entire visit.

After the stat medication has been administered it will fall to the bottom of the eMAR, turn

yellow and remain there for 2 hrs. This way if you need to document anything after you gave the

med you can do so w/o having to bring the med back to the eMAR. You can adjust this time in

the preferences if needed.

Sorting Features of the Medication Cell:

To assist the nurse in performing the documentation of administering medications, you have the

ability to sort your work area on the Desktop by clicking on the column headers.

EDM 89

Clicking on the icons will bring you to the screen that each feature supports. The “pencil to

paper” is the CDS (Customer Defined Screen) icon. When the medication is highlighted

blue (showing which medication is featured in each function) and a user clicks on this icon in the

medication cell, it will show the attached Customer Defined Screens (i.e. BP queries on

Lisinoprol). At this point these pop up boxes are for information only, you enter that information

during the actual process of giving the medication. Below is an example from a facility where

they use a CDS for educating the patient on Digoxin. When viewing the pop ups from the icon,

they are view only at this point but become fields to document on when scanning/administering

the medication in the system.

The next icon over is the two pencils , this is the icon for co-signer required on a specific

medication. When the co-signer actually signs as a co-signer, it will occur when you file the

medications and a box will pop up that has the entry for the co-signers mnemonic and after

hitting enter, will bring up the password box to complete the electronic signature of the co-

signer. (This will be illustrated later).

EDM 90

The next icon is the Admin Criteria, Label Comment and Special Instructions icon which

shows information from the pharmacy or the provider as to parameters he/she wants the

medication given under.

When the user clicks on the icon it will bring up specific information entered by the provider.

This will not pop up when you administer the medication but is always available as information

to the user. You can see this same information when you review the history of the medication in

the ‘Submit’ area.

EDM 91

Medication Schedule Columns:

Immediately to the right of the medication area is the column for the schedule of each

medication. It has a green field to distinguish it from the other columns with the schedules next

to it and does not move. PRNs, Stat, and One time do not have a schedule so for those

medications nothing is showing (See Below). The ED typically only uses PRN and STAT so

you will not see information in the Scheduled Time column.

EDM 92

Below you will see the red background on the 1154 dose of Benadryl. This indicates the

medication is overdue. The green background on the Tylenol indicates the medication is w/in

the timeframe to be given. After the medication has been administered this will change to a gray

reverse highlight.

EDM 93

The Action Buttons at the Bottom of the eMAR Desktop:

Once you are to the point of performing an action against the medication profile, you have the

buttons at the bottom of the eMAR Desktop that have distinct functions and uses.

The document button is used to document any checked medications. You can click on the

Administration time located next to the Sched Time column, or as noted above you can check all

meds and then click on the document button to complete the documentation process.

In the below example you can click in the check box next to the med and then the “Document”

button to document on that single med:

EDM 94

As seen here, the Administration Queries popped up for Documentation, fill out the appropriate

and enter through the screen.

EDM 95

Once you finish the Administration Queries screen, the remaining screen gives you the ability to

select “Non-Scheduled”, “Scheduled” (with a drop down box to select the correct time and date),

“Given”, “Not Given”, the “Administration” time and date which can be changed to reflect a

different time given today, the “Dose”, “Units”, “User” mnemonic, and a “Text” drop down

where you can click on and enter a note with the admin of just this medication.

Buttons at the bottom allow you to “Document” what you have changed on this pop up box or

“Cancel” documenting here.

The next button “Ack” that resides next to the Document button takes you into the

Acknowledgement area.

The next button is the “Preferences” button. This gives you the ability to make changes to your

eMAR view.

EDM 96

eMAR reports is just what is states, they can be placed on the button or auto printed (these are

Meditech standard when seen here).

The “Change Order” button allows you to “Change Order”, “D/C Order”, or “Edit Orders”

depending on your access level

Lastly, the “Submit” button. Use this button after you have documented your meds and are

ready to finalize the process.

EDM 97

Here we are at the point of decisions and choices. On the left we can unselect any medication

that we decide we don’t want to document on. The other point is looking at all the information,

making sure you are filing the right time and dates, using the edit button to make changes on

anything you have documented on up to this point. After saving you will need to put your

password in.

Once you have determined you are ready to file the medication you have the following options:

1. “Return to eMAR” button does just that; it returns me to the eMAR to do additional

documentation. If I don’t return but exit the eMAR I lose everything as if I never entered

the eMAR.

2. “Save and Exit” will file the medications I have and return me to the Tracker.

3. “Save and Recompile” will file the medications and return me to the eMAR.

EDM 98

This is what the eMAR will look like after you have documented and saved the medications.

Anytime a medication has been given it will be gray numbers on a white background.

The next to the Tylenol admin is the reassessment indictor. By clicking on the icon you will

get a pop up like this if the reassessment isn’t due:

EDM 99

You can chose to document anyway, or what until the reassessment time (usually 30 minutes)

arrives. This particular reassessment documentation screen looks like this:

EDM 100

Here is what the medications look like on the patient summary:

EDM 101

The Medication History:

Every aspect of the process of documenting in the Desktop eMAR is saved and available to view

by any user. Everything from when the order was placed, to documentation with a co-signer.

One area to see more detail is by clicking in the ‘Ack’ area as seen below:

After clicking in the “ACK” area or by clicking “ACK” button next to Document at the bottom

left of the screen you will be presented with this Review Order screen:

EDM 102

You will note there is a difference of the areas seen of dark blue to light blue, dark blue is the

area being viewed. By selecting a different area header above, say ‘Administrations’ we see all

the information just about administering the medication show up (see below).

EDM 103

The “History” button shows all the activity of the order from acknowledged, interaction

checking, and documentation of the medication. There is one view, which will show it all in one

place and that is the “Print Order” button.

When you click on this button a box will show to where you wish to print this, if you type in

‘VIEW’ or “PREVIEW in capital letters it will load all the information contained into this area

and you just scroll down to what documentation you wish to see. Here we see the actual

administration of the medication that includes the CDS for the B/P. If you were to look at PCI

that B/P would be there as well.

EDM 104

Section 17: Changing Chief Complaint

Now let’s change the chief complaint. This will also change the assessments on the

Triage/Documentation screen to allow for further charting on a new chief complaint (any

assessments documented and filed will not be deleted). Click on the Chief Complaint on the

Private Tracker or select the edit button next to the chief complaint on the Triage/Documentation

screen.

EDM 105

EDM 106

Hit F9 for lookup or go to private tracker screen and click on the chief complaint of the patient you

are charting on. This will bring up the new complaint box and you can do F9 lookup.

When you find the new complain select it. An update chief complaint screen will appear, click yes.

EDM 107

Section 18: Changing Status Events

Status Events are how we track patient flow.

To manually change a Status Event, use the mouse to click on the current Status Event which is

below the chief complaint on the Private Tracker. This will bring up the Update Status Event

Screen.

EDM 108

Now type in the mnemonic of the status event you want, for example, IR = “in radiology”. You

can also use F9 to bring up a list of status events and select from that menu.

EDM 109

Select the correct Status Event and file.

EDM 110

Section 19: Departure and Discharge Documentation

To complete the DC Disposition screen highlight your patient and click Trg/Doc then click on

DC Disposition. Enter “D” or on your keyboard, or click on the Documentation button.

Type “N” for now appropriate time.

EDM 111

Your cursor will be blinking in a white box labeled “Pain/Comfort Reassessed?” hit Y or N, tab to

Intensity and type 1 – 10, tab to D/C Vitals? type Y or N. If yes then fill in each vital sign box.

Discharge Meds: is free text. Tab over to Pre-Pak # and fill in blank if patient was sent home with

a Pre-Pak. If a prescription was call into a pharmacy tab to Rx called to box and type in appropriate

free text. Click or tab to Discharge Status/ and hit F9 to look up or type in mnemonic. Tab to

Discharged To/, Belongings-Valuables/, Aftercare Instructions/, and Discharged Via/. In each

field hit F9 to look up appropriate response and click. If the patient is admitted to hospital click in

the Report To: field and type the name and title of the person you gave report to and tab over to

time and fill in. The white boxes Equipment Used During Transfer? and Staff Present During

EDM 112

Transfer/ you can use F9 and choose best response. Sedating Meds? Type Y or N and

Transportation Provided By/ is an F9 look up. The Bottom white comment box is free text. When

finished hit F12 to file.

Next you want to depart the patient. From the tracker highlight the patient you want to depart,

click Depart and press “D” or click on the Document button.

Review and confirm what the physician has entered into the screen and file.

When you are sure the information is correct hit the ok and this will take you back to the Depart screen. Click on the Depart button.

EDM 113

EDM 114

The patient is now discharge from the emergency department. Once the charting is complete you

will print one encounter for Medical Records/Billing. To print the encounter click on the Summary

button or double click the patient’s name,

the encounter will come up on the screen. Click the printer icon button and make sure the “print

all” box is checked and print. This should then remove the patient from the Private Tracker to the

Discharged Tracker.

EDM 115

Section 20: Admission Documentation

When the patient is ready to be admitted, you will want to fill out the DC Disposition screen just

like you did on a patient being discharged from the emergency department with one exception. Fill

out the box “report given to” and time report was given and hit F12 to file.

Make sure when you go to Depart the patient you confirm the physician has entered the patient is

admitted to the hospital as inpatient or observation.

EDM 116

EDM 117

Section 21: Documenting on the Wrong Record

If you accidentally chart on the wrong patient you can easily make corrections. Select the patient

from the Private Tracker and click on Trg/Doc. Double click on the Assessment or Treatment that

was charted wrong or click on the (+) to the left of the Assessment/Treatment title. This will

expand the assessment or treatment menu.

Highlight the assessment or treatment you want to undo and click “undo” on the far right of the

screen. You can also type “U”. Click on “yes” to file.

EDM 118

Note, the assessment or treatment that has been undone will not be deleted from the record; it will

turn gray to indicate this documentation has been modified.

EDM 119

EDM 120

Section 22: Editing Records

After you have filed an assessment or treatment on occasion you may need to add or change

information that had been entered. You can only do this if you were the individual who charted on

the patient in the first place. First, highlight the patient from the Private Tracker. Click on

Trg/Doc, double click the Assessment or Treatment that was charted on. You may also click on

the (+) to the left of the Assessment or Treatment and expand the menu. Highlight the Assessment

or Treatment you want to edit and click “Edit/Amend” or hit “E” on your keyboard.

You may now make your changes and then hit F12 to file.

EDM 121

You can now see the record has been edited.

EDM 122

Section 23: Patients Accidentally Departed

If you accidentally depart a patient from the tracker, or make the Status Event “Discharged” before

all documentation is complete it can be undone. First you must back out to the EDM Main Menu.

EDM 123

Click on Patient Routines and a pop up menu will appear, from the list click on “Update Status

Event”.

EDM 124

First type in the patient name and search for the correct patient.

You can see patient Tonka Truck is IN RAD.

EDM 125

To change the status event click in the New Status Event box and hit F9. A menu of status events

will appear, choose your new Status Event and click “OK”.

EDM 126

Section 24: Clinical Review

The “Review” button launches clinical review known as EPS or Extra PCI Database Source.

“Review” allows you to review the latest patient data, for example, results, the patient summary,

order history, PCI, and other visits. Nursing assessments can also be seen here. To launch Clinical

Review simply click the “Review” button on the Integrated Desktop. If you would like to launch

Clinical Review on a patient who is not on the tracker simply use the Magic Key menu by hitting

shift and F12.

EDM 127

When Clinical Review is launched you will see the patients’ demographics at the top of the screen.

On the right of the screen highlighted in red is the Verb Strip, these buttons allow you to navigate

through Clinical Review.

FYI: At the bottom left of the screen you have the option to ask for help , print ,

email , or use the web . You may also launch PCI or Order entry by clicking the buttons

on the bottom of the screen. If at anytime you want to return to the Private Tracker click Patient

List on the bottom of the Verb Strip.

EDM 128

“Pt Summary” shows general information on your patient. ADM/Demographics are also available

here. When clicked you will see the following screen:

EDM 129

“Special Panel” gives access to panels that Meditech has built to cover provider specialties. If labs

have been resulted that are included in these panels they will be available to view. After viewing a

panel use the “Back” button to return to this screen. When the ALL LAB Results button is clicked

in this screen an easy to read lab report is generated.

EDM 130

EDM 131

“Order History” shows details on all the orders that have been placed on your patient. When

clicked you will see the above screen:

EDM 132

“Lab” shows recent lab results. When clicked you will see “lifetime Summary” this will show lab

results from November 2008 to present. Data prior to this date is in PCI.

EDM 133

Microbiology tab will launch microbiology results if the patient had this type of test done.

EDM 134

Blood Bank and Pathology will generate reports if the patient had this type of testing done. If there

are no results to be seen the button will be gray.

EDM 135

The Medications button will generate a report which will allow you to see medications ordered for

the patient, the dose, route, start and stop date, status, and when last administered.

EDM 136

The Imaging tab will launch imaging reports, Other Reports tab will allow you to view many

different kinds of reports, for example, dictations, and Notes History will allow you to see physician

notes which have been filed.

EDM 137

“Assessments” will show nursing documentation.

EDM 138

“Other Menu” is a way of building a panel with I & O and meds or you can launch the Reconciled

Medication screen.

EDM 139

“Other Visits” allows access to data from other visits to the hospital this patient has had.

Information will be available for the other buttons in this screen as tests are completed for those

categories.

EDM 140

Section 25: Patient Care Inquiry

Section 19: Patient Care Inquiry (PCI)

Patient Care Inquiry (PCI), allows you to move into historical data on the selected patient. PCI

provides access to history, lab, radiology, and other data that has been documented on this patient

within our regional hospitals.

PCI allows you to access the following information in a Patient’s Chart:

Orders

Administrative Data

Current and historical medications

Hospital visits (w/abstracts)

Admissions Information Laboratory, Microbiology, Anatomical Pathology, and Blood

Bank

Radiology Exams and Reports

Recent Clinical Results

Ancillary Dept. orders and results

Three important tools help you navigate through PCI with minimal keystrokes:

1. Highlighter Bar

2. Arrow Keys

3. Control Key

Highlighter Bar- horizontal bar that highlights an entry on the screen . You move it up and

down the list of entries using the arrow key.

Arrow Keys- perform the following functions:

*Move the highlighter bar up and down the list of entries.

*Allow you to view the highlighted entry in more detail.

*Allow you to return to the previous screen.

Control Key-allows you to select multiple screen entries on which you want to execute a verb

strip command.

1. Move the highlighter to the entry.

2. Press <Control> (checkmark appears)

3. To select another entry, repeat steps 1&2.

EDM 141

NOTE: For on-line documentation, simply hold down <Shift> and <F8> at the same time. Press

Shift+F8 (documentation key) to view instructions on how to answer a prompt.

On a routine or dictionary screen: On a menu screen:

Press Shift+F8 at a prompt for an Enter a routine number and press

Explanation: Shift+F8 for:

* on how to respond to a prompt * the purpose of a routine

* of the prompt’s function * brief description of the screen

To access PCI from the tracker, highlight the patient you want and type “P” or click on PCI with

your mouse.

That will bring up the PCI screen.

EDM 142

The PCI Identify Patient Menu

After you select PCI from your Main Menu, the system displays the Identify Patient window,

which lists several methods of identifying patients. Use the up and down arrows to move the

highlight bar to what you want to select then right arrow to view your selection.

The PCI Menu lists several methods of identifying a patient in the Identify Patient Window.

IDENTIFYING A PATIENT BY NAME, NUMBER

EDM 143

EDM 144

IDENTIFYING A PATIENT BY SOUNDEX NAME:

This method of identifying patients enables you to identify all patients with a medical record

whose name matches the criteria entered. This feature helps you locate a patient’s record in the

event you are unsure of spelling.

EDM 145

Viewing Data in PCI

Once you have navigated to the correct patient you will be taken to the PCI Table of Contents

screen. This screen provides you with different options use the up and down arrows and place

the highlight bar on an entry to select. Right arrow to view selected entry. The Verb Strip shows

the functions that may be performed on this screen.

PCI uses windows to display patient information in a logical, step-by- step manner, moving from

general to detailed. The Table of Contents displays all information available for a patient. Once

you identify which category you would like to know more about, the ensuing windows provide

increasing levels of detail.

EDM 146

To view data highlight what you want from the table of contents and right arrow to next screen.

EDM 147

You will be taken to the summary window, choose what you want to view and right arrow over

to next screen.

EDM 148

You have now launched to the history screen, right arrow over to next screen.

You are now at the detail window and can view results.

EDM 149

EDM 150

Split Screen Feature

The split screen feature enables you to simultaneously view data from two different sources at

any Summary or History Window. Clinical staff may find this useful when comparing two

different laboratory results.

After you have the summary or history window of one clinical result on your screen,

enter an “S”. The Table of Contents window appears. Select the date source and

highlight the 2nd

item you wish to view. Press the right arrow key twice or after you

right arrow in the table of contents screen enter “S” or click Split. To return to full

screen type “F” or click Full.

Click full to return to full

screen

Click to

print

EDM 151

Printing and Other Verb Strip Functions

Most of the reports in PCI are printed from the History window by selecting the verb command

“P”. A pop up Box with “Print this history report” and “Print details of the highlighted item” will

appear. Make your appropriate selection,

EDM 152

Then choose which printer.

EDM 153

The Bulletin Board is used as a communications tool between clinicians. Information entered

into the Bulletin Board may be viewed by all clinical staff that accesses the patient.

EDM 154

Clinical Highlights is a user defined data source on the Table of Contents where you can group

frequently viewed data on one screen for patients you specify. Entire data sources can be added

or specific entries from the summary window can be added. This feature is user and patient

specific.

EDM 155

Patient Summary will allow you to

quickly access the patient’s

summary.

Click to go over to next screen

EDM 156

Click to view reconciled

medications

EDM 157

Choose which query you would like to view and right arrow over to open Medication Recon

screen.

EDM 158

Viewing Discharge Instructions

Scroll the highlight bar down to “Emergency Department Data” and right arrow key over to next

screen.

EDM 159

Highlight “Pt Instructions” and right arrow over to view.

EDM 160

EDM 161

Appendix A (Chief Complaints)

EDM 162

EDM 163

EDM 164

EDM 165

EDM 166

EDM 167

EDM 168

EDM 169

EDM 170

Appendix B (Assessments)

EDM 171

EDM 172

Appendix C (Treatment Indicators)

EDM 173

EDM 174

EDM 175

EDM 176

EDM 177

EDM 178

References

Agg a b a o S t a c e y, S . A . ( 2 0 11 ) . Em e rg e n c y d e p a r t m e n t m a n a g em e n t

[ E l e c t r o n i c m a i l i n g l i s t m e s s a g e ] . R e t r i e v e d f r om

h t t p s : / / w e bm a i l . p u l lm a n r e g i o n a l . o r g / ow a /

I n l a n d N o r t hw e s t H e a l t h S e r v i c e ( INHS ) , I n i t i a l s . ( 2 0 11 ) . M e d i t e c h

n u r s i n g t r a i n i n g m a n u a l em e r g e n c y d e p a r tm e n t ( e dm ) .

h t t p : / / www. i n h s . i n f o /