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Meditech 6.0 BMV Training Manual ED Introduction to BMV Process

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Meditech 6.0 BMV Training Manual: ED Introduction to BMV Process

What is the eMAR? The eMAR (Electronic Medication Administration Record) is utilized to capture and edit documentation for medication administrations in an electronic MAR format, and enable online charting of meds to the electronic chart. The medication history is also able to be viewed in the EMR.

Advantages over current process:

1. When meds are entered through OM, allergy and interaction checking occurs.

2. Rather than med administration documentation being grouped in with all other Interventions as free text, they are in a separate documentation section which is easy to view.

3. All med administrations are easily viewable from previous visits.

4. When meds are entered, they go to the Pyxis machine and show up on the patient’s profile, allowing for easier selection from the Pyxis.

5. If the patient is admitted, all of the meds given while in the ED are viewable on the same MAR the inpatient units use.

Accessing the eMar Highlight the patient name. Click on the Open Chart tab from the column on the right side (or click on the Open Chart icon in the column to the left of the patient name which also opens the chart). Then click on the MAR button from the column on the right side.

Features of the eMar

There are many different colors that will be seen on the eMAR:

Red Text – Identifies overdue schedule of medication, required fields to fill out before

filing, and any Acknowledge status other than Acknowledged

Green Background – Identifies the selected medication

Green Text – Identifies information that has not been filed yet

Black Text in Date Column – Information that has been filed

Yellow Background – Discontinued/Cancelled medication

Grey – Inactive cell

Blue – Generic name of medication

Patient Header

Allergy info appears in red text until acknowledged by Pharmacy. The little “i” next to the patient’s name can be clicked on to open up more detailed information about the data in the header.



Filter button

The MAR can be filtered by clicking on the desired box. Each box will show only the type of med described. Some of the selections may be low lit, meaning there are no

orders that meet the criteria. These can be used together. For example, if user wants to only see Active IVs, the user would check both Active and IVs. If only PRNs want to be viewed, select PRNs. Medications can be given in any of the sort views.

Medication Cell Header

Starting on left column, the fields are as follows:

Start – time med is to start

Stop – stop date/time of med

Status – status of the med – will show Active

Medication (route) – displays the med’s trade and generic name, route, frequency, Rx number, dose instructions, label comments and specific icons that when clicked on display more information. Icons in the Medication Header (viewable in All View) allow user to sort the meds by type:

Those meds with Flowsheet documentation Those meds that are Linked with another med

Those meds requiring Co-signer Titrated

meds

Time – displays times med due to be given during current 24 hour period

Date Column – shows the dates the med is to be given. There is a TODAY column, and you can also scroll to a past/future date (may change parameters to view based on user preferences). Scroll bar over dates is used to scroll back and forth. Grayed out boxes indicate no scheduled dose is due (e.g. meds with future start dates).

MAR Icons Within the medication cell, you may see the following icons:

Associated Data – Data that is attached to the Medication that a Care Provider would want to view before administering (e.g. lab result)

Monograph – Monograph for the Medication can be viewed and printed from the Medication Detail Screen (patient education)

Protocol – Protocol or Taper Schedule for the selected medication



Assessment – Assessment attached to the medication

Co-signer - The particular medication needs a co-signer with administration

Label Comments – This medication has a label comment attached

Special Instructions - Special Instructions may be entered by the user to communicate important information about a particular med (e.g. Patient prefers med mixed with applesauce)

Order Conflicts - Will open a new window showing any order conflicts.

Linked Medication – Indicates a medication is linked with another medication.

IV Titrations – Allows user to sort the MAR by IV titrations.

Footer Buttons

The footer buttons contain different routines the user will need to perform at med administration. Buttons may be accessed for a med if bold; if low lit, it means this function is not available for this medication.

Refresh: This button will refresh the MAR, and any new information that may have been entered while the user was in the MAR will appear.

Change View: This routine opens in a new window giving the user several options to customize their view of the MAR. Can be used to change dates viewable on the MAR (either future or past).

Document: Used to manually document a medication administration

Document unsched: Manual documentation used for administrations that occur between scheduled times (e.g. New order that pharmacy has ordered to start the next day, but a dose needs to be given today also). This creates an unscheduled administration on the med, and does not affect the next scheduled dose’s timing.

Document Assess: Will allow assessment documentation on the med administration (e.g. Stop time on IV infusion).

Detail: Opens the medication detail, which includes order and administration history,

flowsheet, monograph, associated data (such as lab value), and links.

Manual Barcode: Can be used for patient verification with “full documentation” or when

scanning is not used in your department.

Med Review: Used for 24 hour chart check process.

MAR View: The MAR sorts the medications by the time the next medication is due. Scheduled medications are at the top, followed by non-scheduled meds such as PRNs. Default view of the MAR is to View Dates: All, which allows user to see all the upcoming scheduled administration times. Previous administrations are viewable by using scroll bar above dates.



Changing MAR View: User may change their view of the MAR by selecting the

Change View Footer button.

If Next Due is selected, eMAR will show only the next scheduled time administration due in the Time Column rather than multiple upcoming times. The Last Administration column also is now viewable.

Number of days to view for future and past meds can also be changed.

User can save this preference by selecting Save to Preferences at bottom of

screen. Otherwise preferences will go back to default view when screen is refreshed.

Adding Special Instructions MAR users can use Special Instructions to enter any information about a medication that needs



to be communicated to all users. All MAR users as well as pharmacy can enter and remove a Special Instruction.

All Medication cells have the SI icon to enter Special Instructions.

Click on SI icon

A Special Instructions text box will pop-up.

Type in the Special Instructions, then click Save.

MAR now displays the Special Instructions in the medication cell.

To Remove/Change a Special Instruction

Click SI icon.

Remove/change the Special Instruction, then click Save.

Manual Documentation Routine

Selecting a med to document

After opening MAR, click on the medication cell, which will highlight it in green. Then click on footer button labeled Document. By clicking on this button the user is brought directly into the Medication Administration screen.

If a med has a scheduled time to be given, user can also click directly onto the scheduled time, and select Document from the drop-down list. This will also capture the scheduled time as the dose you are giving.



Medication Administration Screen

After clicking on Document, the Medication Administration screen opens. Across the top are tabs that allow for specific documentation of the med. If highlighted in red, then that section has required fields to document.

Admin: This screen must be filled out for any med documentation. The lower portion is where the user is going to record information specific to the administration of the medication. Items required to complete will have an asterisk next to them.

1. Schedule Date – If a med has been ordered with a scheduled time, select the scheduled date and time for this medication administration (if not already selected by clicking on time from the medication cell). A lookup will provide the available scheduled dates/times. PRN meds will auto fill with the word PRN.

2. Admin Date – Enter the date and time that this medication was administered. It will auto-fill with the current time, so user must change time using the drop down if documenting a dose given earlier.

3. Admin User – Will auto-fill mnemonic of user logged on.

4. Enter Administered Dose – Will have asterisk indicating a required field. Enter the administered medication dose in the specified units.

5. Non-Admin Reason – Asterisk will disappear once an administered dose is entered. Used only if this medication was not administered, or administration is being undone.

6. Administration Comments – Allows user to enter any comments relevant to this medication administration, such as Co-signer for Insulin.

Flowsheet: If a med requires additional information to be documented (such as a site or rate), the Flowsheet tab will be highlighted in red text. When selected, an assessment screen will be viewable to allow the required info to be documented. Complete required documentation, and click OK. Additional screens will populate to allow user to enter any additional information needed before some meds can be filed, such as: assessments, sliding scale doses, vaccination screens



Example of Flowsheet requiring Site documentation

Example of Flowsheet requiring IV Rate documentation - **Outpatients and OBS also require the IV Site to be documented on the MAR.

Associated Data: Associated Data is pertinent information from other areas of Meditech

that is attached to the medication. Examples include lab values or vital signs. This information

will show in the Flowsheet tab before filing the med. Clicking on the data title will allow user to

see full history of that data.



Prot/Taper: If protocol or taper instructions are attached, the Prot/Taper tab will also be

highlighted in red text. Click on tab to view the full info.

Monograph: The user can also view and print the Monograph by clicking on this tab.

Spanish and English versions are available.

Links: Allows user to see any linked med orders, including discontinued.



Summary Session

This is a summary screen that allows user to see a list of all med activity to be documented before filing the session.

Once all meds have been selected to document, click OK. The user is then brought to the

Summary Session screen to review all medications scanned.

If a correction needs to be made, user can click on Back at bottom of screen to open eMAR back up and make any corrections by clicking on the green pending dose time and either editing or undoing it.

If list is correct and complete, then click Save at bottom of screen, which will file the documentation.

The user is taken back to the eMAR and the medication displays as given with the time and amount. The medications will reorganize into scheduled med list by chronological order of next time due.

Meds requiring Co-Signer Upon filing the administration of an order requiring a co- signature, the user will be presented with the Co-signer prompt on the Session Summary screen. If more than one med requires a co-signature, they will be batched together with the co-signer putting in their ID and Pin once.



Pyxis Overrides

When a medication is pulled out on override from the Pyxis machine (presumably because it is needed STAT, and cannot wait for it to be entered as an order), an entry is created on the MAR, with .STK-MED in the medication line. Because the entering of the order is bypassed, there is no allergy or interaction checking that occurs. When the actual order is entered (either by the Nurse or the ED provider), there will be a duplicate entry created on the MAR. Each entry requires documentation. One will need to be documented as Given using the Manual Document process. The other will need to be documented as Not Given with the reason as Duplicate Entry. This is not the same as a duplication notification when entering the med through OM, where the user is given a chance to delete the duplicate entry. Reminder: Pulling meds out on override should be used only in emergencies. Remember, the ED nurse has the ability to enter meds through OM, which will put the med on the Pyxis profile. This ensures the med goes through allergy/interaction checking.

Vaccinations:

When administering a vaccination, user enters today’s date in the Today’s Date line on the Flowsheet. The date will then populate to the Vaccination History in the EMR. Injection Site is also required.

Admin tab will also need to be completed. Click on Admin, and fill out the Lot Number and Expiration Date at bottom of screen. The manufacturer and dose will auto fill. If an expiration date on the vial is listed with only a month and year (e.g. June2014), then



enter the last day of the month as the full expiration date (e.g. 063014 or you can use drop down box).

Titrated Medications

Initiation: When a titrated med is ordered (e.g. Heparin, Dopamine), the order will

appear as below, with the Current Dose entered without an amount.

When the initial dose is scanned, the Initial Titration Dose screen will populate. Enter the initial dose, and the system will calculate the mls/hr for the pump to be set at. Click OK to proceed.

Then the Flowsheet will open, showing the initial dose and indicating this is the Start amount. Click OK to proceed with administration.



The Admin tab will auto fill in with the dose in mls. Click OK. This med will also need a co-

signer.

The current dose/rate will then show on the administration cell.



Titration: When titrating med, user can click on the titrate icon under the medication name. This will open the titration screen. Enter the new titrated amount. The mls/hr will recalculate, and Increase or Decrease will be noted. Click OK. Will be prompted to reverify patient and have co-signer sign.

Once filed, the new rate will show on the order and the administration cell.

Documenting a Medication as Not Given

When a user is going to document a medication as Not Given, the user will click in the box

of the time that he/she wants to document the medication as Not Given.

A pop-up box opens with Not Given as an option. Click on it.

A list of Non-Admin Reasons will display



Click on one of the reasons or click on FREE TEXT to free text in a different reason

not available in the look up.

The user is taken to the Admin tab within the eMAR with the Non-Admin

Reason selected in place.

Continue to complete any additional information that is required and click OK.

The user is taken back to the eMAR with a checkmark in the medication cell and a

Not Given in the Admin box.

Click OK and the user is taken to the Session Summary screen.

Click Save and user is brought back to the eMAR with the medication listed as Not Given.

Click on the comment bubble to see the Not Given reason selected.

Outpatient OBS/IV Documentation

A Stop Time for IV infusions must be documented on all Outpatient/OBS patients. When infusion is complete, highlight med on eMAR, select Document Assess footer button, then click on the IV Stop Time Intervention.

* Different

reasons may be

listed than

what are shown

here.



This will open the Medication Assess screen, where the Stop Time can be documented. Click Save. This can only be documented once per administration.

Undoing Documentation

A user can only Undo his/her own documentation. Undoing will reverse any charge created by the administration.

Click on the administration time to be undone. A pop-up box will populate allowing user

to select an option. Click on Undo.

A list of Undo Reasons will display

Click on one of the reasons or free text in a reason, then hit Enter

The medication administration will be undone, and if it was a scheduled dose the

scheduled time will become available on the eMAR to be documented to again.

To view the history of the medication, highlight the medication.

Click Detail in the footer.

View in the Medication Detail box under History to see the Undone Reason.

* Different

reasons may be

listed than what

are shown here.



Editing Documentation

A user CAN edit another user’s documentation. Editing does not reverse a charge.

Click on administered time to be edited. Select Full Edit.

Medication Detail History screen will open up allowing user to select dose needing to edit. Click on desired administration to highlight, then click Edit at bottom of screen. (User can also Undo from this screen)



Make desired change to documentation, and then click OK at bottom of screen.

Activity history will show original documentation, with the edited version right below it.

Administration record will reflect last edited entry as final documentation.

Pharmacy Edits

Users documenting on orders on the eMAR in batch file administration mode are notified of edits to those orders (e.g. dose and status edits) made in Pharmacy during the current session. Upon notification, the user selects from three choices at the bottom of the screen: Proceed and save all administrations, Save only those that were not edited in PHA, or return to the MAR without saving any. This is only applicable when the eMAR has not been refreshed either manually or by an automatic refresh process.



Viewing the Administration History Through eMAR:

Highlight the medication to be viewed.

Click Detail in the footer, or click on Rx icon next to med name.

The user is taken to the Medication Detail screen to view any information/details about the medication.

o Detail gives a quick order view

o History shows any eMAR documentation that has been done o Flowsheet is any Flowsheet documentation such as site admin o Monograph is a medication information screen (may be printed) o Assoc Data is any data associated with that med such as a lab o Prot/Taper shows the Protocol or Tapered dosing of the med

o Order is a view of the pharmacy and MAR documentation

Through EMR:

Open patient chart and select Medications from tabs on right side of status board view.

Downtime

Follow Downtime Policy & Procedure

The downtime will be announced overhead. DO NOT attempt to log-on or use system until it is announced overhead that system is back up.

A paper MAR will be utilized during downtime. Paper MARs are generated by the IS department for unplanned downtime. A planned downtime MAR will be printed and distributed prior to the downtime

ALL medications administered during a downtime must be reentered into the computer using the Document routine by the clinician caring for the patient when the system is operational again. The paper MAR used during downtime remains in the chart as a

Only those buttons that are

applicable to the medication

will activate. Others will be

low lit. A user can Edit/Undo a

medication from the

History page.



permanent part of the record, despite reentering into the eMAR.

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