Dana Pfingstler, RN
Nursing Analyst
Elk Regional Health Center
St Marys, PA 15857
814 788-8682
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----- Original Message -----
Sent: Monday, April 17,
2006 8:52 AM
Subject: [MEDITECH-L] BMV
without 24 hour pharmacy (Magic 5.4)
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posted in plain text. HTML will be converted to
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Good Morning Everyone,
We are in the beginning stages of BMV and I have a question
for those live with BMV and NO 24 hour
pharmacy coverage.
1. How are you getting
the meds onto the EMAR when pharmacy is not available?
The regular nursing staff have been set up with Enter Med.
They enter mainly one time orders or "simple" med orders.
Our house supervisors have been set up with Enter Orders on
the MAR so they can enter more complicated medications. The sups have
spent time working 1:1 with the Pharmacy staff as the enter order routine has
many fields and is influenced by many variables.
That said - this process is not without it's issues.
We have had instances where the sups have entered orders that the nursing staff
had already entered. There are ongoing discussions between Pharmacy and
nursing on who should enter orders when. Do the staff and sups enter ALL
new meds on a patient during Pharmacy off hours or should they enter only the
meds they will be adminstering before Pharmacy arrives? If all new orders
are entered, then the day shift gets hit with have to re-acknowledge all these
meds when Pharmacy verifies them. If the staff and sups enter only the
medications that they administer, then trying to sign off orders gets
complicated and new meds appear after the staff has reviewed their worklist at
the beginning of the shift. It is less work for Pharmacy to enter an
order themselves than to verify an order placed by nursing.
2. What is your
acknowledgement and chart checking process?
Our process pre-EMAR was identical to yours.
Our process now - the orders are still faxed to
pharmacy. If the sup enters the orders, she usually does that in the
Pharmacy so she writes her notes on the fax. She notes which orders she
entered and which orders were not entered. I don't think
Pharmacy gets a notation from the floor on which meds were entered but they can
see it if they use the Process Patient Activity routine (a routine which leaves
a lot to be desired in my opinion). The Pharmacy now verifies those
orders that were entered by the staff and sups and then enter any new orders
which have not yet been placed in the system.
The difficult ones are the order changes. We have not
given the sups the regular Process Orders screen in PHA - only Enter
Order. The best way we've found to deal with order changes is to enter a
DC Order on the previous order with information in the comment box (order
changed to...). If the only order change is informational ("hold med
if....."), we use Admin Comments to add that info. That seems to
work OK. We use DC order quite often - it works OK but it does keep
creating doses until Pharmacy actually DC's the medication the next
day/morning.
If it is a really bad night with multiple admits/traumas,
etc, the sup can call Pharmacy in to join the fun. We are also getting
the Pharmacy staff set up to receive faxes at home and have a Meditech
connection on their home computer. It saves them the time of having to
come into the facility if all that is needed is order entry.
We are starting to investigate after hours Pharmacy
services.
Our process now is the order is
faxed to pharmacy for entering in the morning. The meds are handwritten on a
MAR and the chart and MAR “noted” by the RN. When we go live
with BMV and EMAR, there will be no paper MAR to write these orders on, and no
off hours pharmacy to enter them into the system.
Any thoughts and help would be
greatly appreciated.
Dana Pfingstler, RN
Nursing Analyst
Elk Regional Health Center
St Marys, PA 15857
814 788-8682
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The information contained in this e-mail is private and confidential and is
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