Even a standard administration times process does not replace the need for the pharmacist to check previous administrations and exercise appropriate professional judgment. In the example Karen cited, a 0945 administration is well within the allowable "window" for a standard 1000 time. The pharmacist must use Print Order and look to see what has already been done to be able to make a determination on how to proceed with the new order. If you turn the example around, using an order for a dose increase from 40 to 100, it might be necessary to dispense a 60 mg dose to bring the administered total up to 100 mg. If it was a change on glyburide, not only would you need to check the previous administration, you probably need to check the current glucose level to determine if the change is to be executed now or later in the day. When you have the information right at hand, and this is where eMAR excels, there is no excuse for not using it. Bill Whitten Pharmacist Lake City Medical Center Lake City, FL (386)719-9343
________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Monday, January 15, 2007 8:26 AM To: 'Grisanti, Michael'; 'Parker Karen'; [email protected] Subject: RE: [MEDITECH-L] eMAR Hi Mike- It's interesting, the different "views" of this issue: a Nurse and a Pharmacist. As a Pharmacist myself it's been difficult to step into a consulting roll and work both sides, but I've worked hard to climb into the nurse's brain (scary!). The other interesting thing is I know Karen Parker and the workflow at Meadville Medical Center...both Pharmacy and Nursing. Your comment that NUR has the responsibility to question scheduling is where I will add my plug (and Karen has heard it from me a million times): STANDARDIZED ADMINITRATION TIMES. The scheduling of an order starts in Order Entry (PHA, POM, etc.) and the questioning should preside there as well... As Pharmacist and Nurses, are we diligent enough to view the last administration of duplicate/similar drugs? I don't think it's enough to ALWAYS pre-date or post-date an order during entry. The first step is to remove the possible variables; after that it's Medication Use, your HCIS, etc. True Standardized Administration Times is a difficult venue for all, but I think a necessary one. Add in POM (CPOE) - ouch! Be well - Kevin. Kevin McConnell, PharmD. Clinical Consultant (713)480-6810 [EMAIL PROTECTED] www.RPhInformatics.com <http://www.RPhInformatics.com> <http://www.RPhInformatics.com> ________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of Grisanti, Michael Sent: Thursday, January 11, 2007 8:13 AM To: 'Parker Karen'; [email protected] Subject: RE: [MEDITECH-L] eMAR Karen.. We look at the PHA print order and see what doses have been documented as given and schedule the new order accordingly. If the timing is very close to the scheduled administration the nurse may not have documented yet. In that case we would call and inquire. Communication between PHA & NUR is critical. We are joined at the hip now and NUR has the responsibility to question scheduling. I would hope the a nurse would realize that: "gee I just gave a dose of this, do I really want to give another". This hopefully generates some sort of communication. -Mike Michael S Grisanti, RPh Pharmacy Services St Mary's Hospital @ Amsterdam NY 518 841-3834 [EMAIL PROTECTED] ________________________________ From: Parker Karen [mailto:[EMAIL PROTECTED] Sent: Tuesday, January 09, 2007 9:50 AM To: [email protected] Subject: [MEDITECH-L] eMAR We are currently live with eMAR but have a problem when it comes to the entering of new orders. If a patient is on a med like Solumedrol 100mg TID and the physician writes a new order for Solumedrol 40mg TID, how does the pharmacist entering the order know that the patient already received the 10 am dose at 0945. They received the new order at 0950. When they enter the med, they enter it for 10 am and it looks like the dose needs to be given again, therefore an error could be made and the patient could potentially receive 140mg total at 10 am. We need a way for the pharmacist doing order entry to be able to know that the dose was previously given. Any ideas? Thanks, Karen Parker RN, BSN Clinical Informatics Specialist Meadville Medical Center 751 Liberty St Meadville, Pa 16335 814-333-5606 [EMAIL PROTECTED]
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