Meditech really missed the ball on IV documentation for e-MAR and I
haven't heard that they are working on any solution either. We chose to
use a CDS to document rate changes and titrations. We thought about
documenting this in NUR intervention, but we wanted to keep all the
documentation in e-MAR
Here is our solution:
1. Scan when hanging new bags, using the next schedule time
2. Full Doc a non-scheduled dose for rate changes, given 'No'
3. CDS example from POV:
ADMIN DT TM USER GVN BTL SCAN REASON CODE DOSES
ITEMS
03/13/07 1224 NS.xxxx Y N 1
1
(03/13/07) (1100) DOSE: 1000 MLS
IV Rate (mls/hr): 50.00
Rate Changed N at- Reason*
03/14/07 0547 NS.yyyy N N Admin Commen
(03/14/07) NON-SCHEDULED
IV Rate (mls/hr): 75.00
Rate Changed Y at- 0545 Reason* Rate Change
In this example, the bag was hung at 50 ml/hr on 3/13 @ 1224. It
infused until 3/14 when the rate was increased to 75 ml/hr @ 0545.
This is not a perfect solution, but it has been working for us in
Med/Surg and Critical Care (including neonatal ICU). One of the issues
is that e-MAR rate changes reflect everywhere (e.g. PCI) that the doses
were 'not given'.
A corresponding change that we made in PHA for titration is to use IV
order types that are dispensed by DURation instead of SIG. This allows
us to use Edit Rate (ER) to edit the IV rate and edit the Duration field
(which drives the next dispenses). Meditech allows us to edit a
duration of an IV but not the SIG (sig is irrelevant for order types
defined by DUR). Prior to e-MAR, we did not use Edit Rate but just used
Copy & Edit (CE) whenever rates changed. CE works better for pharmacy
(cleaner dispensing process), but it breaks up the audit trail for e-MAR
so badly that it is hard to see what has been happening with the
patient. Now we try to retain one IV order as long as possible.
Jeff Lee
Assistant Director of Pharmacy, Support Services
DCH Regional Medical Center
809 University Blvd E.
Tuscaloosa, AL 35401
(205) 750-5323
[EMAIL PROTECTED]
The information contained in this e-mail message is confidential
information intended only for the use of the individual or entity named
above. If the reader of this message is not the intended recipient or
the employee or agent responsible to deliver it to the intended
recipient, the reader is hereby notified that any dissemination,
distribution or copying of this communication is strictly prohibited.
-----Original Message-----
From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf
Of Roberta Laurimore
Sent: Friday, March 09, 2007 8:07 AM
To: [EMAIL PROTECTED]; [email protected]
Subject: Fwd: [MEDITECH-L] Titration of Meds and eMAR
We have been up for over 3 years with the eMAR. We currently have the
nurse document in the eMAR when they hang the drug to be titrated. We
set the schedule for the bag to changed to either Q12H or Q24H. After
the bag is hung the nurse documents the titration itself in the NUR
module in a Titration Intervention with a CDS. We charge on
documentation in the eMAR. This made documenting the titration in the
eMAR difficult to figure out.
This process seems to work for us.
Roberta Laurimore, RN
Clinical Analyst
Culpeper Regional Hospital
540-829-4359
>>> ~BulletinBoard 3/9/2007 8:53:18 AM >>>
** Confidential Information **
The Information contained in this email message is confidential
information intended only for the use of the individual or entity
named above. If the reader of this message is not the intended
recipient or the employee or agent responsible to deliver it to the
intended recipient, the reader is hereby notified that any
dissemination, distribution or copying of this communication
is strictly prohibited.
=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=
To subscribe or unsubscribe to the meditech-l, visit MTUsers.COM.
To check the status of the meditech-l, visit MTUsers.NET.
For help, email [EMAIL PROTECTED]
______________________________________
meditech-l mailing list
[email protected]
http://mtusers.com/mailman/listinfo/meditech-l
