Barcode Medication Administration Begin Next Exit Tutorial Why Barcode Medication Administration? •Ensures Five Rights are followed: •Right Patient, Right Medication, Right Dose, Right Time, Right Route •Supports medication documentation at the point of care. •Real Time documentation of medication administration. •Will significantly reduce the possibility of giving an incorrect medication, thus reducing adverse drug events. Next Next 1. Exit Tutorial What Barcode Administration is NOT„ It will not: •Replace eMAR, Task List or PAL. (it works in conjunction with these tools). •Replace process for Nurse to identify which meds a patient should be given. •Replace the process of acquiring medications (from Unit Based Cabinets, carts, stock in room, etc). •Tell the nurse what has already been given to the patient. Next Next 2. Exit Tutorial Current State Med Process 1. Open Patient’s Electronic chart. 2. Identifies meds to be administered using eMAR, Task List or PAL. 3. Reviews medication orders (Nurse review function). 4. User suspends application (optional). 5. Gather meds to be given. 6. Re-open patient chart (unsuspend if applicable). 7. Nurse administers medications to patient. 8. Charts medications on eMAR, Task List or PAL. Next Next 3. Exit Tutorial Future State Med Process (New Steps) 1. Get a Stinger Cart (computer on wheels) 2. Open patient’s electronic chart. 3. Identify meds to be administered using eMAR, Task List or PAL. 4. Reviews medication orders (Nurse review function) if needed. 5. Gather meds to be given; Must leave in original package with barcode intact. 6. Select medication administration wizard (MAW). (see page 6) • Scan the patient wristband to identify correct patient. • Scan the medication(s) to be given. • If no errors, nurse administers medication(s) to patient. • Nurse “signs” medication(s) given via the MAW. Next Next 4. Exit Tutorial To Begin: Login in to Cerner as Usual Next Next 5. Exit Tutorial • Open chart and review eMAR and/or Med Task List to identify medications to be given, nurse reminders, and last administration times (i.e. pain medication). • Perform Nurse Review if applicable. When meds are ready to be administered, open patient’s chart click on the bar code icon to launch the Medication Administration Wizard (MAW) Next Next 6. Exit Tutorial You will be instructed to scan the patient’s wristband. Next Next 7. Exit Tutorial The MAW window opens & displays all meds due within a 3 hour time frame, along with overdue meds. PRN’s, Unscheduled and Continuous Infusions will be listed at the bottom of the MAW window. Next Next 8. Exit Tutorial Scan the Medication Barcode on the Label. Next Next 9. Exit Tutorial 2. If the med scanned matches 3. The “Result” column will the order, a blue checkmark also be populated with the will display and the task order details. will become bold. 1. The MAW should read “Ready The “Sign” button becomes to Scan” at the bottom of 4. available. When you sign the the window. If it reads med, it will post to the eMAR at “To Scan Press F3”, click the time the med was scanned – F3 button to proceed with actual time given. Multiple scanning. meds can be scanned allowing Next Next 10. “Signing” at the end. Exit Tutorial Duplicate Tasks: The MAW will attempt to match the correct medication. If the medication is listed more than once, a duplicate warning box pops up and you will need to select which tasked med you are giving and click “OK”. Next Next 11. Exit Tutorial Safety Parameters: The clipboard icon indicates that this medication has at least one safety parameter associated to it. In the example below (Digoxin), you will NOT see the clipboard until you scan the medication. The clipboard is a clue that there are safety parameters that need to be charted. Click on the clipboard to open the charting window to add the safety parameters. Note: Safety Parameters are not mandatory. Next Next 12. Exit Tutorial Required Fields: The blue X indicates that a required field has not been completed. The yellow section will show you the info that is missing. The yellow section is telling you that there is a required field. You can left click ONCE to pull up the charting window and fill in the site. Next Next 13. Exit Tutorial Underdose: The red triangle represents an underdose. The appropriate underdose warning will display. You should be scanning additional medication(s) to get the correct dose. Note: you will be able to sign an underdose. Overdose: The red X, and warning message indicate that the dose being charted is an overdose. You will not be able to sign an overdose. To sign: (1) Click the OK button then either (2) Uncheck and rescan the medication or (3) Open up the charting window and change the dose to the correct dose. Proceed with signing the medication. Next Next 14. Exit Tutorial Multiple Dose for the Same Med, Same Time: eg. Warfarin Using the MAW, you would: 1. Scan the 2mg dose. A duplicate warning 2. Medications may have two orders box will appear. You will choose the 2mg Then click on to provide documentation of the dose and click OK. refresh button. correct dose. The example below shows how this medication appears on the eMAR. The above message will appear asking if you would like to sign. You would click on “Yes”. You would then scan the 5mg dose to total 7mg. Then sign the task. Next Next 15. Exit Tutorial Morphine Ranges MAW – You scan a 4mg syringe, but only want to give 3mg. Duplicate tasks appear and the you will select the 3mg dose. You will get an overdose warning because you are scanning a dose larger than the scheduled dose. Next Next 16. Exit Tutorial Morphine Ranges Continued You will click OK, and would see it is red indicating an overdose. You will need to left click on the resulted med to open the charting window. Note: Med was scanned for 4mg so it populates in that dose along with the corresponding volume. It’s necessary to change the dose from 4 to 3. The Volume does not change to 0.75. You will change that to the appropriate measure. The MAW will update with a blue checkmark, identifying that it is correct and you can then sign it off. Next Next 17. Exit Tutorial Insulin / Bulk & Multi-Dose Vials Scale Insulin Ordered Based Upon Blood Sugar Sliding MAW – You will open the wizard & scan the Insulin vial, which is scanned for 1,000 units. Warning window opens indicating order is a freetext dose. You click OK to acknowledge the warning. Charting window opens & the dose box is blank. You will enter the appropriate dose, units and site and signs task. Next Next 18. Exit Tutorial Insulin / Bulk & Multi-Dose Vials Insulin Ordered With Scheduled Dose (ie. NPH 30 units) Scheduled MAW – You will open the wizard & scan the Insulin vial, which is scanned for 1,000 units. Warning window opens indicating that the scanned dose is not the appropriate ordered dose. The correct dose will be indicated on the warning window. Charting window opens with a strength dose of 1,000 units. You will then enter the ordered dose and site. Sign the task. Next Next 19. Exit Tutorial Insulin / Bulk & Multi-Dose Vials Scale Ordered Based Upon Blood Sugar Adjustment MAW – You will open the wizard & scan the Insulin vial, which is scanned for 1,000 units. Warning window opens indicating “1000 units is a freetext dose. You will click OK to acknowledges the warning. Charting window opens and the dose box comes up blank but required. You will enter in the appropriate dose, units, site & sign task. NOTE: all adjustment scales have a scheduled base dose that is adjusted according to the blood sugar. NOTE: This scheduled base dose with adjustment scale is seen on the eMAR med label. Next Next 20. Exit Tutorial Dual Route – IV / IM, Oral / Sublingual open the wizard & scan the med. You will then need to MAW – You will document the correct route. Open charting window by left clicking on resulted med. Then select correct route. Next Next 21. Exit Tutorial Med that is Scheduled and PRN MAW – When the med is ordered every 2 hours and PRN, there may be instances when the PRN does not appear in the MAW window, and only the scheduled time appears. If you are giving the med as a PRN dose and it doesn’t appear in the MAW, document it from the eMAR. Next Next 22. Exit Tutorial The MAW and Error Messages o If an incorrect wristband is scanned, the system will warn the user. If this happens, click OK and check to see that the patient matches the opened chart. If not, open the correct chart or find the correct patient. . When the med scanned is a different form than the ordered drug. Example: In this case, a solution was scanned which is different from the ordered tab. The system will not allow this result to be charted. Click OK, check order and call Pharmacy. Next Next 23. Exit Tutorial The MAW and Error Messages When the med scanned is a different route than the ordered med. Click OK, check order and call Pharmacy Next Next 24. Exit Tutorial The MAW and Error Messages If the med scanned does not appear on the patient’s profile, the following alert will appear: the scanned medication, Dextrose 5% in Water is not on the patient’s profileit is not on the eMAR, If check to see if the order is on the Med Profile. If it is there call Pharmacy to double check why it is not appearing on the eMAR. If there is no order, make sure you have the right patient Expired Medication and IV solution. Click “NO” and call Pharmacy to inform them you need a med that is not expired. Next Next 25. Exit Tutorial This has been a Tutorial on Barcode Medication Administration If you or your staff require additional assistance, feel free to call the Service Desk at 414-647-3520 or 1-800-889-9677 Next 26.