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eMAR barcoding tutorial PowerPoint Presentation Open order

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					Barcode Medication Administration

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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.




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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.

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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.
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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.
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To Begin: Login in to Cerner as Usual




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•   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)




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You will be instructed to scan the patient’s
                   wristband.




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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.
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Scan the Medication Barcode on the Label.




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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
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                                    10.        “Signing” at the end.
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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”.




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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
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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.

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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
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 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.



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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.




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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
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   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.




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    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.



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    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
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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.




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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.




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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.

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The MAW and Error Messages
When the med scanned is a different route than the ordered med.




               Click OK, check order and call Pharmacy




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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.

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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

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Description: eMAR barcoding tutorial PowerPoint Presentation Open order