Bar Code Medication Administration

Verifying Orders in EHR

Objective

• Understand Nursing Order Verification Process in EHR and the Relationship to the Bar Code Medication Administration application

What Does it Mean to Verify an Order?

• Acknowledge receipt of the order• Agree that it is appropriate within the plan of

care• Arrange to have order accomplished

• Transcription when needed• Ensuring meds are entered in such a way that

they will display appropriately in BCMA

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Lab Orders

How can you determine this Ward Collect?

Note:

Ward Collect Labs stay PENDING until specimen received in lab

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X-ray Orders

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Nursing Orders

>> symbol means text order

They go only to Nursing, RT, or clerks

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Nursing Orders???

Should these BE Nursing Orders?

NO!

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Fields To Check When Verifying a Med Order

• Drug• Dose • Units/Dose• Route • Schedule Type• Schedule

• Admin Times• MD• Start date/time• Stop date/time• Special instructions• # of orders created

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Finding the Info in CPRS

• Drug• Dose • Units/Dose• Route • Schedule Type• Schedule

• Admin Times• MD• Start date/time• Stop date/time• Special instructions• # of orders created

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DOUBLE CLICKFor These Three Fields:

Units/dose Schedule Type Admin Times

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Double Click Fields - What’s the big deal?

Where are the Admin Times??

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More Double Click Fields

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What Did the MD Write?

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Which Double Click Field is wrong here?

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Day of Week Orders

May or may NOT show admin times on first look

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Day of the Week Orders

Time MUST be in Details

Another reason to . . . Double-Click!

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RememberTo check the Double Click fields . . .• Units/dose• Schedule Type• Admin Times

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TIMING is EVERYTHING

When can you give the first dose?

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First Dose Rule

• First dose rule—The first dose is always due on the start date of the order. (But BCMA might not LET you give it!)

• For meds due Q 48 hours or LESS OFTEN (more time between doses) the first dose rule determines when the med will display in BCMA

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First Dose Rule in Action

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First Dose Rule Again

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More About Timing…

Is this going to work?

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Remember

• The first dose is always due on the start• date of the order – even though you can’t

give it

• Where this will be an issue . . .• QOD, Q48H, and Q72H orders

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Stop Dates

• Meds good for 30 days (or period as defined by local policy) EXCEPT• Narcotics• Antibiotics

• Doctor may specify a shorter stop date

• (Please note, examples were taken from long term care where 100 days was standard)

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Stop dates

Which are correct?

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Anything Wrong Here?

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Topicals—Where to Apply

P.S. Did you notice the stop date? -28 days!

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How Many Orders Should I See?

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How many orders should be created?

1or2

MD order:Atenolol 25 mg po bid, first dose now

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One Order or Two?

• Know your admin times!

• Is your now dose going to be too close to your first scheduled dose?

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One or Two Orders??

• One-time NOT too close to regular dose• Verify both• Give both

• TOO CLOSE• Call MD to cancel now order OR• Verify both

• Give NOW dose• Mark first regular dose as held

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MD order:Temazepam 15 mg bedtime.

May repeat x 1 if first dose not effectiveHow many orders

should be created?

Two

One Continuous, One PRN

With “cross reference”

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Verifying IVPB Orders

No Units/Dose, No Schedule Type

Why 30

days?

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IVPB Antibiotic Stop Dates

Is the Stop Date Correct?

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ODD Schedules

• Odd schedules are not divisible into 24 hrs• Q18H

• Odd schedules are not divisible by 24 hrs• Q36H

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ODD Schedules

This is a GOOD example

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Two strengths in one dose

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Partial TabletsSpecial Instructions and U/D

Can you really cut th

is tab in

fourth

s?

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Would YOU Verify?

This will NOT be due at 06 & 18

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How About a Little . . .

TEST??!?40

Test Question #1

Needs Special Instru

ctions

½ tab = 12.5 mg

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Test Question #2

Schedule II Meds

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Test Question #3

Before you double click—what’s missing here?

Where is the First Dose Now order?

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Test Question #4

What Time Will This b

e Due?

Is the Schedule Ty

pe OK?

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Test Question #5

How Many Doses Will Patient Get

AND are the units/dose correct?

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Test Question #6

Should this be PRN or Continuous? Can’t be both

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Test Question #7

1. Special instructions needed ½ tab = 12.5 mg

2. Units/dose should be 0.5

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Test Question #8

Pharmacy could and should change

this to before meals times

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Test Question #9

Needs special instructions—where to apply

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I will verify carefully!

I will verify carefully!

I will always always always verify carefully!

I am NOT too busy to verify carefully!

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