scott & white mak

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Scott & White MAKScott & White MAK

Medication Administration Check

MAK

Scott & White Memorial Hospital

Version 1

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Scott & White Memorial Hospital is implementing Seimens MAK system. This application utilizes wireless technology and barcodes to add an additional measure of safety to the five rights of medication administration: right patient, right drug, right dose, right route, and right time.

Benefits of the MAK system

• Decreases Medication Errors

Some of the most common errors in hospitals occur in the medication administration process. Poor handwriting, incorrect transcription, and (or) as well as dispensing medications erroneously add to the problem. This system is designed to enforce the 5 “R”s of medication administration. Medication Administration Check is an administration system, not a documentation system. By identifying trends from MAK reports, processes are being re-designed to help make S&W a safer hospital!

• Decreases Uncharted Occurrences

All uncharted occurrences display each time a user accesses the patient’s MAR. This helps remind the user to document on the uncharted medications. Utilizing MAK prior to shift report to reconcile all medications can eliminate omissions.

• Improves Charting Accuracy

Charting is done as the medication is administered. Flags for required follow-up are automatically added for certain medications.

• Provides Online Drug Information

Drug information from the First National Drug Databank is updated quarterly. This puts the most recent drug information in the hands of the caregivers in a timely manner.

• Defines medication orders that require additional information.

Examples of this function are Digoxin, which prompts for a pulse, and Insulin, which prompts for a blood sugar.

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Medication Administration ProcessMedication Order

Received

Faxed to Pharmacy

Processed by Pharmacy

Medication Released to

PYXIS

Medication Delivered to Nursing Unit

Order Verified by RN in MAK

Medication Scanned Using the MAK Application at the

Bedside

Patient Identified, Then Confirmed by Barcode

Scan

Appropriate Patient Assessment Performed

Charting completed

Follow-up performed and documented if

applicable

Medication Administered to Patient


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Scott & White MAKScott & White MAKEquipmentMobile Workstations: MAK is loaded on each mobile workstation. The wireless carts must be taken to the bedside when administering medications. The one exception to this is in isolation rooms. For isolation rooms, the cart should be positioned outside of the room in the direct line of sight of the caregiver.

Barcode Scanner: The barcode scanner is a key link in the MAK safety check. These scanners are not tied to any specific workstation. Once you sync the scanner to the cart, you may proceed in medication administration.

Rechargeable Batteries: Each scanner has two batteries. Additional batteries are stored on each MAK unit. S&W stongly encourages starting your shift with a freshly charged battery.

Base Unit: Each workstation has a green base unit attached to the cart. Scan the barcode on the base unit before you log in to MAK to ensure that the scanner “talks” to the computer.

Scanner beep does not indicate a correct scan: The beep from the scanner only indicates that the scan has been read. You must look at the screen to verify the scan was correct.

Patient ID Bracelet: Each patient’s ID Bracelet prints out with the MRN number and the case number. The case number should be the bar code scanned to identify your patient in MAK. If this barcode becomes unreadable, make the patient a new armband and discard the old one.

Badge: Each employee badge has a barcode on the back of the badge. This is used in the third security step for caregiver identification. You must have your badge before you report to work.

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MOO !

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Scanner

Keyboard

Screen

Height adjustment

pedal

Supply drawer

with lock

Basket

Brake

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Original “Teal” Barcode Scanners

These wireless scanners “talk” to a certain cart by “syncing” the scanner : scan the base unit on that cart with the scanner. These scanners can be used with any cart that has a base unit. Change the battery at the beginning of your shift to ensure a full charge.Trouble shooting

• Make sure all connections are in place

•Re-sync the scanner to the base unit

•Tag the old scanner. Replace the and resync the new scanner to the base unit

•Change carts and notify the Help Desk: 4-2501. They will request the scanner tag number

“Wasp” Barcode Scanners

The small black and yellow scanner is labeled with a number and can only be used with a computer that has the corresponding label number. The wasp can be placed in a charger that also contains a spare battery.

Trouble shooting

• Make sure all connections are in place

•Check for corresponding label numbers

•Change the battery

•Tag the old scanner, change carts and notify the Help Desk: 4-2501. They will request the scanner tag number

http://aikis.com/redirect.php?id=4245

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Scanning Tips

Hold scanner close to small bar codes and farther away for large bar codes.

Move the angle of the laser (don’t “stare” at the barcode).

Change the distance between the scanner and bar code.

Turn the scanner or barcode upside down.

Click on another med and back on the med you want, then scan.

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MAK LoginMAK is located on the Desktop of each wireless workstation as a icon.

Once you open the application, a Login ID and Password are required. Following the Login and Password, you will be prompted to scan your badge.

* If you forget your password contact the Help Desk at 4-2501.

Med Admin Chk 23.4.10.LNK

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Security

• Each MAK user is responsible for safeguarding the security of their individual login, password and badge.

• S&W has security measures in place to keep your information confidential. If you think someone knows your User ID and Password, you must contact the Help Desk at 4-2501.

• If you lose your badge, you must report it to Human Resources so that a new one may be issued.


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The first time you sign in, you will enter the Login ID in both boxes

You will then be directed to enter your own password: make it something you will not forget!!!

MAK icon

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Scan your badge.

The default is your SS# or employee#: this will be reported as an override.

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Click on

Location Census

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Choose your unit.

This will become a default.

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A list of your unit census will appear by order of room number.

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Hold the “Ctrl” key down and click on all your assigned patients.

These will be highlighted in black.

Select “Add to Personal”.

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Next, click Cancel

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Select “Chart-Select Patient by Census” from navigator or New Patient List

Select “Personal Census” from the New Patient

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Select All

You must choose this to embed your

patients.

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Chart - Select Patient by Census

This will bring the patient meds on screen.

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Here’s what it looks like!

The MedSummary is the default screen if there

are orders to be verified.

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Screen Layout and Windows Functions

Minimize (-) : Removes window from view and places it on the Taskbar.

Maximize : Returns the window to full size. Close (X) : Closes the window and removes the application from the Taskbar.

Title Bar: Contains the names of the user, patient, and hospital. By double-clicking on the title bar, the size of the window will decrease. Repeating will make the window return to the original size.

Scroll Bars: Both vertical and horizontal. Move the bar or use the arrows to scroll through the patient window

Tabs & Buttons: Selecting tabs “turns the pages” of the screen. Buttons complete or request a function.

Column Name: Clicking on any of the cell names in the column will re-sort the rows.


* Right click on the screen to refresh the display.

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System Window and Terms

Patient Header: Contains allergies, and room number.

Navigator: Provides a list of options allowing you to “navigate” through the system.

The Log off button returns the user to the log on screen. Any time you leave the mobile workstation unattended,you must log off.

To hide or show the Navigator: Go to Navigator and click Show Navigator or Hide Navigator.


Screen Security• Minimize the screen if someone approaches

you while charting.

• Never walk away from a patient screen.o Log Out First!oDo Not minimize or Turn off the ScreenoOthers could pull the screen back up and look

at information under your ID or enter data.

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MAK List of Symbols

Order pending verification by Nurse

One time dose not reviewed by Pharmacy

Condensed text

Order returned to the pharmacy for clarification

Follow-up required

Discontinued Medication

Expanded view of text

Additional data present

Error

Order requires countersignature


You can determine what each symbol means by placing the cursor over the icon and reading the “Tool Tip”

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This tab on the far left is the Active Worklist.

This is where medication administration occurs.

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Rapid Allergy and Height/Weight Entry

Rapid entry of allergies and height/weight information is more important now than it has ever been. With a medication administration system that performs safety checks on each drug administration, the sooner this information is in the computer the safer we can be as an organization.

Enter this data quickly!

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Diagnosis Information crosses over from Invision.

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The “Lab Results” folder provides a quick view of selected lab results.

Only the most recent lab results display.

All official lab results will always be posted in Invision.

Abnormal lab results are noted with the yellow triangle icon.

Go to SoftLIS for more results and detail.

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The “MED SUMMARY” Folder lists all current medications including those that are new or discontinued.

When a patient has new orders, the “MED SUMMARY” is the default screen.

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Med Summary Folder

On-line verification of medication orders occurs in this folder. The order will have the red tipped pen icon. Unverified medication orders cannot be charted as administered.

On-line Verification

Medications should be verified as soon as possible after the order is written. Similar to “signing off orders”, Verification produces a “signature” by the RN proving that the order is correct as entered. On-line verification should be done with the physician's order in hand.


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If the order is correct, select the “Verify” button.

Click on “Verify All” and the system will automatically go through all orders pending.

Verify Orders

If the order is not correct, select the “Intervention”

button

If you are unsure “Skip Order”

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Rx Message

Goes to your unit Pharmacist

Include your ASCOM phone number so the Pharmacist can contact you for any questions.

Contacting Pharmacy for non-emergent

needs

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Cumulative Dose – monitors medications that have Dose Limiting Toxicities (DLT’s) such as chemotherapy.

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Any orders that are not verified (Interventions) will be listed.

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Meds that have been given.

Use the scroll bar in each section to see further information.

Note all the buttons at the base of the screen.

The Charted List is All Powerful!

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The Active Worklist

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Active Worklist FolderThe ACTIVE WORKLIST displays a list of current, active, and uncharted medications within a specific time range. You can adjust this time range by selecting the expand list option on the screen. Medications due within the original time frame display in white. Active by not yet administered medications greater then two hours display in PEACH. PRN medications display at the bottom of the screen.

Charting FunctionsThe following functions are available in the ACTIVE WORKLIST folder:

ADMIN - Medications are automatically charted as administered unless the user specifies NOTADMIN

NOT ADMIN - Document when medications are NOT given (BEWARE!)

BARCODE OVERRIDE - Use if there is a problem with a barcode scanning properly and it cannot be read by the barcode scanner

ENTER NOT ADMIN REASON - A drop-down menu is available to chart the reason that a medication is not administered. This field will also allow the user to document free text

ENTER ADMIN SITE - A drop-down menu is used to document administration sites. These are typically used for injections

ENTER REASON - A drop-down menu is used to chart the reason a PRN medication was given

DETAIL - Details the selected medication order

ID PATIENT - Scan the barcode on the patient identification bracelet. MAK verifies that the right patient is receiving the meds

CHART - Use to complete and store charted data

CLOSE - Closes the patient window and returns to the navigator functions

RX MESSAGE - Allows the user to send a message to the Pharmacy

EXPAND LIST - Allows the user to change the “date/time” window to view more data


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Active Worklist defaults to a 3 hour view.

You can Expand List to see your entire shift.

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Night Shift can expand to the next day.

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Expanded view of Scheduled Doses

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Navigator:

Provides a list of other options within the system

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Chart – Pharmacy Review Pending by Census

Allows you to enter verbal orders that are STAT medications. You become the pharmacist!

This eliminates a safety check. These are one-time meds only. Subsequent doses should be entered by Pharmacy

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RX Drug Inquiry

A rapid method of obtaining up to date information about medications.

Updated quarterly from the National Drug Databank, the Drug Inquiry data includes indications, contraindications, side effects, drug-drug interactions, food-drug interactions, and education monographs in English and Spanish

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Click on “Report” to print the information

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Print MAR/IVAR if the patient is going to a non-MAK area such as surgery, MRI, Interventional Radiology, etc.

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Click Navigator – Hide Navigator to close this column.

Click the Maximize icon to restore your view to full screen.

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1. Override Barcode

2. Rx Message

3. Detail

4. Not Admin – the med will be eliminated from this view.

• Do not use if the med is on hold or the patient is off the floor: eg. Surgery.

• Use for meds that will not be given at all: eg. Digoxin when the pulse is <60.

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Administration Process

• Select the name of the patient

• Select the drug you are going to administer

• Scan the medication with the barcode scanner

• If four (drug, dose, time, route) of the five rights are met, the medication line will change to green and a green check mark will appear next to the medication

• Repeat for each medication you plan to administer at this time

• If any of the rights are violated, a red x will appear next to the medication and the line will turn red

• Once all medications are correctly scanned, select the ID PATIENT button (drugs may be scanned in the hall or at the bedside)

• Scan the case number on the patients armband. MAK will determine if you are giving the meds to the right patient.

• If no errors are present, administer the medications

• Enter any additional required data

• Select CHART


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Click on the med – black highlight appears

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Scan the med.

The correct med will be highlighted in green and have a green check in the column.

A “beep” does not mean that the scan is correct! You must SEE THE SCREEN.

If a med won’t scan, click elsewhere on the screen, then click back on the desired med and scan, again.

The black highlight will automatically move to the next med for scanning. Scan the next med.

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The wrong med = Big Red X!

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Re-Highlight and scan the proper med.

Some medications will elicit pop-ups with extra information.

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Insulin requires another nurse to look at your dosing. If it is correct, scan their badge.

Override if no other licensed staff: eg. Santa FE

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You must click on “ID Patient” next.

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Do what it says!

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An incorrect scan would show that red X.

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Extra boxes appear at the top of the screen.

The system will not let you proceed until required data is entered. (yellow box)

The system will not allow you to progress if these are empty.

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You MUST click “Chart” for the medication to

be documented.

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The medications

are now on the Charted List.

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PRN Medication

s 1. Highlight the med

2. Scan the med

3. Scan the ID band

4. Enter Data

5. Chart

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Don’t forget Chart!

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I forgot to enter Pain Scale and Pain Location!

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Enter Pain Scale number and choose the location.

You may text in a limited number of characters.

THEN Chart!

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Now a red star and 30 minute follow-up reminder appear.

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Click on the red star, fill in the blanks and Chart.

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From the Charted List, you can Revise data, time, etc.

You can, also, document Effect, Not Admin, etc.

You can even give a Not Admin med from this screen.

The Charted List is all powerful!

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Now there is History behind the Insulin NPH-dose

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Click on the blue Hx and scroll over to see the change.

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Override!

Pharmacy Review Pending

And

We’ll override the meds!

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Calculate

Choose Route

Choose Site

Date and time

Chart Reason

ID Patient

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Override options for

ID band.

And

CHART!

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These meds show up on the DC’d list as “one time” without a corresponding order in the system.

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Charting “Not Admin”

This function is utilized to document medications that have not been administered. Meds that will not be given or a patient refusal of a medication would fall into this category.

Select the correct medication

Select NOT ADMIN

Enter NOT ADMIN reason

If NO, Select chart

Other medications or fields?

If YES, Continue


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PRN Medication AdministrationThe primary difference in PRN medication administration is use of the ‘Reason’ field. For all PRN medication administrations you are required to enter a reason. By combining the use of the vital signs options and the drop down box under ‘Reason’, you can document most if not all of the vital data we used to document in progress notes.

In this example, Tylenol was ordered for a temp > 101. Charting was accomplished on this page by adding the patient’s temperature and by citing ‘Vital sign out of parameter’ reason.


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Charting a Follow-upAll PRN medications should have a follow-up. Users can access follow-up in one of three ways. From the navigator you can select ‘Chart Follow-up Inquiry’ or from the Active Worklist, you can select the medication. This will be flagged with a red star icon . After selecting the medication, a window will pop up prompting you for the required information.

Charting follow-up can be done voluntarily from the CHARTED MEDS folder. Select the medication occurrence. Select ‘EFFECT’ from the bottom of the screen and document the follow-up. Remember to chart the appropriate information. If you gave a medication for pain, your assessment should include a pain score. Don’t forget to select ‘CHART’ when you are done.


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Miscellaneous Scanning the barcode

Always attempt to scan the barcode before you assume it does not work. A barcode that does not work one day may work the next. Pharmacy is working on a daily basis to correct any barcode issues.

Before you override, click on another medication and then back on the one that you want. Rescan.

Replace the armband if it does not scan.

HIPPA

Do not walk away from a screen with patient information. You can minimize if someone is speaking to you and you stay at the ‘cow’.

If you must walk away, LOG OFF!

End of shift

Review the ACTIVE WORKLIST to confirm that you do not have any uncharted medications or any unverified orders.

Review the CHART FOLLOW-UP INQUIRY to ensure you do not have any uncharted follow-ups.

Log out!

Downtime

Planned vs. Unplanned: paper MAR’s can be printed by the clerks from other sources.

When downtime is over, meds will be charted as administered using the barcodes to override. The revise reason and charted reason will be documented, also.

It is imperative that you CHANGE THE CHARTED DATE AND TIME!


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Scott & White Unique Situations MAKScott & White Unique Situations MAKMedication Situation Action

Sliding Scale Insulin No insulin required -Choose Insulin-Chart as Not Admin-Enter CS= in “Reason” Field

Heparin DripInsulin Drip

Change in rate required -From the Charted List, select the bag of heparin or insulin that is presently hanging-Choose Revise-Leave the Charted date/time as is, the revision time will appear in MAK-Revise Reason, drop down box to APTT= or CS= Enter the value-Charted Reason, drop down box to rate increased or decreased to and enter new rate.

Any First dose given on a non-MAK unit

-Document the dose as ADMIN-In the reason field, chart “Given in a non-MAK unit”

All Patient is on isolation -Scan medications outside the room.Position the cart in the doorway to provide line of sight. Scan the patient’s armband. Once you leave the patient’s room wipe down the scanner with a germicide wipe.

Home Medications Patient taking home medications -Nursing charts as ADMIN-Enter Home Med Taken in reason field.

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Medication Administration Record Discharge

11/05/2003 14:22 DISCHARGE MEDICATION ADMINISTRATION RECORD PAGE: 1 OF 12 Scott and White Memorial Hospital

PATIENT NO: 1108513 NAME: DUCK, DAFFY DSCH LOC: 006B/060801MED REC NO: 103843 AGE: 51Y SEX: M

ATN DOCTOR: FRANK, DONALD A ADMIT DATE: 10/31/2003 DSCH DATE: 11/05/2003

*** MEDICATIONS CURRENT AT THE TIME OF DISCHARGE ***

*** SCHEDULED MEDICATIONS ***

ORD# 7 CEFTRIAXONE 1 GRAM(S) = 1 VIAL (ROCEPHIN) IV Q24H Q24H RECONSTITUTE WITH 10 ML SWFI AND INFUSE OVER 3-5 MINUTES START: 11/04/03 16:00 STOP: Nrs Verified By: JAW 11/04/03 16:00 NOTADMIN JAW at: 11/04/03 16:05 Charted Reason: Dc'd by MD

ORD# 7 (REVISED) CEFTRIAXONE 1 GRAM(S) = 1 VIAL (ROCEPHIN) IV Q24H Q24H RECONSTITUTE WITH 10 ML SWFI AND INFUSE OVER 3-5 MINUTES START: 11/04/03 16:00 STOP: 11/04/03 16:03 Nrs Verified By: JAW **** NO OCCURRENCES CHARTED ****

ORD# 12 ATENOLOL 25 MG = 1 TAB (TENORMIN (EQUIV)) PO GIVE 25 MG STAT THEN 12.5 MG Q Q 12 HOURS START: 11/02/03 08:04 Nrs Verified By: WIJE 11/02/03 09:00 ADMIN WIJE at 11/02/03 09:13 Pulse: 110 BP: 108/54 11/03/03 09:00 ADMIN MAC at: 11/03/03 09:25 Pulse:148 BP:98/56 11/04/03 09:00 ADMIN JAW at: 11/04/03 08:45 Pulse:68 BP:120/68

Medication, instructions, and order number

Verification and administration information


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Medication Administration Record - Net Access

The browser enabled MAR is viewed through Net Access. Real time entries can be reviewed including effectiveness and associated vital signs. The view of this MAR can be expanded to the level of detail desired.

Moving the mouse to the date and left clicking will bring up only medications administered for that day and provide greater detail. Moving the mouse over the drug and left clicking will bring up detailed data for individual drug administration over multiple dates.


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Problem resolution

Application Charting or use issues

Question or Problem with the System

*Type of Problem*

Notify Core Trainer if available

Medication questions for the

pharmacist

Barcode scanner

Battery charged? Re-

sync done?

Printing problems

Call Pharmacy

4-3815

If unable to resolve, Contact the Help Desk at 4-2501

User ID- Password issues

Help Desk 4-2501


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•The Med Summary will LOCK orders currently being Verified by another

nurse.

•Orders requiring Verification will be locked.

•Another user can access the Active Worklist and administer any meds that have been Verified.

•Orders requiring Verification will only LOCK if the nurse signing on has the authority to verify orders.

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•The Active Worklist will LOCK orders requiring Verification if currently opened by another nurse.

•You can see the User ID of that other nurse by moving the column border. Or you can double click on the grey area and it brings up a box with the user and the pc they are on.

•Any Verified meds can be administered while another nurse is Verifying new orders.

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•If another nurse is currently administering a medication on this patient, it will be LOCKED.

•This will prevent two users from giving the same medication.

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•The Charted List will LOCK to prevent two users from revising the same charted occurrence at the same time.

•This will not prevent another user from accessing the Med Summary to verify orders.

•This will not prevent another user from accessing the Active Worklist to administer medications.

The column border can be mover over more to display the ID# of the computer being used.

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The Chart-Pharmacy Review Pending function will not lock or error out .

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• MAK users must Log Off the system when

charting is completed.

•This will prevent other users from being locked out unnecessarily!

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• MAK users must Log Off the system when charting is completed.

•This will prevent other users from being locked out unnecessarily!

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Computer Lab

•Take advantage of the lab time to use the Test System.

•Make sure that your ID works.

and

•“Let’s be careful out there!”

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