Bar Code Medication Administration and MAR Resource Manual
Basic Information
Glossary of Terms 2
MAR Summary 5
MAR Summary – Frequently Asked Questions 8
Changing MAR Summary Defaults 9
MAR Tab 10
Glossary of Terms
Care Mobile: Cerner software package that interfaces with PowerChart to allow scanning and charting with a mobile device; the Cerner application used to communicate with the PDA.
Chart not done: used to chart on the MAR, meds that have been omitted based on clinical guidelines, orders (low pulse or BP), duplicate administration (already taken at home), or pt. refusal.
Create an administrative note: used on eMAR (not on PAL) to note patient preferences; displays in Care Mobile.
Cross encounter: patient data from one admission will appear on the next admission’s chart, depending on the tab and search criteria set in PowerChart; medication tasks can carry over to the PAL but not to the MAR or CareMobile.
Diluent: the base solution in which IVPB medications are mixed, such as D5W or NS; when scanned, the meds and diluent are recorded on the MAR and I&O.
Drop down menu selection: the button with a drop down arrow on the PDA used to select patient list or medication list
Drop-down menu list
· Due tasks: currently due meds. Display meds 1 hour prior to
due time to approx 30 minutes to 1 hour after med is due
· Overdue tasks: meds that are past due 30 minutes
· Continuous IV’s: IV ‘s ordered to run continuously
· Sched Meds: due meds and overdue meds.
· Sched Pt Care: scheduled patient related tasks,
such as vitals signs
· PRN Meds: med orders available for administration
as needed
· PRN Pt Care: optional patient related tasks
· Unscheduled Meds: one time meds for which
administration time is not known, such as pre-op
· Resp Therapy: Respiratory Therapists’ med list
· To be Signed: completes charting process; signing occurs
after scanning meds and completing PPID
· Discontinued: a list of discontinued tasks for 24 hours
EMAR: electronic Medication Administration Record.
Enter Orders through Ad Hoc: used to enter Stat and Now orders of floor stock meds; the nurse enters the order so the med and patient can be scanned; the med is given without Pharmacy review, presenting a potential safety issue.
Icon: pictorial short cuts that open specific applications or programs.
Image reader: the scanner part of the PDA (see Scanner)
Indicator: a pictorial symbol that alerts the user to certain information. For example, the eyeglasses indicate that the medication order has not been Nurse Reviewed; the symbol does not open when tapped.
Label: the manufacturer’s packaging or sticker applied in Pharmacy containing drug dose, description and UPC code; also the patient ID band.
Locked MAR: the charting function on the eMAR will be locked (unavailable); all medication charting will be done through CareMobile. The information charted using the PDA will be viewable on the eMAR. The eMAR will be unlocked following periods of PowerChart downtime so that meds may be back charted. Some departments, such as IV Therapy, ED and Dialysis will chart on the eMAR
MAR: Medication Administration Record tab in PowerChart where medication information displays. Synonymous with eMAR
Near code: an emergent patient condition that requires rapid med administration; the nurse administers meds without scanning drug or patient (see Retrospective Charting.)
Not Given: used to chart meds that have been omitted based on clinical guidelines, orders (low pulse or BP), duplicate administration (already taken at home, etc.), or patient refusal.
PDA: Personal Digital Assistant. A hand-held wireless computer that allows the clinician to scan patients for Positive Patient Identification (PPID) and to scan and chart medications in PowerChart.
Tap: selects an option or places the cursor in a field; equivalent to left-click mouse function
Tap and Hold: opens a short cut menu; equivalent to right-click mouse function
1st time login: the first time a user logs into a PDA, the device needs to load settings; occasionally this requires the user to enter his or her password a second time
Load settings: the period of time following login when the PDA readies itself for use
PMAR: paper medication administration record; used during periods of PowerChart downtime.
PPID or Positive Patient Identification: at Munson, PPID includes scanning the patient ID band and asking able patients to state his or her name and birth date.
Range Dose Administration: for orders with a dose range, for example: for Morphine 1-10mg PRN, IVP, the nurse must enter the dose and unit of measure dose.
Reader: the scanner part of the PDA (see Scanner).
Remove: an option to take a patient off a custom list or to remove a medication from the ‘To be Signed’ list (before signing.)
Retrospective charting: back charting a period of time after the medication has been administered; the med packaging is no longer available for scanning; retrospective charting will be done following PowerChart downtime and near-code situations.
Save: the step prior to signing when in a charting window. When saved, the information goes to the “To be Signed” list.
Scanner: the Scan button on the PDA emits the laser light needed for barcode reading; a beep will sound when scanning is complete.
Sign: the final step of the bar coding medication administration process, done after PPID and drug administration; charts the medication in the patient record.
Symbology: refers to the different UPC codes that display on labels; “linear” and “two dimensional” are two of the UPC codes that exist on product packaging.
Task Bar: the bottom bar on the PDA screen
Workflow: tap on Workflow for Exit option
Tasks: tap on Tasks for List Maintenance option
Tasks: a general term used in PowerChart and CareMobile that refers to work or interventions to be done for the patient; there are many different tasks found in PowerChart and CareMobile. Medication tasks are on the PAL and listed in CareMobile (see picture of drop down menu selection above for task examples.)
Time Charted: time the medication task is signed
Time Out: when the CareMobile application is left inactive beyond set parameters, the user is returned to the login screen and presented with the message: “The application has timed out
MAR Summary
MAR Summary is a separate tab within PowerChart that will enable clinicians to see med administration information in a condensed view. It provides:
· A high-level view with easy access to more detail.
· Concise med information, including pending, given, not given, and overdue medications.
Features:
· Reverse Chronological order
· Hovering to display more detail
· Legend of indicators that appear for any order or result
· Links to order or result details
· Use of color to indicate pending/overdue/given/not given
· Ability to change settings (time frame, time columns, sections, IV events) and store preferred defaults
· Ability to filter by section (scheduled/unscheduled/PRN/continuous infusions) and/or by active/inactive orders
MAR Summary:4 Sections:
· Scheduled
· Unscheduled
· PRN
· Continuous Infusions
24 hour intervals
Search criteria:
· 48 hours back
· 8 hours forward (see next page for customizing)
· Selected encounter only
Midnight start-of-day
Color-coding:
· Blue: pending
· Red: overdue
· White: given
· Yellow: given
· Orange border: not given/not done
Hover for more detail:
· Order detail
· Status
· Icon legend
· Administration detail
Customizing:
Click on Navigator button, then select Change Properties
Date Range tab:
· Date
· Column time intervals
Filters tab:
· Sections
· Display inactive orders
Options tab:
· Pending doses
· Continuous infusions
· Save As Default
Note: selecting Infuse (Volume Documented) will display infused volumes charted on I&O on the MAR Summary
Change Interval
· Select number of hours to display in time column
Navigate to sections
· Quickly move to specific section
Changing defaults:
· Right-click on blue search criteria bar
· Select Change Defaults
Hours back
Hours forward
Column Time
Interval
Day begin time
Font size
· Click OK
Scheduled meds
· Displays administered dose and time
· Pending dose time displays
PRN medications
· Multiple doses may list in one cell, depending on column intervals
· Hover on cell to display details
Continuous and Titratable IVs
· Hover on cell to display details for each ingredient
· Allows access to View Details screen
· Infused volume charted on I&O tab displays
Inactive Orders
· Display with gray background
MAR Summary – Frequently Asked Questions
I don’t see a dose that I know was given. / * Change search criteria dates/times* Click the Refresh button
What do different colors/indicators mean? / * Hover to view details including indicator description and medication status
I have to scroll too much. / * Change column intervals to a larger interval
* Change date range
* Click on Navigator button and use ‘Navigate to’ option to go quickly to a section
How do I know who gave a med or IV? / * Hover over cell
Why use MAR Summary instead of the MAR? / * MAR is a high level overview
* MAR Summary provides a more condensed view and more detail than
MAR
* Can filter off sections, change defaults on MAR Summary
How do I know site of injection? / * Hover over cell; if charted will display
Why don’t I see all of my sections? / * Change your Properties to include sections you want displayed
Why can’t I see a pain response? / * Only PRN responses yet to be charted display; once charted, data may be viewed on the Assess flowsheet or the Forms tab
What do I need to do to see IV infused volumes in the continuous IV section? / * Click on the Navigator button and select Change Properties. Go to the Options tab and select Infuse (Volume Documented). Also select Save as Default if you always want to view infused volumes.
Can I change my view to match my unit’s usual shifts? / * Yes. Right-click on the search criteria bar and select Change Defaults. Click the dropdown arrow next to Column Time Intervals and select the desired number of hours. Then change the Each Day Begins At time.
Changing MAR Summary Defaults
1. Go to MAR Summary tab
2. Click Options on the Menu bar
3. Click Change Defaults
4. Make changes
5. Click OK to apply defaults
MAR Tab
The MAR (Medication Administration Record) tab displays a patient’s medication orders and documented administrations for the selected time frame and selected order status’. Medications will display when a Provider has entered the order into PowerChart or Pharmacy has entered them into the PharmNet application. The MAR tab includes scheduled, unscheduled and PRN medications, continuous infusions and a discontinued section.
Time Frame Selection
The MAR tab time frame default is the current 24 hrs and the previous 24 hrs. To change your time frame, right- click on the Search Criteria bar, select Change Search Criteria and enter the desired time frame. You may also select Set to Today.
Order Status Filters
To change the types medication orders displayed on the MAR tab, click Options on the Menu bar. Click Filters. Select or deselect the order status’ to include by clicking in the box.
Navigator and Medication Sections of the MAR
The Navigator on the MAR tab allows you to move within the Medication Section by clicking the various medication categories (the ‘Future’ category is not used). The Medication Section displays the patient’s medications and associated order details. The time frame and filters selected determine which medications will be listed. Administration dates and times are displayed to the right on the same row. The current date and time column is highlighted in yellow.
Medication Section icons
Right-click options in the Medication Order section
The following options are available by right-clicking the medication order:
Administration column indicators - Viewing
Right-click options in the Administration section
The following options are available by right-clicking the medication task cell:
Right-click options for a charted medication
v View Details – Click to view medication and administration details.
v View Comments – Click to view comments.
v View Order Info - Click to view general details of the order.
v Add Comment – Click to add comments.
v Modify – Click to modify charted details.
NOTE: If you modify the date +/or time of a medication that generates a Pain Response task, and the Pain response task has not been completed, the Proposed Modifications window displays:
If the proposed date/time are appropriate, click to highlight and click OK.
The task will then display in the new date/time column. If you click Cancel, the Pain Response task remains at the original date and time.
When the Pain Response task has been completed prior to the modification, the New Response Task window opens.
Click OK. Pain Reassessment form opens. Click the Cancel Charting button.
On the MAR, right – click on the task and select Chart Not Done.
Enter a reason of inappropriate at this time.
NOTE: The charted pain reassessment may need the time changed.
Unchart – Click to unchart a medication. Uncharting will return the medication to its previous status of due, overdue, etc. and mark it as ‘In Error’.
NOTE: If you unchart a medication that has a documented pain response, a warning displays indicating that the pain assessment may also need to be uncharted.
Charting on a unlocked MAR following Downtime
During periods of scheduled or unscheduled PowerChart downtime, medication charting will be done on the pMAR. When PowerChart becomes available the MAR tab will be ‘unlocked’ to allow downtime charting. All medication documentation done on the PMAR will be back charted in PowerChart through the MAR tab or PAL.
Unlocked MAR
Administration Column Indicators
To chart on the MAR tab, click the medication in the Administration column:
The medication charting window displays. Verify information, make changes, complete any required fields and sign.
NOTE: When back charting, verify that the Performed date/time and the Performed by fields are accurate.
Right-click options in the Administration section