Training for BMV/Emar

**Set up prior to training (for trainers)--- Receive a patient onto the Tracker and edit the patients allergies. Go into orders, New Sets (select a provider), Category--- ED MD SETS, select/order EDM TEST MEDS for the test patients.

Training for BMV/eMAR

You will be assigned a test patient. Sign up for this test patient and go to your RN tracker and ACK the medications that have been ordered reviewing the order history.

1) Once all of your medications have been ACK’d please verify your patient (simulated scanning of the wristband) by selecting manual barcode at the bottom of your MAR and entering the patients account number.

2) Once the patient is verified, scan and administer the ordered medications ensuring to edit the correct dose with the administration.

3) Review your administration and save.

Scenario

Please receive a patient into the system and sign up for the patient as you will need a new patient to perform each of these scenarios. Ensure to enter patient allergies as you will not be able to order on the patient until they are entered.

A) Patient arrives via lobby with CC of a right wrist deformity. There is a 2 hour wait to be seen by the MD. You obtain verbal orders for Ibuprofen 400 MG tab, and a wrist film.

1) Enter the orders for the wrist film

2) Scan to order enter the order for the Ibuprofen and administer.

B) Pt arrives via EMS tremulous and anxious. Reports going through DT’s. Verbal order obtained from MD for Lorazepam 2 Mg. The MD evaluates the patient, orders a CBC, CMP, ETOH and a urine tox screen.

The patient soon starts to be in pain, another verbal order is obtained for Acetaminophen 325 MG tab.

1) Scan to order the Acetaminophen

2) Order the studies as if you were the ordering MD using the verbal order source

3) Attempt to scan to order second dose of Acetaminophen. (note you can not scan, manually enter the order as a verbal order under the correct provider)

C) Patient arrives via EMS unresponsive, febrile and hypotensive. CBG of 650 also noted. MD at Bedside orders Insulin Regular 10 units IV times one, Insulin GTT, Levophed GTT and Ceftriaxone 1gm IV once.

1) Initiate RN orders for fever

2) Order the medications that are ordered by the MD above. (note: order strings for the GTT’s will be set up for the ED MD’s—to order for testing…..Levophed is under order sets>IV DRIP MEDICATIONS>VASOACTIVE/CARDIAC DRIPS and Insulin GTT is under CRITICAL CARE ORDER SET > IV INSULIN (not for DKA) for testing only

3) Scan and administer manually the medications (note that the Insulin will require a co-sign)

4) Titrate the Levophed GTT to maintain a SBP greater than 90 using the titration flowsheet (IVF/bag symbol next to medication)

2 hours later the patient’s blood glucose is 34. Verbal order obtained to d/c the insulin GTT and to admin 1 amp of D50

1) Scan to order the D50 and administer.

Items to note

1) Review your documentation on the worklist. Go into the new IV infusion/I&O to view the medications that have crossed over.

2) Allergies must be entered prior to ordering

3) Here you are ordering GTT’s for TESTING ONLY this will not be common practice in the ED

4) Scanning the patients wristband will launch you to the MAR

5) Review the RN order sets in the order set category.