WORKFLOW PROBLEM AREAS

Workflow without orders

  1. Verbal order received
  2. Pyxis override to get the med
  3. Go to give med, scan it(someone puts order in right then if possible)
  4. Confirm
  5. When order is put in go in and Choose Not given – already given to address the med.

If Med is not documented at the time of administration:

  1. Then save the container to scan later.
  2. Use containers to remember what was given and verify an order is put
  3. Save and then change the time to actual administration time.

Put plastic bags on cart to save packages in to scan

What to do if armbands NOT available from the armband machine?

  1. Go to another armband machine
  2. Call Admitting
  3. Use manual process and annotate no armbands available until you get an armband.

Transfers from the ED

1. Get report

2. Pt. to transferred in Medipac by Trauma MR on arrival to floor

3. go into CO and pull the IV’s the patient already has orders for by selecting them under New IV (this is a manual workaround only to facilitate ability to take of the patient immediately on arrival to floor and not worry about IVManage – not acceptable as common practice)

4. If patient does not get transferred to 10N in Medipac timely:

a. Scan pt. armband to bring them up in CO.

b. Go to pt. select in CO screen and find them in EMER department. You can document on them there and documentation will come across when patient is transferred.

Isolation patients in nonisolation rooms without a computer in it:

1. For all but airborne isolation patients leave the cart just outside the door with the screen facing in.

2. Skip the first armband scan (only acceptable to skip in this instance and initial transfer),

3. Scan the meds at the cart (save the packages)

4. Go into room, scan the armband

5. Address warnings that come

6. At the confirm screen – give the meds first – then confirm

Airborne isolation patient in a room without a computer in it:

  1. Put a WOW in the room and leave it until patient leave. Wipe it down thoroughly with the wipes on the isolation cart once it is removed from the room.

ADMIN-RX CHARTING TIPS AND REMINDERS

  1. Always scan when you can – manual workarounds should be the exception
  1. Remember not to click on SAVE but scan armband instead
  1. Click on the little blue curvy arrow to back out of administration if you see it is incorrect
  1. Early Admin warning is usually a sign of a “Stolen Dose”
  1. Check the time on the administration in the upper R corner of the med information. – wrong scheduled time shows up – click on the underline med name and select the appropriate schedule, if it does not display it was probably “stolen” – select extra dose in this case.
  1. Pt Refuses to take a medication – don’t scan the med – select Not Given – Pt refuses
  1. Dose given by physician during a procedure – once order is processed, choose Not Given- Given by MD
  1. Med given during dialysis- choose “Not Given-given off unit” (most units dialysis is off the unit), or “Other and annotate”
  1. No Insulin Required- Choose “Not Given-no insulin required”
  1. PRN meds do not show in Admin Screen – you can scan the med and they will then display or go to Med Order screen to see the full list – time last given shows in CO TO DO list at bottom of meds for this pt.
  1. Med won’t scan – reset the scanner!
  1. Troubleshooting tips:
  2. Use the Changes view when sorting out new and modified orders
  3. When scanning a med a getting an unexpected warning such as “No Med Order Found”, Click on the underlined med in Admin Screen to see the detail of the order, is it Active, discontinued, when was the start and end date, order # etc.
  4. Narcotics that expire after 3 days will usually end a little before that – i.e. if order is for q4h PRN, pharmacy will calculate the doses out for q4h and the order will actually end at the last full 4 hours – not at the end of the full 3 days.
  5. When a dose that has an end date reaches the end date, it shows as discontinued when you scan but you do not have a physician order to match this (same as currently happens), it just falls off.

Armband scan goal is at least 95%!Challenge: highest on day is 99% - let’s do 100%!