We are Magic 5.5 SR2 and are still rolling out house-wide. Pharmacy is open 24/7. ED has been held off for now as we're also implementing EDM and will roll out e-MAR and possible BMV at that time. We use dispensing machines for PRNs and controlled substances. Nurses can override certain drugs, but we have intentionally suppressed the dispensing machine orders from showing on the e-MAR. We feel this is a major safety issue that gives the nurse a false sense of security that the order was either reviewed by pharmacy already or went through computer 'decision support' processes, which it hasn't. We chose the Enter Med (EM) routine route for documenting override orders. We didn't like the idea of nurses doing a lookup into the PHA drug dictionary, so with Meditech's help, we wrote a rule that only allows the EM routine if the drug is scanned through BMV. That way we know they are actually creating the order for the med that they are actually giving. The nurse also gets order entry warnings (allergies, duplication, interactions, etc) before giving the drug. All EM orders by nursing/RT are unverified. We allow UNV orders on the nurse's e-MAR, so it seems this process would also work for facilities that are not 24/7. Every order is verified (VEC) by pharmacy. If it is a 1x order, it just goes to dc after it is verified, otherwise the pharmacist edits the order to match the physician order if the nurse did not enter it correctly. Personally, I'm surprised that JCAHO hasn't picked up on what we consider to be a hole in the BMV process by charting against dispensing machine override orders. I know we are in the minority with how to handle this situation. Certainly, allowing the dispensing machine orders to flow to e-MAR makes the process much smoother for pharmacy and maybe nursing, but does it really meet the intent of pharmacy order review in regard to patient safety? Comments? I suspect I've may have hit a nerve on this one. Jeff Lee Assistant Director of Pharmacy, Support Services DCH Regional Medical Center 809 University Blvd E. Tuscaloosa, AL 35401 (205) 750-5323 [EMAIL PROTECTED]
The information contained in this e-mail message is confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. ________________________________ From: Burgos, Gloria [mailto:[EMAIL PROTECTED] Sent: Friday, April 13, 2007 7:01 AM To: Jeff Lee Cc: Burgos, Gloria Subject: RE: [MEDITECH-L] eMAR - Verified/Unverified Meds do your nurses enter in med orders as verified without Pharmacy verification? Does your pharmacy ever have to verify the order? How do you meet JCAHO requirements for 24 hour review? Is this system used in the Inpatient and ED at your facility? Are you a C/S or Magic facility? Thanks in advance, Gloria Burgos, PMP Halifax Community Health System Daytona Beach, FL ________________________________ From: [EMAIL PROTECTED] on behalf of Jeff Lee Sent: Thu 4/12/2007 8:58 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: [MEDITECH-L] eMAR - Verified/Unverified Meds You could use the Enter Med routine from e-MAR. The nurses would have to have PHA access to enter Verified Orders since you are suppressing them from e-MAR. I believe you could use the new 'Conflict' settings to still queue these orders up for pharmacist review. If there was an error in order interpretation, etc but the dose was administered, the pharmacist could discontinue the order with a reasonable explanation why it is being discontinued and re-entered. We use Enter Med for this scenario but leave their orders UNV and show these on the e-MAR. In the case that there was an error, the pharmacist still has to verify the order and they didn't feel comfortable with this at first. We have them say something like 'verified dose was given' and then edit or re-enter the order. The patient did in fact receive that medication/dose. We were looking for a phrase that wasn't too critical or would draw undo attention. Jeff Lee Assistant Director of Pharmacy, Support Services DCH Regional Medical Center 809 University Blvd E. Tuscaloosa, AL 35401 (205) 750-5323 [EMAIL PROTECTED] The information contained in this e-mail message is confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Monday, April 09, 2007 12:14 PM To: [EMAIL PROTECTED] Subject: [MEDITECH-L] eMAR - Verified/Unverified Meds We are firmly entrenched in eMAR maddness here and are trying to look at medication process/workflow. Recently we had a custom moved in that would restrict all unverified meds from going to the eMAR to prevent nursing from administering medications that have not been reviewed by a pharmacist. We have however found a flaw in the plan. If the physician writes a stat order, the nurse gives the medication (because it is an emergent drug that they can overrid in the dispensing machine), but pharmacy refuses to verify the medication without making a change because they feel it is not appropriate. How can the nurse document exactly what they gave, when the medication will not be on the eMAR, or the dose on the eMAR may be different than the dose they gave. (We are also not allowin nursing to use the adjust dose functionality). I know other sites have this custom and are using it, anyone out there have any ideas? Thanks as always for your insite! Danielle J. Peppard RN Clinical Systems Consultant for Berkshire Health System ________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com <http://www.aol.com?ncid=AOLAOF00020000000437> . ________________________________ ** Confidential Information ** The Information contained in this email message is confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. ** Confidential Information ** The Information contained in this email message is confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited.
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