Documenting on Override Pulls

Override med with MD order present Denotes override pull along with magenta color Hyperlink on BOTH override pull AND MD order Hyperlink on BOTH override pull AND MD order

When you scan the med, the “select and order” window will appear When you scan the med, the “select and order” window will appear. Select the magenta line with correct medication and click Accept

A “link override” window appears. 1 A “link override” window appears. 1. Click the bubble for the overrode med. 2. Click the bubble with the matching order. NEVER click the “Never Link” as this will not make the override pull go away

Now document the administration

The med should fall off the “override pulls” tab in the MAR and under “All” tab should be the medication administered with the “chain link” symbol.

How to properly document an override med with no MD order in an URGENT or EMERGENT situation

* You can locate all overridden medications under the “override pulls” tab in the MAR * You will notice a small icon representing a Pyxis and under Admin Instruction you will see “cabinet override” along with the med highlighted in magenta

Scan the medication immediately upon administration * Scan the medication immediately upon administration. This will ensure documentation of the med in the MAR. * You will notice the magenta color has now become peach and fall under “completed” meds in the All tab of the MAR * More importantly, it remains under the “OVERRIDE PULLS” tab until linked * In the event of an emergency, take note of the medications that were overrode, scanned, and administered and report to physician immediately for proper order placement

Once a proper order has been entered, there will be a hyperlink indicated by arrow above prompting you to LINK TO RELATED ORDER

The “Link Overrides” window follows. 1 The “Link Overrides” window follows. 1. Click the circle next to the indicated time you gave the medication in green. 2. Next click The bubble next to the “Due” time generated by the new order. This will automatically document the med for the original scanned time in step one. NEVER click “This is a one-time order.” It will not clear the med from the override pulls tab. Due : 10/11/14 1230

Congratulations!! You have now officially linked an Override Med with an order. This is indicated by the “chain link” icon indicated by the arrow to the left. Your “Override Pulls” tab should be clear of the medication you overrode

Documenting High Risk Gtts * Heparin *Insulin *Magnesium *PCA

High risk gtts, indicated by a double exclamation point ( *High risk gtts, indicated by a double exclamation point (!!), need to be documented each shift with off-going and on-coming RN.

1. Scan patient. 2. Scan Drip 3. Under the “action” tab, there is a drop down menu. Select “HANDOFF”

A “Dual sign-off” window appears. Verify content is correct A “Dual sign-off” window appears. Verify content is correct. Scroll down. Select Verify. A second RN will then verify.

The high risk gtt is properly documented The high risk gtt is properly documented. Again, this NEEDS to be done with EVERY shift report.

Override Pull Data In one week there were : 68 Override Med Pulls Unnecessary override meds (Tylenol, Oxy, KCL…) 36 Linked correctly (53%) 27 meds unaccounted for Of these 27 unaccounted for meds, SEVEN (7) were narcotics including bottles of propofol/fentanyl Pharmacy’s plan was to call police and begin investigation Our override ability could be taken away

High Alert Gtt Data In nine shifts we had at least 86 high alert gtts Of these 86+ drips, only 5 were properly documented as dual “Handoff” in MAR Per UCH Standards of Care: Heparin, Insulin, Magnesium, PCA require co-sign of these high alert meds Shift to Shift RN Handoff worksheet to be implemented – see sample

Shift to Shift RN Handoff Offgoing RN Oncoming RN 1. All Override Medications reconciled 2. "Handoff" Hight Alert Drips properly *Insulin *Heparin *Magnesium *PCA