Bar Code Medication Administration Verifying Orders in EHR

Objective Understand Nursing Order Verification Process in EHR and the Relationship to the Bar Code Medication Administration application

What Does it Mean to Verify an Order? Acknowledge receipt of the order Agree that it is appropriate within the plan of care Arrange to have order accomplished Transcription when needed Ensuring meds are entered in such a way that they will display appropriately in BCMA 3

Lab Orders How can you determine this Ward Collect? Note: Ward Collect Labs stay PENDING until specimen received in lab 4

X-ray Orders 5

Nursing Orders >> symbol means text order They go only to Nursing, RT, or clerks 6

Nursing Orders??? Should these BE Nursing Orders? NO! 7

Fields To Check When Verifying a Med Order Drug Dose Units/Dose Route Schedule Type Schedule Admin Times MD Start date/time Stop date/time Special instructions # of orders created 8

Finding the Info in CPRS Drug Dose Units/Dose Route Schedule Type Schedule Admin Times MD Start date/time Stop date/time Special instructions # of orders created 9

DOUBLE CLICK For These Three Fields: Units/dose Schedule Type Admin Times 10

Double Click Fields - What’s the big deal? Where are the Admin Times?? 11

More Double Click Fields 12

What Did the MD Write? 13

Which Double Click Field is wrong here? 14

Day of Week Orders May or may NOT show admin times on first look 15

Day of the Week Orders Time MUST be in Details Another reason to... Double-Click! 16

Remember To check the Double Click fields... Units/dose Schedule Type Admin Times 17

TIMING is EVERYTHING When can you give the first dose? 18

First Dose Rule First dose rule—The first dose is always due on the start date of the order. (But BCMA might not LET you give it!) For meds due Q 48 hours or LESS OFTEN (more time between doses) the first dose rule determines when the med will display in BCMA 19

First Dose Rule in Action 20

First Dose Rule Again 21

More About Timing… Is this going to work? 22

Remember The first dose is always due on the start date of the order – even though you can’t give it Where this will be an issue... QOD, Q48H, and Q72H orders 23

Stop Dates Meds good for 30 days (or period as defined by local policy) EXCEPT Narcotics Antibiotics Doctor may specify a shorter stop date (Please note, examples were taken from long term care where 100 days was standard) 24

Stop dates Which are correct? 25

Anything Wrong Here? 26

Topicals—Where to Apply P.S. Did you notice the stop date? -28 days! 27

How Many Orders Should I See? 28

How many orders should be created? 1or2 MD order: Atenolol 25 mg po bid, first dose now 29

One Order or Two? Know your admin times! Is your now dose going to be too close to your first scheduled dose? 30

One or Two Orders?? One-time NOT too close to regular dose Verify both Give both TOO CLOSE Call MD to cancel now order OR Verify both Give NOW dose Mark first regular dose as held 31

MD order: Temazepam 15 mg bedtime. May repeat x 1 if first dose not effective How many orders should be created? Two One Continuous, One PRN With “cross reference” 32

Verifying IVPB Orders No Units/Dose, No Schedule Type Why 30 days? 33

IVPB Antibiotic Stop Dates Is the Stop Date Correct? 34

ODD Schedules Odd schedules are not divisible into 24 hrs Q18H Odd schedules are not divisible by 24 hrs Q36H 35

ODD Schedules This is a GOOD example 36

Two strengths in one dose 37

Partial Tablets Special Instructions and U/D Can you really cut this tab in fourths? 38

Would YOU Verify? This will NOT be due at 06 & 18 39

How About a Little... TEST??!? 40

Test Question #1 Needs Special Instructions ½ tab = 12.5 mg 41

Test Question #2 Schedule II Meds 42

Test Question #3 Before you double click—what’s missing here? Where is the First Dose Now order? 43

Test Question #4 What Time Will This be Due? Is the Schedule Type OK? 44

Test Question #5 How Many Doses Will Patient Get AND are the units/dose correct? 45

Test Question #6 Should this be PRN or Continuous? Can’t be both 46

Test Question #7 1.Special instructions needed ½ tab = 12.5 mg 2.Units/dose should be

Test Question #8 Pharmacy could and should change this to before meals times 48

Test Question #9 Needs special instructions—where to apply 49

I will verify carefully! I will verify carefully! I will always always always verify carefully! I am NOT too busy to verify carefully! 50

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