1. Tulare Regional Medical Center Educational Services
Medication Administration Record View Only for
Clinical Suite (MS4)
Why do I care about the Electronic MAR in Clinical Suite?
View Only (Not for Documentation at Time of Administration)
March 12, 2012

2. Medication Administration Record View Only for Clinical Suite (MS4)
Why do I care about the Electronic MAR in Clinical Suite?
Overview:
Welcome to our online module on how to view the MAR in Clinical Suite (MS4). This module is a must for all TRMC Physicians/Providers, RN’s, LVN’s, Nutritionists, Respiratory Care Practitioners, Case Managers, and Physical Therapy. The intent of this module is to assure all the above listed employees are well versed on how to view/read the MAR in Clinical Suites as it pertains to their practice.
Description:
This brief educational session is designed to inform Tulare Regional Medical Center staff about how to view/read the Electronic MAR located in Clinical Suite.
Medication Administration Check (MAK) is going LIVE March 26, After this date there will not be any paper MAR’s being printed except for transfer from department to department. The Clinical Suite MAR will be a real time (View Only) of the patients medication list and administration and will include administration notes from the Clinical Staff.

3. Objectives:
By the end of this session the participants will be able to:
Access Clinical Suite (if not able to prior to session)
Locate a Patient record and Access it.
Locate the MAR on the Navigator Bar
Understand how the MAR grid is set up for viewing Medications only.
Recognize the symbols used by the Clinical Suite Program and what they mean in regards to medication administration.
Access the individual Medication Order contents.

4. Target Group:
All TRMC Physicians/Providers, RN’s, LVN’s, Nutritionists, Respiratory Care Practitioners, Case Managers, Physical Therapy.
Continuing Education Credit/In-service Credit:
In-service credit only. No CE.  
Prepared by:
Lisa Watson RN, Clinical Informaticist
Fee:
No fee

5. Course Dates:
Start: Monday, March 12, 2012
Complete: Monday, March 26, 2012
Course Sequence:
Review the PowerPoint Slides entitled “MAR View Only for Clinical Suite (MS4), Why do I care about the Electronic MAR in Clinical Suite?”
Take the appropriate Post-test. Must pass 84 %.
Return/send the completed test to the Education Department by March 27, 2012.

6. MAR View Only for Clinical Suite (MS4)
Why do I care about the Electronic MAR in Clinical Suite?

7. Description
This brief educational session is designed to inform Tulare Regional Medical Center staff about how to view/read the Electronic MAR located in Clinical Suite. Medication Administration Check (MAK) is going LIVE March 26, After this date there will not be any paper MAR’s being printed except for transfer from department to department. The Clinical Suite MAR will be a real time (View Only) of the patients medication list and administration and will include administration notes from the Clinical Staff.

8. Learning Objectives Access the individual Medication Order contents.
By the end of this session the participants will be able to:
Access Clinical Suite (if not able to prior to session)
Locate a Patient record and Access it.
Locate the MAR on the Navigator Bar
Understand how the MAR grid is set up for viewing Medications only.
Recognize the symbols used by the Clinical Suite Program and what they mean in regards to medication administration.
Access the individual Medication Order contents.

9. Section 1 How to Access Clinical Suite from a hospital computer

10. How Do I Access Clinical Suite?
Go to the Hospital Intranet Page
Click on MS4 Clinical Suite

11. Why Does the Intranet “Pop Up” a Second Time?
What you select in the drop down determines your ability to place orders on patient accounts as well as the ability to print to the printer on the same unit you are located at.

12. Log In Window

13. How Do I Obtain My Username and Password if I Do Not Already Have One??
Med Staff has List of User names and Passwords for Physicians and Providers that do not already have their log in information.
If you are New to the facility and have not filled out your CSAF form Please do so in a timely manner so that your computer access can be built and distributed to in a timely manner.

14. If you have not logged into Clinical Suite before now you will be asked to reset your password
Hint: The first character of your password must be a letter and the password needs to contain at least one number.

15. How do I locate a Patient?
Search Tabs
Provider Census: The Provider Census is available only to physicians. It displays your own patients, based on your provider ID. (Currently the View is by Patients in a Room/bed).

16. Provider Group Census: Is available only to physicians
Provider Group Census: Is available only to physicians. It displays patients associated with the active physicians in a provider group to which you belong, based on your provider ID.
The Provider Group Census initially displays a drop-down list containing the provider groups to which you are authorized.

17. Personal Census: displays a customized, scrollable list of patients you have created to facilitate quick patient selection. This view is empty until you add patients from the Provider Census, Provider Group Census, Patient Search, Account Select, or Nursing Station Census.
You can add a patient to your Personal Census using the Add link in the Action column of the Provider Census, Provider Group Census, Patient Search Results, Account Select, and Nursing Station Census views.

18. When you no longer need a particular patient in your Personal Census, you can remove the record from the Personal Census list by clicking the Remove link in the Action column.
Patient Search Tab: provides two primary options for locating a specific patient:
Searching by name
Selecting by account number or medical record number

19. (Required) At least two characters of the patient's last name
The Search by Name section on the Patient Search tab lets you search for patients using the following criteria:
(Required) At least two characters of the patient's last name
(Optional) First name, major/minor patient type, service code, and discharge status
The Discharge less than [X] days field lets you enter a value between 1 and 999 to limit the search to currently hospitalized or recently discharged patients. For example, a value of 5 limits the search to patients who have not been discharged or who have been discharged within the last 5 days. The default value is facility defined.
Note: An entry of 999 does not mean 999 days; instead, it lists all patients.

20. When you perform a patient name search, any matching results are returned in the Patient Search Result view. Click on the patient name you want to select.
Name searches can identify patients who have multiple accounts; you will need to select a specific account to work with.
The Add link in the Action column of the patient search results list lets you add a patient to your Personal Census.

22. A name search identifies multiple account matches what do I do?
To locate a specific account, you must click the MULTIPLEACCT link to display the Multiple Accounts view, which lists all accounts in reverse chronological order.

23. Account Select: The account selection process always returns a single, matching patient record. The Add link in the Action column of the Account Search Results list lets you add a patient to your Personal Census.

24. Nursing Station Census: In the drop down you can choose a nursing station and search for the patient that way.

25. How do I access a patient record?
Click on the hyperlinked name or account of the patient you are looking for.

26. Section 2 How To Access the Medication Administration Record (MAR) in Clinical Suite

27. How do I access the MAR View for a patient??
Click on the Med Admin Record on the patient’s Navigator Bar in MS4 Clinical Suites

28. The Medication Administration Record (MAR) view displays confirmed medication orders for the currently selected patient.
You can use options at the top of the MAR view to filter the view of the patient’s medication orders.
The patient’s medication orders are displayed on the MAR in a grid format shown below.

29. The Elements of the MAR View are Defined as Follows:
Filter By – Three filters are available to limit the medication orders that display on the MAR grid. (You can only apply one filter at a time)
Previous/Current/Next – These links at the top of the MAR view change the shift for which medication orders are displayed in the MAR grid.

30. Elements of the MAR View cont.
Medication Column – For each medication order, this column displays the order description, dosage information, scheduled information, priority, and order notes if applicable. If a reason was supplied when the order was entered, the reason text is also included in the order description. Hyperlinks in this column allow authorized users to view medication order details.
Complex Medications include a button that displays a list of the complex medication components.
Schedule Codes that begin with an asterisk (*) are system-generated, based on the frequency specified in the medication order. This occurs when a schedule code is not explicitly provided by the pharmacy system with the order.

31. Elements of the MAR View cont.
Order and Medication Notes are displayed on the MAR Grid as Follows:

32. Elements of the MAR View cont.
Last Column – Indicates the last time the medication order was administered. You can click on the administration time in this column to view the details of the last administration.
Next Column – Indicates when the medication order should be administered next. Depending on the order status, this column may indicate that the order status has been changed to Discontinued or Complete.
If the order is ACTIVE, this column may indicate if the next administration should be administered as needed (PRN), the administration is unscheduled (Unshed), the medication must be administered immediately (Stat), or the medication is administered continuously (Continuous).

33. Elements of the MAR View cont.
Time Increment Columns – the MAR grid displays a time increment column for each two-hour period in the displayed shift, with the current time column highlighted in yellow. The last two hours of the pervious shift are also displayed in the first time increment column.

34. Order Status Filters Supported by the MAR
Active: (Default) Lists all medications considered active for the displayed shift. This includes scheduled, PRN & unscheduled, and continuous medication orders, as well as orders that were inactivated during the current shift.
Inactivated: Orders include discontinued, canceled, and completed orders until the end of the shift where the order status was changed.

35. Order Status Filters Supported by the MAR cont.
All: Lists all medications associated with the patient for the selected account, grouped into their appropriate categories.

36. Section 3 Medication Order Categories on the MAR

37. How Medication Orders are Categorized on the MAR
Scheduled: Non-continuous medication orders that have administrations scheduled for specific times or intervals.
PRN & Unscheduled: Simple medication orders that are administered as-needed and do not have scheduled administration times.
Continuous: Medication orders that require continuous administration, such as IV’s. (Continuous medications could be ordered as PRN or Unscheduled)

38. How Medication Orders are Categorized on the MAR cont.
Inactive: Medication orders that were discontinued, canceled, or completed prior to the beginning of the current shift.
Inactivated During Shift: Medication orders that were discontinued, canceled, or completed during the displayed shift.

39. How Administration Information is Indicated on the MAR
Notes Attached:
In the LAST Column, indicates that notes were included with other details for the administration.
In the NEXT and TIME INCREMENTS Columns,
indicates that a notes-only administration was charted

40. How Administration Information is Indicated on the MAR cont.
Complex Medication:
In the Medication column, this button identifies a complex medication. You can click the button to display a popup window listing the complex medication components.
Contact Pharmacy to Correct Discrepancies in the Order: :
In the Medication column, this icon and a pink background behind the order description indicates that MS4 received but rejected either an update to the order from Pharmacy or an administration event on the order from Med Administration Check (MAK). As a result, details about the order and/or administration history are different in MS4 and Pharmacy/Med Administration Check (MAK).
When this occurs, you should contact the pharmacy immediately to reconcile the two versions of the order (the pharmacy may do this by discontinuing the order and placing a new order with the correct information).

41. How Administration Information is Indicated on the MAR cont.
Given Early:
In the LAST and TIME INCREMENT Columns, this icon indicates the complete dose was given, earlier than the scheduled time. You can click the hyperlink to view administration details.
In the LAST Column, parentheses () identify the scheduled time of the administration. This could also be Stat, PRN, or Unscheduled, depending on the schedule priority of the original order.

42. How Administration Information is Indicated on the MAR cont.
Given Late:
In the LAST and TIME INCREMENT Columns, this icon indicates the complete dose was given, later than the scheduled time. Click the time hyperlink to view administration details.
In the LAST Column, parentheses () identify the scheduled time of the administration. This could also be STAT, PRN, or Unscheduled, depending on the schedule priority of the original order.

43. How Administration Information is Indicated on the MAR cont.
Partially Given:
In the LAST and TIME INCREMENT Columns, this icon indicates a partial dose was given on time. You can click the time hyperlink to view administration details.
In the LAST Column, parentheses () identify the scheduled time of the administration. This could also be Stat, PRN, or Unscheduled, depending on the schedule priority of the original order.

44. How Administration Information is Indicated on the MAR cont.
Partially Given Early:
In the LAST and TIME INCREMENT Columns, this icon indicates a partial dose was given, earlier than the scheduled time. You can click the time hyperlink to view administration details.
In the LAST Column, parentheses() identify the scheduled time of the administration. This could also be Stat, PRN, or Unscheduled, depending on the schedule priority of the original order.

45. How Administration Information is Indicated on the MAR cont.
Partially Given Late:
In the LAST and TIME INCREMENT Columns, this icon indicates a partial dose was given, later than the scheduled time. You can click the time hyperlink to view administration details.
In the LAST column, parentheses () identify the scheduled time of the administration. This could also be Stat, PRN, or Unscheduled, depending on the schedule priority of the original order.

46. How Administration Information is Indicated on the MAR cont.
Not given:
In the TIME INCREMENT Columns, indicates the medication was charted as not given. The time hyperlink indicates the time at which the administration was charted as not given. You can click the time hyperlink to view the details.

47. How Administration Information is Indicated on the MAR cont.
Given as scheduled:
In the TIME INCREMENT Column, this icon indicates the administration was given on-schedule, as determined by a facility-defined time window before or after the scheduled administration time. The hyperlinked value indicates the administration time. Click the link to view administration details.
On-time administrations are shown without any special indicator In the LAST Column.

48. How Administration Information is Indicated on the MAR cont.
Administration was voided:
In the TIME INCREMENT Columns, this icon indicates that the administration or administration action was voided. Links related to voided administrations in the TIME INCREMENT Columns are displayed with a line through the text.
When a scheduled administration is voided, the scheduled time is reinstated and displayed with the modified icon described above.

49. How Administration Information is Indicated on the MAR cont.
Given as scheduled:
In the LAST Column, this icon indicates an on-time administration.
This icon is a hyperlinked value including the date of administration, given as scheduled, the scheduled administration time (in parentheses), and the actual charted administration time. Click the link to view administration details.

50. How Administration Information is Indicated on the MAR cont.
New bag action:
In the LAST Column, This icon indicates the date and time at which the current IV bag was hung.
Canceled:
In the NEXT Column, this icon indicates the medication order has been canceled before the first administration was charted
When scheduled meds are canceled, all future scheduled administrations are inactivated.

51. How Administration Information is Indicated on the MAR cont.
Discontinued:
In the NEXT Column, indicates the medication order has been discontinued; any future scheduled administrations have been discontinued and removed.
When scheduled meds are discontinued, all future scheduled administrations are inactivated.

52. How Administration Information is Indicated on the MAR cont.
Completed:
In the NEXT Column, indicates no future administrations are scheduled.
When scheduled meds are completed, all future scheduled administrations are inactivated, and it is not possible to chart additional administrations.

53. How Administration Information is Indicated on the MAR cont.
As needed:
In the NEXT Column, indicates that the medication should be given as needed, according to physician instructions.
Continuous :
(charted via Med Administration Check)
In the NEXT Column, indicates the medication is continuously administered until complete. This status is used for continuous IV orders.

54. How Administration Information is Indicated on the MAR cont.
Unscheduled:
In the NEXT Column, this icon indicates the medication is active, but administrations are not scheduled. The medication should be given once according to physician instructions.
An estimated date and time for the next administration may also be displayed.

55. How Administration Information is Indicated on the MAR cont.
Late:
In the NEXT Column, this icon indicates the next administration should have already been given and is now late. The date and time in the hyperlink indicates when the medication was scheduled to be given.

56. How Administration Information is Indicated on the MAR cont.
Stop Time:
In the NEXT Column, this icon indicates the medication order is scheduled to stop during the displayed shift (or possibly a previous shift that also contains the next scheduled administration, which is now late). The time in parentheses indicates the scheduled stop time.
The full stop date and time display if you hold the mouse pointer over the stop time indicator for a moment.

57. How Administration Information is Indicated on the MAR cont.
Future start date:
In the NEXT Column, this icon indicates the medication order is scheduled to start at a future date and time.
Late:
In TIME INCREMENTS Columns, this icon indicates a scheduled administration that is now late and has not yet been charted.

58. How Administration Information is Indicated on the MAR cont.
Due now:
In the TIME INCREMENT Columns, this icon indicates the next administration is currently due.
Continuous IV:
(charted via Med Administration Check)
In the TIME INCREMENT Columns, the continuous IV indicator will include a hyperlinked check mark if the new bag was charted via Med Administration Check. You can click the check mark to view the administration details as received from Med Administration Check.

59. Section 4 MAR View Display FAQ’s

60. MAR View Display FAQ’s
In addition to medication administration information for the current shift, the MAR view allows you to display past shifts as early as the first shift where a medication order was administered to the patient.
You can also display shifts up to 24 hours into the future to view scheduled administrations.

61. MAR View Display FAQ’s cont.
MAR shifts are displayed as a series of columns indicating two-hour periods.
The last two-hour increment of the shift previous to the displayed shift is always located in the first time increment column.

62. MAR View Display FAQ’s cont.
For example, if the MAR shift started at 06:00 and the current time is 07:30, the first time increment column would represent 04:00-05:59, the second column would represent 06:00-07:59, and so on.
At 08:00, the yellow shading would shift to the right to indicate that the current time falls within the 08:00-09:59 time increment.
Note: Medications on the MAR view are always categorized according to their current status, regardless of which shift is displayed.

63. What Sort Options are Available on the MAR
By Medication
By Last Dose
By Next Dose
All sorting occurs within medication categories, not within the entire list. By default the orders in each category are sorted according to the NEXT Column.

64. Medication Order Detail View

65. The above view displays details about the medication order
Discontinuing/canceling a medication order
Signing an order (CPOE Function)
Reordering or renewing an order
Viewing the administration history
Viewing the order status history
Viewing the order alert history (CPOE Function)

66. View Medication Administration Detail View

67. scheduled (non-continuous) Medication.
The View Medication Administration Detail View (Previous Page) contains details about a single administration for a
scheduled (non-continuous) Medication.
The information on this view is read-only
Scheduled admin time - The date and time the administration was scheduled to be given.
Actual admin time - The date and time the administration was actually given.
Timing - Indicates if the administration was given on time, early, or late.
Reason for early/late admin - If the administration was given early or late, this indicates the reason for the schedule deviation.
Charted by - The name of the user who charted the administration.
Charting time - The date and time that the administration was charted. Note that this is different from the scheduled and actual administration times, which are also displayed on this view.

68. The View Medication Administration Detail View cont.
Admin history - Indicates if the administration history is available for this medication (Yes or No). You can click the Yes link to view the medication administration history. (Administration history is only available if administrations were scheduled or charted in the past.)
Medication description - The full medication order description, including the name (generic and trade), dosage details, and schedule information. Complex medications include a button at the end of the description ( ) that displays a list of the complex medication components.

69. The View Medication Administration Detail View cont.
Status - Given, Partially given, or Not given, indicating the status of the administration as charted.
Reason for partially/not given - Indicates the reason why the administration status was Partially Given or Not given, if applicable.
Given by other - If selected, this indicates that the medication was not given by the person who charted the administration. The text field next to the option indicates who actually gave the medication.
Manufacturer details - This link displays only if a lot ID, expiration date, manufacturer name, and/or vaccination indicator were received from Med Administration Check when the medication was charted.
Witnessed by - A display only field that only displays when the name of the person who witnessed the administration of medications is provided from the Med Administration Check system "Co-signed by" field.

70. The View Medication Administration Detail View cont.
Order notes - Any physician or pharmacy notes associated with the medication order.
Admin notes - Any notes that were entered when the administration was charted.
Patient response - A free-text patient response entered by the clinician when charting a PRN administration. (This is not available for non-PRN medications.) The patient response is optional and may not be recorded for every PRN administration.
Dose given - Indicates the dose given for sliding scale, dose range, and free-text orders (if applicable).
Site - The administration site, if applicable.

71. The View Medication Administration Detail View cont.
Last dose(s) - This link displays a pop-up window with a read-only list of the dates, times, and amounts of the last four doses that were given to the patient. The link is visible if there are administrations charted prior to this one.
Last site(s) - This link displays a pop-up window that lists the four previous administration sites for the medication. The link is visible if there are administrations charted prior to this one.
Link to <flowsheet> - The selected option indicates whether an assessment was charted at the time the administration was charted, was charted separately, or whether there was no assessment associated with the administration.

72. Voiding a drug administration
When you void an administration, all details about the administration are preserved, but the status of the administration is changed to Void.
Note: In some cases, voiding an administration can result in a change to the order status from Completed to Active.
Warning: If a flowsheet assessment was completed at the time an administration was charted, and you later void the administration, the flowsheet results are not voided. You must void the flowsheet results from the corresponding flowsheet, if necessary.

73. Voiding a drug administration cont.
The MAR grid only indicates "voided" status for voided PRN or Unscheduled administrations. If a scheduled administration is voided, the administration appears uncharted on the MAR, as it did before the voided administration was originally charted, although a modified icon appears next to the administration hyperlink on the MAR.
Voided PRN or Unscheduled administrations are indicated by an "X" symbol and strikethrough text on the MAR grid.

74. Medication Administration History View
Users can view an administration history for medication orders that have had administrations scheduled or charted in the past. The Medication Administration History view can be displayed from any of the following locations:

75. When launched from the MAR view by selecting a medication name from the Medication History drop-down list, the Medication Administration History displays as a full view (replacing the MAR grid) and allows hyperlinking to related views, such as administration details or an assessment flowsheet charted in conjunction with an administration event.

77. When launched by selecting Yes in the Admin history field on any of the following views, the Medication Administration History displays in a pop-up window and allows hyperlinking to an assessment flowsheet charted in conjunction with an administration event.

78. Locations in which to find links to the Administration History
View Medication Administration Detail screen
View Continuous IV Administration Detail screen
Medication Order Detail
Quick Overview Medication Orders quadrant
The contents of the Medication Administration History view may vary depending on the order type; different information is displayed for IV and non-IV medications.
Note: Voided administrations are indicated by the symbol, and all values for the administration are displayed in strikethrough text.

79. In addition to the medication description, the current order status, and the first administration date/time (is displayed at the top of the view), this view contains the following information about each charted administration:
Evt# (Event number) - A sequential number used to indicate how many times the medication has been administered.
Scheduled - The scheduled administration date and time, or the word "PRN" or "Unscheduled" if applicable. The administration history is sorted by this column in reverse chronological order, placing the most recent scheduled administration at the top of the table.
Note: If clarification on the order is required, no hyperlinks are available in this field.

80. Administered - This is used for administrations that were given or partially given, and is also used to indicate the time an administration was charted as "Not given." This column also displays the Notes icon if administration notes were entered.
Status - Indicates whether the administration was given, partially given, or not given.
Reason - The reason code that was selected when an administration was charted as not given or partially given. This is only used for not given or partially given administrations.
Dose - The dose that was given. This is displayed for sliding scale or dose range.
Site - The site code where the medication was given. This is only used for medication orders that require the site to be specified when charting (as defined by the ordered route).
Response - The free-text patient response entered by the clinician when charting a PRN administration. (This is not available for non-PRN medications.) The patient response is optional and may not be recorded for all PRN administrations.
Assessment - The name of an assessment flowsheet displays in this column when observations are charted in Med Administration Check that were associated with the administration.

81. Thank you for your participation.
If you have any further questions or concerns please call and open a ticket with the help desk for further education.