1. Documenting on Override Pulls

2. 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

3. 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

4. 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

5. Now document the administration

6. 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.

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

8. * 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

9. 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

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

11. 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 : /11/

12. 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

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

14. 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.

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

16. 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.

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

18. 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

19. 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

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