Meditech PHA Training Manual - Kootenai Health Information

Meditech Client Server 6.0 Training Manual JUNE 2011 1 | P a g e Shortcuts to memorize:
F11 does not work as an exit key like it did in MAGIC. In certain screens it does have a function,
that we may find useful later.
F1 is the “help” key. If you are in a field or at a screen that needs further explaining, you can hit the
F1 function key. This will usually bring up an interactive copy of the screen you are on where you can
click on questionable fields for definitions. Hit the X in the corner of the screen to close the help
functionality.
F8 will highlight/underline buttons on menu screens so that the user can avoid toggling between the
mouse and keyboard.
F9 is the default for “lookup”. If you are ever in a field that has a limited number of choices (versus a
free text area), hit the F9 function key while your curser is in the field to bring up an alphabetical list of
options for that field. This hot key is always an option when you are in a field that has a
to the right.
symbol
F12 is the “save” key. When you have completed an order or made changes to a record you can hit
F12 instead of using the mouse to click on the save button. When the only option on the screen is
“close” using F12 will also close the screen you are on.
Drugs mnemonics are case-sensitive. You’ll want to perform all order entry in UPPERCASE. The
mnemonics for different drugs and order sets are all built in UPPERCASE.
A green bar (across a set of data, an order, a patient on a list, etc) is indicating that is your current
selection.
The system is EXTREMELY ANAL about uppercase versus lowercase and spacing during order
entry. “DAILY” does not equal “daily”.
Typing a sig code and accidentally hitting the spacebar before you hit enter will result in the system
not recognizing it. If you know you’ve got the sig code or the mnemonic correct but the system is
stating it is wrong, check your capitalization and spacing.
Once you’ve populated the patient’s height and weight, the system will calculate the BSA, IBW,
adjusted body weight and lean body weight! All of this additional data is accessible by clicking on the
blue “i” next to the patient’s name in the header bar of the patient’s profile.
2 | P a g e To locate a patient profile when you cannot read the name on the addressograph use the following
shortcuts:
From the main patient list click on “Patient Profile” to make a search box appear
To search by MRN type: U#KM041411893 (Put in your patient’s MRN with the leading 0) and hit
enter
To search by room type: R\KM0335 (Put in your patient’s room number preceded by your institutions
alpha) and hit enter
To search by location, type: L\KM.MEDICAL (Put in your patient’s location, works for outpatient
locations too) and hit enter
3 | P a g e Table of Contents Topic
Page Number
Logging into Meditech
Locating and Selecting a Patient
Entering Patient Demographics
EMR tab – Laboratory, etc
Entering Orders
Order Types
Medication (UD) Order Type
MultiDose OrderType
Respiratory (RESP) Order Type
IVS Small Volume Order Type
IV – Large Volume Order Type
Split Medication (SP) Order Type
Order Session Summary Screen
Linking Orders
Pending an Order
Unverified Orders
Reject/Acknowledge Orders
Documenting an Intervention
Documenting an Adverse Drug Reaction
Viewing the Patient’s Bill
Debit/Credit Routines
Printing Options
6
9
16
25
26
28
29
31
32
32
33
35
37
39
42
45
46
48
53
54
54
59
4 | P a g e Using Canned Text Labels
Three Day Home Supply
Patient Medications from Home and Miscellaneous Drug Entry
Rx Audit
Profile Override
Profile Copying
Medical Record and Account Number in Meditech
Order Sets
IV Fill Lists
Producing a List of Patients on a Drug
5 | P a g e 63
64
64
67
68
70
73
74
77
83
LOGGING IN TO MEDITECH
Once you click on the Meditech icon and log onto the network, this log in screen will appear. All the
data fields should autopopulate for you.
Follow this path to get to the Pharmacist Desktop or Technician Desktop, which is where you will
enter patient orders:
When logging in click the down arrow to the right of the HCIS and select KOM.TEST6OF, which will
take you to the desktop.
6 | P a g e When you click on Pharmacist Desktop or Technician Desktop you will see the following screen:
7 | P a g e Select the
to the right of Facility and Kootenai Medical Center, Benewah Community Hospital or
Kootenai Cancer Center SP depending on which facility you want to bring up. For Kootenai, you can
type in KMC and hit F12 – for Benewah type in BCH and hit F12.
You do not have to fill in the HIM Department but can just click OK or hit F12.
A screen will then come up asking you to select PHA Site, for inpatients select KMC. For Coeur
d’Alene Cancer Center select KCC, and for Post Falls Cancer Center select KCP. Remember to
select the Sandpoint Cancer Center you must be in the facility Kootenai Cancer Center SP.
8 | P a g e LOCATING AND SELECTING A PATIENT
Welcome to your new patient list screen!!!
Each individual can set their preferences for what they see when they click on the Pharmacist
desktop or Technician Desktop, the above is what is seen unless you change your preferences. To
change you preference select Chart Review and then click Preferences. DO NOT CHANGE YOUR
PREFERENCES AT THIS TIME. Changing your preferences can by dangerous and result in missed
information..
9 | P a g e Click Yes for Set Chart Review as Default Button and Select Permanent for Save Preferences. Be
very careful in Preferences as you can change the way you view patients and then not remember
you did it or be able to figure out why you cannot see something. Good advice would be to leave the
default settings for fear that you won’t be able to see something important.
10 | P a g e orders! If your partner is entering orders on a patient, you can ask your partner to exit that patient’s
profile or you can choose the view option.
This is the default screen for the patient list. This is a list of current patients only! Discharged
patients can only be accessed by a name lookup (to be discussed later). Note that patients are listed
by alphabetical order of the patient’s Location. Patients with a blue + symbol next to their location
have active pharmacy orders. You can click on the blue + symbol to see a short order summary
without actually going into the patient’s profile. The “Recently Accessed” tab will produce a list of
patients that you have interacted with during your Meditech session. This is helpful when you “just
entered” an order on a patient and then are struggling to remember whose profile it was. If there is a
patient you want to keep an eye on, or are awaiting an intervention resolution on, you can click on the
checkbox next to the patient’s bed and then “Add to My List” to move that patient to “My List”. The
patient list on “Recently Accessed” and “My List” are unique to the user. Patients listed on “My List”
will remain until you remove them.
Helpful point: Only one user can be actively entering orders in a patient profile at a time! No duplicate
11 | P a g e You can also view patients alphabetically by patient location by clicking on the “Rounding” tab at the
top of the screen. Clicking on the + sign next to the patient care unit will produce a list of all the
patients in that unit. Click on the – sign to shrink the list.
12 | P a g e Account
Medical
number
Record
number
To select a patient, click anywhere on the patient’s row of information to put a green highlight on the
patient, or simply click on the box next to the patient’s room. Note that when you select a patient, the
height
weight
BSA
top of the screen will show more patient details (such as Meditech account number, Meditech medical
record number, height, weight, allergies, BSA, etc.).
s Once you’ve highlighted/checked your patient from the main list, click on the “Patient Profile” or “Edit
Patient Data” on the right hand side. Edit Patient Data will take you to the screen to enter patient
demographics, Patient Profile will take you to the screen to view patient orders. The “Enter Orders”
button will not be accessible until you access the patient via the Patient Profile button.
13 | P a g e ADR DATA A quick scan of the right hand column of the Patient List will show you which patients have
intervention data (can be pending or complete), ADR data (pending or complete). The icons in the
patient bar of information will only show if data is populated in the patient profile, note the icons in the
patient bar will match the icons on the right hand buttons.
14 | P a g e To return to the alphabetized patient list when you are in a patient profile, click on the Patient Lists
button on the right hand side to pull up the alphabetized list
or click on “Select Patient” to pull up a box that allows you to search for a single patient.
15 | P a g e To use the Select Patient function type all or part of the patient’s last name followed by a comma, and
then all or part of the patient’s first name. This will pull up an alphabetical list of inpatients,
outpatients, AND RECENTLY DISCHARGED patients that meet your typed criteria. You can even
search by starting with a “,” and then a portion of the patient’s first name. This is the only way to pull
up outpatients and discharged patients.
ENTERING PATIENT DEMOGRAPHICS
To enter patient demographics, select your patient and choose the “Edit Pt Data” button. Height and
Weight should be manually entered into the appropriate fields. You can use a combination of feet and
inches and pounds and ounces. BSA will autocalculate. Height and Weight may already be populated
by nursing. This screen will display allergies and adverse drug events; but to enter new
allergies/ADEs you need to click on the button at the top of the screen labeled “Allergy/AdvReac”. If
you have not completed height, weight, and allergy data entry you will receive a notification at the
start and completion of EVERY ORDER you work on for a patient. Use the F12 hotkey or click on the
Save (bottom right) at completion of data entry.
16 | P a g e To enter allergies/adverse drug events click on “Allergy/AdvReac”. You will then need to click on the
“Enter/Edit button at the bottom of the screen.
NOTE: Always use this manner to enter/modify allergies and adverse drug events so they will carry
across from one admission to another.
17 | P a g e Type all or part of the drug/food name that the patient is allergic or reacted to in the green “Search
for” box. Then hit enter or F9 to pull up an alphabetical menu of choices
18 | P a g e “Edit” Option “Snapshot You must complete the data entry for all items with an “ * ” next to their name in order to save and file
the allergy/ADE. Note that “Severity” and “Comments” are optional. The “Reaction” box can be free
text, or you can use the F9 key to pull up a list of common reactions. Click on “Save” in the bottom
right or simply hit F12 to save and file your entry. This will be tied to this patient’s medical record
number forever-meaning all subsequent admissions; so thankfully there is an “Edit” option. To edit an
allergy or ADE you would select the appropriate choice and click on the edit button at the top of the
screen. You can also select a listing and “Audit” it to view who has input/changed info for that specific
allergy/ADE. The “Snapshot” button lets you view changes to a listing that occurred over a period of
time you designate (this will be useful for auditing allergy data after a patient has had multiple
admissions).
19 | P a g e “blue + icon”
“Edit” button
Note that allergies and adverse drug events will be viewable from the Patient Profile screen, see
below. Additional details are accessible by clicking on the blue + icon. You can edit allergies and
adverse drug events from this screen (versus clicking on the Edit Pt Data button) by clicking on the
small blue “Edit” button.
20 | P a g e This is the screen that is brought up once you have clicked “edit”.
T
Once you’ve saved an allergy/event, all related drugs will be included in the patient’s allergy/event list
in addition to the primary agent you entered. You can exclude any of the related agents via the
“Exclusions” button at the bottom of the Allergy/AdvReac screen. This is particularly useful when a
patient is allergic to one agent but has experienced no problems with a similar agent (i.e. allergic to
“sulfonamides” but takes Celebrex and Lasix with no problems). See below. 21 | P a g e 5 ft 10 in 177.S cm 2.13 m2
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Once you click on the Exclusions button you will see the following.
You can then click on what you would like to exclude. If you exclude please make a comment on
what and why it was excluded.
Note that if there are multiple allergies, do not be fooled if one is highlighted in green thinking that is
the one you are editing. Make sure you are editing what you think you are editing.
23 | P a g e You can also enter Disease Conditions (beyond what is listed in the primary diagnosis which is not
modifiable) and Comments from the “Comments” screen. We can attach certain “diseases” to drugs in
our inventory so that a warning/contraindication appears when a drug is added to a patient profile with a
disease of concern. This will be useful for diseases like liver failure, renal failure, and “pregnancy”. Use
the F9 key to pull up an alphabetical list of patient disease conditions to choose from.
From the Comments screen you can also enter internal (only visible by Pharmacy) and external (visible to
everyone via electronic MAR and electronic physician order entry when those options are live) comments.
Choose wisely. Don’t forget to hit “Save” or F12 when you are done. All of this data is now viewable on the
patient profile screen! See below.
24 | P a g e EMR TAB – LABORATORY, ETC.
Once you have entered a patient’s profile one of the tabs on the right hand side is the EMR tab. If you
hit this tab you are brought to the following screen
You may use the scroll bar to the right to look at all the current labs.
If you look at the tabs at the right you will see the following:
Select Visits
This tab lists all of the visits/account numbers that are in 6.0.
Summary
This tab provides access to general information about the selected patient account.
Clinical Panel
This tab shows the various panels currently available, selecting a panel results in data appearing in a
set flowsheet.
You will probably want to spend some time exploring the EMR and looking at the help screens to
familiarize yourself with the information available in this area.
25 | P a g e ENTERING ORDERS
From the patient profile screen, you can click on the “Enter Orders” button on the right hand side of
the screen. This will bring up the order session summary screen. From the order session summary
screen you can leave the order assigned to the attending of record (which will be defaulted in) or you
may choose another by deleting out the MD’s name and hitting F9 to do a look up. You’ll have to
choose to search by mnemonic, name, DEA# etc when you use the look up screen.
Also note that changing the MD in the location previously described will assign all orders in that Order
Session Summary to that same physician. If you are satisfied with the ordering physician, start your
26 | P a g e drug order. Type all or part of a drug generic or trade name in the green “Medication” field. You can
also type the mnemonic. Hit enter once you’ve typed part of the drug name and an alphabetized
menu will appear (see below).
NOTE:
You can see that once the dictionary of drugs is active there are many ways in which you can search
the drugs. Any special comments that are associated with the drug will appear in the “Formulary
Comments” box at the bottom of the screen when you highlight the drug. These comments are for
Pharmacy only and will not print out on the label. The associated order types for that drug (IV, MULTI,
UD, etc) will also appear in the “Order Type” box in the middle. You must choose an order type. They
are listed in the following table.
27 | P a g e ORDER TYPES
ALT
ALTERNATING IVS
ALT
The
following
ORDER
TYPES
are
just
as
they
were
in
the
Magic
BILL
DAILY CHARGE (NOT TO EMAR!)
MEDSystem
COMPOUND
COMPOUND
COMP
ORDER
TYPE
DESCRIPTION
SCREEN
DIAL
DIAL
IV
EPI
EPIDURAL
IV
IM
INTRAMUSCULAR INJECTION
IV
INFO
INFORMATION (NOT TO MAR)
MED
INTRATHEC
INTRATHECAL
IV
IRRIGATION
IRRIGATION
IV
IV
IV - LARGE VOLUME
IV
IVCONC
IV BY CONCENTRATION
IV
IVDRIP
IV BY DRIP
IV
IVS
IV - SMALL VOLUME
IV
IVS-CC
IV-SMALL VOLUME-CANCER CENTR IV
IVSCC
IV - SMALL VOLUME - CANCER CNT IV
IVT
TPN
IV
LIP
LIP (NOT TO EMAR)
MED
PYXISIV
PYXIS IV OVER-RIDE
IV
PYXISUD
PYXIS - UD OVERRIDE ORDERS
MED
RESP
RESPIRATORY
MED
SPLIT
SPLIT MEDS
SPLIT
SPLIT-CC
SPLIT MEDS - CANCER CENTER
SPLIT
SC
SUBCUTANEOUS INJECTION
IV
UD
UNIT DOSE
MED
UD-CC
UNIT DOSE-CANCER CENTER
MED
UD-PYXIS
UD - PYXIS
MED
The following ORDER TYPES have been added to Meditech 6.0
CS
CSIV
MULTI
NARC
CENTRAL SUPPLY
CENTRAL SUPPLY IV
MULTI-DOSE
NARCOTIC/CONTROLLED
MED (Fleet’s enema)
IV (CS IVs that come from central)
MED (containers hydrocortisone cream)
MED (for CII safe items)
If the ORDER TYPE has been defaulted in the DRUG DICTIONARY you will not need to select,
however if not, you will need to fill in the ORDER TYPE from the drop down below the drug selection
box. (see previous page).
28 | P a g e MEDICATION (UD) ORDER TYPE
Below is the screen that appears after you’ve selected a medication from the order session summary
screen with an order type of “UD”. You will find that in many instances a lot of data defaults in when
you choose a medication. In this example, every field has defaulted, and an order type didn’t need to
be chosen because the only option was UD. All the RPh needs to do is check all the fields and
ensure they are appropriate. Any field with an asterisk is a necessary field that must be completed to
add the drug to the patient’s profile.
Let’s review the fields.
The “Medication” field lists the mnemonic for the medication and the generic name, you chose this
from the order session summary screen.
The “Dose” field has defaulted, but is modifiable. If you wanted two tablets, you would enter “162” for
the dose or “2T” to force the system to multiply out the dose for you.
The “Route” field has defaulted in. You can always perform an F9 lookup to see routes of
administration that are assigned to this drug. You can only pick from the list, you cannot add a new
route.
29 | P a g e The “Frequency” field is for the most part what you have been used to in Magic, with some
standardization. Use F9 to look for freqeuencies.
NOTE: This system requires dispensing times to be assigned to frequencies, assess what the
dispense field is populating with and adjust if necessary to achieve a day and a dose.
The “Schedule” field has 5 options and you must choose one. A description of the options is below.
Your most popular choices will be SCH and PRN. ONE and STAT will d/c after 1 minute of activity,
but they will display on the EMAR until administered.
PRN- As Needed. The process remains the same, a PAR level needs to be entered so the robot will
dispense the correct amount. Billing occurs when the nurse administers and scans the medication.
Note: manual debits and credits do not need to be administered to be billed and will show up on the
patient’s bill. Please be very careful as we do not want patients double billed!!!
STAT- A medication order with a schedule of STAT has a default start date of today and a default
start time of now. The stop time equals the start time plus one minute and may not be edited. In
addition, the start date and time cannot be edited to a future start for STAT orders.
ONE- One time. A medication order with a schedule of ONE has a default start date of today and a
default start time of now. The stop time equals the start time plus one minute. You can edit the start
date and time. The dispense amount is appropriate for the date and time entered.
The “Inventory” field will default to MAIN.
The “Charge Type” field should default in for you.
The “Charge” field is a display only field. You cannot modify the patient’s charge.
30 | P a g e MULTIDOSE ORDER TYPE
This ORDER TYPE is billed one time at dispensing. It is not billed on scan. At Kootenai this ORDER
TYPE will default in for those drugs are set that way.
31 | P a g e RESPIRATORY (RESP)ORDER TYPE
It is the same as a MED order type. RESP is designated this way for reporting purposes and to allow
for a Respiratory Therapist medication list.
IVS IV – SMALL VOLUME ORDER TYPE
The example below shows the two screens for IVS. In this example the RPh typed in the duration of
the infusion and a rate was automatically calculated. The rate, IV volume, and duration (infusion time)
will all appear on the label for this medication. The system has chosen to dispense 1 bag, based on
the time of day and the timing of the next IV fill list; the RPh may dispense a different amount. (We
can now use the EXTRA DOSE function which we will get to later). Note that the sig of “DAILY”
defaults to a dispense time of 9 AM; therefore, the system is only dispensing one bag because that is
how many times 9 AM will occur before the IV fill list is run again (IV fill lists are automatically run at
4:55PM with manual lists run in between). Note: Important to remember that with IV fill list is run a
label generated equals a charge.
32 | P a g e IV – LARGE VOLUME ORDER TYPE
The following two screens are an example of an IV order type. It also highlights a useful functionality
in the additive section that we can use for potassium IVs. We can put the concentration the physician
ordered in the “ordered dose” section, and the system will automatically calculate for us the additive
amount for a smaller or larger sized IV. In this example the MD ordered a concentration of
10mEq/1000mL but the system knew that we were using a 500mL size bag and calculated that only
5mEq would result in the correct concentration for this bag size. On the second screen the RPh
entered in the rate of the IV as 25mLs per hour, and the system calculated the duration of the bag
and automatically populated the frequency field. It then used the IV frequency to calculate how many
bags to dispense until the next IV fill occurs. The rate determining the frequency of dispense is
characteristic of the IV order type.
33 | P a g e ***IMPORTANT CONCEPT***
The fill list for IVs will automatically print out at 4:55PM. When you are performing order entry you
should always ensure the calculated dispense or your chosen dispense amount will provide the
patient with enough doses until the cart exchange.
If you are building an IV from scratch (rather than using a SET), put the additive in first so that the
ORDER TYPE fills in appropriately.
For one time orders you can enter ONE into the Schedule field. Note for BMV purposes you may
want to future time the order, this is to allow time for mixing and the IV to get to the floor for the RN to
hang.
You may use “As Directed” (note there is a space between) in the Ordered Rate field.
34 | P a g e SPLIT MEDICATION ORDER TYPE
The next order type we will discuss is a split med. The split dose functionality is a way of joining two
meds with the same active ingredient in one drug order. The meds must be the same dispensing form
and same generic name to use SPLIT order type!!! An example of a case to use the split med order is
warfarin 7.5mg. You can join a 5mg and 2.5mg tablet in the same order instead of giving 3 x 2.5mg
tablets.
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ORDER SESSION SUMMARY SCREEN
Each time you complete an order on a patient, you will return to the order session summary screen
for that patient. You will see your orders accumulating on that screen and you can still edit or delete
them before you file them and finalize them into that patient’s profile. At this point if you want to send
an extra dose to the floor you can utilize the Extra Dose Function. This will replace our current back
timing. (Yay!)
37 | P a g e Once you click Extra Dose you will see the following screen showing the extra dose to be given.
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Pha,Kevin
KM0001112
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KM00000483
Allergy: Paclitaxel Semi-Synthetic
41/M 01/01/1970
Order Session Summa ry
Order Type Order Type
Medication
1 IMP UD
ASPIRIN 325 MG TAB
2
IMP UD
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325 MG PO .EXTRA DOSE OME
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To finalize the orders listed on the order session summary screen, click on the save button in the
lower right hand corner of the screen, or hit the F12 key. A new screen will appear that will indicate
what labels will be printing out where, and you have the option of turning off the print by putting an N
in any of the places where a Y is present.
LINKING ORDERS
The link functionality is available for connecting orders that are different order types and/or different
active ingredients. Linking two or more orders only demonstrates to us that the orders are connected,
but will still display the drugs separately in Pyxis (i.e. the nurse will need to touch both drugs in order
for both drawers to open). With electronic MARs, the link functionality will still only provide a visual
connect; it will be the nurse’s responsibility to recognize the cue that the two medications need to be
administered concurrently. Linking can be done from the order session summary screen during order
entry. In the “Type” field the RPh would choose the link to be “concurrent” or “alternating”. This means
the drugs will either always be given concurrently (Diovan 160mg and HCTZ 25mg given together), or
administration will be alternating (digoxin 0.25mg alternating with 0.125mg daily). The appearance of
linked orders in the patient profile is below. The drugs may not be listed next to each other(drugs are
in the patient’s profile based on order type and then alphabetically); so your clue that drugs are linked
is the little chain link that appears in the righthand side of the patient’s profile. If you click on the link
symbol, a box will appear listing all the orders that are linked to the order you are clicking on.
39 | P a g e To save phone calls and confusion on the nurses part, in the Valsartin order, type in the label
comments to give concurrently with HCTZ and visa versa.
49 | P a g e The orders also could be linked directly in the patient’s profile by clicking on the checkbox next to
each order that you want to link, and then clicking on the Link/Unlink” button at the bottom of the
screen. This would also be how you would unlink orders. If you link orders, any change that you later
make to one member of the linked set will result in the system asking you what to do with the other
linked orders. Please remember that for now, “link” is a visual clue, it will not force the nurse to give
the linked meds together.
This is the box that appears if you click on the link symbol that appears in this patient’s profile next to
each of these drugs. You are not limited to two drugs when you link. Nor are you limited to drugs
within the same order type.
41 | P a g e PENDING AN ORDER
Now we will assess how to document that an order has a pending intervention. This will be extremely
helpful to us because anyone who views the patient’s profile will be able to see that there are
interventions pending and/or orders pending. You will be able to detail why the order is pending and
even assign the order to a specific MD if you so choose. This will keep everyone on the same page
when a member of the nursing staff calls to question why a drug is not available yet. (For nursing
there will be a button on the top of the EMAR that “lights up” whenever there is a Stat/Onetime or
pending order. They can quickly sort the orders by clicking that button. They are being educated on
this issue.) To put the order in the patient’s profile, but prevent it from being accessed by Pyxis or
interacting with the fill list, put a Y in the pending box. A text box will appear that you will use to
describe why the order is pending. Once saved this text is visible on the Comments tab.
42 | P a g e When you save and file the order, it will appear in the “orders with activity section of the patient
profile”, indicating that the order is not complete. Clicking on the blue “i” icon will bring up the pending
comments information.
43 | P a g e Notice that the status of this order is “Unverified”. When the order is finalized, you can change the
status to Cancel, Discontinue or you can Edit Pending. If you edit the order to turn off the pend,
change the Pend field to “N” and provide details as to why the order is no longer pending. You will
then need to click the status again to change the order to verified. You could also click on the “Verify”
button at the bottom of the screen or choose the “Edit Orders” button on the righthand screen. It is a
bit cumbersome, but will provide an electronic trail to justify why some orders are delayed.
44 | P a g e UNVERIFIED ORDERS
Unverified orders may include CPOE orders and RN entered orders. To verify an order first put a
check mark by the order you wish to verify, then click the Verify button on the bottom of the screen.
You cannot verify an incomplete order.
45 | P a g e REJECT/ACKNOWLEDGE ORDERS
A nurse may reject an order for any number of reasons. To find reject/acknowledge orders go to the
New Activity button and then highlight the account as shown below and enter the patient profile.
46 | P a g e BE VERY CAREFUL!! Be sure and read the RNs comments carefully and remember the RX number
BECAUSE once you have clicked the Review button, the order is simply reactivated as is and
put back on the EMAR.
47 | P a g e DOCUMENTING AN INTERVENTION
We can document our actions electronically. Use the “Intervention” button on the right hand side of
the screen to document an intervention at any time during order entry. You do not need to be in the
patient’s profile that the intervention occurred in to document. The following screen shots are of the
intervention that was associated with this prochlorperazine order. Note: pending an order is not
connected to the intervention functionality. You still need to document on the intervention tab in order
for this to be a reportable intervention!!!
This series of screens shows how an intervention is documented. Remember that this is completely
independent of the pended order process that occurred while we waited to hear back from the
patient’s physician. At any time you may click on the “Intervention” button on the right hand side of the
Pharmacist Desktop. This will bring up a series of screens where you will document your intervention.
Fields with an asterisk are required to be completed.
48 | P a g e If the patient has no interventions, you will see the following:
Click the Enter button at the bottom of the screen.
49 | P a g e You must fill out the fields with an asterisk: Type, Status, User (which fills in automatically), Severity,
Staff Type and Staff Member (which must be filled in with your Meditech Initials). These are the
same as was in MAGIC.
50 | P a g e Note that the RPh completed all three screens to document this order (we will not be using the
“Queries” screen). All interventions (regardless of their status) are visible in the Intervention section of
the patient’s profile. An icon is also present on the right hand side of the patient list indicating there
are interventions placed on the patient.
51 | P a g e August,Jane
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Allergy ; ·• • •No Allerg1e:s Entered• •
0 55/F 03/lZ/1955
154·.94 cm
l.44 m2
47.627199 kg
3 Patient View
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DOCUMENTING AN ADVERSE DRUG REACTION
You can also document adverse drug events independently of the Edit Pt Data way of documentation.
The only difference in this form of documentation is that the event will not carry across to the next
admission AND IT WILL NOT INTERACT AGAINST THE
PATIENT’S PROFILE. Thus, events that result in an update to the master allergy sheet should be
documented via the Edit Pt Data button. Less serious events can be documented in the manner
demonstrated below using the ADR events button.
Clicking on the ADR events button will pull up a patient look up box if you are on the main patient list;
otherwise if you have a patient highlighted or are in a patient’s profile, it will pull up a list of ADR
events already documented for that patient. Click on the “Enter” tab at the bottom of the screen to
enter new event details. You will complete the exact same series of screens seen above for
interventions, they are just associated with an ADR versus an intervention. When done, the ADRs will
not show on the patient profile summary screen like the interventions. You will need to click on the
ADR events button to view them. You will be able to tell a patient has an ADR on their profile from the
patient list via a small icon that matches the icon on the ADR event button.
53 | P a g e VIEWING THE PATIENT’S BILL (OLD Billing Inquiry)
To view all the charges that a patient has incurred you can go to the Billing button. The bill will
demonstrate all the medications that have been charged out to the patient. Clicking on the + symbol
will show the dates and times of individual charges if that line item has been charged out multiple
times during the patient’s admission. Remember that this shows the patient charge.
DEBIT/CREDIT ROUTINES
You can also debit or credit doses from the billing screen.
Even though you are accessing the debit/credit button from this screen in August, Jane’s profile, you
will be brought to a generic screen that is not patient specific when you click on “Debit/Credit”. You
will be forced to enter the service date (Note that date of service is extremely important and must
be correct) and time of the
debit/credit, pull up the rx number by typing it in or via a search by patient name (type in part of the
name and then hit F9) and then you will be forced to type the amount to debit or credit (i.e. -1 or 1)
and the service date and time to assign the credit to. Please also note that if you charged for 2
and really only wanted to bill 1, you must credit 2 and debit 1, if you just credit 1 this can
result in incorrect charges and number of items on the bill.
54 | P a g e Debit/Cred it
service oato I • Time
10/31/ ICI
19Se
Charge New for MAR Billed rtems
MAR
-1
000000608
Med1cat1on
P.Bt,eot
Items
BT
Number
Doses
-1
Svc Date
10/31/10
Time
1958
Biiied
N
CEiFAZOUN SODIUM 1GM 1n SOIDIUM CHL01UDE 1000 ML <Active>
MHo:279000007 AUGUST,
JANE 55/F <ADM JN 10/06:,, (H0'4141190S) 6ll0-B WD5 AMIN,K
55 I P a g e
An alternative way of debiting/crediting is by highlighting the order in the patient profile and then
hitting the debit/credit button.
This will bring up a small box asking you if you want to debit or credit the order that you chose. Make
your selection and then click on the OK button or hit the F12 key. A screen will appear that contains
almost all the data already populated for you. You just need to enter how many doses to debit/credit
and a comment if you deem it necessary.
56 | P a g e After you’ve debited the patient, a box will appear indicating where the label will print out. You have
the option to cancel the print if you don’t need the label. Cancelling the label print does not cancel
your debit! You can also click on any of the + symbols to obtain a drop down menu of alternative
printers to select from.
57 | P a g e This is the screen you will see after you perform the
debit/credit routine. You can cancel out of the print if you
don’t need a label to print out for your debited dose.
58 | P a g e PRINTING OPTIONS
The Print button at the bottom of the screen provides a variety of choices. Note: you need to be in a
patient’s profile in order to access the print button pictured below; and the menu that appears is
applicable to that patient only. In a moment we will discuss printing options outside of a patient’s
profile.
59 | P a g e These are the options
using the print button at
the bottom of the
patient profile.
You will need to investigate the print functions at your leisure.
Order – prints out a summary sheet of all pertinent information about a specific order.
Profile– prints out a summary sheet of all drugs in the patient’s profile, including discontinued
medications
Dispensed Amount Inquiry- prints out a summary sheet of dispenses for that drug.
Labels-prints out a label but DOES NOT CHARGE.
Cart Label- prints out a single cart label for that patient.
Duplicate Labels – allows you to print out multiple labels for the order you’ve selected. Be careful b/c
the “Dispense” field that you populate using this print function is only to put a quantity of dispense on
the label, NOT TO CHARGE.
MAR, MAR Labels, MAR Summary can be used to see what the EMAR looks like.
Monographs- prints out a monograph for that drug with no patient information.
Rx Monographs – prints out a monograph for that drug with patient specific information in a header
across the top of the page.
Rx Billing Inquiry – prints a detailed list of the billing activity for that order.
LAB Test View Groups – will allow you to select via a drop down menu pertinent labs for this patient
that you would like to print in a report type format.
60 | P a g e There are other print options also available via the path below. Once again it is encouraged that you
review these options at your leisure, most are simply reports that will print for a specific patient or
specific order. All of these options can be printed to “preview”; meaning you can complete the print
routine but view the results on the screen instead of printing them on paper. The most useful options
here for us now are “Duplicate Labels”. Duplicate labels can also be obtained via the print button
within the patient’s profile, but will be limited to one order if done in that manner. Choosing duplicate
labels from this screen allows you to print duplicate labels for multiple patients all at once.
61 | P a g e ******IMPORTANT CONCEPT******
Printing labels in Meditech DOES NOT CHARGE OUT DRUG!!!! You need to use a Debit routine to
charge a drug to a patient.
62 | P a g e USING CANNED TEXT
Follow the path below to get to the canned text printing option. Upon hitting enter a search menu will
appear.
When using CANNED TEXT, the Maximum Width for our labels is 50.
63 | P a g e THREE DAY HOME SUPPLY
A three day home supply will be entered as a one-time order on a patient’s profile Use the “label
comments” field to enter in patient instructions, quantity, lot number, expiration date (required by
Idaho State law). Use TAKH in the Charge Type, this designates a revenue code 253 on the bill,
which lets the insurance/Medicare know the drug went home with the patient. If you change the type
of Order button to Discharged, the system will automatically make the Charge Type TAKH. This will
also keep the drug off of the EMAR. Don’t forget you can print a monograph from the system by
highlighting the drug on the patient’s profile and using the print button!
PATIENT MEDS FROM HOME and MISCELLANEOUS DRUG ENTRY
Patient medications from home and miscellaneous drugs that are not in our drug dictionary are pulled
up during drug entry via the mnemonics PTOWN and NONF (use F9 after NONF to bring up the
various forms of Non-Formulary entries), respectively. Below is an example of the order entry process
for a patient’s own medication.
It is absolutely imperative that you type over the drug name and strength into the field at the top to the
right of Rx Number before the “PATIENT OWN MEDICATION”. A dose instruction box will pop up,
type in the dose instructions including the drug name and hit save. Then fill in the typical fields of
route, frequency, and schedule. You must also type in the drug name and strength AGAIN in the
64 | P a g e label comments field. It is necessary to type this information twice so that the drug name and
strength is visible on EMAR and visible to you on the patient profile screen (via the field next to Rx
Number). See the following screen shots. The drug is listed in the patient’s profile under “Patient’s
Own Medication”; therefore if you had not typed in the drug name at the top of the order entry screen
the drug name and strength would be listed as “Patient’s Own Medication” from the main patient
profile screen unless the order was expanded (by hitting the blue + symbol) to see the label
comments.
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Familiarize yourself with how a patient’s own med or non formulary drug will appear in the patient’s
profile. The drug name and strength is visible on the second line because the RPh manually adjusted
that field during order entry. Clicking on the blue + symbol will show the label comments and the
dose comments.
RX AUDIT
The RX Audit feature is used to see full details on every single thing that has happened to a patient
order. It will list interactions that were overrode, billing events that occurred, dates the order was
initiated, changed, and discontinued, etc. Basically anytime anyone digitally touched that order, it will
leave a trail on Rx Audit. So forever will it be documented that you ignored an important allergy
warning or forgot to dispense an initial dose!!!! Rx Audit can be accessed via the patient list by
clicking on the Rx Audit icon on the right hand menu and typing in the rx number. You can also
access it within the patient’s profile by highlighting the order and simply clicking on Rx Audit button on
the right hand side.
Audit after highlighting the order in question within the patient’s profile. Let’s use the RX Audit feature
to figure out why a medication in a profile was discontinued. In this example the RPh has opened the
profile in question, highlighted an order in the patient’s discontinued list, and clicked on “Rx Audit”.
Review the screen that pops up and all of its amazing detail. In the screen shot below the RPh has
scrolled down to identify why the order is discontinued. An important point here: nothing escapes Rx
Audit!!! It is highly recommended that you become familiar with the data available within RX Audit. It
will be your quickest way of checking to see when a dose was dispensed and charged, a function to
use to try and track down missing medications.
67 | P a g e PROFILE OVERRIDES
Profile overrides in Meditech couldn’t be easier. Meditech will document any drug override (meaning
obtainment of a medication from Pyxis that is not an active order on the patient’s profile) in the
patient’s discontinued drug list. This documentation has a specific look to it (see below). The order
will remain in “Orders with Activity” until the RPh clicks on the blue “Review” button. Once the RPh
clicks that they’ve “reviewed” the override, the order will move down into the discontinued section of
the patient’s profile. You may still need to place an order in the patient’s profile if the overridden
medication is a standing order.
68 | P a g e f-
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I
PROFILE COPYING
This is the function we can use to obtain orders from a previous admission and place them on the
patient’s current profile. This is a very useful functionality for when a patient changes from
observation to full admit or for copying chemotherapy orders, or for copying really tough orders.
From the main patient list click on “Patient profile”. Type the patient’s name (last, first) in the box that
appears. A list of all patients (past and current admissions) that meet the name criteria will appear
when you hit enter. Select the profile you want to copy FROM and hit enter.
From the old patient’s profile, select all the orders you wish to copy by clicking in the box next to the
order. Then click on the “Copy/Edit” button at the bottom of the screen.
70 | P a g e This will bring up a window that allows you to choose which admission for the patient you want to
copy the order(s) into. Clicking on the drop down menu in the green highlighted field will bring up all
the admissions to choose from.
71 | P a g e Once you’ve selected your “Copy to Account Number” admission, F12 or clicking on “Save” will move
that order right onto the current patient’s profile, and the system will allow you to edit it if necessary
before saving and filing. You will still be in the OLD patient’s profile when this process is complete,
so don’t forget to locate the newer admission to see the order you just copied.
72 | P a g e MEDICAL RECORD AND ACCOUNT NUMBER IN MEDITECH
You may have noticed that the numbers displaying in the patient header and in the recent profile copy
example KM medical record number or KM account number, see the following screen shot for the
positions of both numbers. The labels have been designed to print out the KM account number and
the RX# as follows:
Kootenai
MK (the reverse of the KM we used to see)
Sandpoint Cancer Center
BK
CDA Cancer Center
OK
Post Falls Cancer Center
CK.
M 73 | P a g e ORDER SETs
ORDER SETs from Magic have been built into our new system. All ORDER SETS are now Inpatient
to facilitate BMV. We have constructed a spreadsheet that lists all the ORDER SETS available. You
will notice there are 3 tabs on the spreadsheet, Kootenai, Benewah and Chemotherapy. You can
search the appropriate sheet by CTRL F, which will bring up a find box. You can now search for the
ORDER SET you are looking for. The spreadsheet is accessible on Pharmacy computers. To pull up
an order set in 6.0, you click on the “Set” button at the bottom of the patient’s Order Session
Summary screen. Use the F9 lookup key or click on the drop down arrow to see a list of all order sets
available.
74 | P a g e Pha,Cindy
KM0000194
c!if!
5 ft 6 in 1
67 .64 cm 1.96 m2
1
90 lb O oz 86.183 kg
KM00000130
Allergy: *.DFT CDP ALLERGY UPDATE MSG GREMLIN* AdvReac: Carboplatin, C
@ 111/F 01/01/1900
KM.MEDICAL KM0369-01
I
Select Order Set
If you need to discard some of the orders in the set you must put a Y in the "Discard Orders" field.
Order Set
CICUPCU
*Start Datel *Time
Stop Datel Time
CICU/PCU Admit Orders (04/10)
IJmlll B 1045
Discard Orders
Place All Orders in Pending
Pending Comments
-Chemotherapy Data Chemo Cycle
Cycle Days
Max Cycles
Last Cycle
Next Cycle
Cycle Number
75
IP a g e
Cancel
OK
x
<!}
Here is the screen you will see if you choose to discard orders. Be careful because it is asking you in
a negative sense as to whether or not you want to discard orders, so a Y means discard and an N
means keep. If you do not discard, all orders within the set will populate on the Order Session
Summary screen and you can edit, delete, or save them as necessary. When using this functionality
for chemotherapy order sets you will need to edit each order to adjust for your patient’s dose. Sets in
this system can be combinations of different order types (including IVs and UDs).
76 | P a g e IV FILL LIST
The IV fill list will print automatically every afternoon at 4:55 PM. This includes an automatic print of
all associated IV labels. The usual IV Fill List will continue to be manually run around 12:00 noon.
Interim IV Fill Lists can be run as they have in the past with Magic.
Should a problem with the printer occur and a reprint is necessary the following steps would be taken.
Follow the login procedures at the beginning of this manual (LOGGING INTO MEDITECH). Go to the
Technician Desktop:
The fill list functionality is accessed via the “FillList” button on the right hand side of the Technician
Desktop.
Click on the (+) symbol by “Inpatient” to expand the choices. You will have choices to reprint from the
Unit Dose fill list or the IV fill list. Click on the (+) to expand all of your choices within the IV fill list.
The Unit Dose fill list goes through the automated process.
77 | P a g e --
Inpatient IV Fill List
B Inpatient
Patient Lists
Et) Unit Dose
SeleC't Patient
B IV
Cart •
Order Group
Date-Time
Batch
No Batches
Next Patient
Patient Profile
.
rsfJ
+
Gf}
Edit Pt Data
Patient Audit
EMR
Ger
Enter Orders
Stock Orders
f!i1;J
Edit Orders
Rx Audit
nterventions
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<!zl
ADR Events
lr7
Progress Notes
l1i'
Fill Lists
MARs
d
l8il
Billing
lilll
I
nventory
nterfaces
I
78 I P a g e
C•:iil
System Mgmt
,M.,
Preferences
IJ
You may find the “Worksheet” option useful. This will give you an alphabetical list of all the items you need to pull from the shelf to complete your unit dose or IV fill list. You would obtain the worksheet by clicking on the worksheet button on the bottom of the screen (see the following screen shot). 79 | P a g e Click create at the bottom of the screen.
Select IV under Order Group.
Select the area you want under Cart Run
89 | P a g e You may find the “Worksheet” option useful. This will give you an alphabetical list of all the items you
need to pull from the shelf to complete your unit dose or IV fill list. You would obtain the worksheet by
clicking on the worksheet button on the bottom of the screen (see the following screen shot).
81 | P a g e Inpatient IV Fill List
El Inpatient
Ei:) Unit Dose
E) IV
Cart •
KM.CCU
KM.ICU
Date-Time
Order Group
I
V
JV
ALLI
VS
ALLI
VS
Batch
05/18-1700
05/18-1700
Patient Lists
Select Patient
Next Patient
Patient Profile
rsfJ
•
+
Gf}
Patient Audit
MARs
l8il
Enter Orders
Stock Orders
Edit Orders
Rx Audit
Fill Lists
d
Billing
lilll
nventory
I
I
I
Preview Create Schedule
82 I
P a ge
I
I
Reprint Worksheet Check
I
I
Compound Transfer Compound Check Rules
Verify
Number
I
nterfaces
C•:iil
System Mgmt
,M.,
Preferences
IJ
PRODUCING A LIST OF PATIENTS ON A DRUG
From the either the Pharmacist or Technician Desktop click on “System Mgmt” button on the right
hand side of the screen. Then click on the “Searches” button at the top of the screen. You’ll need to
“Start” a new one by clicking on “Start” at the bottom of the Screen.
Once you do this the following image will appear.
83 | P a g e The search profiles from MAGIC have been copied over to 6.0. Hit F9 and select the report you want.
Fill in the FROM START DATE and the THRU START DATE. You can change the Sorts or leave
them alone. Under selection type in DRUG and then under VALUE type part of the drug name and
use an F9 to look and select the drug you want (or you can simply type in the mnemonic if you have it
memorized). Then hit save. You will then see your search listed as pictured below.
84 | P a g e The search will take a minute or so, so keep hitting “Recompile” until the “Print” button at the bottom
of the screen is dark in color and accessible. When you hit “Print” this screen will appear.
This screen indicates that 1359 RXs were reviewed by the system and 9 of them were for the drug
I’m interested in. Clicking on “OK” at the bottom of the screen will allow you to print a list of those 9
orders. Change the selection from “Preview” to “Print” by clicking on “Print” and choose the
appropriate printer by clicking of the (+) symbol and highlighting the printer and clicking “OK”.
85 | P a g e