Meditech PHA Training Manual - Kootenai Health Information
Transcription
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 KM0000194 crJI Pha,Cindy 210 lb O oz 95.254 kg G 111/ F 01/01/1900 KM00000130 Allergy: Warfarin AdvReac: Carboplatin, Cephalosporins KM.MEDICAL KM0369-01 (Patient Data) (Comments )(Allergy/AdvReac) (Queries ) (Lifetime Treatments) q::, Verified Allergy/ Adverse Reaction for I nteraction Checks: Type Severity Date AdvReac I ntermediate 01/25/11 Yes Cephalosporins q::, Hives Warlarin Severe 01/25/11 Yes AdvReac Severe 01/25/11 Yes Anaphylaxis .... Patient Profile a, Selec t Patient tf!} Edit Pt Data Patient Audit EMR Allergy Bleeding Carboplatin Ne t Patient Patient Lists q::, @"" Enter Orders Stock Orders E(i",\l Edit Orders l.1W' R A..td•t I nterventions ADR Events (""' w aw Progress: Note< Uncoded Allergy/Adverse Reaction Type Severity Date Fill Lists MARs B1ll1ng lml nventory I I nterfares v<tem Mgmt I Pnnt Audit Trail 22 I P a ge I r I R ltt d Exclusions Enter/Edit Cancel Save r.;._:i fl}., 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. 35 | P a g e iH00.,9000007 Aug ust,lane ii) 55/F 03/12(1955 H041411905 Aller-gr : *'*•No Allergies 6ntere,:f•1< WDCi 610-B Rl( N11mber Totilll Dooe -" Roum -.: Frequenc·y *Schedule! NEW WAR.FAR.If SODIUfit 2.5 MG WARFi\ lUtl.l SODIUM 5 MG , 7_5 rG ORAL PO 22.00 @Dally QHS Par Level SCH P RN Reason r 5 ft 1in 154.94 cm 1.4'1 m2 47 .627199 kg 105 lb O oz , ' SIB<t Dal•I lime 10/3()/10 T Totilll Oosee 2200 stop Date l Tlrne Soll: Stop All Freq - - *Inventory MAIN -t: Dlspense 2 Cart Amount 0 M.AI N $CMrge Type chatge Items- Pendlfll!J ,ED 0.33 Label Comments CAIJI'ION - LOOK A.LIKE, SOUND ALIRE - Vli:RI:E''i' MEDCAlJTIO>J LOOK JI.LIKE;, 30UND .;ti.LIKE. - 1a111 36 I Pag e 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. @ Pha,Kevin KM0001112 DIS RCR 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 ASPIRIN 325 MG TAB nstructions I 325 MG PO QAM 325 MG PO .EXTRA DOSE OME First Admin 01/25 0900 01/24 1400 Patient Profile Edit Pt Data EMR "" 'g- Enter Orders Stock Orders !§ fdit Orders ["' Patient Audit * Ordering Doctor KDC22 DEA Mumber Medication Chester,Kawal D MD " 805507782 I *Type of Order ® *Output Option ® Rx Audit I npatient o Outpatient o Discharged Review o Auto o Mone nterventions ® ADR Events MARs Prowess Motes " ,,.... Y Fill Lists Links 1 Type Alternating 1 2 , 2 3 Enter Edit Delete Extra Dose 38 I P a g e c! 1rf Cancel )t ""' . 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 MH0270000() O? S fl: li n 10s lb o oz WD6 610-ll H041411905 Allergy ; ·• • •No Allerg1e:s Entered• • 0 55/F 03/lZ/1955 154·.94 cm l.44 m2 47.627199 kg 3 Patient View - lnterventi on = Sla:rt Oiit e-Time 5tiltUi= Ct-!A NGE ROUTE PENDING 10/31/10,- 1740 O of l9 Selected =I r "" Current Orders Instrut:ticns AMINO AC[O'S , OE:XTROSE, ANO E lO... l0/3l oaoo Al"\o1iNO ACiDS, l'.lol!Xf ROSI!, AND !; UJilil 1'11L iV OA.iLY SCt-t•... 00000061 2 TPN MAIN 1000 ML [V DA.CLY SCl-l O Ba,g i!ll 41.567 MLS/MR Status • $B8 .B3 Ordered Dose BUPIV.i\Clllri E HYD:ROCHLORJOE, ... Oil ML @ Per Protocol IV.... 1 0 BUPIVACJ..IM E HYOROCHLORJOE 200 ... 10/22 1245 Bl OMAIN 500 ML @ Per Protocol V .QOM SCH O Ba,g Amount 1000 ML AMINO ACID 2.7596 lkDEXTROSE 10% PF'N WJTH LVTES 000000524 Active, Amount Ordered Dose 200 ML sootuM OI LORIDE 0.9'1& 5Cil0 ML BAG, FOR t..l.JE:CTCON l 300 Ml 1 -- ,n -- 1 0 CEFAZOUN SODIUM 1 GM 00000060:e in SODIUM c... 1000 MLI R QBH SCH... in SOOIU... 10/30 1810 I PHA AMIN, KIM $12 1.32 lllJPIVACAINE HYDPOCHLORI DE CAOD ADMINISTRA T!ON SET CE·FAZOUN SODIUM Source AMIN, PHA KIM Active (ff OMAIN 1000 ML l.R Q8H SCH @ Per ProtocI llci:iv9 :ii aagi PHA AMIN, KIM S;7.67 Amoont Ore!ered Dos.e l GM CEFAZOLIN SODIUM -- kl) -- 1000 ML SOCl!UM CHLORIDE 0.991. OOCJ ML POUR' SOTTli! DAPTOMYC[N in SODIUM CHLORJDE 50 ML IV DAILY SCH... 1. 0 DAPTOMVC!N 500 MG in SODJlJM Cl-l ... 10/310800 000000609 PB OMAJN 50 ML IY DAil'i' SCH @ 100 MLS.11-lR 52 I Page 2 aags lldiv9 PHA AMIN, KIM $963 .73 ., 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. 65 | P a g e S ft G in/ 190 l b/2 .03 m 2 111 F 01/0 1 /1900 O PHA,CINDY Pha,Cindy KM .MED CA L KM0309-0l KM0000194 111/F 01/01/1900 q11 A dm npat ient I A llergy/A dvRea c : C arbop lat1n, Ceph..3 1osponns Ancill-:1ry Financ ial Tn fn c;y c;tpm ,:;; 1.96 m2 KM00000130 190 lb O oz 86 .183 kg Allergy: *.OFT CDi> ALLERGY Ui>DATE MSG GREMLIN * AdvReac: Carboplatin, C KM.MEDICAL KM0369-01 r I PRN s Vs I ncluele: IY A ctrve l n TA Cl MK.UUUUutLSb UD-CC MAll L VlAL ',ll'.>.::S4 l-'et:rone11 A Deltasone,Deltasone 60 MG PO DAILY SCH Active PHA c:5l St.art .. ,0 PREDNISONE 50 MG,PREDNISONE ...08/19 0900 TODAY Timmermans, c:;.!01 Mc dic.::ition lime Mon Jan 4 St.Jtu::; Tu e Jan 2 (Ro ut e)MA N O TAB $14.50 00000049 Si>LIT-CC Petronell A A-..; k Sll u I ] n,PO OT I SCH I Eskal th : Lithonate(LITHIUM C ..• 300 MG DAILY Active PHA - 47 unavailable Ifill ,0 LITHIUM CARBONATE 300 MG CAP 01/06 0900 Timmermans , I (:i ve:l C Al-'SlJLl::/:3 UU mg OK00000002 UD MAIN O CAP $3. 53 Petronell A 01/12/112 1:OD a.I Avon e>< 30 mcq M BID SCH Generic n terferon in ML Kefzol : Ancef i n NaCl:I 0.9°A> e.eta- tA/A Ibum 1 00 V QBH SCH. . Active PHA c:5l 09 :00 -ld -5111 P.x # : MK00000836 A c- t iv1.1 Mt:!IJiL:d iur 1 l ,0 CEFAZOLIN SODIUM 1 000 MG in N..08/18 1 000 Timmermans, UnAclmowlcdgcd 100, IHI -12h 00000047 VS MAIN 1Bag $40.01 2 1:00 Petronell A e : 1YIAHOME(PATI••. L/30 MEDICATIONGivFROM 0 DOSE PO DAILY SCH Active PHA tolin HFA nhaler 60 multidose NH BID SCH 13/1121: 00 r= 0 01/ FISH OIL CAi>S Gener PATIENT OWN MED...01/25 0900 Timmermans, c : A lbuterol i A r:t iVR Rx# : MKnnnnnR.c:;n MK00001 1 90 UD O MAIN O tem $0.00 00 :00 r.:it icnt C.:irc c m Petronell A ld @Ifill Un/\cknowlie dge,d NaCl 0.9oA, 1 000 ML V . NFUSION SCH.•. Active PHA 21:00 -1 2h Refresh EMR D ,;:psn r;,: i 1multidos:G/inh•I nh;i sr ,0 SODIUM CHLORIDE 0.9% 1 000 MlGr 1inh.;ilgr 08/18 1 245 Timmermans, Lobel Comm ent s: MK00000002 VS MAIN O Bag $20.11 Petronell A Order s " Clin ical Admi1 i:5t1-ative K M000001 30 5 ft 6 inK M0000194 167.64 cm - .. l UJ./:dti/ J.J. U Y :uu l .. Prov ent 1I HFA 11h-3le1I iSIIVIE!dicat on t-rom Home ee uose nstructions 1-'U oD rc 0d/o3n2 T ab Yi>D C5O T/A P O DAILY SCH '0 N HY RoOco e51 0M G(H /A AR PO 32 MD G......0 08 1B 81 1 58 Q4H PRN A c t ive Generic : Patient Own Medication MK00000001 UD O MAIN 2 tems $3.80 Rx # : MKnnnn 11cm 1JnArkn11wlP.rl1JP.ii @Ifill Sectral(ACEBUTOLOL HCL) 200 MG PO DAILY SCH 09 :00 , ACEBUTOLOL HCL 200e MG CAP 08/19 0900 D ,;:psn i : 1do,;:s 00000051 UD Dose Instruction s: MAIN 2 CAP $3.69 F SH OIL C A PS 2000 MG Tylenol(ACETAMINOPHEN) 325 MG PO Q4HP PRN Labelt;omments: , ACETAMINOPH EN 325 FISH MG OI L 2000MG TAB C A PS 12/03 0856 CK00000001 UD O 350 0 TAB $0.60 Ventolin HFA nhaler(ALBUTER ••• 60 MultiDose NH BID SCH 0 ALBUTE ROL HFA nhal , er (#60 nha ...01/1 3 21 00 MK00000856 UD O MAIN 840 INHALER $3633.04 Deltasone(PREDNISONE) 50 MG PO DAILY SCH , predniSONE 50 MG TAB 08/20 0900 - 08/21 0901 00000013 UD O MAIN 1TAB $3.59 Deltasone(PREDNISONE) 50 MG PO DAILY , predniSONE 50 MG TAB 08/18 0845 - 08/22 0300 0000014 UD O MAIN 4 TAB $3.92 66 I P a g e • ·t p ; t Patient Profile 00 Edit Pt Data Patient Audit rn EMR @' Enter Orders Stock Orders Edit Orders !§'> Amh OrrlA r-=; At11""' 4 HA : Rx Aud 1 t i Clinical Dat a ; - Pl.;in Of Ccirs Active w orklist -5 m Active Active D i scon i t nued Dose Warning Timmermans,, Petronell A PHA Timmermans., Petronell A PHA Timmermans,, Petronell A PHA Timmermans,, Petronell A PHA Progress Notes ca' FiIILists csil MARs 121 Billing ITl nventory I nterfaces I System Mgmt ell M.- 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- I _,_ rt ,t 0..-der Deta 1ils - Instructions8 Status _ A Sou rce - "' The following screen shows how a profile override appears in Rx Audit. El l_ !lwl 00000929 OVER ,---- ,_ EJ El -- .0 \1 V D -A 1 g @ •••Discontinued $7.10 Order Detail Start Dam 11./05/ 10-1817 Discontinued on 11/05/10- 1818 MAIN P'HA Sire Charge Type = 1 rLE1 - K- E flE 1 f.. . J 8fflt,r c b'a_ r,oo ML o Dnug1 11/05/ 10-1818 Stop Dam OiSCOf1tin LI00 By IV $7 .10 Tota l Cha rnes "' D IN,KIM STK MED Total Dispensed 1 Total costs S:1.69 Deta ils (Dose Calculations) SODI.100519 SODIUM CHLORIDE 1.00 ML 100 ML BAG - 100 ML Date-Tim@ ----, 13 Review Activity Dlsoenslng !Machine Order 11/05/10-1821 Sourc@ Uoor APECHIE Efl Review Mist,ory HI Comrnents Int,eiractions 1±) B Billi ng Service T Charge Source 0 11105/10·1821 11/0.5/10- 1617 ill'HTIAL ORDER · Uoor Ac.cou nt 4 110279000007 Jnventory WOOD!>· A APECIH E 6502.9043 'f'otals B Full Audit Aetl vlty 'fyoe T U/ 05}lD-1821 DISCO:NTI? UE ItelllS AUt.o ct:ed ited : Doses Auto ci:edit.ed : a DC Cc»IMENT S; DC 'd by J!, P!B:CHIE 11/05/10'- 69 I Page 1821 PYXIS TO PH11. Charge 7.10 l - Payment i>rocedum 1 7.10 User S'rK MEIJI 0 Items A!PE:CHIEi e:f f : 11/05}10-11ll8 l 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 I <!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