[MT-L] Warning on eMAR for Stop Time Required
Bruce, April N.
We upgraded to 5.67pp20 last week and are having some difficulty with the new warning message that displays when entering the eMAR reminding staff to document a stop time for discontinued IV fluids. In theory, this sounded great and worked great in TEST. But there have been multiple scenarios that have been identified where the warning is less than ideal.
Here are the areas where it is causing some pains:
- IVPB’s – we document stop times using med reassessment
- Med station overrides – once med is administered it auto dc’s causing the warning to come up right after the med is hung
- Various edits to the drug causes new rx’s to be created, leaving a broken and somewhat confusing process on the IV spreadsheet
Just wanted to get some feedback from other sites to see if anyone else is having the same issues.
Thanks,
April
April Bruce, BSN, RN
Clinical Systems Analyst
Memorial Hospital and Health Care Center
800 West 9th Street
Jasper, Indiana 47546
Office: 812-996-5738
Marian Nguyen
We are definitely having some of the same issues. During testing, I knew it wasn’t going to be a favorable enhancement and was hoping it would be an option like most of their other enhancements. Unfortunately, it’s a standard function. I have opened up a task with Meditech after our Go-Live expressing our frustrations but of course, no response yet. :-/
Marian Nguyen, RN, BSN
Informatics Nurse
IT Department
Hazel Hawkins Memorial Hospital
Kristopher Brown
I think you need to set the active until infused setting to yes in the PCS intervention dictionary. Often times a bag needs to continue infusing even though it is no longer active in Meditech. We have pp21 in TEST and I’m not getting the stop flags, but we’ve been LIVE with IV Spreadsheet for a couple years. Also, take a look at KB16570 that refers to limited or full edits. We try really hard not to create a new rx number for IV bags. This means if you aren’t using the edit functionality for rate changes you might want to start. Also, I have a MUSE presentation from a couple years ago I can send out if anybody wants it. Some of the field names have changed, but I think it would help.
Thanks, Kris
P.S. Ask me how I can beat other consulting rates.
Kristopher P. Brown R.Ph.
Founder & Pharmacy Consultant
Med Preservation, Inc.
| t. 615-406-7453 |
| e. kbr...@medpreservation.com |
| w. www.medpreservation.com |
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Marian Nguyen
Sent: Wednesday, April 19, 2017 4:51 PM
To: Bruce, April N. <abr...@mhhcc.org>; (medit...@mtusers.com) <medit...@mtusers.com>
Subject: Re: [MT-L] Warning on eMAR for Stop Time Required
We are definitely having some of the same issues. During testing, I knew it wasn’t going to be a favorable enhancement and was hoping it would be an option like most of their other enhancements. Unfortunately, it’s a standard function. I have opened up a task with Meditech after our Go-Live expressing our frustrations but of course, no response yet. :-/
Marian Nguyen, RN, BSN
Informatics Nurse
IT Department
Hazel Hawkins Memorial Hospital
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Bruce, April N.
Sent: Wednesday, April 19, 2017 10:08 AM
To: (medit...@mtusers.com) <medit...@mtusers.com>
Subject: [MT-L] Warning on eMAR for Stop Time Required
We upgraded to 5.67pp20 last week and are having some difficulty with the new warning message that displays when entering the eMAR reminding staff to document a stop time for discontinued IV fluids. In theory, this sounded great and worked great in TEST. But there have been multiple scenarios that have been identified where the warning is less than ideal.
Here are the areas where it is causing some pains:
- IVPB’s – we document stop times using med reassessment
- Med station overrides – once med is administered it auto dc’s causing the warning to come up right after the med is hung
- Various edits to the drug causes new rx’s to be created, leaving a broken and somewhat confusing process on the IV spreadsheet
Marian Nguyen
We have ours set to Y. In Test, I tried testing it to Y and N and the message pops up no matter what. The only difference is whether the med stays active on the IV spreadsheets or it gets placed under the discontinued header. I went back and forth with Meditech while I was testing this to no avail.
I’m curious now though why you aren’t. Are you C/S?
Marian Nguyen, RN, BSN
Informatics Nurse
IT Department
Hazel Hawkins Memorial Hospital
O: 831.636.2672
- IVPB’s – we document stop times using med reassessment
- Med station overrides – once med is administered it auto dc’s causing the warning to come up right after the med is hung
- Various edits to the drug causes new rx’s to be created, leaving a broken and somewhat confusing process on the IV spreadsheet
Marian Nguyen
Sorry meant to say I was curious why you aren’t receiving the pop up message. :-D
Marian Nguyen, RN, BSN
Informatics Nurse
IT Department
Hazel Hawkins Memorial Hospital
O: 831.636.2672
Kristopher Brown
Yes, CS 5.67 pp21. Do you have this set to Yes:
Option to recalculate the end time of Stock and DM IVs to stay active while infusing, based on the administered rate and bag volume. This is controlled by a new PHA CDP “Update IV Stock Med Stop Upon Admin” under the PCS/POM tab
P.S. Ask me how I can beat other consulting rates.
Kristopher P. Brown R.Ph.
Founder & Pharmacy Consultant
Med Preservation, Inc.
| t. 615-406-7453 |
| e. kbr...@medpreservation.com |
| w. www.medpreservation.com |
- IVPB’s – we document stop times using med reassessment
- Med station overrides – once med is administered it auto dc’s causing the warning to come up right after the med is hung
- Various edits to the drug causes new rx’s to be created, leaving a broken and somewhat confusing process on the IV spreadsheet
Ventura, Andrew
I'd love to hear from someone that managed a workflow for allowing CPOE/POM users to edit an IV's rate, with using IVSS.
So far, meditech has said that setting the parameter for all edits, not just full edits, to create a new Rx# to YES is something they now recommend as a best practice, however, when they designed IVSS, that parameter was recommended not to be set that way, and new RX#'s on every rate change for normal saline are a challenge to look nice and document on IVSS.
Thanks,
Andrew Ventura, Pharm.D, MBA
Pharmacy Informaticist, Information Systems
Augusta Health, Fishersville VA
- IVPB’s – we document stop times using med reassessment
- Med station overrides – once med is administered it auto dc’s causing the warning to come up right after the med is hung
- Various edits to the drug causes new rx’s to be created, leaving a broken and somewhat confusing process on the IV spreadsheet
Just wanted to get some feedback from other sites to see if anyone else is having the same issues.
Thanks,
April
April Bruce, BSN, RN
Clinical Systems Analyst
Memorial Hospital and Health Care Center
800 West 9th Street
Jasper, Indiana 47546
Office: 812-996-5738
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Freeman, Gale
Are you Client server, Magic, or 6.1 ?
Bruce, April N.
Client Server 5.67pp20
Thanks,
April
April Bruce, BSN, RN
Clinical Systems Analyst
Memorial Hospital and Health Care Center
800 West 9th Street
Jasper, Indiana 47546
Office: 812-996-5738
Stiefermann, Marlene
We have found it only works in the order is actually stopped from POM. The warning does not work if the med is ordered as a X1 or if it reaches its auto stop date (antibiotics, narcotics). And the warning also does not display if the original order included a future stop date/time, although “CLIN-7662 introduced a message that will remind users to stop an IV in the IV Spreadsheet if it has been manually discontinued or reached its Stop Date/Time”. Any one else finding that is the issue?
I agree it seemed like a great enhancement, but it needs to work in all scenarios, not just some
Marlene Stiefermann, RN
Clinical Analyst
Health Informatics
Capital Region Medical Center
From: Marian Nguyen [mailto:mng...@hazelhawkins.com]
Bruce, April N.
In TEST we now have both fields set to Y – ‘Active Until Infused’ & ‘Update IV Stock Med Stop Upon Admin’
The ‘Update IV Stock Med Stop Upon Admin’ will help greatly with the override med issue we are experiencing – users no longer get the stop time warning right after the IV is hung.
The ‘Active Until Infused’ functionality makes me a bit nervous, the med remains active on both the IVSS & the eMAR. I would have expected it to only remain active on the IVSS. While I see the ‘DC at date/time’ in the next scheduled field and a stop time populated on the eMAR, the medication can still be administered even though it is technically discontinued. You don’t even get a warning message or anything. I’m not so sure the benefits outweigh the risks for this one – unless I’m missing something. The only thing I see this setting helping with is allowing staff to more easily find the entry on the IVSS instead of having to expand the discontinued section on the IVSS to find it.
How do you all have the ‘Admin Required’ field set? We currently have ours to N but I am wondering if this will help keep things cleaner on the IVSS?
Thanks,
April
April Bruce, BSN, RN
Clinical Systems Analyst
Memorial Hospital and Health Care Center
800 West 9th Street
Jasper, Indiana 47546
Office: 812-996-5738
From: Kristopher Brown [mailto:kbr...@medpreservation.com]
Sent: Wednesday, April 19, 2017 6:49 PM
To: Marian Nguyen; Bruce, April N.; (medit...@mtusers.com)
Baker, Tara
April,
We are really struggling with using the IV Spreadsheet and are trying some ways to capture data so that we do not have to use it. I see that you remarked that you are using reassessments on IVPB for stop times. Can you send me a screenshot of this assessment. We are trying to gather some other ideas, right now we are having nurses go into Admin Comments and document this….if they remember to do so.
To all in this email string,
Are all of you using the IV Spreadsheet?? We are going LIVE with 5.67 PP21 next week and we are not sure what we are gonna see as far as these “errors” in LIVE since you can only test so far in TEST.
Tara Baker RN,BSN
Nursing Informatics ACMH
"Life is either a great adventure or nothing at all"
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Thank you.
Bruce, April N.
We do NOT have the Admin Required field set to Y. We discussed this and found that it would hinder the workflow of our critical care unit regarding vasopressors being overridden out of pyxis in emergency situations. How are others getting around these types of situations?
After thorough discussion, we have not really found much benefit of this new enhancement. Our PCS specialist said if we would like to pursue backing out CLIN-7661 we would need to submit a custom for it to be evaluated. We are starting that process today.
For those of you NOT using the IVSS, how are you capturing stop times on continuous fluids? We have used the IVSS since our initial go-live back in 2008, so it’s hard to imagine not using it.
Thanks,
April
April Bruce, BSN, RN
Clinical Systems Analyst
Memorial Hospital and Health Care Center
800 West 9th Street
Jasper, Indiana 47546
Office: 812-996-5738
From: Kristopher Brown [mailto:kbr...@medpreservation.com]
Sent: Friday, April 21, 2017 11:55 AM
To: Baker, Tara; Bruce, April N.; Marian Nguyen; (medit...@mtusers.com)
Subject: RE: Warning on eMAR for Stop Time Required
We do have the Admin Required field set to Y, I think this keeps the spreadsheet much cleaner. I understand that Meditech’s best practice is full edits, however, that was not the recommendation 2+ years ago when we went up on IV Spreadsheet. The stop messages weren’t even there for about a year after we went live. While the stop messages aren’t perfect, they have greatly improved our documentation. I would get calls from the quality nurses all the time because there was no stop data. I don’t get those calls anymore. We were documenting in an intervention before the IV spreadsheet and nursing was bad about filling it out. I would say if you have a process that works and it is successful (i.e. reassessments), then use it. Our pharmacists review all rate changes, as well as, any comment updates that might come across as a result of the limited edits. We don’t have a lot of orders that get the comments/instructions updated, so it is mainly rate changes. All rate changes are tracked on the IV spreadsheet whether it is a titratable drip or a constant rate, this is really nice as well to see all the information in one place. Keeping one rx number over the life of the order is really the key to keeping a clean IV spreadsheet. If your facility is not comfortable with limited edits, then I am not sure the IV spreadsheet will work for you.
Thanks, Kris
P.S. Ask me how I can beat other consulting rates.
Kristopher P. Brown R.Ph.
Founder & Pharmacy Consultant
Med Preservation, Inc.
| t. 615-406-7453 |
| e. kbr...@medpreservation.com |
| w. www.medpreservation.com |