[MT-L] Drug Waste documented in MAR
Richard Martell
Is anyone out there making nursing document on the eMAR or in the medical record somewhere what drug waste there is for single dose vials, or maybe multi dose where appropriate? It appears we are not required to have JW modifier on claims so we are not going that route but then further questions came up if we are required to at least document waste in the medical record. So this is more of a clinical question, not so much billing.
Thank you in advance.
Rich Martell
Systems Analyst II
Information Services & Telecom
Oswego Health
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David Brown
Hi Rich,
All the facilities I have been to do not document waste in the record, but do in their medication vending machine and if required have a co-signer to verify the waste. If it’s to verify a correct amount given, the settings for co-sign at admin, not sure what the rationale is for documenting wastes as it doesn’t specifically address care of the patient. Of course, I am always enlightened by things I never considered. Being that waste is documented in Pyxis or similar VM and there is an electronic audit trail for all other reasons outside the patient record.
Regards,
David E Brown, RN, BSSE
Senior Healthcare Consultant
Cell: 509-991-5874
Office: 509-340-2535
“Transforming Healthcare, One Hospital at a Time”
David Brown
Hi Rich,
Just as I pressed send, I remembered one instance of doing this and it’s on PCAs, where they want to capture use and remaining volume on the patient and we do build Admin and Reassess CDS for them on the eMAR. That is the only instance I now can think of (yeah right until about midnight I’ll remember another one). This has been done to accommodate moving away from the PCA flow sheet documentation and does work well. The cartridge when removed at DC the waste is also documented in the Pyxis machine as well.
Thanks
David E Brown, RN, BSSE
Senior Healthcare Consultant
Cell: 509-991-5874
Office: 509-340-2535
“Transforming Healthcare, One Hospital at a Time”
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com]
On Behalf Of Richard Martell
Sent: Thursday, April 04, 2013 5:14 AM
To: medit...@mtusers.com
Subject: [MT-L] Drug Waste documented in MAR
Is anyone out there making nursing document on the eMAR or in the medical record somewhere what drug waste there is for single dose vials, or maybe multi dose where appropriate? It appears we are not required to have JW modifier on claims so we are not going that route but then further questions came up if we are required to at least document waste in the medical record. So this is more of a clinical question, not so much billing.
Kathy H. Craig
If it is something prepared in the Pharmacy, we document the waste in the PHA Rx comments. I’m not sure whether we have addressed waste on the nursing units.
Kathy Craig, R.Ph.
Licking Memorial Health Systems
Newark, Ohio
HIMSS Analytics Stage 6 Hospital
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com]
On Behalf Of Richard Martell
Sent: Thursday, April 04, 2013 9:14 AM
To: medit...@mtusers.com
Subject: [MT-L] Drug Waste documented in MAR
Is anyone out there making nursing document on the eMAR or in the medical record somewhere what drug waste there is for single dose vials, or maybe multi dose where appropriate? It appears we are not required to have JW modifier on claims so we are not going that route but then further questions came up if we are required to at least document waste in the medical record. So this is more of a clinical question, not so much billing.
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Carpenter, Michael--IRM
Hi L’ers,
In the client server Meditech pharmacy dispensing machine dictionary the site has the option to VEND AS SINGLE DOSE , which if set to Y would treat a multiple unit med vend as a single dose, with 1 upcharge , rather than seperate upcharges for each unit.
For you client server sites with the option=Y what happens if the user returns 1st unit of the prior 2 unit override? Is the return calculated correctly, as such to allow the potential return of the 2nd unit to zero $/QTY the override rx correctly/completely?
For you magic sites has Meditech enabled this feature for you in magic?
Thanks for your time!
Mike
Michael D. Carpenter
Sr. Analyst/SE
Meditech Pharmacy Infomatics
Information Resource Management
Inland Northwest Health Services
Spokane, Wa.
Chase, Margaret
Currently we document waste either in the Drug dispensing machine (Pyxis) or we have a separate computer program for the non pyxis units. Because we could not get a system to work in Meditech with the eMAR for nurses, we still use the other custom software program—but that will go away when we get Pyxis on all units. We did build an assessment for nurses to document waste, but since it requires and intervention to be a cosign/and you cannot put an intervention on a med in PHA—we had to move in the direction above
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Charles Downs
The pharmacist or the tech documents in the Rx comments section of the order. I certainly wouldn’t expect nurses to do it as they only thing that they could document would be say Reglan injection where documentation of 5 mg (since 5 mg billing units) would be expected on a 5 mg dose. But, that is small fry and I don’t think that anyone is going to come back and ding you on that one. If they do, the most they can do is not pay you the pennies for the 5 mg wasted.
Charlie
Charles Downs PharmD
Information Systems Pharmacist
Meritus Health, Inc.
11116 Medical Campus Road
Hagerstown, MD, 21742
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com]
On Behalf Of Richard Martell
Sent: Thursday, April 04, 2013 9:14 AM
To: medit...@mtusers.com
Subject: [MT-L] Drug Waste documented in MAR
Is anyone out there making nursing document on the eMAR or in the medical record somewhere what drug waste there is for single dose vials, or maybe multi dose where appropriate? It appears we are not required to have JW modifier on claims so we are not going that route but then further questions came up if we are required to at least document waste in the medical record. So this is more of a clinical question, not so much billing.
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Pope, Amy
It is not a Joint Commission/billing requirement. It is a Board of Pharmacy/DEA requirement to be able to produce documentation for narcotic waste. We produce these reports via dispensing machine reports for DEA if needed.
Amy P. Pope, Pharm.D., RPh
Pharmacy Team Coordinator
Harnett Health
P.O. Box 1706 | Dunn, NC 28334
Office: 910.892.1000 ext. 4096 | Cell: 910.814.7212
email: amy....@harnetthealth.org
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of David Brown
Sent: Thursday, April 04, 2013 11:24 AM
To: Richard Martell; medit...@mtusers.com
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P Please consider the environment
Charles Downs
There are two different issues here. The original post was asking about JW modifiers which relates to being able to receive reimbursement for waste in single dose vials from Medicare (and some other insurers). Some fiscal intermediaries require that the waste be on the claim, while others like ours, just require that it be documented in the medical record. If you haven’t documented the waste, then if someone comes in and does an audit, you will not be reimbursed and will have to pay back the difference in dollar amounts between what the patient received and what you used. The other option is to build waste entries in pharmacy and/or the CDM and actually generate a charge for the waste using a JW modifier. You need to document waste for all drugs with J-codes if there is waste of one billing unit or greater.
The second issue of narcotic waste is totally separate and is regulatory in nature.
Charlie
Charles Downs PharmD
Information Systems Pharmacist
Meritus Health, Inc.
11116 Medical Campus Road
Hagerstown, MD, 21742
Ray Fernandez
Mike,
If it is set to Vend as a Single Dose =Y then all units removed will count as one single dose. MEDITECH doesn’t allow for the return or credit of a partial dose, so returning any amount of the vend will result in crediting the entire amount. For example, if the user vended three vials of drug X for a charge of $100 and later returned one vial, the credit would be $100. If the user returned two vials the credit would still be $100.
Winston Forred
Please correct me if I’m wrong, but I have always understood this setting to apply to dispensing machine override vends only in terms of charging the qty as a single dose. The description of return or credit is how I understand it for credits to any order.