Sepsis question for all Cerner users
Deborah Hill
Good morning,
I have a sepsis question for all Cerner users please. Here is the scenario – we have created a power order set for our ED and another one for our Medical side to include stat blood cultures and stat antibiotics among other things. When our physicians order the blood cultures and the antibiotics, they are entered into the Cerner system at the same time. Our lab uses a different system that feeds into Cerner and I have been informed that the blood culture time is taken directly from the tube where the nurse signed with date and time. Our pharmacy places the time for the stat antibiotic as the time it was ordered, so if the med was ordered at 0800, it will show up on the MAR to administer at 0800. I have been told by our IT department that this is the way the system works and cannot be changed. This means that every stat entry in the MAR, the nurse must manually change the time that they spike the bag. As this does not happen with any great consistency, we have several cases where it appears as if the antibiotic was initiated before the blood culture was obtained, resulting in failure of the sepsis case. Our ED currently does not scan medications, although that will be coming in the next 6 months as we upgrade our RX stations. I do not know if scanning an antibiotic will change the default time on the MAR.
My question is, for those facilities using Cerner, how are you educating staff to be consistent with manually changing the time on the MAR. Also there is the ability to take a screenshot of a behind the scenes entry in the MAR which shows a “performed by” and “verified by” with the actual time the antibiotic was administered but that is all that screen states. Is anyone taking screen shots and submitting this for validation? Thank you so much in advance for any information you can provide.
Sincerely,
Deborah S. Hill MSN, MHA, RN
Outcomes Specialist, Quality Management
Medical Arts Suite 2
252-633-8273 office
252-633-8271 fax
252-464-4829 pager
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Stacey Montgomery
(Trying again to see if it will go through without the original email.)
We have Cerner, and we had similar issues in the beginning. We actually changed the system to default to the current time when the nurse goes to document, instead of defaulting to the scheduled time. Once we explained to them that if they didn’t correct that time, all of their meds were likely going to look like they were given late, they started paying a lot more attention to the time on the administration documentation. Now we have bar-code scanning, and that is still set to default to the current time the med is being scanned, rather than defaulting to the scheduled time, and we have no issues with it anymore.
We also have an interface with lab, so where we occasionally have problems is when the lab doesn’t change the time to the actual drawn time but defaults to current time (when the sample finally gets upstairs to the lab). Not nearly as common a problem as the MAR issue, though.
Hope that helps!
Stacey Montgomery, CPHQ
Quality & Risk Coordinator
Delano Regional Medical Center
Phone: (661) 721-5396
Email: mo...@drmc.com