[MEDITECH-L] Reminder to Draw Pre and Post Vancomycin Levels

[Frank Magliery]

We are approaching implementation of eMAR-BMV. Nursing would like pharmacy to find a way to remind nurses to have pre and post vancomycin levels drawn before and after the third dose of vancomycin. Meditech suggested a rule, but that doesn't seem practical in view of the fact that it wouldn't apply to every patient (only those followed by pharmacy.) I'm at a loss how to do this. It seems any solution would involve first of all coding the vancomycin entry with the fact that pharmacy is doing the dosing, then invoking a rule with a reminder prior to the third dose. Anyone out there have any idea how to do this?

Frank Magliery
Hendricks Regional Health
Danville, IN

[McNamara, Tara]

We would all like a solution to this. Let me know if you come up with
anything. I think Meditech should have a new indicator on the status
board. There should be a place to set up a free text reminder and assign
a time. When the first reminder time comes up, it should turn red, then
the nurse should be able to acknowledge it to have it fall off the
reminder list. Then the indicator should turn green until the next
reminder time appears overdue. The functionality should extend to set up
automatic reminders, based on the med you are ordering-for your example,
we should be able to attach a reminder to the drug to set up a time x
minutes before and x minutes after the 3 scheduled dose. I would submit
a mix request, but I am tired of them telling me that I am the only one
who wants the enhancement.

Tara

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[Maxwell Becky]

You can build a different vancomycin vial to be used when pharmacy is
doing the dosing. So the pharmacist do not get confused, I would build a
rule with pop up to let them know or I would build sets for them to use.
I had to do something similar with our epidurals, we have cds popup with
our epidural to capture information, but I did not want the cds to pop
up when pacu uses one of the same ingredient as a push, Ex: fentanyl.

Just enter a mnemonic that you want EX: VAN in the drug dictionary. It
will tell you not active drug, activate it and it will ask you if you
want to copy a preexisting drug, copy your active vancomycin drug. Add
the CDS and or pharmacy rule to this one only. I would then build a set
for the pharmacist that they only use when dosing, not one for a
physician order. Will take some training.

One other thing, if building a cds for nursing, I highly recommend a cds
with a required response. If not they can fly right through it. Sorry I
do not have an example of how to only get it to pop up for the third
dose, that would be an attribute. I do know how to make it skip a
question, if you need that Example you could do this: Is this the third
dose Y/N?
( if they answer no , you do not see the next
question, but if they enter yes, you see)
Make sure you get a trough and peak level
with this dose Y?N?

The attribute to skip is IFE=IF{[ANS,"G.PHACHF"]|0="N" "";1}

Hope this helps,
Becky Maxwell

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Frank Magliery
Sent: Wednesday, December 05, 2007 9:49 AM
To: medit...@mtusers.com
Subject: [MEDITECH-L] Reminder to Draw Pre and Post Vancomycin Levels

[Paul Goedicke]

I better duck after tossing this one out since I also support Pharmacy and we're just starting our BMV implementation, BUT, if Pharmacy is the one determining when the 3rd dose is scheduled, shouldn't they be the most logical ones to enter timed orders for the pre- and post- levels for any antibiotic?
We all have to work as a team for the best patient care - no one should whine about being too busy to do what is appropriate and timely for optimal patient care. It would be nice if we could get the computer systems to automate all processes and reminders, but the bottom line is we must rely on the professionalism and compassion of staff to provide the best patient care available.
Off my soapbox now.
Paul

Paul Goedicke
IT Clinical Analyst III
Jackson County Memorial Hospital
1200 E.Pecan, Altus, OK 73521
Phone: (580) 477-7485
Fax: (580) 477-7366
Email: paulgo...@jcmh.com

Change is good.....Change is our friend............

Tara

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[McNamara, Tara]

Keep this in mind: When we take away the paper, we take away the nurses
ability to put those reminders some where. It is a very difficult
transition and Meditech does not have anything to replace this process.
Meditech could argue that they have special instructions etc.. but who
looks at that each day? They are great a reminding one another via a
paper MAR and we don't give them the same tools in the computer-it
really is not fair to them.

[Jeff Lee]

We have our pharmacist enter a 1x order of a drug like the one attached.
They schedule the blood draw in relation to the scheduled administration
time.

Jeff Lee

Assistant Director of Pharmacy, Support Services

DCH Regional Medical Center

809 University Blvd E.

Tuscaloosa, AL 35401

(205) 750-5323

jl...@dchsystem.com

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-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Frank Magliery
Sent: Wednesday, December 05, 2007 8:49 AM
To: medit...@mtusers.com
Subject: [MEDITECH-L] Reminder to Draw Pre and Post Vancomycin Levels

[Angeloni, Terry]

We have a couple of "non medication orders" on the e-MAR. They entered
by Pharmacy as a reminder to the Nurse.

Terry Angeloni

Clinical Application Specialist II

Provena Health Information Services

2175 W. Oneida St.

Joliet, IL 60435

Ph: 815-730-2858

Fx: 815-744-7565

terry.a...@provena.org

[Whitten Bill]

We also use the "dummy order" entry for the vancomycin levels. The
pharmacist schedules it for the same time as the dose is scheduled to be
given and the dummy order contains the reminder information for the
nurse on how/when to schedule the levels to be done.

We also attach a rule to vancomycin that asks if levels are scheduled to
be done and if YES, gives a reminder to enter the dummy order.

;Prompts to initiate process for obtaining drug levels.
;
IF{[f pt status]'="ADM IN";
[f rx yes/no]("Have drug levels been ordered for this? Y/N ")^YN,
("Enter order for drug levels on the MAR (Sets SLDA, SLDG, SLDT,
SLDV).")^A,
IF{YN=1 [f rx msg](A);
[f rx ok]}};

Bill Whitten
Pharmacist
Lake City Medical Center
Lake City, FL
(386)719-9343

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Frank Magliery
Sent: Wednesday, December 05, 2007 9:49 AM
To: medit...@mtusers.com
Subject: [MEDITECH-L] Reminder to Draw Pre and Post Vancomycin Levels

[Kirkland, Cathy]

Hello

Can anyone tell me their experience with the Iatrics VMV -
We already have the Meditech eMAR and have BMV on a test run here...
But can anyone tell me their experience with VMV ...

THANKS!!!

Cathy Kirkland MIS IS/IT
Clinical Systems Analyst / Nurse Informatics
[Meditech Magic 5.6]
Brazosport Regional Health System
100 Medical Drive Suite 421
Lake Jackson, Texas 77566

Cathy.k...@brhstx.org

Office 979-285-1238
Fax 979-285-1650

[Tammy Cieplowski]

I developed a drug dictionary item Mnemonic=NN for Nurses Note.

We can then enter a note for the RN to order a trough level of
Vancomycin 30 minutes before the 3rd dose. Because Pharmacy has dosed
and timed the order we can enter the 1 time order at the time/date when
the trough is to be drawn. The time will show up on the eMAR.

We also use this Nurses Note for reading PPD's, removing patches etc.

Susan Converse, Staff Clinical Pharmacist
Beaufort Memorial Hospital
Beaufort SC 29920
843-522-7773
scon...@bmhsc.org

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Whitten Bill
Sent: Wednesday, December 05, 2007 11:24 AM
To: Frank Magliery; medit...@mtusers.com

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[Thompson, Jeff]

So in the situation below with BMV, how does one "scan" the item to make
it drop off and mark it addressed. Doesn't this then document somewhere
in the patient record that you administered this non-drug?

Jeff Thompson, R.Ph.
Pharmacy Informatics
Newman Regional Health
Emporia, Kansas 66801
Direct: 620-340-6150

[McNamara, Tara]

I sure they have to full doc which throws off of the scan stats, but
that is why Meditech needs to address this issue.

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