Welcome To eMAR Update

1. The purpose of this module is to: Review the proper use of the eMAR Identify ways to handle specific situations Improve patient safety Let’s begin! Welcome To eMAR Update

2. The goal of Electronic Charting is to have a “real time” picture of a patients care.To achieve this goal certain criteria must be met… • Providers must enter care given in a timely manner- • Including medications or treatments the patient receives. • Correct information must be entered.

3. Mark As Not Done If dose will never be given i.e. dose is held because heart rate is too low If profiled incorrectly i.e. the wrong medication is on the eMAR If medication has already been given and marked as done on another task i.e. profiled medication was Marked as Done and mark the Pyxis override as not done When To…

4. When To… • Mark As Done • Immediately after giving the medication • Mark As Done By Other • If you know med has been given & by whom • i.e. in report, the off going nurse tells me she gave the patient the 1900 medication dose but did not mark it as done.

5. When To… • Leave a task overdue: • Vaccines - if it will be given at a later time • If med hasn’t arrived on unit and will be given when it arrives • If med will be given at a later time • i.e. patient is off the floor having a procedure and will receive the med when he returns. Reset a Task Status • When a task has been marked as done by mistake

6. Also when… • Adding a comment- • Make sure the reason stated is meaningful and correct. • If it is not meaningful and correct you are • Jeopardizing patient safety. • Falsifying information on the chart. • Giving an unclear picture of the patient’s healthcare. • It must stand up in a court of law.

7. When … • Adding a comment that med will not be given is not the same as Mark As Not Done. • If you are not going to give the med you must address it appropriately- • Mark As Not Done and choose correct reason. • A comment may be added if you wish.

8. Document Immunizations Click on the syringe icon at the top of the page, Immunization Manager will open, then fill in the information. *Remember-Pneumonia, H1N1 & Influenza vaccines are required to be recorded in Immunization Manager ,as well as charted on the Emar. Where To…

9. Where To… • Document Meds Pulled from Pyxis on Override • Mark profiled as done, override as not done-reason pt already received medication. • Find Help for Emar Charting • Inside Scoop-Click on Sunrise News on left hand side then click on appropriate section • Call if you have questions • Help line 24/7 @ 8927

10. Use Worklist Views for Uncharted Overdue & Override Meds When in the Emar, near the upper left corner, click the down arrow (where you select the view) and choose either ADM OVERRIDES This Patient or OVERDUE MEDS This Patient to see either list. How To… • You can document on tasks right from these views. Once you document the task it will disappear from the Overdue or Override view.

11. How To… • Find Patients when they are no longer on your unit or in the hospital: Click on the icon of the man with the looking glass, enter the Patient Name, MR Number, or Visit Number.

12. How To… • Properly chart IV’s & TPN’s • Always enter the time the IV was hung in the Administered To area on the right hand side of the form. • On TPN’s check not only the bag # but also the date the order was written, then document the time the bag was hung in the Administered To area on the right hand side of the form

13. When a patient arrives on your floor from surgery or a procedure, the receiving nurse is responsible for addressing all the tasks which became due during surgery, PACU or procedure time. The floor orders are not in effect until the patient goes to the floor. If an order states STAT or in PACU then it is for the Surgery or Recovery area to address. Even if you were not punched in when med was due-if you are the receiving nurse you are to address all floor related tasks while pt was in procedure/surgery/PACU. Nursing Workflow

14. The purpose of an electronic chart is so there is “real time” charting - meaning you chart as soon as you give the medication. Did you know if you... give a medication without charting it or don’t give a medication and not chart the reason It is considered a medication error. Nursing Workflow

15. Nursing Workflow • It’s OK to not give a medication as long as there is a valid reason and you chart the reason when you mark the medication as not given. • Next shift can and should address meds due at change of shift which have not been addressed yet.

16. The Emar should be checked by both the off-going and on-coming nurse to address all tasks which have not been completed on the prior shift. *When you receive report you are taking responsibility for the patient’s care, this includes all medications which have been ordered for the patient.* Nursing Workflow

17. FYI… • Sunrise recognizes the time which a discharge isphysically enteredinto the computer. If you wait 2 hours to enter a discharge, even though you enter the time as two hours ago, tasks will keep generating and becoming overdue. • Therefore-enter discharges as soon as the patient leaves

18. FYI… • If it is not documented it is • Not done • Not charged for • The chart is not complete • And a medication error has occurred • It presents a risk to the patient that a second dose can be administered • Keep your patients safe and be sure to document timely and accurately on the eMAR!

19. Key Points • Check the eMAR at the beginning and end of your shift for overdue/overrides which have not been charted. • Document ASAP after performing a task. • Mark As Not Done doses which will never be given. • Always enter valid and meaningful reasons when documenting a task. • Only adding a comment does not address the task-you must mark as done or not done. • Document Pneumovax, H1N1 and Influenza vaccines in the Immunization Manager. • Discharge patients from the computer ASAP after they leave the hospital. • The receiving nurse is responsible to address tasks which came due during OR/PACU/Procedure time.

20. Questions 1. When reporting off on a patient you should: • Leave the eMAR exactly as it is • Review the eMAR for overdue/uncharted tasks and address them with the receiving nurse • Mark all tasks as not done because the patient is leaving your care. 2. When a medication is due at change of shift, who’s responsibility is it to give and document? • Only the off-going shift. • Only the on-coming shift. • If it is not done by the off-going shift, then it becomes the responsibility of the on-coming shift. 3. If you “add a comment” to a task stating you did not give the dose because the patient was nauseated,, but did not mark it as not done, is this sufficient? • Yes, you addressed the task. • No, you need to mark it as not done and for the reason use Pt. was nauseated. • Yes, you want it to stay red so everyone knows the dose wasn’t given. 4. Your patient is scheduled to receive Phos-Lo before meals. However he is NPO for a procedure scheduled for 1100. It is now 1000 and the 0800 task is overdue. The next dose is due at 1200. What do you do with the task? • Leave it red-you didn’t give the medication • Mark it as not done because the patient will never receive that dose. • Add a comment that patient is NPO, but don’t mark the task as not done. 5. If there is an overdue task from the prior day can you mark it as not done even though you weren’t punched in? 6. When is the best time to discharge a patient in the computer? • As soon as possible after they leave-this will prevent tasks from becoming overdue. • Wait as long as possible so the floor does not get another admission • Whenever you get a chance, it doesn’t matter how long you wait.

21. Questions (cont.) 7. When you hang a bag of IV fluid, where do you record the time the bag was hung? • Only in the nurses notes. • In the “Administered to” section of the eMAR task form. • In the “Administered to” section of the eMAR task form and on the IV Flowsheet. 8. You receive a patient from surgery. There are overdue tasks for medications scheduled while the patient was in the OR/PACU. What should you, as the receiving nurse, do with the tasks? • Leave them alone-you weren’t punched in when they were due. • Verify with the chart the patient was in OR/PACU, mark the tasks as not done with the reason “Pt. in Surgery”. • Find out who the nurse was taking care of them in OR/PACU and mark them as done by other. 9. Which vaccines are required to be entered into the Immunization Manager? • Pneumovax, DPT • Influenza, MMR, DPT • Pneumovax, H1N1 and Influenza 10. Is it OK to skip a dose of a patient’s ordered medication? • Yes, if I am busy it is OK to miss a dose. • No-you should give every dose of medication the provider orders-always! • Yes, as long as I mark the task as not done with a valid and appropriate reason. 11. What do you do if you mark a task as done/not done by mistake? • Reset the task status by right clicking on the task and choosing the appropriate remedy. • Nothing, someone will figure it out sometime. • Call the pharmacy to re-profile the medication. 12. At the end of your shift how do you check if you missed a medication or override? • You don’t have to-your manager will let you know in a couple of days if you missed something. • Look at the alternate views on the eMAR - ADM OVERRIDES This Patient or OVERDUE MEDS This Patient. • Ask the patient if he/she received all their meds today.