2 Goals: Demonstrate how rules, NPR reports and customer defined screens can be used to aidin regulatory complianceDemonstrate how NPR reports can be used toincrease the efficiency of clinical monitoring
3 JCAHO National Patient Safety Goal 2008 Goal 3E: Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
7 Anticoagulation monitoring - Medication administration The medication should not be administered ifthe most recent (within 24 hours) INR isoutside the acceptable range.eMAR rule to warn the nurse that the INR isoutside the safe rangeDisplay INR valueRequire action and response
11 Anticoagulation monitoring - Clinical monitoring Pharmacist monitoring patient progressPatient response to therapyPotential drug interactionsMonitoring all anticoagulantsUse scheduled NPR reportScreen patientsPertinent data (lab trends, other meds)
12 Anticoagulation monitoring - Performance measures Administrative report for all anticoagulant useDegree of complianceInstitutional performance trendsDetail for follow-up as neededUse NPR reportRun for specific date rangeUse data from PHA, LAB, NUR, OEInclude heparin, enoxaparin, argatrobanand warfarin) for baseline labs andchanging renal function if applicable
14 Black Box Warnings Types of Black Box Warnings Intervention required at order entryInformational for nursingIntervention required during therapyCan be a combination of the above
15 Black Box Warnings - Intervention at order entry PHA order entryRule with pop-up screenData used from other modules to prevent over flagging (example: female, childbearing age, pregnant? Yes, No, or information missing)
20 Black Box Warnings - Informational for nursing Information in entirety can be placed in special instructions to be viewed by nurse in eMARAdvantage: no need for external printer or separate routineDisadvantage: requires extra keystroke to seen entire text or RN may not notice it is there
24 Black Box Warnings - Intervention at administration Information in entirety can be placed in Rx comments to be viewed by nurse in eMARFull text seen on AcknowledgeDrawback: requres extra key stroke to view full text on first screen of eMAR
28 Black Box Warnings - Intervention at administration Information in entirety can be placed in admin criteria to be viewed by nurse in eMARWill pop-up automatically for viewing in eMAR with each administration and on acknowledge (example: use for quinolones)Other potential uses: look-alike, sound-alike
36 Vaccine Administration Vaccine administration requirementsRecord lot number and expirationProvide patient with current vaccineinformation sheet (VIS)
37 Vaccine Administration Create a CDS for eMARAdministration query to record lot numberand expirationPrompt “Vaccine Information Sheet Given?Automatic launch to CDC website to obtaincurrent VIS (www.immunize.org/vis)
42 Neonatal Dose Verification and Documentation Witness Dose verification and preparation verificationby a second nurseAlleviate need to create a separate pediatricdrug formularyAudit trail for policy adherence / accountability
43 Neonatal Dose Verification and Documentation Witness eMAR cosignature as part of the prescription audit trail is a great solution…. BUTeMAR cosignature has been an all or none phenomena once set up in the drug dictionary…. UNITIL NOW
44 Neonatal Dose Verification and Documentation Witness Set up eMAR ruleIf patient age is <30 days, require acosignature for verification of dose andpreparationInclude the cosignature as part of the Rxaudit trailAttach the eMAR rule at the globalCustomer Defined Parameter level
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