Presentation on theme: "MAK Scott & White Memorial Hospital Scott & White MAK"— Presentation transcript:
1 MAK Scott & White Memorial Hospital Scott & White MAK Medication Administration CheckMAKScott & White Memorial HospitalVersion 1
2 Scott & White MAK Benefits of the MAK system Scott & White Memorial Hospital is implementing Seimens MAK system. This application utilizes wireless technology and barcodes to add an additional measure of safety to the five rights of medication administration: right patient, right drug, right dose, right route, and right time.Benefits of the MAK systemDecreases Medication ErrorsSome of the most common errors in hospitals occur in the medication administration process. Poor handwriting, incorrect transcription, and (or) as well as dispensing medications erroneously add to the problem. This system is designed to enforce the 5 “R”s of medication administration. Medication Administration Check is an administration system, not a documentation system. By identifying trends from MAK reports, processes are being re-designed to help make S&W a safer hospital!Decreases Uncharted OccurrencesAll uncharted occurrences display each time a user accesses the patient’s MAR. This helps remind the user to document on the uncharted medications. Utilizing MAK prior to shift report to reconcile all medications can eliminate omissions.Improves Charting AccuracyCharting is done as the medication is administered. Flags for required follow-up are automatically added for certain medications.Provides Online Drug InformationDrug information from the First National Drug Databank is updated quarterly. This puts the most recent drug information in the hands of the caregivers in a timely manner.Defines medication orders that require additional information.Examples of this function are Digoxin, which prompts for a pulse, and Insulin, which prompts for a blood sugar.
3 Medication Administration Process Scott & White MAKMedication Administration ProcessMedication Order ReceivedFaxed to PharmacyProcessed by PharmacyMedication Released to PYXISMedication Delivered to Nursing UnitOrder Verified by RN in MAKFollow-up performed and documented if applicableMedication Scanned Using the MAK Application at the BedsidePatient Identified, Then Confirmed by Barcode ScanCharting completedMedication Administered to PatientAppropriate Patient Assessment Performed
4 Scott & White MAK Equipment Mobile Workstations: MAK is loaded on each mobile workstation. The wireless carts must be taken to the bedside when administering medications. The one exception to this is in isolation rooms. For isolation rooms, the cart should be positioned outside of the room in the direct line of sight of the caregiver.Barcode Scanner: The barcode scanner is a key link in the MAK safety check. These scanners are not tied to any specific workstation. Once you sync the scanner to the cart, you may proceed in medication administration.Rechargeable Batteries: Each scanner has two batteries. Additional batteries are stored on each MAK unit. S&W stongly encourages starting your shift with a freshly charged battery.Base Unit: Each workstation has a green base unit attached to the cart. Scan the barcode on the base unit before you log in to MAK to ensure that the scanner “talks” to the computer.Scanner beep does not indicate a correct scan: The beep from the scanner only indicates that the scan has been read. You must look at the screen to verify the scan was correct.Patient ID Bracelet: Each patient’s ID Bracelet prints out with the MRN number and the case number. The case number should be the bar code scanned to identify your patient in MAK. If this barcode becomes unreadable, make the patient a new armband and discard the old one.Badge: Each employee badge has a barcode on the back of the badge. This is used in the third security step for caregiver identification. You must have your badge before you report to work.
6 Height adjustment pedal Scott & White MAKScreenScannerKeyboardSupply drawerwith lockBasketHeight adjustment pedalBrake
7 Original “Teal” Barcode Scanners “Wasp” Barcode Scanners Scott & White MAKOriginal “Teal” Barcode ScannersThese wireless scanners “talk” to a certain cart by “syncing” the scanner : scan the base unit on that cart with the scanner. These scanners can be used with any cart that has a base unit. Change the battery at the beginning of your shift to ensure a full charge.Trouble shootingMake sure all connections are in placeRe-sync the scanner to the base unitTag the old scanner. Replace the and resync the new scanner to the base unitChange carts and notify the Help Desk: They will request the scanner tag number“Wasp” Barcode ScannersThe small black and yellow scanner is labeled with a number and can only be used with a computer that has the corresponding label number. The wasp can be placed in a charger that also contains a spare battery.Trouble shootingMake sure all connections are in placeCheck for corresponding label numbersChange the batteryTag the old scanner, change carts and notify the Help Desk: They will request the scanner tag number
8 Scott & White MAK Scanning Tips Hold scanner close to small bar codes and farther away for large bar codes.Move the angle of the laser (don’t “stare” at the barcode).Change the distance between the scanner and bar code.Turn the scanner or barcode upside down.Click on another med and back on the med you want, then scan.
9 MAK Login Scott & White MAK MAK is located on the Desktop of each wireless workstation as a icon.Once you open the application, a Login ID and Password are required. Following the Login and Password, you will be prompted to scan your badge.* If you forget your password contact the Help Desk at
10 Security Scott & White MAK Each MAK user is responsible for safeguarding the security of their individual login, password and badge.S&W has security measures in place to keep your information confidential. If you think someone knows your User ID and Password, you must contact the Help Desk atIf you lose your badge, you must report it to Human Resources so that a new one may be issued.
11 MAK iconThe first time you sign in, you will enter the Login ID in both boxesYou will then be directed to enter your own password: make it something you will not forget!!!
12 Scan your badge.The default is your SS# or employee#: this will be reported as an override.
21 You must choose this to embed your patients. Select AllYou must choose this to embed your patients.
22 Chart - Select Patient by Census This will bring the patient meds on screen.
23 Here’s what it looks like! The MedSummary is the default screen if there are orders to be verified.
24 Screen Layout and Windows Functions Scott & White MAKScreen Layout and Windows FunctionsMinimize (-) : Removes window from view and places it on the Taskbar.Maximize : Returns the window to full size Close (X) : Closes the window and removes the application from the Taskbar.Title Bar: Contains the names of the user, patient, and hospital. By double-clicking on the title bar, the size of the window will decrease. Repeating will make the window return to the original size.Scroll Bars: Both vertical and horizontal. Move the bar or use the arrows to scroll through the patient windowTabs & Buttons: Selecting tabs “turns the pages” of the screen. Buttons complete or request a function.Column Name: Clicking on any of the cell names in the column will re-sort the rows.* Right click on the screen to refresh the display.
25 System Window and Terms Scott & White MAKSystem Window and TermsPatient Header: Contains allergies, and room number.Navigator: Provides a list of options allowing you to “navigate” through the system.The Log off button returns the user to the log on screen. Any time you leave the mobile workstation unattended,you must log off.To hide or show the Navigator: Go to Navigator and click Show Navigator or Hide Navigator.
26 Scott & White MAKScreen SecurityMinimize the screen if someone approaches you while charting.Never walk away from a patient screen.Log Out First!Do Not minimize or Turn off the ScreenOthers could pull the screen back up and look at information under your ID or enter data.
27 Scott & White MAK MAK List of Symbols Order pending verification by NurseOne time dose not reviewed by PharmacyCondensed textOrder returned to the pharmacy for clarificationFollow-up requiredDiscontinued MedicationExpanded view of textAdditional data presentErrorOrder requires countersignatureYou can determine what each symbol means by placing the cursor over the icon and reading the “Tool Tip”
28 This tab on the far left is the Active Worklist. This is where medication administration occurs.
29 Enter this data quickly! Rapid Allergy and Height/Weight EntryRapid entry of allergies and height/weight information is more important now than it has ever been. With a medication administration system that performs safety checks on each drug administration, the sooner this information is in the computer the safer we can be as an organization.Enter this data quickly!
30 Diagnosis Information crosses over from Invision.
31 The “Lab Results” folder provides a quick view of selected lab results. Only the most recent lab results display.All official lab results will always be posted in Invision.Abnormal lab results are noted with the yellow triangle icon.Go to SoftLIS for more results and detail.
32 The “MED SUMMARY” Folder lists all current medications including those that are new or discontinued. When a patient has new orders, the “MED SUMMARY” is the default screen.
33 Scott & White MAK Med Summary Folder On-line verification of medication orders occurs in this folder. The order will have the red tipped pen icon. Unverified medication orders cannot be charted as administered.On-line VerificationMedications should be verified as soon as possible after the order is written. Similar to “signing off orders”, Verification produces a “signature” by the RN proving that the order is correct as entered. On-line verification should be done with the physician's order in hand.
34 Verify OrdersClick on “Verify All” and the system will automatically go through all orders pending.If the order is correct, select the “Verify” button.If the order is not correct, select the “Intervention” buttonIf you are unsure “Skip Order”
35 Contacting Pharmacy for non-emergent needs Rx MessageGoes to your unit PharmacistInclude your ASCOM phone number so the Pharmacist can contact you for any questions.
36 Cumulative Dose – monitors medications that have Dose Limiting Toxicities (DLT’s) such as chemotherapy.
37 Any orders that are not verified (Interventions) will be listed.
38 Meds that have been given. Use the scroll bar in each section to see further information.Note all the buttons at the base of the screen.The Charted List is All Powerful!
40 Active Worklist Folder Scott & White MAKActive Worklist FolderThe ACTIVE WORKLIST displays a list of current, active, and uncharted medications within a specific time range. You can adjust this time range by selecting the expand list option on the screen. Medications due within the original time frame display in white. Active by not yet administered medications greater then two hours display in PEACH. PRN medications display at the bottom of the screen.Charting FunctionsThe following functions are available in the ACTIVE WORKLIST folder: ADMIN - Medications are automatically charted as administered unless the user specifies NOTADMIN NOT ADMIN - Document when medications are NOT given (BEWARE!) BARCODE OVERRIDE - Use if there is a problem with a barcode scanning properly and it cannot be read by the barcode scanner ENTER NOT ADMIN REASON - A drop-down menu is available to chart the reason that a medication is not administered. This field will also allow the user to document free text ENTER ADMIN SITE - A drop-down menu is used to document administration sites. These are typically used for injections ENTER REASON - A drop-down menu is used to chart the reason a PRN medication was given DETAIL - Details the selected medication order ID PATIENT - Scan the barcode on the patient identification bracelet. MAK verifies that the right patient is receiving the meds CHART - Use to complete and store charted data CLOSE - Closes the patient window and returns to the navigator functions RX MESSAGE - Allows the user to send a message to the Pharmacy EXPAND LIST - Allows the user to change the “date/time” window to view more data
41 Active Worklist defaults to a 3 hour view. You can Expand List to see your entire shift.
44 Navigator:Provides a list of other options within the system
45 Chart – Pharmacy Review Pending by Census Allows you to enter verbal orders that are STAT medications. You become the pharmacist!This eliminates a safety check. These are one-time meds only. Subsequent doses should be entered by Pharmacy
46 RX Drug InquiryA rapid method of obtaining up to date information about medications.Updated quarterly from the National Drug Databank, the Drug Inquiry data includes indications, contraindications, side effects, drug-drug interactions, food-drug interactions, and education monographs in English and Spanish
53 Print MAR/IVAR if the patient is going to a non-MAK area such as surgery, MRI, Interventional Radiology, etc.
54 Click Navigator – Hide Navigator to close this column. Click the Maximize icon to restore your view to full screen.
55 4 1 2 3 Override Barcode Rx Message Detail Not Admin – the med will be eliminated from this view.Do not use if the med is on hold or the patient is off the floor: eg. Surgery.Use for meds that will not be given at all: eg. Digoxin when the pulse is <60.4123
56 Administration Process Scott & White MAKAdministration ProcessSelect the name of the patientSelect the drug you are going to administerScan the medication with the barcode scannerIf four (drug, dose, time, route) of the five rights are met, the medication line will change to green and a green check mark will appear next to the medicationRepeat for each medication you plan to administer at this timeIf any of the rights are violated, a red x will appear next to the medication and the line will turn redOnce all medications are correctly scanned, select the ID PATIENT button (drugs may be scanned in the hall or at the bedside)Scan the case number on the patients armband. MAK will determine if you are giving the meds to the right patient.If no errors are present, administer the medicationsEnter any additional required dataSelect CHART
58 Scan the med.The correct med will be highlighted in green and have a green check in the column.A “beep” does not mean that the scan is correct! You must SEE THE SCREEN.If a med won’t scan, click elsewhere on the screen, then click back on the desired med and scan, again.The black highlight will automatically move to the next med for scanning. Scan the next med.
86 These meds show up on the DC’d list as “one time” without a corresponding order in the system.
87 Scott & White MAK Charting “Not Admin” This function is utilized to document medications that have not been administered. Meds that will not be given or a patient refusal of a medication would fall into this category.Select the correct medicationSelect NOT ADMINEnter NOT ADMIN reasonOther medications or fields?If NO, Select chartIf YES, Continue
88 PRN Medication Administration Scott & White MAKPRN Medication AdministrationThe primary difference in PRN medication administration is use of the ‘Reason’ field. For all PRN medication administrations you are required to enter a reason. By combining the use of the vital signs options and the drop down box under ‘Reason’, you can document most if not all of the vital data we used to document in progress notes.In this example, Tylenol was ordered for a temp > 101. Charting was accomplished on this page by adding the patient’s temperature and by citing ‘Vital sign out of parameter’ reason.
89 Scott & White MAK Charting a Follow-up All PRN medications should have a follow-up. Users can access follow-up in one of three ways. From the navigator you can select ‘Chart Follow-up Inquiry’ or from the Active Worklist, you can select the medication. This will be flagged with a red star icon After selecting the medication, a window will pop up prompting you for the required information.Charting follow-up can be done voluntarily from the CHARTED MEDS folder. Select the medication occurrence. Select ‘EFFECT’ from the bottom of the screen and document the follow-up. Remember to chart the appropriate information. If you gave a medication for pain, your assessment should include a pain score. Don’t forget to select ‘CHART’ when you are done.
90 Scott & White MAK Miscellaneous Scanning the barcode Always attempt to scan the barcode before you assume it does not work A barcode that does not work one day may work the next. Pharmacy is working on a daily basis to correct any barcode issues.Before you override, click on another medication and then back on the one that you want. Rescan.Replace the armband if it does not scan.HIPPADo not walk away from a screen with patient information. You can minimize if someone is speaking to you and you stay at the ‘cow’.If you must walk away, LOG OFF!End of shiftReview the ACTIVE WORKLIST to confirm that you do not have any uncharted medications or any unverified orders.Review the CHART FOLLOW-UP INQUIRY to ensure you do not have any uncharted follow-ups.Log out!DowntimePlanned vs. Unplanned: paper MAR’s can be printed by the clerks from other sources.When downtime is over, meds will be charted as administered using the barcodes to override. The revise reason and charted reason will be documented, also.It is imperative that you CHANGE THE CHARTED DATE AND TIME!
91 Scott & White Unique Situations MAK MedicationSituationActionSliding Scale InsulinNo insulin required-Choose Insulin-Chart as Not Admin-Enter CS= in “Reason”FieldHeparin DripInsulin DripChange in rate required-From the Charted List, select the bag of heparin or insulin that is presently hanging-Choose Revise-Leave the Charted date/time as is, the revision time will appear in MAK-Revise Reason, drop down box to APTT= or CS= Enter the value-Charted Reason, drop down box to rate increased or decreased to and enter new rate.AnyFirst dose given on a non-MAK unit-Document the dose as ADMIN-In the reason field, chart “Given in a non-MAK unit”AllPatient is on isolation-Scan medications outside the room.Position the cart in the doorway to provide line of sight. Scan the patient’s armband. Once you leave the patient’s room wipe down the scanner with a germicide wipe.Home MedicationsPatient taking home medications-Nursing charts as ADMIN-Enter Home Med Taken in reason field.
92 Medication Administration Record Discharge Scott & White MAKMedication Administration Record Discharge11/05/ : DISCHARGE MEDICATION ADMINISTRATION RECORD PAGE: 1 OF 12Scott and White Memorial HospitalPATIENT NO: NAME: DUCK, DAFFY DSCH LOC: 006B/060801MED REC NO: AGE: 51Y SEX: MATN DOCTOR: FRANK, DONALD A ADMIT DATE: 10/31/ DSCH DATE: 11/05/2003*** MEDICATIONS CURRENT AT THE TIME OF DISCHARGE ****** SCHEDULED MEDICATIONS ***ORD# 7CEFTRIAXONE GRAM(S) = 1 VIAL(ROCEPHIN) IV Q24HQ24HRECONSTITUTE WITH 10 ML SWFIAND INFUSE OVER 3-5 MINUTESSTART: 11/04/03 16: STOP:Nrs Verified By: JAW11/04/03 16:00 NOTADMIN JAW at: 11/04/03 16:05Charted Reason: Dc'd by MDORD# (REVISED)START: 11/04/03 16: STOP: 11/04/03 16:03**** NO OCCURRENCES CHARTED ****ORD# 12ATENOLOL MG = 1 TAB(TENORMIN (EQUIV)) POGIVE 25 MG STAT THEN 12.5 MG QQ 12 HOURSSTART: 11/02/03 08:04Nrs Verified By: WIJE11/02/03 09:00 ADMIN WIJE at 11/02/03 09:13Pulse: 110 BP: 108/5411/03/03 09:00 ADMIN MAC at: 11/03/03 09:25Pulse:148 BP:98/5611/04/03 09:00 ADMIN JAW at: 11/04/03 08:45Pulse:68 BP:120/68Medication, instructions, and order numberVerification and administration information
93 Medication Administration Record - Net Access Scott & White MAKMedication Administration Record - Net AccessThe browser enabled MAR is viewed through Net Access. Real time entries can be reviewed including effectiveness and associated vital signs. The view of this MAR can be expanded to the level of detail desired.Moving the mouse to the date and left clicking will bring up only medications administered for that day and provide greater detail. Moving the mouse over the drug and left clicking will bring up detailed data for individual drug administration over multiple dates.
94 Scott & White MAK Problem resolution *Type of Problem* Question or Problem with the System*Type of Problem*Barcode scanner Battery charged? Re-sync done?Application Charting or use issuesPrinting problemsMedication questions for the pharmacistNotify Core Trainer if availableUser ID- Password issuesCall Pharmacy4-3815If unable to resolve, Contact the Help Desk atHelp Desk
96 The Med Summary will LOCK orders currently being Verified by another nurse. Orders requiring Verification will be locked.Another user can access the Active Worklist and administer any meds that have been Verified.Orders requiring Verification will only LOCK if the nurse signing on has the authority to verify orders.
97 The Active Worklist will LOCK orders requiring Verification if currently opened by another nurse. You can see the User ID of that other nurse by moving the column border. Or you can double click on the grey area and it brings up a box with the user and the pc they are on.Any Verified meds can be administered while another nurse is Verifying new orders.
98 If another nurse is currently administering a medication on this patient, it will be LOCKED. This will prevent two users from giving the same medication.
99 The Charted List will LOCK to prevent two users from revising the same charted occurrence at the same time.This will not prevent another user from accessing the Med Summary to verify orders.This will not prevent another user from accessing the Active Worklist to administer medications.The column border can be mover over more to display the ID# of the computer being used.
100 The Chart-Pharmacy Review Pending function will not lock or error out .
101 Log Off !MAK users must Log Off the system when charting is completed.This will prevent other users from being locked out unnecessarily!
102 Log Off !MAK users must Log Off the system when charting is completed.This will prevent other users from being locked out unnecessarily!
103 Computer Lab Take advantage of the lab time to use the Test System. Scott & White MAKComputer LabTake advantage of the lab time to use the Test System.Make sure that your ID works.and“Let’s be careful out there!”