INP 100 Chapter 6 Study Questions Complete And 100% Correct!

Give two advantages of using the Work List instead of the Due Meds report to review your patients' medications. Then give two advantages of using the Due Meds report instead of the Work List. Work List: Can see ALL medications for ALL patients; can see other tasks at the same time; can document without opening a patient's chart. Due Meds: Can see ALL of one patient's medications due within the current shift; can see last administration time of all meds; can easily see administration instructions. What does an "!!" icon next to a medication on the MAR mean? How is the administration workflow different for that medication? The medication requires dual sign-off. Another nurse will need to review and verify the administration and enter his user ID & password when documenting the administration. You're about to give a pain medication to a patient. You know the patient hasn't received any doses of this medication, but you'd like to see the last time he received any pain medications over the last 24 hours. How can you do that without having to scroll through multiple shifts of the MAR? Use the MAR Report in the MAR activity. How do medications that are discontinued appear on the MAR? The medication row appears with all the cells highlighted in yellow. What is the main difference between documenting a PRN medication compared to a scheduled medication? PRN medications do not have scheduled times that appear on the MAR. To document giving the medication, the nurse clicks anywhere in the cell and documents administering the medication. Scheduled medications appear with a due time in the cell at the time the medication is scheduled to be given. To document administering the medication, click the due time on the MAR. Can a nurse document giving a medication that has NOT been verified by pharmacy? Yes. He sees warnings that the medication has not been verified but can continue with the administration. What are two reasons why a nurse might need to pull a medication from an ADS cabinet on override? No one has entered an order for the medication into Epic. An order has been entered in Epic, but pharmacy hasn't verified it yet, so it does not appear on the patient's ADS profile. What is a MAR? The electronic Medication Administration Record (MAR activity) helps nurses see what medications need to be administered and record doing so. What is a PRN medication? A PRN medication is a medication that is administered as needed. What is a scheduled medication? A scheduled medications is due at a particular time. What is Dual sign-off? Dual sign-off means a second nurse must verify the "rights" along with the nurse who is actually administering the medication. What is an overdue dose? An overdue dose is a medication that has yet to be documented. What is Willow Inpatient Pharmacy? Willow Inpatient Pharmacy is Epic's pharmacy system. What is an Automated Dispensing System (ADS)? An ADS cabinet is like a computerized vending machine for medications. What is an override pull? If a medication is not on the ADS patient's profile, the nurse can only pull it if it is available as an override pull. Each ADS cabinet has a list of medications in its inventory that can be pulled on override. How do you use the Due Meds report to review all of a single patient's medications? To get a complete view of a patient's medications, a nurse can use the Due Meds report in Patient Lists or the Meds report in Summary. The Due Meds report shows all scheduled doses due this shift and any overdue doses from the last shift. The scheduled doses appear in chronological order. How do you identify when the last dose of a medication was given? A nurse can use the "Last Admin" column in the Due Meds report and the MAR Report in the MAR activity. How do you read and navigate the MAR? Each row in the MAR represents the different medications, and each column represents a different hour. Icons are used in the MAR to call attention to important pieces of information about the medication. How do you filter the MAR? Nurses can use the tabs across the top of the MAR to filter the medications. How do you identify an active, future, completed, or discontinued medication? The MAR groups orders based on their status and sorts them alphabetically within the active, future, completed, or discontinued medication groups. How do you identify a medication that has not been verified by pharmacy? Unverified orders appear on the MAR with a red stop sign. How do you use the MAR Report to review med administrations across multiple shifts? Each column in the MAR report shows an entire day's worth of administrations and due times. Click on an administration or due time to see more details about that action at the bottom of the report. Use the day range hyperlinks to zoom in or out or to shift your view forward or backward. How do you document giving a PRN medication? In the MAR under the column for the current time, click the cell for the medication you are about to administer. Verify you have the right patient, medication, dose, and route. For PRN medications, confirm you are giving the med for the indicated PRN reason. If you haven't already, verify that enough time has passed since the last administration. If necessary, update the Time and Dose fields to reflect when and how much of the medication was actually administered. How do you document pertinent flowsheet data while documenting a medication administration? If you have a new assessment to record, enter the value in the Associated Flowsheet Rows. If you recently entered an assessment in Flowsheet, select the last filed value to associate it with this administration. How do you edit an administration that has already been documented? From the MAR, click the existing action you wish to edit. Select the Edit administration checkbox. Update the appropriate fields to reflect the actual administration. How do you document giving a scheduled medication? In the MAR click on the medication bubble you want to administer. Verify that you have the right patient, medication, dose, and route. Adjust the Time field to reflect when you actually administered the medication. How do you document giving a medication with a ranged dose? In the MAR click the due time for the medication you want to administer. Verify that you have the right patient, medication, dose, and route. For medications with ranged doses, refer to the administration instructions, and update the dose field to reflect how much medication you are giving. Adjust the Time field to reflect when you actually administered the medication. How do you get dual sign-off on a medication? Document giving the administration as normal and click Accept (before actually giving the medication) to see the Dual Signoff Summary window. From the Dual Signoff Summary window, the second nurse reviews the administration details and confirms you have the right patient, medication, dose, route, and time. The second nurse clicks Sign Off. The second nurse enters her user ID and password. How do you document multiple scheduled administrations at once? In the MAR click the top of the time column which opens the administration window, showing all the medications that are due within that hour. Now the nurse only has to enter the MAR Action, the date and time of the administration, and the comments once in the fields at the top of the screen. All that information then automatically fills in the appropriate fields for each medication. After confirming the "rights" for each medication, the nurse administers the medications. How do you document an administration that occurred in the past? In the MAR click in the appropriate cell for the hour in which you actually gave the medication. Change the Time field to reflect when you actually gave the medication. Confirm that the Action and Dose are accurate. How do you identify any overdue medication doses for a patient? A column on the nurse's My List shows an icon for patients with overdue meds, and the Due Meds report, available from Patient Lists, displays overdue doses in red and bold. The Work List also shows overdue medications (along with other overdue tasks). They appear in yellow. An Overdue button appears at the top of the Work List if any of the patients on the Work List have overdue tasks. A red "Overdue" button appears on the MAR if any doses are overdue for the current patient. Clicking the button opens a report with all overdue doses (and the nurse can click each overdue time to act on it). Also, the Due/Overdue Meds tab includes any medications with overdue doses. How do you document not giving a medication? In the MAR click on the medication bubble you want to document on. Mark the dose as "Not Given" and state the reason then add comments if needed. This can also can be access through the "Doc" button on the Work List task. How do you document giving a makeup dose of a medication? If a medication is given more than 60 minutes late, policy requires you to document the due time as "not given." You should document a makeup dose—if any—as an unscheduled administration. How do you reschedule a single medication due time? In the MAR click on the medication bubble you want to document on. Change the action to "Due" and update the time. Note, however, that the subsequent doses are still scheduled. You adjusted the next scheduled dose, but that did not impact any subsequent scheduled times. You'll need to ask pharmacy to reschedule the medication if you want all the future due times to change. How do you send a message to pharmacy? On the MAR click the "RX" On the right side of the line of the medication you wish to contact the pharmacy. The Send Message to Pharmacy window opens. Note that it already includes the patient's name and the relevant medication. How do you view pharmacy's response to a messages? Messages written by someone in pharmacy are visible to the nurses in the MAR. When nurses have unread messages from the pharmacy, a yellow message bubble appears in place of the Rx Messages button. How do you hold a dose of a medication? On the MAR, find the future dose you wish to hold. Click the due time you wish to hold. Select an appropriate Reason. If necessary, enter any additional rationale in the Comments field. How do you document giving medication doses from the Work List? To document a dose of a medication from the Work List, simply click the "Doc" button. A floating administration window appears, much like the one that appears in the MAR. From here, the nurse can document giving, not giving, or rescheduling a dose just like she could from the MAR. How do you document giving a medication pulled on override from an ADS cabinet? Log in to the ADS cabinet, call up the patient's profile, and pull the medication on override. This triggers an interface message to Epic that creates the override pull as a "dummy order" in Epic. Log in to Epic and go to the patient's MAR. The override pull appears on the MAR with a magenta background. Find the override pull and click its scheduled due time. The Dose and Route fields are blank by default. Confirm that you have the right patient and medication in hand. Manually enter the Route and Dose you are about to administer. How do you link an override pull administration to an actual Epic-entered order? To link an override pull that was already given to an Epic-entered order find the newly entered order on the patient's MAR, and click to the right of the medication name to expand the medication details. Click the Link to related order link and select the "Given" action for the override pull. For the Epic-entered order on the right, select the due time that the override pull represents. If there is no due time, select "New Administration". How do you document giving a medication pulled on override when an unverified order exists in the system? Log in to the ADS cabinet, access the patient's profile, and pull the medication on override. This triggers an interface message to Epic, which creates the override pull as a "dummy order" in Epic. Log in to Epic and open the patient's MAR and the override pull appears on the Override Pulls tab with a magenta background to the left of the medication name. The unverified Epic entered order appears with a stop sign. Expand the medication details, and click the Link to related order link for either the Epic-entered order or the override pull. Select the due time for the override pull on the left side of the window. For the Epic-entered order on the right, select the due time that the override pull represents. If there is no due time, select "New Administration". The magenta override pull row is disappear and the actual Epic-entered order has a due time with an icon. How do you reconcile outstanding override pulls at the end of your shift? Nurses can use the MAR's Override Pulls tab to reconcile outstanding override pulls. How does the MAR change dynamically as orders are entered, modified, or discontinued? The electronic MAR automatically rearranges itself as new orders are placed or existing orders are completed or discontinued. The MAR groups orders based on their status and sorts them alphabetically within those groups. Current medications, future medications, completed medications, and discontinued medications. How medications are sorted on the MAR? The MAR groups orders based on their status and sorts them alphabetically within those groups. Current medications: active medications and any order that starts within the next two hours. Future medications: Orders that have a start time in the future. Completed medications: Orders might be placed to run for a certain period of time or for a certain number of doses. When an order reaches the end of its time or the last dose is administered, it becomes completed. Medications that have been completed appear on the MAR with a salmon-colored highlighting. Discontinued medications: Orders that have been canceled drop to the bottom of the MAR and are highlighted in yellow. The yellow is meant to mimic highlighting medications on a paper MAR when they are discontinued.