EMAR Medication Pass with Pre-Pour This manual includes the setup of medications with Pre-Pour and the recording of resident medication passes. The Pre- Pour options must be turned on in File Setup Community. Select your community and click on the Clinical tab. Click on the EMAR button. Pre-Pour must be turned on by Eldermark Support Staff. To begin your set up of medications, click on the EMAR icon, and select Pre-Pour. Enter the time that you want to Pre-Pour for and click OK. Use the up and down arrows to change the time or click into the field to type in the time. The time increases or decreases in 15 minute intervals. The date defaults to the current date.
Select the Med Provider to Pre-Pour for and click OK. The listing of Med Providers will vary based upon the shift times for the provider. The providers listed are specific to each community. Once a Med Provider is selected, you will see a listing with a preview of the provider s shift starting at the time you selected to Pre-Pour for. The residents are listed in the order of the Currently Due medication administration time. Note: The passing window is specific for each community. Click on the resident name to select. EMAR Medication Pass with Pre-Pour Revised 8/14/17 2
Residents will be on the Select a Resident screen if they have any routine medications due, PRN medications without results recorded, missed medications, held medications, or have future due medications on this provider s shift. Currently Due: This column indicates residents with medications due during the Pre-Pour passing window. The medications will be listed with a preview of the passing times. The number in parentheses indicates the total number of medications due at that time for that resident. If there is no number in parentheses, there is only one medication to be administered at that time. PRN Rslt: This column will list out the number of PRN s waiting to be resulted for each resident. The number reminder will remain on this list until the results are recorded or for up to 24 hours. This will flow from shift to shift if not resulted. Missed: The Missed column will show the number of medications that were missed during the provider s shift. Held: The Held column will show the number of held medications during the provider s shift. Future Due: The Future Due column shows all scheduled medication administration times during the providers shift and the count of medications for each time. If there is no number in parentheses, there is only one medication to be administered at that time. Record items are listed in parentheses in the Currently Due and Future Due columns. Once you select a resident, it will open the Pre-Pour Medication Passing screen for the resident. A listing of medications that are due within this Pre-Pour window will be displayed. The Scheduled tab will show the Time Due, Medication Order, Previous Pass Information, Refill Requests, and Adverse Effects. The Medication column lists the Medication/Strength or Treatment Name, Instructions, Indicated For, and Record Items. EMAR Medication Pass with Pre-Pour Revised 8/14/17 3
Medication Pre-Pour Screen Overview Buttons/Information at the top of the screen: The Resident s Photo, Name, Unit, and Pouring For Time will populate. Click on the resident s name to review/edit the Resident Chart and the resident s medical information. Click Change Resident or press the F1 key to open the Select a Resident list to move on to a different resident. The tabs listed at the top of the screen are Scheduled, Recent PRNs, Missed/Held, Allergies, and Resident Information. The number in parentheses on the tabs will change per resident and throughout the medication pass. For example, this now shows the resident has zero Recent PRNs, three Missed/Held medications, and one Allergy. Selection of Medications to Pre-Pour: To select the medications you are going to set up, click once on the line that contains the medication. Note the change to the Scheduled tab after selecting medications. The medication row will turn a darker yellow, showing it has been selected. If you are using a scanner, you will see the word Scanned in the Select column rather than the X. Once you have setup the medications for this resident, click Med Poured. EMAR Medication Pass with Pre-Pour Revised 8/14/17 4
You will then see the Status column update with the time poured, your initials, and the word Poured in green. Click Change Resident or press the F1 key to continue to set up medications for all residents with meds due during the selected passing window. Missed/Held Tab: Click on the Missed/Held tab to see all medications that have been Missed (not charted on) or Held during this Med Provider s shift. If you have the option to Allow Pre-Pour of Held Medications and/or Allow Pre-Pour of Missed Medications turned on, you will also be able to Pre-Pour in the Missed/Held tab. These options can be turned on in File Setup Communities Clinical Setup tab EMAR Setup. The Missed/Held tab will list the Medication, Instructions, Date, and Time the medication was due. The Status column will either read Missed or Held. The # of Attempts column will list how many times it was charted as Attempted. The Passing column will list any Record items set up for this Medication order. EMAR Medication Pass with Pre-Pour Revised 8/14/17 5
Allow Pre-Pour of Held Medications: If this setting is turned on, it will allow Pre-Pouring of medications previously held during a Medication Provider s shift. Allow Pre-Pour of Missed Medications: If this setting is turned on, it will allow Pre-Pouring of missed medications during a Medication Provider s shift. Click once to highlight the Held or Missed medication(s) that you are going to Pre-Pour. Click the Med Poured button at the bottom of the screen. This will override the previous Held or Missed Status on this medication to the time poured, employee s initials, and the word Poured. The change history will be stored on the Medication Delivery Record. Completion of Pre-Pouring Medications: Once the Currently Due column is empty for all residents, you have completed the Pre-Pour for this passing window. When completed with Pre-Pouring, click Finished to close out of the Pre-Pour EMAR screen to change to a different Pre-Pour time or to sign in to administer medications. This completes the pre-pour of medications for the medication provider. EMAR Medication Pass with Pre-Pour Revised 8/14/17 6
Selection of Medications to Administer: To sign off the medications that were previously set up, click on the EMAR icon and select the Med Provider. Once a Med Provider is selected, you will see a listing with a preview of the provider s shift. The residents are listed in the order of the Currently Due medication administration time. Once you select a resident, it will open the Medication Passing screen for the resident. Medications that have been Pre- Poured will automatically be selected. EMAR Medication Pass with Pre-Pour Revised 8/14/17 7
Note: Record at Passing items are listed in the instructions of the medication order. The Previous Pass column includes the Record at Passing information from the previous administration of this medication. The Select Time button in the upper right is only available to employees with Administrator access to EMAR. When you select a resident, the current time is displayed. The time will refresh to the current time during the medication pass. Once a medication is selected, the Note field, Attempted, Med Not Given, and Med Given buttons appear at the bottom of the screen. How to Lock a Windows computer screen: It is recommended to lock the screen if you are walking away from the computer to protect resident information. If you are using a Windows laptop or computer, you can lock the screen by pressing the windows key on your keyboard + the letter L. Press these 2 keys together to lock the screen, that way no one can see the resident information. You will need to put in the password for the computer when you return to unlock the screen. Charting Medications as Attempted, Given, or Not Given: Take the medications to the resident. When you return to the computer, you will need to enter any Record at Passing items and select Attempted, Med Given, or Med Not Given. Attempted: If you attempt to administer a medication, highlight the medications that were attempted and click the Attempted button to record the date and time of the attempt in blue. All attempts will be stored in the Medication Delivery Record Change History. EMAR Medication Pass with Pre-Pour Revised 8/14/17 8
Given: Highlight the medications that were given and click the Med Given button. You will see the time and your initials in green in the Status column. Med Not Given: If a medication is not given, highlight the medications and click the Med Not Given button. A Med Not Given Reason choice list will appear. Select the reason. The date, time, and held reason will show in the Status column in red. There is a setup option to enable Delivery of Held Medications at a later time. That feature is discussed later in this manual. Note: If the resident takes some of the medications, but not all of the medications, deselect the medication(s) they did not take by clicking on the medication before clicking on the Med Given button. Then reselect the medication(s) that were refused and click on Med Not Given. Select the Med Not Given Reason from the following window. EMAR Medication Pass with Pre-Pour Revised 8/14/17 9
Record Items If Record items have been setup for a medication, these will also be listed in the Medication column. When this medication is selected, you will see the Record at Passing items at the bottom of the screen, or in the Passing column. The Previous Pass column will list the previous Record at Passing information for the medication. The Record items must be recorded before the medications can be marked as Given. Completion of Record items is not required to save an Attempt. If you do complete Record items with the attempt, they will be saved. If you edit the Record result when the medication is administered, the change will be recorded in the Medication Delivery Change History. Some Record items must be recorded on the medication line. These are the Site, Amt, and Other because they could be different for the medications selected. Site, Amt, and Other are not shared as these could require different responses on medications selected at the same time. For those Record items, you will see them listed in RED in the Passing column. Click to record your response. Click where you see <Click here to record > and another window will open to record your response. When recording site, choose the appropriate site from the look up choice list. After choosing the site, the corresponding numerical code will appear in the site field. EMAR Medication Pass with Pre-Pour Revised 8/14/17 10
Click OK to save and return to the med passing window. To edit the Record item in the Passing window, click <Click to change>. To identify the body site is coordination with the numerical value, click on Site Key hyperlink for a table with numerical code and body site specification. For all other Record items, you only need to enter it once and the result will be recorded on selected medications as appropriate. For example, if you have weekly vitals scheduled at the same time as a Lanoxin with a pulse, you only need to enter the pulse once and it is recorded on both to save time. EMAR Medication Pass with Pre-Pour Revised 8/14/17 11
You must enter the results into the fields below before you will be able to mark Med Given or Med Not Given. If the Record fields are not completed, an alert will prompt and remind you to fill in vital sign entries. Click OK and complete your Record items, then select Med Given or Med Not Given. Med Delivery Record: To view the delivery history of a medication, right click within the medication line and choose Show Med Delivery Record. This will show the delivery history, attempts, and change history for the scheduled date and time. EMAR Medication Pass with Pre-Pour Revised 8/14/17 12
Continue with Medication Pass: Once you have completed passing this resident s medications, click Change Resident in the upper left corner or press the F1 key on the keyboard to bring up a list of resident names to select the next resident. Click on the next resident to open their EMAR window. Continue until all resident s medications are charted. Medications that are on the screen when the resident s Medication Passing record is open, will remain on the screen even if their Time Due has passed. If you close the selected resident record by changing residents or clicking Finished without administering the medications that are no longer in the passing window, those medications will move to the Missed/Held tab. Missed/Held tab: Click on the Missed/Held tab to see all medications that have been Missed (not charted on) or Held during this Med Provider s shift. The Missed/Held tab will list the Medication, Instructions, Date, and Time the medication was due. The Status column will either read Missed or Held. The # of Attempts column will list how many times it was charted as Attempted. The Passing column will list any Record items set up for this medication order. EMAR Medication Pass with Pre-Pour Revised 8/14/17 13
Allow Delivery of Held Medications: If this setting is turned on, it will allow the medication provider to administer a medication previously Held during their shift. This setup option is located in the File Setup Community Clinical tab EMAR Setup. Click once to highlight the Held medication(s) that you are going to administer. Click the Med Not Given button or the Med Given button at the bottom of the screen. This will override your previous Held charting on this medication. The Change History will be stored on the Medication Delivery Record. The Previously Held Med Given Reason screen will open. If the choice list has not been set up, you will be prompted to do so. Select the reason from the list. The status column will be updated with the time and employee s initials in green if the medication was charted as Given or the date, time, and Held reason if the medication was charted as Not Given. Require Reason when Recording a Missed Med: If this setting is turned on, it will require the medication provider to enter a reason for changing the medication with a status of Missed to either Held or Given. This setup option is located in the File Setup Community Clinical tab EMAR Setup. Click once to highlight the Missed medication(s) that you are going to administer. Click the Med Not Given button or the Med Given button at the bottom of the screen. This will override the previous Missed charting on this medication. The Medication Late Entry Reason screen will open. If the choice list has not been set up, you will be prompted to do so. Select the reason from the list. EMAR Medication Pass with Pre-Pour Revised 8/14/17 14
The status column will be updated with the time and employee s initials in green if the medication was charted as Given or the date, time, and Held reason if the medication was charted as Not Given. Override Reason to Exit Medication Pass: If your community has the Require Med Pass Completion to Exit Passing Window setting turned on, when you click Finished to exit the medication pass prior to completion, the following prompt will be displayed. When selected, you will also need to complete the time frame in Allow Provider to close Passing window if remaining meds to be given have minutes or more remaining to pass. There are times when a resident will have medication passes that are more frequent, such as every 2 hours. If your medication passing window is set for 60 minutes before to 60 minutes after the scheduled time and you have residents with frequent medication passes, the medication provider will be allowed to exit the passing window if there are medications that still have remaining time to be administered within the passing window. Click 'Continue Passing Meds' to complete the medication pass. Click 'Close EMAR' to exit the medication pass. The Override Reason to Exit Medication Pass screen will open. Highlight the reason and click 'Select' or double click the reason to select. Note: These choices must be setup in the main database if your company uses Point of Care. EMAR Medication Pass with Pre-Pour Revised 8/14/17 15
Completion of Medication Pass: Once the Currently Due column is empty for all residents, you have completed your medication pass for this passing window. When completed with your medication pass for your shift or when there are no medications scheduled on your shift, click Finished or if you click Change Resident, you will receive an alert on the screen stating There are no residents with Meds Due or waiting for results. Click Close to exit out of the EMAR screen. Click Show All to see a list of all residents for this Med Provider. PRN tab: Click the PRN tab to see a listing of the resident s PRN medications and previous pass information. The last date and time that the PRN medication was given will be displayed in the Prev Pass (Previous Pass) column. Click on the medication to select. If the PRN medication has only one reason/condition to be given it will automatically fill in the Reason Given (Rsn Gvn) column. If there is more than one reason/condition that a medication can be given you will see <Click Here to Select> in the Rsn Gvn Column. EMAR Medication Pass with Pre-Pour Revised 8/14/17 16
When you click on <Click Here to Select>, you will have a list of reasons/conditions to choose from. Click on the appropriate reason(s) and click OK. This is a multiple select choice list. Once the medication is given, click Med Given at the bottom of the screen. The date, time, and your initials will show in the Passing column in green and the reason/condition you selected will show in the Reason Given column. The Result column will have <Click here to enter Results> and the PRN tab will change to PRN (1 Waiting Results). EMAR Medication Pass with Pre-Pour Revised 8/14/17 17
When you are ready to result the PRN Medication, select the resident. Click on the PRN tab and click on <Click here to enter Results>. The PRN Med Results list screen will open. Click on the appropriate option. Note: Recorded in Error: Remove should only be used if you recorded that you gave a PRN medication and did not give it. This will remove the record of this PRN medication being given. If you choose Other and click Select, you will be prompted to enter a specific reason. EMAR Medication Pass with Pre-Pour Revised 8/14/17 18
Results have been recorded on the Acetaminophen order below. The Prev Pass (Previous Pass) column has been updated to show the date, time, and employee s initials that gave the PRN medication. The Result column is updated with how the PRN medication was resulted. Note: PRN meds given will also be shown in the Medication Dashboard. Recent PRN s: To see the 24 hour history of PRN s click on the Recent PRNs tab. The Recent PRNs (2) will show the record of PRNs given in the last 24 hours. The number in parentheses refers to the number of PRNs that have been given. Note: Recent PRNs information is updated when you close the resident. The next time you select this resident, you will see any additional PRNs given. Medication Needing Refill: During a medication pass, you can mark Needs Refill on non-cycle fill medications. There is an option in the File Setup Community Clinical tab EMAR Setup to Allow Refill Requests from Medication Passing Window. Select this option to send refill requests via the Pharmacy Interface or Docutrack Interface directly from the medication passing window. If this option is not turned on, you can still indicate a medication needs a refill in the medication passing window but it will not directly send via the pharmacy interface. You must use the Medication Dashboard to send the refill request. For Scheduled or PRN medications, click in the column that says Refill and a new window will open. Or you can double click on the row to open the window. If you have the option turned on for Allow Refill Requests from Medication Passing Window, the refill window that opens will read Request Refill. Check the box for Request Refill and click OK to send the refill request directly to EMAR Medication Pass with Pre-Pour Revised 8/14/17 19
pharmacy via Docutrack or the pharmacy interface. Refill Ordered cannot be selected from here. Now you will see Refill Ordered in the Refill column. If you do not have the option turned on, the refill window that opens will read Needs Refill. Check Needs Refill and click OK to save. Refill Ordered cannot be selected from here. Now you will see Needs Refill in the Refill column. EMAR Medication Pass with Pre-Pour Revised 8/14/17 20
To close out of the EMAR passing screen, click Finished in the bottom right hand corner. To view Prescriptions Refills, open the Medication Dashboard. If refill requests have been turned on to be sent through the Medication Dashboard, you will see the Send Refill request icon when a medication is selected. Highlight the medication with the status of Needs Refill. If this medication was created from an interface message, you will see the Send Refill request button. Click on Send Refill Request button, and the status will change to refill ordered. The pharmacy will process the refill request. When a new message is received from the pharmacy, the status of the medication will be updated. Status History of Pre-Poured Medications: The status history of Pre-Poured meds can be viewed on the Delivery History tab of the medication record. Open the resident s medications. Click the Delivery History tab. EMAR Medication Pass with Pre-Pour Revised 8/14/17 21
Double click on the medication to view the status history. The poured date, time, and employee who was logged in will be entered along with the delivered date, time, and employee along with the Given box checked. Allergies Tab: Click the Allergies tab to view all of the allergies listed in the Resident Chart Medical History tab. The total number of allergies that the resident has will be indicated by the number in parentheses on the Allergies tab. The allergy type, reaction, severity and status will be listed. EMAR Medication Pass with Pre-Pour Revised 8/14/17 22
May Crush Meds: If the May Crush Meds box has been checked in Resident Chart under Orders tab, May Crush Meds in red font will print on the paper Medication Sheet and at the top of the EMAR Passing screen. EMAR Medication Pass with Pre-Pour Revised 8/14/17 23
Do Not Crush: If a medication is not to be crushed, check the check box for Do Not Crush on the Medication record. When selected, ***DO NOT CRUSH*** will be included in the medication instructions on the EMAR Passing screen. Hazardous Drug: If a medication is a hazardous drug, check the check box for Hazardous Drug on the Medication Record. When selected, ***HAZARDOUS DRUG PRECAUTIONS*** will be included in the medication instructions on the EMAR Passing screen. Resident Information Tab: Additional resident information can be viewed directly from the EMAR Med Pass screen. Click on Resident Information tab. The Resident Information tab provides a read only list of Code Status, Date of Birth, Diagnosis, Diet, Evacuation Status, Durable Medical Equipment, Note/Alert, and Emergency Contacts. This information is pulled from the Resident Chart. The headings will disappear from this tab if nothing has been entered for that resident in the Resident Chart. EMAR Medication Pass with Pre-Pour Revised 8/14/17 24
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