EMAR Pending Review This manual includes Pending Review, which is the confirmation that the information received from the pharmacy is correct. This is done by verification of the five (5) rights of medication administration, completing the scheduling detail of the order, attaching record at passing items and/or medications not given by medication techs. The purpose of Pending Review is to verify the orders received from the pharmacy. Pending Review is where medications are held until facility staff reviews and approves the orders. This is also where you will complete the record at passing and/or passing exceptions. Completing the Medication Review: This is a critical step to maintain the accuracy of the resident medication sheet. This is the responsibility of the community staff to complete. After the initial population of medications is sent from the pharmacy, you will be comparing your paper Medication Sheet to the Electronic Medication Sheet. This is similar to when you would compare paper for the current month to paper for the next month. Note: Non-Medication orders will not be populated from pharmacy. Examples: Vitals, Weights, and Blood Sugar checks. These will have to be manually added by the community staff during the comparison of the paper Medication Sheet to the Electronic Medication Sheet. Pending Review is an ongoing process and should be checked for new items to review on a routine basis. It is recommended to check the status of Pending Review at least 2-3 times a day. After the initial population, medications will be in Pending Review if any of the following are present: New Order, Discontinued Order, or Order Change. The medications or changes to a medication will not be available on the resident s medication passing screen until the medication is reviewed and the changes are accepted by community staff. To access Pending Review, click on the icon on the EMAR home screen. The Pending Review screen will open:
The top portion of the screen lists the medications that need to be reviewed. The bottom portion of the screen lists error messages. Note: If there are no error messages, you will only see medications needing review. Each employee can set the font color for the Initial Review Message or the Update Review Message by right clicking on any line. Note: The Medication record and Resident chart can also be opened from the right click menu. Status: Each medication listed will have a status of Waiting Initial Review or Waiting Update Review. Waiting Initial Review: This is the first message for this medication record. This medication will not be available on the resident s medication passing screen until the review is completed. Waiting Update Review: This is created whenever a new message is received for this medication record from the pharmacy and there is a change to a key field. The changes contained in this message will not be available on the EMAR: Pending Review Revised 3/23/17 2
resident s medication passing screen until the review is completed. Example: The pharmacy makes changes to the instruction field. Medication Order Processing: When you receive new orders, discontinue orders, or order changes from your physicians, you will still need to fax the order to the pharmacy to be entered. It is recommended that you keep the paper copy of the physician s order in a folder or basket by the computer that will be used for reference when completing the medication review. Once the pharmacy enters and completes the order in their program, a message will be sent through the interface. New medications and order changes will be in Pending Review. The medication record in Pending Review should be validated or reviewed using the physician order. There are two ways to open a medication for review. The first way is from the Pending Review screen, double click on the medication to open the record. You can also complete pending review in the Resident Chart from the Orders tab. Medications that need to be reveiwed will be in a green font. Once reviewed, they will be updated to a black font. The steps will be the same either way you choose to review the medications. Double click on the medication to review and the Resident Medication screen will open: Medication Review: Verify that the information received from the pharmacy is accurate. EMAR: Pending Review Revised 3/23/17 3
Items that never come from the pharmacy: Record at Passing items, Exceptions to Administration and Community Instruction Note. Items that may not come from the pharmacy: Dosage, Schedule, Scheduling Detail, Origin, Dispense/Refill, and Number of Refills Remaining. These may vary per pharmacy. Disable editing of Medication / Strength and Instructions: This option must be setup by Eldermark Support Staff. When selected, all medication records created by the pharmacy interface will have the Medication/Strength and Instruction fields grayed out. If corrections are needed, you will need to contact your pharmacy so they can make the necessary changes. Key items to check are: 5 Rights of Medication Administration: Right Patient, Right Drug, Right Dose, Right Route, and Right Time. Prescription Start Date/Time: This is the date the pharmacy entered related to the physician s order start date. When entering dates use the calendar lookup or you can enter the date as MM/DD and then press the tab key. When you move to the next field the current year will fill in to complete the date. Prescription End Date/Time: Enter the date and time the physician discontinues the medication order. On Initial review orders, this will be left empty indicating this medication will be active on the resident s chart indefinitely, until the user ends the medications at later time following the physicians order or if the resident is discharged. If reviewing a short term order, enter the discontinue date if known. Stop Now: Click to enter the current date and time in the Prescription End date and time fields. Medication/Strength, NDC, Dosage and Route: Review for accuracy. Medication/Strength: The Medication name/strength field will populate from Pharmacy. If corrections are needed, you will need to contact your pharmacy so they can make necessary changes. NDC Code: The program uses the NDC code to obtain the list of side effects for this medication. Dosage: This field may be populated from your pharmacy interface. This information should be a part of the Medication name/strength or Instructions field. There is an option in the Community setup to turn on the Dosage field on the medication record screen. To turn on, go to File Setup Community double click on the Community to select Clinical tab - Medication/Medication Sheet button and click to turn on Show Dosage Field. Route: This field may be populated from your pharmacy interface. This information should be a part of the Instructions field. There is an option in the Community setup to turn on the Route field on the medication record screen. To turn on, go to File Setup Community double click on the Community to select Clinical tab - Medication/Medication Sheet button and click to turn on Show Route Field. Schedule: Review for accuracy. This field is not necessary for EMAR. The Schedule and Passing times will be defaulted from the SIG code the pharmacy uses on the medication order, for certain interface types. Use the lookup at the end of the Schedule field to open the Med Schedule choice list. EMAR: Pending Review Revised 3/23/17 4
Passing Times: When the Med Schedule is selected, the passing time(s) will be filled in for you as long as the default passing times are set up in the Med Schedule Codes master list. The default passing time(s) can be edited for each medication as needed. PRN Medications: If the pharmacy has PRN populated in the SIG of the order they are sending to Eldermark, this box will be selected. Check the PRN box if needing to mark this medication to be given as needed. Click on the lookup at the end of the Schedule field to bring up a list of PRN passing schedules. Scheduling Detail: For any medication that is to be given less than daily, click on the scheduling detail button and select the appropriate frequency. For details on this, see EMAR Chapter 5: Orders manual. Once you have completed the Scheduling Detail, verify that it is correct by reading what is displayed to the right of the Scheduling Detail button. This is a critical step. If the scheduling detail is not set correctly, the medication will not be available for signing on the appropriate days. Instructions: The instructions from the pharmacy will be in this field. If corrections are needed, you will need to contact your pharmacy so they can make needed changes. It is recommended that you use the Community Instruction Note for any additional staff instructions. Community Instruction Note: Add any instructions for your staff. This information will pull to the EMAR for medication passing and be shown on the printed Medication Sheet. Example: Crush Meds, Give with full glass of water. Do Not Crush: Select the box for Do Not Crush to add this to the Medication Record. When selected, ***DO NOT CRUSH*** will print on the medication sheet in the instructions field on the medication. If you community uses EMAR, it will also be displayed on the medication pass screen in the instructions field on the medication. Note: There is a checkbox for May Crush Meds on the Resident Chart Orders tab. Check this if you want the option to apply to all medications in the resident s chart. May Crush Meds will appear in red text on the medication passing screen. Hazardous Drug: Select the box for Hazardous Drug to add this to the Medication Record. When selected, ***HAZARDOUS DRUG PRECAUTIONS*** will print on the medication sheet in the instructions field on the medication. If you community uses EMAR, it will also be displayed on the medication pass screen in the instructions field on the medication. EMAR: Pending Review Revised 3/23/17 5
Indicated For: The Indicated For field is the reason the medication is ordered. This can be either a diagnosis or a condition. If the instructions from the pharmacy contain the following: For, As Needed, As Needed For, or DX, the system will pull the text written after that text to the Indicated For field. Note: If the word for is immediately followed by a number, this information will not pull to the Indicated For field. Example: Ampicillin 500 mg by mouth three times a day for 7 days. If your pharmacy enters characters or other text after the Indicated For reason, there are parameter settings to exclude text after certain characters. Contact Eldermark Support to set this up. For example: Give 650 mg by mouth twice a day for Pain (do not exceed 4000mg in 24 hours). Eldermark can setup options to exclude the text after the parentheses. Indicated For - Routine Medications: This is optional for Routine medications. There is a setting to remind you to complete, if it is incomplete when you save. If this setting is turned on, the following message will be displayed if the Indicated For field is incomplete. However, you will still be able to save your changes without having the Indicated For completed. Indicated For - PRN Medications: Completion of this field is required for ALL PRN medications. The indicated for on PRN medications will become your reason or list of reasons for giving a PRN medication. If there are multiple reasons, you need to separate the reasons with a comma or the word or. EMAR: Pending Review Revised 3/23/17 6
Example: Headache, Pain, or Fever. This will appear on the EMAR as 3 separate reasons for the medication providers to select as a reason for administering the PRN. The med providers have the ability to select all that apply. If it is entered as Headache and Pain then it will be one reason when you give the PRN medication. If it is entered as Headache; Pain; Fever then it will be one reason when you give the PRN medication. Select Record Items : Click to select vital signs and/or other items your staff would record at passing on the EMAR and Medication Sheet. Select all that apply on the medication record. If the item you need to record is not on the list, use the Other Specify options to create your own field. Note: These items will be displayed in both the med pass and on the medication sheet. Med providers will be required to complete the value(s) before charting the medication or treatment as Given in the medication pass. EMAR: Pending Review Revised 3/23/17 7
Prescription Number, Prescribed By, Pharmacy, Dispensing Pharmacy: Prescription #: This will be populated by the Pharmacy. Prescribed By: This will be populated by the Pharmacy. Pharmacy: This will be populated with the Pharmacy name the community is interfaced with. This field should not be changed away from the interfacing pharmacy if using bi-directional features. Dispensing Pharmacy This will be populated with the Pharmacy name the community is interfaced with by default. The user can edit this field to the correct dispensing pharmacy, if the interfacing pharmacy does not dispense this medication for the resident. The medications that are available for Cycle Fill Check In are determined by the dispensing pharmacy. This field is only available if Enable Receive Medications is turned on in Community setup. Exceptions: Self Administered: The resident takes this medication independently. This medication will not be listed in the medication passing window. It will print on the completed medication sheet with Self in the passing time column. There is an option in the Medication Sheet setup to include passing times for Self Administered medications. Note: There is a check box on the Orders tab to mark all medications as Resident Administers own Meds. Administered by Nurse Only: Mark this if only a nurse provider can administer this medication. Note: There must be a Med Provider that is setup as Is a Nurse. If all med providers are nurses, then you do not need to mark each med as Administer by Nurse Only. Administer by Other: Mark this if someone other than community staff will be administering this medication (ex. Hospice or a Home Health Agency). This medication will not be listed in the medication passing window. It will print on the completed medication sheet with Other in the passing time column. There is an option in the Medication Sheet setup to include passing times for Administer by Other medications. Is a Supply: Mark this for Supplies that you do not want or need your staff to record, for example alcohol prep pads, lancets, or syringes. Some states require these on the physician orders for the pharmacy to supply. If this is marked you will not be required to enter a schedule or passing times. This will not pull to the EMAR. EMAR: Pending Review Revised 3/23/17 8
Once you have reviewed the medication and the information is correct, check Review Complete and click Save. This will make the medication order active on the residents chart and on the medication pass for the next time it is scheduled. Change History: The information from the pharmacy will be recorded in the Change History with no initials. Any changes or additions to the medication will be recorded in Change History with the users initials, date, and time the change is saved. If a field is not changed, you will see ~ in the field on that line. You will see the new value in any field that is changed. The second way to open Pending Review is from the Resident Chart Orders tab. If a medication needs review, you will see a Needs Review column and the medication(s) needing review will be in green. Current medications are in black and inactive medications are in red. Double click on the medication to open the record. Follow the process described above to review the medication. EMAR: Pending Review Revised 3/23/17 9
Waiting Update Review: After the Initial Review, each time the pharmacy makes an update to the medication, a new medication message is sent. Behind the scenes, the data in this message is compared to the data on the medication record. If there are differences in key fields you will have a Waiting Update Review message in Pending Review. Automatic updates to medication messages: Non-Critical field changes that are processed and updated on the medication record without the community staff having to accept the changes are: Dispense/Refill Date, Number of Refills Remaining, Prescription Number, Barcode Numbers, Prescribed by, NDC Codes, Dose, Origin, Needs Refill, Refill Ordered, multi part index, medication description (color, shape, imprint), and label warnings. Differences that are ignored and do not come to pending review: Scheduling detail, schedule, dosage, PRN check box, and medication passing times, for some interfaces. For some interfaces, the community determines the medication passing times. Your pharmacy interface will be covered in training. For additional questions, please contact Eldermark Support. Example of an Update Review: Waiting Update Review status in Pending Review. EMAR: Pending Review Revised 3/23/17 10
The Pharmacy Changes Waiting Review tab at the bottom of the screen will list the fields needing review, the current value, and the new value from pharmacy. The default setting is to have a check in the Accept column. If you do not want to save a change, uncheck the item or items and click Review Complete. Click Save in the bottom right corner to save your changes. Click on the question mark for the help message. Errors/Warnings: Mismatch on Resident SSN, Mismatch on Resident DOB, No Matching Resident. Mismatch on Resident SSN or DOB The resident s Social Security Number (SSN) and Date of Birth (DOB) are key resident identifiers. Whenever there is a mismatch between the information in Eldermark and the Pharmacy, you will receive this message. To resolve this issue: Verify the resident s SSN or DOB. If the information is incorrect in Eldermark, correct the SSN or DOB in the Resident Chart on the Main tab. Highlight the message in pending review and click Re-Process. You will then have the medication for review. If the pharmacy information is incorrect, notify the pharmacy so they can update their information. Highlight the message and click on Accept Mismatch. You will then have the medication for review. Note: You will continue to get these messages for this resident until the pharmacy updates their information. Note: You will NOT get a new medication message once you make the change in Eldermark or the Pharmacy makes the change in their system. You MUST Re-Process or Accept Mismatch whichever is appropriate for this resident for EMAR: Pending Review Revised 3/23/17 11
EVERY message in the Errors/Warning section. Do not click Ignore Message for mismatch on DOB or SNN. If you click Ignore Message, you will NOT receive the medication for review. In the example below, the message is No Matching Resident. This is fairly common with the initial population of the database. Highlight the message. Once you have highlighted a message you have the choice of Ignore Message, Open Msg, or Re-Process. If the person listed is no longer a resident click Ignore Message and notify the pharmacy of the discharge. If the person listed is a current resident and they are in your database, click Re-Process. If the person listed is a current resident and they are not in your database click Open Msg. Click Create Resident to add the resident to the database. Then click on Save to return to the list of error messages. Ensure this message is highlighted and click on Re-Process. You will need to highlight each message for this resident and click on Re-Process. EMAR: Pending Review Revised 3/23/17 12