Scott & White MAK

1. Scott & White MAK MedicationAdministrationCheck MAK Scott & White Memorial Hospital Version 1

2. Scott & White MAK • 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 system • Decreases Medication Errors • Some 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 enforcethe 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 Occurrences • All 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 Accuracy • Charting is done as the medication is administered. Flags for required follow-up are automatically added for certain medications. • Provides Online Drug Information • Drug 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 additionalinformation. • Examples of this function are Digoxin, which prompts for a pulse, and Insulin, which prompts for a blood sugar.

3. Medication Order Received Faxed to Pharmacy Order Verified by RN in MAK Follow-up performed and documented if applicable Patient Identified, Then Confirmed by Barcode Scan Charting completed Scott & White MAK Medication Administration Process Processed by Pharmacy Medication Released to PYXIS Medication Delivered to Nursing Unit Medication Scanned Using the MAK Application atthe Bedside Medication Administered to Patient Appropriate 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.

5. Scott & White MAK MOO ! COW Computer On Wheels

6. Scott & White MAK Screen Scanner Keyboard Supply drawer with lock Basket Height adjustment pedal Brake

7. Scott & White MAK Original “Teal” Barcode Scanners These 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 shooting • Make sure all connections are in place • Re-sync the scanner to the base unit • Tag the old scanner. Replace the and resync the new scanner to the base unit • Change carts and notify the Help Desk: 4-2501. They will request the scanner tag number “Wasp” Barcode Scanners The 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 shooting • Make sure all connections are in place • Check for corresponding label numbers • Change the battery • Tag the old scanner, change carts and notify the Help Desk: 4-2501. 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. Scott & White MAK MAK Login 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 4-2501.

10. Scott & White MAK Security • 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 at 4-2501. • If you lose your badge, you must report it to Human Resources so that a new one may be issued.

11. MAK icon The first time you sign in, you will enter the Login ID in both boxes You 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.

13. Click on Location Census

14. Choose your unit. This will become a default.

15. A list of your unit census will appear by order of room number.

16. Hold the “Ctrl” key down and click on all your assigned patients. These will be highlighted in black. Select “Add to Personal”.

18. Next, click Cancel

19. Select “Chart-Select Patient by Census” from navigator or New Patient List Select “Personal Census” from the New Patient

21. Select All You 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. 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. Minimize (-) : 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. Column Name: Clicking on any of the cell names in the column will re-sort the rows. Scroll Bars: Both vertical and horizontal. Move the bar or use the arrows to scroll through the patient window Tabs & Buttons: Selecting tabs “turns the pages” of the screen. Buttons complete or request a function. Scott & White MAK Screen Layout and Windows Functions * Right click on the screen to refresh the display.

25. System Window and Terms Patient Header: Contains allergies, and room number. The Log off button returns the user to the log on screen. Any time you leave the mobile workstation unattended,you must log off. Navigator: Provides a list of options allowing you to “navigate” through the system. To hide or show the Navigator: Go to Navigator and click Show Navigator or Hide Navigator. Scott & White MAK

26. Scott & White MAK Screen Security • Minimize 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 Screen • Others could pull the screen back up and look at information under your ID or enter data.

27. MAK List of Symbols Order pending verification by Nurse Order requires countersignature  Order returned to the pharmacy for clarification One time dose not reviewed by Pharmacy Follow-up required Condensed text Expanded view of text Additional data present Error Discontinued Medication Scott & White MAK You 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. Rapid Allergy and Height/Weight Entry Rapid 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 Verification Medications 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 Orders Click 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” button If you are unsure “Skip Order”

35. Contacting Pharmacy for non-emergent needs Rx Message Goes to your unit Pharmacist Include 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!

39. The Active Worklist

40. Scott & White MAK Active Worklist Folder The 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 Functions The 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.

42. Night Shift can expand to the next day.

43. Expanded view of Scheduled Doses

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 Inquiry A 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