Documenting Medicated Drips. IV Manage Closed Loop Orders. Physician . Medicated Drip Ordered in CPOE. IV Manage Closed Loop Orders. Pharmacist . Order Interfaced to pharmacy. Pharmacy receives the order. . IV Manage Closed Loop Orders. Nurse. Order Interfaced to IV Manage. - PowerPoint PPT Presentation
Documenting Medicated Drips
Now that weve covered intake and output, well review how continuous medicated infusions are documented in CareDoc. CareDoc is integrated with Dukes pharmacy system. This means that CPOE orders for medicated infusions flow electronically from cpoe, to the pharmacy system and then to CareDoc. Heres how it works.1Medicated Drip Ordered in CPOE.
IV Manage Closed Loop OrdersPhysician The physician or provider will place an electronic order in CPOE for a continuous medicated infusion. The order is sent electronically to the pharmacy system.2
Order Interfaced to pharmacy
Pharmacy receives the order. IV Manage Closed Loop OrdersPharmacist The pharmacist reviews the order, makes any necessary changes, adds pharmacy comments and then verifies the order.3
IV Manage Closed Loop Orders
Verified order displays in IV Manage.OrderInterfaced to IV Manage NurseYoull be notified of the order by the printed OCR and youll see the pharmacy-verified order display in CareDoc. An important point to remember is that only pharmacy - VERIFIED orders display in IV Manage.
In the next few slides, well cover some things you need to do before you hang or document an infusion.4
First, be sure that your patient has an IV Calc Weight documented in the Measurements section of the vital signs flowsheet. Although there are many types of weights, the only weight viewed by pharmacy is the IV Calc Weight on the vital signs flowsheet.
This weight is used for dosing of all types of medications, not just for continuous medicated drips; therefore, all patients must have it documented.
As a rule of thumb, if you are infusing a weight based drug, the IV calc weight should exactly match the weight on the alaris pump. 5
Next, when you receive a new order, youll need to check the infusions and drips web link to be sure it is a drug that documented within IV Manage. The pharmacy system will send orders to IV Manage that are NOT documented in IV Manage; therefore, you must check this link. To do this, click Web Links on the tool bar and then select either the adult or pediatric Drips link. 6
and then select either the adult or pediatric Drips link.
Heres an example of the infusions and drips guide. The items on the left are documented in IV Manage and the items on the right are documented manually on the VS Flowsheet.
As you become an experienced CareDoc user, youll soon memorize the drugs you give frequently.
Finally, youll need to check your patients allergies. This can be done from eBrowser or the allergy button in CareDoc. Click the allergy button now.9
Hmmm The reaction for the morphine allergy is sudden and pain free death lets try to avoid that.
On a serious note, there is no automatic allergy checking in CareDoc; therefore, it is very important that you understand the importance of clicking the viewing allergies here.
Now click close to remove allergies from view.10ReviewLets review these critical steps before we start a medicated drip:First, enter the IV Calc Weight in the measurements section of the vital signs flowsheet. This must be done even if there is no order for a medicated drip.Second, check the infusions and drips weblink to see if the drug is documented on the vs flowsheet or iv manage.Last, be sure your patient is not allergic to any drugs you hang or document.11New Order
Patient Weight: 100 Kg
Order:Heparin 1200 units/hrSodium Chloride 40 ml/hrNow, your ready to learn how to start a continuous medicated drip. The physician has ordered heparin at 1200 units per hour and normal saline at 40 mls per hour. Your patient weighs 100 kg. 12
To easily determine if an IV Calc Weight has been charted on your patient, you can hover over the IV Calc Weight row label with your mouse.
If this value has been charted, CareDoc will display the most recent value and the date and time that it was charted. As shown here, 100 kg has been charted for this patient; therefore, we dont need to chart it again.13
Now, lets look at the infusions and drips weblink. The ordered items are highlighted in green. Heparin should be charted in IV Manage and IV Fluids should be charted manually on the vital signs flowsheet.14
To document heparin, click the IV Manage tab now.15
The IV Manage screen displays. Now, check the IV Calc Weight within IV Manage. If it is incorrect, type the correct weight.
Also note there is an allergy button in the upper right corner. This is another way that you can check your patients allergies.16
Lets get started with the documentation. Click the Set Dt/Time button now.17
Ill type the time for you.
Keep in mind that if you are working night shift, you might also have to change the date.
Click the OK button now.18
Youll see the date and time that I entered in the upper left corner.19
Click the New IV button now.20
CPOE orders display under the Available Ordered Bottles Heading. Remember, we wont use the sodium chloride because it is documented on the VS flowsheet.21
Lets take a closer look at the components of the CPOE order: Column one displays the drug name and total amount of drug in the bag22
Column 2 shows the total amount of fluid in the bag.23
Column three shows the order number and the bottle number. The order number is specific to IV Manage and will not match CPOE or ebrowser order numbers. As shown here, sometimes more than one item displays for the same drug.
When selecting an item, always choose the lowest bottle number for that drug. In this case well start with bag 2 of heparin.24
Column four displays the pharmacy scheduled administration time. Dont be concerned if this does not match the nursing administration time.25
Select bag 2 of the heparin by double-clicking on it.26
The heparin displays as a hanging bag You can see the status here.
Youll also see the drug name and concentration along with administration comments. Be aware that these comments could be incomplete.
The physician-ordered dose and rate display in the upper right corner.
Youll need to confirm that all of the order elements displayed correctly and view the COMPLETE version of the comments in eBrowser before you proceed with you documentation and administration. On the next slide, well look at the eBrowser order.
Here is the heparin order.Ill click on it once to open order details for you. 28
Now youll need to look at the ordered dose to be sure that is matches what is displayed in IV Manage. If It does not, youll need to do some research for figure out why. A good starting point is to contact the pharmacist.
Also, review the administration instructions where youll see the complete comments for the order. Some things you might see here include:
Titration and hold parameters Pharmacy and physician commentsTarget lab valuesAny additional instructions
In this case, the physician ordered 1200 units per hour; therefore, the correct dose displayed in IV Manage. Now well proceed with our documentation.
Now back to our heparin bag. Lets finish this documentation. We see the correct dose
And the correct rate.we also need to check two other things:
Verify that the correct dosing unit displayedin this case units/hr
and that ml/hr displays in this drop down.
Everything looks correct, so lets proceed.
Click the site drop-down now.
P-e-r-i stands for peripheral, m-i-d-l stands for midline and c-e-n-t stands for central. Well select the peripheral site. 31
Now, click save in the upper right corner.32
The drip turns blue indicating that it is saved. Click exit in the upper right corner.33
Click refresh now to populate the vital signs flowsheet.34
In the intake section, youll see the heparin with a zero for the volume. This indicates the start of the infusion.
In the IV Med Drips section, youll see the dose of the drug.
Later, youll learn how to:
document intakeHold and resume Titrate And discontinue35