Download Creating an Order in CareMobile (Ad Hoc Order Entry)

Bar Code Medication Administration and MAR Resource Manual
Creating Orders
Creating an Order in CareMobile (Ad Hoc Order Entry) .............................................................2
Creating an Order for med that is already ordered with a different dose/frequency. ...............4
Ad Hoc Order Entry Tips .........................................................................................................4
Troubleshooting Ad Hoc Order Entry ..........................................................................................5
Special Situations
Back Charting .............................................................................................................................6
Overdue Medications..................................................................................................................7
Charting Not Given .....................................................................................................................8
Changing IVPB Infusion Time...................................................................................................10
Correcting Medication Charting Errors .....................................................................................11
Modify ...................................................................................................................................11
Unchart .................................................................................................................................12
Rescheduling a Dose ...............................................................................................................13
Insulin .......................................................................................................................................14
Scanning Insulin....................................................................................................................14
Insulin Correctional Scale Detail ...........................................................................................14
Vaccines ...................................................................................................................................17
PCAs ........................................................................................................................................18
Epidurals ..................................................................................................................................20
Charting epidurals on the PDA (CareMobile) ........................................................................20
Charting Epidural totals on the form......................................................................................21
MAR Notes ...............................................................................................................................23
Isolation ....................................................................................................................................24
Discontinued Medications .........................................................................................................25
CareMobile............................................................................................................................25
MAR Summary......................................................................................................................26
MAR ......................................................................................................................................26
SAM Meds in Maternity ............................................................................................................27
Transfers to Other Facilities......................................................................................................27
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Creating an Order in CareMobile (Ad Hoc Order Entry)
Ad Hoc Order entry is a function that allows clinicians to enter med orders into CareMobile and
administer medications before order is entered.

Only use function for now and stat orders

Must have medication as a floor stock item

Most likely to occur in the critical care areas

Ad Hoc Order Entry takes longer to chart than a medication that has been entered by
pharmacy

A pharmacist will not verify Ad Hoc orders
During emergent times, the clinician is most likely to chart after the patient is stable. In this
scenario, the orders will be entered and back charted.
1. Scan the med
2. Tap “Yes” on the alert
3. Drug Alert window opens
Tap to view details
2
4. Consult the pharmacist or physician when making a decision to override the alerts
5. Tap Continue to enter the order
6. Tap Cancel to not enter the order
7. The Override Reason window pops up
8. Tap drop-down arrow and select a reason for the override
9. Tap Continue on Override reason window
10. Review medication information and change dose if needed. (An error occurs when 2
packages are scanned. Scan 1 package and change the dose.)
11. Complete the required fields (yellow)
12. Tap Save
13. Go to the To Be Signed folder.
14. Verbally confirm patient and Scan patient’s name band.
15. Administer medication.
16. Tap Sign.
Change dose if
needed.
Do not scan 2
packages.
If having trouble
entering physician,
tap the binoculars
and enter the name in
the search window.
3
Creating an Order for med that is already ordered with a different
dose/frequency.
There are times when a stat med is ordered and a routine order already exists. For example,
sliding scale insulin has been ordered ACHS. Physician gives verbal order for stat Regular
Insulin 5 units. If the insulin is scanned the sliding scale order opens, not the order window.
1. Tap the Ad Hoc Order Icon
2. Scan the medication
3. Respond to the alerts
4. Complete the order window
5. Complete the med administration process.
Tap Icon
Scan med
Do not use
Product Search
Ad Hoc Order Entry Tips
When order has been entered into PowerChart a med task will be generated. The nurse must
chart “Not Given” with the reason “already given”.
Ad Hoc orders (order created by the nurse in CareMobile) go to discontinued status
immediately. On the MAR all discontinued meds are listed at the bottom. On the MAR
Summary Ad Hoc ordered meds are grayed and listed in the Scheduled section alphabetically
with the active orders.
4
Troubleshooting Ad Hoc Order Entry
An Ad Hoc Order for a pain medication does not generate a pain reassessment task in
CareMobile
Ad Hoc orders are considered one time orders in CareMobile and therefore do not generate a
PRN Pain Response task. Go to Ad Hoc Charting in PowerChart to document the pain
reassessment. Following current policy, the pain reassessment should be performed and
documented within one hour of administering pain medication
Entering an Ad Hoc Order for a medication that has multiple packages
You can scan only one package to enter an Ad Hoc Order. If you attempt to scan 2 packages,
two separate orders will be created, or an alert will prevent the 2 nd scan.
 Scan 1 package and change the dose in the order window
Alert if scan 2 packages
Change dose
to correct
amount.
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Back Charting
1. Tap med task in “Overdue Tasks” folder
2. Tap Yes on not verified by scan alert. Scanning is bypassed because the med was
already administered.
3. Tap Back Charting Icon
4. Change time and/or date
5. Tap OK
6. Tap Save on the charting window
7. Go to the “To be Signed” folder
8. Verbally verify patient’s name and birth date
9. Scan the patient’s name band
10. Tap Sign
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Overdue Medications
1. Tap Overdue Tasks list
2. Follow procedure for preparing meds
3. Scan med(s)
4. Select a Task window opens if there are multiple late doses
5. Tap the desired task (due time is in red)
Select a Task
window opens
Tap the desired task
6. Go to the To be Signed folder
7. Scan the ID band
8. Sign
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Charting Not Given
There are times that you chart a med was not given such as,
Dose held for 1 day due to a procedure
Patient took the medication at home before coming to the hospital
Patient refused
Medication was given on a non-eMAR unit.
Charting not given can be accomplished on PAL, MAR or CareMobile (PDA).
PAL
1. Click on the task cell to open the Tasks window
2. Right-click on the med task
3. Click chart Not Done
4. Chart Not Done window opens
5. Click the drop-down arrow to select a reason
6. Click the sign button
MAR
1. Right-click on the med task
2. Click Chart Not Done
3. Complete the Chart Not Done window as directed above
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CareMobile
1. Tap on the med task in the To be Signed folder
2. Tap Not Given
3. Tap the drop-down arrow for the reason field and select a reason
4. Tap Save
Tap on med to open
charting window
Tap Not Given
Tap the Reason dropdown arrow and select
a reason
Tap Save
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Changing IVPB Infusion Time
Infusion times can be changed in CareMobile. For example, Vancomycin 1 gm has an infusion
time of 1 hour. You are going to infuse the IVPB over 2 hours.
1.
2.
3.
4.
5.
Tap the task in the To be Signed list to open the charting window
Tap the Infuse Volume icon
Change the Infuse Over field to the desired time
Tap Save
Continue with medication administration process
Change the
Infuse Over
field
IVPB volumes auto-chart on I&O under the Medication section
The IVPB Infuse Over was changed to 2 hours.
The volume is charted in three time columns because
the start time is 1802
10
Correcting Medication Charting Errors
All medication charting errors must be corrected on the MAR including IV Begin bags.
Medication Drip rate changes charted on IV Drips section of Interactive View may be corrected
on Interactive View.
Modify
1. Open MAR
2. Right click charted dose cell
3. Select Modify
4. Make corrections such as changing time
or dose
5. Click Comment and enter reason
for correction.
6. Sign
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Viewing Modified Documentation
 Corrected documentation displays with (c)

Double click to view detail
Unchart
Use Unchart function for a charted med that was not administered or when medication has
been charted on the wrong patient.
1. Open MAR
2. Right click charted dose cell
3. Select Unchart
4. Enter reason and click OK
5. Sign
Uncharting displays as ‘In Error’
and the task is available to chart
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Rescheduling a Dose
Reschedule doses only when administering a dose early (giving meds prior to discharge) or
moving doses back on the standard administration time (rescheduling today’s IVPB antibiotics
following a procedure).
1. Open MAR
2. Right-click on the dose to be rescheduled
3. Select Reschedule This Dose
4. Enter the new administration time
5. Click OK
Currently scheduled time
Enter new time
Rescheduled time
Do not enter a reason.
It does not display.
Task has moved to new time on MAR.
Task will display in CareMobile on the Due Tasks list 1 hour prior to the due time.
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Insulin
Scanning Insulin
Because nursing does not send the insulin back to pharmacy for re-labeling every time the
dose is changed, you must scan the manufacturer’s barcode instead of the barcode on the
patient label.
1. Select a task window will open. Tap the desired task.
2. Enter the site
3. Tap Save
4. Continue with the medication administration process
5. The medication charting will display on the Diabetic
Flowsheet
Tap the task
Insulin Correctional Scale Detail
To view Insulin Correctional Scale detail you must go to Order Detail on CareMobile, MAR
Summary or MAR.
CareMobile
1. Tap and hold on task
2. Tap Order Details
3. Tap Comments
4. Comments may have 2 options: MAR Note and Order Comments
5. Click the drop-down arrow and select the other option to view all comments
Tap drop-down arrow
and select other option
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MAR Summary
1. Hover on the order
2. Click Order Info
3. Click the Comments tab
Displays all comments
entered by pharmacy
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MAR
1. Hover to the order to view the detail that is partially displayed
2. Click the Push Pin icon to view the comments not displayed in the order
Click the Push Pin
Displays all comments
entered by pharmacy
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Vaccines
Do not administer the vaccine(s) prior to Nurse Review. Notify the pharmacy of orders
that have been placed incorrectly.
A vaccine order is a one-time order with the start date and time of 0900 the day following
admission:
Frequency: Once
Start time: 0900
Start date: Day following admission
Reviewing the MAR Summary tab as part of the shift change report will further ensure the
accuracy of vaccine orders that have been entered.
Verify that no other doses
have been administered
Scan the vaccine barcode
1. Complete required fields (yellow or peach)
 VIS publication date is found at the bottom
of the Vaccine Information Sheet
 Administration date is required so that the
data will populate the AHA and AP for the
next admission
2. The Vaccine lot number will not accept letters.
Enter the number
3. Click the comment icon
and enter the
entire lot number including the letters
4. Tap Save
5. Continue med administration process
Use scroll bar to view all the
required fields.
When the vaccine is not available from the manufacturer, pharmacy will enter an order
indicating patient meets the vaccine criteria but it is not available. The order will display on the
MAR, MAR Summary and Orders tab but does not generate a task in CareMobile (PDA).
When the vaccine is available, pharmacy will enter an order to administer.
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PCAs
Charting on the PDA (CareMobile)
PCA tasks display in the PRN folder in CareMobile.
Chart the PCA when a new bag/syringe is started
1. Tap and hold on the task to view the comments
2. Tap Order Details
3. Tap Comments
4. Scan the med bar code
5. Complete the med administration process
The PCA will display the entire dose on the MAR and MAR Summary.
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Charting PCA totals on the form
When a PCA order is placed, a PAL task will generate every 8 hours, 0800 -1600 - 0000. The
task opens the PCA/Continuous Narcotic Infusion form.
Follow the
instructions
The charted data will display on a Pain Flowsheet. The specialty flowsheet is accessible from
the Patient Assessment and Results Review.
Click the Level arrow on the dashboard
The PCA will not create a row for charting volumes on the I&O.
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Epidurals
Charting epidurals on the PDA (CareMobile)
Epidural tasks will display in the Continuous IV folder in CareMobile.
Chart the epidural when a new bag/syringe is started
1. Tap and hold on the task to view the comments
2. Tap Order Details
3. Tap Comments
4. Tap the drop-down arrow and select the other option to view all
Pharmacy comments
Charting is the same as continuous IV charting
1. Scan med bar code when hanging a new bag/syringe
2. Tap Add IV Events
3. Tap Begin Bag
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4. Complete the Charting window
 Click the Calendar to change the Performed Date/Time when back charting
 Complete the required fields (peach or yellow)
 Dose and Dose unit refer to the medication
 Verify that you selected the correct dose unit for the medication
 Completing the dose field will auto calculate the rate. If rate is entered, then dose
will auto-calculate.
5. Tap Save
6. Continue med administration process
Click to change the
Performed Date/Time
Medication
Verify that Dose unit
is correct before
tapping Save
Charting Epidural totals on the form
The Epidural Flowsheet will be tasked every 4 hours on the PAL for charting the cumulative
volume of the current bag.
1. Complete all the required fields
2. The 4 Hour Pump Running Total will populate the I&O under Other Intake Sources
The Epidural 4 Hr Running Total will not add into the Total volume on I&O.
21
Charting on IV Drips section of IView
Chart the rate/dose on IV Drips in Interactive View q 4 hours
*Critical Care units will chart epidural doses and volumes hourly on IV Drips and I&O.
22
MAR Notes
Mar Notes are entered by pharmacy as reminder notes or charting fields.
1.
2.
3.
4.
Tap the task
Tap “Yes” on the bypass scanning alert
Tap “Not Given” (MAR reminder rotes) or complete charting window.
The patient’s name band must be scanned to sign, except “Not Given” charting.
The documentation displays on the MAR tab.
MAR Reminder Notes
These notes do not require charting, i.e., the Warfarin note reminding the nurse to check the
chart daily.
Chart Not Given (CareMobile) or Chart Not Done (PAL or MAR) with the reason “Note
Acknowledged.”
The patient’s name band does not need to be scanned when Not Given is charted.
CareMobile
PAL
MAR Notes for Charting
Notes such as the BP MAR Note allows the user to
chart the BP via the PDA and view the data on the
MAR and MAR Summary. If the BP has already
been documented via PowerChart, go to the PAL or
MAR, and Chart Not Done.
The charted blood pressure is viewable on the
MAR, and all other tabs and specialty flowsheets
that currently display blood pressure.
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Isolation
When PDA is left in room and patient has vacated the room:
1. Clean with Sani-Cloth Plus Wipes.
2. Squeeze excess fluid from wipes.
Isolation Process for PDA when it is not possible to have a dedicated PDA
Duplicate patient ID bands placed in the anteroom for scanning is a violation of hospital policy
and a significant safety risk. You must scan the ID band on the patient.
Outside Patient Room:
1. Scan and prepare meds outside room.
2. Gown up to enter the room.
3. Take PDA into the room.
In the patient room:
1. Scan the patient ID band.
2. Set down the PDA in the patient room.
3. Administer medications.
4. Complete charting on the PDA.
After Medication Administration:
1. Remove gown and gloves in the room.
2. Perform hand hygiene with alcohol gel.
3. Re-glove and squeeze excess liquid from Sani-Cloth Plus Wipes so the solution does
not run onto the screen.
4. Clean PDA with Sani-Cloth Plus Wipe.
5. Leave room with the PDA and discard gloves.
6. Perform hand hygiene with alcohol gel.
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Discontinued Medications
CareMobile
Medications that have been discontinued will drop off the Due Tasks List. The med order will
display in the Discontinued folder.
1. Tap Due Task or the arrow to open the list of folders.
2. Tap Discontinued folder
 Tap on the med to view order information
3. The med order will display for 24 hours.
Overdue medications will display in the Overdue folder until charted as given or not
given.
Indicates
Discontinued
Continuous IVs that have not been started will not display in the Discontinued folder.
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MAR Summary
Discontinued meds are grayed and continue to display in the Scheduled, Unscheduled, PRN
and Continuous IV sections.
Continuous IVs that have not been started will drop off the MAR Summary.
MAR
Discontinued meds move to the Discontinued sections of the MAR. Meds ordered in
CareMobile go to Discontinued status as soon as the med is signed.
It is recommended to view medications on the MAR Summary where the discontinued meds
remain in the active sections.
Continuous IVs that have not been started will not display in the Discontinued Continuous
Infusions section.
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SAM Meds in Maternity
SAM meds (Self Administered meds) will not be charted via CareMobile (PDA). The med
orders will display on the MAR Summary and MAR tab. SAM meds are acetaminophen,
multivitamins, docusate and ibuprofen.
Transfers to Other Facilities
The MAR will not be printed except for a transfer outside the Munson Healthcare system. The
Mercies, Kalkaska and Paul Oliver can view the MAR and MAR Summary sections of the chart
and therefore, will not need a pMAR with transfers.
Discharges to other institutions
Print the MAR using Publish Medical Record function.
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