Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Access (Look at ethics and provision of care)
Transcript
Millennium and JCI Medication Management and Use Accreditation Standards September 1, 2008 Introduction The purpose of this white paper is to present Cerner’s opinions concerning how it believes Millennium and associated solutions can potentially support the efforts of clients to comply with many of the standards contained in the Medication Management and Use (MMU) section (pp.117-129) of the 2008 Joint Commission International (JCI) Accreditation Standards for Hospitals, 3rd Edition (effective January 2008). The white paper and the information and opinions it contains have not been reviewed or endorsed in any way by JCI. While every effort was made to ensure the accuracy and completeness of information in the white paper when it was published, it should be used only for reference purposes. Interested parties should contact Cerner directly to obtain the most up-todate information concerning solution offerings and functionality, and to discuss how they might be used to address specific JCI standards. General Focus of the Standards The general focus of the accreditation standards in this area can be summarized as follows: - - That care is delivered in an interdisciplinary manner including coordination internally and externally of resources required for patient care Ensuring that the hospital makes sufficient patient specific information available when needed for supporting medication management requirements Assuring that all medications to be used are approved and regularly reviewed against written criteria developed by the medical staff o Assuring that a process exists for approval of medications not on the approved list for the hospital Assuring medications are properly stored and available when and where needed Assuring medications brought into the hospital by patients are used and administered according to hospital policy Ensuring that only medications required to treat a patient’s conditions are ordered, and that orders are clearly written and transcribed Assuring that appropriate order review occurs for all medication orders by a pharmacist Ensuring that medications are prepared, labeled and dispensed safely and appropriate to the patient’s needs Ensuring that recalls of discontinued medications is managed appropriately Assuring that risk of diversion of medications is properly mitigated through control procedures Ensuring that medications are safely and accurately administered including those to be self administered Assuring that the effects of medications on patients are monitored Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. - Ensuring that the a proper response is given to actual or potential adverse drug events and medication errors That the entire medication management system is subject to evaluation and review Millennium’s Role in Enabling Compliance The standards found within the Medication Management and Use section of the JCI accreditation standards are focused on the continuous management of medication formularies and the physical stock of medications in the pharmacy and on patient floors. Many of the standards are procedural in nature, but many also are directly supported by different aspects of Millennium’s computerized prescriber order entry (CPOE)/order management, nursing/physician documentation, clinical event and clinical document viewing, pharmacy, stock control and storage, and other applications that support the medication management lifecycle. The standards also are focused on the entire lifecycle of medication management from how a hospital identifies their formulary requirements, how medication items are managed through the supply chain to how they are dispensed and administered. The standards also focus on patient safety and process improvement relative to the entire life cycle. These standards are also mainly procedural in nature, but many are directly supported by different aspects of Millennium’s materials management, pharmacy, patient safety, and patient care solutions. The key Millennium solutions involved include: - Order Management PowerPlans CareNet Documentation Management eMAR PowerPOC Results review Discern Expert Patient Management Patient Privacy PharmNet ProCure Note: The solutions, solution functionality, and services referenced in this white paper may not be available in all markets. At a more granular level, Millennium can assist in enabling compliance with these standards in the ways described below. (Specific JCI accreditation standards are stated followed by the abilities of Millennium to enable compliance.) The JCI standards that are highlighted for comment are those that seem to most directly imply a system role in compliance. Medication Use MMU.1 – Medication use in the organization complies with applicable laws and regulations and is efficiently organized to meet patient needs. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. There is a plan or policy or other document that identifies how medication use is organized and managed throughout the organization. All settings, services and individuals who manage medication processes are included in the organizational structure. Policies guide all phases of medication management and medication use in the organization. There is at least one documented review of the medication management system within the previous 12 months. The pharmacy or pharmaceutical service and medication use comply with applicable laws and regulations. Appropriate sources of drug information are readily available to those involved in medication use. See responses below for information on how Millennium enables compliance with medication use requirements. See MMU.4 for Multum comment. MMU.1.1 – An appropriately licensed pharmacist, technician, or other trained professional supervises the pharmacy or pharmaceutical service. An appropriately licensed, certified, and trained individual supervises all activities. (Also see GLD.5, ME 1) The individual provides supervision for the processes described in MMU.2 through MMU.5. Millennium can enforce what roles can perform tasks such as to verify orders. It restricts who can verify/update orders by role and user. MMU.2 – An appropriate selection of medications for prescribing or ordering is stocked or readily available. Medications available for prescribing and ordering are appropriate to the organization’s mission, patient needs and services provided. There is a list of medications stocked in the organization or readily available from outside sources. A collaborative process was used to develop the list (unless determined by regulation or an agency outside the organization). There is a process established for when medications are not available that includes a notification to prescribers and suggested substitutions. The system supports definition and maintenance of the active formulary appropriate to a hospital’s approved list of medications, and the definition of medications appropriate to be stocked and available in defined inventory locations including patient care areas, surgery and the ED. In a patient specific context, this information is available through the patient’s medication profile. Pharmacist order verification provides the point of approval for use of non-formulary items as such orders have to be processed through the pharmacist. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. For RxStation for medication dispensing, the provider is able to define the list of medications appropriate for dispensing from a particular device as a part of the device set up. Millennium’s inventory management capabilities available through ProCure support ongoing inventory management for the device on a consistent basis with any other inventory location. Restocking is driven by reorder levels which determine if a medication item should show up on a reorder list. The reorder level can be set for a particular low stock level and indicated as critical if at a very low level which can generate a page alert or other notification. For narcotics, RxStation helps enable a true perpetual inventory management approach in that the device requires a true blind count back to be performed so the inventory level is maintained at all times. It should be noted that RxStation dispensing devices have not yet been used in the ED or in surgical areas. (Note: Availability of the RxStation dispensing cabinet outside the United States is currently limited, although it may expand in the future.) MMU.2.1 – There is a method for overseeing the organization’s medication list and medication use. There is a method for overseeing medication use in the organization. Medications are protected from loss or theft throughout the organization. Health care practitioner involved in ordering, dispensing, administering, and monitoring processes are involved in monitoring and maintaining the medication list. Decisions to add or remove medications from the list are guided by criteria. There is a process or mechanism to monitor patient response to medications newly added to the list. The list is reviewed at least annually based on safety and efficacy information. The system supports the management of an active formulary as mentioned above. See responses to more specific questions below for information on how medications may be handled and managed throughout both the medication management life cycle as well as the inventory management lifecycle. MMU.2.2 – The organization can readily obtain medications not stocked or normally available to the organization or for times when the pharmacy is closed. There is a process to obtain and procure required medications not stocked or normally available to the organization. (Also see GLD.3.2.1, ME 1) There is a process to obtain medications at times the pharmacy is closed or medication supply locked. (Also see GLD.3.2.1, ME 2) Staff understand the processes. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. The system supports use of a template to order non-formulary items. There is not an active routing of these orders to a pharmacy director for approval, but there is reporting on such orders that have been written which could be the basis for approval. Non-formulary items can be added to the drug file for ordering purposes, and to enable clinical checking. This is a more complete way to address this than the use of a template. The system can support the use of automated cabinets to route dispensing requests to when the main pharmacy is closed – the alternate cabinet appropriate to the patient’s location may be specified. Most sites allow a nurse to document against the medication order administration task but to leave the order unverified until a pharmacist can review the order. At other sites, a nurse may have to hand document what is taken out of supply after hours (if a 7x24 pharmacy not available) for later review and for support of online documentation or the nurse may call an available on line resource or reach an on call pharmacist to dial in and review the medication order. The ability to chart prior to verification is an all or none proposition in the system currently. The system does not differentiate between emergency situations and nonemergency situations for this purpose. Enhancement work may be considered to differentiate these situations by drug and by order priority. MMU.3 – Medications are properly and safely stored. Medications are stored under conditions suitable for product stability. The RxStation device is designed to assure the stability of the medication. In the future, this capability will be improved by the support of dedicated (to the device) refrigerated storage with a remote control lock. (Note: Availability of the RxStation dispensing cabinet outside the United States is currently limited, although it may expand in the future.) Controlled substances are accurately accounted for according to applicable law and regulation. Prospectively, RxStation helps prevent diversion by assuring only authorized users gain access to controlled substances, and for items subject to controlled substance controls, once the cabinet has been accessed, only one storage area opens at a time. Millennium provides the context of what is being dispensed through a transaction that passes to the device and the device makes available what is being requested and nothing more – there also is a less secure area that allows for access to non-controlled items that do not require higher levels of security. The system provides reporting retrospectively on the controlled substance dispensing activity to help support monitoring of controlled substances. For anesthesia related medications, signatures are required for any controlled substance wastage in the anesthesia documentation. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. Medications and chemicals used to prepare medications are accurately labeled with contents, expiration dates, and warnings. All medication storage areas are periodically inspected according to hospital policy to ensure medications are stored properly. Organization policy defines how medications brought in by the patient are identified and stored. If a site uses the system’s inventory management capabilities, that can be used to track inventory levels for approved medications that are on the formulary. The system will rely on the fact that an approved formulary has been defined for use, and that medications stocked in dispensing devices would only be from the approved formulary. The system also supports the definition of virtual inventory locations to help track investigational use medications that have a 0 inventory level in the ProCure supply chain management solution. From an RxStation (Cerner’s medication storage cabinet solution) perspective, the hospital determines what medications are to be stored in the device, and the device is set up as an inventory location. The device enables separate physical storage and access for controlled and non-controlled substances, and separate authorization is required to enter either storage area. The device is physically designed to be tamper proof. For RxStation, all inventory management events with the device that involve stocking, removal, refill and return of medications are logged and tracked with the responsible user ID, date and time of the event noted within Millennium just as with any other pharmacy inventory location. MMU.3.1 – Organization policy supports appropriate storage of medications and applicable nutrition products. Organization policy defines how appropriate nutrition products are stored. Organization policy defines how radioactive, investigational and similar medications are stored. Organization policy defines how sample medications are stored and controlled. Organization policy defines how emergency medications are stored and maintained. The system assumes that whatever stock selection is determined to be an emergency medication (also considering age appropriate requirements) will be maintained in appropriate locations where needed. RxStation has not been used in ED settings as of yet. RxStation use in the ED aside, the dispensing machines that Cerner has seen used most commonly in the ED are typically located in controlled and secured care areas. All storage is according to organization policy. . See above for MMU.3. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. MMU.3.2 – Emergency medications are available, monitored, and safe when stored out of the pharmacy. Emergency medications are available in the units they will be needed or readily accessible within the organization to meet emergency needs. (Also see GLD.3.2.1, ME 1 and MMU.2.2, ME 1) Emergency medications are protected from loss or theft. Emergency medications are monitored and replaced in a timely manner after use or when expired or damaged. See above for MMU.3.1. The system enables the tracking of quantity on hand for floor stocks and through interfacing with dispensing devices. The system will use this information to support generation of reorder/refill lists when required. The system would not be aware of the status of crash carts until returned to central inventory for replenishment. MMU.3.3 – The organization has a medication recall system. There is a medication recall system in place. Policies and procedures address any use of medications known to be expired or outdated. Policies and procedures address the destruction of medications known to be expired or outdated. Policies and procedures are implemented. See comment under MMU.3 for capabilities to track the lot number and expiration of medications from inventory through to dispensing – role of the system relative to recalled medications would be similar. The system can enable comparison of dispense events to administration events to determine the status of any dispensed medications of a type and specific lot number. Positive identification of patients receiving such medications can be based on the administration event. The system may help identify through reporting what patients have received a given drug as of a date – but do not track specific lots to know which patients received drugs out of a specific lot unless documented in an order comment. MMU.4 – Prescribing, ordering, and transcribing are guided by policies and procedures. Policies and procedures guide the safe prescribing, ordering, and transcribing of medications in the organization. (Also see COP.2.2, ME 1; AOP.3, ME 1; and International Patient Safety Goal 2, ME 1) Policies and procedures address actions related to illegible prescriptions and orders. There is a collaborative process to develop the policies and procedures. Relevant staff is trained in correct prescribing, ordering, and transcribing practices. Patient records contain a list of current medications taken prior to administration and this information is made available to the pharmacy and the patient’s care providers. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. The system plays a significant role in enabling the activities of the medication management process. The main capabilities are as follows: Ordering – The system enables required elements of a medication order to be required through the order formats used to support medication order entry. The system enables specification of frequency, dosage strength and route of administration with the placement of the medication order, and this information is available both to the pharmacist for dispensing activity and to the clinician administering the medication for confirmation. The system enables the use of “Tall Man” patterns of naming medication items for order entry selection which calls for the use of mixed case characters. The system can provide for order formats to capture all required elements for order entry in support of weight based pediatric dosing, and the dose calculator can help calculate a dosage into a finite standardized dose for a pediatric patient. Under normal circumstances, the system can enable provider notification of any contraindication for the medication at time of order against both known allergies and active medications. The system can maintain record of any such alerts, and this information is available to the clinician administering the medication for reference. Order Review – Unverified orders may be routed to an unverified order review only accessible by users identified to be in a pharmacist role. Orders will show in an unverified state on the patient’s medication administration record until reviewed. Sites can also elect to require the review to occur prior to a medication being documented as administered. As a part of the order review process, the system can enable dose range checking (which includes review of frequency), route/form checking for consistency, interactions and sensitivities (through Multum), and can also automate checking against documented patient conditions. The system enables orders placed through CPOE to have a halted status applied by a pharmacist to allow for the pharmacist to get clarification from a prescriber. MMU.4.1 – The organization defines the elements of a complete order or prescription and the types of orders that are acceptable for use. Acceptable medication orders or prescriptions are defined in policy(s) and at least elements a) through i) are addressed in the policy(s). [NOTE: The following section is from the intent statement.] Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. The elements addressed in the policy(s) include at least the following: a. The data necessary to accurately identify the patient. Millennium generally supports the use of two identifiers for purposes of patient identification for support of medication administration, blood product administration, drawing of samples for testing and for support of other significant clinician/patient interactions where patient identification is elemental. Millennium supports use of patient name, medical record number and financial number as the primary means. Other clinical demographic information may also help such as DOB. Patient identification information to support this requirement is customarily formatted for display on the banner bar in Powerchart. This information is available for inclusion in patient wrist bands that are bar coded for patient identification as well as for online reference. This is true both for direct support of traditional Millennium based capabilities as well as those provided in support of bedside or mobile computing such as through Cerner Bridge or through for positive patient identification for medication administration, specimen collection or blood product administration or through Care Mobile/Care Admin for point of care support. b. The elements of the order or prescription. The system enables required elements of a medication order to be required through the order formats used to support medication order entry. c. When generic or brand names are acceptable or required. The system enables the definition of the relationship between generic and brand name medication items so as to enable suggestion of substitutions or automatic ordering of the generic drug if appropriate in cases where a generic drug may be substituted for a brand name drug that may be more expensive. d. Whether or when indications for use are required on a PRN or other medication order. It may be something captured with the medication order. The system generally enables definition and/or entry of order requirements to address the above types of orders. These requirements can flex based on the order type. e. Special precautions or procedures for ordering drugs with look-alike or soundalike names. For medication ordering, the Tall Man capabilities referenced in the Millennium and NPSG Requirements white paper under NPSG 3C can help prevent errors for items defined in the Order Catalog. For RxStation, the hospital determines what medications are to be stored in the device, and the device enables separate physical storage and access for controlled and nonCerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. controlled substances. The device uses RFID technology to reduce the chance of loading errors and for the selection of the wrong medication. f. Actions to be taken when medication orders are incomplete, illegible, or unclear. g. The permitted additional types of orders such as emergency, standing, automatic stop, etc. order and any elements required in such orders. The system generally enables definition and/or entry of order requirements to address the above types of orders. These requirements can flex based on the order type. h. The use of verbal and telephone medications orders and the process to verify such orders. Verbal orders can be identified as a type of order when transcribed in the system by the receiving clinician or staff member. The system maintains an audit trail of each action taken with an order from its creation through its authentication and completion. The identity of the responsible user who originally transcribed the order, as well as of the identities of users subsequently involved with authentication, are recorded as a specific event in the action history for the order. The physician identified on the order as the ordering physician typically is the physician to whom the order is routed for signature. The attending physician also might have the signature task routed to them. The physician who has the order routed to them may elect to refuse to sign the order and have it routed to another responsible physician. The system supports password-based authentication of the user at the time of order authentication – and can use advanced authentication methods for purpose of authenticating the user at time of log in. The system can support time-out policies for the user session to mitigate the chance of an unauthorized user accessing verbal orders in order to modify them or take other actions while posing as the user. Verbal orders can be identified as a clinical data type to be monitored for the purpose of deficiency tracking and management within ProFile, both online and through reporting. The requirement for verbal order authentication is supported through a task assigned to the responsible physician (typically the ordering or attending physician), and ProFile can support the generation of a notification of overdue deficiencies to the responsible physician on-line or through other means (such as fax or mail). i. The types of orders that are weight based, such as for pediatric populations. The system can provide for order formats to capture all required elements for order entry in support of weight based pediatric dosing, and the dose calculator can help calculate a dosage into a finite standardized dose for a pediatric patient. Medication order or prescriptions are complete per organization policy. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. The system enables required elements of a medication order to be required through the order formats used to support medication order entry. MMU.4.2 – The organization identifies those qualified individuals permitted to prescribe or order medications. Only those permitted by the organization and by relevant licensure, laws and regulations prescribe or order medications. There is a process to place limits, when appropriate, on the prescribing or ordering practices of individuals. (Also see SQE.10, ME 1) The authorization right of who may place an order is determined procedurally. The system supports the definition of ordering privileges for particular medication items as a part of the set up of access rights of individuals as users who are identified to be in a physician role. Individuals permitted to prescribe and order medications are known to the pharmaceutical service or others who dispense medications The identity of the individuals placing orders for medications is captured through a user ID associated with the original order and with any physician order review (e.g., of verbal orders), and this is used to link to the display name of the physician which can include the credentials of the physician as a suffix. The pharmacist may review the prescriber’s identity based on this information when reviewing orders. MMU.4.3 – Medications prescribed and administered are written in the patient’s record. Medications prescribed or ordered are recorded for each patient. (Also see MCI.19.1, ME 4) Medication administration is recorded for each dose. Medication information is kept in the patient’s record or inserted into his or her record at discharge or transfer. Any orders placed within the system through CPOE are stored in the patient chart, which maintains all historical information and actions taken on the orders. The process of documenting the administrations can be accomplished any one of three ways within the system. The first is via the electronic medication administration record; in that pending medications are noted as well as previously administered medications. This creates a view that includes historical, present and future medication history for the patient. The second mechanism that can be utilized to document the administration of medications is a task list for a single patient, multiple-patients or the Patient Activity List (PAL). This tool enables the caregiver to see only those items that are due to be given at a particular time, along with any PRN (as needed) or continuous medications. Thirdly, the eMAR serves as the foundation for licensing Cerner’s PowerPOC solutions, a related but separate set of offerings that provide mobile access to the eMAR via either cart-based or handheld devices. Together this solution is designed to automate the documentation of medication administration and Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. other care activities, incorporating barcode verification of the “Five Rights”, data review and collection, and medical device integration at the patient bedside, promoting improved patient safety. MMU.5 – Medications are prepared and dispensed in a safe and clean environment. The system can support printing of mixing instructions for the label to direct the pharmacist on how much to draw up, how much to put in the bag, etc. In 2007.18, the system will support the concept of a codified mixing instructions rather than simply using free text to enable the pharmacist to have on line reference to help assure accurate preparation. Bar coding in 2007.19 will allow for validation of the physically selected drug against what the system is expecting to ensure the right medication is dispensed. Medications are prepared and dispensed in clean and safe areas with appropriate equipment and supplies. (Also see PCI.7, MEs 1 and 2) The system supports the definition of pre-built IV Sets in standard concentrations. The system does not currently play a role in preparing medications for dispensing as to packaging. The objective in the future for the dispensing device from Cerner will be to support single dose dispensing. There will both be occasions where the form is based on what the manufacturer directly provides and where a manual step of preparation is necessary to load the dispense device. Medications preparation and dispensing adhere to law, regulations, and professional standards of practice. Staff preparing sterile products are trained in aseptic techniques. The system enables medication order sets to be built according to local law and regulations, but does not have a role in the cleanliness of task related techniques. MMU.5.1 – Medication prescriptions or orders are reviewed for appropriateness. The organization defines the patient-specific information required for an effective review process. (Also see MCI.4, MEs 1 and 3) Each prescription or order is reviewed for appropriateness and includes elements a) through g) in the intent. Thus, each prescription or order is evaluated for appropriateness review. [NOTE: The following section is from the intent statement.] The process to review an order or prescription includes evaluation of: a. the appropriateness of the drug, dose, frequency, and route of administration; b. therapeutic duplication; c. real or potential allergies or sensitivities; d. real or potential interactions between the medication and other medications or food; Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. e. variation from organization criteria for use; f. patient’s weight and other physiological information; and g. other contradictions. Each prescription or order is reviewed for appropriateness prior to dispensing. There is a process to contact the individual who prescribed or ordered the medication when questions arise. Individuals permitted to review orders or prescriptions are judged competent to do so. Review is facilitated by a record (profile) for all patients receiving medications. Computer software, when used to cross-check drugs for drug/drug interactions and allergies, is periodically updated. The system supports a preference for pharmacy medication verification that can be set to prevent medication tasks from being charted on within PowerChart via the eMAR or the Patient Access List (PAL) until the medication order has been verified by a Pharmacist or authorized personnel. This preference can be set to make certain that pharmacy verification has occurred before the nurse can chart/document on any medication task(s), that such review is optional prior to charting or that it is not required. This preference is set for each medication item. When the medication is something that requires pharmacist review prior to dispensing, we do not generate any dispensing labels or documentation until the verification occurs. All orders eventually can require verification by the pharmacist – whether before or after the medication is actually given in recognition of the exception conditions. Anesthesia medications are defined not to require any prior verification to their use as they are under the control of the anesthesiologist or the nurse anesthetist. The system also provides the nurse review process through the PAL. As a part of the order review process, the system can enable dose range checking (which includes review of frequency), route/form checking for consistency, interactions and sensitivities (through Multum), and can also automate checking against documented patient conditions. MMU.5.2 – A system is used to dispense medication in the right dose to the right patient at the right time. There is a uniform medication dispensing and distribution system in the organization. Medications are appropriately labeled after preparation. Medications are dispensed in the most ready to administer form. The system supports timely dispensing. The system can enable the order being routed to the appropriate location or automated cabinet. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. PharmNet generates order specific label and can support generating routine automated fill reports indicating which non-floor stock medications need to be dispensed from the pharmacy. RxStation delivers a unified closed loop medication solution, automating every step of the process – from order and dispense to administration. As to ensuring only authorized individuals will be able to access the cabinet, authentication for access to the machine will be done through Millennium in terms of the ability to launch tasks that integrate to the use of the machine. The system assumes the medication is available from the dispensing source in ready to administer form (whether a dispensing device, as per provided by the manufacturer or as prepared by the pharmacy). The system supports accurate dispensing. As a part of the order review process, the system can enable dose range checking (which includes review of frequency), route/form checking for consistency, interactions and sensitivities (through Multum), and can also automate checking against documented patient conditions. MMU.6 – The organization identifies those qualified individuals permitted to administer medications. The organization identifies those individuals, by job description or the privileging process, authorized to administer medications. Only those permitted by the organization and by relevant licensure, laws, and regulations administer medications. There is a process to place limits, when appropriate, on the medication administration of individuals. (Also see SQE.13, MEs 1 and 2) The system restricts who can document administrations in the EMAR and who can document prior to verification. See Response to MMU.1.1 MMU.6.1 – Medication administration includes a process to verify the medication is correct based on the medication order. Medications are verified with the prescription or order. The dosage amount of the medication is verified with the prescription or order. The route of administration is verified with the prescription or order. Medications are administered on a timely basis. Medications are administered as prescribed and noted in the patient’s record. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. Unverified orders may be routed to an unverified order review only accessible by users identified to be in a pharmacist role. Orders will show in an unverified state on the patient’s medication administration record until reviewed. Sites can also elect to require the review to occur prior to a medication being documented as administered. Most sites allow a nurse to document against the medication order administration task but to leave the order unverified until a pharmacist can review the order. At other sites, a nurse may have to hand document what is taken out of supply after hours (if a 7x24 pharmacy not available) for later review and for support of online documentation or the nurse may call the Pyxis on line resource or reach an on call pharmacist to dial in and review the medication order. The ability to chart prior to verification is an all or none proposition in the system currently. The system does not differentiate between emergency situations and nonemergency situations for this purpose. Enhancement work may be considered to differentiate these situations by drug and by order priority. The system also provides the nurse review process through the PAL. MMU.6.2 – Policies and procedures govern medications brought into the organization for patient self-administration or as samples. Policies and procedures are implemented to govern patient self-administration of medications. Policies and procedures are implemented to govern the documentation and management of any medications brought into the organization for or by the patient. Policies and procedures are implemented to govern the availability and use of medication samples. The system supports the documentation of self-administered medications in the patient’s medication profile so they can be made available for medication reconciliation and interaction checking for subsequent medication orders. MMU.7 – Medication effects on patients are monitored Medication effects on patients are monitored, including adverse effects. (Also see AOP.2, ME 1) The monitoring process is collaborative. The organization has a policy that identifies those adverse effects that are to be recorded in the patient’s record and those that must be reported to the organization. (Also see QPS.6, ME 3) Adverse effects are documented in the patient’s record as required by policy. Adverse effects are reported in the time frame required by policy. The system can provide reference text available for clinicians and pharmacists to see information concerning possible patient responses, and appropriate procedures for monitoring. For patients, monitoring activities may be documented through capture of information on patient responses as a part of the medication administration documentation. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. For multiple dose prescriptions, as each dose is administered or at any time after administration for a single dose, this information may be captured. The system enables documentation of monitoring and assessment activities associated to medication administration. The system supports monitoring responses for PRN related events or at the orderable level, the system can support definition of tasks to monitor the effects of a medication on the patient such as a task for monitoring vital signs. Discern Expert rules may also be defined in setting up other monitoring conditions as may be required. PowerForms are typically used to document monitoring activities including those for first dose response. In the ED using FirstNet, no monitoring tasks are generated per se as may be the case in the inpatient setting. Monitoring is documented as it occurs. Lab values can be accessed from within PharmNet or for the direct patient care team through Powerchart via the flow sheet to make relevant lab results available for consideration during medication monitoring. Pain management responses can also be documented in the system for post operative monitoring while a patient is in recovery. MMU.7.1 – Medication errors are reported through a process and time frame defined by the organization. A medication error and near misses are defined. (Also see QPS.6, ME 4 and QPS.7, ME 1) Medication errors and near misses are reported in a timely manner using an established process. (Also see QPS.7, ME 2) The organization uses medication errors and near misses reporting information to improve medication use processes. (Also see QPS.7, ME 3) The system can enable candidate identification of potential events. The system can enable internal reporting. External reporting is usually handled through procedural means although may involve use of data extracted from the system if the system is used to record these events. PowerInsight captures data in the form of alerts fired, alerts overridden, pertaining to orders for medication that could result in a possible ADE. Cerner Corporation Confidential Information ©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
