Medical Administration Record

feature

(Jboyd13) #21

There are some things to consider in the model:

  • Drug-Drug Interactions - this would be meds in the MAR, Rx’d, and the patient’s med list

  • Allergies/intolerances - would need to connect to the food and medication allergy list

  • Listing next scheduled dose

  • Ensure that scheduled meds are separate from PRN meds

  • Signature for person administering all drugs. 2nd signature or witness only required for certain types of drugs

  • Calculate administration rates for IV, Central Line, Intra-arterial drugs

  • For routes of administration (ROA), will need a check to make sure the right route is selected. (This is a sophisticated feature.) For example, if the doctor ordered the medication to be given orally and the nurse has an IV medication. The system would alert the nurse they selected the wrong route.

  • ROAs - (some that I remember, but we can look up to make sure all are covered)

    • Oral (PO), Sublingual (SL), buccal, Inhaled, ET Tube
    • Nasal
    • PEG/G-tube, PEJ/J-tube,
    • Intradermal (ID), Transdermal, Intramuscular (IM), Intravenous (IV)
    • Central line - PICC, CL
    • Intra-arterial
    • Rectal (PR)
    • Intravaginal
    • Otic (ear)
    • Ophthalmic (eye)
  • When it comes to route and if it is IV make sure they person has an IV and the user can specify which IV the medication is being administered. There may be IV incompatibilities you need to be aware of and alert the user about (I don’t remember if we look these up or if the newer EHRs consider that. I haven’t worked in a hospital in awhile).

  • Assessments before and after administration, e.g.:
    *Tie pain assessments to pain meds.
    *Tie heart rate assessments to certain BP meds.
    *Tie BP assessments to BP meds.

    • Temperature after meds given for fevers or where body temperature is relevant

Labs for meds that require levels to be monitored for therapeutic or toxicity levels.

Robert, would there be separate modules for special administrations such Blood, FFP, High Risk meds (e.g. heparin), anti-epileptics, etc.

This may not be true for international hospitals but some have dispensing machines and the EHR MAR is tied to those dispensing machines to confirm meds dispensed match meds being administered. This would be a nice to have if a facility needed it.

That’s all I can think of right now. I hope it helps.


(Robert Down, BSN, RN) #22

Wow, thanks @jboyd13! You definitely took it way further than our initial look.

A typical workflow involves scanning the medication into the EHR just before Administration. I believe this ties a particular vial of medication or pill to the patient. As for the dispensing mechanism, we’d need a way to emit data from OpenEMR to that server (likely FHIR or HL7)

There’s probably more to it than this, but what a great start.


(André Millet) #23

may I contact Medscape team in order to negotiate access to their API ?


(Robert Down, BSN, RN) #24

That may be better coming from a project admin. I can reach out to them.


(Robert Down, BSN, RN) #25

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