Q. How do you see what medications have been given?
Medical staff would view this on the MAR Summary.
Medications due up to 48 hours in advance can be viewed.
Q. How do I write a script if the patient has gone home but e.g. lab sensitivities return suggesting a different antibiotic?
- Can write a script without needing a hospital encounter
- External outpatient PBS scripts can be issued from specific locations
- Internal discharge/outpatient scripts can be issued from any normal PowerChart printer
Q. How do you write up medication chart orders before the patient is admitted (e.g. Botox, infusions for MDU)?
Select the "future order" option when prescribing and place the order on the waitlist encounter
or create a service department encounter.
When patient arrives, the medication order is "activated" to appear on the MAR for administration. Pharmacy can see future orders for dispensing via a report.
Q. Are fluids ordered per bag or as an ongoing order?
Up to six bags can be ordered. Once the prescribed bags have been used the nurse will see an alert to initiate review. If less than 6 bags were originally ordered, the order can be modified to increase the number of bags. After 6 have been used, the order can be cancelled and copied to start again.
Q. Sometimes when placing an order at other hospitals the times don't do what I expect - why does this happen?
There are 2 types of frequency:
- interval frequencies default to the nearest hour (e.g. 24 hourly, 12 hourly, 8 hourly)
- scheduled frequencies have specific default times (e.g. daily, BD, TDS) and if ordering even a minute after the default time (e.g. 08:01), the system will schedule the next dose for the next default time (e.g. 12:00, 20:00 or 08:00 the next day).
- Default settings can be adjusted or changed (e.g. choose STAT, change the default times manually, reschedule doses)
https://learning.schn.health.nsw.gov.au/medication-frequencies
https://learning.schn.health.nsw.gov.au/medication-frequencies-list
https://learning.schn.health.nsw.gov.au/reschedule-all-doses-medication
Q. How do I prescribe a medication if I can't find it in the order catalogue?
Search for "unlisted" and enter the drug name manually
Q. Does the system allow dose calculations for safe weights (e.g. lean body weight)?
Yes. Growth Chart Weight and Dosing Weight for medication calculations are recorded separately in the system and can be set differently if circumstances require. The dose calculator also allows individual adjustments for medications (e.g. lean body weight, percentage dose adjustments, dose rounding, dose capping)
Q. Is Bear Cottage on eMM? How do we write charts for outpatients who will be admitted there?
Yes - instructions can be found on Learning.Kids
Q. If PBS prescriptions are only for outpatients, how do we do authority prescriptions for inpatients?
Under the PBS reform agreement, NSW is not permitted to do PBS prescribing for inpatients, so this is not supported within eMM. Handwritten prescription pads will not be removed completely as they are required for downtime situations.
Q. If I have a patient with an medication intolerance/contraindicated condition how do I alert other clinicians that the medication should not be ordered for them?
The allergy documentation on PowerChart can handle more than just allergic reactions, you can also use this tool to record Side Effects, Toxicity, Intolerance, Sensitivity, Adverse effects.
Medication classes and individual medications can be documented, and the database also alerts for cross-reactivity (e.g. penicillins and cephalosporins).
If the patient has a condition where a medication is contraindicated (e.g. opioids for sleep apnoea), document the affected medication, select the appropriate reaction type and symptoms, then include any other relevant detail in the comment. All this information will display in the allergy interaction checking window when a medication is prescribed that will trigger the alert.
Q. How does the system handle overweight patients and maximum doses?
- Weights can be adjusted within the dose calculator for specific medications - see quickstart for more information
- Dosing weight can vary from the measured growth chart weight to allow for safer dosing, you can document why you are deviating from the measured weight for dosing - see Memory FAQ page for weight info
- Dose capping has been applied to the maximum adult dose wherever possible (e.g. paracetamol dose cap is 1g for all patients)
- Order sentence filtering has been used when different indications require different maximum dose caps. As long as a weight is recorded, the appropriate dose/dose calculation will display.
Q. How do I order "continuous" medications that aren't infusions, e.g. nasogastric electrolytes or nebulisers?
These orders do not appear in the continuous infusions section of the MAR because you must have a "diluent" (e.g. sodium chloride 0.9%, neat infusion) and an appropriate parenteral route (e.g. IV continuous infusion, Subcutaneous infusion) to appear in that section.
For non-parenteral "continuous" orders, these will appear in the regular scheduled section of the MAR, and you need to order an appropriate frequency that the nurses can use to document. e.g. for 100mL of hydralyte NG per hour, the dose is 100mL and the frequency is hourly. Add instructions for the nurse that this is to be given continuously.
Q. How do I order blood products?
On the blood component order sheet paper form (SCN130310). Nurses can record blood product volumes on the online fluid balance chart, but blood orders are not currently available on the MAR.
Q. Why don't the mg/kg order sentences calculate when I document a home medication?
The medication history documentation tool uses the same medications database as the prescription orders, so order sentences with mg/kg that are functional for discharge/outpatient prescriptions are also available when documenting medications taken at home even though the calculator is not available in that tool.
The medication history tool assumes you don't need to do a mg/kg dose calculation, because you should be documenting what the patient actually takes (a specific dose).
For the majority of medications, if you document the number of mL or tablets/capsules etc. the patient is taking, the admission reconciliation conversion process will auto-convert that to the correct dose in strength (preferred dose expression for paediatrics), using information from the Cerner MULTUM medication database. Not all medications in our catalogue have come from MULTUM however, such as SAS medications or formulations manufactured in our local hospital pharmacy. For those medications you may need to enter some details manually.
Q. How can a nurse tell if I have placed a new order (if I haven't told them directly?)
eMM does not replace direct communication between clinicians so if you need a medication to be given urgently or otherwise outside of regular medication rounds you should still tell the nurses directly (e.g. phone call) even if prescribing from a location off the ward.
There is a feature in the system that can alert the nurses if changes have been made when reviewing the CareCompass task list (available for nurses only). An orange box will appear around the patients' name, and any new orders placed since the last time a nurse opened the patients' chart will be displayed in a window when the orange ! icon is clicked