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Meditech Rule of the Week

This rule checks to see if another order is entered for the same PRN reason. It is not foolproof because if free text PRN reasons are utilized duplicated may not be caught. It is especially helpful for orders relating to a specific pain scale, when a duplicate order should be avoided for the same pain parameter.

This rule was directed at CPOE users, who may not be as focused on making sure the patient’s allergies are documented in the system before ordering medications. It will require the user to enter patient’s allergies before proceeding – a bypass allergy needs to be available for situations where the patient is unable to state allergies or they cannot be obtained. But the act of adding the “unable to state” as an allergy can be monitored for abuse by users and actions can be taken.

This is an eMAR rule designed at the request of NICU nurses. They wanted to know how many total doses of a drug were given, and if levels had been taken, when they were drawn and what the results were before giving the next dose. This rule is able to provide all the information as part of the eMAR administration process, streamlining the workflow for NICU nurses.

eMAR rule – multiple medications may contain acetaminophen as a component. Acetaminophen dosage should be monitored and limited in any 24 hour period. By utilizing a query on the drug CDS that contains the amount of acetaminophen in the specific drug, a rule can be built to calculate the accumulative acetaminophen dose a patient has received in the past 24 hours. It can be set to start displaying the accumulated total to the nurse administering the medication after a trigger amount is reached and to prevent administration once a particular total dose is reached.

This rule is designed to be a backup to alert fatigue that ignores a duplicate generic warning, for drugs that may have a narrow therapeutic index and could be harmful to the patient if administered too close together. In this case it was designed to prevent double ordering/dosing of low molecular weight heparin that was being ordered post op. Errors had occurred where multiple orders had been processed in post op patients and medication errors related to multiple doses administered from different orders. This can be an error rule to stop the order from being entered. Error type rules should be used cautiously as they stop the user, so you need to make sure that is what you want 100% of the time.

Facilities with multiple sites and inventories often struggle with accuracy of associating the correct inventory with each order. By checking the patient location and associated inventory, the system can warn the user when the incorrect inventory is entered on an order. This can save much time since an incorrect inventory can have multiple ramifications in the medication management process.

This a great rule for facilities with pediatrics. It will calculate and display the calculated mg/kg dose for the dose entered. This is a great safety check for the user. As an added feature the calculated value can be added to the label comments so the nurse administering the dose will have the value. It also serves as an audit trail for the order.

This rule can be used in three modes – as a Pharmacy Rule, as an eMar rule for nursing, and as an OE rule for CPOE. It displays a black box warning text and can include links to additional information.

This is a creatinine clearance rule that works in conjunction with queries added to the drug customer defined screen. It will display the current estimated creatinine clearance, along with 2 previous values so the user can see any trend. It displays the appropriate suggested dosage modification for the patient as well as all the supporting values that were used to calculate the creatinine clearance. The user can easily validate if all the data appears appropriate and if there is a trend that needs to be considered.