2.8 Self Administration of Medication Feature of function For MISC drugs only First dose must be checked and given by nurse Patient is fit for self administration of drug In Drug Admin by Patient After admin first dose of drug, long-hold the admin record
2.8 Self Administration of Medication Choose ‘Self-admin’ Icon indicate Self-admin function activated Self-admin record will be marked after due time To cancel Self-admin, long-hold timeslot and choose ‘Cancel Self-admin’ Will disappear if cancel Self admin
2.9 Checking of Corporate IP Prescribing History Enquiry > Corporate IP Prescribing History Enquiry Intra-hospital transfer Discharge Select the hospital and episode
2.10 Checking of IP Prescribing History Enquiry > IP Prescribing History IP Prescribing History is shown Choosing either ‘Drug Admin Enquiry’ or ‘IP Prescribing History’
Chapter 3 - Handling of Medication CONTENT 3.1 Workflow for Handling Verbal Order in IPMOE 3.2 Workflow for Obtaining Medication from Nightcabinet 3.3 Workflow for Handling of Non-KH Formulary Items in IPMOE 3.4 Workflow for Handling Self-Financed Item (SFI) 3.5 Workflow for Handling of Brought-in Medication 3.6 Workflow for Handling of Pending Prescription for Clarification in IPMOE 3.7 Workflow for Handling Ultra-Urgent Item
3.1 Workflow for Handling Verbal Order in IPMOE Verbal Order of drug should only be accepted by Enrolled or Registered Nurse who must immediately record the drug in IPMOE and select the corresponding doctor. Doctor is required to verify patient’s drug allergy status upon making the Verbal Order. Following doctor’s instruction, nurse selects the corresponding order by using functional tab [Verbal Order] under IPMOE. Before save with the selected drug and the corresponding doctor, Verbal Order must be read back to the doctor for verification and nurse should confirm the followings with the doctor: 1. Check Doctor’s Code 2. Patient’s identity (at least 2 identifies) 3. Patient’s drug allergy status 4. Drug name 5. Dosage or strength 6. Dosage form 7. Frequency 8. Route of administration Nurse administers the drug under IPMOE system. The Verbal Order will be confirmed by corresponding doctor upon his/ her log on CMS within 24 hours. Ensure the right doctor was chosen before save prescription in IPMOE. If wrong doctor was chosen, please log-in CMS, chose ‘Admin’ ‘Print CMS Request Form’ print ‘CMS request/ report/problem form’ fill in the form by ward and sign the form by Department Head send to HAHO IT
3.2 Workflow for Obtaining Medication from Nightcabinet Doctor Prescribes medication in IPMOE during non-Pharmacy service hours Nurse checks the availability of medication in Night Cabinet. If not available, contact Pharmacist from contact list for stock arrangement 1. Nurse Print 1 copy of eMAR* (Paper MAR in case of downtime) 2. Circle for the required item on eMARs* Nurse Obtains medication from Night Cabinet and leave the eMAR* in the cupboard Nurse administers the medication via IPMOE to the Patient
3.3 Workflow for Handling of Non-KH Formulary Items in IPMOE Doctor prescribes non-KH formulary items in IPMOE Drugs cannot be ordered in IPMOE Doctor contacts Pharmacy to check the formulary status and stock availability Some non-drug Item Code is available Item Code is not formulary item but locked available* codes have Pharmacy releases item Doctor prescribes via already been code, inform doctor “Free text” Pharmacy released, doctor to prescribe through prescribes as IPMOE arranges stock and informs nurse once usual stock is available Doctor fills in “Adhoc Request of Non-KH formulary Item” form for request of non-KH formulary items Nurse faxes the completed form to Pharmacy Pharmacy verifies prescription and Pharmacy releases item code supplies medication to ward and informs doctor to Nurse administers medication to patient prescribe through IPMOE *For free text order, when item code is available and patient is still in hospital
3.4 Workflow for Handling Self-Financed Item (SFI) Doctor prescribes the medication as SFI Is patient’s own stock enough? Yes NO Doctor prescribes the 1. Doctor fills in Part A of In-patient medication as SFI select SFI(IP-SFI) form “Continue with own stock” 2. Nurse sends IP-SFI form to during prescribing Pharmacy via fax 3. Pharmacy calculates the required cost and faxes the invoice to ward 4. Patient/patient’s carer: ▪ Hands in invoice and original IP-SFI form to shroff to settle payment ▪ Brings invoice, original IP-SFI form and hospital receipt to Pharmacy for dispensing ▪ Collects SFI from Pharmacy and provides the SFI for ward to administer during inpatient stay Nurse administers medication to patient after Rx vetted by pharmacy [Mark the balance of quantity in “Remark” using “Amend” function ] Note: 1. Ward should initiate the purchase if it is a newly prescribed SFI or if patient does not bring his own med or insufficient; Pharmacy will not send reminder to ward for the purchase 2. Pharmacy will make one-off dispensing according to the duration requested by doctor 3. The whole process should be repeated for subsequent request of SFI drug
3.5 Workflow for Handling of Brought-in Medication Patient brings in own medication Doctor prescribes patient own medication in IPMOE Is the medication available in KH Formulary? Yes NO 1. Doctor prescribes as 1. Doctor prescribes as Free Text formulary items in IPMOE Entry if no alternative available ( “Continue with own stock” is 2. Pharmacy verifies default) prescription and dispenses 2. Pharmacy verifies prescription 3. Nurse administers 3. Nurse administers patient’s medication to patient (Return Own meds to own medication [Mark the patients and Remind patient balance of quantity in “Remark” not to take his/her own drug) using “Amend” function ]
3.6 Workflow for handling of Pending Prescription for Clarification in IPMOE Prescription Requires Clarification Pharmacy send “Pending Reason” to doctor via system Pharmacy contact prescribing doctor or most appropriate doctor to clarify the problem Follow up action required Issue settled Pharmacy faxes “Pending Order Note” (eMAR with the involved item marked) to ward and notify nurse by phone Prescription is confirmed, modified or ended by doctor Pharmacy resumes order, verify and dispense medication to ward
3.7 Workflow for Handling of Ultra-Urgent Item e.g. In Life- threatening situation or when patient is in Procedure Room Doctor prescribes item in IPMOE and inform nurse Nurse marks item “Urgent” in administration module and call pharmacy Pharmacy notes patient’s HN, Name and item requested and read back to confirm Pharmacy verifies and dispenses item immediately (use specially assigned basket for easier identification) Collected by ward staff after ~30 mins Types of Ultra-urgent / Urgent Medication Definition Communicate Drug Estimated with Pharmacy Delivery Duration Ward staff ~30 minutes Immediate Life- Ward calls Ultra-urgent threatening Pharmacy By regular The next medication delivery round situation (Delivery round delivery STAT By prescription No need is approx. (by Doctor’s + if necessary every 2 hrs) prescription) Urgent (by nurse) STAT + Urgent
Chapter 4 - Patient transfer CONTENT 4.1 Workflow for Patient Transfer (Inter – From Non-IPMOE Hospital) 4.2 Workflow for Patient Transfer (Inter – From IPMOE Hospital) 4.3 Workflow for Patient Transfer (Intra – From Non-IPMOE Ward) 4.4 Workflow for Patient Transfer (Intra – From IPMOE Ward) 4.5a Workflow for Patient Transfer to Procedure Room in Department of Respiratory Medicine 4.5b. Workflow for Patient Transfer to Procedure Room in Department of Psychiatry
Parent Hospital4.1 Workflow for Inter-hospital Patient Transfer (Non-IPMOE Hospital) From Non-IPMOE Hospital Nurse : ▪ Prepare for transfer patient to receiving hospital ▪ File the LATEST Paper MAR in the patient’s medical record Patient Transfer To IPMOE Hospital To Non-IPMOE Hospital (KH) Receiving Hospital Doctor: Nurse : ▪ Check drug prescriptions in ▪ Follow current practice Parent Hospital Paper MAR and of their hospital in prescribe medication in IPMOE handling the Paper MAR Nurse: ▪ Check drug prescriptions in IPMOE against Paper MAR ▪ Review and set time schedule if necessary for drug administration in IPMOE ▪ Administer medication to patient in IPMOE ▪ Check drug prescriptions in Parent Hospital Paper MAR and prescribed medication in IPMOE
4.2 Workflow for Inter-hospital Patient Transfer From IPMOE Hospital Parent Hospital Nurse: (IPMOE Hospital) ▪ Prepare for transfer patient to receiving ward ▪ Print the LATEST eMAR for current episode of admission upon transfer: Log on CMS “Clinical” “Drug Admin by Patient” Select the patient Click on “Print MAR” ▪ File eMAR in the patient’s medical record Patient Transfer To IPMOE Hospital To Non-IPMOE Hospital Receiving Hospital Doctor: Nurse : ▪ Check detail drug profiles from ▪ Follow current practice “Corporate IP Prescribing History” of their hospital in ▪ Copy and repeat previous IPMOE handling the Paper MAR drug profile if required ▪ Prescribe or change drugs if required Nurse: ▪ Check detail drug profiles from “Corporate IP Prescribing History” ▪ Set AOM schedule ▪ Administer drug in IPMOE
Parent Ward4.3 Workflow for Intra-hospital Patient Transfer (Non-IPMOE Ward) From Non-IPMOE Ward Nurse : ▪ Prepare for transfer patient to receiving ward ▪ File the LATEST Paper MAR in the patient’s medical record Patient Transfer To IPMOE Ward To Non-IPMOE Ward Receiving Ward Doctor: Nurse : ▪ Check medication order of ▪ Follow current practice Paper MAR and prescribe in handling the Paper medication in IPMOE MAR Nurse: ▪ Check drug prescriptions in IPMOE against Paper MAR ▪ Review and set time schedule if necessary for drug administration in IPMOE ▪ Stamp “To IPMOE” on each page of Paper MAR and file in corresponding patient’s medical record ▪ Administer medication to patient in IPMOE
4.4 Workflow for Intra-hospital Patient Transfer From IPMOE Ward Nurse : ▪ Prepare for transfer patient to receiving ward To IPMOE Ward To Non-IPMOE Ward Parent Ward Nurse : Nurse : (IPMOE Ward) ▪ No need to print ▪ Print the LATEST eMAR for current episode eMAR if patient is of admission upon transfer: in current episode Log on CMS “Clinical” “Drug Admin by of admission (under same Patient” Select the patient Click on hospital number) “Print MAR” ▪ File eMAR in the patient’s medical record Patient Transfer To IPMOE WardReceiving Ward To Non-IPMOE Ward Nurse : Doctor : ▪ Review the Drug ▪ Prescribe medication on Paper MAR Profile in IPMOE after and check medication order of Paper transfer and amend MAR against eMAR and refer to “IP the schedule if it is Prescribing History Enquiry” for detail needed and refer if necessary to “IP Prescribing History Enquiry” for Nurse: detail ▪ Check medication order of Paper MAR against eMAR and refer to “IP Prescribing History Enquiry” for detail if necessary ▪ Set up time schedule for drug administration on Paper MAR ▪ File eMAR in corresponding patient’s medical record ▪ Send Paper MAR to Pharmacy for drug supply as usual
4.5a Workflow for Patient Transfer to Procedure Room in Department of Respiratory Medicine – Pulmonary Function Lab and Bronchoscopy Room Parent Ward Pulmonary Function Lab Bronchoscopy Room Before procedure Before procedure Doctor Nurse ▪ Prescribe drugs in Paper MAR ▪ Prepare a new sheet of Paper Nurse ▪ Fax Paper MAR to Pharmacy MAR ▪ Withhold drugs via IPMOE if ▪ Withhold drugs via IPMOE if required required ▪ Print eMAR and attach eMAR ▪ Print eMAR and attach eMAR to medical record before to medical record before leaving ward leaving the ward Patient Transfer Procedure Room Pulmonary Function Lab Bronchoscopy Room Nurse Doctor ▪ Check the name on eMAR ▪ Prescribe drug on Paper MAR Nurse against patient’s hospital ▪ Check the name on eMAR bracelet upon arrival at the Pulmonary Function Lab against patient’s hospital ▪ Paper MAR should be signed bracelet upon arrival at the after procedure and attached Bronchoscopy Room to patient’s medical record ▪ Paper MAR should be before transfer patient back signed after procedure and to parent ward attached to patient’s medical ▪ Fax Paper MAR to Pharmacy if record before transfer the medication is withheld patient back to parent ward Patient Transfer Parent Ward Nurse in Parent Ward ▪ For Post Bronchoscopy, fax Paper MAR to Pharmacy
Parent Ward4.5b Workflow for Patient Transfer to Procedure Room in Department of Psychiatry – Procedure Room Electroconvulsive Therapy Room Parent Ward Before procedure Doctor / Nurse : ▪ Prescribe and administer drugs via IPMOE if required ▪ Withhold drugs via IPMOE if required ▪ Print eMAR and attach eMAR to medical record before leaving the ward Patient Transfer Upon arrival Electroconvulsive Therapy Room Nurse : ▪ Check the name on eMAR against patient’s hospital bracelet upon arrival at Procedure Room Electroconvulsive Therapy Room Doctor (Anaesthetist): ▪ Document drugs given intraoperatively in treatment & anaesthetic records Nurse : ▪ Put treatment & anaesthetic records to patient’s medical record when transfer patient back to original ward Patient Transfer Nurse : ▪ When patient is back, check the treatment & anaesthetic records ▪ Monitor patient’s condition
Chapter 5 - Offline CMS Backup CONTENT 5.1 Pairing Ward for Offline CMS Backup 5.2 Workflow of printing Offline MAR 5.23 Downtime Offline MAR printing procedure
5.1 Paring Ward for Offline CMS Backup Dept. Affected Ward Pairing Ward 2A1 2A2 R&E 2A2 2A1 2B1 2B2 RM&E 2B2 2B1 Psy 3A1 3A2 3A2 3A1 3B1 3B2 3B2 3B1 4A1 4A2 4A2 4A1 4B1 4B2 4B2 4B1 5A1 5A2 5A2 5A1 5B1 5B2 5B2 5B1 3D 3E 3E 3D 4D 4E 4E 4D 5D 5E 5E 5D 6D 6E 6E 6D 7D 7E 7E 7D 8D 8E 8E 8D 9D 9E 9E 9D 10D 10E 10E 10D IJ2 KL3 KL3 IJ2
5.2 Workflow of printing Offline MAR When contingency plan is triggered Printing of Offline MAR is needed Get Offline MAR Printing login ID & password from the designated locked cupboard Print Offline MAR from chosen CMS workstation using Offline MAR Printing login ID & password* The login ID and password will be valid for one episode only. ▪ Keep the used login ID & password until a new set of login ID & password is obtained from IT Department ▪ Replace the new set of login ID & password, sealed, in designated locked cupboard
5.3 Downtime Offline MAR printing procedure A shortcut for printing IPMOE offline MAR was created at the Start Menu of designated CMS workstation Click “IPMOE” Login with the IPMOE offline MAR printing login ID and password: User Name: ipmoeuser Password: xxxxxx Select the correct ward code, press <Batch Printing> to print all the MARs on list OR Go to the patient’s offline MAR by clicking patient’s name Click Printer icon to print
Chapter 6 - Smart Tips CONTENT 6.1 How to print eMAR? 6.2 Quick Reference for AOM round in IPMOE 6.3a Hardware Features - Toughpad 6.3b Hardware Features - Scanner 6.3c Hardware Features - Printer
6.1 How to print eMAR? eMAR can be printed in case of: ▪ When transfer to non-IPMOE ward ▪ Before Scheduled / Unscheduled System downtime ▪ Get drug from Night Cabinet ▪ Before the patient is transfered to Procedure Room
6.2 Quick Reference for AOM round in IPMOE IPMOE Function Reason (Examples) 設定派藥時間 For no default AOM schedule drug order Verbal Order Verbal Order For urgent case only 不給藥 “Withhold Admin” For procedure or appointment/ Home Leave/ NPO “Omit” NPO/ Patient’s condition changed/ Refused by patient 再給藥 “Re-admin” Drug was contaminated/ “Defer” Patient condition changed 遲些給 “On-hold” “Retrospective” No Heparin block/ 記錄之前已給 ”Amend” Drug not available at moment 注解 / 改記錄 “Early given” “Late given” Patient is vomiting/ 早些給 “Self Admin” Patient was not available/ Refused by patient 遲些給 自己吃 Drugs given during procedure/ Drugs given by doctor Enter Remark/ Amend Record Fit the appointment or procedure/ Patient condition changed Back from home leave/ Diet resumed/ Drug was not available/ IV site was not available/ Post procedure or consultation Self-admin of MISC drug only 自携藥 Continue with Own Stock Private Drug/ Own stock medication 無藥 “Urgent Dispensing” For Unvetted item “Replenish” For Vetted item When you finish the drug round, please check Overdue list/ PRN drug/ STAT drug/ On-hold list/ Unschedule list/ PD Tab/ Clinical Dashboard
6.2 Quick Reference for AOM round in IPMOE How? Drug Admin by Patient Right click/ Long-hold order line Select “Amend Custom Schedule Rule” Amend timeslot Drug Admin by Patient Click “Verbal Order” at bottom Select drug & Dr. Name/ code Click “Save” Admin drug Drug Admin by Patient Click “Withhold Admin” at bottom Click “Withhold ALL Drug(s)” or “Withhold Individual drug” Enter Date, Time & Reason Drug Admin by Ward Select Patient Do NOT scan “Omit” drug label during admin Click Proceed Select “Omit” Enter Reason Drug Admin by Patient Right click/ Long-hold due/ overdue timeslot Select “Omit” Enter Reason Drug Admin by Ward/ Drug Admin by Patient Scan drug again in drug admin page Click “Re-admin” Enter Reason Drug Admin by Ward/ Drug Admin by Patient DO NOT scan “Defer” drug label during admin Click “Proceed” Select “Defer” Drug Admin by Ward Select patient Scan drug Click “Proceed” Click “Unlock” Click “On-hold” at bottom Print out “Onhold” label When patient is back Choose “On-hold list’ in Drug admin by ward Admin On-hold drug Scan “On-hold” label Drug Admin by Patient Right click/ Long hold time schedule Select “Retrospective” Enter admin date, time(or remarks) Drug Admin by Patient Right click/ Long hold time schedule Select“Amend” Enter Remarks *Not for the first dose Drug Admin by Early Given Enter *For overdue item ward/ Late Given Reason Admin the drug Drug Admin by Patient *After Admin 1st time by nurse Drug Admin by patient Right click/ Long-hold time schedule Select“Self-Admin” Doctor prescribes drug Click“Continue with Own Stock”in advanced tab Continue with own stock Drug Admin by Patient Right click/ Long-hold drug order line Click“Urgent Dispensing” Click “Replenish”
6.3a Hardware Features - Toughpad Toughpad Power Button Home Button A1 Button Turn on Printer/Scanner Shut Down/Reboot Turn on or Turn off the Daily reboot Scanner virtual keyboard Battery Status Green: Power On Orange: Charging Blinking Green: Sleep Red: < 10%
6.3b Hardware Features - Scanner Battery Power Level Indicators : Sufficient battery power remains : The battery power is partially depleted. Charge promptly : The battery power is almost fully depleted. Charge immediately : The battery power is fully depleted. Charge immediately or replace with fully charged battery cartridge Screen Indicators
6.3c Hardware Features - Printer Printer Battery Power Level Indicators Battery charging status descriptions are as follows Lamp Charge Status Charge Time Red Lamp On Charging 2.5 hours Green Lamp Blinking Green Lamp On Over 80% Charged Fully Charged Red Lamp Blinking Error Replace or Reinstall Battery Control Panel Power Button Turn On or Turn Off the printer by pressing this button for approximately 2 seconds Paper Feed Button Press this button to feed paper manually Battery Status Lamp (Blue or Red) 1. More blue lamps are lit, it indicated that the battery is more charged 2. If the red lamp is lit, the battery must be charged or replaced Error Lamp (Left-side) 1. Red lamp is lit: the paper cover is opened 2. Red lamp is blinking: the paper has been fully used or the print head is overhead 3. Red lamp continues to blink: serious problem which required to consult authorized service dealer Bluetooth Lamp (Green) If the printer is ready for wireless communication with any Bluetooth, the green lamp as well as the battery status lamp is turned on. In power save mode, only the Status lamp is lit
6.3c Hardware Features - Printer Paper Installation 1 Press the Open button to open the paper cover 2 Insert the paper as shown in the diagram 3 Take care to align the paper correctly 4 Pull the paper out as shown in the diagram 5 Tear off any excess paper in the direction of the side of the paper
Appendix Reminders The contents will be updated regularly, therefore, the printed copy may not be the most updated version. Please refer to KH IPMOE website for the most updated or confirmation if in doubt. Intranet site: http://kh.home/ipmoe/home.aspx Handbook: https://www3.ha.org.hk/kh/files/KH%20In-Patient%20 Medication%20Order%20Entry%20Hand%20Book.pdf How to access KH IPMOE Website and KCC IPMOE Portal? 2 1 3
Scan the QR Code to download the full version of IPMOE Handbook Version as 03/2020
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