EPIC

kbrn2002, ADN, RN · Sep 20, 2020

I don't use EPIC specifically but I might be able to help with question 2 if EPIC is programmed like the software I am familiar with. What has happened to me in that situation is when a new order is entered the time of administration automatically defaults to the standard med administration time which in my case was 0800. That time will be triggered for the same day the med order is entered in the computer no matter what time the orders are entered unless the person entering the order manually changes the time or day to start the med.

I came from a LTC setting where multiple orders were entered for a new resident or one returning from the hospital as soon as the faxed orders were received so it was usually before the resident was physically in the building and entering multiple orders is pretty time consuming so skipping the part where the order start time/day can be adjusted was pretty common so entire med passes would show up as several hours late in the EMAR despite the person not even being there yet.

The scenario where this would happen that's sounds more like what you are experiencing was on provider rounding days when new orders are received and entered well after the morning med pass was completed but the default time triggered the order to show up as due the same day so the med appeared to be way overdue even though the order hadn't actually been written yet.

Fortunately there was a drop down in the med administration tab where if "order not administered" was chosen and none of the default check boxes applied to the situation there was a box that says "other" where a manual entry could be made. Then we typed in "resident not admitted yet." Or "order not received yet" if it's the situation of a new order being received and entered later in the day which was common on provider rounding days.

It's my guess that something like this is happening when orders appear out of nowhere hours after they were supposedly due. About the only thing you can do if you are not 100% sure why the order is showing up later in the day on the EMAR is contact the ordering provider and ask if they want the med started now and if so do they want to change the default administration time going forward.

I'm guessing your question 1 answer is most likely the order was entered and the software didn't have time yet to sync the order with pyxis

Sour Lemon · Sep 20, 2020

10 hours ago, jag nurse said:

I have an issue with EPIC that I never had with Cerner and would grateful for any help.

1. I pull all currently due meds from the Pyxis and many times, once I get to the patient's room, and pull up their MAR, there is a medication due that wasn't shown on the Pyxis, so I make multiple trips back and forth.

2. Sometimes, a medication will show up as being late several hours after it said it was due, and I KNOW it wasn't on the MAR, when I gave out that hour's medications.

Note: Our med room is not large enough to bring our computers in to double-check MAR to Pyxis. A second option that I see is to write down every single med for every single patient--something I feel would be very time-consuming and wouldn't help situation #2.

If anyone else has experienced this or knows of a fix, I'd be happy to hear it! (I have asked other nurses--one said it happens all the time to her as well, and she doesn't have any solutions.)

Thanks.

EPIC is different everywhere depending on how it's been set up. You should check with your tech people. Individual set-ups vary, as well. My MAR confuses everyone, because apparently my set-up is unusual.

Do you have a work list that shows medications that are due? Is that also inaccurate?

LibraNurse27, BSN, RN · Sep 20, 2020

That sounds dangerous! And frustrating/waste of time. We use epic and I have never had a problem with this. Our omnicell defaults to showing only meds that are due at the time we log in, but we can click active orders and it will show all the meds, or PRN, etc. I think the provider does have to specify the start date/time of the med though, because I've seen meds starting at weird times, like a stat med with due time tomorrow, or a med they already got to be given an hr later when really the provider meant next dose tomorrow.

I would definitely clarify with providers if meds are showing up due suddenly and are showing late when they weren't in the MAR at the time it now says they were due. And definitely talk to IT because that sounds like a potential safety issue. Good luck!

Advanced Practice Columnist / Guide · Sep 21, 2020

On 9/20/2020 at 8:37 AM, LibraNurse27 said:

That sounds dangerous! And frustrating/waste of time. We use epic and I have never had a problem with this. Our omnicell defaults to showing only meds that are due at the time we log in, but we can click active orders and it will show all the meds, or PRN, etc. I think the provider does have to specify the start date/time of the med though, because I've seen meds starting at weird times, like a stat med with due time tomorrow, or a med they already got to be given an hr later when really the provider meant next dose tomorrow.

I would definitely clarify with providers if meds are showing up due suddenly and are showing late when they weren't in the MAR at the time it now says they were due. And definitely talk to IT because that sounds like a potential safety issue. Good luck!

If your Epic is similar to ours, providers just have to pay attention to the order details before hitting sign. Epic order entry gives us the option to give the medication now, as scheduled (based on standardized facility times), or start tomorrow. If a medication is ordered as a one time dose it will default to now, otherwise meds written on a schedule will default to "as scheduled".

LibraNurse27, BSN, RN · Sep 21, 2020

57 minutes ago, juan de la cruz said:

If your Epic is similar to ours, providers just have to pay attention to the order details before hitting sign. Epic order entry gives us the option to give the medication now, as scheduled (based on standardized facility times), or start tomorrow. If a medication is ordered as a one time dose it will default to now, otherwise meds written on a schedule will default to "as scheduled".

Yes, I think they often forget to make the start time "now". Good thing we're there to remind them I guess LOL

Advanced Practice Columnist / Guide · Sep 22, 2020

2 hours ago, LibraNurse27 said:

Yes, I think they often forget to make the start time "now". Good thing we're there to remind them I guess LOL

Right, it's always fun when a resident comes in yelling about why a medication ordered wasn't given yet and the nurse says "you ordered it for tomorrow", LOL.

mmc51264, BSN, MSN, RN · Sep 22, 2020

We have an Omnicell for meds (Pyxis is for supplies and fluids). There is a program called Anywhere RN that I can pre-select all my meds, but if it is a med that is not stocked, one that is in the pt specific bins (these are usually meds that are odd doses or something that can't be stocked like Lantus). The ones that aren't stocked I have to manually pull.

I have gotten used to looking for the non-stocked meds, but there is always something that gets forgotten, or a PRN that they want, or a new order. I try to medicate all and then go back to give the others.

There's always gonna be something. Something to drink, a new gown, use the bathroom, salt, a fork. It never seems to end. ?

Dragonfly.RN · Sep 23, 2020

Honestly.. I just write them down. I get report; do a round on the patients, assess and vitals, then take a few minutes to go over the chart and go over the meds. I make a quick jot of what meds I am giving and what prns they have. I use my own short hand, it honestly doesn't take me too long. I do another round on the patients, ask what I can bring them with their meds; a snack, water, prns. I've seen other nurses print out the MAR rather than write it down, and a couple others just write down how many meds are due.

jag nurse, RN · Sep 23, 2020

On 9/20/2020 at 9:06 AM, Sour Lemon said:

EPIC is different everywhere depending on how it's been set up. You should check with your tech people. Individual set-ups vary, as well. My MAR confuses everyone, because apparently my set-up is unusual.

Do you have a work list that shows medications that are due? Is that also inaccurate?

It's a "Report", which is just a simpler form, in the MAR, that tells me when they're due, so they can both be inaccurate.

Thanks, all, for your replies! I'll bet part of it is what some of you mentioned--new orders placed that populate to a default time. Again, thanks.

BSN-to-MSN, ADN, BSN, RN · Sep 24, 2020

On 9/20/2020 at 10:06 AM, Sour Lemon said:

EPIC is different everywhere depending on how it's been set up. You should check with your tech people. Individual set-ups vary, as well. My MAR confuses everyone, because apparently my set-up is unusual.

Do you have a work list that shows medications that are due? Is that also inaccurate?

Yeah, print the work list and take it to pyxis no need to write down.

JKL33 · Sep 24, 2020

On 9/21/2020 at 9:33 PM, juan de la cruz said:

Right, it's always fun when a resident comes in yelling about why a medication ordered wasn't given yet and the nurse says "you ordered it for tomorrow", LOL.

It's definitely a good lesson for people to learn about investigating before reacting.

But too bad for patient care, since these problems are numerous and are not limited to any particular dumb or inept provider.

Personally I can't help feeling sorry for them. I find the ordering mechanisms tedious and I haven't seen one yet that isn't. This is a bit of a different issue than what we're talking about here, but in one iteration of a popular EMR (at a particular place) for example, the ED providers had a pick list that included all medications used throughout the system; plenty of them not even available at whatever site they happened to be working.

All of that is just unnecessary and it is unsafe and frankly it has made me angry and embarrassed when nurses go off about how dumb or wrong or [whatever] the providers are based on this ridiculousness.

I suppose I'm going into a rant, but some of the medication-related functioning of the EMR is just flat out maddening. There are the long-standing quirks that only get changed by a process that goes at a snail's pace (e.g. have to order X med Y way because blah, blah, blah and "pharmacy is aware".....for 6 months....in other words quit calling them about it), and then there are the fun/new little problems discovered practically daily.