Booking-in/Receiving Medication into eMAR (UK)

The Receive Orders Screen

Using Receive Orders

Validation Results

Matched

New Order Review

Potential Duplicate

Order Details Mismatch

Custom Cycle Review

Care Home To Schedule (CHTS)

Quantities

Alert Medication

Body Map Required

Receive Orders allows users to book-in or receive medication into eMAR.

The Validation feature checks and validates current orders on the Medication Profile against new orders in Receive Orders.

The Receive Orders Screen

1. “Search in results” – allows you to search for a resident or a medication.
2. Show - “All”, “Un-Validated”, ‘Matched’ & ‘Un-Matched’
3. Order Type – MAR (Medication Administration Record) or TAR (Treatment/Topical Administration Record).
4. Unit filter – allows you to filter the results to specific units within the home.
5. “Validate” button - checks and validates current orders on the Medication Profile against new orders in Receive Orders
6. “Receive” button – Used to receive orders into the system.
7. “Reject” button – Used to reject orders that are no longer required. 

Using Receive Orders

1. Work on ONE RESIDENT AT A TIME. Use the “Search in results” box to search for your resident.
2. Click the blue “Validate” button.

The system will check and validate:

1. Medication name/ingredient
2. Administration time(s)
3. Administration dose amount
4. If the order is a Custom Cycle (i.e. not taken every day)
5. Order type – MAR or TAR

The system will then display one of the following in the Validation Results column:

• Matched (green)
• New Order – Review (amber)
• Potential Duplicate (amber)
• Order Details Mismatch (amber)
• Custom Cycle Review (amber)

Amber results require the user to check and confirm the order before it can be received.

Green results can be received.

REMEMBER TO CHECK THAT THE PHYSICAL STOCK MATCHES THE DETAILS IN RECEIVE ORDERS.

Validation Results

Matched

The new order in Receive Orders matches a current order in the resident’s Medication Profile. This is a refill of an existing medication order.

Users can click on the green “Matched” button to review both the current order and the new order Details, if required. 

New Order Review

This is a new medication for that resident. It does not match an ingredient or medication name on the resident’s Medication Profile. The user must satisfy themselves that the new medication is expected, for example, that the prescriber has not recently discontinued it.

Click on the amber “New Order” button to review and check the schedule.

1. If you are expecting this new medication for this resident and are happy with the scheduled time(s), select “Confirm New Order”. 

The order will be marked as “Reviewed” and the Validation Result will update to “New Order – Confirmed” in green:

2. If it has been scheduled incorrectly, click “Edit Order” to update the schedule. Update the order as required and click “Save All Edits”

A warning message will be displayed – “You are about to make changes to a medication Order. Click OK to continue or Cancel to return to the previous screen.” – Click “OK”

3. If you need to review the Medication Profile, use the ‘Check Medication Profile’ button to view their current medication details. 

To maintain a robust audit trail, you may be required to enter the reason why you made the change(s). You may also require a colleague to enter their username and password to act as a witness to the changes made:

Click “Confirm” 

Click  “Confirm New Order” The order will be marked as “Reviewed” and the Validation Result will update to “New Order – Confirmed” in green, as in step 1.

Users should follow their Home or Group policy in relation to communicating this change to their pharmacy, as they will not be notified automatically.

Potential Duplicate

The order in Receive Orders has been identified as a potential duplicate of an order that is currently active on that resident’s Medication Profile. The user must click on the amber “Potential Duplicate” button to resolve the potential duplication. The user will have three options to resolve this:

1. Keep Both – this can be used if a resident is prescribed more than one strength or form of the same medication, for example if they have both Warfarin 1mg and Warfarin 3mg tablets.
2. Replace Existing Order – this will replace the existing order (at the top of the screen) with the new order (at the bottom of the screen).

Users must enter the date and time that they want the existing order to stop on (this is the last date and time that order will appear on the MAR), and the date and time that they want the new order to start from (this is the date and time the new order will appear on the MAR). Once you have entered the Existing Order Stop date and time, the New Order Start date will automatically populate with the next day, this can be changed if required. 

The current on-hand figure is displayed and can be changed here.

Users can write off the stock from the old order by entering this figure in the Destroyed/Returned box. This will update the On Hand figure displayed.

1. Edit Order – the user can edit the frequency, time, give dose amount, start date and add a PRN dose. Users can also add or delete additional doses and choose if the medication will appear on the MAR or the TAR. Users are required to enter a reason for this in to the system. They may be required to obtain a witness signature for this change (setting dependent). Users should follow their Home or Group policy in relation to communicating this change to your pharmacy as they will not be notified automatically

Order Details Mismatch

The order in Receive Orders has been checked against the resident’s current Medication Profile. A current order exists for the same medication/ingredient, but there is a difference between the new order and the current order, for example a change in the time the medication is to be given. The system will highlight this difference in red. The user must click on the amber “Order Details Mismatch” button to resolve the difference. The existing/current order is displayed at the top of the screen. The new order is displayed at the bottom of the screen. The user will have three options to resolve:

1. Start New Schedule – the current order schedule will be replaced by the new order schedule.
2. Copy Existing Schedule to New – the current order details will be kept. Users are required to enter a reason for this in to the system. They may be required to obtain a witness signature for this change (setting dependent). Users must communicate this to their pharmacy.
3. Edit Order - the user can edit the frequency, time, give dose amount, start date and add a PRN dose. Users can also add or delete additional doses and choose if the medication will appear on the MAR or the TAR. Users are required to enter a reason for this in to the system. They may be required to obtain a witness signature for this change (setting dependent). Users should follow their Home or Group policy in relation to communicating this change to your local pharmacy.

Custom Cycle Review

Custom Cycle meds are those that are not on a daily repeating schedule, for example, an Alendronic Acid taken once a week, or a Buprenorphine patch changed every three days.  

Click on the amber “Custom Cycle Review” button to review and confirm how this medication has been scheduled.

• If the item is a new medication, follow the “New Order – Review” process above.
• If the item is a refill of an existing medication and the schedule matches the existing medication's schedule, click ”Reviewed”
• If the item is a refill of an existing order, but it has been scheduled differently, follow the “Order Details Mismatch” process above. 

Care Home To Schedule (CHTS)

Some pharmacies are able to send custom cycle medications and medications that have ambiguous instructions as “Care Home To Schedule” (CHTS). This allows the home to add the appropriate schedule.

Quantities

Check that the amount received in the Quantity column matches the physical amount received. 

Follow your Home/Group policies in relation to opening boxes to check quantities. 

For drops, change the quantity received from millilitres to drops. For example, a 10ml bottle of eye drops is in Receive Orders. If the instructions are ONE drop into BOTH eyes TWICE a DAY, for 28 days, the number of drops would be 112 drops. In this example, change the quantity received from 10 (mls) to 112 (drops). Please see the Eye, Nose and Ear Drop Ready Reckoner to help with this.

For topicals such as creams, etc, you have two options: 

1. Record by volume – book in the volume received, e.g. millilitres or grams. When stock counts are performed, estimate the amount remaining and adjust the on-hand figure accordingly. E.g. a 500g tub of cream is received, you receive 500(g). When stock counting, you estimate the amount remaining, if the tub is approximately half full you would adjust the on-hand to 250(g).

1. Record by application – change the amount received to the maximum number of applications you will give from that container, e.g. a cream that is applied twice a day and is in a screw-top tub will be kept for a maximum of 28 days before it is disposed of for infection control purposes, therefore the maximum number of applications from that container would be 56.

Ensure that everyone in the home is following the same method of recording topicals. 

Alert Medication

Selecting the “Alert Medication” tick box will designate the medication as a High Alert Medication for that resident. This means the system will require a witness signature at the point of administration.

Note that the system automatically requires witness signatures for all Controlled Drugs, regardless of this setting.

Body Map Required

Selecting the “Body Map Required” tick box will make a body map entry mandatory at the point of administration.