Chart: New Med Log (MAR)

The new Med Log/MAR updates the visuals of the existing MAR, making it easier to navigate, review, and administer medications. It introduces the Bulk Actions feature and expands functionality within the Med Log tab, where users can complete standardized assessments like vitals, observe or administer prescribed medications (including PRN as needed), and, if enabled, adjust inventory directly from the same page.

Super Admins can create templates for comments, refusal reasons, and first responses (efficacy and adverse reaction) under Settings > Med Log.

Note: The name of this tab is customizable under Patient Processes so this tab may have a different name in your instance.  

To enable the new med log, set the the toggle to New Med Log. 

Integrated Assessments

Required Roles: Integrated assessments can only be logged by super admins, record admins, doctors, nurses, and techs.

From the Med Log, you can document key integrated assessments including:

Vitals Glucose Height and Weight Orthostatic Vitals

CIWA-AR CIWA-B COWs

1. To expand the window, click the down arrow.
2. To add a new measurement or assessment, click on the + icon and choose the desired assessment from the list.
3. Measurements and assessments will only be added to the section when they are filled out.
4. You can view reading history by clicking on the clock icon.

5. In the history window, you can see the readings for the entry. The exact appearance will differ based on the measurement or assessment.  

   

   1. Click on this icon to open the trend analysis chart to view readings over time.
   2. If you have many readings, use this slider to view different dates and times.
   3. Click the Close button to close the window.
   4. Click the Show Deleted button to show any deleted readings.
   5. Click the Print button to print the vitals history.

Not seeing an assessment in your environment? Check out this article for help setting up integrated assessments. 

Med Log Navigation and Actions

Let's break down the Med Log options.

1. Med Pass: Click on this text to navigate to the Med Pass tab on the Dashboard.
2. Search: Click on this field and begin typing the name, quantity, form, or administration method of a medication (start with three letters or more). The results will filter as you type. Click the x to clear the search.
3. Sort By: Sort medications by name (alphabetically from a-z), newest first (medication orders will appear in order of creation from newest to oldest), oldest first (medications will appear in order of creation from oldest to newest), and by due (medications will appear in order of date and time they are due to be administered). By default, medications order with due and past due at the top.
    

4. Filter By: Click on the filter icon to filter by the following options. Click Reset to clear the selection, Apply to apply the selection, and click on the x to close the Filter By options. 

   

   • Medications Scheduled: View all medications scheduled for dispensation
   • PRN Medications: View all PRN medications
   • Action Orders: View all action orders
   • Due: View all PRNs, action orders, and medications that are due for completion
   • Past Due: View all PRNs, action orders, and medications that are past due for completion

5. Days to Display: By default, the Med Log displays medications scheduled for today. Doctors and providers can automatically adjust the date range of the Med Log tab from 1 to 30 days. 

   

   • All other users will need to have View Multi-Day MAR added to their user profiles under the Features section in Manage Users.
6. Add Patient Signature: Once a medication has been administered, this option will be available. Click on the Add Patient Signature text to open the signature box. Have the patient sign, and click Submit. 

7. Bulk Action: You can administer multiple medications at the same time by clicking the checkboxes on each dose, and then clicking the Bulk Action button, which will be interactable and blue once you select at least one item. 

   

   • You can also click Select Due to select all medications, action orders, and PRNs that are currently due, and update them in bulk.
8. The schedule allows you to view medications by time, and based on the sorting and filtering selections chosen above. 
9. Today: Clicking on Today returns you to the current date after you have navigated forward or backward using the calendar icon or arrows.
10. Date/Calendar: Click on the forward or back arrows to view the previous or next day, or click on the calendar icon to select a date to view.
11. Current Time: Click Current Time to return to the current time after using the forward or backward arrows to view different times in the current day.
12. Forward and back arrows: Click on the forward and back arrows to view timeslots in the past or future.
13. Select Due: Select all medications currently due for administration and administer them like a bulk action.

Orders

Medications, action orders, and PRNs all appear in the next section, and function similarly.

Additionally, if a controlled substance appears anywhere in the Med Log, it will be accompanied by a Controlled Substance label.

• C-I: These drugs have a high potential for abuse. No medical uses for treatment.
• C-II: High potential for abuse. Has accepted medical use for treatment.
• C-III: Less abuse potential than C-II drugs. Accepted medical use.
• C-IV: Less abuse potential than C-III drugs. Accepted medical use.
• C-V: Less abuse potential than C-IV drugs. Accepted medical use.

Observed vs. Administered

Medication and Action orders will be marked as Observed or Administered based on your user role and the Observation Status setting which can be set in your Instance settings and/or individual locations (in a master instance).

• Mark MARs observed/administered based on roles: Doctors and nurses will document as administered, and techs will document as observed.
• Mark all MARs as observed: All roles will document as observed.
• Mark all MARs as administered: All roles will appear as administered.
• Mark all MARs as patient-reported: All roles will document as patient reported to [user documenting].

Order Details

The order details box contains information about the medication, action, or PRN order. It also contains any instructions, warnings, justifications, and information about the user who created the order.

• Hover over the ordered by icon to see the name of the user who created the order, along with the date and time of creation.
  
• eRx orders created in Rcopia or in the EMR will appear with the eRx tag.
• Clicking on the order name will open the Order Details page.
• If a warning is associated with the order, it will also appear in this box.

• Orders with variable dosages will display the options in the instructions and in the order cards.

Order Cards

The medication, action order, and PRN cards appear as dictated by the instructions (for example, if an order instructed that a medication be administered every two hours, a card would appear in the medication row every two hours).

Click the header below to expand.

• This table indicates all order card types and the icons you may find on them.

  Upcoming: The medication, action order, or PRN action/dose is scheduled for a future time.
  Due: The medication, action order, or PRN action/dose is scheduled for the current time.
  Past Due: The medication, action order, or PRN action/dose was scheduled for a time in the past, and is overdue. The card will include how many hours past due the scheduled time is.
  Completed: The medication, action order, or PRN action/dose has been completed. The card will include the name of the user who completed the card, together with the date and time.
  Variable Dose Options: If an order has a variable dose, the options will appear on the card. When the order is administered, the dose selected will appear on the card.
  Pending Nurse Review: The medication, action order, or PRN action/dose is pending review by a nurse and cannot be interacted with until the review is completed in the Doctor's Orders tab.
  Refused: The medication, action order, or PRN action/dose was refused. The documented reason will appear on the card.
  Not Administered: The medication, action order, or PRN action/dose was not administered. The documented reason will appear in the card.
  Not Given: The medication has been charted as administered/observed but was not in fact given.
  Max Daily Dose Reached: If an order has a maximum daily dose, once that max has been reached, you will not be able to administer additional doses until the next day.
  Hover over each icon for more information about the following: Medication marked as administered but not given Notes added during administration Patient signature captured First response First response, documentation captured

Completing Orders

Let's review the steps for administering or observing medications, action orders, and PRNs in the Med Log, both one at a time and in bulk.

Important: Once medication/action is logged, it cannot be changed or deleted (not even by a Super Admin).

Completing Single Orders

Find the desired dose/log on the list of Medications, PRNs, or Action Orders, either by scrolling, using the filters, or by searching for it. 

Note: Orders pending nurse review cannot be interacted with until reviewed from the Doctor's Orders tab or the Nurse Review tab of the Dashboard. Check out this article for more information on completing nurse reviews.

1. Double-click on the order card you want to open.

   To mark a medication as taken, select the Yes option, add comments if needed, and click Save Status.
   To mark a medication as not taken, click No, add a comment (required) then clicking Save Status.
   To mark a medication as refused, click the Refused checkbox, and type the reason into the Refusal Reason field, or select an option from the drop-down. (This field is required.)
   If the order has a variable dose, you will be able to choose which quantity is being administered here. Complete everything else as usual, and save. The order card will display the quantity chosen.
   If there is no inventory present for a medication, you will not be able to administer it until the inventory is replenished. For instructions on refilling patient inventory, check out this article. For instructions on refilling facility inventory, click here.
   If the medication had a refill included when added to the patient's inventory, there will be a replenish option. When you click on it, you will be taken to the patient's inventory.

2. Once the medication has been completed, you can add a note, mark the medication as not given, or document a first response.
   1. To add a note, click + Add Note, type your text into the Add Note field, then click Save.
   2. To add a not given note, click + Note Not Given, type the reason, and save.
   3. To add a first response (if configured in your Instance or Location Settings) click the + First Response button then type the relevant information into the Efficacy and Adverse Reaction fields, then click Save.
      

PRN Orders 

PRN Medications can be administered early if the PRN Medication Administration Interval setting is configured for the instance or location.

1. To begin, locate the desired PRN, and click on the box.
2. By default, the time is set to the present time, but can be changed. Add a comment, if needed, and click Save Status.
   
3. The order card will appear as normal on the administered line, and an additional line will appear, indicating when the PRN was last administered, and when the next dose is available.

Completing Bulk Actions

If you need to complete a large number of orders at the same time, you can use the bulk options.

1. To begin, click on the boxes of each card you want to complete in bulk, or click the Select Due button. Then click Bulk Action.

2. The green header indicates that the medication is marked as administered, red means it is marked as not administered or refused, the orange header indicates that the medication administration is overdue, and the gray header indicates an upcoming medication. You can choose to select all orders as administered or not, or you can answer individually for each option.  

   

   • The comment box is optional when a medication is marked as taken and required when the medication is marked as not taken. When the medication is marked as Refused, the Refusal Reason field appears and must be completed. You can either free-type in the field or click on the arrows to access a drop-down list of potential reasons.
3. Click Save Status when you have completed reporting on medications.
4. You can have the patient bulk sign by clicking on Add Patient Signature.