CHPPC Section 19.3: MAR & Administration Views
Part 5: Data Entry & EHR Mastery (New Track)

Module 19: Meditech (Expanse) — Order Entry & Verification

19.3 MAR & Administration Views: The Pharmacist’s Lens on Bedside Safety

Translating your verification work to the point of care and mastering the critical administration parameters that ensure safe medication delivery.

Your journey through the Meditech workflow has taken you from the strategic heights of the verification queue to the detailed mechanics of order entry. Now, we arrive at the final, crucial destination of every order you verify: the electronic Medication Administration Record, or eMAR. This is the digital interface where your clinically approved orders become tangible, administered doses at the patient’s bedside. To a novice, the eMAR is simply a place where nurses document their actions. To an expert hospital pharmacist, it is a rich, dynamic source of clinical data, a critical feedback loop on therapeutic efficacy, and the final battleground for preventing administration errors. This masterclass will teach you to see the eMAR through the eyes of a clinical guardian. You will learn not just what the eMAR is, but how to read it, how to influence it, and how to use the information it contains to make powerful, proactive clinical interventions.

Retail Pharmacist Analogy: The Will-Call Bin vs. The Interactive Delivery App

In your retail practice, the will-call bin is the final point of handoff. You prepare a prescription, place it in a bag with the patient’s name, and put it on the shelf. The process is largely static. You trust that the patient will pick it up and take it correctly. You might attach a note—”Pharmacist must counsel”—but you have no real-time visibility into what happens after it leaves your hands.

The inpatient eMAR is like a sophisticated, interactive delivery app for every single dose of medication. When you verify an order, you’re not just putting a bag on a shelf; you are creating a “delivery task” with a precise due time. The app (the eMAR) tracks the “delivery driver” (the nurse) in real-time. You can see exactly when they “pick up the package” (scan the medication), when they “arrive at the destination” (scan the patient), and when they “complete the delivery” (document the administration). More importantly, you can embed special delivery instructions directly into the task—”Must obtain signature (co-signer),” “Verify recipient’s ID (check vitals before giving),” “Deliver between 9:00 AM and 9:05 AM only.” Your influence and your safety checks extend all the way to the patient’s front door.

19.3.1 Deconstructing the Meditech eMAR: A Pharmacist’s Guide to the Layout

The Meditech eMAR, found within the Patient Care System (PCS) module, is a chronological, grid-based view of a patient’s medication regimen. Your ability to quickly scan this grid and extract clinically relevant information is a fundamental skill. While layouts can be customized, they are all built upon a common set of data columns.

19.3.1.1 Simulated Meditech eMAR View

Imagine a grid with medication names on the left and time slots across the top. Each cell in the grid represents a potential administration event.

Medication Dose/Route Frequency 08:00 12:00 16:00 20:00 PRN Reason / Comments
Lisinopril 10 mg PO DAILY GIVEN Hold if SBP < 100
Ceftriaxone 1 g IVPB DAILY DUE Infuse over 30 minutes
Furosemide 40 mg IV BID GIVEN HELD Held per nursing, BP 88/50
Oxycodone 5 mg PO Q4H PRN GIVEN For Moderate Pain (4-7/10)

19.3.1.2 Masterclass: Reading the Administration History

The true clinical goldmine of the eMAR is the administration history. Clicking on any cell in the grid reveals the story behind that dose. This is your feedback loop, telling you what actually happened at the bedside.

Admin StatusWhat It MeansWhat It Tells the Pharmacist (Your Clinical Insight)
GIVEN The nurse scanned the patient, scanned the medication, and documented the administration at the specified time. Confirmation that the therapy is proceeding as planned. You can correlate this admin time with lab results or vital signs to assess efficacy.
HELD The nurse consciously decided not to give the dose and documented a reason. This is a critical signal. Why was it held? Was the patient’s blood pressure too low for the lisinopril? Was the patient nauseous and unable to take their oral meds? A pattern of held doses requires your immediate investigation and intervention.
REFUSED The patient declined to take the medication. This indicates a potential adherence issue or a problem with side effects. Is the patient refusing their potassium supplement because it tastes bad? Are they refusing their antidepressant because it makes them feel tired? This is an opportunity for you to provide patient counseling or recommend an alternative.
MISSED / NOT GIVEN The scheduled administration time passed without the dose being given, and no reason was documented. This is a potential safety event. Why was a critical antibiotic dose missed? Was the patient off the floor for a procedure? Was the drug not available in the ADC? This requires immediate follow-up with the nursing staff to ensure continuity of care.

19.3.2 Masterclass: Verifying & Influencing Critical Administration Parameters

Your job as a pharmacist doesn’t end with verifying the drug and the dose. You are also responsible for ensuring that the *instructions for administration* are safe, clear, and built directly into the order. These parameters, which you structure in the PHA module, directly translate to on-screen instructions for the nurse in the PCS eMAR. This is how you project your clinical expertise to the bedside.

19.3.2.1 Parameter 1: Rate of Administration for IV Medications

The speed at which an IV medication is infused is as critical as the dose itself. Pushing a drug too fast can lead to severe, life-threatening adverse reactions.

The Dangers of the IV Push

A nurse sees an order for “Potassium Chloride 20 mEq IV x 1.” Without a rate parameter, they might be tempted to administer it as a rapid IV Push. This can cause immediate, fatal cardiac arrhythmias. Similarly, a rapid push of vancomycin can cause profound hypotension and a pseudo-allergic reaction known as “Red Man Syndrome.” You are the gatekeeper responsible for preventing this.

Your Meditech Workflow:

  1. When verifying an order for a rate-dependent drug, you must use the “Administration Instructions” or “Order Comments” field.
  2. You will enter a clear, unambiguous command that becomes a permanent part of the eMAR entry.

Order: Potassium Chloride 20 mEq in 100mL NS IVPB

Admin Instruction Field: “INFUSE OVER 1 HOUR. DO NOT EXCEED 20 mEq/hr.”

Order: Vancomycin 1.5 g in 250mL NS IVPB

Admin Instruction Field: “INFUSE OVER 90 MINUTES TO PREVENT RED MAN SYNDROME.”

This text will appear directly next to the medication on the nurse’s eMAR, serving as a just-in-time safety reminder at the point of administration.

19.3.2.2 Parameter 2: Drug-Food and Drug-Drug Timing

You know from your retail experience that many medications have critical timing requirements. Your role in the hospital is to build these requirements directly into the eMAR schedule.

Your Meditech Workflow:

This is often a two-part process: adjusting the schedule and adding a clarifying comment.

Scenario: A provider orders “Levothyroxine 100 mcg PO DAILY” and “Ferrous Sulfate 325 mg PO DAILY” for a new patient.

Your Intervention:

1. Edit the Schedules: You will access the administration schedule for each order. You will set the Levothyroxine schedule to “0600” and the Ferrous Sulfate schedule to “0800” or later.

2. Add Admin Instructions:

  Levothyroxine Comment: “ADMINISTER AT 0600 ON AN EMPTY STOMACH.”

  Ferrous Sulfate Comment: “ADMINISTER WITH FOOD. SEPARATE FROM LEVOTHYROXINE BY AT LEAST 2 HOURS.”

This ensures that even if the nursing staff changes, the specific scheduling requirements for optimal absorption and efficacy are hard-coded into the patient’s permanent record.

19.3.2.3 Parameter 3: The High-Alert Medication Co-Signature

For the highest-risk medications (e.g., IV insulin, heparin, chemotherapy, PCA doses), hospital policy requires an independent double-check by a second nurse before administration. Your verification action in the PHA module is often what triggers this requirement in the PCS eMAR.

How It Works: The Digital Co-Signature

When you build the medication in the Meditech dictionary, you can attach a “Co-Signature Required” flag to it. When an order for this drug is verified:

  1. The order appears on the eMAR with a prominent visual flag (e.g., an icon of two people).
  2. When the primary nurse scans the medication to administer it, the system will halt the process with a pop-up alert: “CO-SIGNATURE REQUIRED.”
  3. A second nurse must then come to the bedside, independently review the order on the screen and the physical product, and enter their own username and password to confirm their verification.
  4. Only after this digital co-signature is captured can the primary nurse complete the administration.

Your initial verification of a high-alert drug sets in motion a mandatory safety process at the bedside that you do not have to manually manage on a dose-by-dose basis.

19.3.3 The eMAR as a Proactive Clinical Monitoring Tool

An expert pharmacist does not just look at the eMAR to see what was given. They analyze the *patterns* of administration to make powerful clinical judgments. The eMAR is your primary source for assessing adherence, therapeutic efficacy, and the need for regimen optimization.

19.3.3.1 Masterclass: Using PRN Usage to Optimize Pain Management

Scenario: You are reviewing the chart of a post-operative patient. You see the following active pain medication orders:

  • Morphine 10mg ER PO Q12H (Scheduled)
  • Oxycodone 5mg PO Q4H PRN for Moderate Pain (5-7/10)

Your Action: You navigate to the eMAR and review the administration history for the past 24 hours for the PRN oxycodone. You see the following entries:

GIVEN @ 02:15 (Pain 7/10)
GIVEN @ 06:30 (Pain 6/10)
GIVEN @ 10:45 (Pain 7/10)
GIVEN @ 15:00 (Pain 6/10)
GIVEN @ 19:20 (Pain 7/10)
GIVEN @ 23:30 (Pain 6/10)

Your Clinical Insight: The patient is requiring their “as needed” breakthrough medication every 4 hours, around the clock. This is a clear, data-driven indication that their scheduled, long-acting basal pain regimen (the Morphine ER) is inadequate. The patient is experiencing predictable, recurring breakthrough pain.

Your Intervention: You now have the objective data to make an evidence-based recommendation to the provider. You would write a pharmacist note or contact the provider directly: “Patient has required 6 doses of PRN oxycodone in the past 24 hours for moderate-severe pain. This suggests the current scheduled pain regimen is insufficient. Recommend increasing the Morphine ER dose to 15mg PO Q12H to provide better basal pain control and reduce reliance on PRN medication.”