Hemodialysis Medications

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Order Entry

Electronic MAR

For patient safety reasons, separate procedures have been created for medications commonly administered to hemodialysis patients, in order to standardize the way these medications are ordered and scheduled in the EPR. As a standard, HEMOdialysis Related medication procedures are ordered with a process if condition and will schedule at 0730 for pre hemodialysis orders and 1500 for during or post hemodialysis orders. Note that the dose will be rescheduled to an appropriate time once the actual hemodialysis treatment time is confirmed.

Order Entry

1. From within the Order Entry screen, click on the Search tab. Type the name of the medication that you would like to order and click the Search button. These procedures include the text ‘HEMOdialysis related’ in the procedure name. For example, when using Search to look for ceFAZolin, you will find multiple options, including ceFAZolin (intermittent HEMOdialysis related). ceFAZolin (intermittent HEMOdialysis Related) is the procedure that you would select if you wished to order Cefazolin for a hemodialysis patient. Select the appropriate medication from the list and click the Add Order button to proceed with the order.

2. On the Typical Order screen, select the appropriate order and then click the Add Order button. In this example, we are ordering ceFAZolin (intermittent HEMOdialysis related) 2 g IV-Int every Monday, Wednesday, and Friday to be administered DURING hemodialysis.

3. Additional frequency options have been added to the medication frequency screen (under Order Profile), and these allow for scheduling doses relative to the schedule of the patient’s hemodialysis treatment. (Note that the ‘qHD’ frequency is no longer available in EPR as this has been replaced with the hemodialysis customized frequencies.)

4. As mentioned, hemodialysis medication procedures are conditional and include a “process if” statement that specifies when the medication should be administered relative to the schedule of the patient’s hemodialysis treatment.

Note: If a ‘now’ dose is required, it should be ordered separately, without a “process if” condition.

Also, HEMOdialysis related procedures have not been built for antibiotics dosed every 12 hours, every 8 hours, and more frequently. These have been excluded since the practice of adjusting administration time relative to hemodialysis for these medications varies between practice areas. These should be ordered through regular medication procedures.

5. The order will now appear in the Order Preview area of the screen. Review your order, and then click the Order Summary and Accept Order buttons.

Electronic MAR

1. Hemodialysis medications will appear on the eMAR at standard times so that nursing staff will be able to easily locate them:

• 0730 for PRE hemodialysis procedures;

• 1500 for DURING and POST hemodialysis procedures.

2. Nurses may reschedule the doses as appropriate according to the "process if" condition once the actual hemodialysis treatment time is confirmed.

3. Hemodialysis units are out of scope for MOE/MAR. Therefore if medications are to be administered during the hemodialysis treatment, the Transfer Report should be printed just prior to the patient going to the hemodialysis unit. The hemodialysis nurse will document the medications given on the Report and the inpatient unit nurse will use this to reconcile the electronic MAR. The printed Transfer Report with documented administration information will become part of the patient’s permanent paper chart.

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