On Tuesday, July 9, pharmacy charges will be moving from a charge on dispense (COD) model to a charge on administration model (COA).
On Tuesday, July 9, pharmacy charges will be moving from a charge on dispense (COD) model to a charge on administration model (COA).
The charge on administration model is possible due to the recent implementation of eMAR in our inpatient areas. As nurses scan medications for administration, the system records the administrations as charges. The COA model will lead to improved accuracy rates by ensuring that patients are not charged for medications until they actually receive them.
Outpatient and mixed use areas that are not live with eMAR will continue to work within the COD model until implementation of Epic@UNC at UNC Hospitals, UNC Faculty Physicians, Chatham Hospital, and UNC Physicians Network West in April 2014 (current models include pharmacy dispensing, Pyxis removal, CPA/CPM, or clinic charge vouchers).
Charting
Charting is essential to COA. This new model relies on the medication being scanned to generate the charge for the patient. This means that it is very important for eMAR documentation to be complete and accurate. If you administer a medication on an eMAR-live floor, an administration needs to be documented in the system. If there is a time of administration, but a medication is not given please remember to mark as “not administered.”
The goal is to have >97% charting compliance. If you have questions about how to chart a medication, contact the super user on your floor. Nursing and pharmacy leadership will be monitoring charting compliance and working closely together to ensure that we meet our goal.
PRN Floor Stock Fluids
Floor stock fluids are currently scheduled in order to generate a charge each night. As we experienced during eMAR go live dates, workflow would be improved if these fluids were prn items. The CPOE update on July 7 will move floor stock fluids to the prn section of eMAR. This will allow nurses to hang bags at the times most appropriate for their patients and document at any time. When a bag is hung, it will be scanned, and the patient will be charged for the fluid.
Respiratory Therapy Spacers
Respiratory Therapy (RT) will start carrying spacers for inhalers. If the spacer is provided by RT, they will ensure that there is not an order for a spacer in CPOE. If RT is not providing coverage for that patient, an order must be placed in CPOE for pharmacy to send a spacer to the patient (same as process today).
Exceptions
As mentioned above, non-eMAR areas will continue to function as a COD model. Another exception is that bulk items will remain COD. Examples of bulk medications are tubes of cream, inhalers, and other multiuse items. For these items, a charge will still be generated each time a new product is dispensed from the pharmacy.