Nursing Questions

NURSING QUESTIONS

Q – Isn’t there a ruling that the nurse must observe a patient take a pain pill?

  • A – There is no Joint Commission (TJC) requirement that the patient must be observed
    while taking the medication. TJC states that under the 2014 accreditation standard MM
    06.01.03 hospitals should have a policy for self-administered medications to be safely
    and accurately administrated. Under that guideline the patient must receive training and
    appropriate information regarding the nature of medication, how to administer the
    medication and the expected action and side effect of the medication. In the policy there
    should also be a plan as to how to monitor the patient. Patients taking medication from
    the MOD® device must also be determined to be competent before being allowed to use
    the medication. The MOD® Hospital Sample Policy provided with MOD® support
    materials addresses these areas. All patients should complete a simple teaching module
    and demonstrate that they are capable of using the device before the device can be left
    at the bedside.

Q – How does the MOD® device save nursing time?

  • A – A published study at a well-known academic medical center showed that each
    manual delivery of oral pain medication took a minimum of 10.9 minutes of nursing labor
    time per dose including documentation and reassessment. In a patient unit with frequent
    prn oral pain medication dosing, this task can take up to 30% of the shift time. With the
    MOD® device, it is estimated that the nursing time will be less than half of that recorded
    with the manual delivery of medications. An ongoing study is now determining the time
    savings using the wireless MOD® device as compared to the manual delivery of
    medications. With this time saved, more nursing time will be freed up for other critical
    tasks and patient satisfaction with pain management will increase.

Q – How do you prevent diversion of pain medication when using the MOD® device?

  • A – Narcotic control and medication reconciliation is an important part of the nursing and
    pharmacy process. In addition to having security features on the device itself, the
    workflow process using a MOD® device has several checkpoints required to aid in
    preventing diversion. The following steps of the MOD® device process require a dual RN
    signature within the device program as part of the programming software:
     Programming the device and loading the pill tray
     Wasting medication at the time of discharge
     Order change in medication (new medication or dose change)
     Order change in a time interval between doses
     Replacing an empty tray of medication
    The nurse identifier that programs the device and the second sign-in nurse identifier are
    recorded in the device database for review at any time. The Avancen White Paper
    entitled “The MOD® Experience after 1,000 Patients” highlights current users’ findings
    and can be found on the home page of www.avancen.com. To date no staff or patient
    diversion of medications from the device have been reported as noted in the White
    Paper.

Q – Do we need a special IV pole for the MOD® device?

  • A – No. The MOD® device and its IV pole clamp may be locked to any IV pole in the
    facility and moved to the patient bedside for easy reach and access by the patient.

Q – Is the MOD® device locked onto the IV pole?

  • A – Yes, the MOD® device clamp has a unique locking mechanism. The device is locked
    onto its steel tray support and the attached IV pole clamp is locked onto the IV pole. A
    proprietary tool is required to lock and unlock the MOD® device from the IV pole. The
    tool (wrench) is supplied with each MOD® device and should be stored in a safe, secure
    location.

Q – Where do I get a filled MOD® tray to place into the device as part of the initial
patient programming step?

  • A – Medication trays for use in the device are prepared in the central pharmacy and
    placed for storage into the automated dispensing cabinet on the unit. Trays are not
    usually patient specific – only medication specific, e.g., a tray will be labeled with the
    name of the medication, dose, and lot number and any other identifiers applied by
    pharmacy.

Q – Will the trays be barcoded?

  • A – Yes. Your central pharmacy may affix a barcode label to each medication tray. The
    nursing staff will scan the medication trays during the validation process, which will
    match the medication to the specific patient. The barcode will signal that you are
    verifying a multidose tray of medication containing eight identical pills in the filled tray.
    This step is identical to barcode validation of a multidose syringe or pre-filled medication
    IV bag that will be loaded into an IV-PCA pump.

Q – What do we do about our usual orders, since the physician usually writes for 1-2
tabs q 4 hours?

  • A – Orders that provide one or two tabs cannot be used with the MOD® device as each
    slot in the medication tray contains only one dose of medication. In order to achieve the
    ability of the patient to receive up to two doses within four hours we recommend that the
    lockout interval be set at two hours on the MOD® device. See on the Avancen website
    under Resources/Healthcare Professionals the white paper which discusses this topic,
    entitled “A Better Way to Deliver Oral PRN Pain Medication in Today’s Hospitals.”
    Allowing a patient a dose every two hours is equivalent to two doses every four hours if
    needed. The medication is dispensed by time and not by pain score although the device
    captures that score with each patient request for medication. If additional clinician doses
    are needed at any time to provide adequate pain control, this option is available within
    the MOD® program so that all doses of medication are delivered and recorded from the
    device itself.

Q – If a patient records a pain number of 0 or 1, will they be able to get a dose of
medication when the green ready light comes on?

  • A – Yes. The pain scale number that is entered is for documentation only. It does not
    make a decision regarding the dose of medication. Patients are educated regarding this
    fact and a zero or one score is very rare because of this. The same dose will be
    dispensed regardless of the pain scale. This allows the patient to self-regulate and
    obtain the dose when they need the pain medication. Entered pain scores are available
    to monitor overall how well the patient’s pain is being controlled not only from the
    medications from the device but from all the medications and procedures ongoing for
    patient pain control.

Q – Does the MOD® device record how many attempts have been made to remove a
dose of medication from the device? This is recorded in some IV PCA devices.

  • A –The MOD® device does not have this function. Patients learn very quickly that if the
    bright green ready light is not on, then it is futile to try to obtain a dose of medication
    from the device.

Q – How does the device capture a pain reassessment score after each selfadministered
dose of medication?

  • A – One hour after each self-administered dose, an audible reminder asks the patient to
    “enter your pain score now.” The patient is instructed that this is only to better
    understand if the pain medication is adequately managing their pain. If they do not
    respond to the reminder, it repeats intermittently for 20 minutes or until a pain number is
    entered. If the patient does not reassess his/her pain within that time frame, the audible
    reminder will stop and it will be the clinician’s responsibility to obtain the reassessment
    score, when/as applicable.

Q – How do we clean the MOD® device between different patient uses?

  • A – FDA standards require that medical devices be evaluated for proper cleaning
    procedures as designated in the Association for the Advancement of Medical
    Instrumentation document AAMI TIR 12:2004. The MOD® has been formally reviewed by
    North American Science Associates, Inc. (NAMSA), for cleaning requirements. The
    MOD® has been judged to be a reusable device with a disposable clean tray of
    medications supplied for each patient. Because the tray is disposable, the risk of cross
    contamination is minimized. Therefore, the MOD® can be cleaned using a simple wipedown
    of all the exposed surfaces between patients or when soilage occurs. A low level
    disinfectant is acceptable. A detailed cleaning protocol is available as part of the MOD®
    Device User Manual provided with each purchased unit, or as a separate document from
    Avancen.

Q – Does a bell ring to remind the patient when they are able to get a pill out of the
MOD® device?

  • A – No. However, any time the patient sees the bright green ready light, the appropriate
    time has passed and the patient is allowed access to get their pain medication. The
    visual queue (green light) is easily recognizable by all patients, especially those who are
    hearing impaired. If the patient does not need medication when the green light comes
    on, the device will stand ready until the patient requests and obtains a dose of
    medication. Once a dose is obtained, the green light will not illuminate again until the
    lockout interval has passed.

Q – How does the memory keep up with the time of the drug administration since
there is no clock to set on the MOD® device?

  • A –The MOD® device obtains the correct time from the computer platform or network
    that is used for the MOD® device programming, similar to most medical devices that
    have programming ability and database capture.

Q – Can the data from the wireless MOD® device be integrated into the electronic
medical record (EMR)?

  • A –Since there is no standard hospital EMR, different hospitals use different EMR
    systems, so this is done on an institution-by-institution basis. The wireless MOD® device
    can be used alone before EMR integration takes place. Even without EMR integration,
    the MOD® device still provides a detailed database of each patient’s medication use from
    the device including a graphic pain scale chart which reflects all the patient pain scores
    at the time of medication administration and the reassessment pain scores patients are
    reminded to enter usually one hour after self-administration of a medication. MOD®
    device data is stored in an MS Sequel database, and relevant MOD® device data can be
    integrated into an EMR system using open platform tools or interface engines used by all
    EMR providers to integrate devices.

Q – Why is the wristband a security feature of the device?

  • A – The programmed RFID wristband only recognizes the device to which it was
    programmed; it is the only wristband that will activate the device for that particular
    patient. Therefore, two people in the same room or unit cannot access another person’s
    device with their wristband. Only their device will respond to their wristband.

Q – What if a patient is discharged before all the medication in the MOD® device’s tray
is used?

  • A – If this occurs the medication is disposed of according to the hospital policy for the
    disposal of controlled substances. The facility pharmacy dictates how that procedure is
    accomplished and as part of each facility’s medication reconciliation policy.

Q – What are the advantages of the device from a nursing standpoint?

  • A – The device is a tool to improve nursing workflow efficiency by reducing the time and
    number of trips necessary to deliver prn pain medication. With the MOD® device, instead
    of the patient waiting on the busy nurse to deliver the medication, the medication is
    available at the bedside and waiting on the patient to dispense when they need it
    according to the scheduled lockout intervals. In no way is the device use intended to
    replace nursing staff. It is a technology to free up time so nursing can spend more time
    providing quality bedside patient care.

Q – What if a patient drops a pill or loses a pill while using the MOD® device?

  • A – The MOD® device is ergonomically designed to make removing a pill from the pill well
    easy to do. When the dispenser wheel turns to expose a dose of medication for selfadministration,
    the pill is available for removal for 45 seconds, a sufficiently long period of
    time so that the patient does not need to rush with removing the medication. However,
    there is always the chance that a patient will drop or lose a dose of medication. Should this
    occur, follow your hospital guidelines for dropped/lost pills. If you have any doubt the
    patient who has dropped or lost the pill is not a good candidate for the device, remove the
    device from that patient’s room, discharge the patient from the device, and return to
    manual delivery.