ALIS Self-Onboarding Guide Part 4: eMAR

Use this guide to learn the basics of the ALIS eMAR, and if you have a pharmacy integration, refer to the Pharmacy Integration Addendum.

Manage Orders

Manage Orders is where you can view and edit the details of your resident's medications. You can also schedule vitals checks on Manage Orders.

Navigating to Manage Orders

There are a few ways to get to a resident's Manage Orders page:

1. 1. In the Medications menu at the top of your page, click Manage Orders. This takes us to a landing page where we can search for a resident or applicant name in the space provided and click Manage Orders. This is also where we can export MARs and Physician Orders documents in bulk! 
      • How do I print MARs for all or multiple residents?
      • How do I view and print Physician’s Orders for all residents? 
   2. On a resident (or applicant) profile, click the Manage Orders button beneath their photo. 
   3. Additionally, if you are on any medications pages (Pass Meds, Administer PRNs, Pharmacies, Medication-related Reports), clicking the resident's name will take you to their Manage Orders page.

MARs and Physician Orders

The Manage Orders landing page as shown in the first section of this article gives you options to efficiently generate MARs and POs for multiple residents at a time. Read on to learn details about these documents.

MARs

MARs contain a lot of information about each order, and will display all vitals checks recorded on the Pass Meds page.

• On a resident's Manage Orders page, you can quickly review and print their current month's MAR by clicking the blue Current MAR button below their photo.
  • You can also generate this document at the top of your resident's profiles below their photo.
• To look at previous month's MARs, use the Past MARs button to select the month or months you need to see.
• The Blank MAR (also called Unfilled MAR) will generate a MAR document with all of the resident's current orders, but displays no administration records (no staff initials) in the boxes. This document is designed for printing as a paper MAR if you need staff to document on paper.

The key toward the middle of each page of a MAR shows you the full names of staff initials that display on the MAR, and the symbols that indicate the following:

• Not Recorded means the order was scheduled but never recorded (sometimes called a "hole on the MAR"). This displays as a dash symbol.
• Not Scheduled means the order was not scheduled for a particular date or time. This displays as an X on a gray background.
• An Exception could be a refusal or other reason the resident did not take the medication as scheduled. Any time an order has exceptions during the month, the reason and notes will display below the order on the MAR. This displays as an exclamation mark on a red background.
• Self Administered orders will display as a small person icon on a blue background. These orders do not display for documentation on the Pass Meds page.
• On Leave Meds Packaged refers to orders that were scheduled while a resident was documented as being On Leave, and the order was marked as having some doses packed. When the resident is returned from leave, more information about this will show at the end of the MAR document. This status displays as a black filled circle on a yellow background.
  • Read this article for more information about resident On Leave status: How to Set a Resident "On Leave".
• On Leave Meds Not Packaged refers to orders that were scheduled while a resident was documented as being On Leave, but the order was marked as not having any doses packed. When the resident is returned from leave, more information about this will show at the end of the MAR document. This status displays as an unfilled circle.
• On Hold means the order was scheduled for temporary hold for a particular date or time. This status displays as an uppercase "H" on a gray background. Read this article for more information about scheduling holds: Medication Holds. 

Physician Orders

• Click the Physician Orders button to select either Print Current Physician Orders or Print All Physician Orders.
  • Print Current Physician Orders generates for view the list of resident orders that are active on the Manage Orders page. You can Print All or you can click Select Meds to Print if you want to select specific orders to display on the document. If you choose to select meds, the meds will be grouped by Prescriber.
  • Print All Physician Orders will require a date range and generate a document that contains all orders that were active during your date range. This can include discontinued orders, and will display the date of discontinuation.

• Physician Orders always display a column for Diagnoses for the orders. To fulfill this column, you can edit your orders and type the diagnosis for the order in the Diagnosis field. Read this article for more information about editing orders: How to Edit Medications, PRNs, and Treatments.
• The final page of Physician Orders documents contains a New Orders section for prescribers to write new orders if needed.
• The signature lines at the ends of each page can be customized, and you can add a custom disclaimer to display at the end of each page. Read this article for more information: How can I add a disclaimer and signatures to resident Physician Orders?

Edit MAR

• The Edit MAR feature allows nurses and admins to update the information displaying on MAR documents. It is typically only available to specific staff members.
• If staff need to update an administration record that they recently created, this can be done using Med Pass History. Read this article to learn more: Med Pass History.

This powerful page allows us to click the squares that represent individual order administrations to change any information.

Use the arrows to either side of the month and year (below the resident photo) to view different months, and you can filter by Order Name or Time of Day.

1. To edit a record, find the order you want to change and click the square representing the administration time.
2. A pane from the right side of your screen gives you options to update the administration outcome (Passed, Refused, Adverse Reaction, or Other), and you can make updates to the date, time, and dose administered.
3. Users with administrator permissions can also change the staff member who administered the order (Administered By) and delete administrations.
4. Click the Submit button to save any changes.

For more details about the MAR Editor, read this article: How to Edit a Resident's MAR.

Order Types:

Routines and PRNs

Routines and PRNs include all of the medication orders for your residents.

For complete details about how to add these orders and all of the details of the Add/Edit orders pages, read this article: How to Manually Add a New Medication.

Treatments

Treatments are scheduled non-drug orders that show on Pass Meds for staff to document. Some examples of treatments are vitals checks, oxygen orders, and wound care.

The main difference between routine medications and treatment orders is that treatments do not have Routes or Doses.

For more information about Treatments, read this article: How to Add a Treatment.

Informationals

Informationals are orders that display on resident Physician Orders documents, but do not require any administration records on the eMAR. These may pertain to specific statements required by your state license or a doctor's recommendation.

We can organize informational orders into different types, and if all or many of your residents need the same details on their Physician Orders documents, we can manage these in settings and easily apply them to all or selected residents.

Common informational orders may include:

• Dietary recommendations: Low salt diet, No concentrated sweets, Regular
• Code Status
• Immunizations: Pneumonia, Influenza
• Lab Orders
• "Ancillary Orders"

For complete details about Informationals, read this article: Informational Orders.

Order Options Menu

The Options button to the right of each order gives a list of actions that may be slightly different depending on your company's medication settings and features. Also, your security role will determine which options you can access. 

See below for details about each Options item:

Edit MAR This takes us to the Edit MAR page for this particular order. On the Edit MAR page, you can edit administration records by clicking on a box that represents a specific administration time.

• Near the top of the Manage Orders page below the photo, you can click the Edit MAR button to access this page for all of the resident's orders.
• For more information about the Edit MAR page, read this article: How to Edit a Resident's MAR.

eFax Refill Click here to submit a refill request to your pharmacy or prescribers! Read this article for more information about eFax Refills: eFax Refills.

Request Resupply Instead of eFax Refills, you may have a different refill request setting that submits your requests directly to your pharmacy's software without using fax. Read more information about this type of refill request here: How to Request Refills through your Pharmacy Integration.

Schedule Hold This is a useful feature that allows you to schedule med holds. Orders on hold will not display on Pass Meds until the hold is over, and the schedule can be edited as needed. Read this article for more information about med holds: Medication Holds. 

Discontinue Click Discontinue to confirm and enter a reason for the discontinuation of the medication. You will find all discontinued orders in the DC/Changed tab on Manage Orders. Discontinued orders can be cloned to create new ones if needed. You can learn more about discontinued orders here: Discontinuing Medications.

Disable Routine/PRN/Treatment This option removes the medication from showing in Pass Meds. It is similar to Schedule Hold, except there is no scheduling component. It is an ideal practice to use Schedule Hold instead.

Replicate Across Residents  This allows you to copy the order onto other resident's MARs. Click the checkbox next to the resident names to copy the order. This is most often utilized for Treatment orders for vitals checks. Read more about this feature here: How to Replicate Orders and Vitals Across Residents.

Clone allows you to duplicate a medication for the resident, and you can change the order type between routine, PRN, and treatment.  A common use is cloning an order from a routine medication to create a PRN. You can also clone orders that have been discontinued in the DC/Changed tab to create new orders. Read more about this feature here: Clone a Medication, Treatment, or PRN.

Enable Drug Counting If you have Drug Count turned on for your community, this option is how you will add this order to be counted. This opens a pane where you should choose to 'Create New Account' and add the current quantity on hand. For more information, read this article: Enabling Medications for the Drug Count.

Disable Drug Counting For orders that have been added to the drug count, you can click this option to remove them from the drug count.

Edit Drug Count Link For orders that have been added to the drug count, you will see this option to edit whether the order quantity is linked to another order quantity. It is uncommon to link the quantities, but may be done if the same package of a drug is used for routine and PRN administration. 

Link to Drug Database If you have Drug Database turned on for your community, you typically link the order to the database when you are adding it when you search for a name and NDC #. This option allows you to search for the order within our drug database if you have not already linked it. Read this article for more information about the Drug Database feature: ALIS Drug Database Reference Guide.

Edit Drug Database Link If the order is already linked to the drug database, this option allows you to link it to another. Use this if you have made a mistake with the name and NDC of the order.

Delete Drug Database Link This is very unlikely to be used. You can remove the order's link to the drug database with this option.

Delete will remove the order from the MAR and med pass. You will not be able to delete an order if administrations times have already elapsed in on Pass Meds, but you can discontinue the order instead.

Audit History

Of the tabs in a row across the middle of the page, the last one is called Audit. Here is where you can review all events that have taken place to add, edit, and discontinue your resident's orders. 

A useful way to search for details about an order is to begin typing the name of the order in the Notes filter. If you add just the first few letters of the name of the order and click the magnifying glass, you can see a detailed history of all updates made to your order. 

This audit also shows all vitals records.

Scheduled Vitals

The Wellness Vitals tab provides a way to schedule vitals for your team to record on a separate Record Vitals page. Most communities prefer to add scheduled vitals checks as Treatments so that they display in Pass Meds, which removes the need for staff to visit two different pages to document their items.

Read this article for more details and best practices for vitals: Recording Vitals.

Miscellaneous

• You can update the resident's med cart on the right side of the page below the pharmacy contact button. For more information about med carts, read this article: Med Carts.
• You can navigate to other residents' Manage Orders pages using the menu at the top right of the page below the search.
• The order types showing as a column of tabs on the left side of the page when you are looking at Orders will help you navigate quickly to the different sections. Click one of the order types to jump to that section.

How to Manually Add a New Medication

Most care teams will benefit from utilizing a Pharmacy integration so that order information entered by pharmacy staff can help us create the orders in ALIS. This saves time entering the order details and allows us to be aligned with the pharmacy on these details.

For more information about processing orders using a pharmacy integrations in ALIS, check out these two articles:

How to Process Resident Messages

How to Process Order Messages

If it is not possible to integrate with your community's long term care pharmacy, or if there is an extenuating circumstance in which you may need to quickly add a new order to the resident's MAR, we can always add orders manually on a resident's Manage Orders page.

Don't forget: we can add orders for Applicants in ALIS too! This means we can get the medications all set up prior to admission.

Manage Orders

There are a couple of ways to get to a resident's Manage Orders page:

• 1. In the Medications menu at the top, click Manage Orders. This takes us to a landing page where we can search for a resident or applicant name in the space provided and click Manage Orders. This is also the page where we can export MARs and Physician Orders documents in bulk!
  2. On a resident (or applicant) profile, click the Manage Orders button beneath their photo. 
  3. Additionally, if you are on any medications pages (Pass Meds, Administer PRNs, Pharmacies, Medication-related Reports), clicking the resident's name will take you to their Manage Orders page.

Manage Orders displays the resident's basic details at the top of the page, has a few buttons for generating documents and taking bulk actions on the orders, and is then split between four tabs. For adding an order, you only need to focus on the main left-most tab, Orders. You may find it useful to look in the DC/Changed tab or the Audit tab for historical order information.

• Within the Orders tab, we have the four different types of orders linked on the left column of the screen: Routines, PRNs, Treatments, and Informationals.
• We must determine which type of order we are adding, and go to the correct section.
• We can either scroll down to find the appropriate order section, or click one of the options in the left column to jump there.
• At the top of each section we will have a button on the right to add the order of each type.
• The first and most utilized is Routines, referring to routine medications.
• When we click the +Add Routine button, this is how we will add a routine medication to go on the resident’s MAR.

Order Information

Our first section on the page when you click to add a new order is Prescription & Refill Information. In this location we can track prescription dates and keep an uploaded file of the prescription. This section is often skipped an will not impact your MAR or Pass Meds records.

In the Routine or PRN Information section, the required fields are the Medication Name, Route, and Instructions. Even though the other fields are not required to add the order, they will display clearly on the Pass Meds page and on MAR and Physician Order documents.

• Medication Name: Type the name here to find it within the database. This should include the name of the order, the strength, and the form of the medication.
• Drug Package: You can select from this menu to find the package and NDC number in order to set the correct image of the medication if you are using the ALIS Drug Database feature.
  • The NDC number refers to a drug package within the National Drug Code Directory. This number allows for you to preview an image of the order and the adverse reactions. In order to see the image and adverse reactions based on this number, you must have the ALIS Drug Database feature turned on. For more information, read this article: ALIS Drug Database Reference Guide
• Equivalent to: The brand name equivalent of a generic medication goes here. This is meant to make it easy for med passers to know when they are working with a generic form of a brand name medication they may already be familiar with.
• Prescriber: This field is optimized to link the order to a resident's ALIS Contact. You can select any resident contact within your ALIS community who has been tagged as a 'Medical Contact'. This list should include primary care providers, nurse practitioners, and specialists. It is not possible to add a prescriber to this list from this page.
  • If you need to add a prescriber to this list, go to the resident's profile and add the prescriber as a contact with the Medical Contact tag. If you come back to this refreshed page after adding the contact, the contact's name will appear in the list for you to select. Remember that this field is not required, so if that sounds like too much effort at the time, you can leave this field blank. For more information about resident contacts, check out this article: Resident Contacts Reference Guide 
• Route: This menu is straightforward!
• Instructions: Add complete instructions here. It is recommended to avoid abbreviations. If you are adding a vitals check to the order (this is done in the Order Details box), add more instructions here detailing what med passers should do if the resident's vitals are outside of the safe ranges for the order.
• The checkbox labels to the right of the Route and Instructions should be reviewed carefully, and you should check all that apply to the order. These will display as prominent badges next to the order, and can be used to filter all of your orders in reports. The standard options are listed here, but they can be customized if you want to add or remove some. In bold are the most commonly useful of these labels:
  • Narcotic Drug, Controlled Substance, Antibiotic, Court Ordered, Crush, Do Not Crush, Hazardous, Non-standard Psychotropic, Psychotropic Drug. 
• Diagnosis: This field populates the right column on the ALIS Physician Orders document next to each order. It is recommended to fill out the relevant diagnosis here for the order.
• Check Pain Scale: If you switch this to Yes, the med passer is required to select from 0-10 to indicate the resident's reported pain level.
• Injection: If the order is an injection, make sure you click Yes for this option! This will give you space to type a "General Location" that is not required or necessary. In the Med Pass, this requires the med passer to type the injection site on the resident's body, and shows med passers the previous injection site.
• Patch: If the order is a patch that goes on the resident's skin, make sure you click Yes for this option! This will give you space to type a "General Location" that is not required or necessary. More importantly, further down the page in the dose area, you can select the steps of whether the scheduled time is meant for applying, removing, or replacing the patch. In the Med Pass, this requires the med passer to type the patch location on the resident's body, and shows med passers the previous location of the patch.
• Drug Count: If you have the Drug Count turned on, this option will be available. When you click Yes, you will be required to add the current quantity of the order on hand or link the quantity to another order for this resident. For more information about enabling the drug count for an order, read this article: Enabling medications for the Drug Count
• Check Vitals: When you click yes for this option, you can then select vitals required to be recorded before this order can be administered. When you click the checkbox next to a vital type, you can then optionally select a "Scale Type" which indicates whether there is an acceptable upper, lower, or upper and lower range for the vital. If you add a scale type range of any kind, it is recommended to add details to Instructions a description of what med passers should do if the vital is recorded outside of the range. For more information about vitals in ALIS, read this article: Recording Vitals 

Panel on the right side of the page:

• Service Level: The default level is Administer, but we can update the default level for your building in Settings. If you need us to change this, contact ALIS Support.
  • Administer: This option is appropriate for most orders under most building licenses, with the exception of buildings in Florida.
  • Assistance: This is an alternative to Administer for Florida licenses.
  • Self-Administered: Mark this option for residents who administer their own medication. When you select this option, you can then choose whether the order should show on the MAR document and/or the Med Pass. The most common practice for this is to check Show in MAR, but uncheck Show in Med Pass.
  • Third Party: This has the same options as Self-adminstered. Most likely you want the order to show on the MAR, but not in the Med Pass, since third party providers typically do not have access to ALIS and maintain their own MAR tool.
  • Nurse Only: This is only available if you have Administer selected above. For more information about Nurse-give Only medications, check out this article: Nurse-Only Orders
• Goal: This field is not commonly needed. Enter here the physician's stated goal of the resident taking the medication.
• Physical Description: This field is not commonly needed. Enter here the physical description of the medication.

Routine Orders: Scheduling & Dosage

Required fields are Drug Unit of Measurement, Start Date, Interval, Dosage Type, Dose, and Time.

• Drug Unit of Measurement: This is a long list of possible order unit abbreviations that a pharmacy might use. By far the most common option is TABS, for tablet. Any time you change this field, notice that the Dose field below will reflect the change. 
• Packaging: Most likely you want to leave this alone. This menu affects orders tracked in the ALIS Drug Count that are packaged as partial pills in a bubble package. It is a very rare situation that you will need to change this menu from Based on Dose (default) to As 1 Packed Unit. 
• Min. Interval Between Admins: It is not recommended to use this menu for Routine Orders, because they are always scheduled for specific days and times. This is very useful for PRNs however. This allows you to select up to 72 hours within 30 minute increments. This is the length of time between administrations that the resident can safely be given the order. The order will show the label 'WAIT' if it is too soon to give the order based on your selection in this menu.
• Start Date: This date can not be edited later, unlike almost everything else on this page.
• End Date: If the order schedule should stop at a specific date and time, make the selection here. This might apply for antibiotics or tapering dose orders. The order will automatically Discontinue at this date, and this field should remain blank for most orders.
• Interval: This determines which days after the start date an order is scheduled on the Med Pass. If you are unsure if you have scheduled the order for the appropriate days based on this, you can always review the resident's MAR after processing to make sure it is scheduled to be given on the intended days. If you need to change this menu later, it is editable from Manage Orders.
• Dosage Type: Almost all orders will be "Fixed". Range dosages are rarely used for Assisted Living, and indicate the resident can basically choose the dosage they want within a range you set. Sliding Scale is used by some communities mostly for the purpose of administering a specific number of insulin units based on the resident's blood glucose level. For more information about sliding scale orders, read this article: How do I add a sliding scale vitals check to a medication order?
• Dose: The number of units given at the times specified below, units being determined by the above-mentioned Drug Unit of Measurement. Select "Dose is different per time" if the order is given at multiple times in different amounts.
• Time: First you must select one of four time range options, and then you can select a specific time. If you need to edit the specific times available within the time ranges for your community, contact ALIS Support. To add additional times, click the green plus sign! 
• The "+Add Another Schedule" button creates a new section for a different schedule with different instructions and start and end dates. This may be used for alternating dose orders or tapering dose orders, but do not use this for adding another administration time for a simple order. (How to enter a tapering dose medication, How to enter an alternating dose medication)

PRN Orders: Administration & Dosage

This contains nearly all the same fields as the Scheduling & Dosage section for routine orders. There are two additional fields:

• Max. Admins. in 24 Hours: Select the number of times per day it is prescribed to administer this order.
• Check and Record Outcome: This is an important step to select for your PRNs if you are tracking the outcomes of administering PRN orders. For most orders it is appropriate to select 1 hour, but some medications may take effect very quickly and others after several hours. For the time length you select here, ALIS will require an outcome entry from your med passers. If the outcome time length expires, the PRN outcome will be considered overdue.

It is a good idea to utilize the Min. Interval Between Admins. menu together with the Max. Admins. in 24 Hours menu! It depends on the instructions of the order, but these will both be relevant if an order has instructions such as: can be given every 2 hours, but only a maximum of four times per day.

Med Pass Scheduling Information

Unless advised by your onboarding manager, do not update the fields here. Ignore this section entirely!

Once all required fields have been filled in with the correct information, you can click the Create Order button at the bottom right. If orders are enabled for the resident, the next administration time will display on Pass Meds!

If your resident is still in the applicant stage, the orders will begin showing on Pass Meds when you Move In the Applicant.

eFax Refills

The ALIS eFax feature is an easy way to request order refills via fax directly from ALIS without having to use a fax machine. This guide covers how to request refills from pharmacies and prescribers, and how to set up the feature.

No pharmacy integration is required, and you can request refills from multiple pharmacies and prescribers.

If you have an integrated refill feature set up between ALIS and your pharmacy, read this article for more details: How to Request Refills through your Pharmacy Integration.

Request eFax Refills

Refills can be requested on Pass Meds and on Manage Orders for any order. 

When you are recording the med pass for a resident, find the eFax Refill button toward the middle of the page.

Once you click eFax Refill, a pane opens on the right side of your screen. Notice that the details of the order and resident are already queued up to send in your fax message. You may have up to three options that will populate the correct fax number:

1. Connection: This will send the request directly to your pharmacy's software. This option is only available for specific types of pharmacy integrations.
   • If the pharmacy's fax number has been added to the Pharmacy Integration settings, this will automatically pull into the Fax # field.
   • This number can also be added by navigating to Settings > Medications > eFax Refills > Manage Pharmacy Fax Information.
2. Community Contact: This will allow you to choose from a list of Community Contacts that either have the Pharmacy Contact Type or have been set as a Medical Contact for a resident. If the contact has a fax number added, this will automatically pull into the Fax # field.
   • This number added or changed by navigating to Settings > Medications > eFax Refills > Community Contacts.
   • For more information about managing these and other Community Contacts, read this article: How to Add Community Contacts.
3. Manually Enter Info: This allows you type the name of any pharmacy or prescriber and their fax number.

Type additional message details and click Submit!

To send refill requests to prescribers, click the Community Contact option (item 2 in the image above), and select from the list of community contacts.

This list contains community contacts that either have the Pharmacy Contact Type or have been set as a Medical Contact for a resident. If the contact has a fax number added, this will automatically pull into the Fax # field.

If the prescriber is not showing in the list, you will need to add them as a community contact. 

• • The fax number can added or changed if you go to Settings > Medications > eFax Refills > Community Contacts.
  • For more information about managing these and other Community Contacts, read this article: How to Add Community Contacts.

You can also request the eFax refills for an order on a resident's Manage Orders page when you click the Options button next to an order.

Status and eFax Messages Report

The Fax status will display on the Pass Meds and Manage Orders pages to show whether it was successfully delivered. You can click View PDF to review the details of the last time a fax was submitted.

Additionally, you have an eFax Messages Report available in Reports>Medications Reports. Review this to see the status of all eFax refill requests sent from ALIS.

eFax Setup

First the ALIS team must enable this feature. For help with this part, contact your onboarding manager or ALIS Support.

To update the following settings, click Settings >  Medications > eFax Refills tab.

You will need Administrator permissions to access the settings.

1. Add the community's fax number.

This is labeled Community Fax Information in eFax Refills settings.

2. Add fax numbers for the pharmacies and prescribers.

• If the community sends refills directly through their pharmacy integration, verify the fax number in Manage Pharmacy Fax Information in eFax Refills settings.
  
  • This is only available for specific types of integrations.
  • For more information, read this article: How to Request Refills through your Pharmacy Integration.
• Verify that all pharmacies and prescribers are added as Community Contacts with their fax numbers.
  • Find this in the Community Contacts section of eFax Refills settings.
  • For more information about community contacts, read this article: How to Add Community Contacts.

3. Verify permissions for which staff members can request the refills.

This permission is automatically turned on for any security role that can access Pass Meds. If you need help seeing which Security Roles have access to the eFax Refill button, contact ALIS Support.

How to Pass Meds

Pass Meds is where you can document the administration of routine orders and PRNs. The page is organized into four different time frames so that it is easy to see if orders are overdue and what orders are scheduled for the future.

The Time Frames are set in Medication Settings by an administrator and represent ranges of time throughout each day. If you would like to update this or any settings, please contact ALIS Support!

Notification Badge and Banner

The number indicated in the notification badge on the Pass Meds icon is the sum of any unrecorded scheduled orders within the current time frame and those in the previous two time frames. 

The reason for this is to help you see the progress of the current med pass, and if there are any outstanding orders from previous shifts. This makes it a useful tool for preventing holes on your resident MARs.

The breakdown of these totals displays in the orange banner at the top of the Pass Meds page as shown below:

Time Frames

The breakdown of the time frames displays below the notification banner, focused on the current time frame by default. Click the tabs to the left to see the details of the two previous time frames, and click the tabs to the right to see details of the next three future time frames.

Filters

In the blue area, you can use the filters to find specific residents, decrease the time frame to look at orders within a smaller window of time, see which orders are still outstanding to be recorded, look at a specific med cart, and look at orders that are specifically for nurse administration only.

Pass Meds for a Resident

Once you have applied filters and you need to start passing meds for a resident, scroll down to find the residents in the list.

• You can reorder the list by clicking some of the column headers:
  • Resident Name will sort by alphabetical order
  • Room will sort by room number
  • Outstanding Meds will sort by residents with the earliest outstanding med schedules

Click the Pass Meds button to get started recording meds for a resident within the filters.

Record Pass Meds Page

The top of the page will show you basic information about the resident including diagnoses, allergies, and diet. If the resident has a Pharmacy content set on their profile, you can see their contact details when you click the View Pharmacy Contact button. For more information about resident contacts, read this article: Resident Contacts Reference Guide

In the Routines tab, we have a list of all Routine Medication and Treatment orders scheduled within the filters you selected on the previous page. Read the information about the orders on the left, and use the buttons on the right to indicate if the order was Passed as directed, or if there was an exception. You can also update the date, time, and dose fields. Add notes if needed. 

You can record all orders on the page before saving your work. Once you are ready to submit it, click the green Record Med Pass button at the top right of the page. This button won't be available until all required details have been filled in for any orders you have recorded. 

Additional fields may be required for specific orders such as injection locations, patch locations, or pain scales.

The badges toward the middle of the page indicating OK, WAIT, and LATE are there to guide you on the appropriate administration time based on the schedule. These do not prevent you from recording any details. For more information, read this article: Why does a medication say "WAIT" or "LATE"?

If your community uses Barcode Scanning for the Med Pass, be sure to review the details here: How to Use Barcode Scanning in Pass Meds

You can navigate to the next resident within your filters on the previous page using the resident menu at the top right of the page. No need to click the back button each time!

Vitals Records

Some orders may require vitals checks, or some Treatments may be only there for the purpose of recording vitals at scheduled times.

These require you to save a vitals record before you can see the options to mark the order as Passed or an exception reason. 

PRNs and PRN Outcomes

Click the PRNs tab to get to the resident's available PRNs to administer. Click the Administer PRN button for the order you wish to record. 

If a resident has an exclamation symbol within a triangle next to their name on the main Pass Meds page and on their PRNs tab, this means there is an outstanding PRN outcome for the resident. These outcome requirements remain until the outcome is recorded.

How to Record PRNs and PRN Outcomes

A resident's active PRNs can be administered from two locations in ALIS: the Administer PRNs page and the Pass Meds page.

Administer PRNs Page

If you are not recording a PRN administration from Pass Meds, you can always do it from your home screen in ALIS. Find the Administer PRNs icon in the Meds section.

1. Click the Administer PRNs icon. The number notification on the icon is the number of outstanding PRN outcomes.
2. On the Administer PRNs page, start typing a resident's name in the "Choose Residents" field. Click the name of the person for whom you need to document PRNs. Click the Administer PRNs button.
   • The next page shows you the health details for your resident at the top. Active PRN orders for a resident will display with an Administer PRN button.
   • Any Outstanding PRN outcomes for your resident will display above the PRNs you can administer.
   • Recent PRN history will display toward the bottom of the page if a PRN was administered in the last 72 hours.
     
3. Click the Administer PRN button.
   • Verify the date and time you gave the PRN. Update this to match the time the resident took the medication.
   • Type the purpose for giving the medication.
   • Record any other required fields such as pain scale, injection site, or patch location.
   • If you already know the outcome of giving the medication, you can enter it now. If the medication is particularly fast-acting, it may be required for you to enter the outcome during this step.
   • Click the Record PRN button.
   • You will now see a record of the PRN administration under "Recent PRN History" toward the bottom of the page.

PRNs on the Pass Meds Page

If you are already recording routine medications for a resident in the Pass Meds page, you can easily record PRNs from the same page.

1.  On the Pass Meds page for a resident, click the PRNs tab.
2. Follow all of the same steps as described above in steps 2 and 3!

PRN Outcomes

Most PRNs should have outcome requirements. These requirements are set on a per-medication basis.

You always have the option to enter the outcome if you already know the effect of giving a PRN. Most likely you will need to document the administration of the PRN shortly after giving it, and then an hour or more later, document the outcome.

The pending outcomes will show very obviously in the Pass Meds page and on the Administer PRNs icon on your ALIS home screen.

On Pass Meds, outstanding PRN outcomes display as an exclamation symbol with an alert above the total number of outstanding routine medications.

When you Pass Meds for a resident, the same exclamation symbol displays on the PRNs tab to help remind you to document the outcomes.

Type the outcome and click the Record Outcome button to remove the alert!

How to Audit Resident MARs

Auditing medications for residents can mean two different things: auditing all medication order details, or auditing the completion of administration records. This guide describes ways to audit both.

Auditing All Medications

It is a good practice to regularly audit all of your resident's medications, taking a close look at important details to catch errors. 

Medication List Report

Use this report to see a list of each routine and PRN medication and treatment on your residents' profiles. There are many filters on this report that can help you narrow down a list of residents or types of medications if needed.

Export this report to Excel to see many more columns than can fit on the report page in ALIS. If you can use Excel to audit the medications, Excel will help you focus on specific columns of details. Here are some suggested columns to isolate and review:

• End dates: Verify that any end dates are set to exactly when you expect! Orders discontinue automatically on their end dates.
• Times/Dosage: Verify accuracy of times and dosage and look out for any less-than-ideal units. If you see "TBEC" instead of "TABS", it may be worthwhile to update this to the more obvious unit for your med techs.
• Scheduling Status: See if any orders are Disabled, and verify if this is correct. Disabled orders will not show on the Pass Meds page.
• Narcotic and Medication Tags: Verify that all the right tags are associated with the right orders.
• For PRNs, look at the Min. Admin. Interval, Max. Admin. in 24 Hours, and Check and Record columns. Using these will make PRN administration safer and more careful.

Physician Orders

If you work for a smaller building, do not have access to Excel, or want to audit the orders printed on paper, you may prefer to generate the Physician Orders documents in bulk for all residents (or a group of residents).

To learn how to generate the POs for multiple residents, read this article: How do I view and print Physician’s Orders for all residents?

You may also find it easiest to navigate the details of your resident orders on their Manage Orders page, so you have easy access to make updates to orders if needed. Use the resident menu at the top right to navigate to each resident you are auditing.

Auditing Administration Records

• The ideal practice is for your team to work together to audit the Pass Meds page each shift to make sure all scheduled orders have been documented.
• If you have a shift lead, they can verify that all orders on the previous shifts displaying on Pass Meds have been documented, and that orders during their shift are all documented by the appropriate scheduled time.

Pass Meds

The first place you should look to audit administration records is on the Pass Meds page, because here you can see the details of the current shift and the last two shifts. If there are any unrecorded items, it is easiest to catch them now and update them while they still display on Pass Meds.

For more information about what displays on Pass Meds, read this article: Navigating the Pass Meds Page

Pass Med Report

This report is very useful for generating a list of all unrecorded records within a specified range of time.

Update the Variance filter to 'Not Passed' to see anything unrecorded (this will not include recorded Exceptions) and update the Scheduled Date range filter to any amount of days in the past. It is not recommended to include the current day, because it will show you scheduled medications for later today.

You can also review resident MAR documents themselves, and print them out if you prefer to do so. Read this article to learn how to generate MARs for multiple residents in one file: How do I view and print MARs for all or multiple residents?

How to Edit a Resident's MAR

ALIS has an interactive MAR Editor tool to make it easy for us to update medication administration records. This feature gives nurses and admins greater control over information displaying on the MAR documents.

• This feature is typically only available to specific staff members.
• If staff need to update an administration record that they recently created, this can be done using Med Pass History. Read this article to learn more: Med Pass History.

Follow the steps below to access the MAR Editor:

1. Access the resident's Manage Orders page. 
2. Click the Edit MAR button below the resident's medical information.

MAR Editor

This powerful page allows us to click the squares that represent individual order administrations to change any information.

You can change MAR month by clicking the arrows to either side of the month and year (below the resident photo), and also filter by Order Name or Time of Day.

1. To edit a record, find the order you want to change and click the square representing the administration time.
2. A pane from the right side of your screen gives you options to update the administration outcome (Passed, Refused, Adverse Reaction, or Other), and you can make updates to the date, time, and dose administered.
3. Users with administrator permissions can also change the staff member who administered the order (Administered By) and delete administrations.
4. Click the Submit button to save any changes.

Resetting Orders

If you need to update an administration time to Not Passed, click on the box, and then click the Reset button at the bottom left of the pane.

When you click Reset, there is another pane that prompts you to confirm you would like to reset this administration time. If you are sure, click Reset again. Then, the box will go back to being blank with a small dash to indicate that it was not administered!

Deleting Orders

• We also have the ability to delete entire orders from the MAR if they have never been administered in ALIS.
• If you've already administered some, don't sweat it, you can always use the above trick to "Reset" any administrations first!
• This can come in handy if an order was added with an incorrect schedule or misspelled name.

1. Click the trashcan to the right of the order name.
2. A pop-up will require you to add a reason for deletion. Once you have typed the reason, click the Delete button.
   

You also have the ability to edit and delete Treatments and Administered PRNs. These display toward the bottom of the page after the scheduled medication orders.

How do I print MARs for all residents?

The main Manage Orders page allows you to generate MARs in bulk for all or several select residents.

There are two different formats for these documents: Filled MARs and Unfilled MARs.

Filled MARs

Filled MARs contain all administration records for residents in your selected month. These may be useful if your team needs to temporarily record meds on paper while also seeing the administration records that were previously recorded on the Pass Meds page this month.

These may also be requested by a surveyor. For more information about generating files for a survey, read this article: ALIS Survey Guide.

1. Click Medications > Manage Orders in the menus at the top of the page.
2. Click the button that says Print Filled MARs. These documents will contain all orders within a single selected month.
3. This will open a pane on the right for you to select options. 
   
   • To print MARs for all residents, keep the Resident menu set to All. For printing MARs for specific people, click the checkboxes next to their names in the menu. You can also print a MAR document for a single resident from here.
   • You can also filter using the Med Cart and Product Type filters to gather MARs for groups of residents. 
   • Select the Month and Year for which you need the documents. If you need multiple months, you will need to complete this process and print on month at a time. Read on for more details about printing previous month's MARs.
   • When you generate MARs from here, they do not automatically contain Exceptions, Med pass notes, Injection sites, or Vitals checks. Click the checkboxes next to these items in order to include these details. 
4. Click the Print button to generate a file containing all MARs for the selected residents. Review this and print as needed.

Unfilled MARs

The Print Unfilled MARs button will generate MAR documents that do not contain administration records. They will include resident names and order details only.

Past MARs

You can generate a MAR for more than one month at a time on a specific resident's Manage Orders page. Navigate to the resident's Manage Orders page and click the Past MARs button. This will create a pop-up that allows you to multi-select the months that the resident has been in ALIS and print.

Read this article for more information about Manage Orders.

You can also access a resident MAR for the current month by clicking the Current MAR button on a resident's profile below their photo.

How do I print Physician Orders for all residents?

The main Manage Orders page allows you to generate Physician Order documents in bulk for all or several select residents.

There are two different formats for these documents: Current Physician Orders and All Physician Orders.

Current Physician Orders

1. Click Medications > Manage Orders in the menus at the top of the page.
2. Click the button that says Print Current Physician Orders. These documents will contain all active orders. This will open a pane on the right for you to select options. 
   • To print orders for multiple residents or all residents, keep the Multiple Orders options highlighted blue.
   • To print POs for all residents, keep the Resident menu set to All. For printing POs for specific people, click the checkboxes next to their names in the menu.
   • You can also filter using the Med Cart and Product Type filters to gather POs for groups of residents. 
3. Click the Print button to generate a file containing all POs for the selected residents. Review this and print as needed.

All Physician Orders

The Print All Physician Orders button on Manage Orders provides a way to generate POs containing all orders active within a specified date range. This option requires you to enter an Order Date Range, and then you can filter for specific residents, Med Carts, or Product Types. Orders that have since been discontinued will display with a clear "discontinued" label.

Printing Physician Orders for a single resident or specific medications

You can also print POs for a single resident from here. Whether you are generating Current POs or All POs, you can select Single Resident and choose the resident name. Then you will then also have the option to Select Meds to Print. When Select Meds to Print is highlighted blue, you can use the Select Meds menu to include specific orders grouped by Prescriber name.

POs can also be printed for individual residents by accessing their specific Manage Orders pages. Read this article for more information: Manage Orders.

Recording Vitals

This article overviews how to add vitals records from your ALIS Dashboard, and how to schedule vitals checks to create future records.

Bulk PRN Vitals

1. Once logged in to ALIS, locate and click the icon called Bulk Vitals. 
2. In the pop-up, we have several ways for you to select the specific residents for whom you want to record vitals and give all vitals types as options. We also give the ability to add notes for each vitals check if needed.
3. First, select residents:
   • The Residents menu at the top left allows us to select specific residents, all residents, or everyone within a Product Type. We can search within this list to pick specific people by name or to search for the Product Type. Use the checkboxes on the left part of the menu to select individuals or groups of residents.

1. • Alternatively, use the text fields in the Resident column of the table to search for individual residents by typing part of their name, or use the down arrow in these fields to look for a specific resident within the list. Use the red Xs on the left to remove anyone you may have unintentionally added, and use the button at the bottom left +Add 5 More to give yourself more rows for additional residents.
2. Make sure the vitals you need to record are available as text fields in the table. The Vitals to Record menu at the top center will allow you to select all of the seven possible vitals types, or just the ones you need.
3. Type the values of the vitals records in the correct text fields. If for any records we don't have all fields filled out, not to worry! All records that are added will save even if there are blanks on the page. If you want to add notes, click the Show Notes Field checkbox at the top right in order to expand the rows with a text box next to each record.
4. Update the date and time fields at the top right if needed. Once all your records are typed on the screen, click the Record Vitals button at the bottom right to save.

The best way to schedule vitals checks in ALIS is to add the vitals checks as Treatment orders. Below we will outline how to add the vitals as Treatment orders. This is the same process for adding vitals checks to medication orders.

Adding vitals checks as Treatment orders:

1. Go to the resident's Manage Orders page.
2. The quickest way to add and manage Treatments is to select Treatments from the menu on the far left of the page under the resident's photo. This brings any existing Treatments into view. Click the +Add Treatment button at the top right of the section.
3. On the next page, add a name for the vitals check, type the instructions, and then click Yes for the Check Vitals toggle. In the box that expands below, select the vitals you want to check.
4. Below in the Scheduling portion of the page, add the start date, interval, and time as are required. Once you are done adding all information you need, click the Create Order button at the bottom right of the page.

The treatment will display in the Med Pass with other regularly scheduled orders, and reflect on the resident's MAR as well as other reports! We can also replicate this treatment for other residents. To do this, use the Options button to the right of the order and click Replicate Across Residents. From there, you can choose if you would like this order to appear on the MAR and Med Pass for all residents or a specific group.  

Adding Vitals in Observation Notes

We can set certain Observation Types to provide specific fields for vitals records when your team is creating an Observation Note. This requires us to update the settings for your Observation Type to specify the Nurse security role. This allows us to exclude other security roles if needed. Contact ALIS Support or your onboarding manager for help setting this up!

Vitals recorded here will be viewable in the Vital Sign Details and Vital Sign Summary reports!