Medications put in the additive section of the fluid calculator are NOT counted towards inventory. However, adding fluid additives in the Medication section of the flowsheet can result in an inaccurate Medical Record (i.e. when it looks like you have given the medication as a bolus vs. a dose). Following these instructions will ensure that your additives are tracked effectively.
We suggest creating a Route called Added to Bag. This way, we can avoid fluid additives being mistaken for fluid boluses on the Medical Record.
Open up any medication and in the Route section where you would normally select from the drop-down, click the Search bar and type in Added to Bag (see the screenshot below):
Enter the volume of the medication you'll be adding to the bag in the ml field here and click Done to save:
This way, it is clearly indicated that although the medication will be administered IV (as an additive to the fluids), it will not be given directly to the patient at that time. It is also displayed clearly on the flowsheet (as seen in the screenshot below). The cell is to be initialed after the medication has been added to the bag of fluids. Each medication within the bagged drug cocktail (i.e Morphine, Lidocaine, Ketamine) should be added to the medication section of the flowsheet individually, with the volume of drug shown and Route indicating Added to Bag:
As the additives section is limited to one line on the iPad, when you're creating a multiple-drug cocktail, you may want to create a fluid named accordingly. If you're only adding one additive, you can just use your regular fluid (LRS) and add the additive there:
Let's walk through MLK as an example
To track the dose rate of your bagged drug cocktail, create a new fluid called MLK (you may need to contact your clinic admin to do so), and add the information about each additive in the Additives section:
The Medical Records for this patient's flowsheet will appear as in the screenshot below:
After tracking fluid rates and adding more medications to the bag to increase the dosage, it will also be shown on the Medical Record:
When the dosage is changed on the flowsheet, highlight that cell to show that changes were made:
If you don't want them to come across as billable items, you can see THIS FAQ on how to turn the Billing OFF.
We hope you found this information useful!