Nursing Care & Medication Administration Records (MAR)

1. Overview & Business Value#

This comprehensive operational guide details the architecture, business workflows, configuration parameters, and execution steps for Nursing Care & Medication Administration Records (MAR) within SmartERP.

Guide for ward nurses to execute doctor orders, maintain electronic MAR charting, record fluid balance, and perform shift handovers.

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2. Prerequisites & Security Access Groups#

• Required Modules: smarterp_healthcare, smarterp_clinical_core, smarterp_pharmacy
• Security Groups:
  • Healthcare Receptionist (Technical ID: smarterp_healthcare.group_medical_receptionist)
  • Physician / Attending Doctor (Technical ID: smarterp_healthcare.group_medical_doctor)
  • Pharmacy Dispenser (Technical ID: smarterp_healthcare.group_medical_pharmacist)
• Master Data Dependencies: Patient master registry (Medical Record Number - MRN), EFDA drug formulary, Ethiopian Ministry of Health (MoH) HMIS disease codes, and EHIS insurance tariffs.

3. Step-by-Step Configuration & Execution#

Step 1: Navigating to the Module Interface#

1. Log into your SmartERP instance at https://smarterp.et/odoo.
2. Open the main App Switcher (grid icon in the top-left corner).
3. Select the Healthcare app icon.
4. From the top navigation bar, open Healthcare → Clinical Dashboard → OPD Triage / Inpatient ADT / EMR / Pharmacy Dispensing.

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Step 2: Creating and Parameterizing Records#

1. Click the New button in the top-left control panel.
2. Complete the mandatory fields in the record form:
   • Medical Record Number (MRN) (Mandatory): Unique national health identifier or generated hospital record code
   • Patient Demographics (Mandatory): Full legal name, gender, date of birth, and Kebele residential location
   • Encounter Type (Mandatory): Outpatient (OPD), Inpatient (IPD), Emergency, or Triage consultation
   • Attending Physician (Mandatory): Licensed healthcare practitioner responsible for clinical encounter
3. Configure optional operational parameters and localized tags as required:
   • Insurance Provider & Policy (Optional): EHIS CBHI/SHI policy or corporate credit contract
   • Triage Vital Signs (Optional): Blood pressure, pulse rate, respiratory rate, temperature, and SpO2
   • ICD-11 / HMIS Diagnosis Code (Optional): Standardized diagnosis category for statutory health reporting
4. Click the Save icon in the control bar to commit the record.

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Step 3: Validating and Processing Transactions#

• State Transitions: Execute operational state progression (Reception / Triage → Consultation → Lab / Radiology → Prescription → Billing / Discharge).
• Ledger & System Impact: Patient billing registers medical service revenue, debits patient or insurance accounts receivable, and debits pharmaceutical inventory upon prescription dispensing.
• Audit Verification: Automated recording of author ID, timestamp, and immutable revision history.

{screenshot:nursing-care-and-medication-administration-transaction-processing-state}

Electronic Medication Administration Record (e-MAR)#

The e-MAR module eliminates paper medication sheets, verifying the Five Rights of Medication Administration:

1. Right Patient (Barcode MRN scan)
2. Right Medication (Barcoded dose unit)
3. Right Dose
4. Right Route (Oral, IV, IM, SC, Topical)
5. Right Time (Scheduled administration window)

Administering Scheduled Inpatient Medications#

1. Open Healthcare > Inpatient > Nursing Station > Medication Chart.
2. Select the assigned ward and room.
3. Review the timeline of scheduled doses (e.g., 08:00, 14:00, 20:00).
4. Scan the patient's wristband barcode or verify identity via MRN.
5. Click on the due medication line (e.g., Ceftriaxone 1g IV Stat).
6. Select the administration status:
   • Given: Enter exact administration timestamp and injection site.
   • Refused: Record clinical reason and notify attending doctor.
   • Held / Omitted: Specify clinical contraindication (e.g., SBP $< 90\, mmHg$ prior to anti-hypertensive).
7. Digitally sign the administration entry.

Fluid Intake & Output (I/O) Balance#

Accurate fluid balance monitoring is critical for surgical, cardiac, and renal inpatients:

• Intake: IV infusions, blood products, oral fluids, enteral feeding tube volumes.
• Output: Urine output (catheter / urinal), surgical drain volumes, nasogastric aspirate, emesis.

The system calculates net fluid balance every 12 and 24 hours:

$$\text{Net Balance} = \sum \text{Intake (mL)} - \sum \text{Output (mL)}$$

Alerts trigger if hourly urine output falls below $0.5\, mL/kg/hr$ in adult patients.

Structured Nursing Shift Handover (SBAR)#

At shift change, nursing teams conduct handovers utilizing the standardized SBAR framework:

• Situation: Patient name, age, day of admission, admitting diagnosis.
• Background: Relevant medical history, surgical procedures, drug allergies.
• Assessment: Current vital signs, neurological status, IV lines, drain outputs, active lab results.
• Recommendation: Pending diagnostic investigations, scheduled medication changes, planned discharges.

4. Advanced Configuration Points#

• Automated Actions & Scheduled Tasks (Crons):
  • Healthcare: Generate daily MoH HMIS aggregate tally (smarterp_healthcare.ir_cron_hmis_sync): Runs daily at 23:00 to prepare DHIS2 health data summaries
  • Pharmacy: Flag expiring EFDA medicine batches (smarterp_healthcare.ir_cron_fefo_expiry): Runs daily at 06:00 to alert dispensers of lots expiring within 60 days
• Custom Print Templates & Reports:
  • Official Patient Encounter Summary & Medical Certificate
  • Electronic Prescription Order Form (Model 19 Compliant)
  • Ethiopian Health Insurance Service (EHIS) Claim Dossier
  • Daily MoH Outpatient / Inpatient Morbidity Tally Sheet
• Multi-Company Rules: Record-level security isolation under Company 1 (Ashewa Technology Solutions S.C.), preventing cross-company ledger leakage across parent and subsidiary legal entities.

5. Comprehensive Troubleshooting Matrix#