Nursing Care, Inpatient Operations & eMAR

This section describes the clinical workflows in the Nurse Dashboard, including inpatient census tracking, electronic Medication Administration Record (eMAR), batch vitals recording, ICU admissions, blood tracking, and structured SBAR shift handovers.

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1. Vital Signs, NEWS2 Scoring & Deterioration Alerting

Nurses record vital signs using the Batch Vitals Rounding Grid (all ward patients simultaneously) or the individual Record Vitals action.

1. Enter all available vital signs: Heart Rate, Systolic BP, SpO2, Body Temperature, Respiratory Rate.
2. Enter Level of Consciousness (AVPU: Alert, Voice, Pain, Unresponsive).
3. The system calculates an automated aggregate National Early Warning Score 2 (NEWS2).

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IMPORTANT:

Patient Safety Checkpoint: NEWS2 ≥ 7 — STAT Deterioration Alert When the aggregate NEWS2 score reaches 7 or higher:

1. A STAT-priority alert fires simultaneously to the assigned ward nurse AND the attending doctor.
2. Attend the patient immediately. Call the doctor directly.
3. Acknowledge the alert in the system and document clinical response with timestamps. Note: The STAT alert triggers on the AGGREGATE score, not on individual isolated readings.

Vital Signs Clinical Threshold Reference Ranges

Vital Sign Parameter	Critical Low	Low	Normal	High	Critical High
Heart Rate (bpm)	≤ 40	< 60	60 – 100	> 100	≥ 130
Systolic BP (mmHg)	≤ 90	< 100	100 – 130	> 130	≥ 180
Oxygen Saturation (SpO2 %)	≤ 90%	< 95%	≥ 95%	—	—
Temperature (°C)	≤ 35.0°C	< 36.1°C	36.1 – 37.8°C	> 37.8°C	≥ 39.0°C
Respiratory Rate (/min)	≤ 8	< 12	12 – 20	> 20	≥ 30

Batch Vitals Rounding Grid with NEWS2 Deterioration Score Calculator🔍 Click to enlarge

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2. Nursing Task Management & Lifecycle

Clinical tasks follow a strict status progression:

graph LR
    A[Acknowledge Task] --> B[Start Task]
    B --> C[Complete / Hold]
    C --> D[Document Clinical Outcome]

• Task Statuses: Completed (with outcome notes), Held (with mandatory explanation — minimum 10 characters), or Returned / Declined (with mandatory justification).
• Medication Tasks Rule: Medication-linked tasks cannot be completed using the generic "Complete" button. The system throws a validation block by design — medication administration must be completed through the dedicated eMAR endpoint to enforce the Five Rights check.
• Ward Coverage Rule: If no nurse is assigned to a specific bed, all nurses covering that ward receive outstanding task notifications — tasks are never silently lost.

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3. Electronic Medication Administration Record (eMAR)

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IMPORTANT:

Patient Safety Checkpoint: The Five Rights of Medication Administration Before administering any medication:

1. RIGHT PATIENT: Confirm wristband barcode or Moana ID against the patient banner.
2. RIGHT DRUG: Match the dispensed drug package against the prescription on the MAR.
3. RIGHT DOSE: Confirm package strength matches the MAR dose.
4. RIGHT ROUTE: Confirm oral, IV, IM, or SC route as prescribed.
5. RIGHT TIME: Confirm it is the scheduled administration window. If any of the Five Rights does not match: DO NOT administer. Hold dose and contact doctor & pharmacy immediately.

Action Button	Recorded State	Required Documentation & Validation
Given	Given	System logs nurse digital ID and exact administration timestamp.
Held	Held	Mandatory reason required: Select from Hypotension (BP Low), Bradycardia (HR Low), NPO for Surgery, Patient Sleeping, Patient Vomiting.
Missed	Missed	Mandatory reason required: Select from Patient Refused, Patient Off-Ward (X-Ray/OT), Medication Unavailable, IV Access Lost.

eMAR Medication Administration Record with Given, Held, Missed Buttons🔍 Click to enlarge

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4. AI-Assisted Shift Handover

1. Before the conclusion of your shift, open Shift Handover in the Nursing module.
2. The AI assistant drafts a summary based on: latest NEWS2 score, open/outstanding tasks, and medication given/missed counts.
3. Review & Edit Draft: Read the entire summary. Correct any inaccuracies and add missing clinical updates (escalations, family discussions, pending labs).
4. Official Sign-Off: Click End Shift & Handover to save and commit.

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IMPORTANT:

AI Handover — Draft Only Rule The AI-generated handover is a drafting aid. The submitting nurse is personally responsible for its clinical accuracy. Review, correct, and submit using "End Shift & Handover" — not the SBAR print button, which only prints the visible screen and does not save the official record.

AI-Assisted Nursing Shift Handover Editor with NEWS2 and MAR Counts🔍 Click to enlarge

AI-Assisted Nursing Shift Handover Editor with NEWS2 and MAR Counts🔍 Click to enlarge

AI-Assisted Nursing Shift Handover Editor with NEWS2 and MAR Counts🔍 Click to enlarge

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5. General Ward vs. ICU vs. NICU Workflows

Operational Feature	General Inpatient Ward	Intensive Care Unit (ICU)	Neonatal ICU (NICU)
Alerting Mechanism	NEWS2 aggregate score ≥ 7 fires STAT alert to assigned nurse & doctor	Critical threshold breach (HR < 40 or > 150, SpO2 < 90%, SBP < 80, GCS < 9) fires room-wide broadcast	Alerts are pull-only (dashboard banner indicators)
Vital Signs Parameters	Standard 5-parameter vitals + AVPU	ICU-specific vitals: GCS, arterial line BP, CVP, ventilator modes	Neonatal parameters: birth weight, incubator temp, oxygen therapy
Alert Durability	Durable — stored and displayed until actively acknowledged	Non-Durable — anyone not connected at alert time will not receive historical ping	Pull-only — regular manual dashboard checks required
Offline Caching	Standard ward views cached locally	ICU Admissions list confirmed to cache for offline viewing	Consult Moana Technical Team for offline cache status