Overview of eMAR Electronic Medication …

1 Overview of emar . Electronic Medication administration record March 2006. WHAT IS emar ? emar Electronic Medication administration record - Replaces the paper MAR. MAK Medication administration Check (Siemens). Main Components: Bar-coding of Medication ;. Bar-coding of patient wrist band;. Bar-coding of employee;. Scanning all of the above into the MAK system to ensure the 6 Rights of Medication administration are met. Medication PROCESS FLOW WITH TECHNOLOGY APPLICATIONS. Pharmacy Information CPOE Systems emar . Computerized Automated Medication Bar Code Educational Tools Management Systems Verification (PYXIS). Prescribing Dispensing administration INDUSTRY DRIVERS. To Err is Human, Institute of Medicine The Leapfrog Group Crossing the Quality Chasm, Institute of Medicine Reducing and Preventing Adverse Drug Events Hospital Costs, AHRQ.

2 Patient Safety Act of 2001. JCAHO Patient Safety Standards MANUAL Medication MANAGEMENT PROCESS. Flags aren 't pulled to indicate an order Medical Students take chart to get Physician doesn 't stamp the order Charts put everywhere except the but it is placed back in chart rack . Resident to countersign orders . and handwriting is illegible . rack . So orders delayed or lost . Unit Clerk /RN Confusion Physician is to Nurse or Clerk Is the Faxes Med Orders about Medication Order Written by stamp orders with Physician is to pulls the chart satellite to Main Pharmacy . which fax Physician . Chart Flagged by his /her name stamp , place the chart from the rack to No Pharmacy is Then stamps the line to use . Dr . Red for Stat or Green for for compliance / back in the rack review and take off There is open?

3 Order as being When to regular orders legibility the orders sometimes faxed . page the confusion Pharmacist because the because it change is not know Pharmacist reviews order is not if he /she is faxed Med Order . always in the Contacts Physician for Yes found and satellite problems and writes a there has office , etc. Verbal Order for changes Is this the been no received from Physician . first day of No Unit Clerk /RN. verbal admission ? Faxes Med Orders discussion Fax line is busy , then between the to Satellite somone will remove the The Unit Clerk /RN Pharmacy . Then Pharmacist order sheet , in order to Verbal Order handwritten on the stamps the order and Nurse . Yes fax something else . Pharmacy as being faxed.

4 Change written of Therefore the Pharmacy computer blank Physician does receive the order . generated MAR . Order Sheet . The Unit Clerk /RN. Was this Many nurses don 't want to stand creates done by the Yes in line for PYXIS and so have handwritten two - RN reviews one Unit Clerk ? part MAR . adopted the procedure of pulling Pharmacist enters The Unit Clerk patient 's MAR and The new all their patient meds . They write pulls the Yellow prepares their Pharmacy Med Order into room numbers on cups and stack Siemens No Flag to alert the Medication . Med verbal the cups to make med rounds . nurse an order may be in supply order is Pharmacy system needs to be room , refrigerator , lost and checked . PYXIS , or med nursing Meds are given to cart.

5 Does know of When the RN RN checks orders the patient but Order Sheet the completes transcribed by Unit some indicated delivered to Unit in change transcription of the Clerk and signs that the MAR is left RN takes med to a bag with other patient room in the until 8 or order, he / she orders & initials at the station . Pharmacy items 24 hour signs the order MAR . Also it was noted factory package . and placed in that MAR sign -off Conducts 5 right checks sheet & initials the Pharmacy Box are done . MAR . for administration check and occurs are time administers med . Order is now complete and can be they pull the med from PYXIS . administered . Is the Pharmacist fills the RN does end of ordered RN documents No Med Order and shift check of Med Medication in Med administered deliver to Unit Orders against on MAR.

6 Yes PYXIS ? MAR . Red lines This process / procedure is the order & initials , not followed consistently . also initials the MAR . Night RN does 24. Pharmacist prints The nurse charts hour check - Old MAR daily early the effect and No action required MAR against New morning hours and scale of pain MAR against Med delivers to Units . meds . Orders . HIGH LEVEL Medication administration PROCESS WITH emar . Nurse Goes to Bedside Nurse Prepares Meds Process Processredesign redesign Software Softwaresupports supportsclinical clinicalworkflow workflow Bar-code Bar-codeIDIDat atadministration administration Online Onlinedocumentation documentation Nurse Scans ID, Patient Medication administration and Meds Automatically Documented (6 Rights Checked).

7 BENEFITS OF BAR CODING AND emar . Patient Safety: Verifies that the RIGHT Drug, is being administered to the RIGHT Patient, at the RIGHT Dose, by the RIGHT Route, at the RIGHT Time. Medication administration is automatically documented. (6th RIGHT). Online MAR is likely to be more accurate than traditional MARs generated manually. Real-time orders on emar . REQUIREMENTS FOR A SUCCESSFUL PROJECT. Strong clinical leadership Nursing, Pharmacy and IT must work together along with Physicians, Respiratory Therapy and Admissions Unit specific work flow analysis with Nursing and Pharmacy Reporting to Patient Safety Committee Staff must own the process: Nursing: Medication administration Pharmacy: Bar Coding. REQUIREMENTS FOR A SUCCESSFUL PROJECT.

8 Committed Steering Committee Representation: administration Nursing Physicians Education, Development and Research Performance Improvement / Patient Safety Pharmacy Respiratory Therapy Health Information Services Information Technology Other Clinicians Medication administration PROCESS RE-ENGINEERING TEAM. Team includes: Key Nursing Leaders Key Pharmacy Leader and IS Pharmacist Director of Nursing Informatics Goals: Review and revise Medication policies, procedures and processes;. Impact analysis to Nursing productivity;. Review of Medication distribution process, Pyxis. OVERALL BAR CODING STRATEGY FOR UCSD. Various Bar Code Symbologies Available: Scanners that can read multiple symbologies are key! Patient and staff bar coding solutions can enable safer: Specimen collection Tissue tracking Blood product administration Final Thoughts from the Institute for Safe Medication Practice (ISMP).

9 Technology is just one tool, among many, that needs to be consistently and effectively used by organizations striving for fail-safe Medication use.