Lessons Learned: The Completion of a New Installation


In August our hospital implemented the e-mar – electronic medication administration record – documentation system. It was decided by the powers to be that a "Big Bang" roll-out would work much more efficiently than trialing the system on one unit first. This decision was made despite the months of "team" meetings where numerous members of lower Leadership expressed their concern and apprehension. Part of the package purchased with the software contract included on-site program developers and support. It was with this promise of guidance and support, that we were urged forward – pressured into meeting our initial launch date. It was said that we were facing a change in "thought process" among the older staff members – we were told that once the product was on the units that "buy in" would be quick – that the system was here to stay and the staff would have no choice but to adapt and accept. It has been and absolute nightmare to say the least. We have literally two nurses assigned to our computerized programming department. Neither one has had actual computer training other than what the emar company has provided. The provided program developers are nonclinical based professionals trying to create in a clinical field. Input from participating departments is often dismissed. Instruction to the staff has been inconsistent with unit based nurse clinicians being forced to teach computer classes with minimal orientation and little to zero resources. Feedback to staff over system errors, challenges and restrictions is inconsistent and varies depending on who is delivering the message. The list could go on for pages and has created dismay and distrust, a sense of failure within the Nursing department. Pharmacy has had an even more difficult struggle – expressing their concern over the timing and method of implementation during a period that their department had several vacant positions, including that of a department director – but we had a deadline to meet after all. In addition we have since discovered that there are several different software systems being utilized throughout the organization, L&D, ASU, Endo, OR, IRU, Dialysis, offsite, Dental and ER – to name a few. Not only do these systems not communicate with each other but they are for the most part not able to effectively incorporate the e-mar system. This has created an environment of half paper half electronic documentation, inconsistent between departments. Errors are being made, system failures and limitations are not being addressed within a timely fashion – if at all. With that said, the e-mar system may be more time efficient, cost effective, and allow for increased patient safety…but without expertly trained program developers, consistent clinical based instructors, adequate and around the clock implementation support staff, consistent and accurate communication between all departments of the organization – including frontline staff, realistic goals and time lines and the ability to make corrective and adaptive changes – the transition for the staff can become difficult, frustrating and unsafe for both patients and healthcare professionals alike.

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