Healthcare Informatics Resources

I have worked at a Medical Center for 5 years. During that time frame I have seen many changes in the way that orders are processed and medication administration to patients has gone from manual paper MAR system to using a scanning computer system. Five years ago orders were handwritten by doctors on carbon copies that were then faxed to pharmacy and medication orders were printed out on a paper MAR system or transcribed on the MAR by nurses to update orders. This system led to many errors mostly due to illegible writing by doctors, errors in transcription by pharmacy/nurses, and, or errors by nursing in checking the doctors orders. Medication errors were reduced in part by the Pyxis system; however, the nurse could possibly pull the wrong medication from the wrong pocket or container and give the patient the wrong medication. This was and had been a problem at our hospital with sentinel events. The hospital eventually moved to doctors placing their orders through the computer system directly to pharmacy reducing errors of transcription because of illegible writing. However, this did not take care of the problem of nursing errors with wrong medication given to patients. Even with the 5 rights, errors still occur due to human error, fatigue, multitasking, and multiple medication administrations to several patients at one time. UCSD implemented the MAK system or Medication Administration Check System. This system uses a bar code scanning system that corresponds with a bar code on the medication packaging and also with the patient’s identification band upon admission. The computer system also checks times so that alerts are given if a medication is given too soon or was given late. Pain medication is assessed for a pain scale and where pain is located and that information is flagged so that the nurse can then go back and assess the patient for pain 2 hours after the pain medication is given and if the medication was effective for the pain or not. Also it has made insulin administration easier to follow with 2 nurses required to sign in and document correct insulins and dosages given for blood sugars entered into the MAK system. All this information can be accessed by the doctors in one easy to access place to see if pain medication, blood pressure medication or diabetic medications are effective and if changes need to be made based on the information entered into the MAK system. The Pyxis system has also been reconfigured to reduce medication errors. Medication used to be in an open container where a nurse could pull a medication from the wrong open container. If checks were not in place, a wrong medication could be given to the patient with dire consequences. The Pyxis is now loaded with closed containers that only open when the drawer is pulled out fully and the correct flap for that container opens. This reduces errors in pulling out the wrong drug from the wrong container. This system has worked very well on the unit with few or any problems. The major problem was getting people to CHANGE their routines. Many nurses were resistant to change from the MAR system to the MAK system. However, the MAK system has been far easier to use and with the use of laptop computers that are mobile with the scanning device attached, meds can be given anywhere. The only issues I have seen that were problems are when the MAK system goes down and a MAR paper must be instituted to chart medications. This seems now to be such an archaic system and more difficult to use. The other issue that is a problem specific to our inpatient psychiatric unit is that we work with very paranoid, suspicious patients or Chronic Paranoid Schizophrenics (CPS) who are extremely wary of scanning devices and refuse to have any “laser cross my skin.” The MAK system also has a bypass for ripped bar codes on medications or a refusal of patient’s band to be scanned so that medications can be given. I believe that these computers programs are designed to make our jobs easier, more assessable with less leeway for errors to occur. The real reward for me as a nurse is that I get to spend more time with my patients then spending time with my paperwork!

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