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.

Tags: Healthcare Informatics, Healthcare Informatics Resources, Health Care Informatics electronic medication administration record e-mar, Health Care Informatics Electronic Medical Record

Medication administration is going to be a difficult task with all the new and different types of computer documentation systems available. Medication administration will always be the responsibility of many parties, not just nursing. One of the post mentions nurses as the last line of defense, and there are many steps where errors can occur. The physician writes the order, hopefully correctly and legibly. It is then the responsibility of the pharmacy to ensure the medication is available and that it has been profiled against all current medications and allergies. The nurse must need to teach the patient the effects of the meds, the reason for the med and side effects. Last line of defense in an era where too many people rely on computers for correct information, but we must remember that information within the computer is only as good as the people inputting that information. So every one should think of themselves as the last line of defense against med errors. That, and only that, will lead to a decrease in med errors. As long as excess meds are stocked on units and physicians are allowed to write illegibly, and pharmacists don’t verify everything that comes out of the pharmacy, errors will always be there.

Original Post
July 17, 2009
Title: The 6 rights of medication administration, comment
Coming across this post, l recognised the device (scanner) which the writer says her facility uses. On the face value, JAHCO will applaud this device because it acted as if the cases of med errors have been eliminated. Yet as the writer said, it still goes back to knowing your patients and knowing your medications. Nurses are the final check point in the health team providers list. We are in between the ordering physicians and the releasing pharmacists. Nurses have to see that the parameters for which the drug is being administered is not in violation. For instance, nurses know by common sense that once the med is due, the scanner will scan and does not tell if the parameter for using a betablocker is checked for not. It is up to the nurse to make sure that the blood pressure is stable and the heart rate is within normal range. Despite these technologies, we are still required to do our checks before trusting the device.

Original Post:
June 30, 2009
Title: The 6 rights of drug administration
The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

Defense Attorney Lawyer Medication Drug Error

Tags: Healthcare Informatics, Healthcare Informatics Resources, Computerized Medication Drug Administration, Drug Medication Error, Electronic Health Record, Defense Attorney Lawyer Medication Drug Error, Healthcare Informatics Information Systems

Coming across this post, l recognised the device (scanner) which the writer says her facility uses. On the face value, JAHCO will applaud this device because it acted as if the cases of med errors have been eliminated. Yet as the writer said, it still goes back to knowing your patients and knowing your medications. Nurses are the final check point in the health team providers list. We are in between the ordering physicians and the releasing pharmacists. Nurses have to see that the parameters for which the drug is being administered is not in violation. For instance, nurses know by common sense that once the med is due, the scanner will scan and does not tell if the parameter for using a betablocker is checked for not. It is up to the nurse to make sure that the blood pressure is stable and the heart rate is within normal range. Despite these technologies, we are still required to do our checks before trusting the device.

Original Post:
June 30, 2009
Title: The 6 rights of drug administration
The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

Tags: Healthcare Informatics, Healthcare Informatics Resources, Computerized Medication Drug Administration