Improving Safety in Facilities Without E-MAR Systems

Technology definitely serves an immense purpose in healthcare. In this article, I want to take a moment to acknowledge what an E-MAR is and why it’s important for healthcare facilities to utilize them. We’ll also discuss actions you can take to improve medication administration safety when your facility does not utilize an E-MAR system. Nursing is the specialty, and covering your backside is the name of the game in this situation.

So what is an E-MAR? It’s an electronic medication administration record. In other words, it is an electronic record of all the patient’s scheduled and PRN medications that you have available to access and administer. If it’s not on their record, you likely won’t be able to access that med in the pyxis without a supervisor’s override to do so. Many of these systems require you to verify the patient and medication when removing the medication from the pyxis, sometimes verify certain medications and/or doses with another nurse, and scan/verify the patient and each medication at the patient’s bedside as you are preparing to administer them. This provides at least 2-3 checkpoints in the medication administration process to help prevent errors and ensure proper safety involved with the drug, dose, time, route, and frequency of administration.

In some facilities, especially those long-term hospitals, have yet to upgrade their computer systems and med dispensing systems to provide these extra checkpoints in the medication administration process. This lack of improvement in technology can contribute to an increase in medication errors if nurses are not hypervigilant of their every action. So, let’s discuss some of the actions you can take to CYA and prevent an error from occurring with one of your patients.

First and foremost, focus on one patient at a time. When you go to withdraw medications from your med dispensing system, make sure you are comparing the med, dose, route, time of administration, frequency, and reason for administration for each and every single medication on your list. You’ll want to take these measures when you select the med on the dispensing system, when you are withdrawing the med from the dispensing system, and perform a third check prior to your administration of the medication at the patient’s bedside. Consider having a second nurse verify all of your high risk medications with you prior to administration. Examples of these types of meds include, but are not limited to: insulins, drip medications, narcotics, seizure medications, and emergency medications during a code situation.

When administering your medications, take every possible action to limit any distractions during that time. Put the phone away, focus on the patient and the medication you’re giving in that moment. Perform your checks on the rights of drug administration and ensure criteria are met for administration of the medication. For instance, you may have the right med, dose, time, route, and reason for use of a medication but if their vitals are too abnormal, some medications cannot be administered (Ex: giving metoprolol to a patient with a HR 62 and BP 98/68).

If you are unsure about what a medication is used for (so you can ensure they meet appropriate criteria for administration) or if a medication is compatible with another, contact your pharmacy department or speak directly with the pharmacist. They should be able to tell you if a dose should be adjusted for renal/hepatic function or based on lab results, if there are specific contraindications for a medication, incompatibilities, if a med should be held until after a hemodialysis session, etc. The pharmacy staff are there for a reason, so utilize them whenever you have any second thoughts or doubts.

Lastly, many of the med dispense systems have a way to generate and print reports about the medications you withdraw. If the dispensing system doesn’t communicate with the charting system, this is a particularly handy tool to use. Print the report of drugs you pulled out for the shift, especially narcotics, and make sure that their administration was correctly documented. For narcotics, doing this can also help ensure that you account for all doses being administered and any wastes that were necessary to document as well.

Safety is the top priority with medication administration in the nursing profession. You want to take every possible measure to ensure the patient is receiving the right medications for the right reasons, not only for their sake but also to protect that license you worked so incredibly hard to earn.

Until next time, happy studying!

Andra Alyse