Successfully Implement Universal Electronic Medication Administration Record (eMAR) in the Operating Room Management (ORM) Module of MEDITECH Client Server
Note: To relate to this BLOG, the reader should have some basic understanding of MEDITECH Client Server Operating Room Management Module build and functionality.
As consultants, we often experience a strong resistance to change when we arrive at a new customer site for an engagement. It’s hard to blame the organization’s staff for feeling this way. Even when implemented with thorough planning, training, and execution, change is difficult. When we talk about implementing Universal eMAR in the ORM module of MEDITECH Client Server, one of the most common complaints I hear often comes from the Operating Room Charge Nurse: “You know the nurses are not going to do this! It’s too many clicks! Too many steps! As a nurse, I am NOT going to document for someone else!”
As an ORM Nurse Consultant, I can say that in my experience, the learning curve is about 3 weeks. The degree to which documentation occurs ensures medication documentation accuracy and prevention of errors. With the Order/Admin Single Dose feature, an OR nurse can document medications in the same manner and location as the rest of the organization. If desired, scanning of medication barcodes can be implemented. Because the medications are documented in one universal tool, their administration can be tracked enhancing the narrative of a patient’s care.
The comprehensive Electronic Medication Administration Record (eMAR) is accessible from all clinical areas where medications are administered. Features allowing the quick order and administration documentation, including incremental dosing of one time medications have been developed to support operating rooms and to accommodate different workflows.
Enabling the Universal eMAR replaces standard ORM Medication and Intakes screens with the PCS eMAR, IV Spreadsheet, and Intake & Output Assessments which are launched from the Operative records (PreOperative, Holding, Operative, Phase I and Phase II records) based on Access Option Sets permissions. The Universal eMAR displays any medications that exist on a patient’s profile, and depending on access, nurses may create orders using Order/Admin or Get From Pref Card functionality.
If you have not implemented Operating Room Management (ORM) yet, my recommendation is: Implement the Universal eMAR with the initial project. This will prevent many pain points in trying to transition after a go-live where Standard Medications and Intakes documentation was implemented.
Recently, one of our customers made the decision to move to the Universal eMAR when the following challenges were identified:
- The initial ORM build allowed for the creation of mnemonics for medications that were not in use in the Pharmacy Formulary. This was done to allow Preference Cards to be built with Medications in the items section so that double billing did not occur if medications were pulled from the dispensing machine as well as included in the Preference Cards. The double billing was also caused, in part, by the parameter settings of the dispensing machine and the setup of the charge formulas. Pharmacists spent numerous hours tracking down supporting medication administration documentation.
- The Standard medication documentation did allow for nurses to choose from orders entered onto the patient profile if the end-user used the “drop-down” functionality from the date field. If the end-user chose the drop-down function within the “Medications Administered” field, the end-user was presented with the entire pharmacy formulary. This allowed for documentation of and billing of medications that were not administered because the end-user selected the wrong form of the medication.
- When an end-user was unable to identify the correct medication in the drop-down list (using the drop-down of the formulary vs the drop down of medications ordered), they documented a narrative in the Nurses Notes. Because the PHA parameters were set to Admin Bill on Dispense, the patient bill showed a medication was dispensed for the patient but the pharmacists could not see administration documentation. Pharmacists spent an inordinate amount of time searching for documentation of administration of medications that were pulled from dispensing machines. Often, assistance (IT Help Desk tickets were created) from the IT applications team was requested to locate the documentation.
In Order to proceed with a transition to the Universal eMAR, several tasks had to be tackled. There were many workflow changes, but the big decisions are listed here:
- The customer did not allow nursing order entry (POM) of medication orders. The policy was updated to allow for this. This is necessary for use of the Order/Admin Single Dose and Get From Pref Card functionalities.
- The customer had to decide to set the Vend as Single Dose parameter to “YES,” allowing the full dose dispensed to be visible on the eMAR.
- Based on the previous point, pharmacists needed to have access to edit billing. When “Vend as Single Dose” is set to “YES” and the facility “Admin Bills on Dispense” and has Charge Formulas set to provide a lower cost when multiple units are dispensed as one dose, return of a unit does not credit accurately.
(Note the test patient data above is not reflective of the medications shown in the screenshots below, but the concepts are represented)
This view shows the incorrect crediting of 1 returned item when Vend as Single Dose is set to Yes.
Needless to say, more testing and preparation has to be completed before a process change than has to be done with an initial implementation based on Best Practice. The ultimate goals:
- Patient Safety: everyone sees the same medication administration record
- Decreased pharmacy workload: not searching for administration documentation
- Increased pharmacy revenue: capture of meds administered that may not be pulled from Pyxis (stored in cupboard or on shelf in department)
- Increased end user satisfaction: communication of patient story – subsequent care providers can see what has been administered and when