Potential Effects Medication Safety When Adding EMR

Last year Inpatient Unit converted from paper charts to electronic documentation Pharmacy entering orders electronically Phased approach Bedside Medication Verification (BMV) not planned until August 2012, so nursing using printed MAR

Complaints Complaints surfacing about variance between paper MAR and orders during chart checks Nurses felt that pharmacists were making errors Pharmacists felt nursing complaints were unfounded Chart checks took a long time Nurses were handwriting corrections

First Steps Created a reporting mechanism Encouraged reporting

Action Steps Reviewed each entry with pharmacy and nursing Grouped similar items Started with low-hanging fruit Looked at processes and re-education Continued each month

Looking at the Problem 63 discrepancies in the first month of measurement Missing medication14 Incorrect dose10 Missing time9 Duplicate8 Incorrect number of doses7 Incorrect admin times3 Missing dose3 Unclear order3 Incorrect medication2 Incorrect time2 Incomplete form1 Incorrect frequency1

Looking at the Problem Missing medication14Process change after hours Incorrect dose10Pharmacy review of printed MAR Missing time9Pharmacy review of printed MAR Duplicate8Pharmacy review of printed MAR Incorrect number of doses7Pharmacy review of printed MAR Incorrect admin times3Pharmacy review of printed MAR Missing dose3Pharmacy review of printed MAR Unclear order3Process change for clarification Incorrect medication2Pharmacy review of printed MAR Incorrect time2Pharmacy review of printed MAR Incomplete form1Process change for clarification Incorrect frequency1Pharmacy review of printed MAR

PfP Metrics Jan-12Feb-12Mar-12Apr-12May-12Jun-12Jul-12Aug-12Sep-12 MAR Variance Total Patients Metric23.5%10.4%11.7%15.1%8.1%7.3%5.2%3.3%3.9% ADE (Cat C-I) Total Patients Metric0.0%0.3%0.4% 1.4%1.2%0.8%1.0%1.2% Note: ADE increase in May due to inclusion of nausea or itching

Changing Landscape eMAR and Bedside Medication Verification Scanning problems Barcode issues Training and training and training Printed MAR versus eMAR

Current and Future Fewer discrepancies or less reporting? User error or system error?