Electronic Medication Administration Record
ELECTRONIC MEDICATION ADMINISTRATION RECORD (eMAR)
Technology that automatically documents the administration of medication into certified EMR (electronic medical record) technology using electronic tracking sensors (for example, radio frequency identification (RFID)) or electronically readable tagging such as bar coding).
A Medication Administration Record or MAR (eMAR for electronic versions) is the report that serves as a legal record of the drugs administered to a patient at a facility by a health care professional. The MAR is a part of a patient's permanent record on their medical chart. The health care professional signs off on the record at the time that the drug or device is administered.
Recently, the name eMAR (electronic medication administration record), has been used interchangeably with the name BCMA (bar coded medication administration)
Many medication mistakes occur during the prescribing and dispensing stage but 26% to 32% of errors occur during administration. The bedside nurse needs a safe method to make sure that medications are administered correctly. Use of a paper MAR could be incomplete, misinterpreted, or even lost. A medication administration record system which fully integrates with a computerized physician order entry (CPOE), and pharmacy systems should increase efficiency while providing a fail-safe system.
eMar increases the efficiency and safety of the prescribing and administration process for patients, nurses and physicians. eMAR also complies with federal regulations developed as a result of the American Recovery and Reinvestment Act (ARRA) of 2009 which incentivizes all health care facilities and doctors' offices move from paper medical records to electronic medical records (EMR). eMar is one tool that can help to reduce adverse medication errors. The bar coding technology used is similar to that seen in supermarkets. Quality assurance flags and audit tracking tools are typically inherent in eMARs to enable user audits and tracking of errors.
A nurse at the Colmery-O'Neil Veterans Affairs Medical Center (VAMC) in Topeka, Kansas is credited with the initial idea of using bar coding technology for medication administration. In 1994, she thought the bar coding used by a rental car company to track vehicles could also be used in a similar manner to track medications ordered and administered to patients. Her idea of electronic checks and balances would augment, but not replace, a nurse's clinical judgment.
“A prototype system was developed at the Colmery-O'Neil VAMC and later became the model for the award-winning bar-code medication administration (BCMA) system used throughout the Veterans Affairs (VA) health care system beginning in 1999. By 2003, throughout the VA health care system, all inpatient care areas were consistently using positive patient identification at the point of care to document activities associated with medication administration through the use of BCMA.”
- Objective Meaningful use stage 2 started in 2012
Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record(eMAR).
More than 10 percent of medication orders created by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period for which all doses are tracked using eMAR.
HOW IT WORKS
A provider makes an electronic entry detailing a patient’s medication orders. The orders then appear in the pharmacy software package of BCMA to be edited and verified by a pharmacist. Verified orders become available in the nursing staff’s point-of-care BCMA. (Figure 2). A virtual list of medications due is used to display medications and the appropriate administration time frame for each medication. Medications may be scanned and administered, following a medication order verification by a registered nurse. As a handheld barcode reader registers each medication, the software verifies the correct medication was ordered, administered on time, and measured in the correct dosage, while at the same time documenting the actual administration of the medication.
According to CMS, Centers for Medicare and Medicaid Services, the recent meaningful use definitions (October 2012) under the American Recovery and Reinvestment Act, eMAR(s) should enable the user to electronically verify the following before administering medication(s):
- (A) Right patient. The patient to whom the medication is to be administered matches the medication to be administered.
- (B) Right medication. The medication to be administered matches the medication ordered for the patient.
- (C) Right dose. The dose of the medication to be administered matches the dose of the medication ordered for the patient.
- (D) Right route. The route of medication delivery matches the route specified in the medication order.
- (E) Right time. The time that the medication was ordered to be administered compared to the current time.
Doylestown Hospital in Doylestown, Pennsylvania has implemented the Electronic Medication administration Record (eMAR), which is a full integrated system that bring together bluetooth wireless and hand-held scanners to read the bar codes of drugs. This systems tracks the patients drug dosage from the pharmacy to the nursing station and finally to the patient bedside. All patients are given a bar coded wrist band that is used for identification. The nurse scans the wrist band before the medication is given. When the nurse scans the wristband and medication the eMAR will alert the nurse if any allergy or incompatibility.
The Medication Administration Process:
- Physician writes the order then is sent the pharmacy
- Pharmacist enters information into Meditech
- Pharmacy bar code medication and is given to patients floor
- Nurse review patients medication list
- eMAR alerts nurses on next dosage and complication
- Heath, Hazel (1995). Potter and Perry's Foundations in Nursing Theory and Practice. Elsevier Health Sciences. ISBN 0-7234-2005-X. Retrieved 2008-04-21
- Schneider, R., Bagby, J., Carlson, R. (2008). Bar-Code Medication Administration: A Systems Perspective. American Journal of Health System-Pharmacy, 65(23), 2216-2219
- ICU nurses' acceptance of electronic health records.