eMAR Has Dramatic Results Study Says

Using bar-code technology with an electronic medication administration record (eMAR) "substantially reduces transcription and medication administration errors, as well as potential drug-related adverse events," said a new study funded by AHRQ.

Researchers at Brigham and Women's Hospital in Boston compared 6,723 medication administrations on hospital units before bar-code eMAR was introduced with 7,318 medication administrations after bar-code eMAR was introduced. Having bar-code eMAR technologies in place was associated with reductions in errors related to the timing of medications, such as giving a medicine at the wrong time, and non-timing medication administration, such as giving a patient the wrong dose.

Lead Study Author Eric G. Poon, M.D., M.P.H., Corporate Manager II, BWH Clinical Systems, Partners Healthcare, said he's seen the benefits first-hand. "We've had computerized physician order entry for more than 10 years, and we know that the technology alone reduces the incidence of medication errors at the point of prescribing by 55 percent, but in spite of having that in place we knew there were other opportunities to improve patient safety. We knew errors were being made at the point of medication dispensing and in the pharmacy when orders are transcribed onto paper medication sheets, so safety leaders at Brigham saw an opportunity to reduce errors with this technology at the points of medication dispensing, order transcription and medication administration. "

The researchers documented a 41 percent reduction in non-timing administration errors and a 51 percent reduction in potential drug-related adverse events associated with this type of error. Errors in the timing of medication administration, meaning a patient was given medication an hour or more off schedule, fell by 27 percent. No transcription errors or potential drug-related adverse events related to this type of error occurred.

Bar-code eMAR is a combination of technologies that ensures that the correct medication is administered in the correct dose at the correct time to the correct patient. When nurses use this combination of technologies, medication orders appear electronically in a patient's chart after pharmacist approval. Alerts are sent to nurses electronically if a patient's medication is overdue. Before administering medication, nurses are required to scan the bar codes on the patient's wristband and then on the medication. If the two don't match the approved medication order, or it is not time for the patient's next dose, a warning is issued.

Poon said implementing eMAR successfully depends on seeing it as far more than a technology project, and involving clinicians heavily. "Our pharmacists and nurses got together and really thought about how they were processing medications throughout the system, about how we translate the idea of an aspirin order for Ms. Jones into her actually getting the pill. They thought there was an opportunity to streamline and reinvent the process, and they took that opportunity to introduce technology to support that new process. I think that we have learned that a key to success is getting front-line clinicians to buy into a new process that can be supported with IT."

The findings have important implications because bar-code eMAR technology is being considered as a 2013 criterion for Meaningful Use under HITECH. The study is published in the May 6 issue of the New England Journal of Medicine.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].