Skip to contents
In This Issue:
Kerri Duggan scans baby Catherine’s tiny bar-coded bracelet, as parent Lea Proia-Roy watches.
This spring, BWH’s landmark electronic medication administration record with bar-code scanning, or eMAR, was rolled out in the nurseries in the Connors Center for Women and Newborns, providing one more safeguard for BWH’s tiniest patients.
“For a parent, it’s reassuring to watch us scan a medication or milk product and then scan the baby’s bracelet,” said Kerri Duggan, RN, of the NICU. “And for me as a nurse, it’s important to be on the cutting edge of technology that enhances patient safety.”
Duggan’s sentiments were echoed by many nurses throughout the NICU and the well-baby nurseries on CWN-8, 9 and 10, where eMAR went live in May and June. The revolutionary system links order-entry, pharmacy and the medication administration record to improve patient safety. Since the bar-coded medication distribution and administration system began in early 2000 and eMAR first went online in the Tower in 2005, targeted pharmacy dispensing errors have been reduced by 85 percent and potential adverse events by approximately 63 percent.
With the Connors Center roll-out complete, eMAR is now on all inpatient units at BWH.
A Strong Team
“We had a great team of postpartum and NICU nurses and physicians, as well as Information Systems and Pharmacy staff, who were critical to the success of the implementation,” said Anne Bane, MSN, RN, manager of Clinical Systems Innovations for the Department of Nursing. In addition to medications, the eMAR system in the Connors Center also includes a unique application created by IS and staff from the NICU for bar-coding a mother’s or donor’s breast milk to ensure that the right baby receives the correct breast milk.
Although the Connors Center is the last inpatient area to implement eMAR, there was an incredible amount of work for IS, Pharmacy and Nursing to complete on the back end. That’s because all of the hospital’s other eMAR systems are based on the adult patient pharmacy system.
“The existing eMAR system was already connected with the adult pharmacy system. After reviewing the requirements to get eMAR up and running in the NICU and well baby nurseries, we decided to incorporate the existing NICU pharmacy system into the adult pharmacy system so that we had one system for approving and one system for administering medications,” said Michael Sweet, corporate team lead for IS. “There were also new features we needed to develop in both systems to support the newborn patients.”
Enhancing Patient Safety
One of those safety features is an automatic way for the pharmacy system to calculate the amount of medication and diluent used when diluting a medication several times. “Medications don’t always come in sizes specifically for babies,” said Michael Cotugno, RPh, director of Pharmacy Patient Care Services. “We have to measure out and dilute doses, sometimes several times, to come up with the small dose a baby requires. There’s no reason that staff should have to do this math manually; rather, we want the system to automate it and then staff can check it to make sure it’s correct.”
IS and Pharmacy began this work last summer, completed development by January and spent a few months working on quality assurance prior to the go-live this spring. With the merging of the Pharmacy systems, the groups also wanted a way for a nurse to determine right away if he or she was looking at a mother’s profile or a baby’s. To enable nurses and other care providers to make the distinction at first glance, a blue border was added for adult patients, and a maroon border for babies. IS, Pharmacy and Nursing met as a group for a year to make adjustments that ensure the system fit in with nurses’ workflow.
“The successful implementation of NICU eMAR reflects outstanding teamwork from IS, Nursing, Nutrition, Respiratory Therapy, Medicine, Pharmacy, unit coordinators and unit service assistants,” said Marianne Cummings, MSN, RN, nursing director of the NICU. “Their combined efforts have enhanced the safety of administering medication and breast milk to our tiny and vulnerable patients. We are so grateful to everyone who worked hard to develop and implement this patient safety process and, in particular, would like to acknowledge Anne Bane for her extraordinary leadership.”
Nurses had extra support so they could learn the new technology while providing patient care. “IS had people here 24 hours a day while we were getting up to speed,” said Duggan. “We also had nurse super-users from the NICU and other areas of the hospital to help us learn the system.”