eMAR Rolls out Across Oncology Units
Pharmacy’s Jarett Szczepanski, left, and Dan Voit, join Ashley Karol, RN, and, at computer, Katie Connelly, BSN, RN, during the eMAR roll-out on Tower 6C.
Karen Contois immediately noticed the precision and diligence of the nurses caring for her on Tower 6A. “Everyday, they pointed out each pill I was taking and what I was taking it for,” said Contois, a leukemia patient.
After three weeks, Contois was informed that the unit was rolling out eMAR—BWH’s electronic medication administration record—to enhance patient safety. “The only change I noticed was that the computer came into the room with nurses now, and they scanned my wristband,” she said. “It’s been seamless to me because the care is so good here. I just have to worry about getting myself well; they take care of everything else.”
Tower 6A and 6C were the final inpatient units to receive eMAR in November, completing the fall roll-out across all Hematology/Oncology/Bone Marrow Transplant units at BWH. The transition from paper to eMAR in Oncology has been three years in the making as nurses, physicians, pharmacists and IS staff have collaborated to revamp the Chemo Order-Entry system in order to add chemotherapy administration into eMAR.
Because of the complexity of chemotherapy regimens, which often involve four to five additional medications, in addition to hydration and anti-nausea medications given in advance, the planning has been detailed and precise. eMAR provides prompts for nurses at the correct times to administer each medication.
In addition, there are approximately 500 active research protocols at DF/BWCC, and each carries a bit of nuance, said nurse educator Ruth Muller, MSN, RN, AOCNS. “We’re different from the rest of the hospital in that, in addition to chemotherapy, there’s the complexity of the research protocol and its stringent requirements,” said Muller, one of the nurses working with IS and Pharmacy to design the system.
Many nurses were looking forward to receiving eMAR, and they have embraced the technology as an important safety measure.
“I love it,” said Katie Connelly, BSN, RN, of Tower 6C. “Your labs are right there, your bloods are right there, all on one screen.”
The user-friendly design is due, in large part, to the staff nurses who participated in the development process and offered practical and crucial input. “I think the involvement of staff nurses in the development of eMAR has been key in that the users guided it,” said Muller.
Any new technology or system requires a change in practice, and this one was monumental and the right change to improve the safety of patients. “We have many nurses who, for their entire career, have been looking at pieces of paper,” said Anne Bane, MSN, RN, manager of Clinical Systems Innovations for the Department of Nursing, who has led the implementation of eMAR throughout the department.
To support nurses in learning the eMAR system, a group of super-users “lived” on each inpatient unit 24 hours a day, seven days a week, for the first two weeks. After the initial two weeks, staff could access the super users through a designated pager number they could call with any questions. With the roll-out complete, super users returned to their own pods and continue to serve as a unit-based resource.
“We’ve recieved a lot of support,” said Cathleen Rowland, MPH, BSN, RN, who graduated from the Peter Bent Brigham Hospital School of Nursing and has been here since. “At first, it’s hard getting used to a change in your practice and your daily routine, but the fact that it is safer for patients really increases your security.”
Pamela Thomas, RN, a nurse in-charge on Tower 6A, agreed. “Once you learn it, I am finding that it is easier,” said Thomas, a nurse at BWH for 30 years.
As an added support, Center for Nursing Excellence staff became super users and served as resources during the implementation.
Paulita Alinskas, BSN, RN, of the Center for Nursing Excellence, said, “We teach eMAR in orientation, and to see it in use on the inpatient units enriches our teaching ability. We can bring real-life examples to the classroom.”
All nurses agreed: eMAR enhances the safe environment for their patients. As Chemotherapy Resource Nurse Colm Gormley, MSN, RN, said, “It’s a change in workflow for nurses, but it’s worth it for the increase in patient safety.”