Find Patient Safety In Numbers With Bedside Medication Administration Solutions

By Joan Harvey, DNP, MSN, RN, CCRN

Ocean Medical Center is an acute care hospital with 281 acute beds, 40 rehabilitation beds, 15,339 admissions and 68,000 emergency visits annually. It is part of Meridian Health, a leading health care organization in New Jersey, comprising of six hospitals and partner companies. Recently, hospital leadership recognized the need to use information technology to collect medication safety data. The goal was to find solutions that would aid in the prevention of serious adverse drug events.

In June 2010, with that goal in mind, Ocean Medical Center implemented an Electronic Medication Administration Record (eMAR), a system that includes bedside barcode scanning technology to monitor and safeguard the administration of medications.

Not surprisingly, implementation of the new system posed a significant change for the nursing staff, pharmacy staff and information technology department. Managing change at a health care facility comprised of 530 physicians and 1,400 total team members required buy-in from everyone in the organization. To achieve that support, team members and providers needed to understand how the initiative would benefit not only the hospital, but also their jobs and their patients.

Medication error metrics showed impressive declines soon after implementation. Within the first three months:

• administration errors decreased from 36 percent to 29 percent;
• moderate-severe administration errors decreased from 35 percent to 21 percent; and
• the wrong patient receiving medication decreased from 7 percent to less than 1 percent.

Before MAK, the three medications most commonly involved in errors were insulin, hydromorphone and heparin. After the implementation, insulin and heparin were still linked to the most errors, but hydromorphone dropped out of the top three. Interestingly enough — and contrary to the hospital's expectations — medication administration omission and wrong-time errors actually appeared to increase after MAK from 8 percent to 17 percent. On closer inspection, it was found that the automation offered current time documentation and made nurses more aware of missed or late doses. Late medications now are flagged with a different color in the system, which provides an opportunity to improve.

Aside from the error reduction, other benefits of the MAK implementation include:

• decreased incidental overtime (because workflow is more efficient and documentation is completed immediately);
• more timely documentation (because mobile workstations at the bedside reduce the need to walk to a charting station); and
• an increased perception of nursing presence among patients.