Nursing Home EMAR – Needed?

I recently had dinner with some of my nursing colleagues who work in a local nursing home and somehow we started talking about some of the issues they face and the need for a Nursing Home EMAR. They mentioned that patient safety is their top priority. In their second breath, they said that medication errors are a problem and a growing concern in the nursing home. Their nursing home, with paper-based charts and records, including the medication administration record (MAR) is all handwritten. They were wondering how they could get the same kind of technology and convenience that hospitals use where patients get perhaps more medicine, treatments, and attention from nursing staff than in acute care facilities and more importantly over the long term.

My colleague mentioned that some of the patients who had several medications, sometimes 10-20 per day, had a paper MAR the size of a book. They had to transcribe individual dosage instructions and explained that’s just the way it has been done for decades.

The problem they said is that illegible entries translates into medication mistakes. Reading a handwritten note left by a doctor or colleague about discontinuing a medication or changing the dosage can sometimes be difficult. If a med pass is delayed when nurse must meet another urgent resident need, they said “It’s common to put a marker or pen  into the MAR when interrupted”. With manual practices that introduce so much margin for error, confidence that their MARs will pass scrutiny and inspection gets pushed way down. In addition, they said that they had to reconcile their paper-based MARs with the pharmacy at the end of the month to match the – this web drugs. Needless to say, sometimes its just hard to reconcile all the differences and these differences can result in huge fines.

Fine dinner discussion, but I guess they were really excited that they had several companies in to present their nursing home EMAR solutions and were looking forward to getting rid of their pencil and paper. I said they will always need their pencil and paper, but maybe not for MAR!