Holyoke Medical Center Turns the Tide with Pocket PCs
(1/24/2008)

Moving from a manual Medication Administration Record (MAR) to an electronic MAR (eMAR) can be a challenge for any hospital, but Holyoke Medical Center (Holyoke, MA) rose to the occasion when they became the first MEDITECH site to use MEDITECH’s Point-of-Care eMAR software. Working closely with MEDITECH's Development team, Holyoke experienced a smooth June go-LIVE in their pilot unit, which left nurses raving about the new technology.

Brief History To evaluate which eMAR software would best suit Holyoke's needs, they first organized an eMAR Core Team, which included nurses, a respiratory therapist, a pharmacist, and I.T. professionals. The Core Team met each month for one year prior to the implementation of the eMAR. After a thorough review of the software, the Core Team received the thumbs-up from Holyoke's management to implement the MEDITECH Point-of-Care eMAR on pocket PCs. "The ease of storing handhelds, combined with straightforward point-and-click functionality, led us to choose MEDITECH's eMAR for handheld devices," says Sue Sullivan, RN, manager application services. Implementation Approach Holyoke first held conference calls with other sites to determine the best pilot approach for implementing the Point-of-Care eMAR. While many other sites chose the OB unit as their pilot site, Holyoke pursued a different approach by selecting its Transitional Care Center (TCC) instead. “Using our transitional care unit as our pilot made more sense to us, as it allowed us to test the software in an environment that mirrored an acute care setting,” explains Sullivan. “In the TCC, we deal with the most common drugs, so we knew that when we went to roll out the application to other units we would only need to deal with unique scenarios or medications not prescribed in the transitional care unit.”

Another benefit to selecting the TCC is that patients do not transfer into and out of the unit, but are only admitted and discharged, eliminating potential conflicts between automated processes in the TCC and manual processes in other units.

In moving from a manual to an electronic MAR, one challenge Holyoke faced was ensuring the electronic display of information would be clear to nurses and pharmacists alike. According to Sullivan, this involved reevaluating existing processes for communicating with the pharmacy. “Both the nurses and the pharmacists worked together to determine the most efficient method of data entry so all information would flow accurately and clearly,” explains Sullivan. “People often underestimate the amount of work it takes to modify pharmacy workflow to accommodate a new process, but this is a critical step. It not only affects nurses, but will also affect physicians when we later role out CPOE.”

Holyoke trained one Super User per shift as the "go-to" person for other staff members. The rest of the nursing staff was provided with a four-hour training session by the I.T. department before going LIVE. With I.T. on board for support, every nurse was up and running on the system within one week. "Considering how long the TCC nurses had used a manual MAR, we were extremely impressed with how quickly the staff adapted to using handhelds with the eMAR," says Debbie Lajoie, RN, project leader for point-of-care implementation. An Eye on Patient Safety While use of the eMAR greatly improved communication between nurses and pharmacists, one challenge Holyoke faced was their pharmacy was open only until 9:00 P.M. As Joint Commission guidelines require two licensed practitioners to review and verify medications before administration, Holyoke needed someone available to verify medications when their pharmacy was closed. To avoid placing this added responsibility on nurses, Holyoke determined the best way to ensure patient safety was to hire a "virtual," or on-line, pharmacy to verify these orders. Holyoke pharmacists trained the pharmacists employed by the on-line pharmacy company on how to use MEDITECH Pharmacy software and on Holyoke's standard operating procedures.

Realizing the Benefits of the eMAR
Now that nurses in the transitional care unit have gone LIVE with the eMAR, they cannot imagine ever going back to paper. “I can say with 100% certainty that within a week, all of our staff felt comfortable using the electronic eMAR. In fact, in June, we chose to take the system down for eight hours to install a SAN, and when we did, all of our nurses wanted the eMAR back, as they did not want to go back to documenting medications manually,” recounts Sullivan.

Nurses especially enjoy having access to real-time information readily available. "The transmission of data from the eMAR to the Patient Care Inquiry product (PCI) makes viewing the last administered dose especially straightforward for physicians and nurses. This allows them to make key decisions about their patients, without having to interrupt another nurse to ask when the last dose was administered," states Lajoie.

But beyond automating processing and real-time access to medication data, Holyoke has also realized countless other benefits which make their electronic MAR far superior to their previous paper one. “In the manual world, there were no flags to alert nurses to check lab results prior to administering certain medications,” explains Lajoie. “In the electronic world, however, lab results are automatically displayed during administration, and nurses can be flagged of potentially dangerous values. The system can require nurses to enter specific information, such as a patient’s blood pressure, prior to administration. These types of features help ensure greater patient safety." Another major benefit Lajoie acknowledges is the ability to flag nurses when medications are due or overdue. “Color-coding lets nurses know when medications are overdue. Also, the system can require nurses to enter comments if a medication is not administered or is administered late,” explains Lajoie. Furthermore, the eMAR has changed the workflow for Holyoke's unit secretaries. "No more dealing with manual transcription," she notes. Sullivan also finds the system’s reporting capabilities helpful for trending documentation. "I can use the MEDITECH system to generate reports, which are very useful as management tools. Trended documentation is a way of pinpointing accountability," she explains.

The Future
After going LIVE in the Transitional Care unit, the eMAR Core Group took a step back to evaluate strategies and workflow for rolling out the software in all other units. With the stage now set, Holyoke will begin the process in January and has given itself an eMAR implementation timetable of three to four weeks per floor. They anticipate being LIVE in all inpatient nursing units by June of this year.

“Implementing an eMAR was one of the biggest challenges nurses at Holyoke have ever undertaken, and I am amazed at the awesome job they did. Everyone was so positive and willing to learn,” remark both Sullivan and Lajoie.

With the eMAR under its belt, the next step in Holyoke's strategic plan is to begin implementing CPOE, with a Physician Care Manager (PCM) pilot group planned for September.

 

About Holyoke Medical Center
Since 1893, Holyoke Medical Center (Holyoke, MA) has provided personal, superior health care by employing highly credentialed medical staff who have trained throughout the world. An affiliate of UMass Memorial Health Care, Holyoke is a member of Valley Health Systems, which includes Holyoke Visiting Nurse Association, Inc., Western Mass Physician Associates, and River Valley Counseling Center. A MEDITECH customer for over 20 years, Holyoke is the first MEDITECH site to use MEDITECH’s Point-of-Care eMAR software.

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