Running Head: IMPLEMENTING EMAR SYSTEMS IN HOMECARE 1

Implementing eMAR Systems in Homecare

Delaware Technical Community College

NUR 410 Nursing Informatics

Reneé Smallwood

April 15, 2018

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Implementing eMAR in Homecare

Nursing informatics has vitally impacted one of the significant aspects of nursing,

medication administration and prescribing. According to Techopedia (n.d.), “eMAR speeds up

the prescribing process for patients and physicians” (Techopedia, n.d., para. 2). The use of

electronic medication administration records (eMAR), enables information to navigate smoothly

and quickly from the physician to the pharmacist to the bedside nurse. “An electronic medication

administration record documentation system is associated with overall nurse satisfaction and

perceptions of improvement in workload, teamwork, ease of documentation, drug information

accuracy, and patient safety but not nurse/pharmacy communication” (Moreland, Gallagher,

Bena, Morrison, & Albert, 2012, p.1). According to Sewell (2016), the new and improved

eMAR systems used in the refilling process of medications comply with the American Recovery

and Reinvestment Act (ARRA) of 2009, which enforces the use of electronic charting systems

and clarifies and secures the process of giving medications (Sewell, 2016). The use of such

systems has proven to reduce medications errors, transcription errors, and wait times, yet,

enhance patient satisfaction and quality of life.

The information provided by an eMAR system is beneficial and detailed. For example,

the medication dosages, number of refills, medication types, medication classifications, patient

refill history, real-time prescription status, and tracking capabilities are included on an eMAR

(Techopedia, n.d.). These automatically programmed tasks were once the duties of the nurse to

physically track, monitor and check all aspects of medication administration. The barcode

systems used in many inpatient hospital floors takes on much of the load associated with

automatic refilling medications, monitoring contradictions, and communication to pharmacies,

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though nothing negates sole responsibility for any nursing duty. Informatics has helped with

organizing, integrating and systemizing many essential parts of nursing and healthcare.

The growth and overall development of the eMAR systems used in the healthcare

industry today is a rather rapid and lucrative one. As with coordinating any new program into a

system, a trial and error period helps develop the final product accordingly. According to

Middleton et al. (2013), specific steps and strategies are needed to improve the usability of such

eMAR’s systems. A research team at the National Center for Cognitive Informatics and Decision

Making in Healthcare developed fourteen principals that helped usability including the safe and

effective use of electronic health records (EHR), visibility, consistency, reversibility, feedback,

and flexibility to name a few (Middleton et al., 2013). These fourteen principles are based on

evidence-based research and are thought to provide the plan and execution of this electronic

health record (Middleton et al., 2013). “US healthcare delivery is in the midst of a profound

transformation which results, at least in part, from federal public policy efforts to encourage the

adaption and use of health information technology (health IT)” (Middleton et al., 2013, p. e2).

Technology brings every aspect of healthcare together allowing a user to communicate with a

computer to influence a providers’ productivity and speed up work while a poorly designed

system takes away time from an already busy schedule (Middleton et al., 2013).

Filtering the good from the bad parts of an eMAR system encourages continuing and

accurate record keeping, assisting in identifying potentials for medication errors and improving

the quality of care provided. Negative consequences and outcomes may occur because of user

errors requiring proper use and understanding of the eMAR system (Middleton et al., 2013).

eMAR’s are incredibly paramount but only claims a small part of a massive picture of nursing

informatics. Sewell (2016) explains that as a nurse, there’s a code of ethics that states the
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professional values and beliefs which are based on ethical choices. Privacy and confidentiality

are beyond imperative to patients in healthcare today. The use of informatics warrants a rather

high likelihood of patient confidentiality breaches. The comfort of secrecy and privacy brings a

sense of comfort in going to the doctor and cushions the uncomfortably of discussing personal

health issues or concerns. One of the most talked about privacy acts that define and limits how

patient health information is used or disclosed, is, the Health Insurance Portability and

Accountability Act of 1996 (HIPAA). The healthcare industry has gained much compliance and

emphasis on HIPAA, and it now stands perpendicular to healthcare. According to Prater (2014),

“privacy, as distinct from confidentiality, is viewed as a right of the individual client or patient to

be left alone to make decisions about how personal information is shared” (p.7). Maintaining

patient confidentiality and privacy is a multidisciplinary effort that is the duty of healthcare

professionals with access to EHR to keep the information confident (Prater, 2014). Electronic

medical records have its perks but likewise has disadvantages but the advantages of using an

eMAR system are significant, especially in the home care setting.

Currently, at my weekend homecare job, communication between other agencies poses a

significant risk for a slew of mishaps including medication errors, overdosing, change in status,

routine changing of trach and g-tubes. One of my patients and his family are Spanish- speaking

only, and communication is solely dependent upon the nurses amongst three nursing agencies.

Due to the rarity of the non-traditional hours required, neither agencies cross paths. The patient's

mom cannot safely communicate the needs or wants of her child, and him being non-verbal

makes it impossible to communicate with him regarding his health.

Although it is not as familiar as in acute care facilities, medication changes are possible

and semi-likely. In-home care, the wrong medication can quickly be given out of routine placing
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the nurses’ license in danger though one may say that this should never happen due to the

process of checking and rechecking required by the nurse during medication administration. For

example, if a patient is scheduled to go to an early morning doctors’ appointment at the start of

the shift this will not allow enough time to provide morning activities of daily living (ADL’s),

safety and emergency equipment checks, and transfer of the patient. Though the clients’ chart is

to accompany them during transports, any change(s) that was initiated by another agency will not

be communicated in the current agencies chart on duty, making the risk for medication errors

high.

Poor communication makes it easy to forget a medication or overdose a patient without

proper and easily- assessable communication. In the home care setting, medications are signed

off via paper medication records with each agency providing their own and individualized

medication record. In my experience, when I report for a shift, the previous nurse lack of

communication leaves me to cipher through the unfamiliar patient chart of the agency's and hope

that the nurse charted everything because incomplete charting in-home care is a likewise issue.

Another significant issue that lack of communication poses is keeping a record of

scheduled changes such as trach and feeding tube changes which are vital to overall patient

health and quality. When changing these life-saving devices becomes delayed or omitted, the

already highly-likely risks of infections enhance tremendously. Specific days and shifts are

assigned to do such tasks, and it becomes difficult when three agencies share the responsibility.

In charting, I am expected to document these changes and often find it difficult to obtain an

accurate date of when these changes occurred.

There have been several attempts to communicate with a paper communication log that

often goes missing, which is ineffective because many nurses do not use them and even if
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enforced by one agency, the next agency may not deem it as necessary. With this, I would like to

prompt a transition into an electronic charting system for homecare agencies that enable

communication amongst a standard database like those of healthcare systems of Mainline Health,

Nemours, and Christiana Care. In these systems, patient information is always up to date and

accurate, eliminating the questions of whether a task was done.

One way to solve the communication issues amongst agencies and provide accurate

patient information is for the insurance companies to provide a tablet or electronic device that

incorporates all the charts from each agency. The proposed integrated medical record system will

result in one medication/treatment record as well as a flagging system that flags any changes in

medications or treatments. It will also aid in monitoring bowel movements and intakes and

outputs. Although unmentioned earlier, this is a likewise common issue amongst home care

where regular monitoring of toileting is often poorly relayed to the next shift.

The financial benefits of the systems mentioned above are grand. One unified, electronic

system reduces the cost and improves the risk of medication errors. Ideally, medication errors

become training experiences and are used to educate and prevent reoccurrences. Training often

involves paid sit-in and computer training, and workshops with a fee attached seen in some

healthcare settings. A unified electronic charting system has financial benefits and increases

patient satisfaction. Patients are satisfied when quick, high quality, accurate, and sufficient care

is provided. Patients are also often pleased when caregivers advocate for them. A system of great

communication can satisfy the needs of home care patients today.

Furthermore, this initiation may also enhance workplace satisfaction where nurses may

safely work within their scope without feeling concerns surrounded by lack of communication

which may lead to neglect of a patient. When one is happy with their workplace, they tend to
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work harder, have more pride, and are confident. The overall rippling effect satisfies both patient

and nurse. A policy in addition to a workflow map that can be utilized by the nurses to maintain

consistency and maintain effective electronic record keeping can help break down and condense

the needed steps to get a system that fixes the issue of communication in home care.
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Electronic Medical Records Policy

Statement: Electronic medical records are used instead of paper records to ensure effective

communication.

Purpose: To ensure that the medical records are documented accurately, globally and

efficiently.

Procedure/Policy:

I. Electronic records are an approved form of medical record management.

II. Only authorized persons who have been issued a password and user ID code will be

permitted access to the electronic medical records system.

III. Authorization to access medical records data is based on the need to access the data.

Restrictions permit staff only to access data that must be viewed or modified by them.

IV. When personnel changes occur, or there is a reason to believe that unauthorized

access to data has occurred, information technologist (IT) will investigate and review

the security of the data and change passwords and user ID codes if necessary.

V. Authorized federal and state survey agents, may be granted access to electronic

medical records.

VI. Our electronic medical system:

A. Has safeguards to prevent unauthorized access

B. Has individual passwords and user ID codes and permission is established to ensure

only authorized persons to enter appropriate data;

C. Records each entry into the medical records at the time of entry.

Will not permit a change in record once it has been recorded without approval
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START

At client’s bedside

Receive report from family/nurse

NO Ask family about

Chart Located medication
administration
status

YES

Read chart for any change in

status or care

Medical Record Reviewed

Meds verified

YES

Administer medication

Document
\ on MAR

Report administration to family

upon departure
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START

At client’s bedside with

tablet

Receive report from family/nurse

Unified Chart Located NO

Ask family about
medication administration
status

YES

Read chart for any change in

status or care

Medication Record Reviewed on

unified data base

Meds verified

YES

Administer medication

Document
on EMAR

Document a thorough report in

electronic charting database
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References

Middleton, B., Bloomrosen, M., Dente, M. .., Hashmat, B., Koppel, R., Overhage, M., . . .

Zhang, J. (2013, June 1). Enhancing patient safety and quality of care by improving the

usability of electronic health record systems: recommendations from AMIA. Journal of

the American Medical Informatics Association, 20(1), e2-e8.

doi:https://doi.org/10.1136/amiajnl-2012-001458

Moreland, P., Gallagher, S., Bena, J. F., Morrison, S., & Albert, N. A. (2012, February). Nursing

satisfaction with implementation of electronic medication administration record.

Computer, Informatics, Nursing (CIN), 31(2), 97-103.

doi:10.1097/NCN.0b013e318224b54e

Prater, V. S. (2014, December 8). Confidentiality, privacy and security of health information:

Balancing interests. Retrieved April 15, 2018, from HealthInformatics.uic:

https://healthinformatics.uic.edu/blog/confidentiality-privacy-and-security-of-health-

information-balancing-interests/

Sewell, J. (2016) Informatics and Nursing: Opportunities and Challenges. (5th Edition). Wolters

Kluwer.

Techopedia. (n.d.). Electronic medication administration records (eMAR). Retrieved from

Techopedia: https://www.techopedia.com/definition/25658/electronic-medication-

administration-records-emar