Академический Документы
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Культура Документы
Reneé Smallwood
Nursing informatics has vitally impacted one of the significant aspects of nursing,
the prescribing process for patients and physicians” (Techopedia, n.d., para. 2). The use of
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
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,
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
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
IMPLEMENTING EMAR SYSTEMS IN HOMECARE 4
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
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
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
IMPLEMENTING EMAR SYSTEMS IN HOMECARE 5
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
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.
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.
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
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
IMPLEMENTING EMAR SYSTEMS IN HOMECARE 6
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
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
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
IMPLEMENTING EMAR SYSTEMS IN HOMECARE 7
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.
IMPLEMENTING EMAR SYSTEMS IN HOMECARE 8
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:
II. Only authorized persons who have been issued a password and user ID code will be
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.
B. Has individual passwords and user ID codes and permission is established to ensure
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
IMPLEMENTING EMAR SYSTEMS IN HOMECARE 9
START
At client’s bedside
YES
Meds verified
YES
Administer medication
Document
\ on MAR
START
YES
Meds verified
YES
Administer medication
Document
on EMAR
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
doi:https://doi.org/10.1136/amiajnl-2012-001458
Moreland, P., Gallagher, S., Bena, J. F., Morrison, S., & Albert, N. A. (2012, February). Nursing
doi:10.1097/NCN.0b013e318224b54e
Prater, V. S. (2014, December 8). Confidentiality, privacy and security of health information:
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: https://www.techopedia.com/definition/25658/electronic-medication-
administration-records-emar