A Safeguard for BWH’s Tiniest Patients
Kerri Duggan scans baby Catherine’s tiny bar-coded bracelet, as parent Lea Proia-Roy watches.
Joann Slymon, RN, a clinical nurse on CWN-9, remembers when that unit was the first in the hospital to implement BWH’s landmark electronic medication administration record, or eMAR, with bar code scanning for adult patients in 2005.
This time around was a much smoother process, as eMAR was rolled out in the nurseries in the Connors Center for Women and Newborns (CWN) this spring, providing one more safeguard for BWH’s tiniest patients.
“We have been using eMAR for the mothers on our units for years,” said Slymon of CWN-8,9 and 10. “Learning the new system for newborns was basically an adaptation of what we already do for the moms. Staff adjusted pretty quickly, and we feel good about the safety it ensures for our babies.”
Her sentiments about the safety features eMAR provides were echoed by many nurses throughout the NICU and the well-baby nurseries on CWN-8, 9 and 10, where eMAR went live.
The revolutionary system links order-entry, pharmacy and the medication administration record to improve patient safety. Since the bar-coded medication distribution and administration system began in early 2000 and eMAR first went online in the Tower in 2005, targeted pharmacy dispensing errors have been reduced by 85 percent and potential adverse events by approximately 63 percent.
“For a parent, it’s reassuring to watch us scan a medication or milk product and then scan the baby’s bracelet,” said Kerri Duggan, RN, NICU clinical nurse. “And for me as a nurse, it’s important to be on the cutting edge of technology that enhances patient safety.”
With the CWN roll-out complete, eMAR is now on all inpatient units at BWH.
“The successful implementation of eMAR reflects outstanding teamwork from IS, Nursing, Nutrition, Respiratory Therapy, Medicine, Pharmacy, unit coordinators and unit service assistants,” said Marianne Cummings, MSN, RN, nursing director of the NICU. “Their combined efforts have enhanced the safety of administering medication and breast milk to our tiny and vulnerable patients. We are so grateful to everyone who worked hard to develop and implement this patient safety process.”
A Strong Team
Anne Bane, MSN, RN, director of Clinical Systems Innovations for the Department of Nursing, provided the nursing technology leadership for this eMAR implementation as she has done for every inpatient unit throughout the hospital.
“We had a great team of postpartum and NICU nurses, physicians and respiratory therapists and pharmacists, as well as Information Systems staff, who were critical to the success of the implementation,” said Bane.
Although CWN is the last inpatient area to implement eMAR, there was a substantial amount of work for IS, Pharmacy and Nursing to complete behind the scenes. That’s because all of the hospital’s other eMAR systems are based on the adult patient pharmacy system.
“The existing eMAR system was already connected with the adult pharmacy system. After reviewing the requirements to get eMAR up and running in the NICU and well baby nurseries, we decided to incorporate the existing NICU pharmacy system into the adult pharmacy system so that we had one system for approving and one system for administering medications,” said Michael Sweet, corporate team lead for IS. “There were also new features we needed to develop in both systems to support the newborn patients.”
Enhancing Patient Safety
One of those safety features is an automatic way for the pharmacy system to calculate the amount of medication and diluent needed when diluting a medication several times. “Medications don’t always come in sizes specifically for babies,” said Michael Cotugno, RPh, director of Pharmacy Patient Care Services. “We have to measure out and dilute doses, sometimes several times, to come up with the small dose a baby requires. There’s no reason that staff should have to do this math manually; rather, we want the system to automate it and then staff can check it to make sure it’s correct.”
IS and Pharmacy began this work last summer, completed development by January and spent a few months working on quality assurance prior to the go-live this spring. With the merging of the Pharmacy systems, the groups also wanted a way to determine right away if they were looking at a profile for a mother or a baby. To enable nurses and other care providers to make the distinction at first glance, a blue border was added for adult patients, and a maroon border for babies. IS, Pharmacy and Nursing met as a group for a year to make adjustments that ensure the system fit in with nurses’ workflow.
In addition to medications, the eMAR system in CWN also includes a unique application created by IS and staff from the NICU for bar-coding a mother’s or donor’s breast milk to ensure that the right baby receives the correct breast milk.
For nurses working in the nurseries, that aspect of eMAR ensures a more streamlined process. “Before we had eMAR for the newborns, we had to bring in a second nurse to ensure that we were giving the right milk to the right baby,” Slymon said. “eMAR does that for us with a quick scan, and we don’t have to take another nurse away from what he or she is doing elsewhere.”
Maureen Kent, RN, scans a medication on CWN-9.Support from Nursing Colleagues
Support from Nursing Colleagues
Nurses had extra support so they could learn the new technology while providing patient care. “IS had people here 24 hours a day while we were getting up to speed,” said Duggan. “We also had nurse super-users from the NICU and other areas of the hospital to help us learn the system.”
Slymon and Janet Kelly, RN, Cardiac Surgery clinical nurse, were two of the super users assigned to the NICU during the implementation.
“As super users, we wanted to ensure that we were there if nurses had a problem or a question, and to support them as they took care of their patients and learned new technology at the same time,” said Kelly, who has worked as a nurse at BWH for 30 years. “I told them that once you learn the system, it quickly becomes automatic for you to incorporate it into your care.”
Kelly recalled how important it was to have nurse super users when Cardiac Surgery received eMAR in 2005. “As a clinician, it was very reassuring to have someone there to ask if you needed help,” she said.
For Kelly, it was also an opportunity to appreciate her colleagues on the other side of the hospital. “I really learned about the differences between our adult care ICUs and the Newborn ICU,” she said, recalling how touched she was watching a set of newborn twins grow during the six weeks she was there. “I was so impressed with the NICU nurses. It made me really proud of my profession to step back and see what nursing does and what nurses do.”