Question

1 1. How should medication errors be addressed at each step of the EMAR process: Prescribing, Transcribing, Dispensing and Administration? 2. Why should closed-loop medication administration (CLMA) technologies be the last defense to medication errors in the delivery of optimum patient care and safety?

Answer 1

Ans) 1) Bar code eMAR technology ensures that the correct medication is administered in the correct dose at the correct time to the correct patients. When nurses use this technology, medication orders appear electronically in a patient’s chart after pharmacist approval.

- The technology also alerts nurses electronically if a patient’s medication is overdue. Before administering medication, nurses are required to scan the bar codes on the patient’s wristband and then those on the medication itself. If the two don’t match the approved medication order, or if it's not time for the patient’s next dose, a warning is issued.

2) Closed Loop Medication Management (CLMM) system is a fully electronic medication management process that integrates automated and intelligent systems to completely close the inpatient medication management and administration loop, and seamlessly document all the relevant information.

- New Closed Loop Medication Administration Process:
1. Physician enters orders online using CPOE and evidence based order sets.
2. Medications populate in the eMAR in real-time.
3. Orders are routed to automated dispensing cabinets for cart fill and first dose dispensing.
4. Nurse views medications on eMAR and obtains medications that are due for the patient.
5. Nurse signs into CareMobile using his/her barcoded ID badge.
6. Nurse uses CareMobile™ to scan pre-packaged unit-dosed medication(s).
7. Nurse scans patient armband.
8. Nurse reviews and resolves any alerts, administers medications to the patient and signs off the administration on CareMobile.

- Discrepancies/alerts detected at any of the above stages require clinician intervention in order to proceed to the next stage. Therefore, CLMA technologies have been viewed as the last defense against medication errors at the sharp end of care.