e-MAR headaches!!!!!

  1. Recently started using eMAR. It had been a few weeks now. Nurses have encountered all kinds of problems. Some problems listed below:

    1. Font size too small to read. (My guess is a size 8 font. We have been told it is too difficult to change the font size and to just deal with it.)

    2. The medication box is cluttered with too much information so it is difficult to read the dose, route, and how often to give. Also, the generic and trade name are repeated multiple times within the box. The box may or may not contain all the information you need to administer the med (route, dose, etc.)

    3. Once orders are scanned to pharmacy it can take 12-24 hours for the meds to be entered by pharmacy. So pts have to go without meds. Occasionally we encounter a med we can "over-ride" in the drug pyxix. So if this happens and you give the drug on June 17 at 10 am and the drug is not entered until June 18 at 1600, the earliest you can chart that you gave it is June 18 at 1600. You cannot put in the acutal times meds were given. If you give a med and have the weekend off and the patient leaves, it appears you did not give a med because you were not there to sign it as given.

    4. Yellow boxes are supposed to indicate when a nurse is to give a med. Because of the tiny font size and clutter many nurses are relying on the yellow box. Many med errors have been made because this function does not always indicate when meds are to be given.

    5. With paper MARs we countered an average of 15 incorrect enteries by pharmacy on a given day in ONE unit only. On paper we could indicate to the following nurse that it was an incorrect entry or discontinued and we did not have to worry about it being given. With the eMAR the incorrect med can only be removed by pharmacy and that can take up to 24 hours for it to happen. Med errors have happened.

    6. Discontinued meds do not "fall off", but instead appear with a line through each word to "cross" it off. This just does not seem right. (Additionally, it makes for too many eMAR pages if the patient is in for any length of time.)

    7. If a daily med is given, and the dr comes and DECREASES the dose, it may appear 12 hours later on the eMAR and indicate it is to be given per a yellow box. In reality, the dose is not due until the next day. Example: Drug X 40 mg IVP every day is ordered and first shift nurse gives it. DR comes in and changes it to Drug X 30 mg IVP every day. Pharmacy enters it at 8 pm and it appears on eMAR with a dose to be given at 9 pm. The pt receives a total of 70 mg, when they should have only recieved 40 mg today and 30 mg tomorrow.

    8. One med pass takes about 15 minutes longer than it used to. Combine that with call lights, interruptions from drs and families.... and it is not a pretty picture. I don't know how the nurses with 7 patients are able to cope! Two patients in ICU takes at least 30 minutes on a good day!

    9. ICU nurses are not being able to access drips like nitroglycerine, cardene, levophed, etc. All nurses complaining they are unable to access antibiotics and prescribed drugs.

    Is your eMAR experience similar? Did our hospital buy the cheapest program out there and it is not working? We have been writing up incident reports left and right. Meds are being charted in the narrative charting to CYA. Complaints are falling on deaf ears. Pts are suffering. Pts are complaining (can't access pain meds either).

    Don't you think it would have been prudent to test the eMAR in one area first and work the bugs out? Our pts are NOT safer !!!!

    Suggestions, please!
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    About UnionRN2

    Joined: Jul '09; Posts: 56; Likes: 361


  3. by   AgentBeast
    If it were me I'd fire the computers out the window into the parking lot, but I wouldn't advise you doing that.

    Sounds like IT dropped the ball big time on this one, and **** flows downhill and nursing just happens to always end up at the bottom of the hill.
  4. by   raskol
    i'm curious what program is being used
  5. by   melmarie23
    why does it take pharmacy 12-24 hours to enter the meds? that wait is ridiculous. Scanned orders to pharmacy take at most an hour or two where I work. And if we need it sooner, we just call down and ask them to expedite it.

    Right now we are moving to CPOE (Computerized Physician Order Entry) where they enter all the med orders and pharmacy then verifies. Its nice. And again it only takes pharmacy an hour or two to verify the med orders.

    We also use EMAR for certain tasks such as specimen collections, pain reminders for pain reassessments, dressing changes etc. I think its nice.

    I believe for discontinued orders you can either keep them striked out on your EMAR or sort it so that just current orders are listed. Even further, you should be able to change the time to just your shift and see only the meds and tasks that are due on your time.

    EMAR can be very useful and helps with organization. Just give it more time to get the hang of it.
  6. by   UnionRN2
    I'm not sure of the name of the program.

    And I'm not sure why it takes pharmacy so long to turn around the meds. We were instructed by nurse manager and supervisors to stop calling because phone calls only compound the problem and makes the wait longer. I did call to try and get an antibiotic after 24 hours for an endocarditis pt and my name was collected (not sure of the reason... write up?) because nurses were not to call.

    Also asked the IS people walking around to help if it was possible to filter out the cancelled orders. It is... but they still appear. IS does not know why but they would get back to me. (But not one did.)
  7. by   Airidis
    I have emar where I work too and it is horrible how things happen. The other day in the system it said to give warfarin 2mg and then I found out later from NM that dr decreased their warfarin to 1mg... I was so upset with the pharmacy!
  8. by   ~Mi Vida Loca~RN
    The eMAR systems I have seen used have been very good and useful. One hospital system has the Electronic orders and another is switching to that soon. I LOVE that aspect. The docs are not happy about the change on this one but it makes it so much easier on reading their writing. The time pharmacy takes is quick to where I have seen and exceptions can be made if it's needed even sooner.

    Sounds like your facility has a lot of kinks to work out.
  9. by   Flo.
    I love Emar. I think your facility has a faulty program. What brand are you using. We have meditech and it works great.
  10. by   Jessy_RN
    The length of time for pharmacy to enter orders is insanely ridiculous. What if those meds are antibiotics or special compounds?

    We use Cerner and although I am not too thrilled about the charting system itself it is very easy to read and navigate the emar.

    If the system goes down or pharmacy is backed up with orders to be put in, then we can always pull our "down time" folder and chart the good ol' fashioned way (on paper MAR).

    Through our eMAR we can request a med, reschedule doses, add notes, etc
    If a dc's med doesn't fall off then, we can request it and then pharmacy will grey it out.
  11. by   ~Mi Vida Loca~RN
    Quote from Flo.
    I love Emar. I think your facility has a faulty program. What brand are you using. We have meditech and it works great.

    We have used meditech too. Here between the 2 health systems they use Meditech and Cerner
  12. by   blue heeler
    i can't wait for cpoe.
  13. by   2bTraumaRN2008
    Quote from blue heeler
    i can't wait for cpoe.
    CPOE is GREAT!! We have been using it for almost a year now...I love the fact that we have done away with paper for orders. It's very easy to enter a verbal order also, and if a med is involved, it is profiled by pharmacy within 5 minutes!!
  14. by   Jessy_RN
    My last place used Epic and it was great. Cerner is okay imho. When I work women's health they use Essentris and ER uses medhost at all the sister facilities I work.

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