e-MAR headaches!!!!!

[UnionRN2]

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!

[RosesrReder, BSN, MSN, 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.

[3dayRN]

we use Meditech also, sounds like a pharmacy problem also not just a computer problem. We do not have ANY of the problems you mentioned. If there is an error it is usually the pharmacy that entered it in wrong but it's as easy as a phone call and the problem is corrected. Our discontinued meds the whole box turns yellow so it is easy to identify.

[Mommy&RN, BSN, 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.

We also use Cerner, I really like the Emar on it.

12-24h to have meds entered is INSANE!!!! We very rarely have a 2 hour wait. Our physicians still write paper orders, we scan to the pharmacy and have the option of routine or stat. That will prioritize your stat gtt over my new routine med orders.

It is very nice that we can reschedule meds also. Say the pt is away from the floor for a few hours, and they had a q6h med due while they were gone, I can give it when they get back and move the next dose so they don't get them too close together, and have to stop and call or message pharmacy.

If something isn't in our stock, we can send a note. There is a drop box of options, so 3 clicks your done.

Once an order is d/c'd it turns grey and goes to the bottom.

Our scheduled meds are on a blue background, prns are green and infusions are blue, but are at the bottom of the list. Overdue meds get a red box.

[ava2012]

Your experience certainly sounds like a nightmare! We have been using a system called Extended Care Professional (http://www.ecp123.com). It is so easy to use & is very affordable for any type of facility.

It has everything we need all in one. We really like that it doesn't require you to buy or install any type of software. It is completely web-based and you can access it from anywhere with an internet connection. Whenever we have any questions, their staff is very friendly and has always answered our questions in a timely fashion.

It would be our best recommendation for an eMar!

[picurn10]

hmmm, that sounds terrible. Our physicians write an order and a paper order prints, and an electronic copy is sent to pharmacy. At most it takes 10mins for it to show on the emar and the pyxis. If its longer than that, I just call to pharmacy and they fix it while I'm on the phone. Cancelled orders show up the same way, except that they fall off the emar, and you can see it at the bottom of the screen in yellow as a "d/c'd med" If you try to scan the med, it will give you a pop up that its been d/c'd. The stuff your describing sounds more dangerous than papers mars!

[BettyPalen]

My question with filling out both the 7 and the 14 days MARS is what do you do when the list of meds is longer that the MARS itself? Do you use a new one for the same day? So confused; need to know for an assignment. Thanks!