Article-eMars-Challenge for Nursing Education

eMars-Challenge for Nursing Education

One of the newest technological advancements in healthcare is the use of an electronic or computerized medication administration reporting system (eMars). Research has shown that implementation of this type of system decreases medication errors in the hospital setting (http://www.dh.org/body.cfm?id=434).
One of the JCAHO initiatives is to improve patient safety and decrease adverse drug reactions (ADRs) related to medication errors (JCAHO, 2009). Hospitals are using electronic or computerize medication administration systems with bar coding to address this initiative (Hughes and Blegen, 2008).
Implementation of these systems presents a new challenge to nursing educators. No longer do students have access to a patient’s MAR. For security reasons, many clinical facilities are opposed to granting students access to patients’ medical records. Faculty is now being taught how to navigate the computerized systems. The faculty then accesses the MAR for the student prior to administering the medication. This results in multiple barriers to the way that medication has been administered in the past.
The systems require a learning curve for faculty to become comfortable with the technology. Several agencies surveyed reported they require 4-8 hours of education prior to being allowed to access the computer system. Most faculty require a yearly update, usually at the beginning of the fall semester. Other barriers include: limited access to the computers (many times faculty needs to wait until the nurses have completed their medication pass), relying on the nursing staff to keep the faculty member abreast of any patient changes, time spent listening to report and reviewing the chart for each medication order. Because of the amount of time spent preparing for medication administration for the patient(s) and the fact that there are 8 clinical students in each rotation who are assigned 2 to 3 patients, some hospitals recommend only two to three students administer medication on a single clinical day.
Each student is given an electronic patient worksheet which is a synopsis of the patient’s assessment information, tests, medications, etc., for the period since admission.
So the dilemma becomes how to maximize the experience for all students. Several strategies were developed. Strategies include:
Clinical Simulation
All students are required to practice and pass a skills competency. Included in this is medication preparation and administration for all routes. Medication administration is a component of high fidelity simulation critical thinking labs. Students review an electronic medication administration tool and administer medication as indicated for their patient. During the simulation creative strategies are used which include: potential allergic reaction, a violation of the 5 rights, indiscernible signature, no armband, etc.
Medication Administration Tool
A medication administration tool was created that would mimic a medication pass (Appendix A). All elements of safe medication administration were included. The topics included information about each medication (dose, route, frequency and classifications), indications, labs/supporting data, side effects and evaluation of effectiveness. Students who are not assigned to pass medication on that clinical day would still be responsible for completing the tool on each of their assigned patients.
Checking Patient’s Chart
Students must check patient’s chart prior to administering medication. The original order must be checked against the eMar for accuracy. Faculty will also review the original orders.
Saline Flushes
Faculty requests nursing students perform all IV saline flushes. The students then perform the procedure under the supervision of the faculty. Faculty can evaluate technique. Students practice hand movements as well as safety when administering an IV medication.
Changing IV Tubing
Faculty requests nursing students perform all IV tubing changes. The students then perform the procedure under the supervision of the faculty. Faculty can evaluate technique and monitor competency.

Evaluation- A qualitative survey was completed by each student at the end of the semester. The survey focused on the number of times students were administering medications in each semester. Also graduating students were asked if they felt competent to administer medication. The results demonstrated
(1) Frequency of administration of medication increased as the students progressed through the semesters (Appendix B).
(2) Frequency of practice in the nursing lab for medication administration decreased as the students progressed through the semesters
(3) 85.1% of all graduating students felt prepared to administer medication (Appendix C). 14.9% of all graduating students did not feel prepared to administer medication. Upon further investigation, these students expressed a desire for more supervised practice.

Analysis
By augmenting traditional medication administration practices with creative and innovative solutions, the faculty was able to meet the educational goals of the students. Also, remediation opportunities were created to assist the students who did not feel prepared to administer medication. At completion of the program, all graduating nursing students felt prepared and competent to safely administer medications

I will be more than happy to provide all forms as requested. Thanks, Kathy