Being in communications and long-term care, I couldn’t resist “The Real Nurse Jackie’s” column posted on McKnight’s today. In ”Whatchamacallit”, she uses Mensa formatting to come up with some new terms that will surely become part of long-term care nursing’s every day vocabulary. I may even start using these myself!
As we get ready for the last weekend of summer, I just wanted to share some of these fun favorites:
D-prescribing — The inability to get pain medication for you residents since no e-prescribing system exists that meets the DEA requirements
Documagicmentation — A director of nursing's wishful thinking that she can magically change the horrific nursing note she just stumbled across by mental telepathy
Physiciass — That attending physician who won't return your calls because he thinks the nurses in nursing homes won't have anything of importance to tell him
Regdiculous — That incredibly stupid deficiency you received because the survey team couldn't find anything substantial but they just wouldn't leave without tagging you with something
Read them all for yourself… something tells me some of these will committed to memory easily, no 'quysicals' needed.
Often, the desire to move away from paper to electronic medical records prompts a closer look into alternatives eMARs (electronic medication administration records). One can find many options, from those simply downloaded from the internet to solutions developed and provided by institutional pharmacies.
Not all eMARs are created equally. You have to choose what is right for your facility and will help you achieve your goals. Is it simply that you want to eliminate paper? Is it that you want to create assurances of complete, accurate documentation? Are you looking to change processes to gain more timely information regarding pharmacy issues to reduce errors and improve resident safety?
As you embark on your quest for an eMAR, consider the following "must ask questions":
- How will an eMAR enhance your relationship with the pharmacy? Does it allow for a direct connection to a pharmacist? Can the pharmacist access your eMAR remotely?
- Is the eMAR simply an electronic version of a paper MAR? Do you understand its limitations and inability to prevent errors or validate quality administration?
- How does the eMAR communicate within your facility? Does the vendor supply a wireless connection? Who installs this? Who pays for it?
- What will it take to implement an eMAR? How long? What resources will it take to get started?
- How will you train your nursing staff? How much is training and how much support is given on the days after launch? What about on-going training of new staff?
- Are you able to send and receive information to and from the pharmacy in real-time? If not, what is delay and on what information?
- Is support provided around the clock?
- Who do you call with problems? Do you have different people to call for software issues than pharmacy issues? What about for networking or hardware issues? Does the company selling the solution own the technology?
- Can your eMAR interface with another in-use application to share admissions, discharges, and transfer information to eliminate the need for duplicate entry?
- Does the eMAR allow physicians and managers to have remote access? Can physicians enter their own orders from their office and expect these orders to immediately become available to both the nurse and the pharmacy?
Choosing an eMAR that is right for your facility is important. Asking the right questions can eliminate surprises that may make or break your experience.
I recently read a great blog post in Long-Term Living titled “When a resident runs out of a med” by Kathleen Mears, a nursing home resident. The information she provides about her experiences of going without prescribed, necessary medications served as a reminder to why advances in pharmacy services for long-term care are necessary.
Ms. Mears sites several possible causes for medications to be unavailable to her or her neighboring residents. In reviewing these closely, all are often avoidable.
Reason 1: Billing or payment issues
Insurance companies have listed formularies and often, when a nurse in a nursing home goes to place an order, they are notified hours (or even days) later that the medication requires pre-authorization. Often a medication is even dispensed and then later, it is learned that it is not covered, then the medication needs to be changed. In a manual world of faxing orders to pharmacies and pharmacists evaluating each order then notifing the facility of conflicts, the delivery of medications can be delayed.
Alternative: Instead of faxing and waiting, electronic medication management systems will allow the order to be checked against a payer's formulary immediately, even before the order goes to the pharmacy. This allows the caregiver to make changes or get authorizations quickly so that the medications are dispensed in a timely manner and according to the resident’s insurance requirements.
Reason 2: Failure to Re-order
Some pharmacies use a sticker system for re-ordering and it often is missed by busy caregivers or due to varying nursing shifts.
Alternative: Using an electronic medication system, reorders can be completed with a simple click – nothing to lose, nothing to forget. This happens regardless to what nurse is doing the med pass and regardless of who did it last.
Reason 3: Discontinuation of Meds
Medications are discontinued by the manufacturers from time to time. Sometimes communicating those changes to the prescriber delays delivery as an alternative is made available.
Alternative: Once again, technology that keeps the pharmacy connected to the facility’s medication management system allows for prompt notification of discontinuations and prompts the caregiver to address the situation accordingly so that the resident does not miss a dose. Again, this process is independent of the caregiver on duty and forces compliance.
Medication availability is a compliance issue for a reason. It disrupts and possibly jeopardizes the health of the resident. Ms. Mears, it is your right to question the operation practices of your facility when they result in you missing medications. You understand more about how pharmacy is suppose to work than the phycisian you questioned credited to you. Physicians, pharmacists, and caregivers have a responsibility to provide quality care to residents and ensuring med availability is a large part of that responsibility. Although supply issues exist sometimes beyond their control, the instances sited here are all manageable though the use of pharmacy dispensing and management technologies available today.