One of the last barriers to a paperless workflow in long-term care is the availability of software for managing medications. This software replaces paper processes such as notebooks on medication carts, trips to the fax machine to order medications, telephone order forms and month-end turnover.

REDUCING ERRORS

Approximately 800,000 people are injured by medication errors every year in long-term care, according to the Institute of Medicine. But many adverse drug events could easily be prevented by using computers instead of paper.

From the moment a resident enters a facility, software tools can track every medication he is taking, look for potential drug interactions, including drug-drug and drug-allergy, and provide current drug reference information.

It can also reduce the errors that are caused by illegible handwriting when prescribers choose medications from lists that include strengths, doses and routes of administration. Once the orders are in the system, the risk of handwriting errors is further reduced because there is no need to manually copy MARs or write orders and reorders for faxing.

Further, an eMAR can help nurses keep track of where they are in a medication pass. If a nurse is interrupted during the med pass, an eMAR remembers the stopping point and will resume where she left off, unlike paper forms in medication notebooks. Before moving on, the eMAR can alert nurses of any medications not delivered.

INCREASED EFFICIENCY

Electronic tools can also save time and resources. By entering medication orders in the software, order forms can be eliminated along with sorting, filing, traditional MARs, resupply reports and month-end MAR turnover.

Depending on the e-prescribing software, as soon as orders are entered, they are automatically sent to the pharmacy by electronic message or computer-generated fax.

When supplies run low, medications can be reordered with a click in the eMAR. The traditional process involves looking up the resident's pharmacy and how to order from it-by phone, fax or driver pickup. Similar to online banking, e-prescribing is set up once with specifics on how to order from each pharmacy. After that, all the system needs is direction on when to order and how much.

An electronic system increases the speed and accuracy of communication with the pharmacy and throughout the facility. For example, when a change in a resident's condition causes a change in medication, e-prescribing eliminates steps in the order process and eMAR ensures the revised medication is listed for the next medication pass. During the medication pass, eMAR gives nurses quick access at the point-of-care to the electronic medical record for data such as diagnoses lists, allergies, nursing alerts and code status.

BETTER DOCUMENTATION

Data collected at the point-of-service during a med pass automatically becomes part of the EMR with eMAR. The software can flag certain orders to require notes or a vitals check at the time of delivery. Charting may also be required for orders that are late, missed, held or PRN.

An eMAR can be used to create an unlimited number of reports, such as how many PRN acetaminophen were delivered in a day, outcomes of PRN medications, residents who received specific medications or orders administered late.

eMAR supports real-time documentation, making vitals and notes entered at the point-of-care accessible immediately to all with authorization. An eMAR can date stamp and identify the caregiver for each order delivered, and encourage follow-up charting of order delivery.

Electronic medication management will prepare LTC providers for the future, when the National Electronic Health Record comes in 2014, and more importantly, can improve care in the present.

Linda Spurrell is a clinical product manager, Keane Care, Redmond, Wash. DISCLOSURE: Keane Care is a long-term care software provider.