Computerized Physician Order Entry & Electronic Medication Administration Record
Fiona Graham
Ramapo College of New Jersey
Digital Literacy
Prof. E. White

Computerized Physician Order Entry & Electronic Medication Administration Record
Computerized Physician Order Entry (CPOE) is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. Directly entering orders into a computer has the benefit of reducing errors by minimizing the ambiguity of hand-written orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support tools (Ash, 2008).
CPOE systems are designed to reduce medication errors. The best evidence to date demonstrates that patients who experience adverse drug events (ADE’s) that are preventable have, on average, longer hospital lengths of stay (by approximately two to four-and-a-half days) and higher hospital costs (between $2,000 to almost $5,000).
Researchers and practitioners have demonstrated impressive reductions in ADE costs when a CPOE system is used in conjunction with clinical decision support systems, such as prescribing cheaper but equally effective drugs, reducing unnecessary lab tests, and using evidence based treatment guidelines (Lee, 2002).

A CPOE system is designed to reduce medication errors in several ways. First, a CPOE system can provide physicians with a menu of medications from the formulary, complete with default doses and a range of potential doses for each medication. It also ensures that all drug orders are legible and can display patient-specific, relevant laboratory results on the screen at the time of ordering. It can also check for drug-allergy contradictions and drug-drug interactions (Lee, 2002).

A test of a CPOE system at Brigham and Women’s Hospital in Boston determined that it reduced drug-related preventable adverse events by 17 percent and serious medication errors by 55 percent. The researchers estimated net savings of CPOE that includes decision supports to be between $5 million to $10 million per year (Lee, 2002). At my hospital it has been a slow process to implement CPOE especially with the older physicians but they are coming around. CPOE has saved so much time because doctors handwriting can be very difficult to decipher at times and sometimes it is impossible. I would say at least 75% of our physicians are using CPOE but it has taken nearly 2 years to encourage physicians to partake in this process.

Electronic medication administration record (E-Mar) provide the potential to make the administration of medications safer for patients by reducing error rates, and also by allowing nurses to more efficiently manage medication tasks. When patients are admitted they receive a bar coded ID bracelet to be used for identification. The nurse scans the medication at the bedside before the medication is given. eMar ensures easy tracking of medications from the physician’s order, to the Pharmacy, to the floor’s medication carts, to the patient (Doylestown Hospital, 2009).

Electronic Medication Administration Record and Bar Coding technology is in use where I work. Whenever a medication is given to a patient at my hospital, it is documented on a MAR that is stored in your medical record. Up until a year and a half ago this was done by a manual paper process. My facility is almost finished with implementing a computer generated or electronic version of the MAR called eMAR and Bar Coding. This technology is part of our core pharmacy information system where all aspects about your medication orders are recorded. The critical components of this safety technology are bar coded armbands, bar coded medications, and safety checks within the eMAR and bar coding. At the patient’s bedside, if any of the scanned information does not match the doctor’s orders, a warning message is provided to the nurse (Brady Worldwide, 2009).

The eMAR process inserts sentry like activities at the critical bedside point-of-care, minimizing the opportunities for human error or lack of documentation. The process adds the automatic data collection element provided by employing data capturing technology (Brady Worldwide, 2009).
Within a hospital, drug therapies need to move quickly and accurately from the prescribing physician to the dispensing pharmacist and then to the bedside where the nurse typically administers the drug. As the medication administration safety check of last resort, ideally the nurse can access all available data on patient medications and their administration, and reconcile the physician’s order with what the pharmacy has actually dispensed.

The Medication Administration using eMAR is:
 the physician writes the order which is sent to the pharmacy,
 A pharmacist then enters the order in Meditech.
 The Pharmacy bar codes the medication and distributes to the floors.
 The nurse views the eMAR screen and reviews the patient’s medication list and verifies with the physician orders.
 eMAR alerts the nurse about the next dose due, overdue doses, or cautions about medication.
 Nurses takes the cart to the patient, scans the medication and the patient’s wristband (Doylestown Hospital, 2009).

Some of our older physicians were not enthusiastic with the change at first but now when they see how easy it is to use and view they have come around. The electronic medication record has gained a foothold in inpatient settings to support medication administration safely. With paper records prone to being lost, incomplete, or misread, the bedside nurse needs a fail-safe method to ensure that medications are administered correctly. eMAR is a vast improvement over paper medication administration records.
The overriding benefit of implementing a CPOE and eMAR system in a hospital is to ensure patient safety and reduce medication administration error. At my hospital nurses have embraced their arms around these systems. Knowing that medications are administered in the right dose at the right time to the correct patient is integral to ensuring medication safety and supports our motto of patient safety.

References
Ash, J. (2008, August 8). Computerized physician/provider order entry. Retrieved January 13, 2009, from http://www.ohsu.edu/academic/dmice/research/cpoe/index.php
Brady Worldwide. (2009). Electronic Medication Administration Record (eMar) FAQ’s. Retrieved January 13, 2009, from http://www.bradyid.com/bradyid/cms/contentView.do/0/1894/2208/0/HealthCareindustry/About-eMar-(FAQ’s).html
Doylestown Hospital. (2009). Electronic Medication Administration Record (eMar). Retrieved January 13, 2009, from http://www.dh.org/body.cfm?id=434&oTopID=434

Lee, J. S. (2002, October). Computerized physician order entry (CPOE) systems. Retrieved January 13, 2009, from http://www.academyhealth.org/syntheses/cpoe.htm

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