I have to wonder if the old ways of ensuring safety in medication administration (the Five Rights, which would now be coupled with two identifiers) has suffered in hospitals that do NOT have online documentation. Online systems create or add to some problems, in and of themselves.
There is something about the way nurses interact with a computer that is different from the way they interact with a chart that they can hold in their hands. They make conscious or subconscious assumptions about the computer's ability to prevent error, and they don't check things they would normally check. Some think that anything the computer lets them do must be alright to do. They don't "get" that the computer is a compact and portable chart rack that can't be left exposed to all in an unprotected area. Above and beyond the patient safety issue, they don't understand the legal liability they are creating for themselves when they try to scam the system by find workarounds to electronic BMV. How much of this can we blame on individual nurses? What about the administrative forces within a facility that determine the length, content and quality of nurse orientation? What is being done out there to follow up on the practices of nurses 3, 6, 12 months after the training? Do hospitals have the resources, or will they apply them, for monitoring this kind of thing? If not - if hospitals aren't paying attention to what nurses are doing with computers - are they paying attention to what nurses are doing with patients, or is that on "auto pilot" these days, too? What about the ever increasing workload of the nurse, which strongly motivates him or her to invent workarounds/shortcuts, or embrace those demonstrated by others? I would like to believe that most hospitals have managers, charge nurses, educators, clinical specialists, or others on the clinical side who are directly observing the practice of nurses to ensure competence. That kind of competence assessment, which is far more valid than a test or a skill lab, should include the assessment of competence in the use of the computer. And as for the Ohio Pharmacy Board: wow. I wonder how they developed that kind of power. It must be conferred/delegated to them by the Department of Health or other government agency. Sharon -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bill Mullins Sent: Thursday, June 21, 2007 1:03 PM To: Dana Pfingstler; Meditech L Cc: Rose Willeford; Steve Pruter; Judy Leverette; Karen Ham; Ellen Roll Subject: Re: [MEDITECH-L] Access to eMAR Dana: Believe me, I do understand your reasoning and have seen the exact scenario in my practice too. I was an ER RN for 12yrs before getting into IS. I have built and supported ER systems for years, not just Meditech's EDM. I can see the benefit of entering the PIN number to file/finalize your MED administration if your users do not log on and off the device they are using to document/scan meds (like the situation you mentioned in your ER). We do not encourage that (as policy/practice), not to say it has not happened. But we then have the nurse who charted on another user's ID without themselves logging in, print the data they charted, rechart it on the correct patient, them we undo the charting on the wrong patient, etc...It only takes once or twice and they do not make that error again... In our ER, the users log in and out, except the ER Docs, they can stay logged in for up to 12hrs. They have their own PC's, in their own office area. NO ONE uses the docs PC or the US PC(you know what I mean). If the users are allowed to document meds and enter a PIN number to identify who administered the meds on that occurrence to that patient, what happens with regular documentation? If that same user wants to document a VS or PAIN SCALE or a note, do they then log off the real user who is logged into that device and log in themselves to chart non med data? Don't get me wrong, I do see your reasons for the MED pin if not logging on and off the computer. But I prefer to try and get the staff to use the system the way we designed it and trained them to use it. NO ONE is supposed to walk away from a computer while logged in, of course they do, but them it times them out and if the data is not filed, they lose it. Lesson learned... I am an old nurse (30yrs now) and I just think we are creating some of these problems ourselves, by not re-enforcing good nursing practice. What happened to basic nursing practice, checking armbands, asking patients their names and correlating that with their arm band. The 5 rights of med administration as another example. I would not pick up a chart off the rack and start writing in it, without first looking at the room number and name on that chart (would you?). So why would any nurse (or caregiver of any profession) go up to a computer they know they did not sign onto and start to chart. Even thought the user logged on is present on the screen in front of them. I believe we are creating careless practice, it seems to me there is less accountability for poor practice, lack of charting, failure to follow the policies and procedures set in place to increase patient safety and decrease med errors (i.e. Scanning labels stuck to a clipboard instead of the patient's armband).....Why would any professional try to circumvent the safety mechanisms set up to protect their patients and themselves. Is it really so hard to scan the patient's armband, instead of cheating and using a single label? I just do not understand that. We have our menus and sessions timeout for a reason, just in case someone is careless and walks away from the device they were working on. I have not used proximity badges, but they might help, along with the devices having multiple MT sessions on them and the users have multiple logins assigned to them in MIS USER DICT. I am just one person, there are probably a lot of different opinions and methods other facilities have used to deal with these issues. If TN forces us to use PIN# for Med administration, I am sure we will comply. Thanks for your input, -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Dana Pfingstler Sent: Thursday, June 21, 2007 11:41 AM To: Meditech L Subject: Re: [MEDITECH-L] Access to eMAR I agree that an additional level of security is a pain, and may times a waste of time, BUT, do to nurse practice of not logging off it has become almost necessary. A prime example is our ED. We use BMV in the ED, where portable carts and wall mounted PC's are used. It is not an uncommon practice for users to "forget" to log out. Many times users find their documentation and notes done by another user because that user did not sign out and the second user didn't notice. How easy it would be to walk up and begin documenting meds under someone else's name. Our system is set up for the Meditech password when users open the eMAR only. Users find right away that someone else is signed in when their password does not work. And I know, users should be signing out every time. But as an ED nurse as well as IT analyst, I can tell you what should happen and what does happen are 2 very distinct different things. For the various reasons given, users do not always sign off. Until that happens consistently, the password will remain. Dana Pontious, RN Nursing Analyst Elk Regional Health Center St Marys, PA 15857 814 788-8682 ------------------------------------------------------------------------ ---- -------- The information contained in this e-mail is private and confidential and is intended only for the person or entity to whom it is addressed. If you are not the intended recipient, please note that any review, dissemination, distribution, or copying of this e-mail is strictly prohibited. If you have received this communication in error, please notify the sender of the error and thereafter delete this e-mail. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bill Mullins Sent: Thursday, June 21, 2007 11:21 AM To: Kimberly Frick; meditech-l@MTUsers.com Cc: Rose Willeford; Steve Pruter; Kevin Goecke; Karen Ham; Cassie Davenport Subject: Re: [MEDITECH-L] Access to eMAR What next? What is the purpose of this secondary security feature (PIN NUMBER when filing meds)? The user enters a secret code to get into the dispensing machine to get the meds, then they enter another secret code to log onto the computer, now they want a 3rd secret code to administer the med. The defense department doesn't have that level of security (ha ha...) Has there been a rash of incidents where a rough nurse rooms the hallway and sneaks into a patient's room where a computer session is actively on the Process Meds screen and the primary nurse has walked away in the middle of Passing meds and those rough nurse files that administration??? I am all for patient safety, I think EMAR and BMV are great and do increase safety and decrease med errors, but there has to be some common sense. God I am so glad I do not practice nursing these days. Thanks, -----Original Message----- From: Kimberly Frick [mailto:[EMAIL PROTECTED] Sent: Thursday, June 21, 2007 9:48 AM To: Bill Mullins Subject: RE: [MEDITECH-L] Access to eMAR I'm sure you didn't. Ohio's Pharmacy Board is the strictest in the nation. Meditech had a custom for Ohio sites because of the requirements. We must scan our pin and the pin must be unknown to the user so the user cannot type it in. It works beautifully, so I think MT is going to make it standard in a future release. Kim Frick, RN Project Coordinator Licking Memorial Health Systems Phone: 740-348-4114 Fax: 740-348-4769 [EMAIL PROTECTED] www.LMHealth.org -----Original Message----- From: Bill Mullins [mailto:[EMAIL PROTECTED] Sent: Wednesday, June 20, 2007 8:10 PM To: Kimberly Frick; Sharon LaDuke; Kenny Whiteside; Deborah L O'Briant; meditech-l@MTUsers.com Subject: RE: [MEDITECH-L] Access to eMAR We did not have this requirement in Tn, 5 yrs ago, I do not know about it now... -----Original Message----- From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf Of Kimberly Frick Sent: Monday, June 18, 2007 9:21 AM To: Sharon LaDuke; Kenny Whiteside; Deborah L O'Briant; meditech-l@MTUsers.com Subject: RE: [MEDITECH-L] Access to eMAR I thought that an additional level of authentication was unnecessary too, but our State Pharmacy Board requires it. This level of security doesn't exist in the paper MAR world, so why is it so restrictive in the electronic version? Our State Board of Pharmacy requires us to enter our pin last, so we did not have a choice for that either. The only advantage I can see of entering it last is that you can access the e-mar to view the MAR, run MAR reports or do anything else except document without entering your pin. The "enter pin" prompt only comes up when you document something. Kim Frick, RN Project Coordinator Licking Memorial Health Systems Phone: 740-348-4114 Fax: 740-348-4769 [EMAIL PROTECTED] www.LMHealth.org -----Original Message----- From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] Behalf Of Sharon LaDuke Sent: Monday, June 18, 2007 7:36 AM To: Kenny Whiteside; Deborah L O'Briant; meditech-l@MTUsers.com Subject: RE: [MEDITECH-L] Access to eMAR I recently worked for a multi-facility organization which did not require anything additional for eMAR access. No problems that I ever heard of. Sharon -----Original Message----- From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf Of Kenny Whiteside Sent: Friday, June 15, 2007 2:42 PM To: Deborah L O'Briant; meditech-l@MTUsers.com Subject: Re: [MEDITECH-L] Access to eMAR Deborah, We just had this discussion this afternoon also! If your nurses ALWAYS log off when they walk away from their computers.... I would say that the redundancy would be insane. But I also know that in the fast-paced, pulled in every direction at once world of hospital nursing... that's not likely to happen. For this reason, we chose to require the user's password when entering the eMAR from the Status Board. But who knows, maybe someday we will decide that this is not necessary! Have a good weekend, Kenny Whiteside >>> "O'Briant, Deborah L" <[EMAIL PROTECTED]> 06/11/2007 11:38 PM >>> Hello All, I am trying to gauge how the majority of sites live with the eMAR set up their password/pin options in MIS. We are currently using the NUR Status Board and the Project lead for nursing wants to take out any additional requirement to authenticate the user signing on to the eMAR. The thought is that the original request for a user mnemonic/password to log onto Meditech is sufficient and asking for the password again if accessing the eMAR, once in the Status Board, is redundant (we've set it up so all inpatient nurses get the Status Board upon successful sign-in). Our State Board of Pharmacy does not currently have any specific guidelines (yet) for us to follow. Has anyone experienced problems (ie, diversion) with the eMar and what security was in place at the time? I am trying to think of every scenario where having no additional requirement to access the eMAR might get us into trouble. I greatly appreciate anyone taking a minute to answer this posting! Thanks in advance! Deborah O'Briant Sr. Project Manager IT Applications Arkansas Children's Hospital (501) 364-3643 [EMAIL PROTECTED] ------------------------------------------------------------------------ ------ The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. 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