As more hospitals adopt an electronic method for medication administration (eMAR), simulation can provide a much needed gap between theory and practice. Recently HealthySim covered Low Cost Bar Code Solutions for Sim Labs and How to Use Excel Templates for Sim Lab Documents, with this week’s article on how to provide low cost eMARS for healthcare simulation labs.
Traditionally, medication administration in both practice and Nursing education consisted of paper MARs and med carts. In attempt to prevent errors, hospitals have switched to eMARS and automated medication dispensing system such as the Pyxis. While Nursing schools with plenty of money can afford the expense of an automated dispensing system and an online teaching platform complete with electronic health records (EHRs) and eMARs, many nursing schools cannot afford these high priced items. Fortunately, much less expensive options are available.
Automated Dispensing Device
One of the first steps in the physical process of medication administration is removal of the drug from the automated dispensing device.
- Repurpose an old med cart to use as a pyxis.
- Instead of having patient names on the cassettes, assign a letter to each row and a number to the cassette. In order to maximize the number of different spaces, divide each cassette drawer into sections and label them with letters for rows and numbers for each compartment.
- Fill your med cart with all the meds you will use in simulation. The medcart can be used for multiple patients because some of the meds will likely be prescribed for more than one patient.
- Find an older laptop with excel (contact your IT department, they might have an old laptop not being used). Create a simple excel database for each simulated patient with the list of prescribed meds. Put the medication location from the medcart next to the drug name. Of course, the drawers will not open automatically but students will only be able to locate the med in the medcart by mimicking the process used in the automated version.
- If possible have the simulated medcart dispenser outside the sim lab because real dispensers are usually is a central location. Students will have to consider time management and medical asepsis.
eMAR with Scanning
- Equipment needed: Laptop with excel, barcode scanner and access to printer to print barcode labels. Barcode scanners are available online for $75 – $150. The scanner needs to scan only when the button on the scanner is pressed otherwise the scanner will beep anytime it recognizes a barcode. A hard-wired versus a hands-free scanner is probably more useful since it will prevent scanners falling or being lost. The scanner should be able to scan linear numbers. Many scanners come with a stand which is useful.
- Create an eMAR in excel:
- Cluster the general information for the patient at the top of the page. This information can easily be copied onto other pages. Include patient identifiers and allergies.
- Create columns with the date the medication was ordered, end date and other components.
- Optional additions: Signature line, injection location, discontinued meds.
- Create barcodes for patient IDs (attach to wristband) and medications (attach barcodes to meds).
- Create “what if” statements for patient ID and medication identification.
- Highlight a box next to medication with a color (in the example the cell F10 is blue). This is where the student will scan the barcode.
- In the cell immediately to the right of the blue barcode box (G10) write the formula: =IF(F10=0, ” “, IF(F10=112233, “Correct Med”, “Error Check Med”))
- In this case, if the medication scanned has a barcode 112233, the message “Correct Med” will appear in G10. If F10 is empty, nothing will show up.
- If the numbers do not match, an error message is generated.
- Be sure not to save changes when closing the program. If a student accidentally saves the program, simply delete the contents of cell F10 and the message in F11 will disappear.
- By changing the view in Excel the toolbars can be hidden. Only the MAR will be visible.
Add as many meds as needed, changing the barcode for each medication. A previous article entitled “Low Cost Barcodes for Sim Labs” gives information on using excel to set up other components of an EHR. Download HealthySim’s example eMAR bar code scanner template from Dr. Baily here!
Today’s article was guest authored by Kim Baily PhD, MSN, RN, CNE, Simulation Coordinator for Los Angeles Harbor College. Over the past 15 years Kim has developed and implemented several college simulation programs and currently chairs the Southern California Simulation Collaborative.
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