Pediatric Informatics: Computer Applications in Child Health (Health ...

362 C. Garger et al.
Smart pumps can be integrated into a hospital medication delivery system
and can be programmed and updated from a central server via a local or wireless
network with customized drug libraries. Additionally, some pumps support bar
coded medication labels, which can further reduce errors by automating patient
and medication identification. Other interfaces from smart pumps are possible, to
computerized order entry systems or to pager-driven alert systems, but to date few
institutions have implemented these.
Errors (some resulting in morbidity and mortality) that have been associated
with the use of smart pumps include: dosing errors due to pump hardware
problems, 23,24 misconnections of intravenous lines, 25 inaccurate programming of the
pump/incorrect dosing, 26 electrical short-circuit 27 and alert overrides. 28 In pediatrics,
smart pumps have been helpful in conjunction with other technologies to reduce
errors in administration of continuous infusions using standard concentrations, 29
but there is need for further research. 30
28.4.4 Electronic Medication Administration
Records (eMARs)
In inpatient and residential care settings, the medication administration record
(MAR) is the principal coordination and documentation tool for nursing and
others (principally respiratory therapists) involved in the direct delivery of drug
doses to patients. In some cases, documentation of a drug dose (such as an intravenous
“push” dose of a specified drug for resuscitation) given by another provider
may be documented by a nurse on behalf of the provider.
Paper versions of the MAR are patient-specific records that provide a
temporal listing of scheduled and given drug doses. The paper MAR is manually
populated by the nurse according to prescribed drug orders (from CPOE or paper
orders), and completed (scheduled or emergent) doses are signed-off by the nurse
(or respiratory therapist). The portion of the MAR in current use is kept with the
active nursing record (which includes nursing assessments and problem lists),
while completed orders are archived with the remainder of the patient chart.
The MAR also provides communications to other members of the care team
regarding informal ( handwritten notes) but important details of the medication
schedule.
Electronic versions of the MAR (eMARs) provide similar functions as paper
versions, with added functionalities of drug dose information linkage from computerized
provider order entry (CPOE) and pharmacy information systems (PharmIS),
drug dose schedule alerts, auto-adjustment of future scheduled doses based on
schedule changes and control over data entry rights (restrictions to nurses and
respiratory therapists). Without modifications, eMARs may not afford unstructured
entry of ad hoc notes that allow informal communication of important details
among providers.