May 23, 2008
Making medications safer with EMAPPS

With medication errors a growing concern for health care organizations across the country, the MGH is implementing a critical new online system to electronically link the ordering, approval, dispensing, administration and documentation of medications. Commonly referred to throughout the health care industry as a "closed loop system," the MGH's new system is called the Electronic Medication Administration Process for Patient Safety (EMAPPS) and aims to enhance patient safety by confirming accurate medication administration and decreasing the number of medication errors at the hospital.

What is EMAPPS?
EMAPPS involves the electronic communication of several different applications: Provider Order Entry (POE) and Chemotherapy Order Entry (COE), automated systems to place medication orders; Sunquest Pharmacy, the MGH Pharmacy's system for medication orders to be approved and dispensed; and the electronic medication administration record (eMAR), which involves barcoding and scanning medications, patient wristbands and employee ID badges to document medication administration. POE and COE have been used at the MGH since 1998, and their interface with Sunquest will launch in June. An interface to automated dispensing machines (ADMs) on MGH units is planned for September. The final step in EMAPPS, the implementation of eMAR, is expected to begin in March 2009 and will roll out throughout the hospital over a 10-month period.

How are medications ordered and administered without EMAPPS?
Currently, medication orders are first entered into POE/COE by a prescriber, and then printed in the Pharmacy for review by a pharmacist. Once the order is approved, a pharmacy technician must then enter the request by hand into Sunquest. A pharmacist then verifies that the medication has been correctly entered and approves the request. At this point, the order must be manually transcribed onto the patient's medication sheet by either an operations associate or nurse and then reviewed once again for accuracy. The medication is then sent from the Pharmacy or is made available in the ADM for administration. There is no way to electronically confirm that the medication ordered is actually the one being administered to the patient.

How will EMAPPS be different?
In the current process, there are several points where errors could occur Ð for example, a pharmacy technician could accidentally enter the wrong medication into Sunquest, increasing the likelihood that the patient will receive the wrong drug. By automating the process, EMAPPS will greatly reduce the potential for dangerous mistakes to occur by having orders electronically flow from POE/COE to Sunquest and then to eMAR. Once a medication is ordered in POE/COE, a pharmacist covering a specific patient care unit will review and approve it in Sunquest, eliminating the need for manual entry of the order. The unit's ADM will then be triggered to release the appropriate drug, a process called "profiling," while a certain percentage of medications will continue to be sent directly from the Pharmacy. Both the medication and the patient's wristband will be bar-coded and electronically matched through EMAPPS. If the barcodes do not match, the clinician will receive an electronic warning and be prompted to review the order again. For the final step, the clinician must then scan his or her ID badge to document the administration. Paper medication administration sheets will no longer be needed.

For more information about EMAPPS, contact Rosemary O'Malley, RN, at
(617) 726-9633 or

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