October 31, 2008
EMAPPS: Evolving the role of the pharmacist

A new MGH initiative currently underway is dramatically reshaping how pharmacists work with other clinicians to provide and administer medications. Known as the Electronic Medication Administration Process for Patient Safety (EMAPPS), the effort aims to decrease the number of medication-related adverse events at the hospital.

EMAPPS involves the electronic communication of several applications: Provider Order Entry (POE) and Chemotherapy Order Entry (COE), which are automated systems for placing medication orders; Sunquest Pharmacy, the system for approving and dispensing orders; and the electronic medication administration record (eMAR), which involves barcoding medications, patient wristbands and employee ID badges to document medication administration.

In June, POE/COE – which have been used at the MGH since 1998  began an interface with Sunquest. Prior to this, medication orders were written in POE/COE and printed in the pharmacy. A pharmacist then reviewed the order, handed it to a pharmacy technician to manually enter the order into the computer and then approved the order in Sunquest. Labels for medications not stocked in the Omnicell automated dispensing machines (ADMs) were then generated. With the new interface, medication orders now flow directly into Sunquest, allowing pharmacists to review and approve orders online, eliminating several steps and decreasing the time from order placement to verification. Additionally, a second interface with the ADMs called "profiling" began in October. With this process, a patient's medication list is presented to the nurse to aid in the selection of the proper medication. This helps nurses identify the correct drugs and saves time. The final phase, eMAR, will begin in March 2009 and roll out over eight months.

MGH attending pharmacist Adrienne Goeller already has witnessed EMAPPS's benefits firsthand. Prior to its implementation, nurses could directly access many of the drugs in the ADMs. Now, no medications – with limited exceptions for emergencies – can be accessed without a pharmacist approving the order in POE. This allows for review of critical information such as dosage, patient allergies and possible interactions with other drugs, reducing the opportunity for error and allowing access only to approved medications. Because Goeller and her colleagues often cover multiple units at one time, clinicians may experience an increased wait time from when a medication is ordered to its release in the ADM than they do currently. Ultimately, these changes will help ensure that at all times, the correct dose of the correct medication is delivered to the correct patient at the correct time.

goellerFor more information about how EMAPPS will affect MGH Pharmacy operations, contact Meg Clapp, director of the Pharmacy, at mclapp@partners.org. For general information about EMAPPS, contact Rosemary O'Malley, RN, at romalley@partners.org

Through EMAPPS, MGH pharmacists like Goeller, left, are working in new ways to ensure patient safety.

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