How to Choose an eMAR system. Part 1 - The Main Considerations
Increasingly Care Home operators are looking for technology to improve safety, accountability and the ability to measure the quality of care that they provide for their residents.
In the domain of medicines management, the search for technology solutions has intensified with the large number of safeguarding incidents and the heavy regulations around medicines. There are now several companies offering eMAR solutions, so how do you choose between them? In this article which is Part 1 of the series, we list all the considerations for choosing an eMAR system but focus on the main considerations. Part 2 of this series discusses further considerations in choosing an eMAR. The overall aim is that when you are reviewing the eMAR systems on the market you are fully aware and are able to make informed decisions.
Why are you looking for an eMAR and what are your objectives?
The first consideration must be what the reasons are for you considering an eMAR system? Do you have issues with medicines that need addressing from recent inspections? Are you being forced to make a change because of your pharmacy provider is stopping blister packs? Or do you want to invest in technology for the future? In all scenarios it important that you consider all the options available to you and not just the ones offered by your pharmacy supplier or the add on module to your electronic care plans. The eMAR must work for you and achieve your objectives rather than suite the pharmacy supplier or to just tick a box.
Common objectives of choosing eMAR systems are for ensuring safety, increasing accountability and reducing the burden of stock control and prescription management. There are a number of other further considerations for eMAR listed below, each of which are discussed further in Part 2 of this series of articles:
- How easy is it to implement?
- What hardware is required?
- What happens if the technology goes down?
- Will the medicine rounds take longer?
- Will there be integration with other technologies?
- Will inspectors like it?
- Is the data secure?
- Can I believe the claims of the benefits?
- Who is the company providing it?
- What is the cost?
It is important to understand how each eMAR system works to achieve the objectives of safety, accountability and efficiency and below we outline the main strategies that eMARs employ.
How does the eMAR provide Safety?
Some eMARs claim to provide safety by the virtue of being digital and getting rid of errors associated with hand writing and reading. Others make claims that because they schedule and alert for medicines administration there is less risk of residents going without medicines.
Some eMARs introduce a new concept of scanning barcodes on dispensing labels at the point of administration. The eMAR then checks if the scanned medicine is correct for the resident at that time and if not, the system produces an alert thus averting a potential error. In this way another level of checking is introduced. The difference between these more advanced systems comes down to the amount of information on the barcodes. Most systems simply have information relating to the resident and the medicines, other systems such as the ATLAS eMAR barcodes have information relating to the pack that was dispensed and can potentially even check for expiry dates of medicines.
Another important consideration for safety is the connection between the eMAR system at the care home and the resident’s medication records at the pharmacy. If there was a true two-way connection, then changes to the resident’s therapy made at the care home, for example after a GP visit would be automatically updated on the pharmacists’ records. Similarly, if the pharmacy dispensed a new prescription for a resident, the eMAR would be automatically updated. The sharing of records allows the pharmacist to check every prescription against the resident’s therapy at the care home. In this way, the pharmacist’s contribution is maximised. The ATLAS eMAR is the only solution that has this true two-way link with the pharmacy dispensing system.
How does the eMAR improve accountability?
Typically, the eMAR systems provide a date and time stamp for certain medicine related activities. If staff members use their own unique log-in details, then reports can be generated to show when and which staff has administered or not administered medicines.
The systems for accountability will therefore only be as good as the methods they have for ensuring people only use their own log in details and the detail of the data that they collect and make available for viewing.
ATLAS eMAR insist on every user having their own unique log-in details and has an easy process for agency personnel to quickly set up and obtain log-in details. There is even a straight forward process for retrieval of details if they have been forgotten.
Users and managers can easily see details of medicines related activity for audit such as Missing entries, Administration details, Booking-in, Returns, Stock takes, Drug changes (including who witnessed the changes), Prescription requests and a plethora of other details. ATLAS eMAR also provides a list of reports that can be scheduled to be sent to relevant individuals within the home eg daily reports, or reports that can be printed / exported as required. The ultimate in accountability functionality is the ATLAS Scorecards that allow managers to see a “at a glance” view of medicines management in the care home and the ability to drill down to see what the issue is and what or who is responsible for it.
How does it ensure you do not run out of stock?
The eMAR systems should have a process for booking-in of stock and have a running stock count for each medicine. Once there is a stock count, then every time a medicine is given to a resident, the stock count is reduced by the amount administered.
The systems are only as good as the way that they maintain the stock count. There has to be processes to prevent booking-in of stock more than once and processes for discarding medicines that have been refused and those that are to be returned to the pharmacy. The systems must also account for medicines such as creams, inhalers, injections and nutritional supplements where the quantity of administration is not always known.
To prevent stock running out, the systems must have a way of alerting to this fact in plenty of time to request prescriptions and for the pharmacy to dispense and deliver these. Ideally the system would have functionality for placing prescription requests and having a way to track the status of the prescription from receipt at the pharmacy to the due time for delivery at the care home.
ATLAS’s process for booking-in of medicines is to scan the barcodes on the dispensing labels which then updates the stock count. Since the barcodes are unique to each pack there is no need to count what is inside the packs and each pack can only be booked-in once. The system has processes for accounting of discarded and returned medicine. For items such as creams, inhalers and eye drops, users can allocate “low stock” status at the point of administration. ATLAS then alerts users when medicines are in “low stock” which is defined as the medicines will run out in 9 days or less. Users then simply place a prescription request from the system which allows them to forward the request to the surgery. They can see the status of the prescription request so that they are assured the medicine is due to be delivered.
What are other issues to consider?
Implementing any technology in the care home sector needs several other considerations including those listed below. Each consideration is expanded on in Part 2 of this series of articles.
- How easy is it to implement? - The more user friendly the system, the easier to implement. All change, however, needs leadership at the care home so this is also an important consideration.
- What hardware and infra-structure is required? - The hardware needs to be fit for purpose. It can't be too big, it must be convenient, it must be robust and suitable for the care home environment. Does the system require internet and Wifi?
- What happens if the technology goes down, what support is there? - There must be provision for a back-up if the hardware is damaged, there is a power failure, or the internet goes down and there must be support through this process.
- Will the medicines rounds take longer? - This is a common questions by care staff so does the system have any evidence to show how long administration rounds actually take?
- Will there be integration with other technologies? - Sharing of information with electronic Care Plans is the main integration that is asked for. Is the eMAR system designed in a way that allows integration to any care planning system?
- Will inspectors like the technology? - The eMAR needs to contribute to evidence of safety, effective care, responsive to people's needs and being well-led.
- Is the data secure? - Data breaches can lead to fines relating to the turnover of the care home. What is the level of information security to prevent data breaches?
- Can I believe the claims of the benefits? - Take time to visit care homes where the eMAR is being used, and ask for independent evaluations.
- Who is the company behind the eMAR? - The company will be your partner not just in technology but in providing care. What is their expertise and experience and are they financially secure?
- What is the cost and contractual model? - Nothing is provided for free, make sure that you understand the costs and the length of contracts. There is usually a cost for software licenses, a cost for hardware and a cost for training and implementation.
The aim of this series of articles is to provide guidance on how to choose an eMAR systems. The conclusion is that not all eMARs are the same and the recommendation is for you to carry out due diligence and see all the eMAR systems on the market. Part 2 in this series of articles discusses in detail the further considerations.