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Self-declared ‘BC’ (before computers) nurse Jodie Healey, once daunted by IT, is now the e-Medication clinical liaison nurse for Southern District Health Board. FIONA CASSIE talks to her about bringing her fellow ‘BC’ nurses over to the advantages of electronic medication management at the bedside.

You think the drug chart shows pain medication was last administered at 3pm or is that 5pm? But the dosage is undecipherable anyway …

Safely administering medications in your average hospital ward can be a daily tussle to decipher doctor, pharmacist, or nursing handwriting – let alone the time spent trying to track down the drug chart.

Electronic medication management eliminates problems with scribbled notes and lousy handwriting with a drug chart (MedChart) that is viewable from any hospital computer and can be pulled up on a laptop trolley at the patient’s bedside.

Jodie Healey is a convert but says as a ‘BC’ nurse, she was initially daunted by MedChart during its 2010 pilot in Dunedin Hospital. She was also worried that the methodical electronic tool may stymie a nurse’s practice but is now convinced it enhances practice.

“MedChart is a system that replaces our paper chart but it doesn’t replace our clinical judgement.”

Healey points out that nursing education doesn’t include deciphering handwriting.

“This is a skill that is picked up on the job. As I have often said to prescribers through my nursing career – if I can’t read it … I can’t give it!” says Healey. “I’ve also found myself saying to the prescriber ‘if you make it legible, I’ll make it happen’.”

With MedChart, prescribers can be paged and update a prescription from any computer in the hospital using their unique ID and password.

When it comes time to administering medication the nurse picks up a ward laptop and takes it everywhere a paper chart would be taken – i.e. from the medication room where the medications are prepared and on to the bedside. There are up to five per ward for drug administration, so no queue in morning, and there are separate trolleys for prescribers.

Healey says this is another plus for MedChart because, as a former resource nurse deployed to different wards most shifts, she quickly found that no ward had the same place to store medication charts and it took time to track them down.

“On some wards, there could be two designated places – and then there were the random ‘drop-off’ zones like the bench, another patient’s clipboard, near the computer, the handover room or tearoom …”

The nurse logs on to the laptop using their ID and electronic ‘signature’ password and accesses the patient’s chart, which opens on an administration medication chart that also provides information on any allergy the patient has, clinical decision support and any alert – like whether the patient is known to hide their medications.

It also clearly shows when the patient’s next medication is due or has an ‘alarm clock’ symbol if it is overdue by more than an hour and a clinical decision needs to be made. In each MedChart ward, there is a ward overview screen up at all times, viewable by nurses (and not the public) that summarises which patients are due for medication and any that are overdue.

Any attempt to catch up by administering medications to more than one patient at time is quickly frowned upon with Healey saying she tells any nurse attempting to do so that they were “in a very dark space in the nursing spectrum”.

Once medications have been successfully administered, the details and any notes entered on screen the nurse logs out leaving an updated chart that is easily readable to the nurse on the following shift.

Healey says MedChart replaces the ward’s Notes on Injectable Drugs (NOIDs), which is a much-loved manual but usually battered, stained, and sometimes missing the vital page. Nurses can now access NOIDs on the laptop in the midst of preparing patient medications. The nurse can still, if the order allows, use their clinical judgement on which medication route is the most appropriate for the patient.

The MedChart alert system can also be used to inform a patient’s discharge notes.

“If you receive a patient from ED at 9.30 at night with a Pak’n’Save bag filled with 15 medications – not all of them belonging to them – you can then put an alert on their chart to say ‘recommend this patient uses blister packs on discharge’,” says Healey.

Which is another advantage as while nurses have been known to complain over their medical colleague’s handwriting, Healey points out nurses should also spare a thought for prescribers trying to determine when a drug was last given from an administration chart filled in by nurses on the run.

MedChart is slowly being rolled out to adult wards across the Southern DHB with one hour formal training on using the scheme – including emphasising how vital it is to protect your password ­– and then intense 24 hour phone support for first two weeks once a ward goes live.

Healey says like any change it initially creates disruptions for nurses. While being able to ‘find’ charts easily does save time, some users feel MedChart takes longer to use the computer than in does a pen.

“Speed does not always equate to safety and this is a patient safety system.”