Redundant MAR Delivery Solution for Cerner Downtimes
By Mike Kirkpatrick

Recently at Children’s Hospital, Boston, we were asked to provide a means of delivering accurate and up-to-date medication administration records (MARs) to approximately 12 nursing units in the event of a planned or unplanned system downtime. The solution enacted provides a single level of redundancy, and requires an alternate network (apart from Cerner) for delivery of end user MAR files.

The need was to provide a means of having MAR data available at all the nursing units, at all times. Our solution leverages existing Cerner PharmNet capabilities to generate the data, and forward it to a non-Cerner, redundant network for storage, where it can be made available on demand to caregivers.

To accomplish our goal, it was desirable to make the existing standard Cerner MAR more in line with caregiver needs. Many hours were spent designing a custom MAR with input from nursing and pharmacy to provide a document that more accurately provided the data most relevant to the needs of caregivers. The resultant MAR was highly customized to provide administration times for 72 hours; 24 hours prior to runtime, and 48 hours post-runtime. Last administration time for each medication is also displayed.

Using Cerner Opsview Scheduler, ops jobs are built to sequentially run each nursing unit’s custom MAR on a frequency desired by the facility; in this case, every hour. This provides data no older than one hour in the event of an unplanned downtime. Another ops job then forwards the MAR files to a separate server, where it is converted from its native postscript to a .pdf format.

Each series of output files is stored with a naming convention, which uses the name of the nursing unit and date/time generated; for example: 10_Northwest_07_Jan_08_1500.pdf

This file is for nursing unit 10 Northwest, for the date Jan 7, 2008, and was run at 15:00. The MAR will display all medications due in accordance with the prescribed frequency, along with the time of the last dose administered (if applicable) for a 72 hour period.

Finally, the files are made available to caregivers for on-demand printing as needed.

Note: As always, with any customized MAR solution, comprehensive post-build testing is necessary to ensure patient safety

To summarize, the main components of the system are as follows:

1. Custom MAR
   a. A highly customized MAR was designed and built in accordance with caregiver inputs.
2. OPS job
   a. On an hourly basis, an ops job containing each nursing unit will run to generate the custom MAR data file.
3. Transfer/conversion of postscript files to safe server
   a. Another ops job is then used to forward the output file to an alternate server, where it is converted to .pdf
4. Delivery to caregivers via alternate network
   a. A separate, non-Cerner network is then used to store the output files which are descriptively named to show nursing unit, time and date. From here, they are selectable by caregivers to be printed as needed.

The end result provides valuable medication administration data to caregivers during a planned or unplanned downtime, which is both timely and accurate.

For more information regarding downtime delivery solutions please contact us at (610) 444-1233 or visit or website at www.getvitalized.com.