Preparing for MAK
By David B. Laundree, RN
What is Medication Administration Check (MAK)?
In today’s fast paced and ever-changing world of medicine, one thing has not changed: the five rights
of medication administration. All competent nurses currently working have this concept imprinted in their
minds. This lesson began in the first year of nursing school and continues in their current day practice.
Before you administer a medication, always make sure you identify the:
- Right Patient
- Right Drug
- Right Time
- Right Dose
- Right Route
To the lay person, this may appear fairly basic; one may wonder how a mistake could be made. In reality,
missing just one of these steps has cost lives and extended hospital stays. It would be difficult to find a
nurse working today who has not either made a medication error or caught one just in time. As a matter of
fact, when looking at the reality of floor nursing today, it is surprising that more mistakes are not made.
Regardless of the statistics of reported errors, the severity of the issue is not in the numbers—one mistake
can end the life of a patient.
To clarify the point, consider this typical example of medication administration responsibility of a
nurse working the day shift. A nursing unit has 28 beds with four staff nurses taking care of patients’
medications. Each nurse is responsible for seven patients. Each patient has an average of five medications
through the shift (which is a low estimate). Thus, each nurse is passing 35 medications on his or her shift.
For this shift, there are a total of 245 medications being passed by all nurses with zero tolerance for
error—that’s just on one shift in a rather small unit. Add to this the multitude of interruptions that
occur while on medication rounds and it is easy to see how mistakes happen during medication
administration.
Siemens has developed a major breakthrough in assuring safe, accurate, and timely medication
administration. Their Medication Administration Check (MAK) program guarantees that the five rights of
administration are followed every time. MAK is able to do this by utilizing bar code technology. This
program identifies every variable through the medication administration process (patient, nurse, and drug),
and lets the nurse know immediately if there is a problem or discrepancy. The MAK system provides the nurse
with an easy-to-use interface between the Pharmacy and the patient by:
- Listing all of the patients’ medications and IV orders
- Organizing medications into grouped work list, displaying at correct times of administration
(all medications due at 8 a.m., 9 a.m., etc.)
- Flagging medications not administered
- Providing online drug information
- Screening for potential clinical conflicts prior to administration
- Displaying administration messages associated with the medication order
- Flagging a drug that requires a co-signature before administration
- Immediate notification of any order changes or new orders
- Access within MAK to pertinent lab results
- Direct communication with Pharmacy to report issues or ask questions
These are just a few of the many features of a fully utilized MAK system. MAK also has limited charting
capabilities with an RTIF to Med/IV charting and to COR (if the client uses Invision), so real time
medication administration information can be displayed in Gold and Net Access. It interfaces with the
hospital’s ADT system, via TIF to Pharmacy. These features make MAK even more efficient to the
administrating nurse.
Hardware/Software Requirements for MAK
MAK runs on the Siemens Pharmacy server and is built utilizing the same tables. Therefore, it is
naturally intertwined with the Pharmacy system and has access to many of the same features, such as the
Pharmacy Drug Master and clinical checking options. The requirements for installing Siemens Medication
Administration Check software are few. A hospital must have currently or be using:
- Siemens Pharmacy version 23.6 or above
- Siemens Openlink 22 or above (or a comparable interface engine)
- Invision version 23 or above (or another vendor HIS)
It is important to note that additional software and hardware not included in the purchase of Medication
Administration Check is required by the hospital and may need to be purchased separately. The following
paragraphs detail some of this necessary hardware and software.
Barcoding software must be purchased if not already in place. At the heart of the MAK program is the
utilization of bar coding technology. In order for MAK to work, all medications and IV’s must be barcoded.
This can be done by the vendor (medications purchased in single dose packaging), or the hospital may choose
to buy medications in bulk and repackage themselves. In addition, there are companies who will contract
with a pharmacy to repackage medications into single dose units. IV medications mixed by the pharmacy must
be labeled in the pharmacy with a barcode at the time of preparation. This barcode must identify the
patient, drug, dose and bottle number. Stock IV’s are generally already barcoded by the manufacturer.
Patient wristbands are also barcoded with the patient account number. Employee identification badges need
to be barcoded to identify the nurse administering or countersigning the medications. Often, a hospital is
already performing some of these functions (in one way or another) and only need to supplement their current
processes.
Hardware in the form of barcode printers is needed at all access points where barcoded labels, armbands,
or ID badges are to be printed. Hospital policy will define this, but generally they will need to be
located in the Pharmacy, Admitting, Security office, Human Resources, and possibly the nursing units.
Vendors may be chosen to provide a single barcoding system that encompasses all of theses areas. Versatile
and fully supported barcoding software is available for purchase by third party companies.
The client should also plan on additional POC devices that are needed on each nursing unit that will
utilize MAK. Hospitals can decide to employ either mobile carts or bedside devices; some hospitals will
choose a combination of both. If mobile carts are to be used, the hospital must have a strong wireless
network environment in place. The number of devices needed depends on the size and layout of the nursing
unit. It is generally accepted that if mobile carts are to be used, there has to be enough carts so every
nurse passing medications has one at his or her disposal. Also, backup carts must exist in the event of
dead batteries or malfunctions. Whether a bedside, cabled device or a mobile wireless device, each must
have a bar code scanner attached to it.
Getting Ready to Install MAK
All of the work mentioned above is, unfortunately, the tip of the iceberg in a successful MAK install.
Once the decision has been made to go forward with MAK, there are several steps that must be taken to insure
a successful experience.
First, an in-house Project Manager should be chosen. Every bus needs a driver and the Project Manager is
it in this scenario. The PM is responsible for overseeing the workplan, schedule, and issues lists.
Second, a core project team must be chosen. This group consists of representatives from the units
involved in the MAK install and nursing education. Included in this team is a representative from the
Pharmacy, who is closely involved in the project.
A cohesive, supportive team is important because a MAK install will involve modification and creation of
policies and procedures. For example, there will be extensive policy and procedure changes from how
medications are handled in the Pharmacy and how they will be administered to the patients. Current work
flows on the nursing units will need to be studied and adapted to the new system. Down time procedures need
to be developed for the floors involved in the install. Staff education needs to be planned and executed.
Lastly, hardware, software, and equipment needs have to be explored, trialed, chosen, ordered, and placed
into service. All of these tasks (and more) need to be assigned and followed through to a successful
go-live.
In conclusion, whenever one begins a MAK install there should be some important preliminary discussions
with the hospital Administration staff and involved team members. In kickoff, the group should know up front
that the MAK program will not save time for the nurses. The hospital purchases this software to reduce
errors and increase accuracy in medication administration. The goal is to raise the level of proficient
patient care in a hospital. As staff becomes accustomed to the program, they will, no doubt, find it to be a
valuable tool that reveals its effectiveness in risk management reports. Securing the accuracy of medication
administration is never an overstated goal.