The impact of electronic medication administration records (e-MAR) on medication administration safety and nurses’ work
The incorporation of information technology into new health care delivery models promises improvements in both the safety and efficiency of care delivery. Medication errors are one of the most significant safety issues for health care systems. Medication management occupies a significant amount of nurses’ time, and is also fraught with error potential. One-third of all medication errors that cause patient harm arise from medication administration errors (MAEs). Electronic medication administration records (e-MARs) provide the potential to make the administration of medications safer for patients by reducing error rates, and also by allowing nurses to more efficiently manage medication tasks. However it is not known whether this is actually the case. Hospitals in Australia and overseas are implementing eMARs in the absence of any rigorous empirical evidence that these systems are effective in achieving reduced error rates or in making nurses’ work more efficient.
In this project we will conduct two prospective, controlled observational studies to determine the effectiveness of an electronic medication administration record (e-MAR) to reduce MAEs and the amount of time nurses spend in the medication administration process. The results will have important implications for hospitals across Australia and internationally as they consider the implementation of e-MARs. The study focuses on the generic features of e-MARs and therefore results will be generalisable across the main commercial e-MAR systems available.
The project will also provide the first comprehensive baseline data regarding medication administration error rates and time spent in specific nursing work tasks (including multi-tasking and interruption rates) in Australia. The project will apply innovative data collection tools using PDA (hand held computer) software purpose-built for these studies which has undergone extensive pilot testing in clinical settings.
The findings will allow the development of recommendations regarding strategies to reduce MAEs and to improve the design of e-MARs.
The aims of this project are to:
- Determine how e-MARs impact upon medication safety by measuring changes in the types, rates & severity of medication administration errors (MAEs) following implementation of an e-MAR.
- Assess changes in the time nurses spend in medication administration following implementation of an e-MAR, and identify by nurse classification if more or less time is spent on other work tasks as a consequence.
- Provide recommendations to reduce MAEs and improve the design of e-MARs.
The two concurrent prospective observational studies, one to measure MAEs and a second to study nurses’ work tasks, will be conducted at a major teaching hospital, using a controlled before & after design. Nurses in eight wards (6 intervention and 2 control wards) will be invited to participate. In the first study nurses will be observed by a nurse researcher while they undertake medication administration and these observational data will be compared against patients’ medication records to identify MAEs. In the second study, nurses will be observed and multiple dimensions relating to work tasks recorded, including multi-tasking, and interruptions. Traditionally, observational error and work measurement studies have relied upon paper-based data collection. This is time intensive and creates distraction from actual observation for the researcher. A further limitation is the difficulty in capturing information about multi-tasking or interruptions, both of which are increasingly important dimensions of clinicians’ work which may impact upon errors. We have developed and pilot tested innovative software to capture these multi-layers of information in an efficient manner. Both observational studies will use PDAs to record all observational data. This project will be the first of its kind in the world and the results will be of national and international significance in establishing the role e-MARs play in improving medication administration safety and their impact on nurses’ work.
Lead Researcher: Professor Johanna Westbrook -
Research Funding: NHMRC Project Grant 2007-2009
Collaborators:
- Concord Repatriation General Hospital, Sydney
- St. Vincent’s Hospital, Sydney
- National Prescribing Service
- Centre for Health Services Management, University of Technology, Sydney