Health Information Technology

Electronic medication administration records improve communication and decisionmaking in nursing homes

The 1.6 million U.S. nursing home residents are at high risk for adverse effects from medication errors. Electronic point-of-care medication administration records (eMARs) can do much to reduce this risk when combined with quality improvement efforts, concludes a new study. Between 2003 and 2007, a team led by Jill Scott-Cawiezell, Ph.D., R.N., partnered with five midwestern nursing homes to implement eMARs. At each nursing home, a medication safety team guided staff during the transition from paper-based systems to the eMAR. The study involved more than 300 hours of observed implementation and integration of the eMAR. The researchers analyzed medication errors made on nearly 16,000 medication doses for 3,700 residents across 200 medication administrations. At each nursing home, the eMAR offered a structure and process to improve communication among a variety of users. For example, instead of using a 30-day hard-copy medication administration record, nurses could access real-time resident-specific medications on the computer on the medication cart. The eMAR also supported effective decisionmaking with use of drug alerts and signaling features on medication safety issues, while at the same time integrating complex tasks.

However, the technology could not overcome the outdated and fragmented medication systems already in place. During its initial implementation, the eMAR highlighted what was broken in these systems rather than fixing medication safety practices. As the eMAR was implemented, staff continued to hold onto traditional strategies and circumvent the new eMAR features. Some types of medication errors, such as late and omitted (or missing) medications, were better reduced by the eMAR and focused quality improvement efforts.

Although the eMAR did not solve these problems, it did provide real-time information that brought together staff to explore the root causes in a blame-free environment. Prior to that, staff tended to keep medication errors underground for fear of punishment. The study was supported by the Agency for Healthcare Research and Quality (HS14281).

See "Medication safety teams' guided implementation of electronic medication administration records in five nursing homes," by Dr. Scott-Cawiezell, Richard W. Madsen, Ph.D., Ginette A. Pepper, Ph.D., R.N., and others, in the January 2009 The Joint Commission Journal on Quality and Patient Safety 35(1), pp. 29-35.

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