The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study

Seetal Jheeta,Bryony Dean Franklin

doi:10.1186/s12913-017-2462-2

Abstract

BackgroundThe aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices.MethodsThe study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses’ medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend.ResultsObservations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3–6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9–5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1–2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8–4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications.ConclusionsFindings suggest no change in medication error rate, although ePA encourages certain types of errors and mitigates others. There was a statistically significant increase in documentation discrepancies which is likely to be due to adoption of new working practices with ePA.

Highlights

The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system on the safety of medication administration in an inpatient hospital setting
One early study observed no difference in Medication administration errors (MAE) rates with the use of electronic prescribing [14] while in contrast, Fowlie et al [15] and Franklin et al [16] reported reductions in MAEs, with the benefits in the latter study at least partly attributable to closed-loop automated dispensing integrated with electronic prescribing and administration (ePA)
A longitudinal time series approach would address some of the limitations associated with before-and-after studies, and allow exploration of the time period required for administration practices to normalise following ePA implementation

Summary

Introduction

The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. The use of electronic prescribing and administration (ePA) systems has been shown to significantly improve patient safety by reducing medication errors [1,2,3,4]. Most studies exploring the impact of introducing ePA have focussed on prescribing rather than medication administration [1]. A longitudinal time series approach would address some of the limitations associated with before-and-after studies, and allow exploration of the time period required for administration practices to normalise following ePA implementation

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Methods

Results

Conclusion