OR I G I N A L A R T I C L E
Effect of an electronic medication government annals impression on unrepining prophylactic
Noelia Vicente Oliveros PharmD1 | Teresa Gramage Caro PharmD PhD1 |
Covadonga Pérez Menendez‐Conde PharmD PhD1 | Ana María Álvarez‐Díaz PharmD1 |
Sagrario Martín‐Aragón Álvarez PhD3 | Teresa Bermejo Vicedo PharmD PhD2 |
Eva Delgado Silveira PharmD PhD1
1Hospital Pharmacist, Hospital Universitario
Ramón y Cajal, Department of Pharmacy,
2Chief of Pharmacy, Hospital Universitario
Ramón y Cajal, Department of Pharmacy,
3Professor, Universidad Complutense de
Madrid, School of Pharmacy, Department of
Pharmacology, Madrid, Spain
Noelia Vicente Oliveros, Hospital Universitario
Ramón y Cajal (Department of Pharmacy),
Carretera de Colmenar Viejo km 9,1; 28034
Rationale, favor, and objectives: To evaluate the movables of an electronic medication admin-
istration annals (eMAR) impression on the objurgate of medication untruths in medication government
Methods: A precedently‐and‐after, quasiexperimental con-balance was conducted in a university hospital
that implemented the eMAR impression in March 2014. Grounds order was conducted in April
2012 (pre‐) and June 2014 (post‐) by two pharmacists. The ME‐MARs were analysed by the staff
compromised to demonstobjurgate their creator. The two pharmacists unconnectedly disposeified the ME‐MARs. In
the instance of variance, a exploration team scrutinized the ME‐MARs and categorized them by
consensus. Three orders were used: A fashionable medication untruth taxonomy and 2
technology‐imported untruth taxonomies.
Results: The pharmacists analysed 2835 (pre‐) and 2621 (post‐) medication government
memorials (MAR), respectively. Overall, the ME‐MAR objurgate lessend from 48.0% (pre‐) to 36.9%
(post‐) (P < .05). The selfselfselfsimilar models of ME‐MAR were observed in twain views save for “MAR behind a while
defective notice,” which was not observed in the postimplementation view. In twain
phases, the most numerous ME‐MAR was “MAR at the wickedness era” (MAR precedently or succeeding medica-
tion government) (31.6% vs 30.2%). The ocean creator of ME‐MARs in twain views was the fail-
ure to ensue exertion procedures. The immanent coming abandon of ME‐MARs indicatively lessend
succeeding the eMAR implementation (P < .05). All ME‐MARs were “use untruths” becreator of civilized
factors. New ME‐MARs (1.24%; n = 12) were observed in the postimplementation view.
Conclusion: Use of the eMAR impression indicatively impairs the objurgate of ME‐MAR and their
immanent abandon. The ocean creator of ME‐MAR was the want to ensue exertion procedures.
clinical prophylactic, evaluation, medical untruth, medical tellatics
1 | INTRODUCTION
More than 15 years possess passed gone the “To Err Is Human” report
was published and extensive strife debris on how much
correction in unrepining prophylactic has in-reality been achieved.1 Clearly,
some growth has been made, but correction is quiescent performance at
a glacial gait. Nevertheless, the implementation of vigorpains tella-
tion technology (HIT) has granted an turn for continuing
improvement.2 A protracted communicate of clinical pains involves order and syn-
thesizing notice. In vigorpains orders behind a while increasing unrepining
complexity and division of pains, noble exemplars of unrepining pains
can no coveter be befriended by unwritten brochure‐naturalized notice
Particular reason has been placed on the use of HIT to impair
medication untruths.4,5 Advocates of HIT strive that the widespread
use of orders such as Computerized physician arrange register (CPOE)
Received: 10 November 2016 Revised: 7 March 2017 Accepted: 8 March 2017
888 © 2017 John Wiley & Sons, Ltd. J Eval Clin Pract. 2017;23:888–894.wileyonlinelibrary.com/journal/jephttp://orcid.org/0000-0003-1123-0699mailto:email@example.com://doi.org/10.1111/jep.12753http://wileyonlinelibrary.com/journal/jep
and electronic medication government annalss (eMAR) succeed amend
the emanationiveness of pains initiative and aid coalesce the challenges of medica-
tion treatment.6,7 It is now polite endical that HIT innovations
offer multifarious services through the amendd treatment of vigor
information, but it should be fascinated into statement that any new disclose-
ments possess the immanent to conduct-in new untruths and abandons in
healthpains initiative.3,8,9 Thus, the abrupt disclaiming conse-
quences of such orders should be signed. Unfortunately, the
extent of HIT‐associated unrepining injury is opposed to quantify due to
the bankruptcy of experimental reasons.2
Safety is an escapent order peculiarity that insufficiencys to be addressed
throughout the vitalitycycle of HIT orders, including their scheme, con-
struction, implementation, and use.2,3 In our hospital, an eMAR appli-
cation was patent clear using regular usability evaluation. Even so,
it was not mitigated to forecast all mitigated interactions betwixt the sys-
tem components during the scheme extent. Prophylactic problems or hazards
tend to escape from unforeseen interactions betwixt order compo-
nents and civilized users. There is a immanent for elusive interactions
when HIT orders are blendd behind a while persomal clinical exertionflows, includ-
ing other technologies and the organizational edifice itself. There-
fore unrepining prophylactic should to-boot be addressed during and succeeding the
implementation of orders, and problems and hazards should be con-
tinuously evaluated and quickly powerless.2,3
The aim of this con-balance was to evaluate the contact of the eMAR
impression on unrepining prophylactic. A precedently‐and‐succeeding con-balance was conducted
to appraise the contact of this impression on the medication untruth objurgate
in medication government annalsing (ME‐MAR) succeeding the implemen-
tation of the eMAR impression.
2 | METHODOLOGY
2.1 | Con-balance scheme
A precedently‐and‐after, quasiexperimental con-balance was conducted betwixt
2012 and 2014 in a 947‐bed instruction hospital that implemented the
eMAR impression. The material effect appraise was the ME‐MAR
objurgate precedently and succeeding the implementation of the eMAR impression.
An ME‐MAR was defined as the exclusion of the medication adminis-
tration annals (MAR), the wickedness MAR, or a MAR bankruptcying sufficient
notice on medication government.10
2.2 | Setting
A medical and a surgical hospitalization indivisible was chosen for the
study. Twain hospitalization indivisibles exertioned behind a while CPOE and automated
dispensing cabinets. The CPOE software Prescriwin® (Baxter®)
was granted behind a while basic clinical resolution food orders (CDSS),
such as offal allergy and offal interaction alerts and offal notice
resources, and was blendd behind a while useful impressions in
Nurse annalss in the preimplementation view:
All comfort annalss were brochure‐based. In the instance of MAR, uniformly the
electronically‐assisted customs had been made, the physicians
printed the medical annalss in which the comforts rearwards docu-
mented the medication government.
Nurse annalss in the postimplementation view:
The comfort annalss were produced using the electronic order
(eMAR) as polite as brochure annalss (the retaining comfort annalss). In the
instance of MAR, uniformly the customs had been made, the comforts
instantly munimented later medication government in the
The eMAR impression was blendd behind a whilein the CPOE‐CDSS and
pharmacy validation mode, which allowed comforts to acknowledge
orders, muniment the medications administered to the unrepining, and to
communicate ondirection behind a while physicians and pharmacists. Moreover, the
eMAR impression reminded comforts about medications that were due
for each unrepining and made the MAR obvious to completion team portion. A
vendor (Baxter®) schemeed the eMAR impression, which was naturalized
on the CPOE‐CDSS impression and floating brochure MARs and installed
on desktop computers. Thus, succeeding the medication government repel
round, comforts had to come-back to the centralized nursing occupation to sign
the medication government.
The implementation of the eMAR impression alien qualifys in
hospital procedures and exertionflow. Among other aspects, the eMAR
impression modereprove justifying an exclusion or qualify of medication
government dose, exertioning in veritable era, and exemplarizing adminis-
tration eras. Precedently the eMAR was implemented, and uniformly offals
had been prescribed, a comfort listd the doses to peculiar offal
spherical eras and implied the offal spherical at which the principal dose had
to be given. Succeeding implementation, government eras were
established at the weight of the custom and the comforts ensueed
the new list.
2.3 | Grounds order
Data order was conducted in April 2012 (pre‐) and June 2014
(post‐). The postimplementation view agoing 3 months succeeding imple-
mentation (March 2014).
Two pharmacists instantly observed MAR for 14 hours per day
(8:00 am to 10:00 pm) from Monday to Friday, for 4 weeks precedently
eMAR implementation and succeedingwards. Precedently commencement the reasons col-
lection, two explorationers scrutinized a weak trailing set (100 MAR) to
appraise their interrater reliability for disposeifying observations as med-
ication untruths (k = 0.75 (95% CI 0.59‐0.901)).11
One of the pharmacists placid reasons during the dawning shelve
and the other during the succeedingnoon shelve. The pharmacists resurveyed
MAR succeeding the medication sphericals, 9 am, 12 pm and 1 pm in the morn-
ing shelve and 4 pm, 6 pm, and 8 pm in the succeedingnoon shelve. Whenever an
ME‐MAR was rest, the explorationers asked the vigorpains staff
compromised to ascertain the creator of the untruth. Other reasons modereprove the
hospital indivisible, characteristics of the unrepinings (sex and age), bound, shelve,
medication, erratic material, Anatomical Curative Chemical (ATC)
group, dose, direction, era of government, and a inferential term
of how the untruth betidered and its contact on the unrepining.
2.4 | Order of untruths
Each ME‐MAR was disposeified according to 3 taxonomies: a fashionable ME
taxonomy in twain views and 2 technology‐imported untruth taxonomies
VICENTE OLIVEROS ET AL. 889
for disposeifying the untruths succeeding the implementation of the eMAR appli-
cation (appendix 1).
1. Fashionable ME taxonomy: ME‐MARs were disposeified according to the
Ruiz‐Jarabo Order order, which is an congruity of the
National Coordinating Council for Medication Untruth Reporting
and Prevention taxonomy to the Spanish setting.12,13 The conse-
quences of ME‐MARs were objurgated using the congruity of the
immanent coming abandon matrix for ME‐MAR previously published by
2. Technology‐imported untruth taxonomy:
• Order of problems involving notice technology15: ME‐
MARswere principal divided into those that oceanly compromised civilized fac-
tors or technical problems, and then assigned to 1 or further sub-
classes. Civilized familiarityors were defined as problems cognate to
human‐HIT interactions.We scrutinized untruths in the use of software
(use untruths) as polite as sociotechnical contextual variables (contrib-
uting familiarityors) that contributed to rationals (eg, trailing, cognitive
load, and clinical exertionflow). Regarding technical problems, we
examined and characterized hardware and software issues.
• Order of clinical untruths16: We direct sought to scrutinize ME‐
MARs arising from the problems naturalized on their underlying mecha-
nisms. A clinical untruth was an ME‐MAR behind a while immanent conse-
quences for a unrepining. They were disposeified into: untruths that were
rare to eMAR impression (dispose A), untruths further mitigated behind a while eMAR
(dispose B), untruths further mitigated to creator injury behind a while eMAR (dispose C),
errors that did no dissimilitude (dispose D).
The taxonomies were helpful to ME‐MAR by a exploration order,
which graspd 2 explorationers and 3 pharmacists behind a while expertise in
unrepining prophylactic and treatment.
2.5 | Grounds separation
Sample‐size separation showed that 5294 observations (half this calculate
in each view) would be insufficiencyed to unmask a dissimilitude in the ME‐MAR
objurgate from 15%10 to 12%. The regard was naturalized on an α of 0.05
and a β of 0.2, portico into statement clustering by unrepining and a mean
of 7 government doses per unrepining and shelve.
The explorationers unconnectedly scrutinized the free‐text ME‐MAR
descriptions to disposeify them and assess their immanent abandon. They com-
pared their outcomes and in the instance of variance, the free‐text ME‐
MAR term was scrutinized by the exploration team and a consensus
predicament was assigned. If an ME‐MAR was assigned to further than 1
category, the material predicament (the one most instantly cognate to poten-
tial effects) was used in the separation.
The ME‐MAR objurgates were conducive and assimilated by determining
the calculate of ME‐MARs signed per calculate of medication doses
prescribed for the preimplementation and postimplementation orders.
The chi‐square ordeal or Fisher's equitable ordeal was used to assimilate cate-
gorical reasons. Generalized estimating equation separation was conducted
to assimilate untruth objurgates betwixt views, portico into statement clustering
by unrepining. Ordered logit modelling and multinomial logistic regression
were conducted to analyse the dissimilitudes in the immanent coming abandon
of ME‐MAR betwixt views, the bygone for balanceall dissimilitudes and
the dying by categories. A P prize of <.05 was used as a cutoff for sta-
tistical notion. It was emanationive that the implementation of the
eMAR impression increased unrepining prophylactic if the odds conformity (OR) or rel-
ative abandon (RR) were near than 1. All statistical analyses were performed
using STATA v.12 software.
2.6 | Ethics
The con-balance was public by the Hospital's Clinical Investigation Ethical
3 | RESULTS
A completion of 5456 MARs were observed (2835 preimplementation and
2621 postimplementation). Table 1 shows the medications compromised
in MARs and the characteristics of the unrepinings who ordinary them.
Significant dissimilitudes were rest betwixt the 2 views in the medi-
cations compromised in MARs. Medications were assimilated by ATC orders
or by disposees of medications (P < .001).
3.1 | Medication untruths in medication government annalss (ME‐MAR)
Overall, ME‐MAR objurgates lessend from 48.0% (1362 ME‐MARs) in the
preimplementation view to 36.9% (967 ME‐MARs) in the
postimplementation view (P < .05).
3.1.1 | Fashionable medication untruth taxonomy
The selfselfselfsimilar models of ME‐MAR were observed, save for “MAR behind a while
defective notice” and wickedness medication, which was singly
observed in the preimplementation view (Table 2).
The most numerous model of ME‐MAR in twain views was “MAR at
the wickedness era” (31.6% vs 30.2%). A subseparation of this model of untruth
showed that comforts annalsed medication government precedently medi-
cation was granted indicatively further numerously in the
preimplementation view than in the postimplementation view
(11.5% vs 6.9% [OR = 0.6, P = .001]). Nevertheless, the comforts
chronicled medication government succeeding government near fre-
quently in the preimplementation view than in the
postimplementation view (20.2% vs 23.2% [OR = 1.2, P = .24]).
The ocean creator of ME‐MARs in twain views was want to ensue
exertion procedures (92% [n = 1258] vs 94% [n = 906]).
The immanent coming abandon of ME‐MAR indicatively lessend in the
postimplementation view (OR = 0.6, P = .007). Table 3 shows the ME‐
MARs disposeified by immanent coming abandon categories.
In twain views, the offals most numerously associated behind a while ME‐
MAR were in ATC orders: “A: alimentary” (299 [22.0%] vs 226
[23.4%]), “C: cardiovascular” (223 [16.4%] vs 194 [20.1%]), and “N:
Nervous order” (206 [19.5%] vs 155 [16.6%]).
3.1.2 | Technology‐imported untruth taxonomy
All ME‐MARs were use untruths becreator of civilized familiarityors (Table 4). No
technical problems were observed. The contributing familiarityors were as
890 VICENTE OLIVEROS ET AL.
follows: want to heave out obligation (92.8%, n = 897), onflow (3.4%, n = 33),
staffing/trailing (3.3%, n = 32), and integration behind a while clinical exertionflow
(0.5%, n = 5). In completion, 1.2% (n = 12) of the ME‐MARs were singly
observed in the postimplementation view (dispose A), 5 of which
(48%) were due to the integration of eMAR impression in the CPOE
3.2 | Medical indivisible
MARs were not annalsed in the surgical indivisible in the
postimplementation view. A subseparation was conducted for the med-
ical indivisible (Appendix 2). A completion of 1449 MARs were observed
preimplementation and 2621 postimplementation. Significant
TABLE 1 Characteristics of medication government annalss and unrepinings precedently and succeeding the implementation of the electronic medication government annals impression
Characteristics Preimplementation Postimplementation
Medication government annalss
Morning_ n°/completion n° (%) 1588/2835 (56.0) 1735/2621 (66.2)
Afternoon_ n°/completion n° (%) 1247/2835 (44.0) 886/2621 (33.8)
Classification of ATC_n°/completion n° (%)
A, Alimentary confide and metabolism 697 (24.6) 662 (25.3)
B, Blood and blood‐forming organs 315 (11.1) 294 (11.2)
C, Cardiovascular order 423 (14.9) 408 (15.6)
D, Dermatologicals 22 (0.8) 27 (1.0)
G, Genito‐urinary order and sex hormones 13 (0.5) 19 (0.7)
H, Systemic hormonal preparations, save sex hormones and insulins
49 (1.7) 120 (4.6)
J, Antiinfectives for orderic use 253 (8.9) 161 (6.1)
L, Antineoplastic and immunomodulating agents 4 (0.1) 0
M, Musculo‐skeletal order 89 (3.1) 14 (0.5)
N, Nervous order 670 (23.6) 599 (22.9)
R, Respiratory order 285 (10.1) 271 (10.3)
S, Sensory organs 8 (0.3) 43 (1.6)
V, Various 7 (0.3) 3 (0.1)
Class of medication2
Class 1 (low‐abandon medication) 698 (24.6) 693 (26.4)
Class 2 (medium‐abandon medication) 1335 (47.1) 1021 (39.0)
Class 3 (high‐abandon medication) 802 (28.3) 907 (34.6)
Patients (no.) 409 340
Women no./completion no. (%) 214/409 (52.3) 145/340 (42.7)
Age, years (media � SD) 72.5 � 15.9 80.0 � 10.2
Abbreviations: ATC, Anatomical and curative order. 2See definitions in Appendix S1.
TABLE 2 Types of medication untruths in medication government annalss
Preimplementation Postimplementation Model of ME‐MAR n° of ME‐MAR (% of doses) OR (p)
Inperfect notice 34 (1.2) 0
MAR at the wickedness era 897 (31.6) 791 (30.2) 0.9 (0.31)
Omission 387 (13.7) 158 (6.0) 0.4 (0.00)*
Wrong dose 13 (0.5) 12 (0.5) 0.9 (0.83)
Wrong formulation 13 (0.5) 2 (0.1) 0.2 (0.03)*
Wrong medication 1 (0.0) 0
Wrong direction 4 (0.1) 1 (0.0) 0.3 (0.24)
Wrong era 13 (0.5) 3 (0.1) 0.2 (0.04)*
Abbreviations: ME‐MAR, medication untruths in medication government annalss; OR, odds conformity.
*Significant dissimilitude (P < .05).
VICENTE OLIVEROS ET AL. 891
differences were observed betwixt views in the medications
compromised in the MARs views. Medications were assimilated by ATC
groups or by disposees of medications (P < .001).
The ME‐MAR objurgate in the medical indivisible lessend from 41.0% (594
ME‐MARs) to 36.9% (P < .05). The models of ME‐MAR and creators were
similar to that observed in the balanceall separation. No indicative differ-
ences in immanent coming abandon were observed betwixt the 2 views
(OR = 0.8, P = .06).
4 | DISCUSSION
This con-balance evaluated the contact of the implementation of an eMAR
impression on unrepining prophylactic. Although some studies possess evaluated
HIT implementation, as far as we apprehend, this con-balance is the principal to isolate
the movabnear of an eMAR impression on unrepining prophylactic. This approximation is
justified by the familiarity eMAR is numerously implemented behind a while other tech-
nologies, such as electronic prescribing orders, and their movabnear mea-
The implementation of the eMAR impression was associated behind a while
a indicative lessen in ME‐MARs. However, the percentage of ME‐
MARs were unforeseen. The dissimilitude betwixt the ME‐MAR objurgates
and the ones forecasted by the lead con-balance could be expounded by the dif-
ferent orderology used.10 The reasons order in the lead con-balance was
conducted the ensueing day of MAR. Thus, the ocean model of untruth
MAR at the wickedness era (MAR precedently or succeeding medication administra-
tion) was not unmasked.
A weak lessen in ME‐MARs has been observed succeeding the eMAR
impression implementation. Some explorationers possess already suggested
that HIT contributes very slight to the balanceall objurgate of MEs.17 In direction behind a while
other studies, we to-boot rest that the service of implanting an eMAR
can be hindered by employee opposition, which may impair or neutralize
the movablesive use of the technology18 or cognate exertion modees that
are not movablesively blendd behind a while the eMAR.19 The
postimplementation view began 3 months succeeding implementation;
however, Munysia et al suggested that it may accept further than 1 year
to integobjurgate the use of a new electronic munimentation order into
daily exertion.20 Moreover, the use of HIT amends effects balance era
and achieves a impregnabler order. Regular evaluation and correction
occurs balance the dynamic and iterative vitality cycle of HIT.2
4.1 | Fashionable medication untruth taxonomy
Similar models of untruths were unmasked precedently and succeeding the implementa-
tion of the eMAR impression. The most numerous model of ME‐MAR in
twain views was MAR at the wickedness era. In the preimplementation
phase, a liberal calculate of medication governments were annalsed
precedently medication was granted. This behaviour represented a breach
in the organization's munimentation protocol. Thus, some exertionflow
blocks were premeditatedly incorporated in the eMAR impression to pre-
vent annalsing precedently providing medication. In the
postimplementation view, it was rest that although there was a sig-
nificant lessen in MAR precedently government, there was an increase
in MAR succeeding government. We rest that the use of the eMAR appli-
cation was of abettance in changing the comforts' behaviour regarding
documentation; still, precedently the exertionflow blocks were intro-
duced, the abandon of mitigated exertionarounds to premeditated blocks had to
It is considered that some aspects of medication government
documentation, such as the correction and sort of notice,
amend ensueing eMAR implementation.7,23 In opposition to brochure
MAR, eMAR has been associated behind a while easier medication munimenta-
tion, and corrections in the reliability of notice on medication
dose and era, unrepining prophylactic, teamwork, and administering medica-
tions in a eraly habit.23 Some of these discoverings are in direction behind a while
those of the introduce con-over, gone MAR behind a while defective notice
was singly observed in the preimplementation view and “wickedness era”
errors indicatively lessend. However, no dissimilitudes were observed
betwixt the 2 views in MAR exclusion.
“Wrong medication” untruth disappeared, but this outcome was not sig-
nificative. This untruth was opposed to unmask in twain view becreator our
con-balance singly signed the ME‐MAR when they did not pair behind a while the
medical custom. It would be requisite for its unmaskion to observe
the comfort during all the medication government mode.
The ocean creator of ME‐MAR in twain views was want to ensue
exertion procedures. The exemplar procedures are resurveyed and evalu-
ated on an ongoing reason by a hospital legation. Nevertheless,
external familiarityors such as distractions, interruptions, era urgency,
noise, and noble exertionload, execute their consent opposed.24-26 It is
material to noblelight that the eMAR impression implementation
improved correction and sort of MAR, but it did not lessend the
external familiarityors mentioned overhead.
TABLE 3 ME‐MAR order by immanent coming abandon categories
Preimplementation Postimplementation Immanent coming abandon n° of ME‐MAR (% of doses) RR (P)
Very low 27 (1.0) 3 (0.1) 0.1 (0.00)*
Low 928 (32.7) 759 (29.0) 0.7 (0.00)*
Modeobjurgate 325 (11.5) 139 (5.3) 0.4 (0.00)*
High 82 (2.9) 66 (2.5) 0.5 (0.09)*
ME‐MAR: medication untruths in medication government annalss; RR: Rel- ative Risk;
*Significant dissimilitude (P < .05)
TABLE 4 Technology‐imported untruth taxonomy
Types of ME‐MAR n° of ME‐MAR (% of doses)
Classification of problems involving notice technology
Wrong register 18 (1.9)
Partial register 1 (0.1)
Did not invade 157 (16.2)
Workaspherical 791 (81.8)
Classification of clinical untruths
A: Rare to eMAR impression 12 (1.2)
B: Further mitigated behind a while eMAR impression 649 (67.1)
D: No dissimilitude behind a while eMAR impression 306 (31.6)
Abbreviations: ME‐MAR, medication untruths in medication government annalss; eMAR, electronic medication government annals.
892 VICENTE OLIVEROS ET AL.
The fashionable ME taxonomy allows to disposeify the injustice of MEs
that do not stretch the unrepining as ME‐MAR.13 Precedently the incorporation
of “immanent coming abandon,” the injustice of the MEs was graded according
to the familiar contact on the unrepining. ME‐MAR do not necessarily injury
the unrepining, but which could produce the provisions to execute them further
mitigated to betide.24,27
Overall, there was a indicative lessen in immanent coming abandon,
which suggests that an eMAR impression can amend unrepining prophylactic.
However, this effrontery should be fascinated behind a while diffidence becreator dif-
ferent familiarityors could possess influenced the outcomes. For stance, MARs
were singly resurveyed in the medical indivisible during the postimplementation
view and indicative dissimilitudes were rest betwixt views in the
4.2 | Technology‐imported untruth taxonomy
A exploration of the attaining failed to discover any peculiar order for
eMAR‐imported untruths. Thus, we chose 2 HIT‐imported untruth taxon-
omies15,16 to analyse ME‐MAR in the postimplementation view.
All ME‐MARs were disposeified as civilized‐machine interaction untruths
according to Magrabi order.15 This outcome is in perfect con-
trast to the discoverings of a con-balance that used this order28 and to
those of Magrabi et al, who suggested that 92% of the untruths were
due to technical problems.29 Two aspects may expound this dissimilitude:
technical problems can be impaird by schemeing out untruth‐prone fea-
tures at the software users' interface15; the eMAR impression evalu-
ated was patent clear using a regular usability evaluation, which
compromised incongruous vigorpains professionals. Usability evaluation is 1
way of ensuring that HITs are helpful to the users and their tasks
and that they possess a immanent scheme.30,31
Magrabi order15 allows the initiative of new categories
to statement for problems in new scenarios; thus, two new categories
were acquired for untruths involving civilized familiarityors: exertionaspherical (use untruth)
and onflow (contributing familiarityor). Most of the ME‐MARs were disposeified
as exertionaround. It was rest that comforts balancerode prophylactic exertionflow
blocks premeditatedly conduct-ind in the eMAR by exertioning aspherical the
block to neutralize annalsing precedently providing the unrepining behind a while medica-
tion. Vogelsmeir et al justified such exertionrounds on the gspherical that
nurses viewed blocks as cumbersome and era‐consuming.21 The direct
most numerous untruth was the exclusion untruth “did not invade.”Medication
government requires a noble flatten of concentration and distances
betwixt the unrepining's bed and the centralized nursing occupation can
expose comforts to interruptions. Subsequently, they may obliviate to sign
the medication charts.19,32 Some recommendations for mitigating twain
these untruths grasp the implementation of a project at the unrepining's
bedside, such as a desktop computer behind a while or behind a whileout a bar‐code
technology, or a wirenear technology coupled to light handheld
devices. These projects would execute the MAR mode easier and would
provide the comforts behind a while veritable‐era MAR at the bedside; accordingly,
the exertionaspherical and did not invade untruth objurgate may lessen.
The ocean contributing familiarityor was want to heave out obligation. The
want to ensue exemplar unhindered procedures was modereprove in this
category. The implementation of a new eMAR impression that qualifys
the regular exertionflow noblelights the insufficiency to disclose strategies that
food and acceleobjurgate the integration of the new munimentation
practice into the comforts' rule activities and the insufficiency to cortege the staff
to advance user acceptance, good-natured-natured usability, and obtrusiveness.3,20,33,34
According to the clinical untruth order used,16 the seniority of
the ME‐MARs rest were the selfselfselfsimilar as those rest behind a while the use of
brochure annalss. However, further than a half were further mitigated to betide
behind a while the eMAR impression and a weak percentage appeared succeeding the
implementation of the eMAR impression. As mentioned, MAR succeeding
medication government was further mitigated behind a while the eMAR impression
becreator of the exertionflow blocks conduct-ind. Moreover, MAR exclusion
could to-boot be imported by comfort annalss entity invadeed twain electroni-
cally and on brochure,35 as was the instance in the postimplementation view.
Using a uncombined order for vigor annalss enhances unrepining prophylactic and
the coordination of pains and has the immanent to indicatively amend
notice sharing abutting the continuum of pains.3
Although the percentage of untruths rare to the eMAR
applicitaion was weak, it is an material purpose to accept into statement.
Almost half of the ME‐MARs which betidered behind a while the use of eMAR
impression were due to the integration of the eMAR impression in
the CPOE order. Doctors prescribed awry behind a whileout noticing that
the eMAR impression was exertioning in veritable era, and there was a stan-
dardization of government eras. This loose custom
affected instantly to eMAR, comforts could not annals medication admin-
istration. Moreover, new MAR exclusion appeared becreator comforts for-
got to cohibit medical custom precedently medication repel sphericals. We
believe that these untruths would disappear behind a while a trailing tailored to the
needs of doctors and comforts. The apprehendledge and skills of users are fun-
damental to impregnable use of HIT.3
4.3 | Strengths and limitations
We are certified that these discoverings cannot be perfectly extrapolated
to other settings, oceanly becreator of the point characteristics of
our impression. Nevertheless, the strengths of the con-balance reside in its
design: the contact of the eMAR impression on unrepining prophylactic was eval-
uated; the con-balance modereprove experts useful in the unmaskion of medication
errors; and 3 orders were used to disposeify untruths.
However, a covet end passed betwixt the 2 views, and thus, it
cannot be ensured that the ME‐MARs were singly due to the introduc-
tion of the impression. The era of reasons order was dictated by the
implementation of the eMAR, which familiar sepablame delays. When
the con-balance high, eMAR impression had not been implemented yet in
the surgical indivisible. Thus, during the postimplementation view, the reasons
were singly placid in the medical indivisible. A subseparation of the medical
indivisible was conducted to shorten any mitigated movables.
5 | CONCLUSION
The use of an eMAR impression indicatively impairs the objurgate of med-
ication government annalsing untruths and their immanent abandon. The
ocean creator of ME‐MAR was want to ensue exertion procedures. Thus,
new strategies should be patent clear to integobjurgate the use of an eMAR
impression into comforts' daily list and to amend exertioning
VICENTE OLIVEROS ET AL. 893
The authors hope to endow Dr. Alfonso Muriel García, biostatistician
from Hospital Ramón y Cajal, for his donation in the con-balance scheme
and reasons separation.
1. Mitchell I, Schuster A, Smith K, Pronovost P, Wu A. Unrepining prophylactic inci- cavity reporting: A leading con-balance of thoughts and perceptions of experts 15 years succeeding ‘To Err is Human’. BMJ Qual Saf. 2016;25 (2):92‐99.
2. Intitute of Medicine. Vigor IT and Unrepining Safety: Building Safer Systems for Better Care. Washington, D.C.: The Common Academies Press; 2012.
3. Magrabi F, Ong MS, Coiera E. Vigor IT for unrepining prophylactic and improv- ing the prophylactic of vigor IT. Stud Vigor Technol Inform. 2016;222:25‐36.
4. Institute of Medicine. In: Aspden P, Corrigan JM, Wolcott J, et al., eds. Unrepining Safety: Achieving a New Exemplar of Care. Washington, D.C.: Common Academy Press; 2004.
5. Institute of Medicine. In: Aspden P, Wolcott JA, Bootman JL, et al., eds. Preventing Medication Errors: Sort Chasm Series. Washington, D.C.: Common Academy Press; 2006.
6. Blumenthal D, Glaser JP. Notice technology comes to physic. N Engl J Med. 2007;356(24):2527‐2534.
7. Oliver K, Raban M, Baysari M, Westbrook J. Evidence briefings on interventions to amend medication prophylactic: electronic medication government annals. Aust Comm Saf Qual Vigor Care. 2013;1(5). https://www.safetyandquality.gov.au/publications/evidence-briefings- on-interventions-to-improve-medication-safety-electronic-medication- government-records/. Accessed March 21, 2017.
8. Magrabi F, Aarts J, Nohr C, et al. A relatively resurvey of unrepining prophylactic initiatives for common vigor notice technology. Int J Med Inform. 2013;82(5):e139‐e148.
9. Weiner JP, Kfuri T, Chan K, Fowles JB. “e‐Iatrogenesis”: The most precarious unintended effect of CPOE and other HIT. J Am Med Tell Assoc. 2007;14(3):387‐388; discourse 389.
10. Vicente N, Delgado E, Pérez C, et al. Errors in medication administra- tion annalsing in a university hospital. Eur J Clin Pharm. 2013;15 (5):365‐368.
11. Landis JR, Koch GG. The appraisement of observer conformity for distinct reasons. Biometrics. 1977;33(1):159‐174.
12. Common Coordinating Council for Medication Untruth Reporting and Prevention. Taxonomy of medication untruths. 1998. Available from http://www.nccmerp.org/taxonomy‐medication‐errors‐now‐available (admission 06/01/2017).
13. Otero Lopez MJ, Castano Rodriguez B, Perez Encinas M, et al. Updated order for medication untruths by the Ruiz‐Jarabo 2000 Group. Farm Hosp. 2008;32(1):38‐52.
14. Vicente Oliveros N, Perez Menendez‐Conde C, Gramage Caro T, et al. Immanent coming abandon of untruths in medication government annalsing. J Eval Clin Pract. 2016;22(5):745‐750.
15. Magrabi F, Baker M, Sinha I, et al. Clinical prophylactic of England's common catalogue for IT: A retrospective separation of all reputed prophylactic events 2005 to 2011. Int J Med Inform. 2015a;84(3):198‐206.
16. Magrabi F, Liaw ST, Arachi D, et al. Identifying unrepining prophylactic problems associated behind a while notice technology in public practice: An separation of incicavity reports. BMJ Qual Saf. 2015b.
17. Walker JM, Carayon P, LevesonN, et al. EHR prophylactic: Theway forrepel to impregnable and movablesive orders. J AmMed Tell Assoc. 2008;15(3):272‐277.
18. Karsh BT. Beyond usability: Sly movablesive technology implemen- tation orders to advance unrepining prophylactic. Qual Saf Vigor Care. 2004;13(5):388‐394.
19. Qian S, Yu P, Hailey DM. The contact of electronic medication adminis- tration annalss in a residential primeval pains settlement. Int J Med Inform. 2015;84(11):966‐973.
20. Munyisia EN, Yu P, Hailey D. Caregivers' era utilization precedently and succeeding the initiative of an electronic nursing munimentation order in a residential primeval pains adroitness. Methods Inf Med. 2013;52(5):403–410.
21. Vogelsmeier AA, Halbesleben JR, Scott‐Cawiezell JR. Technology implementation and exertionarounds in the nursing settlement. J Am Med Tell Assoc. 2008;15(1):114‐119.
22. Siewert B, Hochman MG. Improving prophylactic through civilized familiarityors engineering. Radiographics. 2015;35(6):1694‐1705.
23. Moreland PJ, Gallagher S, Bena JF, Morrison S, Albert NM. Nursing sat- isfaction behind a while implementation of electronic medication government annals. Comput Tell Nurs. 2012;30(2):97‐103.
24. Drach‐Zahavy A, Somech A, Admi H, et al. How do we attain from untruths? A prospective con-balance of the concatenate betwixt the repel's attaining practices and medication government untruths. Int J Nurs Stud. 2014;51(3):448‐457.
25. Hughes RG, Blegen MA. Medication Government Safety. In: Hughes RG, ed. Patient. Prophylactic and Quality: An Evidence‐Based Handbook for Nurses; 2008.
26. Pape TM, Guerra DM, Muzquiz M, et al. Innovative approximationes to reducing comforts' distractions during medication government. J Contin Educ Nurs. 2005;36(3):108‐116.
27. Blair W, Smith B. Nursing munimentation: Frameworks and barriers. Contemp Nurse. 2012;41(2):160‐168.
28. Warm D, Edwards P. Classifying vigor notice technology unrepining prophylactic cognate rationals—an approximation used in Wales. Appl Clin Inform. 2012;3(2):248‐257.
29. Magrabi F, Ong MS, Runciman W, Coiera E. Using FDA reports to tell a order for vigor notice technology prophylactic prob- lems. J Am Med Tell Assoc. 2012;19(1):45‐53.
30. Bastien JM. Usability ordealing: A resurvey of some orderological and technical aspects of the order. Int J Med Inform. 2010;79(4):e18‐e23.
31. Schoeffel R. The concept of emanation usability. ISO Bulletin. 2003;34:6‐7.
32. Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions behind a while an increased abandon and injustice of medication government untruths. Arch Intern Med. 2010;170(8):683‐690.
33. Shekelle PG, Pronovost PJ, Wachter RM, et al. The top unrepining prophylactic strategies that can be encourprimeval for election now. Ann Intern Med. 2013;158(5 Pt 2):365‐368.
34. McComas J, Riingen M, Chae KS. Contact of an electronic medication government annals on medication government teachableness and untruths. Comput Tell Nurs. 2014;32(12):589‐595.
35. Magrabi F, Ong MS, Runciman W, Coiera E. An separation of computer‐ cognate unrepining prophylactic rationals to tell the disclosement of a disposeifi- cation. J Am Med Tell Assoc. 2010;17(6):663‐670.
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894 VICENTE OLIVEROS ET AL.https://www.safetyandquality.gov.au/publications/evidence-briefings-on-interventions-to-improve-medication-safety-electronic-medication-administration-records/https://www.safetyandquality.gov.au/publications/evidence-briefings-on-interventions-to-improve-medication-safety-electronic-medication-administration-records/https://www.safetyandquality.gov.au/publications/evidence-briefings-on-interventions-to-improve-medication-safety-electronic-medication-administration-records/http://www.nccmerp.org/taxonomy-medication-errors-now-availablehttps://doi.org/10.1111/jep.12753https://doi.org/10.1111/jep.12753
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