Effect of an electronic medication administration record application on patient safety


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,

Madrid, Spain

2Chief of Pharmacy, Hospital Universitario

Ramón y Cajal, Department of Pharmacy,

Madrid, Spain

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

Madrid, Spain.

Email: noelia.vicente@salud.madrid.org


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

recording (ME‐MAR).

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


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

DOI: 10.1111/jep.12753

888 © 2017 John Wiley & Sons, Ltd. J Eval Clin Pract. 2017;23:888–894.wileyonlinelibrary.com/journal/jephttp://orcid.org/0000-0003-1123-0699mailto:noelia.vicente@salud.madrid.orghttps://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.


2.1 | 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

eMAR impression.

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


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

our order.14

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



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


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).


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).


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-

sured contemporaneously.7

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

be assessed.21,22

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.


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

medications compromised.

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.


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




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.


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Eval Clin Pract. 2017;23:888–894. https://doi.org/10.1111/


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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