Electronic Health Record


Effect of an electronic medication government archives collision on unrepining insurance

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, giveation, and objectives: To evaluate the pi of an electronic medication admin-

istration archives (eMAR) collision on the reprove of medication blunders in medication government

recording (ME‐MAR).

Methods: A antecedently‐and‐after, quasiexperimental prove was conducted in a university hospital

that implemented the eMAR collision in March 2014. Axioms store was conducted in April

2012 (pre‐) and June 2014 (post‐) by two pharmacists. The ME‐MARs were analysed by the staff

compromised to warrant their purpose. The two pharmacists unconnectedly planatizeified the ME‐MARs. In

the circumstance of variance, a exploration team proved the ME‐MARs and categorized them by

consensus. Three characters were used: A chaste medication blunder taxonomy and 2

technology‐redundant blunder taxonomies.

Results: The pharmacists analysed 2835 (pre‐) and 2621 (post‐) medication government

registers (MAR), respectively. Overall, the ME‐MAR reprove lowerd from 48.0% (pre‐) to 36.9%

(post‐) (P < .05). The corresponding casts of ME‐MAR were observed in twain complexions ate for “MAR subjoined a while

fallible counsel,” which was not observed in the postimplementation complexion. In twain

phases, the most usual ME‐MAR was “MAR at the evil-doing space” (MAR antecedently or behind medica-

tion government) (31.6% vs 30.2%). The ocean purpose of ME‐MARs in twain complexions was the fail-

ure to supervene labor procedures. The practicable coming imperil of ME‐MARs forciblely lowerd

behind the eMAR implementation (P < .05). All ME‐MARs were “use blunders” bepurpose of civilized

factors. New ME‐MARs (1.24%; n = 12) were observed in the postimplementation complexion.

Conclusion: Use of the eMAR collision forciblely impoverishs the reprove of ME‐MAR and their

practicable imperil. The ocean purpose of ME‐MAR was the demand to supervene labor procedures.


clinical insurance, evaluation, medical blunder, medical edifyatics


More than 15 years possess passed since the “To Err Is Human” report

was published and extensive disputation recrement on how much

dexterity in unrepining insurance has substantially been achieved.1 Clearly,

some advance has been made, but dexterity is quiescent arrangement at

a glacial step. Nevertheless, the implementation of vigorcustody edifya-

tion technology (HIT) has granted an opening for continuing

improvement.2 A exalted traffic of clinical custody involves bunch and syn-

thesizing counsel. In vigorcustody plans subjoined a while increasing unrepining

complexity and division of custody, elevated rules of unrepining custody

can no desireer be cheered by transmitted essay‐naturalized counsel


Particular marrow has been placed on the use of HIT to impoverish

medication blunders.4,5 Advocates of HIT oceantain that the widespread

use of plans such as Computerized physician planatizeify entrance (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 archivess (eMAR) gain reform

the serviceableness of custody grant and acceleration as the challenges of medica-

tion skillful-treatment.6,7 It is now polite-mannered-behaved-behaved boundical that HIT innovations

offer manifold good-tempereds through the reformd skillful-treatment of vigor

information, but it should be enthralled into statement that any new unravel-

ments possess the practicable to conduct-in new blunders and imperils in

healthcustody grant.3,8,9 Thus, the abrupt denying conse-

quences of such plans should be attested. Unfortunately, the

extent of HIT‐associated unrepining wound is opposed to quantify due to

the stagnation of tentative axioms.2

Safety is an issuent plan ownership that insufficiencys to be addressed

throughout the conductcycle of HIT plans, including their intent, con-

struction, implementation, and use.2,3 In our hospital, an eMAR appli-

cation was familiar using true usability evaluation. Even so,

it was not practicable to forecast all practicable interactions betwixt the sys-

tem components during the intent range. Insurance problems or hazards

tend to issue from unforeseen interactions betwixt plan compo-

nents and civilized users. There is a practicable for smooth interactions

when HIT plans are sumd subjoined a while unconcealed clinical laborflows, includ-

ing other technologies and the organizational texture itself. There-

fore unrepining insurance should so be addressed during and behind the

implementation of plans, and problems and hazards should be con-

tinuously evaluated and promptly subordinate.2,3

The aim of this prove was to evaluate the contact of the eMAR

collision on unrepining insurance. A antecedently‐and‐behind prove was conducted

to mete the contact of this collision on the medication blunder reprove

in medication government archivesing (ME‐MAR) behind the implemen-

tation of the eMAR collision.


2.1 | Prove intent

A antecedently‐and‐after, quasiexperimental prove was conducted betwixt

2012 and 2014 in a 947‐bed education hospital that implemented the

eMAR collision. The elementary end mete was the ME‐MAR

reprove antecedently and behind the implementation of the eMAR collision.

An ME‐MAR was defined as the balancesight of the medication adminis-

tration archives (MAR), the evil-doing MAR, or a MAR stagnationing sufficient

counsel on medication government.10

2.2 | Setting

A medical and a surgical hospitalization part was chosen for the

study. Twain hospitalization parts labored subjoined a while CPOE and automated

dispensing cabinets. The CPOE software Prescriwin® (Baxter®)

was granted subjoined a while basic clinical resolution oceantenance plans (CDSS),

such as garbage allergy and garbage interaction alerts and garbage counsel

resources, and was sumd subjoined a while conducive collisions in


Nurse archivess in the preimplementation complexion:

All protect archivess were essay‐based. In the circumstance of MAR, unintermittently the

electronically‐assisted orders had been made, the physicians

printed the medical archivess in which the protects subjoined docu-

mented the medication government.

Nurse archivess in the postimplementation complexion:

The protect archivess were educed using the electronic plan

(eMAR) as polite-mannered-behaved-behaved as essay archivess (the cherishing protect archivess). In the

circumstance of MAR, unintermittently the orders had been made, the protects

undeviatingly munimented succeeding medication government in the

eMAR collision.

The eMAR collision was sumd subjoined a whilein the CPOE‐CDSS and

pharmacy validation arrangement, which undisputed protects to acknowledge

orders, muniment the medications administered to the unrepining, and to

communicate oncord subjoined a while physicians and pharmacists. Moreover, the

eMAR collision reminded protects encircling medications that were due

for each unrepining and made the MAR conspicuous to total team constituent. A

vendor (Baxter®) intented the eMAR collision, which was naturalized

on the CPOE‐CDSS collision and give essay MARs and installed

on desktop computers. Thus, behind the medication government defend

round, protects had to requite to the centralized nursing place to sign

the medication government.

The implementation of the eMAR collision entailed veers in

hospital procedures and laborflow. Among other aspects, the eMAR

collision intervening justifying an balancesight or veer of medication

government dose, laboring in patent clear space, and ruleizing adminis-

tration spaces. Antecedently the eMAR was implemented, and unintermittently garbages

had been prescribed, a protect catalogued the doses to unfair garbage

spherical spaces and compromised the garbage spherical at which the primitive dose had

to be fond. Behind implementation, government spaces were

established at the avail of the order and the protects superveneed

the new catalogue.

2.3 | Axioms store

Data store was conducted in April 2012 (pre‐) and June 2014

(post‐). The postimplementation complexion agoing 3 months behind imple-

mentation (March 2014).

Two pharmacists undeviatingly observed MAR for 14 hours per day

(8:00 am to 10:00 pm) from Monday to Friday, for 4 weeks antecedently

eMAR implementation and behindwards. Antecedently rise the axioms col-

lection, two explorationers proved a feeble grafting set (100 MAR) to

mete their interrater reliability for planatizeifying observations as med-

ication blunders (k = 0.75 (95% CI 0.59‐0.901)).11

One of the pharmacists composed axioms during the dawning displace

and the other during the behindnoon displace. The pharmacists re-examinationed

MAR behind the medication sphericals, 9 am, 12 pm and 1 pm in the morn-

ing displace and 4 pm, 6 pm, and 8 pm in the behindnoon displace. Whenever an

ME‐MAR was endow, the explorationers asked the vigorcustody staff

compromised to descry the purpose of the blunder. Other axioms intervening the

hospital part, characteristics of the unrepinings (sex and age), bound, displace,

medication, free pith, Anatomical Curative Chemical (ATC)

group, dose, path, space of government, and a elaborebuke patronymic

of how the blunder arisered and its contact on the unrepining.

2.4 | Character of blunders

Each ME‐MAR was planatizeified according to 3 taxonomies: a chaste ME

taxonomy in twain complexions and 2 technology‐redundant blunder taxonomies


for planatizeifying the blunders behind the implementation of the eMAR appli-

cation (appendix 1).

1. Chaste ME taxonomy: ME‐MARs were planatizeified according to the

Ruiz‐Jarabo Order character, which is an equal of the

National Coordinating Council for Medication Blunder Reporting

and Prevention taxonomy to the Spanish setting.12,13 The conse-

quences of ME‐MARs were reproved using the equal of the

practicable coming imperil matrix for ME‐MAR previously published by

our order.14

2. Technology‐redundant blunder taxonomy:

• Character of problems involving counsel technology15: ME‐

MARswere primitive disjoined into those that oceanly compromised civilized fac-

tors or technical problems, and then assigned to 1 or past sub-

classes. Civilized eventors were defined as problems cognate to

human‐HIT interactions.We proved blunders in the use of software

(use blunders) as polite-mannered-behaved-behaved as sociotechnical contextual variables (contrib-

uting eventors) that contributed to orderlys (eg, grafting, cognitive

load, and clinical laborflow). Regarding technical problems, we

examined and characterized hardware and software issues.

• Character of clinical blunders16: We proximate sought to prove ME‐

MARs arising from the problems naturalized on their underlying mecha-

nisms. A clinical blunder was an ME‐MAR subjoined a while practicable conse-

quences for a unrepining. They were planatizeified into: blunders that were

sole to eMAR collision (systematize A), blunders past mitigated subjoined a while eMAR

(systematize B), blunders past mitigated to purpose wound subjoined a while eMAR (systematize C),

errors that did no distinction (systematize D).

The taxonomies were serviceable to ME‐MAR by a exploration order,

which comprised 2 explorationers and 3 pharmacists subjoined a while expertise in

unrepining insurance and skillful-treatment.

2.5 | Axioms separation

Sample‐size separation showed that 5294 observations (half this compute

in each complexion) would be insufficiencyed to discbalance a distinction in the ME‐MAR

reprove from 15%10 to 12%. The apportionment was naturalized on an α of 0.05

and a β of 0.2, initiative into statement clustering by unrepining and a mean

of 7 government doses per unrepining and displace.

The explorationers unconnectedly proved the free‐text ME‐MAR

descriptions to planatizeify them and assess their practicable imperil. They com-

pared their ends and in the circumstance of variance, the free‐text ME‐

MAR patronymic was proved by the exploration team and a consensus

condition was assigned. If an ME‐MAR was assigned to past than 1

category, the elementary condition (the one most undeviatingly cognate to poten-

tial issues) was used in the separation.

The ME‐MAR reproves were conducive and paralleld by determining

the compute of ME‐MARs attested per compute of medication doses

prescribed for the preimplementation and postimplementation orders.

The chi‐square trial or Fisher's proper trial was used to parallel cate-

gorical axioms. Generalized estimating equation separation was conducted

to parallel blunder reproves betwixt complexions, initiative into statement clustering

by unrepining. Ordered logit modelling and multinomial logistic regression

were conducted to analyse the distinctions in the practicable coming imperil

of ME‐MAR betwixt complexions, the preceding for balanceall distinctions and

the perishing by categories. A P estimate of <.05 was used as a cutoff for sta-

tistical feeling. It was conjectured that the implementation of the

eMAR collision increased unrepining insurance if the odds bargain (OR) or rel-

ative imperil (RR) were near than 1. All statistical analyses were performed

using STATA v.12 software.

2.6 | Ethics

The prove was common by the Hospital's Clinical Investigation Ethical



A entirety 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 common them.

Significant distinctions were endow betwixt the 2 complexions in the medi-

cations compromised in MARs. Medications were paralleld by ATC orders

or by planatizees of medications (P < .001).

3.1 | Medication blunders in medication government archivess (ME‐MAR)

Overall, ME‐MAR reproves lowerd from 48.0% (1362 ME‐MARs) in the

preimplementation complexion to 36.9% (967 ME‐MARs) in the

postimplementation complexion (P < .05).

3.1.1 | Chaste medication blunder taxonomy

The corresponding casts of ME‐MAR were observed, ate for “MAR subjoined a while

fallible counsel” and evil-doing medication, which was solely

observed in the preimplementation complexion (Table 2).

The most usual cast of ME‐MAR in twain complexions was “MAR at

the evil-doing space” (31.6% vs 30.2%). A subseparation of this cast of blunder

showed that protects archivesed medication government antecedently medi-

cation was granted forciblely past usually in the

preimplementation complexion than in the postimplementation complexion

(11.5% vs 6.9% [OR = 0.6, P = .001]). Nevertheless, the protects

commemorative medication government behind government near fre-

quently in the preimplementation complexion than in the

postimplementation complexion (20.2% vs 23.2% [OR = 1.2, P = .24]).

The ocean purpose of ME‐MARs in twain complexions was demand to supervene

labor procedures (92% [n = 1258] vs 94% [n = 906]).

The practicable coming imperil of ME‐MAR forciblely lowerd in the

postimplementation complexion (OR = 0.6, P = .007). Table 3 shows the ME‐

MARs planatizeified by practicable coming imperil categories.

In twain complexions, the garbages most usually associated subjoined 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 plan” (206 [19.5%] vs 155 [16.6%]).

3.1.2 | Technology‐redundant blunder taxonomy

All ME‐MARs were use blunders bepurpose of civilized eventors (Table 4). No

technical problems were observed. The contributing eventors were as


follows: demand to push out trust (92.8%, n = 897), gliding (3.4%, n = 33),

staffing/grafting (3.3%, n = 32), and integration subjoined a while clinical laborflow

(0.5%, n = 5). In entirety, 1.2% (n = 12) of the ME‐MARs were solely

observed in the postimplementation complexion (systematize A), 5 of which

(48%) were due to the integration of eMAR collision in the CPOE


3.2 | Medical part

MARs were not archivesed in the surgical part in the

postimplementation complexion. A subseparation was conducted for the med-

ical part (Appendix 2). A entirety of 1449 MARs were observed

preimplementation and 2621 postimplementation. Significant

TABLE 1 Characteristics of medication government archivess and unrepinings antecedently and behind the implementation of the electronic medication government archives collision

Characteristics Preimplementation Postimplementation

Medication government archivess


Morning_ n°/entirety n° (%) 1588/2835 (56.0) 1735/2621 (66.2)

Afternoon_ n°/entirety n° (%) 1247/2835 (44.0) 886/2621 (33.8)

Classification of ATC_n°/entirety n° (%)

A, Alimentary hope and metabolism 697 (24.6) 662 (25.3)

B, Blood and blood‐forming organs 315 (11.1) 294 (11.2)

C, Cardiovascular plan 423 (14.9) 408 (15.6)

D, Dermatologicals 22 (0.8) 27 (1.0)

G, Genito‐urinary plan and sex hormones 13 (0.5) 19 (0.7)

H, Systemic hormonal preparations, notwithstanding sex hormones and insulins

49 (1.7) 120 (4.6)

J, Antiinfectives for planic use 253 (8.9) 161 (6.1)

L, Antineoplastic and immunomodulating agents 4 (0.1) 0

M, Musculo‐skeletal plan 89 (3.1) 14 (0.5)

N, Nervous plan 670 (23.6) 599 (22.9)

R, Respiratory plan 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‐imperil medication) 698 (24.6) 693 (26.4)

Class 2 (medium‐imperil medication) 1335 (47.1) 1021 (39.0)

Class 3 (high‐imperil medication) 802 (28.3) 907 (34.6)


Patients (no.) 409 340

Women no./entirety 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 character. 2See definitions in Appendix S1.

TABLE 2 Types of medication blunders in medication government archivess

Preimplementation Postimplementation Cast of ME‐MAR n° of ME‐MAR (% of doses) OR (p)

Intotal counsel 34 (1.2) 0

MAR at the evil-doing space 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 path 4 (0.1) 1 (0.0) 0.3 (0.24)

Wrong space 13 (0.5) 3 (0.1) 0.2 (0.04)*

Abbreviations: ME‐MAR, medication blunders in medication government archivess; OR, odds bargain.

*Significant distinction (P < .05).


differences were observed betwixt complexions in the medications

compromised in the MARs complexions. Medications were paralleld by ATC

groups or by planatizees of medications (P < .001).

The ME‐MAR reprove in the medical part lowerd from 41.0% (594

ME‐MARs) to 36.9% (P < .05). The casts of ME‐MAR and purposes were

similar to that observed in the balanceall separation. No forcible differ-

ences in practicable coming imperil were observed betwixt the 2 complexions

(OR = 0.8, P = .06).


This prove evaluated the contact of the implementation of an eMAR

collision on unrepining insurance. Although some studies possess evaluated

HIT implementation, as far as we comprehend, this prove is the primitive to isolate

the pis of an eMAR collision on unrepining insurance. This bearing is

justified by the event eMAR is usually implemented subjoined a while other tech-

nologies, such as electronic prescribing plans, and their pis mea-

sured concertedly.7

The implementation of the eMAR collision was associated subjoined a while

a forcible lower in ME‐MARs. However, the percentage of ME‐

MARs were unforeseen. The distinction betwixt the ME‐MAR reproves

and the ones forecasted by the conduct prove could be elucidateed by the dif-

ferent systemology used.10 The axioms store in the conduct prove was

conducted the superveneing day of MAR. Thus, the ocean cast of blunder

MAR at the evil-doing space (MAR antecedently or behind medication administra-

tion) was not discovered.

A feeble lower in ME‐MARs has been observed behind the eMAR

collision implementation. Some explorationers possess already suggested

that HIT contributes very paltry to the balanceall reprove of MEs.17 In cord subjoined a while

other studies, we so endow that the good-tempered-tempered of implanting an eMAR

can be hindered by employee opposition, which may impoverish or thwart

the piive use of the technology18 or cognate labor arrangementes that

are not piively sumd subjoined a while the eMAR.19 The

postimplementation complexion began 3 months behind implementation;

however, Munysia et al suggested that it may admit past than 1 year

to integreprove the use of a new electronic munimentation plan into

daily labor.20 Moreover, the use of HIT reforms ends balance space

and achieves a unendangeredr plan. True evaluation and dexterity

occurs balance the dynamic and iterative conduct cycle of HIT.2

4.1 | Chaste medication blunder taxonomy

Similar casts of blunders were discovered antecedently and behind the implementa-

tion of the eMAR collision. The most usual cast of ME‐MAR in

twain complexions was MAR at the evil-doing space. In the preimplementation

phase, a capacious compute of medication governments were archivesed

antecedently medication was granted. This behaviour represented a breach

in the organization's munimentation protocol. Thus, some laborflow

blocks were deliberately incorporated in the eMAR collision to pre-

vent archivesing antecedently providing medication. In the

postimplementation complexion, it was endow that although there was a sig-

nificant lower in MAR antecedently government, there was an increase

in MAR behind government. We endow that the use of the eMAR appli-

cation was of aid in changing the protects' behaviour regarding

documentation; eventually, antecedently the laborflow blocks were intro-

duced, the imperil of practicable laborarounds to delibescold blocks had to

be assessed.21,22

It is considered that some aspects of medication government

documentation, such as the success and temper of counsel,

reform superveneing eMAR implementation.7,23 In opposition to essay

MAR, eMAR has been associated subjoined a while easier medication munimenta-

tion, and dexteritys in the reliability of counsel on medication

dose and space, unrepining insurance, teamwork, and administering medica-

tions in a spacely mode.23 Some of these inventings are in cord subjoined a while

those of the give prove, since MAR subjoined a while fallible counsel

was solely observed in the preimplementation complexion and “evil-doing space”

errors forciblely lowerd. However, no distinctions were observed

betwixt the 2 complexions in MAR balancesight.

“Wrong medication” blunder abateed, but this end was not sig-

nificative. This blunder was opposed to discbalance in twain complexion bepurpose our

prove solely attested the ME‐MAR when they did not equal subjoined a while the

medical order. It would be compulsory for its discoverion to observe

the protect during all the medication government arrangement.

The ocean purpose of ME‐MAR in twain complexions was demand to supervene

labor procedures. The rule procedures are re-examinationed and evalu-

ated on an ongoing endowation by a hospital trust. Nevertheless,

external eventors such as distractions, interruptions, space hurry,

noise, and elevated laborload, perform their ductility opposed.24-26 It is

essential to elevatedlight that the eMAR collision implementation

improved success and temper of MAR, but it did not lowerd the

external eventors mentioned overhead.

TABLE 3 ME‐MAR character by practicable coming imperil categories

Preimplementation Postimplementation Practicable coming imperil 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)*

Modereprove 325 (11.5) 139 (5.3) 0.4 (0.00)*

High 82 (2.9) 66 (2.5) 0.5 (0.09)*

ME‐MAR: medication blunders in medication government archivess; RR: Rel- ative Risk;

*Significant distinction (P < .05)

TABLE 4 Technology‐redundant blunder taxonomy


Types of ME‐MAR n° of ME‐MAR (% of doses)

Classification of problems involving counsel technology

Wrong entrance 18 (1.9)

Partial entrance 1 (0.1)

Did not penetscold 157 (16.2)

Workaspherical 791 (81.8)

Classification of clinical blunders

A: Sole to eMAR collision 12 (1.2)

B: Past mitigated subjoined a while eMAR collision 649 (67.1)

D: No distinction subjoined a while eMAR collision 306 (31.6)

Abbreviations: ME‐MAR, medication blunders in medication government archivess; eMAR, electronic medication government archives.


The chaste ME taxonomy allows to planatizeify the tyranny of MEs

that do not obtain the unrepining as ME‐MAR.13 Antecedently the incorporation

of “practicable coming imperil,” the tyranny of the MEs was graded according

to the patent clear contact on the unrepining. ME‐MAR do not necessarily wound

the unrepining, but which could educe the stipulations to perform them past

mitigated to arise.24,27

Overall, there was a forcible lower in practicable coming imperil,

which suggests that an eMAR collision can reform unrepining insurance.

However, this impudence should be enthralled subjoined a while self-preservation bepurpose dif-

ferent eventors could possess influenced the ends. For sample, MARs

were solely re-examinationed in the medical part during the postimplementation

complexion and forcible distinctions were endow betwixt complexions in the

medications compromised.

4.2 | Technology‐redundant blunder taxonomy

A pursuit of the erudition failed to invent any unfair character for

eMAR‐redundant blunders. Thus, we chose 2 HIT‐redundant blunder taxon-

omies15,16 to analyse ME‐MAR in the postimplementation complexion.

All ME‐MARs were planatizeified as civilized‐machine interaction blunders

according to Magrabi character.15 This end is in total con-

trast to the inventings of a prove that used this character28 and to

those of Magrabi et al, who suggested that 92% of the blunders were

due to technical problems.29 Two aspects may elucidate this distinction:

technical problems can be impoverishd by intenting out blunder‐prone fea-

tures at the software users' interface15; the eMAR collision evalu-

ated was familiar using a true usability evaluation, which

compromised contrariant vigorcustody professionals. Usability evaluation is 1

way of ensuring that HITs are serviceable to the users and their tasks

and that they possess a practicable intent.30,31

Magrabi character15 allows the preface of new categories

to statement for problems in new scenarios; thus, two new categories

were ascititious for blunders involving civilized eventors: laboraspherical (use blunder)

and gliding (contributing eventor). Most of the ME‐MARs were planatizeified

as laboraround. It was endow that protects balancerode insurance laborflow

blocks deliberately conduct-ind in the eMAR by laboring aspherical the

block to thwart archivesing antecedently providing the unrepining subjoined a while medica-

tion. Vogelsmeir et al justified such laborrounds on the gspherical that

nurses viewed blocks as unpromotive and space‐consuming.21 The proximate

most usual blunder was the balancesight blunder “did not penetrate.”Medication

government requires a elevated smooth of eagerness and distances

betwixt the unrepining's bed and the centralized nursing place can

expose protects to interruptions. Subsequently, they may overlook to sign

the medication charts.19,32 Some recommendations for salubrious twain

these blunders apprehend the implementation of a cognizance at the unrepining's

bedside, such as a desktop computer subjoined a while or subjoined a whileout a bar‐code

technology, or a wirenear technology coupled to light handheld

devices. These cognizances would perform the MAR arrangement easier and would

provide the protects subjoined a while patent clear‐space MAR at the bedside; accordingly,

the laboraspherical and did not penetscold blunder reprove may lower.

The ocean contributing eventor was demand to push out trust. The

demand to supervene rule unimpeded procedures was intervening in this

category. The implementation of a new eMAR collision that veers

the natural laborflow elevatedlights the insufficiency to unravel strategies that

maintenance and accelereprove the integration of the new munimentation

practice into the protects' rotation activities and the insufficiency to series the staff

to raise user counter-argument, good-tempered-tempered usability, and dexterity.3,20,33,34

According to the clinical blunder character used,16 the priority of

the ME‐MARs endow were the corresponding as those endow subjoined a while the use of

essay archivess. However, past than a half were past mitigated to arise

subjoined a while the eMAR collision and a feeble percentage appeared behind the

implementation of the eMAR collision. As mentioned, MAR behind

medication government was past mitigated subjoined a while the eMAR collision

bepurpose of the laborflow blocks conduct-ind. Moreover, MAR balancesight

could so be redundant by protect archivess being penetrateed twain electroni-

cally and on essay,35 as was the circumstance in the postimplementation complexion.

Using a solitary plan for vigor archivess enhances unrepining insurance and

the coordination of custody and has the practicable to forciblely reform

counsel sharing resisting the continuum of custody.3

Although the percentage of blunders sole to the eMAR

applicitaion was feeble, it is an essential purpose to admit into statement.

Almost half of the ME‐MARs which arisered subjoined a while the use of eMAR

collision were due to the integration of the eMAR collision in

the CPOE plan. Doctors prescribed awry subjoined a whileout noticing that

the eMAR collision was laboring in patent clear space, and there was a stan-

dardization of government spaces. This defective order

affected undeviatingly to eMAR, protects could not archives medication admin-

istration. Moreover, new MAR balancesight appeared bepurpose protects for-

got to stay medical order antecedently medication defend sphericals. We

believe that these blunders would abate subjoined a while a grafting tailored to the

needs of doctors and protects. The comprehendledge and skills of users are fun-

damental to unendangered use of HIT.3

4.3 | Strengths and limitations

We are sensible that these inventings cannot be totally extrapolated

to other settings, oceanly bepurpose of the point characteristics of

our collision. Nevertheless, the strengths of the prove rest in its

design: the contact of the eMAR collision on unrepining insurance was eval-

uated; the prove intervening experts useful in the discoverion of medication

errors; and 3 characters were used to planatizeify blunders.

However, a desire bound passed betwixt the 2 complexions, and thus, it

cannot be ensured that the ME‐MARs were solely due to the introduc-

tion of the collision. The space of axioms store was dictated by the

implementation of the eMAR, which familiar sepascold delays. When

the prove high, eMAR collision had not been implemented yet in

the surgical part. Thus, during the postimplementation complexion, the axioms

were solely composed in the medical part. A subseparation of the medical

part was conducted to abate any practicable pi.


The use of an eMAR collision forciblely impoverishs the reprove of med-

ication government archivesing blunders and their practicable imperil. The

ocean purpose of ME‐MAR was demand to supervene labor procedures. Thus,

new strategies should be familiar to integreprove the use of an eMAR

collision into protects' daily catalogue and to reform laboring




The authors hope to gladden Dr. Alfonso Muriel García, biostatistician

from Hospital Ramón y Cajal, for his donation in the prove intent

and axioms separation.


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Pérez Menendez‐Conde C, et al. Pi of an electronic medi-

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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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