The benefits of going paperless

Australians present electronic medication management study to the world. 

Australian researchers presented their findings on electronic medication management systems at the International Society for Quality in Health Care’s (ISQua) 30th International Conference in Edinburgh in October.

The conference features delegates from 70 countries presenting their expertise and knowledge. Johanna Westbrook and Ling Li were included in the roster to present their work. The pair were amongst the co-authors of the controlled before and after study into the use of the systems was conducted at two teaching hospitals in Sydney.

Li says medication administration errors have been “identified as one of the important reasons for patients’ morbidity and mortality”. She says identifying and resolving these errors will improve patient care and decrease costs.

The aim of the study was to “measure whether the introduction of eMMS [along with electronic medication administration records] was associated with a reduction in medication administration error rates,” Westbrook says.

More than 226 nurses were observed preparing and administrating over 7451 medications. Observational data were compared with patients’ charts in order to determine whether a procedural or clinical error occurred.

The results were clear. The introduction of the eMMS resulted in a significant decrease in medication administration errors compared with the control wards. In particular, there was a decline in timing errors. These were defined as instances when medications were administered more than an hour before or after the requested time, or more than 30 minutes before or after a meal time if the medication was ordered to be given with meals.

Westbrook says this is “new evidence that the systems are valuable safety interventions for reducing” errors in administration of medications.

The reduction in prescribing errors was even greater. In a study that reviewed more than 3200 medication records at two hospitals, it was found that eMMS was associated with a 50 per cent reduction in prescribing errors and a 44 per cent drop in serious prescribing errors.

“This technology eliminates medication orders that are illegible and incomplete, both of which are sources of error,” Westbrook says.

Decision support is embedded within eMMS devices to guide prescribers and nurses in administering medications. The systems implemented in the study had limited decision support and further improvement in this area would be expected in order to provide more relevant and timely information to nurses.

“Designing effective decision support is challenging and there is a balance between providing clinicians with useful alerts and providing too many, which can lead to ‘alert fatigue’, where alerts are ignored by users,” Westbrook says. “Our research, and that conducted overseas, has shown that decision support can be highly effective at both reducing errors and improving medication management when well designed and targeted.”

“Nursing work is complicated and unpredictable,” Li says. “Our previous study showed that nursing work patterns were increasingly fragmented, with rapid changes between tasks of short length; eMMS provide nurses information in a timely and accurate fashion to help them handle their daily tasks.”

Clinicians have voiced some concerns about possible effects of eMMS, including reduced efficiency and time away from direct clinical contact because it might take longer for nurses to administer medicine using a computer than with paper charts. These potential issues were believed to be significant barriers to adoption of eMMS. However, within their studies, Westbrook and Li found these concerns were not realised.

The introduction of eMMS “did not result in redistribution of time away from direct care or towards medication tasks for nurses and doctors”, Li says. The studies found similar patterns of task time distribution as in the control wards.

Another commonly raised concern relates to work practice change associated with an eMMS system. Nurses on intervention wards spent less time with doctors following eMMS introduction. The study’s authors asserted that future investigations should focus on the implications of this reduction.

Another issue the researchers want to sort out is the eMMS system’s complexity. Westbrook says that whilst evidence shows eMMS can provide highly effective safety interventions, they are complex to design and implement.

The study’s report states that the systems can take a long time to bed down and that critics have said measurements are taken too soon after systems have been implemented and may not reflect what will become standard practice.

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