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J Patient Saf. 2017 Feb 28. doi: 10.1097/PTS.0000000000000358. [Epub ahead of print]

Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations.

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1
From the *Center for Quality and Productivity Improvement, †Department of Industrial and Systems Engineering, University of Wisconsin-Madison; Departments of ‡Medicine and §Surgery, University of Wisconsin School of Medicine and Public Health; ∥University of Wisconsin School of Nursing, Madison, Wisconsin; ¶Formerly at Geisinger Health System, Danville, Pennsylvania; **Oregon Pulmonary Associates, Tualatin, Oregon; ††Franciscan Saint Francis Health System, Indianapolis, Indiana; ‡‡University of Illinois at Urbana-Champaign; §§University of Illinois College of Medicine at Peoria, Illinois; ∥∥University of Maryland, College Park, Maryland; and ¶¶Independent consultant, Harrisburg, Pennsylvania.

Abstract

OBJECTIVE:

The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs).

METHODS:

Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm).

RESULTS:

We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13-0, P < 0.001), dispensing (0.49-0.16, P < 0.001), and administration (0.83-0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation.

CONCLUSIONS:

Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.

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