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Running head: TECHNOLOGY TO REDUCE MED ERRORS

Using Technology to Reduce Medication Administration Errors


Joshua Peacott-Ricardos
NURS 211
February 28, 2014
Dr. Paulette Williams

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TECHNOLOGY TO REDUCE MED ERRORS
Using Technology to Reduce Medication Administration Errors
Its estimated that 450,000 medication errors that result in patient harm occur each year,
and that 25% of these errors are preventable (Seibert, Maddox, Flynn, and Williams, 2014).
Medication administration has long been an important responsibility delegated to nurses. If 25%
of harmful errors are preventable, then is the ethical obligation of nurses to find safer ways to
administer medications. Utilizing appropriate technologies may be one way to improve this
process.
Research Examining the Effects of an Electronic Medication System
Current research suggests that the use of electronic systems to manage medication can
contribute to lowered rates of medication errors when compared to a traditional pen and paper
system.
Electronic System Versus Traditional: Comparing Two Different Sites
Redley and Botti (2012) examined medication error reports from two different hospital
sites for the same private health service in Melbourne, Australia. In this descriptive study, one
hospital (Site A) utilizes a traditional pen and paper system in which providers handwrite
medication orders that nurses use to order medications from the pharmacy. The pharmacy
prepares and dispenses medications, and nurses administer them appropriately. The second
hospital (Site B) utilizes an electronic medication management system (MMS) where providers
order medications through a patients electronic chart.

This information is electronically

transmitted to the pharmacy, which dispenses medications and nurses have access to a patients
electronic medication record through portable computers at the patients bedside. The year-long
period from which medication error reports were analyzed coincided with the implementation of
an MMS at Site B.

The purpose of this study was two-fold: to examine the patterns of

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TECHNOLOGY TO REDUCE MED ERRORS
medication errors during the first twelve months after implementation of an MMS, and to
compare rates and types of reported medication reports in an MMS versus a traditional system.
In this particular study, the total number of reported medication errors including all stages
was lower at the site using an MMS. When looking at reported medication errors specifically at
the nurse administration stage, Site A had 178 reported errors while Site B had 79 errors (Redley
and Botti, 2012). Data is also further broken down by the type of errors reported (omission,
wrong dose, wrong patient, etc.). In both sites, the nurse administration stage of medication
delivery had the highest rates of reported errors. The investigators recognize that an important
limitation of their study include that data collection relied on self-reporting (Redley and Botti
2012).
Electronic versus Traditional: Before and After
Another descriptive study collected data at two community based hospitals that are part
of the same health system (St. Josephs/Candler Health System). The purpose was to determine
how implementing a barcode medication administration with electronic medical administration
record (BCMA-eMAR) system impacted medication error occurrences. Seibert, Maddox, Flynn,
and Williams (2014) used a team of pharmacists and nurses to observe nurses administering
medication before and after implementation the system. The BCMA-eMAR system involves
nurses scanning barcodes on patient wristbands to link them to an electronic medical
administration record. Wrong dose, wrong form, extra dose, unauthorized drug and omission
errors were described as target errors as they are the errors that were intended to be prevented
by BCMA-eMAR. Through direct observation of staff nurses, researchers recorded the number
and type of errors made before implementation BCMA-eMAR. Observation was repeated at 3
months post-implementation and 6 months post-implementation.

Observers recorded target

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TECHNOLOGY TO REDUCE MED ERRORS
errors as well as time, technique, and route errors. Voluntary self-reports by of errors by staff
nurses were also recorded.
The results indicated that the overall accuracy of medication administration improved at
both hospitals after implementation of BCMA-eMAR. Accuracy rate was defined as: (total
opportunities for error-total errors)/(total opportunities for error x100). Accuracy rate improved
from 89% to 90% at Hospital 1 and from 89% to 91%. When wrong time errors were dropped
from consideration, accuracy rates improved from 92% to 96% and 93% to 96%, respectively.
The investigators determined all of these increases to be statistically significant. Wrong time
errors were numerous and were not a target error. They were not expected to be stopped by
BCMA-eMAR. Although wrong time errors are may be less important in some cases, there may
be other instances where they are more significant (Seibert et al., 2014).
Strength of the Evidence
Redly and Botti identified in their discussion that their study was limited by its reliance
on self-reporting of medication errors. Data was collected from Site B immediately following its
implementation of the MMS, and so issues associated with the staffs adaptation to a new
technology may have impacted results. Follow up research in the same facility could be useful
in exploring how effective the MMS can be after the staff thoroughly adapts. The study was also
limited in its design: it was not an experiment.
Seibert et al. reduced the amount of bias associated with self-reporting by using trained
observers to collect data on administration errors. However, they failed to acknowledge how
staff nurses knowing they were being observed could impact their results. Like Redly and
Bottis study, data was collected immediately following implementation of a new technology and

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TECHNOLOGY TO REDUCE MED ERRORS
may also have been impacted by staff adjusting to new workflows and technology. This work
was also a descriptive study and not an experiment.
Although they werent controlled experiments, both studies provide evidence for the
using technology to reduce medication administration errors.

Data was collected on the

incidence of medication errors without the use of technology in medication administration and
with the use of technology during medication administration. In both studies, incidence of
medication errors decreased when an electronic system was in place. Although neither study can
prove that the respective technological intervention was the sole cause of the reduction of
medication administration errors, they both show a correlation between technology and reduced
errors.
Current Practice
Many facilities employ barcode technology similar to the hospitals investigated by
Seibert et al. Kapiolani Medical Center for Women and Children (KMCWC) employs an
electronic medical record and barcode technology in the process nurses or other qualified
providers use to administer medication to patients. When administering medications, the nurse
still must verify the patients identity (through name and date of birth) and six rights (patient,
drug, route, dose, time, and documentation). Then, the nurse scans the patients wristband,
followed by the medication, and then their own employee badge (KMCWC, 2013). The
facilitys policy and procedure document explicitly states that the purpose of this is to improve
safety (KMCWC, 2013, p. 6). Documentation is then performed in the electronic medical
record, which is reviewed during shift report, change in caregiver, and/or transfer to another unit.
Barcode and electronic medical record technologies are used here to reduce medication
administration errors and improve patient safety.

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TECHNOLOGY TO REDUCE MED ERRORS
Conclusion
Medications are a crucial part of treating many illnesses and are a central part of a nurses
job. As patient safety should always be a nurses top priority, it is imperative that medication
administration be performed as accurately as possible in order to prevent harm to the patient.
Incorporating the latest technology into medication administration is effective in reducing the
incidence of medication errors, and these technologies continue to be adopted by health care
facilities in an effort to promote patient safety.

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TECHNOLOGY TO REDUCE MED ERRORS
References
Kapiolani Medical Center for Women and Children. (2013). Medication Administration.
[Policy and Procedure]. Retrieved from KMCWC Intranet.
Redley, B., & Botti, M. (2013). Reported medication errors after introducing an electronic
medication management system. Journal Of Clinical Nursing, 22(3/4), 579-589.
doi:10.1111/j.1365-2702.2012.04326.x
Seibert, H. H., Maddox, R. R., Flynn, E. A., & Williams, C. K. (2014). Effect of barcode
technology with electronic medication administration record on medication accuracy
rates. American Journal Of Health-System Pharmacy, 71(3), 209-218.
doi:10.2146/ajhp130332

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