This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.

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PICO Question:
In a 28 bed rehabilitation unit, what is the effect of
Electronic Medication Administration record on
the number of medication errors compared with
handwritten Medication Administration records in
a 30-day period.
EBP Improvement: Reduction in Medication errors
in a Rehabilitation Setting via EMR
Lisa Castellano
Pace University, College of Health Professions, Lienhard School of Nursing
Research Literature Review:
• Medication errors can occur at any stage in the
medication process; doctor’s order,
transcription, preparation and dispensing, and
administration.
• A study was done in 2010, rating the before and
after of the use of bar-code technology. Findings
showed the significant reduction in the rate of
errors from transcription and administration.
• The relationship between experience and
medication error rates. It was found that nurses
with the most experience had lower medication
errors. (Cohen & Shastay, 2008)
Evaluation:
The desired outcome would be that over a period of
30 days the number of medication errors would be
significantly reduced using this method by 80%.” The
use of computer assisted technology has the potential
to prevent an estimated 84% of dose, frequency, and
route errors. (Kliger, Blegen, Gootee & O’Neil 2009)
Change Process:
The physician responsible for the unit must note the
change and would use the computer solely to enter
orders for the next 30 days. In order for this to
happen, nursing administration as well as the doctor
must be open for this and willing to try this proposal
in order for it to work. The computer system is
already in place
References with Level of Evidence:
Cohen H., Shastay A. (2008), Getting to the root of medication errors.
Nursing 38 (12), 37-49 (Level IV)
Fowler S., Sohler P., Zarillo D. (2009), Bar-code technology for
medication administration: medication errors and nurse
satisfaction. MedSurg Nursing 18 (2), 103-109 (Level XI)
Keers R., Williams S., Cooke J., Ashcroft D. (2013), Prevalence of
nature of medication errors in health care setting: a systemic
review of observational evidence. The Annals of
Pharmacotherapy 47, 237-256 (Level IV)
Kliger J., Blegen MA., Gootee D., O’Neill E. (2009), Empowering
frontline nurses: a structured intervention enables nurses to
improve medication administration accuracy. The Joint
Commission Journal on Quality and Patient Safety December,
35 (12), 1-9. (Level XI)
Munyisia E., Yu P., Hailey D. (2012), The impact of an electronic
nursing document system on efficiency of documentation by
caregivers in a residential aged care facility. Journal of
Clinical Nursing 21 (19-20), 2940-8 (Level XI)
Redley B., Botti M. (2012), Reported medication errors after
introducing an electronic medication management system.
Journal of Clinical Nursing 22, 579-582 (Level VII)
Tzeng H., Yin C., Schneider T.E. (2013), Medication error-related
issues in nursing practice, MedSurg Nursing 22 (1), 13-50
(Level IV)
Zwicker D., Fulmer T. (2008), Reducing adverse drug events. In
Evidence-based geriatric nursing protocols for best practice. 3rd ed.
New York, NY: Springer Publishing Company; 257-308. [104 ref]
(Level IV)
Search Strategy:
I used the following databases, CINAHL,
ProQuest Nursing and Allied Health, PubMed.gov
as well as the National Guideline Clearinghouse.
Using keywords such as medication errors,
electronic medical record, and medication
administration errors. Quantitative and qualitative
studies, clinical guidelines as well as systemic
reviews were used. I limited to English language
only, and those within 5 years. I found a number of
references, and limited the research to the 8 that
are in the rehabilitation and elderly field.
Major EPB Recommendations:
The EBP recommendations were education and
training nurses in the need to report medication
errors, to find out the underlying cause of the error.
 “Error reporting is a tool for evaluating
weaknesses in the entire medication administration
process, not or assessing a nurse’s competence.”
 “By analyzing error reports, healthcare
organizations focus on determining how an error
occurred, not who made it.”
 “Errors are viewed as opportunities to learn and
grow.”(Cohen, 2008)
These guidelines although applicable are not
currently in practice at my facility.
Methods of Implementation of
Proposed Practice Change:
The clinical setting is a 28-bed rehabilitation unit,
with one physician responsible for all the residents on
the unit. The practice change that I propose is:
• more consistent use of the computer-assisted
technology for medication order entry.
• Physician input of medical orders via EMR rather
than the use of paper and pen orders
• use this method for 30 days to see if there is a
decrease in the number of transcription errors
made.
Background:
Nurses need to investigate why medication
errors occur and ways to prevent and reduce
such errors. In the rehabilitation unit that I
work in, I do the nightly audits of charts and
found medication errors involving transcription
of orders.
• 98,000 people die every year from medication
errors in U.S. hospitals
• The reported error rate is 5.75%
• Nearly 1 in 10 patients could have a
medication error during a hospital stay
• The cost of medication errors in hospitals
over a year can range “between 3.5 and 29
billion” according to the Institute of
Medicine. (Tzeng, Yin & Schneider 2013)
• Medication errors can constitute professional
misconduct for nurses and can lead to
charges brought against them by the State
Office of Professional Discipline.