The document summarizes two studies that examined the use of electronic medication administration records (eMAR) in long-term care facilities. The first study was a systematic review finding that computerized clinical decision support systems can improve medication safety by reducing prescribing errors and adverse drug reactions. The second study observed the implementation of eMARs in five long-term care facilities, finding they improved communication but some structural issues remained. Neither study directly quantified the reduction in medication errors from using eMARs compared to paper records.

1. PICO Question Research
COHP 450
Ryan Pienta
“In long term care (LTC) facilities,
how does the use of electronic medication administration records (eMAR),
compared to paper medication administration records,
reduce nurse medication errors?”

2. Literature Search
• SearchWords:
• long term care facilities,
electronic medication
administration records, paper
medication administration
records, health information
system, medication errors
• Search Engines:
• Databases: Gale PowerSearch,
PubMed,The Cumulative Index
to Nursing and Allied Health
Literature
• Results
• There were plenty of articles on
medication errors in LTC
facilities, but not many in
regards to using an eMAR.
• I was able to find a systematic
review of clinical decision
support systems in LTC (similar
to an eMAR) and a report
following the implementation
of eMARs in 5 LTC facilities.

3. Literature Search
1 (Marasinghe, 2015)
Marasinghe, K. M. (2015). Computerised clinical
decision support systems to improve medication
safety in long-term care homes: a systematic
review. BMJ Open, 5(5), e006539.
http://doi.org/10.1136/bmjopen-2014-006539
2 (Sc0tt-Cawiezell et al.,
2009)
Scott-Cawiezell, J., Madsen, R., Pepper,G.,
Vogelsmeier,A., Petroski, G., & Zellmer, D. (2009).
Medication SafetyTeams' Guided Implementation
of Electronic Medication Administration Records
in Five Nursing Homes. TheJoint Commission
Journal On Quality And Patient Safety, 35(1), 29-
35. Retrieved from http://0-
www.ingentaconnect.com.libcat.ferris.edu/conte
nt/jcaho/jcjqs/2009/00000035/00000001/art00005
?token=00481cf80eaea2b1240c41333c4a2f7a6c38
6f573a677376763c5f4f6d4e2224aa860853

4. Selection Rationale
1 (Marasinghe, 2015)
• I chose this article because as a systematic
review, it offered many different views and has
a high level of evidence. While is wasn’t
directly focused on eMARs, it included all types
of computerized clinical decision support
systems and how they improved medication
safety in LTC facilities.
2 (Sc0tt-Cawiezell et al.,
2009)
• I chose this article because it studied the
implementation of eMARs at 5 different LTC
facilities. It strongly focused on medication
errors and how technology influenced them.

5. Study Designs
1 (Marasinghe, 2015)
• Theory: InformationTheory
• Type: Qualitative Study
• Design: Systematic Review
38 articles were identified. 7 articles met inclusion
criteria and were reviewed, 5 of which were RCT.
2 (Sc0tt-Cawiezell et al.,
2009)
• Theory: ModernizationTheory
• Type: Qualitative Study
• Design: Observational / Mixed Methods
Approach

6. Study Methods
1 (Marasinghe, 2015)
• Methods:
MEDLINE, EMBASE, scopus, and Cochrane
Library databases were search
LTC, medication safety, and CCDSS
(Computerized clinical decision support systems)
were keywords searched
38 articles were identified. 7 articles met inclusion
criteria and were reviewed, 5 of which were RCT.
2 (Sc0tt-Cawiezell et al.,
2009)
• Methods:
eMARs were implemented in 5 different LTC
facilities. eMAR reports were reviewed for
medication errors over the span of….
300 observations hours
16,000 medication doses
3,7000 residents

7. Study Findings
1 (Marasinghe, 2015)
• Findings:
CCDSS improved care in LTC in the following
areas: quality of prescribing orders, detected
adverse drug reactions, triggered warning
messages, and reduced injury risk among older
adults
2 (Sc0tt-Cawiezell et al.,
2009)
• Findings:
The eMARs improved many aspects of care in LTC
facilities, including communication. However,
some of the framework instilled in the LTC
medication administration process is so outdated,
eMARs could not solve chronic structural issues.
The technology opens the doors to improving
medication safety in short term and long term.

8. 2 (Sc0tt-Cawiezell et al., 2009)

9. Ethical Considerations
1 (Marasinghe, 2015)
• Because this study reviewed multiple different
studies, ethical considerations can’t be
properly assessed.
• No commercial or organizational funding was
used in this study, but did not consider funding
sources of reviewed articles.
2 (Sc0tt-Cawiezell et al.,
2009)
• The 5 LTC facilities were willing to implement
the large scale technology change. Medication
safety teams consisted of invited staff
members and other volunteers from each
facility. Medication errors were observed
through eMAR generated reports and not
during actual administrations.
• The Agency for Healthcare Research and
Quality funded this study.

10. Study Strengths
1 (Marasinghe, 2015)
• Strength: Large number of studies reviewed
• Quality: Highest – Systematic Review
• Credibility: No information or credentials on
author Marasinghe, however, the article was
posted inThe BMJ Open, a peer reviewed
journal.
2 (Sc0tt-Cawiezell et al.,
2009)
• Strength: Large number of LTC facilities
reviewed
• Quality: Low – no comparison group
• Credibility:All of the authors have a Ph. D.
and/or RN.The article was published inThe
Joint Commission Journal on Quality and
Patient Safety, which is also peer reviewed.

11. Inclusion Criteria
1 (Marasinghe, 2015)
• Studies needed to be either…
• Randomized ControlTrial studies
• Cohort Studies
• Retro/prospective studes
• Needed to be LTC based
• Evaluated effects of CCDSS in terms of
improving medication safety
• Written in English
• *Note – exclusion criteria did not consider
funding sources
2 (Sc0tt-Cawiezell et al.,
2009)
• Midwestern nursing homes in 3 states
• Interested and willing to make large scale
technology change
• Typical LTC facilities
• Urban and Rural settings
• Various sizes (60-400) beds
• Various ownership structure

12. EBP Contribution
1 (Marasinghe, 2015)
• This article did not add any information or
research, rather it just compiled multiple
studies into one generalized report.
• No EBP contribution.
2 (Sc0tt-Cawiezell et al.,
2009)
• This article provided useful information
regarding the types and causes of medication
errors in LTC facilities. By using the eMAR to
properly track and record medication errors,
we can view concrete data.

13. Relevant to Practice
1 (Marasinghe, 2015)
• Both articles are relevant to any LTC facility that
is interested in implementing technology for
medication administration and patient care.
• This information could be presented up to a
administration level by staff nurses advocating
for patient and nurse safety.
2 (Sc0tt-Cawiezell et al.,
2009)

14. Quality and Safety
1 (Marasinghe, 2015)
• These articles have information that can change
practice and procedure while improving the
quality and safety of patient care on all levels.
• Nurses would have extra tools to determine
medication schedules.
• Patient would have an extra level of protection
from medication errors.
• Administration would have a greater way to
monitor staff members and medication errors
and risks for errors.
2 (Sc0tt-Cawiezell et al.,
2009)

15. Potential Barriers
1 (Marasinghe, 2015)
• Cost –Technology can be expensive, especially
start up costs
• Training – LTC nurses typically use little
technology and might not have much experience
2 (Sc0tt-Cawiezell et al.,
2009)

16. Additional PICO Questions
1 (Marasinghe, 2015)
• “In long term care (LTC) facilities, how does the
use of computerized clinical decision support
systems (CCDSS), compared to non
computerized clinical decision support systems,
reduce nurse medication errors?”
• “In long term care (LTC) facilities, how does the
use of computerized clinical decision support
systems (CCDSS), compared to non
computerized clinical decision support systems,
improve patient care?”
2 (Sc0tt-Cawiezell et al.,
2009)

17. Summary
• These studies did not exactly answer my PICO question, but they did give
some general reassurance that the implementation of an eMAR did
improve the medication administration process in LTC facilities.
• These studies also gave examples of how they reduced these errors and
how they would reduced errors in the future.
• What the studies did not provide was quantitative data regarding the
specific amount of errors that were reduced.This might be a difficult topic
to study as many times medication errors either go unnoticed and/or
unreported when using the traditional paper MAR.