Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities: a Formative Evaluation

Overview

Journal Appl Clin Inform

Publisher Thieme

Specialties Health Services
Medical Informatics

Date 2015 Jan 16

PMID 25589911

Citations 5

Authors

A Tariq

E Lehnbom

K Oliver

A Georgiou

C Rowe

T Osmond

J Westbrook

Affiliations

Soon will be listed here.

Abstract

Introduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.

Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.

Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.

Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Citing Articles

Exploring Australian pharmacists' experiences with the electronic National Residential Medication Chart: a qualitative descriptive study.

Tan J, Tan J, de Souza L, Wang Q, Wong A, Mcmaugh J Int J Clin Pharm. 2025; .

PMID: 40085412 DOI: 10.1007/s11096-025-01894-3.

Medication administration in aged care facilities: A mixed-methods systematic review.

Garratt S, Dowling A, Manias E J Adv Nurs. 2024; 81(2):621-640.

PMID: 38973246 PMC: 11729541. DOI: 10.1111/jan.16318.

Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities.

Raban M, Baysari M, Jorgensen M, Tariq A, Georgiou A, Westbrook J Appl Clin Inform. 2020; 11(5):812-820.

PMID: 33296919 PMC: 7725592. DOI: 10.1055/s-0040-1721011.

Nursing Information Flow in Long-Term Care Facilities.

Wei Q, Courtney K Appl Clin Inform. 2018; 9(2):275-284.

PMID: 29719883 PMC: 5931917. DOI: 10.1055/s-0038-1642609.

Disjointed medication management systems in aged care.

Elliott R, Ramachenderan J Aust Prescr. 2017; 40(4):125.

PMID: 28947847 PMC: 5601974. DOI: 10.18773/austprescr.2017.048.

References

Forni A, Chu H, Fanikos J . Technology utilization to prevent medication errors. Curr Drug Saf. 2010; 5(1):13-8. DOI: 10.2174/157488610789869193. View

Barber N, Cornford T, Klecun E . Qualitative evaluation of an electronic prescribing and administration system. Qual Saf Health Care. 2007; 16(4):271-8. PMC: 2464937. DOI: 10.1136/qshc.2006.019505. View

Kaplan B . Evaluating informatics applications--some alternative approaches: theory, social interactionism, and call for methodological pluralism. Int J Med Inform. 2001; 64(1):39-56. DOI: 10.1016/s1386-5056(01)00184-8. View

Berg M, Goorman E . The contextual nature of medical information. Int J Med Inform. 2000; 56(1-3):51-60. DOI: 10.1016/s1386-5056(99)00041-6. View

Yu P, Zhang Y, Gong Y, Zhang J . Unintended adverse consequences of introducing electronic health records in residential aged care homes. Int J Med Inform. 2013; 82(9):772-88. DOI: 10.1016/j.ijmedinf.2013.05.008. View

Koppel R, Kreda D . Healthcare IT usability and suitability for clinical needs: challenges of design, workflow, and contractual relations. Stud Health Technol Inform. 2010; 157:7-14. View

McKibbon K, Lokker C, Handler S, Dolovich L, Holbrook A, OReilly D . The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2011; 19(1):22-30. PMC: 3240758. DOI: 10.1136/amiajnl-2011-000304. View

Borycki E, Kushniruk A . Towards an integrative cognitive-socio-technical approach in health informatics: analyzing technology-induced error involving health information systems to improve patient safety. Open Med Inform J. 2011; 4:181-7. PMC: 3097067. DOI: 10.2174/1874431101004010181. View

Redwood S, Rajakumar A, Hodson J, Coleman J . Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents. BMC Med Inform Decis Mak. 2011; 11:29. PMC: 3116457. DOI: 10.1186/1472-6947-11-29. View

10.

Pierson S, Hansen R, Greene S, Williams C, Akers R, Jonsson M . Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system. Qual Saf Health Care. 2007; 16(4):297-302. PMC: 2464957. DOI: 10.1136/qshc.2007.022483. View

11.

Szczepura A, Wild D, Nelson S . Medication administration errors for older people in long-term residential care. BMC Geriatr. 2011; 11:82. PMC: 3254134. DOI: 10.1186/1471-2318-11-82. View

12.

Ash J, Sittig D, Dykstra R, Campbell E, Guappone K . The unintended consequences of computerized provider order entry: findings from a mixed methods exploration. Int J Med Inform. 2008; 78 Suppl 1:S69-76. PMC: 2683676. DOI: 10.1016/j.ijmedinf.2008.07.015. View

13.

Tariq A, Georgiou A, Westbrook J . Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process. Int J Med Inform. 2012; 82(5):299-312. DOI: 10.1016/j.ijmedinf.2012.08.006. View

14.

Niazkhani Z, Pirnejad H, van der Sijs H, de Bont A, Aarts J . Computerized provider order entry system--does it support the inter-professional medication process? Lessons from a Dutch academic hospital. Methods Inf Med. 2009; 49(1):20-7. DOI: 10.3414/ME0631. View

15.

Van den Bemt P, Idzinga J, Robertz H, Kormelink D, Pels N . Medication administration errors in nursing homes using an automated medication dispensing system. J Am Med Inform Assoc. 2009; 16(4):486-92. PMC: 2705251. DOI: 10.1197/jamia.M2959. View

16.

Vogelsmeier A, Halbesleben J, Scott-Cawiezell J . Technology implementation and workarounds in the nursing home. J Am Med Inform Assoc. 2007; 15(1):114-9. PMC: 2274876. DOI: 10.1197/jamia.M2378. View

17.

Clyne B, Bradley M, Hughes C, Fahey T, Lapane K . Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence. Clin Geriatr Med. 2012; 28(2):301-22. DOI: 10.1016/j.cger.2012.01.009. View

18.

Koppel R, Wetterneck T, Telles J, Karsh B . Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc. 2008; 15(4):408-23. PMC: 2442264. DOI: 10.1197/jamia.M2616. View

19.

Gurwitz J, Field T, Judge J, Rochon P, Harrold L, Cadoret C . The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005; 118(3):251-8. DOI: 10.1016/j.amjmed.2004.09.018. View

20.

Roughead E, Semple S, Gilbert A . Quality use of medicines in aged-care facilities in Australia. Drugs Aging. 2003; 20(9):643-53. DOI: 10.2165/00002512-200320090-00002. View