1
|
Vaghasiya MR, Poon SK, Gunja N, Penm J. The Impact of an Electronic Medication Management System on Medication Deviations on Admission and Discharge from Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1879. [PMID: 36767245 PMCID: PMC9915082 DOI: 10.3390/ijerph20031879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Medication errors at transition of care remain a concerning issue. In recent times, the use of integrated electronic medication management systems (EMMS) has caused a reduction in medication errors, but its effectiveness in reducing medication deviations at transition of care has not been studied in hospital-wide settings in Australia. The aim of this study is to assess medication deviations, such as omissions and mismatches, pre-EMMS and post-EMMS implementation at transition of care across a hospital. In this study, patient records were reviewed retrospectively to identify medication deviations (medication omissions and medication mismatches) at admission and discharge from hospital. A total of 400 patient records were reviewed (200 patients in the pre-EMMS and 200 patients in the post-EMMS group). Out of 400 patients, 112 in the pre-EMMS group and 134 patients in post-EMMS group met the inclusion criteria and were included in the analysis. A total of 105 out of 246 patients (42.7%) had any medication deviations on their medications. In the pre-EMMS group, 59 out of 112 (52.7%) patients had any deviations on their medications compared to 46 out of 134 patients (34.3%) from the post-EMMS group (p = 0.004). The proportion of patients with medication omitted from inpatient orders was 36.6% in the pre-EMMS cohort vs. 22.4% in the post-EMMS cohort (p = 0.014). Additionally, the proportion of patients with mismatches in medications on the inpatient charts compared to their medication history was 4.5% in the pre-EMMS group compared to 0% in the post-EMMS group (p = 0.019). Similarly, the proportion of patients with medications omitted from their discharge summary was 23.2% in the pre-EMMS group vs. 12.7% in the post-EMMS group (p = 0.03). Our study demonstrates a reduction in medication deviations after the implementation of the EMMS in hospital settings.
Collapse
Affiliation(s)
- Milan R. Vaghasiya
- Faculty of Engineering, The University of Sydney, Camperdown, NSW 2006, Australia
- Digital Health Solutions, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
| | - Simon K. Poon
- Faculty of Engineering, The University of Sydney, Camperdown, NSW 2006, Australia
- Digital Health Solutions, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
| | - Naren Gunja
- Digital Health Solutions, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
- Faculty of Medicine & Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Jonathan Penm
- Faculty of Medicine & Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| |
Collapse
|
2
|
Vaghasiya MR, Penm J, Kuan KKY, Gunja N, Liu Y, Kim ED, Petrina N, Poon S. Implementation of an Electronic Medication Management System in a large tertiary hospital: a case of qualitative inquiry. BMC Med Inform Decis Mak 2021; 21:226. [PMID: 34315447 PMCID: PMC8314474 DOI: 10.1186/s12911-021-01584-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitals across Australia are implementing Clinical Information Systems, e.g. Electronic Medication Management Systems (EMMS) at a rapid pace to moderate health services. The benefits of the EMMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy that was based on the guiding principle of "one patient, one chart" to avoid a patient being on a hybrid medication chart. This paper aims to study the factors facilitating or hindering the adoption of the EMMS as viewed by clinicians and the implementation team. METHODS Four focus groups (FG), one each for (1) doctors, (2) nurses, (3) pharmacists, and (4) implementation team, were conducted. A guide for the FG was based on the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS A total of 23 unique subthemes were identified and were grouped into five main themes (1) implementation strategy, (2) organisational outcome of EMMS, (3) individual impact of EMMS, (4) IT product, and (5) organisational culture. Clinicians reported improvement in their workflow efficiency post-EMMS implementation. They also reported some challenges in using the EMMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMMS implementation, namely: (1) the patient-centric implementation strategy, and (2) the organisation readiness. CONCLUSION Overall, this study outlines the implementation process of the EMMS in a large healthcare facility from the clinicians' and the implementation team's perspectives using UTAUT model. The result suggests that clinicians' acceptance of the EMMS was highly influenced by the unique implementation strategy (namely, patient-centric approach and clinical leadership in the implementation team). Whereas the level of adoption of EMMS by clinicians was determined by their level of perceived and realised benefits. On the other hand, a number of barriers to the adoption of EMMS were discovered, namely, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems. It is suggested that promptly resolving these issues can improve the adoption of the EMMS.
Collapse
Affiliation(s)
- Milan Rasikbhai Vaghasiya
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia. .,Western Sydney Local Health District, Westmead, NSW, 2145, Australia.
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, 2006, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Kevin K Y Kuan
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Naren Gunja
- Western Sydney Local Health District, Westmead, NSW, 2145, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Yiren Liu
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Eui Dong Kim
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Neysa Petrina
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Simon Poon
- School of Computer Science , The University of Sydney, Camperdown, NSW, 2006, Australia.,Western Sydney Local Health District, Westmead, NSW, 2145, Australia
| |
Collapse
|
3
|
De Lusignan S. In this issue: Digital disparities, complexity and patient safety. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:1129. [PMID: 30398455 DOI: 10.14236/jhi.v25i3.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022] Open
Abstract
In this issue we publish articles about how digital health and the skills needed to use it may increase disparities.
Collapse
|