Changes made to an Electronic Medical Record to minimise medication errors and streamline workflow: An ongoing journey

Madaline Kinlay, Melissa Baysar, Wu Yi Zheng, Rosemary Burke, Iiona Juraskova, Rebekah Moles

Background: The implementation of Electronic Medical Record (eMR) and Electronic Medication Management Systems (eMeds) in hospitals has reduced certain types of medication errors, whilst simultaneously introducing new system-related errors; errors that were not possible with the use of paper records. Little is known about how and why these errors emerge and what approaches have been taken to reduce them.

Aims: To a) classify changes and updates made to an eMeds system in a NSW Local Health District (LHD), and b) establish a link between these changes and the potential system-related errors or workflow blocks they sought to prevent.

Methods: Monthly notes detailing eMR updates across a LHD were collected from November 2015 to December 2019. Updates relating to medications were identified, and then classified according to ‘Change made to the system’ and ‘Rationale for change’. The classification system was iteratively developed using cases as they emerged.

Results: Large variability in updates made to the eMeds system across the 4-year time period were found, ranging from the removal of an item from lists or menus to the addition of a forcing function. The most frequent rationale for making system changes related to direct or indirect prevention of medication errors, although accommodating work practices, streamlining work and optimising workflow were also common.

Conclusions: This research demonstrates that eMRs are not ‘set-and-forget’ systems, but rather they need to be continuously monitored and updated, in order to prevent or minimise potential system risks. Our findings show that a range of system changes are possible. These results will be useful in informing other sites as they begin their journeys to prevent system-related medication errors.