System-related errors associated with the long-term use of electronic medication management

Background: Electronic medication management (EMM) systems can facilitate system-related errors; errors that were less likely with the use of paper-based medication charts. Little is known about the types of system-related errors that persist or emerge with routine system use. This thesis aimed to identify and classify long-term system-related errors, determine contributing factors and compare errors over time. Methods: Research was conducted at three hospitals with the same EMM system in place for different durations. A narrative review was followed by mixed methods research, including an analysis of EMM-related incident reports, interviews with stakeholders and a review of documents detailing EMM system enhancements at the three sites. Long-term system-related errors were examined in terms of error types, contributing factors, consequences, and strategies for detection and mitigation. Analysis of each data source considered the element of time since EMM system implementation. Results: System-related errors were found to persist with long-term EMM system use. Factors related to the EMM system design, user and organisation contributed to system-related errors in varying degrees over time, however certain factors were consistently associated with errors. System-related errors resulted in medication errors, but also impacted the user, and documentation within the EMM system. Detection of system-related errors relied heavily on clinicians, while mitigation strategies targeted the EMM system and the context in which the system was used. Conclusion: This program of research highlighted how system-related errors develop over time. The findings emphasise that system-related errors result from a combination of different factors, and therefore mitigation strategies should be multilayered. Future research should investigate the effectiveness of interventions aimed at minimising system-related errors, particularly as EMM systems are increasingly implemented and improved

Errors resulting from the use of electronic systems – stakeholder perceptions on how to reduce them

Background: Electronic medication management (eMeds) systems improve medication safety, but simultaneously introduce new system-related errors; errors that were not possible with the use of paper records. We know very little about strategies used in Australian settings to reduce system-related errors.Aims: To explore stakeholders’ perceptions and experiences of interventions that were implemented to reduce system-related errors associated with the use of eMeds, as well as other changes they believe could further reduce these errors in the future.Methods: Semi-structured interviews were conducted with users of eMeds and stakeholders with eMeds supporting roles in a NSW Local Health District. Discussions focused on interventions which had targeted or reduced system-related errors, in addition to future changes needed to stop these errors from occurring. Interviews were audio-recorded, transcribed verbatim, and analysis was conducted iteratively using an inductive approach.Results: Twenty-five participants took part. Participants described the redesign of eMeds as central to decreasing system-related errors, with examples of system changes described, including pop-up alerts and changes to the visual display. Increased monitoring of system use was also perceived to reduce errors. However, participants indicated that in some cases, redesign at the local level was not possible, so increased training and support was needed. Future recommended changes included more effective alerts, and a more intuitive system, as well as ongoing training.Conclusions: Redesign of eMeds was a frequent strategy used to reduce system-related errors, but not all desired system changes were possible at a local level. Ensuring that users are well-supported in using the system and monitoring how users interact with the system will likely reduce system-related errors