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

Abstract

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