title: Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations.
abstract: The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs).
  
  
  
  Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm).
  
  
  
  We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13-0, P < 0.001), dispensing (0.49-0.16, P < 0.001), and administration (0.83-0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation.
  
  
  
  Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.
authors.forename: Pascale
authors.initials: P
authors.lastname: Carayon
authors.forename: Tosha B
authors.initials: TB
authors.lastname: Wetterneck
authors.affiliation: Surgery, University of Wisconsin School of Medicine and Public Health.
authors.forename: Randi
authors.initials: R
authors.lastname: Cartmill
authors.affiliation: Formerly at Geisinger Health System, Danville, Pennsylvania.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Blosky
authors.forename: Roger
authors.initials: R
authors.lastname: Brown
authors.affiliation: From the Center for Quality and Productivity Improvement.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoonakker
authors.affiliation: Oregon Pulmonary Associates, Tualatin, Oregon.
authors.forename: Robert
authors.initials: R
authors.lastname: Kim
authors.affiliation: Franciscan Saint Francis Health System, Indianapolis, Indiana.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kukreja
authors.affiliation: University of Illinois at Urbana-Champaign.
authors.forename: Mark
authors.initials: M
authors.lastname: Johnson
authors.affiliation: University of Illinois College of Medicine at Peoria, Illinois.
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Paris
authors.affiliation: University of Maryland, College Park, Maryland.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Wood
authors.affiliation: Independent consultant, Harrisburg, Pennsylvania.
authors.forename: James M
authors.initials: JM
authors.lastname: Walker
mesh_terms: D057286:Electronic Health Records; D006804:Ergonomics; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008510:Medication Systems, Hospital; D011446:Prospective Studies