The Impact of eMAR on Patient Safety and Clinical Outcomes

This report examines the electronic medication administration record (eMAR) within the context of computer and informatics in nursing. It defines eMAR as an automated system for tracking medication from order to administration, emphasizing its role in improving patient safety and clinical outcomes. The report explores the importance of eMAR, its advantages, challenges, and potential for future improvement. It draws on expert opinions, nursing research, and comparative analyses to highlight eMAR's benefits in reducing medication errors, enhancing patient data access, and promoting safe medication practices. The report also discusses the barriers to eMAR implementation, such as a lack of computer literacy and resistance to change, while emphasizing the need for training and patient education. Literature findings are summarized, comparing paper-based and electronic systems, and highlighting the impact of eMAR on factors like medication errors, documentation, and clinical efficacy. Gaps in knowledge and existing challenges, including resistance to change and the need for comprehensive training, are also identified. The report concludes by emphasizing the potential of eMAR to significantly improve clinical outcomes and patient safety, provided that adequate measures are taken to address the identified challenges and gaps.

Running Head: ELECGTRONIC MEDICATION ADMINISTRATION RECORD
Computer and Informatics in Nursing
Student Name
School Name

COMPUTER AND INFORMATICS IN NURSING
Introduction to the topic
Electronic medication administration record (eMAR) is an automated system that tracks the
medication channeling from the pharmacy order to the administration by the patient (Truitt,
et al., 2016). The automation process is adopted by using assistive technology along with the
electronic system for collecting records, analyzing the data, and retrieving information during
electronic health record (EHR) reporting. eMAR was implemented with the objective to
mainstream proper usage of drugs in clinical settings, adopting the strategy of safe
medication usage and effective clinical outcome for community health. Since
pharmacotherapy is the mainstream strategy in clinical settings, the issues related to reducing
adverse drug reactions, avoiding self-medication, and enhancing the quality of life, are of
high importance (Oliveros et al., 2017). The above discussion provides the definition of
eMAR, which is a subsystem of the EHR system. In this report, the focus is on the
importance of eMAR, and its impact on patient safety. The presented information will be
based on the viewpoint of experts in this field, nursing research, and comparative analysis
based on information from peer-reviewed sources. More importantly, the emphasis here will
be on the associated strength and gaps that can be adopted for the betterment of community
health.

COMPUTER AND INFORMATICS IN NURSING
Description of the topic
The mainframe analysis of eMAR will be based on available literature spanning over
the advantages, challenges, and further scope of improvement. In particular, despite the
utilization from the information technology sector, lack of computer literacy and resistance to
change is the key factor behind the unsuccessful adaptation of this prospect (Risør, Lisby &
Sørensen, 2016). However, discussion of these issues is of high importance, in order to render
effectiveness in clinical practices and enhance patient safety.
According to Flynn, Evanish, Fernald, Hutchinson & Lefaiver, (2016), the use of
eMAR is considered, a masterpiece of improved nursing practices. The motivation is linked
with effective delivery of patient care in conjunction with safety consideration for the
administration of medicines. The issue of medication error across the globe mainly arises
because of factors like incompleteness in medication orders, multiple caregivers and their
recommendations, self-medication practices due to higher high fees of practitioners or lack of
insurance, illegible handwriting, and poor interpretation by nurses and pharmacist. On the
contrary, the objective behind using eMAR is to prevent medication errors including
improvement in access to patient data as well as a reduction in errors during the transcription
process.
Furthermore, to support this practice, the act of health information technology
economic and clinical health (HITECH) have made mandatory policies that govern the
participation of healthcare professionals in health information exchange (HIE) programs
(Atasoy, Greenwood & McCullough, 2018). These provisions require updated management
of information regarding patient health, medications, and clinical outcomes. As a result of
which, the healthcare settings were forcefully motivated to adopt such strategies in order to
comply with the regulations and for the improvement of clinical outcomes.

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Importance to practice
Clinical practices are mostly suffered by human error which in turn is responsible for
the deterioration in patient safety. However, the implementation of eMAR can be considered
as a supporting tool that can reduce such problems. The major aspects are associated with
adverse drug events, contraindicated drug combinations, forgetting the prescribed schedules,
inappropriate administration of drugs, and failure to follow up to determine the efficacy of
administered medications. These concerns could easily overcome by using the electronic
system to manage the administration of medications and thus the use of eMAR in clinical
practices is of significant importance (Blobel, 2018).
The common barriers that are existing in the line of implementing eMAR include lack
of motivation, adequate information about beneficial aspects, lack of training to adopt an
electronic system for documentation, and resistance to change. In addition to this, according
to de Jong, Ros, van Leeuwen, and Schrijvers (2016) more than 80% of patients are also
unaware of the benefits associated with such an electronic system. Hence, it is important to
note that the line managers and leaders of the nursing team should adopt appropriate
measures to motivate and educate the workforce regarding the usage of eMAR. Later, with
adequate knowledge about the utility of eMAR, healthcare professionals can also collaborate
with patients, for adopting an electronic system for the medication purpose. As a result of
which, not only the clinical outcomes but also aspects like self-efficacy and safety, can be
enhanced.
Summary of literature findings
According to Staggers, Iribarren, Guo, & Weir (2015), it was analysed that the
barcode medication administration system, to identify the problems in usability among the
nurses. The study identifies that issues related to medication administration chart, situational

COMPUTER AND INFORMATICS IN NURSING
awareness, lack in use of evidence-based practice are the factors responsible for the violation
in clinical care delivery. However, potential gaps where existing such as lack of training and
comprehensive knowledge regarding the use of the eMAR system. These areas are important
because they can potentially affect the productivity of nursing practices and the safety
concern of patients. On the other hand, in the work of Qian, Yu, & Hailey (2015), the
efficacy between paper-based record system and eMAR was evaluated for the residential care
home. The study reveals no significant difference for factors like verbal communication,
infection control, administration, and transit. However, benefits such as reduce error, the
possibility of missing medications, and complaints with document requirements, are the
benefits obtained from the electronic system. The possible source of error with eMAR system
as revealed in this work, is mainly associated with carelessness and inadequate information
collected by nurses. Furthermore, for the electronic system nurses are required proper training
regarding the organization of document in the specified format.
The objective of the work by Flynn et al. (2016), was to identify the effectiveness of
evidence-based strategies in terms of clinical outcomes, where the documentation for
medication is managed through eMAR. The possible interruptions include medication
administration, schedule, and evaluation of medication errors. Importantly, the use of the
electronic system for medication documents helps in reducing interruption and increase
clinical efficacy. Likewise, in the work of Rodriguez‐Gonzalez et al. (2015), the authors
evaluated the reduction in adverse drug events with the concurrent use of “computerized
prescription” order and “profiled dispensing” of medication. It was identified that the use of
eMAR with standardization of drug compounding, decreases the error with medication and
associated adverse events, in more than 25% cases. Here, it is found that eMAR is useful to
improve the medication administration process, however careful attention is required while
handling situations. These include criticality in conditions, failure modes, severity, and

COMPUTER AND INFORMATICS IN NURSING
improvement during the treatment procedure. Another study by Vicente Oliveros et al.
(2017), evaluates the impact of eMAR system on the overall rate of medication error, by
analysing the administration system of medicines. Based on the work practice analysis of
2835 pre- and post-pharmacist practice, it was concluded that eMAR reduces the risk of error.
Although eMAR is helpful in reducing medication errors, their exist lack in knowledge for
follow up clinical procedures. Moreover, the healthcare professionals were also not aware of
documenting verbal and other important information, for which proper format is not present.
From the work of de Jong et al. (2016), it was identified that providing education to
patients can make eMAR a successful practice for improvement in community health. In the
paper, the authors identified that patient education regarding eMAR can improve the self-care
provision. The collaboration from pharmacist and nurses are of high importance, for patient
education regarding safe and self-efficacy. In concern to eMAR, patient education helps in
facilitating the use of electronic medication record. Similarly, in the work of Carayon et al.
(2017), the authors have assessed the usefulness of electronic record system on medication
safety. The beneficial aspects are associated with decrease in omitted information, error-free
abbreviations, appropriate renew orders, which can affect the safety aspects of the patient.
From this work, the efficacy of eMAR is reflective in terms of proper medication and
prescriptions. However, care must be provided for the human factor which can affect the
safety of the patient. The use of eMAR should be implemented in policy measures, to make it
compulsory among all the emergency and ICU units. In addition to this, Musy et al. (2018),
have identified trigger tools based on existing literature for medication errors and adverse
reactions. Implementing this information into the existing eMAR format, can help in accurate
diagnostics, estimates of adverse event prevalence, and accuracy for automatic detection of
adverse reactions. The existing barrier for implementing eMAR include poor knowledge
about the electronic system and its acceptance by healthcare professionals. Overcoming

COMPUTER AND INFORMATICS IN NURSING
resistance to change and gaining computer literacy is the prime factor that can help in the
uniform implementation of eMAR system across healthcare units. Furthermore,
implementing the trigger tools into eMAR format requires IT experts, to make this hypothesis
turn into real-time practice.
Analysis of current evidence
Based on the information collected from peer-reviewed sources, following points can
justify the importance of using eMAR system. There exist clear evidence which stresses on
the fact that eMAR provision is highly efficient in comparison to the paper-based system.
However, the implementation scope requires an effort for change management, including
resource allocation and training to the professionals. Patient efficacy can be significantly
improved, which includes evidenced-based on cohort study and review procedure in several
emergency and ICU units (Carayon et al., 2017).
Factors like the error in medication, wrong scheduling, adverse events, and follow-ups can be
improved by using the electronic system. Also, with appropriate format, important
information including the use of the drug, contraindication measures, and important patient
information can be help in proper documentation (Wei & Courtney, 2018). Likewise,
pharmacist can also improve their practice in conjunction to duplicate orders, prescriptions
containing contraindicated drugs, and order renewal. Note that the follow-up procedures
including the medication history, allergies, adverse events, and efficacy of medication can be
easily reviewed for further successful treatments. In addition to this, evidence also exists that
supports the framework to include patient for educating them regarding the usage of eMAR,
Rich father can improve the self-efficacy (de Jong et al., 2016).

COMPUTER AND INFORMATICS IN NURSING
Identification of gaps
The existing barriers or knowledge gaps are the factors responsible for poor implementation
of eMAR. The knowledge gaps include insight about utility benefits of the electronic system,
requirements for minimizing medication error, and need to improve clinical practices (Fuller,
Guirguis, Sadowski & Makowsky, 2018). Importantly, lack of proper training and hands-on
practices for using eMAR is also responsible for failure in either implementation or
adaptation with violation in formatting for medication information. Also, the lack of
partnership among the healthcare policymakers, stakeholders of clinical settings, and
healthcare professionals are also responsible for the inconsistent vision of adopting electronic
documentation procedures.
Discussion on existing challenges
The above section highlights the existing knowledge gaps which are responsible for
failure in proper implementation of eMAR. Notably, within the existing care facilities that
have adopted the eMAR, either lack of training or absence of reviewing the practices, are the
key factors that result in poor clinical outcomes (Siu, Mangin, Howard, Price & Chan, 2017).
In the following section, the existing challenges for adopting the electronic system is
discussed. For example, resistance to change regarding the learning of internet and IT tools,
is critical gap that leads to failure in implementation of electronic medication system. Poor
leadership skills among nursing head and experienced professionals, fails to improvise the
documentation practices. Also, the requirement for reviewing and monitoring program for the
use of the electronic system is also considered within the scope of the existing gap.
Conclusion
In summary, eMAR concept has potential to improve the clinical outcomes
significantly and improves the patient safety aspects. In particular, factors like medication

COMPUTER AND INFORMATICS IN NURSING
error, adverse drug events, and contraindications were improved by using a suitable format of
electronic documentation system. Also, the electronic system helps in avoiding interruptions
during medication-related documentation and promote patient safety. Other advantages of
using eMAR is that it helps in reducing duplicate orders, wrong information, and prescription
of contraindicated drugs. However, there exists several challenges for proper implementation
of eMAR among the clinical settings. Lack of knowledge and competencies among
healthcare professionals is the most challenging factor, which can be considered as
challenges existing with eMAR. Overall, this report helps in identifying the impact of eMAR
in conjunction to adopt suitable documentation procedure for achieving patient safety.

COMPUTER AND INFORMATICS IN NURSING
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COMPUTER AND INFORMATICS IN NURSING
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COMPUTER AND INFORMATICS IN NURSING
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