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The following is a list of publications produced by HSI related faculty and students. The link for each paper leads you to the citation, keyword, and abstract. For copies of the full papers, please use standard methods for obtaining academic publications, such as online library searches.

Staff perceptions of advantages and disadvantages of a commercial pediatric electronic medication administration record

Authors: P. Edwards, L. Metcalfe, J. Jose, F. Sainfort


American Academy of Pediatrics 2007 National Conference


As pediatric care providers implement electronic medical records (EMR), there is an increased need to understand clinicians experiences in adapting to these new systems to ensure safe and efficient introduction of EMR functions. This study examines nursing staff perceptions of a commercial EMR s advantages and disadvantages prior to and following implementation of EMR functions to inform future implementations.

A pediatric hospital system implemented a commercial EMR in two tertiary care hospitals: 1 academic, 1 community based. Implementation of the 1st EMR phase for nurses included electronic medication administration (eMAR), admissions documentation, ancillary order entry. At the beginning of this implementation (T1) and again 5 months after go-live (T2), nurses identified perceived system advantages and disadvantages. Responses were coded. Chi-squared tests compared reports at both time periods.

Before implementation (n=184), the most cited expected advantages were efficiency (27%), reduced errors (25%), and better access to patient information (25%). After implementation (n=199), access to information was the most cited advantage (41%). Fewer cited efficiency (16%) and reduced errors (9%) as advantages. Prior to implementation, the learning curve was the leading disadvantage (33%); this decreased to 4% at T2. Those citing efficiency as a disadvantage increased from 8% to 68%, largely due to problems with login times (38%) and dual-signoff of high-risk meds in ICU (11%). At T2, fewer cited PC availability (1% vs 10% at T1) as a disadvantage. All reported changes are significant (p<0.05).

Significant investments in hardware and training addressed nurse concerns about the learning curve and PC availability prior to go-live. However, perceived inefficiencies offset perceived advantages in access to information and reduced errors. These inefficiencies were due in part to the intermediate stage in the transition to EMR and unanticipated login difficulties. Lessons learned will be discussed.

Citation: Edwards, P., Metcalfe, L., Jose, J., Sainfort, F. Staff perceptions of advantages and disadvantages of a commercial pediatric electronic medication administration record. American Academy of Pediatrics 2007 National Conference, October 27-30, 2007, San Francisco, CA

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