Summary
Introduction: Electronic medication administration record (eMAR) systems are promoted as a potential
intervention to enhance medication safety in residential aged care facilities (RACFs).
The purpose of this study was to conduct an in-practice evaluation of an eMAR being
piloted in one Australian RACF before its roll out, and to provide recommendations
for system improvements.
Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in
the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF
staff and the community pharmacist were conducted to investigate their views of the
eMAR system. Data were analysed using a grounded theory approach to identify challenges
associated with the design of the eMAR system.
Results: The current eMAR system does not offer an end-to-end solution for medication management.
Many steps, including prescribing by doctors and communication with the community
pharmacist, are still performed manually using paper charts and fax machines. Five
major challenges associated with the design of eMAR system were identified: limited
interactivity; inadequate flexibility; problems related to information layout and
semantics; the lack of relevant decision support; and system maintenance issues.We
suggest recommendations to improve the design of the eMAR system and to optimize existing
workflows.
Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies
in data entry design and offering dedicated organisational support to minimise connectivity
issues. Longer-term benefits can be achieved by adding decision support features and
establishing system interoperability requirements with stakeholder groups (e.g. community
pharmacies) prior to system roll out. In-practice evaluations of technologies like
eMAR system have great value in identifying design weaknesses which inhibit optimal
system use.
Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges
for electronic medication administration record systems in residential aged care facilities:
a formative evaluation. Appl Clin Inf 2014; 5: 971–987
http://dx.doi.org/10.4338/ACI-2014-08-RA-0062
Keywords
Medication administration - electronic medication administration records - residential
aged care facilities - system design - formative evaluation
