Implementing a New Electronic Health Record System in a University Hospital: The Effect on Reported Medication Errors

Abstract

Closed-loop electronic medication management systems (EMMS) have been seen as a potential technology to prevent medication errors (MEs), although the research on them is still limited. The aim of this paper was to describe the changes in reported MEs in Helsinki University Hospital (HUS) during and after implementing an EPIC-based electronic health record system (APOTTI), with the first features of a closed-loop EMMS. MEs reported from January 2018 to May 2021 were analysed to identify changes in ME trends with quantitative analysis. Severe MEs were also analysed via qualitative content analysis. A total of 30% (n = 23,492/79,272) of all reported patient safety incidents were MEs. Implementation phases momentarily increased the ME reporting, which soon decreased back to the earlier level. Administration and dispensing errors decreased, but medication reconciliation, ordering, and prescribing errors increased. The ranking of the TOP 10 medications related to MEs remained relatively stable. There were 92 severe MEs related to APOTTI (43% of all severe MEs). The majority of these (55%, n = 53) were related to use and user skills, 24% (n = 23) were technical failures and flaws, and 21% (n = 21) were related to both. Using EMMS required major changes in the medication process and new technical systems and technology. Our medication-use process is approaching a closed-loop system, which seems to provide safer dispensing and administration of medications. However, medication reconciliation, ordering, and prescribing still need to be improved.

Adverse drug events leading to medical emergency team activation in hospitals: what can we learn?

“…This could be due to omission errors in the medication reconciliation process at admission. 12 13 Levkovich 4 reported that clinical pharmacists achieved medication reconciliation rates exceeding 80% in the study hospital within 24 hours of admission, which is exemplary. It is possible that even though medication reconciliation was performed properly, some medication on the list might be intentionally or unintentionally held during the medication management process by the ordering provider.…”

“…Further information regarding omission errors was not addressed in Levkovich’s4 study. This could be due to omission errors in the medication reconciliation process at admission 12 13. Levkovich4 reported that clinical pharmacists achieved medication reconciliation rates exceeding 80% in the study hospital within 24 hours of admission, which is exemplary.…”

Developing an In-House Comprehensive Medication Review Training Program for Clinical Pharmacists in a Finnish Hospital Pharmacy

“…Part II of the program extends their competence to a more comprehensive level, including, e.g., untreated indications, drug use without indications, interpreting laboratory values, drug use during aging, renal/hepatic diseases, and medications in their own area of specialty. The new EHR system, APOTTI, has promoted pharmacist-led medication reconciliation in several new emergency departments, outpatient clinics, and municipal health centers [ 50 ]. Clinical pharmacists have begun to offer independent appointments for patients where they can receive advice on their medication, medication reconciliations, and medication reviews.…”

“…The core of the in-house CMRTP has remained the same since 2021 and provides for 15 clinical pharmacists per year; however, the current in-house CMRTP consists of two modules: Part (I) Pharmacist-Led Medication Reconciliation (MedRec), and Part (II) Comprehensive Medication Review ( Figure 2 and Table 1 ). The pharmacist-led medication reconciliation was integrated into CMRTP in 2020 because the implementation of a new electronic patient record system (EPIC-based APOTTI) increased the need for pharmacist-led medication reconciliation in HUS significantly [ 50 ]. Integrating these two courses made it possible to train more pharmacists simultaneously.…”

Why medicines are used differently from prescribed: a protocol for a prospective patient-oriented observational case study to investigate reasons for non-adherence in primary care

“…The new electronic client and patient record system Apotti (based on the Epic system) was implemented in the Hospital District of Helsinki and Uusimaa (HUS) starting in November 2018 27 28. The city of Vantaa (approximately 238 000 residents) was among the first municipalities to implement Apotti in May 2019.…”