ADVANTAGES

This study has several limitations. First, the results reflect the experience of one hospital that already has fully implemented computerized physician-order entry for physicians and bar-code verification for pharmacy staff. Hospitals that choose to implement the bar-code eMAR technology without computerized physician-order entry, pharmacy bar-code verification, or both may find that it has a different effect on administration errors. For example, hospitals without computerized physician-order entry will probably not eliminate transcription errors. Second, the study examined potential adverse drug events, not actual adverse drug events. Although an earlier study estimated that one actual adverse drug event occurs for every seven potential events, further research will be needed to determine the true effect of the bar-code eMAR on adverse drug events. Third, the study hospital designed the application in close collaboration with users and clinical leaders who were willing to support a substantial change in workflow to improve the overall medication process. In addition, extensive resources were expended to support the rollout, including adequate training, onsite support, adequate hardware, and a responsive software-development team. Organizations interested in implementing the bar-code eMAR should consider these factors in order to maximize their investment in this patient-safety technology, and future studies should evaluate vendor solutions implemented in the community setting. Fourth, the nurses observed in this study might have performed better because they were being watched (a phenomenon known as the Hawthorne effect); however, this effect probably applied equally to observations made or units with and without bar-code eMAR technology. Previous studies have also suggested that the Hawthorne effect is minimal after the subject is initially exposed to the observer. Fifth, even though observations were made simultaneously on the units with the bar-code eMAR and on those without it for part of the study period, the staggered rollout schedule meant that more observations were made on units without the bar-code eMAR during the early part of the study period. Our findings might therefore have been subject to a secular effect, although it is unlikely that this effect would have been substantial over a period of 9 months.

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