Medication Safety Following Electronic Health Record Implementation in Pediatric Intensive Care
Loading...
Authors
Pereira, Nichole
Date
2025-01-31
Type
thesis
Language
eng
Keyword
Medication Safety , Electronic Health Record , Pediatric Intensive Care , Evaluation , Safety-II , Resilience Engineering , Realist Evaluation , Health Services Research , Incident Reporting
Alternative Title
Abstract
Background: Globally, medication-related safety incidents contribute significantly to patient harm. Patients are at risk of preventable harm from medication use in healthcare, with pediatric care being particularly vulnerable. Electronic Health Records (EHRs) have been implemented to influence medication safety, offering both benefits and challenges for direct care providers and patients. This dissertation investigates the influence of EHR implementation on medication safety in a Pediatric Intensive Care Unit (PICU) at an urban children's hospital in Alberta, Canada, using Safety-II and resilience engineering frameworks.
Methods: This manuscript-style dissertation consists of three studies. The first manuscript is a scoping review identifying approaches to studying medication safety following EHR implementation, highlighting gaps in the literature and conceptual design elements for future studies. The second manuscript is a mixed-methods study analyzing voluntary incident reports submitted pre- and post-EHR implementation in the PICU. Quantitative analysis cataloged and compared primary incidents and contributory factors, while thematic analysis identified correlations between socio-technical influences. The third manuscript is a case study realist evaluation, incorporating qualitative socio-technical, Safety-II, and resilience engineering frameworks to explore the experiences and perceptions of PICU nurses, physicians, and pharmacists related to medication use and the EHR.
Results: The scoping review revealed conceptual design elements for studying medication safety in EHR contexts. The mixed-methods study found that prescribing incidents were reported significantly more often post-implementation, while administration incidents were reported significantly less. Four qualitative themes emerged from the incident reports: (1) order and instruction (in)accuracy at the user interface; (2) misinformation and decision-making; (3) continuity of care between clinical units; and (4) equipment and supply-related challenges. The case study identified three themes demonstrating how direct care providers adjusted their work to ensure safer outcomes: (1) the evolving roles and responsibilities of physicians, nurses, and pharmacists; (2) staying “on top” of orders; and (3) balancing risk, efficiency, and relationships in patient care.
Conclusion: This research highlights the persistent challenges of medication safety post-EHR implementation and the resilient strategies direct care providers employ to mitigate risks. It challenges current structures of power and hierarchy in medication safety and questions the role of standardization as it contributes to safer systems. The findings provide insights to guide future research, system transformation, and quality improvement efforts. Leaders and administrators can use these findings to anticipate potential issues and inform EHR implementation strategies or design their own investigations into medication safety.
Description
Citation
Publisher
License
Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International