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Human Resources For Health Jun 2020Workforce studies often identify burnout as a nursing 'outcome'. Yet, burnout itself-what constitutes it, what factors contribute to its development, and what the wider...
BACKGROUND
Workforce studies often identify burnout as a nursing 'outcome'. Yet, burnout itself-what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients-is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout.
METHODS
We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce.
RESULTS
Ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave.
CONCLUSIONS
The patterns identified by these studies consistently show that adverse job characteristics-high workload, low staffing levels, long shifts, and low control-are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach's theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.
Topics: Burnout, Professional; Health Status; Humans; Internal-External Control; Job Satisfaction; Leadership; Nurse's Role; Nurses; Patient Safety; Personnel Turnover; Quality of Health Care; Sick Leave; Time Factors; Workload; Workplace
PubMed: 32503559
DOI: 10.1186/s12960-020-00469-9 -
Therapeutic Advances in Drug Safety 2020Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare... (Review)
Review
BACKGROUND AND AIMS
Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings.
METHODS
The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types.
RESULTS
A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre-post format, future studies should include a concurrent control group.
CONCLUSION
The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses.
LAY SUMMARY
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INTRODUCTION
Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world.
OBJECTIVE
To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital.
METHODS
Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities.
RESULTS
A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity.
CONCLUSION
A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.
PubMed: 33240478
DOI: 10.1177/2042098620968309 -
The Cochrane Database of Systematic... Nov 2021Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare... (Review)
Review
BACKGROUND
Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. Medication errors in hospitalised adults may cause harm, additional costs, and even death.
OBJECTIVES
To determine the effectiveness of interventions to reduce medication errors in adults in hospital settings.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 16 January 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and interrupted time series (ITS) studies investigating interventions aimed at reducing medication errors in hospitalised adults, compared with usual care or other interventions. Outcome measures included adverse drug events (ADEs), potential ADEs, preventable ADEs, medication errors, mortality, morbidity, length of stay, quality of life and identified/solved discrepancies. We included any hospital setting, such as inpatient care units, outpatient care settings, and accident and emergency departments.
DATA COLLECTION AND ANALYSIS
We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. Where necessary, we extracted and reanalysed ITS study data using piecewise linear regression, corrected for autocorrelation and seasonality, where possible. MAIN RESULTS: We included 65 studies: 51 RCTs and 14 ITS studies, involving 110,875 participants. About half of trials gave rise to 'some concerns' for risk of bias during the randomisation process and one-third lacked blinding of outcome assessment. Most ITS studies presented low risk of bias. Most studies came from high-income countries or high-resource settings. Medication reconciliation -the process of comparing a patient's medication orders to the medications that the patient has been taking- was the most common type of intervention studied. Electronic prescribing systems, barcoding for correct administering of medications, organisational changes, feedback on medication errors, education of professionals and improved medication dispensing systems were other interventions studied. Medication reconciliation Low-certainty evidence suggests that medication reconciliation (MR) versus no-MR may reduce medication errors (odds ratio [OR] 0.55, 95% confidence interval (CI) 0.17 to 1.74; 3 studies; n=379). Compared to no-MR, MR probably reduces ADEs (OR 0.38, 95%CI 0.18 to 0.80; 3 studies, n=1336 ; moderate-certainty evidence), but has little to no effect on length of stay (mean difference (MD) -0.30 days, 95%CI -1.93 to 1.33 days; 3 studies, n=527) and quality of life (MD -1.51, 95%CI -10.04 to 7.02; 1 study, n=131). Low-certainty evidence suggests that, compared to MR by other professionals, MR by pharmacists may reduce medication errors (OR 0.21, 95%CI 0.09 to 0.48; 8 studies, n=2648) and may increase ADEs (OR 1.34, 95%CI 0.73 to 2.44; 3 studies, n=2873). Compared to MR by other professionals, MR by pharmacists may have little to no effect on length of stay (MD -0.25, 95%CI -1.05 to 0.56; 6 studies, 3983). Moderate-certainty evidence shows that this intervention probably has little to no effect on mortality during hospitalisation (risk ratio (RR) 0.99, 95%CI 0.57 to 1.7; 2 studies, n=1000), and on readmissions at one month (RR 0.93, 95%CI 0.76 to 1.14; 2 studies, n=997); and low-certainty evidence suggests that the intervention may have little to no effect on quality of life (MD 0.00, 95%CI -14.09 to 14.09; 1 study, n=724). Low-certainty evidence suggests that database-assisted MR conducted by pharmacists, versus unassisted MR conducted by pharmacists, may reduce potential ADEs (OR 0.26, 95%CI 0.10 to 0.64; 2 studies, n=3326), and may have no effect on length of stay (MD 1.00, 95%CI -0.17 to 2.17; 1 study, n=311). Low-certainty evidence suggests that MR performed by trained pharmacist technicians, versus pharmacists, may have little to no difference on length of stay (MD -0.30, 95%CI -2.12 to 1.52; 1 study, n=183). However, the CI is compatible with important beneficial and detrimental effects. Low-certainty evidence suggests that MR before admission may increase the identification of discrepancies compared with MR after admission (MD 1.27, 95%CI 0.46 to 2.08; 1 study, n=307). However, the CI is compatible with important beneficial and detrimental effects. Moderate-certainty evidence shows that multimodal interventions probably increase discrepancy resolutions compared to usual care (RR 2.14, 95%CI 1.81 to 2.53; 1 study, n=487). Computerised physician order entry (CPOE)/clinical decision support systems (CDSS) Moderate-certainty evidence shows that CPOE/CDSS probably reduce medication errors compared to paper-based systems (OR 0.74, 95%CI 0.31 to 1.79; 2 studies, n=88). Moderate-certainty evidence shows that, compared with standard CPOE/CDSS, improved CPOE/CDSS probably reduce medication errors (OR 0.85, 95%CI 0.74 to 0.97; 2 studies, n=630). Low-certainty evidence suggests that prioritised alerts provided by CPOE/CDSS may prevent ADEs compared to non-prioritised (inconsequential) alerts (MD 1.98, 95%CI 1.65 to 2.31; 1 study; participant numbers unavailable). Barcode identification of participants/medications Low-certainty evidence suggests that barcoding may reduce medication errors (OR 0.69, 95%CI 0.59 to 0.79; 2 studies, n=50,545). Reduced working hours Low-certainty evidence suggests that reduced working hours may reduce serious medication errors (RR 0.83, 95%CI 0.63 to 1.09; 1 study, n=634). However, the CI is compatible with important beneficial and detrimental effects. Feedback on prescribing errors Low-certainty evidence suggests that feedback on prescribing errors may reduce medication errors (OR 0.47, 95%CI 0.33 to 0.67; 4 studies, n=384). Dispensing system Low-certainty evidence suggests that dispensing systems in surgical wards may reduce medication errors (OR 0.61, 95%CI 0.47 to 0.79; 2 studies, n=1775).
AUTHORS' CONCLUSIONS
Low- to moderate-certainty evidence suggests that, compared to usual care, medication reconciliation, CPOE/CDSS, barcoding, feedback and dispensing systems in surgical wards may reduce medication errors and ADEs. However, the results are imprecise for some outcomes related to medication reconciliation and CPOE/CDSS. The evidence for other interventions is very uncertain. Powered and methodologically sound studies are needed to address the identified evidence gaps. Innovative, synergistic strategies -including those that involve patients- should also be evaluated.
Topics: Adult; Hospitalization; Hospitals; Humans; Medication Errors; Medication Reconciliation; Pharmacists
PubMed: 34822165
DOI: 10.1002/14651858.CD009985.pub2 -
Journal of Pediatric Nursing 2022Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be affected by medication errors than adults with medication administration error rates reported to be over 70%.
OBJECTIVE
To identify nursing interventions to reduce medication administration errors and perform a meta-analysis.
METHODS
Online databases; British Nursing Index (BNI), Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and MEDLINE were searched for relevant studies published between January 2000 to 2020. Studies with clear primary or secondary aims focusing on interventions to reduce medication administration errors in paediatrics, children and or neonates were included in the review.
RESULTS
442 studies were screened and18 studies met the inclusion criteria. Seven interventions were identified from included studies; education programmes, medication information services, clinical pharmacist involvement, double checking, barriers to reduce interruptions during drug calculation and preparation, implementation of smart pumps and improvement strategies. Educational interventional aspects were the most common identified in 13 out of 18 included studies. Meta-analysis demonstrated an associated 64% reduction in medicine administration errors post intervention (pooled OR 0.36 (95% Confidence Interval (CI) 0.21-0.63) P = 0.0003).
CONCLUSION
Medication safety education is an important element of interventions to reduce administration errors. Medication errors are multifaceted that require a bundle interventional approach to address the complexities and dynamics relevant to the local context. It is imperative that causes of errors need to be identified prior to implementation of appropriate interventions.
Topics: Adult; Child; Drug Dosage Calculations; Humans; Infant, Newborn; Medication Errors; Pediatrics; Pharmaceutical Preparations; Pharmacists
PubMed: 34507851
DOI: 10.1016/j.pedn.2021.08.024 -
BMJ Quality & Safety Jul 2020Double checking medication administration in hospitals is often standard practice, particularly for high-risk drugs, yet its effectiveness in reducing medication... (Review)
Review
BACKGROUND
Double checking medication administration in hospitals is often standard practice, particularly for high-risk drugs, yet its effectiveness in reducing medication administration errors (MAEs) and improving patient outcomes remains unclear. We conducted a systematic review of studies evaluating evidence of the effectiveness of double checking to reduce MAEs.
METHODS
Five databases (PubMed, Embase, CINAHL, Ovid@Journals, OpenGrey) were searched for studies evaluating the use and effectiveness of double checking on reducing medication administration errors in a hospital setting. Included studies were required to report any of three outcome measures: an effect estimate such as a risk ratio or risk difference representing the association between double checking and MAEs, or between double checking and patient harm; or a rate representing adherence to the hospital's double checking policy.
RESULTS
Thirteen studies were identified, including 10 studies using an observational study design, two randomised controlled trials and one randomised trial in a simulated setting. Studies included both paediatric and adult inpatient populations and varied considerably in quality. Among three good quality studies, only one showed a significant association between double checking and a reduction in MAEs, another showed no association, and the third study reported only adherence rates. No studies investigated changes in medication-related harm associated with double checking. Reported double checking adherence rates ranged from 52% to 97% of administrations. Only three studies reported if and how independent and primed double checking were differentiated.
CONCLUSION
There is insufficient evidence that double versus single checking of medication administration is associated with lower rates of MAEs or reduced harm. Most comparative studies fail to define or investigate the level of adherence to independent double checking, further limiting conclusions regarding effectiveness in error prevention. Higher-quality studies are needed to determine if, and in what context (eg, drug type, setting), double checking produces sufficient benefits in patient safety to warrant the considerable resources required. CRD42018103436.
Topics: Databases, Factual; Humans; Medication Errors; Observational Studies as Topic; Pharmaceutical Preparations; Randomized Controlled Trials as Topic
PubMed: 31391315
DOI: 10.1136/bmjqs-2019-009552 -
Journal of Clinical Nursing Sep 2023Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor... (Review)
Review
BACKGROUND
Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs.
OBJECTIVE
Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings.
METHOD
Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue.
RESULTS
Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies.
RELEVANCE TO CLINICAL PRACTICE
Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.
Topics: Humans; Pharmaceutical Preparations; Patient Safety; Hospitals; Fatigue; Menthol; Nurses
PubMed: 36707921
DOI: 10.1111/jocn.16620 -
Scandinavian Journal of Caring Sciences Mar 2021The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills. (Review)
Review
AIMS
The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills.
DESIGN
A systematic literature review.
DATA SOURCES
The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018.
REVIEW METHODS
Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis.
RESULTS
A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety.
CONCLUSIONS
Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.
Topics: Clinical Competence; Humans; Nurses; Pharmaceutical Preparations
PubMed: 32168398
DOI: 10.1111/scs.12835 -
Nursing Open Jan 2022The aim of this review was to synthesize the best available evidence on the impact of nurses' safety attitudes on patient outcomes in acute-care hospitals. (Review)
Review
AIMS
The aim of this review was to synthesize the best available evidence on the impact of nurses' safety attitudes on patient outcomes in acute-care hospitals.
DESIGN
Systematic review with a narrative synthesis of the available data.
DATA SOURCES
Data sources included MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Scopus and Web of Science Core Collection. Studies published up to March 2021 were included.
REVIEW METHODS
This review was conducted using guidance from the Joanna Briggs Institute for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
RESULTS
A total of 3,452 studies were identified, and nine studies met the inclusion criteria. Nurses with positive safety attitudes reported fewer patient falls, medication errors, pressure injuries, healthcare-associated infections, mortality, physical restraints, vascular access device reactions and higher patient satisfaction. Effective teamwork led to a reduction in adverse patient outcomes. Most included studies (N = 6) used variants of the Hospital Survey on Patient Safety Culture to assess nurses' safety attitudes. Patient outcomes data were collected from four sources: coded medical records data, incident management systems, nurse perceptions of adverse events and patient perceptions of safety.
CONCLUSION
A positive safety culture in nursing units and across hospitals resulted in fewer reported adverse patient outcomes. Nurse managers can improve nurses' safety attitudes by promoting a non-punitive response to error reporting and promoting effective teamwork and good communication.
Topics: Communication; Hospitals; Humans; Nurses; Patient Satisfaction
PubMed: 34538027
DOI: 10.1002/nop2.1063 -
European Journal of Hospital Pharmacy :... Mar 2021The current systematic review (SR) was undertaken to identify and summarise the published literature reporting on the clinical and economic value of automated... (Review)
Review
OBJECTIVES
The current systematic review (SR) was undertaken to identify and summarise the published literature reporting on the clinical and economic value of automated in-hospital pharmacy services with a primary focus on systems supporting the dispensing of medicines.
METHODS
Literature searches were conducted in MEDLINE, Embase and the Cochrane Library on 17 December 2017 to identify English-language publications investigating any automated dispensing systems (ADSs) in the inpatient setting to include central pharmacy and ward-based systems.
RESULTS
4320 publications were screened by title and abstract and 45 of 175 full publications screened were included. Grey literature searching identified an additional three publications. Therefore, 48 publications relating to ADSs were eligible for inclusion. Although a relatively large evidence base was identified as part of the current SR, the eligible studies were inconsistent in terms of their design and the format of reporting of outcomes. The studies demonstrate that both pharmacy and ward-based ADSs offer benefits over traditional manual dispensing methods in terms of clinical and economic outcomes. The primary benefits following implementation of an ADS include reductions in medication errors, medication administration time and costs. Studies examining optimisation/inventory management strategies/refill programmes for these systems suggest that optimal implementation of the ADS is required to ensure that clinical success and economic benefits are maximised.
CONCLUSIONS
The published evidence suggests positive impacts of ADS and should encourage hospitals to invest in automation, with a global strategy to improve the reliability and the efficiency of the medication process. However, one of the key findings of the current SR is the need for further data from adequately powered studies reporting clinically relevant outcomes which would allow for robust, evidence-based recommendations on the return on investment of the technologies. These studies would probably contribute to a larger adoption of these technologies by European hospitals.
Topics: Automation; Hospitals; Humans; Pharmacy; Pharmacy Service, Hospital; Reproducibility of Results
PubMed: 32434785
DOI: 10.1136/ejhpharm-2019-002081 -
Journal of Medical Internet Research Sep 2022Electronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries... (Review)
Review
BACKGROUND
Electronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries worldwide. Despite the abundance of literature exploring their relationship, their practical implications on patient safety and quality of care remain unclear.
OBJECTIVE
This study aimed to examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income health care settings.
METHODS
A systematic search was conducted using 4 web-based medical journal repositories and grey literature sources. The publications included were published in English between 2010 and 2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by 3 researchers in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias assessments were performed using the Risk of Bias in Non-randomized Studies of Interventions and the Cochrane Risk of Bias 2 tools. The findings were presented as a narrative synthesis and mapped based on the Institute of Medicine's framework for health care quality.
RESULTS
A total of 12 studies met the inclusion criteria to be included in our review. The findings were categorized into 6 common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost savings. EHR interoperability positively influenced medication safety, reduced patient safety events, and reduced costs. Improvements in time saving and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty because of the heterogeneity in the outcome measures used and notable variation in study quality.
CONCLUSIONS
The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technology research outcome measures would support higher-quality research on the topic. Future research efforts should focus on both the positive and negative impacts of interoperable EHR interventions and explore patient perspectives, given the growing trend for patient involvement and stewardship over their own electronic clinical data.
TRIAL REGISTRATION
PROSPERO CRD42020209285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209285.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1136/bmjopen-2020-044941.
Topics: Developed Countries; Electronic Health Records; Humans; Income; Patient Safety; Quality of Health Care; United States
PubMed: 36107486
DOI: 10.2196/38144