Keywords order entry systems - safety - medication errors - workflows
Background and Significance
Background and Significance
The introduction of electronic medication management (eMM) systems in hospitals (also
referred to as computerized provider order entry systems) has been transformative
in health care, with research showing that implementation of eMM reduces medication
errors.[1 ]
[2 ] An eMM, often one component of an electronic medical record (eMR),[3 ] allows clinicians to prescribe and review medications, as well as reconcile and
record their administration. In addition, the embedding of clinical decision support
(CDS) into an eMM system provides information to users in real time on potential medication-related
harms by, for example, alerting clinicians to known allergies or drug interactions.[4 ]
Given the complex nature of medication management in hospitals, the interaction between
eMM systems, the tasks required to be performed by their users, and existing workflows
can give rise to unintended consequences.[5 ] A key example of this is the introduction of new safety risks that were previously
not possible with the use of paper records. Research has shown that new types of medication
errors can occur as a direct consequence of using electronic systems, errors referred
to as system-related errors.[6 ]
[7 ]
[8 ]
In a recent systematic review that synthesized evidence of the effectiveness of eMM
to reduce medication error rates and associated patient harms, 12 of the 18 included
studies reported the emergence of system-related errors. In the four studies quantifying
these types of errors, they reported that between 1 and 35% of all medication errors
were system-related.[2 ] Examples of system-related errors described in these papers included medication
errors resulting from the incorrect selection of order components,[9 ]
[10 ]
[11 ] the failure to modify incorrect default options,[12 ] and misuse of system functionalities, including CDS.[13 ]
[14 ]
Another systematic review providing further insight into how and why these new errors
emerge identified eight key areas that contribute to eMM-related prescribing errors,
such as the computer display and system configuration, unintuitive and automated task
processes, and current user workflows.[15 ] There is now little doubt that system-related errors do not result purely from technical
issues, but rather incompatibilities between system design and user factors.[16 ]
[17 ] Users frequently report that eMM systems introduce additional steps to complete
tasks compared with paper-based records, and identify a range of usability issues
with systems, often leading clinicians to adopt workarounds.[18 ]
[19 ] For example, the inflexible design of structured order templates has led clinicians
to use free-text boxes to communicate prescribing information, limiting the system's
ability to detect possible drug interactions and contributing to inconsistent order
information, both of which can lead to significant errors.[20 ]
[21 ]
[22 ]
Objective
This research provides us with a good foundation for understanding the types and prevalence
of new medication errors that arise with the use of eMM systems, but some clear evidence
gaps exist. We know very little about the longitudinal effects of system use on system-related
errors (i.e., whether errors change over time?),[23 ] and about modifications made to eMM systems to mitigate system-related errors.[24 ] Following the implementation of eMM, the system is continuously updated in response
to the identification of glitches, errors, workflow blocks, and user feedback,[25 ] but to date, no research has specifically examined the changes made to eMM systems
to mitigate risks and streamline clinician workflow. In this study, we aimed to (1)
identify potential system-related errors or workflow blocks which were the target
of eMM system updates, including the types of medications involved, and (2) describe
and classify the system updates made to target these new risks.
Methods
Design and Setting
This retrospective qualitative study reviewed and classified updates made to the eMM
component of a commercially available eMR (Cerner Millennium) at three acute public
hospitals within a local health district (LHD) in New South Wales (NSW), Australia.
The NSW State Government (Australia) guidance recommends documenting all updates made
to an eMM and the rationale for the changes.[3 ] This study was approved by the districts' Human Research Ethics Committee.
A staged roll-out of the eMM occurred in the first hospital between November 2007
and May 2015. The other two sites introduced the eMM system hospital-wide in September
2017 and March 2019 respectively, over a 2-week period.
Information and communications technology (ICT) services are delivered by a central
district-wide information management and technology division (IM&TD), as well as facility-based
ICT support teams and specialist staff. For this reason, eMM system updates typically
occur at a LHD level. When a clinician requests an eMM change, the application team
determines what is possible, builds the change into the testing domain of the eMM,
and seeks feedback from the clinician. Once the clinician approves the change, wider
group approval is sought from affected stakeholders (e.g., changes to antimicrobial
prescribing require consultation with the infectious diseases team) and the health
informatics medical, nursing, and pharmacy teams. Once approved, users complete further
testing and the change is released on the eMM system, while the ICT team prepares
the monthly document detailing recent changes.
Data Collection
Documents detailing key system updates and new features in the eMR across the LHD,
published from November 2015 to December 2019, were reviewed. This time period was
selected as it commenced with the regular monthly updates made within the district
and concluded prior to the COVID-19 pandemic. These documents are compiled by the
district's IM&TD staff approximately once a month and distributed to staff via the
intranet. Each document was read thoroughly and all updates relating to the medication
management process were included in the analysis. Medication-related updates were
excluded if they described improvements related to clinical information systems external
to the three hospitals. Documents generally followed a similar format with subcomponents
of the eMR highlighted by headings (e.g., eMM). However, compared with recent reports,
earlier documents were less detailed and structured. Updates ranged from a single
sentence, with or without an image, to a comprehensive update specifying multiple
individual changes, with detailed descriptions and images of each change ([Fig. 1 ]).
Fig. 1 Examples of medication-related updates in the electronic medication record (eMR),
detailing (A ) one system change made to the options available in a drop-down list for reasons
a medication was voided and (B ) multiple system changes for two high-risk medications, including changing the font
to red and the addition of an icon and alert.
Classification
Initially, an attempt was made to categorize medication-related updates and the reason
for updates using three existing classifications,[6 ]
[26 ]
[27 ]
[28 ] including a classification tool for health service organizations based on pioneering
work by Westbrook et al[6 ]
[12 ] and Magrabi et al.[16 ]
[29 ]
[30 ]
[31 ]
[32 ] However, when mapping eMM updates to categories, many were classified into the broad
category of “problems with clinical information system functionality,” which provided
limited insight into the nuances of system enhancements.
As no suitable pre-existing classification could be identified, medication-related
updates were classified according to “rationale for change” ([Table 1 ]) and “change made to the system” ([Table 2 ]; see Appendix A [[Supplementary Material ], available in the online version] for full classifications with definitions and
examples). This classification system was iteratively developed using cases as they
emerged. Specifically, an initial sample of 10 updates was independently classified
by three researchers with expertise in psychology, human factors, and clinical informatics
(M.K., M.B., and W.Y.Z.). Researchers met to review assigned codes, discuss disagreements,
and develop the classification framework. In developing the categories, researchers
ensured they described general changes and concepts that could be applied to other
settings. The remaining updates were then classified by one researcher (M.K.), with
all complicated or unclear updates discussed initially with the other researchers,
and if still unclear, with a specialized eMM pharmacist (L.M.H.) from one of the hospital
sites, to ensure consistent and credible results.
Table 1
The rationale and most frequent medication-related changes made to the system for
each rationale
Rationale for change (%)[a ]
Definition
Most frequent changes
Prevent error (24.3)
To directly or indirectly reduce the likelihood of a medication error occurring
• Alert/s added
• Extra information made available
• Font/background changed
• Component/s of an order sentence modified
Support “work as done” (16.4)
To ensure the system supports practices that were previously completed on paper, for
example by capturing the range of possible order components and regimens used by clinicians
• Option/s added to list
• Field/s added
• Use of free text data entry broadened
Optimize workflow (22.1)
Capitalizing on the capacity of the electronic system to facilitate more efficient
and streamlined workflow, including supporting decision making, providing a better
overview of the patient or patient group, or reducing the number of actions required
by the user
• Extra information made available
• MPage/tab added
• PowerPlan/Care Set added
• Option/s added to list
Improve documentation (8.6)
To maintain accurate and thorough records of use, for example when completing medication
reconciliation
• Field/s added
• Option/s added to list
• Option/s removed from list
Improve monitoring (5.0)
To capture and monitor the use of the system
• Report added
Avoid confusion or misinterpretation (5.7)
To reduce the likelihood of users being confused about system functions, for example
by improving terminology and/or phrasing
• Wording and/or phrasing modified
• Option/s removed from list
• Alert/s removed
Support the expansion of eMM use (13.6)
To enable the broadening of eMM use, for example to ensure consistency across the
district when eMM use expands to additional sites or to support expanded functionality
of the eMM to other patient wards
• Wording and/or phrasing modified
• PowerPlan/Care Set removed
• PowerPlan/Care Set added
• Order sentence/s added
Improve compliance with policies or guidelines (4.3)
To ensure staff are adhering to hospital-, district-, state- or nation-wide rules
as determined by policies or guidelines
• Forced review
• PowerPlan/Care Set removed
Abbreviation: eMM, electronic medication management.
a Percentages reflect the proportion of changes made for each rationale.
Table 2
A classification of updates made to an eMM specifying changes made to the system
Category
Area of change
Change made on the system
Number of changes
% of total changes[a ]
Change to the visual display
Design
Font/background changed
5
3.4%
Icon added
3
2.0%
Order of information modified
3
2.0%
Content
Extra information made available
11
7.5%
Wording and/or phrasing modified
11
7.5%
Category total
33
22.4%
Change to the options available
PowerPlans/Care Sets
PowerPlan/Care Set added
9
6.1%
PowerPlan/Care Set removed
4
2.7%
Component/s of a PowerPlan/Care Set modified
1
0.7%
Use of PowerPlan/Care Set broadened
1
0.7%
Order sentences
Order sentence/s added
4
2.7%
Order sentence/s removed
1
0.7%
Component/s of an order sentence modified
7
4.8%
Filter added for order sentence/s
1
0.7%
Order form fields
Field/s added
4
2.7%
Field/s removed
1
0.7%
Field/s combined
1
0.7%
Field/s modification restricted
1
0.7%
Lists
Option/s added to list
20
13.6%
Option/s removed from list
4
2.7%
Use of option/s broadened
1
0.7%
Free text data entry
Use of free text data entry broadened
3
2.0%
Category total
63
42.9%
Change to clinical decision support
Alerts
Alert/s added
7
4.8%
Alert/s removed
7
4.8%
Alert/s content modified
3
2.0%
Alert/s use broadened
3
2.0%
MPages/tabs
MPage/tab added
7
4.8%
MPage/tab removed
2
1.4%
Other
Task automation or calculation
3
2.0%
Category total
32
21.8%
Adding a forcing function
Forced review
5
3.4%
Forced selection
2
1.4%
Category total
7
4.8%
Improved information transmission
Between eMM and other eMR modules
2
1.4%
Between eMR and other HIS
2
1.4%
Category total
4
2.7%
Other
eMM use broadened
1
0.7%
Report added
7
4.8%
Category total
8
5.4%
Total
147
100%
Abbreviations: eMM, electronic medication management; eMR, electronic medical record;
HIS, health information system.
a Percentages may not add up to their category totals due to rounding.
Results
Overview of System Updates
The sample included 43 documents with 117 updates, totaling 147 individual changes
made to the eMM system over the 4-year period.
We identified between one and three reasons for each update, with a total of 140 reasons
for the changes made in our sample. Eight broad categories of reasons for the changes
made to the eMM system were identified in the dataset: prevent error, support “work
as done,” optimize workflow, improve documentation, improve monitoring, avoid confusion
or misinterpretation, support the expansion of eMM use, and improve compliance with
policies or guidelines ([Table 1 ]). Across the timeframe (November 2015 to December 2019), the most common rationale
for an update to the eMM system was to prevent medication errors (24% of all rationales).
Of the 34 updates that were made to prevent errors, the addition of an alert was the
most common change (13% of the changes that were made to prevent errors). For instance,
an alert was added to inform prescribers of an existing active anticoagulant order
when ordering a new anticoagulant, to prevent duplication and possible contraindication.
Updates also frequently occurred to optimize workflow (22% of all rationales), replicate
work as done on paper charts (16%), and support the expansion of eMM use (14%), either
to another ward or cohort of patients in the hospital, or to another hospital site
in the district. Remaining updates were made to improve documentation (9%), avoid
confusion or misinterpretation (6%), improve monitoring (5%), and to improve compliance
with policies or guidelines (4%). Of the 31 updates made to optimize workflow, eight
updates included additional information on the screen, such as the display of relevant
pathology results during prescribing. Other frequent system changes to optimize workflow
included the addition of an MPage or tab to support clinical decision making, the
addition of a PowerPlan or Care Set, and the addition of options to lists, specifically
folders to menu lists (e.g., addition of a nurse-initiated medication folder). For
example, an MPage (see definition in [Table 3 ]) was added to provide clinicians with a consolidated view of their patients' diabetes
therapy over the last 30 days, allowing review of the trend in blood glucose and ketone
levels over time, and facilitating therapeutic decisions.
Table 3
Definitions of eMM system components
PowerPlan
A set of orders that are grouped together to support a specific condition, procedure,
or process. This could describe multiple phases of care and can include additional
orders
Care Set
Similar to a PowerPlan, but describes a single phase of care and cannot be modified
Order sentence
A prewritten medication order with prefilled values/components
Order form field
A component of a medication order requiring a value to be inputted
Alert
A “pop-up” window notifying the user that an action or event is about to occur, providing
relevant information, providing a recommendation, or warning of a potential risk
MPage/tab
A page in the eMR or web browser that displays specific data from multiple eMR sections
(e.g., pathology and medications) based on certain parameters to assist in decision
making
Abbreviation: eMR, electronic medical record.
Ninety-six updates reported one change, with the remaining 21 updates reporting between
two and five changes. Six broad categories of changes made to the eMM system were
identified in the dataset: change to the visual display, change to the options available,
change to the CDS, adding a forcing function, improved information transmission, and
other. As shown in [Table 2 ], the most common change to the system was “changes to the options available,” followed
by “changes to the content on the visual display.” This former category included options
added to lists, which was the most frequent subcategory of changes. The latter category
included extra information made available on the screen or the wording or phrasing
of text modified. Options added to lists were most frequently to support “work as
done,” optimize workflow, and prevent errors. For example, “IV infusion therapy day”
was added as a route of administration for antineoplastic medications, as this is
regularly prescribed by clinicians. Extra information was made available on the screen
primarily to optimize workflow and prevent errors, such as including the date and
time of the final scheduled medication dose in the clinical display line to prevent
errors resulting from the incorrect continuation of a medication regimen. Modifications
to the wording or phrasing of text were most frequently implemented to avoid confusion
or misinterpretation and support the expansion of eMM use.
Some updates represented modifications or successive additions to previous updates.
[Fig. 2 ] provides examples of linked updates.
Fig. 2 Examples of updates that reflect modifications to previous updates.
Medications That Were the Focus of Updates
Approximately a third of updates (37%) related to high-risk medications or to medicines
known to have an increased risk of causing significant patient harm when misused or
used in error.[33 ] These include antimicrobials, insulin, narcotics, electrolytes, anticoagulants,
and chemotherapeutic drugs.[34 ] For example, an antimicrobial surveillance MPage was implemented to monitor patients
with one or more anti-infective drugs at any point during admission. Additionally,
PowerPlans or electronic order sets were added and modified for anticoagulants, insulin,
and chemotherapy to comply with local protocols. High-risk medications frequently
required multiple changes. For example, updates to make hydromorphone safer included
the introduction of tallman lettering with red text, the forced selection of brand
name or therapeutic substitution when prescribing, and high-risk alerts for both prescribers
and administrators. Although the focus of many system updates, each high-risk medication
was managed differently and there did not appear to be a standard approach or set
of systematic changes for high-risk medications. For example, updates to hydromorphone
included those listed above, while updates for insulin included high-risk alerts combined
with a diabetic patient care MPage and the forced review of blood glucose results
at the point of prescribing.
Rationale for the System Changes Made Across Time
As shown in [Fig. 3 ], reasons for system changes appeared to vary over time. Updates to support the expansion
of eMM use increased from 6% of updates in 2016 to 24% of updates in 2019. In contrast,
29 and 12% of changes were made to optimize workflow and improve documentation in
2016, respectively, but these decreased to 10 and 3% in 2019.
Fig. 3 Rationale for changes made to the eMM across the time-period, as a percentage of
total rationales per year. eMM, electronic medication management.
System changes made to improve compliance with policies or guidelines occurred only
in 2017 and changes to improve monitoring only in 2019. These latter updates represented
the addition of reports to the eMR menu that allowed monitoring of specific elements
of eMM use (e.g., medication administration by dose, date, and time).
Discussion
This study used the unique approach of reviewing and classifying eMM system updates,
providing concrete examples of system changes introduced to prevent error and improve
workflow. We found nearly 150 changes were made to the eMM system over a 4-year period,
with most introduced to prevent medication errors and optimize workflow. Options were
made available in the eMM to allow continuity of work practices from paper to the
eMM. Updates also sought to capitalize on eMM functionality and provide additional
support to assist in decision making and guide appropriate user action; these were
not possible in a paper-based system. Although a large proportion of updates related
to high-risk medications and often multiple changes were introduced in the eMM system
to target high-risk medication errors, there did not appear to be a consistent approach
taken to optimize high-risk medication use. Over time, with ongoing eMM use, the focus
of updates shifted toward monitoring eMM system use and supporting its expansion to
other locations both internally and externally.
Updates reviewed in this study most frequently targeted the prevention of medication
errors. Although medication error rates have been shown to reduce after eMM implementation,[12 ]
[35 ]
[36 ] the system has also been associated with new types of errors.[6 ]
[37 ] Further, the degree of improvement following eMM implementation can vary depending
on context, implementation strategy, and system design.[1 ]
[38 ] Therefore, fulfilling the benefits of eMM requires hospitals to develop error prevention
strategies that also minimize the risk of system-related errors, with consideration
of clinical and organizational needs. Of note, the introduction of an electronic alert
was the most common change aimed at error prevention in our sample. However, an increased
number of alerts can lead to alert fatigue, a well-recognized phenomenon,[39 ] where clinicians become overburdened and their ability to determine which alerts
are clinically significant declines, leading to habitual overrides.[40 ] The importance of optimizing alerts and continually reviewing their effectiveness
in preventing errors is now well recognized.[41 ] In our study, we found that although alerts were added, some were also modified
or removed, suggesting that the local eMM team was aware of the risk of alert fatigue
and its negative impacts.
We found that options were frequently added to drop-down lists and menus (e.g., adding
the frequency of “every 12 hours on therapy day” to antineoplastic orders), to ensure
the system supported prescribing and administration practices previously completed
on paper. When adding items to lists, we recommend that sites be mindful that incorrect
selection from drop-down lists is one of the most frequent system-related errors reported
in the literature.[6 ]
[9 ]
[42 ]
[43 ] Long lists of options can result in excessive scrolling and clicks, increasing the
chance of selection errors.[6 ]
[44 ] Irrelevant or limited options on lists encourage the use of manual entry and free-text
ordering, with flow on effects like unclear or inconsistent order information, or
medication orders that are unable to trigger CDS.[45 ]
[46 ] These potential pitfalls highlight the importance of only including relevant list
items and good design of lists. Placing frequently used items at the top of a list,
rather than alphabetically, can reduce selection errors and the likelihood of picking
medication names that look and sound alike.[6 ]
[15 ]
The use of eMM allows relevant information to be available to users at the point of
decision making, but research has shown that some system designs require users to
search for pertinent information across screens and pages.[43 ] For example, a qualitative case study of eMM implementation at two hospitals found
a reported increase in workload as a result of the time taken to search for information
between systems and computer screens.[43 ] Good design minimizes navigation between screens and the requirement for users to
remember vital information as they move between eMR pages.[47 ] In our sample, we found that providing extra information on the screen (e.g., displaying
the date and time for the final scheduled dose during administration) was a frequently
employed strategy to facilitate the streamlining of workflow and to prevent error.
Further, some changes involved the consolidation and summary of pertinent clinical
information into one location, easily accessible via dedicated MPages to assist in
clinical decision making. Although a common approach, noninterruptive CDS may not
influence decision making unless actively integrated into workflow.[48 ] Rather, we suggest anticipating specific patient needs by integrating frequently
grouped orders into user workflows to act as a noninterruptive CDS. We found that
grouping orders (e.g., PowerPlans and Care Sets) was another strategy for optimizing
workflow and guiding appropriate action. By providing timely patient-specific clinical
information, improvements can be seen in the quality, efficiency, and safety of medication
management.[49 ]
Our results also demonstrate that particular attention is paid to high-risk medications
when preventing errors, as a large proportion of updates related to these. Changes
were often implemented simultaneously in the eMM system, and at multiple time points,
typically targeting different users (e.g., prescribers and administrators) of the
system. This is in line with recommendations from the Institute for Safe Medication
Practices,[50 ] proposing that strategies for risk minimization should be multilayered and target
multiple phases in the medication use process. We also found that there did not appear
to be a single approach used for these medications; instead careful consideration
was given to the appropriate ways to support the use of each high-risk medication.
This involved understanding the specific information required for decision making,
as well as the interdependencies in clinician workflows, before developing appropriate
solutions. For example, the dose and frequency of insulin relies heavily on blood
glucose results. In response, a diabetic MPage with a consolidated view of associated
patient details, medications, and results was made available to prescribers in the
eMM system, while nurses were required to acknowledge previous blood glucose results
prior to the administration of insulin. In another example, prescribers were required
to select a brand name when ordering hydromorphone, as it has a narrow therapeutic
window requiring the correct form to be given (i.e., immediate-release or extended-release).
These examples highlight the complexity of medication management and suggest that
when implementing updates to reduce the risk of high-risk medication errors, careful
consideration should be given to what information is necessary at each point in the
medication use process.
Implementation of an eMM system is rarely district-wide, with most implementations
in NSW (Australia's largest state), occurring sequentially by piloting at one site
first and then expanding to others.[51 ] In this study, we found that expanding eMM use to other sites necessitated several
system changes, particularly to the options available for selection (e.g., removing
Care Sets that comply with site-specific policies), and the wording or labeling of
existing orders in the form of order sentences, PowerPlans and Care Sets. This coincided
with the removal of alerts that were no longer relevant, and the implementation of
forcing functions, such as mandatory second signatures. These changes were implemented
to minimize the likelihood of users misinterpreting system functionality and to enforce
standardization across hospitals, as well as accommodate any site-specific services
(e.g., chemotherapy PowerPlans available at a site that offers these services). As
clinicians frequently move between sites within a district, and find variability between
sites challenging to navigate,[52 ] we recommend ensuring consistency in wording and workflows to minimize the risk
of error and the time required to learn to navigate a new system.
Additionally, monitoring of system use was facilitated by the addition of reports
in 2019. Reports import selected data in a meaningful way to monitor areas of interest.
These changes are likely to reflect increased vigilance with site expansion and accreditation.
Once routine use of the eMM system is reached, attention can be refocused from acute
system safety risks to long-term maintenance and improvement. Although knowing what
and how to measure system use is difficult,[53 ] all efforts to improve understanding of the eMM in a specific context are valuable
and essential for successful widespread use and interoperability with other information
systems.
Limitations
This study is limited by the quality of the data contained in the documents reviewed,
which did not include all system changes (e.g., updates to the drug catalogue) and
were not always exhaustive, particularly with respect to why system changes were made.
To fully understand the “why” of system changes, we plan to complement this study
with a qualitative investigation of stakeholder perspectives of system-related errors
and updates implemented to improve the eMM system. While our study analyzed system
changes, it did not evaluate the impact of these changes on medication error rates
or workflows. Despite this, our data provide valuable insights into why changes were
made and expected benefits from eMM enhancements. Our analysis was conducted primarily
by one researcher, but all difficult cases were reviewed by a group to ensure accurate
and consistent coding. Our study was further limited by its qualitative nature and
the fact that only one type of eMM system in a single LHD was assessed, and although
our findings provide general understanding and lessons for those implementing or optimizing
medication systems, caution should be taken when generalizing results to other hospitals
or different eMM systems.
Conclusion
Following system implementation, new safety risks can emerge as a result of eMM use,
including system-related errors and workflow blocks. To our knowledge, this is the
first study to systematically review and categorize system updates that have been
made to overcome these risks over time, providing real-life examples that can be considered
and applied in other settings. We found that updates or changes to the system sought
to guide user actions by refining options available in selection lists, and implementing
order sentences and grouped orders. Screen displays were modified to utilize clear
language with important information emphasized to reduce misunderstanding and improve
decision making. Particular attention was paid to high-risk medications, which require
a multilayered approach to limit the chance for error. Overall, interventions like
eMM systems are likely to change over time as users become more familiar with the
system and use is expanded to more sites. This research has shown that this is an
ongoing process in which continual monitoring of the system is necessary to detect
areas for improvement and capitalize on the benefits an electronic system can provide.
Clinical Relevance Statement
Clinical Relevance Statement
The transition from paper-based medication charts to eMM has reduced medication errors
but also introduced new safety risks. Systems are continuously updated in response
to these risks, and this article outlines changes made to a system to mitigate system-related
errors and streamline clinician workflow. For institutions planning to implement eMM
systems, it is important to recognize that these are not “set-and-forget” systems
and therefore require ongoing surveillance and maintenance.
Multiple Choice Questions
Multiple Choice Questions
1. What was the most common reason that changes were made to the system?
Correct Answer: The correct answer is option b. Changes were made most frequently to prevent medication
errors (24% of all rationales).
2. To minimize the risk of errors associated high-risk medications, what types of
strategies can be used in electronic systems to align with the Institute for Safe
Medication Practices recommendations?
Strategies should be standardized across hospitals.
Strategies should be multilayered.
Strategies should be integrated into workflow.
None of the above.
Correct Answer: The correct answer is option b. The Institute for Safe Medication Practices proposes
that strategies for risk minimization should be multilayered, combining various approaches
to target specific risks.
