Use of Electronic Medication Administration Records (eMAR) to Support Medication Administration Practices in Long-Term Care (LTC): A Scoping review of the quantitative and qualitative evidence.
Author(s):
Mark Makowsky
Affiliations:
BSP PharmD
Canadian Pharmacists Conference ePoster Library. Fuller A. Jun 4, 2017; 174276
Mr. Andrew Fuller
Mr. Andrew Fuller
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Abstract
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Objectives
Patients who reside in long-term care can have extensive medication regimens. Electronic medication administration records may increase the safety of medication administration in this setting. Our objective was to map the extent, range and nature of research on the effectiveness, level of use, and perceptions about eMAR in LTC, identify gaps in current knowledge and priority areas for future research.

Methods
A search of MEDLINE, CINAHL, Cochrane Library, SCOPUS, Theses Global, and ProQuest Dissertations databases from 2000 to 2016 was completed with the assistance of a medical librarian. Original research relating to eMAR in LTC, nursing homes, residential aged care facilities, assisted living facilities and care homes were eligible for inclusion. Both authors completed two rounds of screening for eligibility of papers. Data regarding country of origin, major themes, design, study methods, outcomes studied, and main results were extracted. Results: Of the 440 citations identified, 11 met inclusion criteria. An additional 5 were obtained from reference lists. Studies were published between 2007 and 2016 and were from the United States (n=11), Australia (n=3), Sweden (n=1) and the UK (n=1). Research themes explored eMAR prevalence in LTC (n=7), evaluated process outcomes (n=6) and the perceptions of the benefits and limitations of eMAR (n=3). Research designs consist of quantitative (n=10), qualitative (n=2) and mixed (n=4) methodologies which included surveys (n=10), interviews (n=6), direct observation (n=4), chart reviews (n=3) and focus groups (n=2). Main process outcomes consisted of nursing time on medication pass (n=1), design challenges (n=1), internal process barriers (n=1), medication administration error (MAE) prevention (n=1), medication order discrepancies (n=1) and eMAR workarounds (n=1).

Results
Of the 440 citations identified, 11 met inclusion criteria. An additional 5 were obtained from reference lists. Studies were published between 2007 and 2016 and were from the United States (n=11), Australia (n=3), Sweden (n=1) and the UK (n=1). Research themes explored eMAR prevalence in LTC (n=7), evaluated process outcomes (n=6) and the perceptions of the benefits and limitations of eMAR (n=3). Research designs consist of quantitative (n=10), qualitative (n=2) and mixed (n=4) methodologies which included surveys (n=10), interviews (n=6), direct observation (n=4), chart reviews (n=3) and focus groups (n=2). Main process outcomes consisted of nursing time on medication pass (n=1), design challenges (n=1), internal process barriers (n=1), medication administration error (MAE) prevention (n=1), medication order discrepancies (n=1) and eMAR workarounds (n=1).

Conclusion
There is a lack of high quality studies evaluating eMAR in LTC. Further investigations are required to evaluate the impact eMAR has on MAEs and patient safety, factors influencing uptake, and pharmacists perceptions of eMAR.

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