Medication safety after implementation of a commercial electronic health record system in five safety-net practices: A mixed methods approach

• Published in: Journal of the American Association of Nurse Practitioners Vol. 26; no. 8; pp. 438 - 444
• Main Authors: Pohl, Joanne M., Tanner, Clare, Hamilton, Andrew, Kaleba, Erin O., Rachman, Fred D., White, Joanne, Zheng, Kai
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-08-2014; American Association of Nurse Practitioners
• Subjects: Electronic Health Records; Humans; information technology; Medication Errors - nursing; Medication Errors - prevention & control; medications; Nursing; Patient Safety - standards; Primary care; qualitative; safety; underserved; underserved; information technology; qualitative; Primary care; safety; medications
• ISSN: 2327-6886; 2327-6924; 2327-6924
• DOI: 10.1002/2327-6924.12089

Purpose
This study, conducted in five safety‐net practices, including two nurse‐managed health centers (NMHCs) and three federally qualified health centers (FQHCs), examined the impact of implementing a commercial electronic health records (EHRs) system on medication safety.
Data source
A mixed methods approach with two sources of data were used: (a) a query of prescription records captured by the EHR retrieving co‐prescribed medications with identified drug–drug interaction (DDI) risks, and (b) semistructured interviews with clinicians and leadership about the usability and benefits of EHR‐embedded clinical decision support in the form of DDI alerts.
Conclusions
We found an exceptionally low rate of DDI pairs in all five practices. Only 130 “true” DDI pairs were confirmed representing 149,087 visits and 62 providers. Among the 130, the largest categories were related to antihypertensive medications, which are in fact often prescribed together. There were no significant differences between physicians and nurse practitioners on the rate of DDI pairs nor between NMHCs and FQHCs.
Implications for practice
Implementation of an EHR in these five safety‐net settings had a positive impact on medication safety. The issue of missing end dates is noteworthy in terms of DDIs and unnecessary alerts that could lead to alert fatigue.