Electronic medication administration records and nursing administration of medications: An integrative review

  • Snezana Stolic
    Corresponding author.
    School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich, Queensland, 4305, Australia
    Search for articles by this author
  • Linda Ng
    School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich, Queensland, 4305, Australia
    Search for articles by this author
  • Georgina Sheridan
    School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich, Queensland, 4305, Australia
    Search for articles by this author



      The medication administration process is particularly susceptible to errors due to the error being least likely to be captured before reaching patients. Nurses administer medications as part of everyday practice.


      The purpose of this review is to identify if medication error rates are reduced during nursing administration when incorporating electronic medical administration records into medication management.


      A systematic review was conducted of six electronic databases to identify original empirical research published between 2007 and 2020. An integrative review method using Strengthening the Report of Observational Studies in Epidemiology guidelines was used to direct this review.


      Eighteen original research articles were identified and included in this review. Data were also collected using electronic data retrieval or chart review, incidence reports, or automated algorithms. Eight studies reported reduced medication errors after the implementation of electronic medication administration records, and two reported increases in medication errors. Studies reported between 2.8% and 16% of medication errors during nursing administration.


      Findings are mixed, some reported positive findings and reduction in medication errors, and other studies reported no reduction in medication errors or the introduction of new types of errors. Electronic medication administration records may not be as effective in paediatric and intensive care units and may require further adaptation. Barriers to successive integration of electronic medication errors are equipment, environment, lack of knowledge, and workload.


      Evidence linking medication administration records use and reducing medication errors and patient safety is weak due to assessment techniques and reporting strategies. More rigorous research is needed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • AHC M.
        Poor EMR usability linked to patient safety concerns, clinician burnout.
        ED Management. 2019; 31
        • Appari A.
        • Carian E.K.
        • Johnson M.E.
        • Anthony D.L.
        Medication administration quality and health information technology: a national study of US hospitals.
        Journal of the American Medical Informatics Association. 2012; 19: 360-367
      1. Australian Commission on Safety and Quality in Health Care. (2020a). Medication safety

      2. Australian Commission on Safety and Quality in Health Care. (2020b). Medication without harm WHO Global Patient Safety Challenge. Australia's response.

      3. Australian Commission on Safety and Quality in Health Care. (2021). The National Safety and Quality Health Service (NSQHS).

      4. Australian Commission on Safety and Quality in Health Care, A. (2019). Electronic medication management

        • Bagley Thompson C.
        • Panacek E.A.
        Research study designs: experimental and quasi experimental.
        Basics of Research Part 3. 2006; 25 (Doi): 242-246
        • Bhatia H.L.
        • Patel N.R.
        • Ivory C.H.
        • Stewart P.W.
        • Unertl K.M.
        • Lehmann C.U.
        Measuring non-administration of ordered medications in the pediatric inpatient setting.
        International Journal of Medical Informatics. 2018; 110: 71-76
        • Bickel A.E.
        • Villasecas V.X.
        • Fluxá P.J.
        Characterization of adverse events occurring during nursing clinical rotations: a descriptive study.
        Nurse Education Today. 2020; 84104224
        • Blignaut A.J.
        • Coetzee S.K.
        • Klopper H.C.
        • Ellis S.M.
        Medication administration errors and related deviations from safe practice: an observational study.
        Journal of Clinical Nursing. 2017; 26: 3610-3623
        • Booth R.G.
        • Sinclair B.
        • Strudwick G.
        • Brennan L.
        • Tong J.
        • Relouw H.
        • et al.
        Identifying error types made by nursing students using eMAR technology.
        Clinical Simulation in Nursing. 2017; 13: 492-500
        • Bronkowski J.
        • Carnes C.
        • Melucci J.
        • Mirtallo J.
        • Prier B.
        • Reichert E.
        • et al.
        Effect of barcode-assisted medication administration on emergency department medication errors.
        Academic Emergency Medicine. 2013; 20: 801-806
        • Carayon P.
        • Cartmill R.
        • Blosky M.A.
        • Brown R.
        • Hackenberg M.
        • Hoonakker P.
        • et al.
        ICU nurses' acceptance of electronic health records.
        Journal of the American Medical Informatics Association. 2011; 18: 812-819
        • Carayon P.
        • Wetterneck T.
        • Schoofs Hundt A.
        • Ozkaynak M.
        • DeSilvey J.
        • Ludwig B.
        • et al.
        Evaluation of nurse interaction with bar code medication administration technology in the work environment.
        Journal of Patient Safety. 2007; 3: 34-42
        • Choo J.
        • Johnston L.
        • Manias E.
        Effectiveness of an electronic inpatient medication record in reducing medication errors in Singapore.
        Nursing & Health Sciences. 2014; 16: 245-254
        • Dalton B.R.
        • Sabuda D.M.
        • Bresee L.C.
        • Conly J.M.
        Use of an electronic medication administration record (eMAR) for surveillance of medication omissions: results of a one year study of antimicrobials in the inpatient setting.
        PLoS One. 2015; 10e0122422
        • de Jong C.C.
        • Ros W.J.G.
        • van Leeuwen M.
        • Schrijvers G.
        Exploring the effects of patients taking a vigilant role in collaborating on their e-medication administration record.
        International Journal of Medical Informatics. 2016; 88: 18-24
        • de Sousa Oliveira B.H.
        • de Sousa V.M.
        • de Sousa Fernandes K.J.S.
        • Leyla V.
        • Costa Urtiga S.
        • Ramos de Carvalho L.J.A.
        • et al.
        Errors in medication dosage in the urgency unit of a hospital.
        Journal of Nursing UFPE. 2019; 13
        • DeYoung J.L.
        • Vanderkooi M.E.
        • Barletta J.F.
        Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit.
        American Journal of Health-System Pharmacy. 2009; 66: 1110-1115
        • Edwards S.L.
        • Williams J.
        • Lee M.
        Reducing drug errors by engaging student nurses in medication management simulation.
        Journal of Prescribing Practice. 2019; 1: 344-355
        • Emergency Care Research Insitute (ECRI)
        EHRs remain near top of ECRI's top health IT hazards.
        Journal of AHIMA. 2016; 87: 11
        • FitzHenry F.
        • Peterson J.F.
        • Arrieta M.
        • Waitman L.R.
        • Schildcrout J.S.
        • Miller R.A.
        Medication administration discrepancies persist despite electronic ordering.
        Journal of the American Medical Informatics Association. 2007; 14: 756-764
        • Franklin B.D.
        • O'Grady K.
        • Donyai P.
        • Jacklin A.
        • Barber N
        The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.
        Quality & Safety in Health Care. 2007; 16: 279-284
        • Fusco L.A.
        • Alfes C.M.
        • Weaver A.
        • Zimmermann E.
        Medication safety competence of undergraduate nursing students.
        Clinical Simulation in Nursing. 2021; 52: 1-7
        • Gates P.J.
        • Hardie R.-A.
        • Raban M.Z.
        • Li L.
        • Westbrook J.I.
        How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis.
        Journal of the American Medical Informatics Association. 2021; 28: 167-177
        • Gilbert E.H.
        • Lowenstein S.R.
        • Koziol-McLain J.
        • Barta D.C.
        • Steiner J.
        Chart reviews in emergency medicine research: where are the methods?.
        Annals of Emergency Medicine. 1996; 27 (PMID: 8599488): 305-308
        • Gorgich E.A.C.
        • Barfroshan S.
        • Ghoreishi G.
        • Yaghoobi M.
        Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint.
        Global Journal of Health Science. 2016; 8: 54448
        • Gunes U.
        • Efteli E.
        • Ceylan B.
        • Baran L.
        • Huri O.
        Medication errors made by nursing students in Turkey.
        International Journal of Caring Sciences. 2020; 13: 1183-1192
        • Hassink J.J.M.
        • Duisenberg-Van Essenberg M.
        • van den Bemt P.M.L.A.
        Effect of bar-code-assisted medication administration errors.
        American Journal of Health-System Pharmacy. 2013; 70 (DOI): 572-573
        • Helmons P.J.
        • Wargel L.N.
        • Daniels C.E.
        Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas.
        American Journal of Health-System Pharmacy. 2009; 66: 1202-1210
        • Heneghan J.A.
        • Trujillo Rivera E.A.
        • Zeng-Treitler Q.
        • Faruqe F.
        • Morizono H.
        • Bost J.E.
        • et al.
        Medications for children receiving intensive care: a national sample.
        Pediatric Critical Care Medicine. 2020; 21: e679-e685
        • Hutchinson A.M.
        • Brotto V.
        • Chapman A.
        • Sales A.E.
        • Mohebbi M.
        • Bucknall T.K.
        Use of an audit with feedback implementation strategy to promote medication error reporting by nurses.
        Journal of Clinical Nursing. 2020; 29: 4180-4193
        • Igene O.O.
        • Johnson C.
        To computerised provider order entry system: a comparison of ECF, HFACS, STAMP and AcciMap approaches.
        Health Informatics Journal. 2020; 26: 1017-1042
        • Jedwab R.M.
        • Chalmers C.
        • Dobroff N.
        • Redley B.
        Measuring nursing benefits of an electronic medical record system: a scoping review.
        Collegian. 2019; 26: 562-582
        • Jo Y.H.
        • Shin W.G.
        • Lee J.-Y.
        • Yang B.R.
        • Yu Y.M.
        • Jung S.H.
        • et al.
        Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process.
        International Journal of Medical Informatics. 2016; 94: 123-133
      5. Joanna Briggs Institute. (2021). Checklist for Systematic Reviews and Research Synthesis.

        • Joseph R.
        • Lee S.W.
        • Anderson S.V.
        • Morrisette M.J.
        Impact of interoperability of smart infusion pumps and an electronic medical record in critical care.
        American Journal of Health-System Pharmacy. 2020; 77: 1231-1236
        • Keane K.
        Reducing medication errors by educating nurses on bar code technology.
        MEDSURG Nursing. 2014; : 1-11
        • Koohestani H.R.
        • Baghcheghi N.
        Barriers to the reporting of medication administration errors among nursing students.
        Australian Journal of Advanced Nursing. 2009; 27: 66-74
        • Koppel R.
        • Wetterneck T.
        • Telles J.L.
        • Karsh B.
        • Koppel R.
        • Wetterneck T.
        • et al.
        Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety.
        Journal of the American Medical Informatics Association. 2008; 15: 408-423
        • Kuo S.-Y.
        • Thadakant S.
        • Warsini S.
        • Chen H.-W.
        • Hu S.H.
        • Aulawi K.
        • et al.
        Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: a cross-sectional observational study.
        Nurse Education Today. 2021; 28105120
        • Lee S.E.
        • Quinn B.L.
        Incorporating medication administration safety in undergraduate nursing education: a literature review.
        Nurse Education Today. 2019; 72: 77-83
        • Leung A.A.
        • Denham C.R.
        • Bane A.
        • Churchill W.W.
        • Bates D.W.
        • Poon E.G.
        A safe practice standard for barcode technology.
        Journal of Patient Safety. 2015; 11: 89-99
        • Li Q.
        • Kirkendall E.S.
        • Hall E.S.
        • Ni Y.
        • Lingren T.
        • Kaiser M.
        • et al.
        Automated detection of medication administration errors in neonatal intensive care.
        Journal of Biomedical Informatics. 2015; 57: 124-133
        • Liping F.
        • Robinson J.
        • Macneil A.
        Case study: using electronic medication administration record to enhance medication safety and improve efficiency in long-term care facilities.
        Nursing Leadership (1910-622X). 2019; 32: 102-113
        • Makowsky M.J.
        • Schindel T.J.
        • Rosenthal M.
        • Campbell K.
        • Tsuyuki R.T.
        • Madill H.M.
        Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.
        Journal of Interprofessional Care. 2009; 23: 169-184
        • McComas J.
        • Riingen M.
        • Kim S.C.
        Impact of an electronic medication administration record on medication administration efficiency and errors.
        Computers, Informatice, Nursing. 2014; 32: 589-595
      6. Medication alerts contribute to alarm fatigue.
        For the Record. 2012; 24 (-7): 7
        • Miller D.F.
        • Fortier C.R.
        • Garrison K.L.
        Bar code medication administration technology: characterization of high-alert medication triggers and clinician workarounds.
        Annals of Pharmacotherapy. 2011; 45: 162-168
        • Mohanna Z.
        • Kusljic S.
        • Jarden R.
        Investigation of interventions to reduce nurses’ medication errors in adult intensive care units: a systematic review.
        Australian Critical Care. 2021;
        • Musharyanti L.
        • Claramita M.
        • Haryanti F.
        • Dwiprahasto I.
        Why do nursing students make medication errors? A qualitative study in Indonesia.
        Journal of Taibah University Medical Sciences. 2019; 14: 282-288
        • Owens K.
        • Palmore M.
        • Penoyer D.
        • Viers P.
        The effect of implementing bar-code medication administration in an emergency department on medication administration errors and nursing satisfaction.
        Journal of Emergency Nursing. 2020; 46: 884-891
        • Pandya C.
        • Clarke T.
        • Scarsella E.
        • Alongi A.
        • Amport S.B.
        • Hamel L.
        • et al.
        Ensuring effective care transition communication: implementation of an electronic medical record–based tool for improved cancer treatment handoffs between clinic and infusion nurses.
        Journal of Oncology Practice. 2019; 15: e480-e489
        • Piroozi B.
        • Mohamadi-Bolbanabad A.
        • Safari H.
        • Amerzadeh M.
        • Moradi G.
        • Usefi D.
        • et al.
        Frequency and potential causes of medication errors from nurses' viewpoint in hospitals affiliated to a medical sciences University in Iran.
        International Journal of Human Rights in Healthcare. 2019; 12: 267-275
      7. PRISMA Transparent Reporting of Systematic Reviews and Meta-Analysis. (2021). PRISMA checklist.

        • Qian S.
        • Yu P.
        • Hailey D.M.
        The impact of electronic medication administration records in a residential aged care home.
        International Journal of Medical Informatics. 2015; 84: 966-973
        • Redley B.
        • Botti M.
        Reported medication errors after introducing an electronic medication management system.
        Journal of Clinical Nursing. 2013; 22: 579-589
        • Roughead E.E.
        • Semple S.J.
        • Rosenfeld E.
        The extent of medication errors and adverse drug reactions through the patient journey in acute care in Australia.
        International Journal of Evidence Based Healthcare. 2016; 14: 113-122
        • Seibert H.H.
        • Maddox R.R.
        • Flynn E.A.
        • Williams C.K.
        Effect of barcode technology with electronic medication administration record on medication accuracy rates.
        American Journal of Health-System Pharmacy. 2014; 71: 209-218
        • Sessions L.
        • Nemeth L.S.
        • Catchpole K.
        • Kelechi T.
        Use of simulation-based learning to teach high-alert medication safety: a feasibility study.
        Clinical Simulation in Nursing. 2020; 47: 60-64
      8. Strengthening the reporting of observational studies in epidemiology (2021). What is STROBE?

        • Ta'an W.F.
        • Suliman M.M.
        • Mohammed M.M.
        • Ta'an A.
        Prevalence of medical errors and barriers to report among nurses and nursing students in Jordan: a cross-sectional study.
        Nursing Forum. 2021; 56: 284-290
        • Takase M.
        The relationship between the levels of nurse's competence and the length of their clinical experience: a tentative model for nursing competence development.
        Journal of Clinical Nursing. 2012; 22: 1400-1410
        • Tavares de Souza M.
        • Dias da Silva M.
        • de Carvalho R.
        Integrative review: what is it? How to do it?.
        SciFlow Brazil. 2010; 8
      9. Tetreault, K. M. (2016). A comparison of the features and functions available in electronic health records. 1.

        • Van de Vreede M.
        • McGrath A.
        • de Clifford J.
        Review of medication errors that are new or likely to occur more frequently with electronic medication management systems.
        Australian Health Review. 2019; 2019: 276-283
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • Gøtzsche P.C.
        • Mulrow C.D.
        • Pocock S.J.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
        PLoS Medicine. 2007; 4: e297
        • Vassar M.
        • Holzmann M.
        The retrospective chart review: important methodological considerations.
        Journal of educational evaluation for health professions. 2013; 10: 12
        • Whittemore R.
        • Knafl K.
        The intergrative review: updated methodology.
        Journal of Advanced Nursing. 2005; 52: 546-553
      10. World Health Organization. (2021). Anatomica Therpeutic Chemical (ATC) classification

      11. World Health Organization, W. (2020). The third WHO global patient safety challenge; medication without harm.

      12. World Health Organization, W. (2022). Nursing and midwifery.