Does the accuracy of medication administration documentation improve with electronic medication systems? A stepped-wedge cluster randomised trial.

Clinical Snapshot

Key Findings

• P Value: p<0.001 for missing time documentation

• Effect Size: 85% reduction in missing time documentation (aOR 0.15) but 4.6-fold increase in inaccurate documented details (aOR 4.6)

• Primary Outcome: Accuracy of medication administration documentation comparing electronic vs paper systems

• Nnt Or Sensitivity: 75% reduction in doses administered from incorrect prescriptions (aOR 0.25)

• Confidence Interval: Missing time: 95% CI 0.07-0.34; Inaccurate details: 95% CI 3.3-6.6; Incorrect prescriptions: 95% CI 0.18-0.36

Clinical Application

Highly feasible as electronic systems are increasingly standard in Australian hospitals; requires staff training and system optimisation Directly relevant to Australian healthcare digitisation initiatives; aligns with National Digital Health Strategy and hospital accreditation requirements for medication safety Nursing staff in Australian hospitals implementing electronic medication management systems, particularly in paediatric settings

Abstract

OBJECTIVES: Accurate documentation of medication administration is crucial for patient safety. This study compares the accuracy of documentation between paper-based and electronic medication management (eMM) systems. METHODS: A secondary analysis of data from a stepped-wedge cluster randomised trial of an eMM implementation was conducted. The eMM module allowed electronic prescribing, recording of drug dispensing, drug administration and medication reconciliation and monitoring. Medication administration processes were observed in a tertiary paediatric hospital in Sydney, Australia. Trained nurse observers recorded details of medication administrations which were then compared with the information documented by nurses about the administrations. RESULTS: 5095 administrations were analysed. With eMM compared with paper, significantly fewer administrations had no time documented (adjusted OR (aOR) 0.15; 95% CI 0.07 to 0.34; p<0.001), but documented details were more often inaccurate (aOR 4.6; 95% CI 3.3 to 6.6). Fewer doses were administered from incorrect prescriptions with eMM (aOR 0.25; 95% CI 0.18 to 0.36). CONCLUSION: eMM improves certain aspects of documentation but introduces new challenges, particularly in accurately recording administration details. Further investigation is needed to optimise these systems. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry 370325.

References

1. 1.Badgery-Parker, T., Li, L., Woods, A., Raban, M., & Westbrook, J. (2026). Does the accuracy of medication administration documentation improve with electronic medication systems? A stepped-wedge cluster randomised trial. BMJ Health & Care Informatics. https://doi.org/10.1136/bmjhci-2025-101507