Effects of Electronic

Charting and Use of

the MAR on Amount of
Nursing Errors and
Quality of Care for
Patients

Makaela Giannini, Jessica

Goist, Paige
Poznar, Nicholas Petro, and
Hayley Socha
Introduction of Problem
Ensures safe and effective medical care Determining &
implementing the most
effective
Guides interprofessional
form of documentation 
communication, reimbursement, discharge
planning, & progress monitoring  (EHR or paper) can
Accurate improve nursing care
& thorough 
documentation; Facilitates nurses' decision-making process 
use of the MAR Researching use of the
MAR can help
determine its
Reduces errors  effectiveness in
reducing medication
errors

Improves quality of patient care

 Research Question
In the hospital setting, how has electronic
charting and use of the MAR influenced the
amount of nursing error and effectiveness
of patient care in the duration of their stay
as compared to paper charting? 
Summary of Findings: Documentation Quality
PA PE R C H A RT IN G
"Labor intensive” due to the abundance of
“redundant data, blank spaces, unclear
writing, and use of inappropriate
abbreviations” (Akhu‐Zaheya et al., 2017, p.
582)
Lack of pertinent information can lead to
medical errors & compromise of patient
safety
EHR
• “Quicker, more legible and easier to share” (Martin et al.,
2018, p. 3176)
• Based upon "clarity, ease of use and use of
abbreviations,” EHR is more effective (Akhu‐Zaheya et al.,
2017, p. 579)
• “Clinical care and research efforts are made more efficient
and perhaps include fewer errors”  (Martin et al., 2018, p.
3176)
Summary of Findings: Documentation Quantity

Quantitative studies show “nurses

EHR flowsheets prompt additional
EHR requires less time and more
documentation relevant to
efficient, improving quantity &
information already documented
consistency of documentation
by the nurse
using EHR documented more
information than those using paper
charts, including the reason for
PRN administration, who initiated the
administration, and
effectiveness” (Martin et al., 2018, p.
3171)
Summary of Findings: Interprofessional collaboration is
important to take into consideration
Interprofessional Collaboration when looking at quality of care for
patients

A 2020 qualitative study looks at

healthcare professional’s personal
experiences regarding
interprofessional collaboration and
the effect the EHR has on providing
quality collaboration between
professionals (Mertens et al., 2020).

Sample used: palliative care

network that includes the settings
of a hospital, the hospital’s palliative
care unit and a nursing home
Summary of Findings: 
Interprofessional
Collaboration

Problem: The BEST way for the

different professionals to
provide the highest quality
care for the patient as a team
is through collaboration
meetings where attendance
and communication are
important 
The EHR helps with care
collaboration and continuity of
care but there are a lot of
developments to be made to
allow for better
communication
  Electronic health records
Summary of Findings: improve patient outcomes
such as infection, pulmonary
Research shows that patient
safety is improved with the
use of electronic health
Patient Safety embolism, and deep vein
thrombosis
records

A study by Walker-Czyz in
2016, showed a greater rate of
Patient safety and quality of
reduction in catheter
care is specifically a priority in
associated urinary tract
acute hospital settings
infections, in relation to using
an electronic health record

Research shows that

electronic nursing
documentation contributes to
these patient safety priorities
if it is accurate, clear, and
accessible
 Summary
of Findings: When exploring the effects of electronic nursing documentation on
Pressure Ulcer the overall condition of the patient, documentation of pressure
ulcers is a common highpoint of care

Documentation
Pressure ulcers can be reduced through proper documentation of
size, characteristics and staging

Photographing pressure ulcers can help assist health care providers

to evaluate care on a day-to-day basis

Accurate documentation is essential to account for the treatment

and care of the patient and interpersonal communication between
the nurse and patient; furthermore, meticulous charting can help to
recognize new obstacles to healthcare and correct them accordingly
Summary
of Findings:
Detection of
Medication Errors
Research done onMedication
Administration Errors (MAEs) after the
implementation of the EHR

MAEs decreased with the electronic health

record and barcode scanners

 The rate of harmful medical errors in a 2014

qualitative study significantly decreased 

The rate of relatively harmless medication

errors such as proper administration times
increased in the same study 
Summary of Findings: Research suggests that the use of electronic health
Multiple Chronic records improves the quality of care for patients with
multiple chronic conditions
Conditions
A 2016 qualitative study about using the EHR to
measure quality of care for these patients was
reviewed

According to Bayliss et al. , there is some EHR data

that reflects quality of care in patients with multiple
chronic medical conditions has improved due to
technology, and as technology advances the EHR can
play a very important role in optimizing care for these
patients Bayliss et al. (2016).
Multiple Chronic Conditions
• Focus group: 10 individuals aged 70–87 with
three to six chronic conditions selected from a
random sample of individuals aged 65 and
older with three or more chronic medical
conditions

• Experts  correlated important components of

care and the assessments in the EHR that
linked to these important components. 

• The EHR allows us to measure important

components of care such as medication
administration and detailed assessments on
these patients

• It is hard to measure other important

components of care such as goal setting and
customized communication of treatment plans 
Summary of Findings: Continuity of Health
Care

The opportunities that the EHR

created allows for continuity of The EHR saves money and time
The EHR improved the continuity,
healthcare by providing by providing a continuum of care
quality, and cost of healthcare
information on the patient's from outpatient clinics to the
especially in communities with
history as soon as they walk in hospitals or from previous
multiple health disparities
the door at the emergency hospital visits to the current one 
department
Summary of
Findings: The EHRs zip code
The zip code feature
Continuity of feature when
implemented
contains models to
detect risk factors 
advances patient care
Health Care
This allows for
important teaching
points to prevent
chronic illnesses
Conclusion

The use of the EHR: enhances the ability of healthcare workers to

promote the continuum of care, reduces the risk for readmission, reduces
the development of chronic illnesses, and lowers costs of healthcare

The use of the MAR: reduces the amounts of harmful medication errors

 References
Akhu‐Zaheya, L., Al‐Maaitah, R., & Bany Hani, S. (2017). Quality of nursing documentation: Paper‐based
health records versus electronic‐based health records. Journal of Clinical Nursing, 27(3–4), 578–
589. https://doi.org/10.1111/jocn.14097
Bayliss, E. A., McQuillan, D. B., Ellis, J. L., Maciejewski, M. L., Zeng, C., Barton, M. B., . . . Zulman, D. M.
(2016). Using electronic health record data to measure care quality for individuals with multiple
chronic medical conditions. Journal of the American Geriatrics Society, 64(9), 1839-1844.
Gunningberg, L., Fogelberg‐Dahm, M. and Ehrenberg, A. (2009), Improved quality and
comprehensiveness in nursing documentation of pressure ulcers after implementing an
electronic health record in hospital care. Journal of Clinical Nursing, 18: 1557-1564. 
https://doi-org.eps.cc.ysu.edu/10.1111/j.1365-2702.2008.02647.x
Hardmeier, Anna; Tsourounis, Candy; Moore, Mary; Abbott, Wendy E.; Guglielmo, Joseph B. Pediatric
Medication Administration Errors and Workflow Following Implementation of a Bar Code
Medication Administration System, Journal For Healthcare Quality: July 2014 - Volume 36 - Issue
4 - p 54-63 doi: 10.1111/jhq.12071
Li, D. (2016). The relationship among pressure ulcer risk factors, incidence and nursing documentation in
hospital‐acquired pressure ulcer patients in intensive care units. Journal of Clinical
Nursing /doi/10.1111/jocn.13363
Liao TV, Rabinovich M, Abraham P, Perez S, DiPlotti C, Han JE, Martin GS, Honig E.
(2017). Evaluation  of medication errors with implementation of electronic health
record technology in the medical intensive care unit. Open Access Journal of Clinical
Trials. 9:31-40. https://doi.org/10.2147/OAJCT.S131211 
Martin, K., Ham, E., & Hilton, N. Z. (2018). Documentation of psychotropic pro re
nata medication administration: An evaluation of electronic health records compared
with paper charts and verbal reports. Journal of Clinical Nursing, 27(15–16), 3171–
3178. https://doi.org/10.1111/jocn.14511 
McCarthy, B., Fitzgerald, S., O’Shea, M., Condon, C., Hartnett-Collins, G., Clancy, M., Savage, E.
(2018). Electronic nursing documentation interventions to promote or improve patient
safety and quality care: A systematic review. Journal of Nursing Management, 27(3),
491-501. doi:10.1111/jonm.12727 
Mertens, F., Debrulle, Z., Lindskog, E., Deliens, L., Deveugele, M., & Pype, P. (2020).
[Review]. Healthcare Professionals’ Experiences of Inter-professional Collaboration
during Patient’s Transfers between Care Settings in Palliative Care: A Focus Group
Study. Palliative Medicine 35(2), 355-366. 
Viola, D, and Peter S. A. (2020) “Can Hospitals Advance Health in the United States?
The Influence of Technology, Economics, and Policy.” 2017, pp. 62–66.