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Patient Safety Perspectives of Providers and Nurses: The Experience of a Rural Ambulatory Care Practice Using an EHR With E-prescribing

Authors

  • James D. Bramble PhD,

    Corresponding author
    • Department of Pharmacy Sciences and Center for Health Services Research and Patient Safety, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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  • Amy A. Abbott PhD, RN,

    1. School of Nursing and Center for Health Services Research and Patient Safety, Creighton University, Omaha, Nebraska
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  • Kevin T. Fuji PharmD,

    1. Center for Health Services Research and Patient Safety, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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  • Karen A. Paschal PT, DPT,

    1. Department of Physical Therapy and Center for Health Services Research and Patient Safety, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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  • Mark V. Siracuse PharmD, PhD,

    1. Department of Pharmacy Sciences and Center for Health Services Research and Patient Safety, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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  • Kimberly Galt PharmD, PhD

    1. Schools of Pharmacy and Health Professions, Nursing, Dentistry, and Center for Health Services Research and Patient Safety, Creighton University, Omaha, Nebraska
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  • Funding: This project was supported by grant number R24HS018625 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research Quality. This project was approved by the Creighton University IRB No. 09–15470 entitled: Creighton Research Infrastructure Program to Achieve Sustainability Project.

  • Acknowledgments: The authors would like to thank Jamie Steemken for her help in the final preparation of this manuscript. We would also like to thank Ted Kasha for his assistance with information technology and database management on this project.

For further information, contact: James D. Bramble, PhD, 2500 California Plaza, Boyne 141, Omaha, NE 68116; e-mail: jbramble@creighton.edu.

Abstract

Purpose

The purpose of this study was to identify and describe safety improvements and concerns indicated by providers and nurses in a rural community ambulatory care practice using an electronic health record with an e-prescribing feature (EHR with eRx).

Methods

Two focus groups were conducted; 1 with providers and the other with nurses. Participants responded to questions and discussed their perceptions of safety improvements and concerns with use of an EHR with eRx. Transcripts were analyzed using sequential and continuous analytic methods.

Findings

Three themes centered on efficiency and patient safety emerged from data analysis: (1) EHR with eRx adoption has led to new improvements and concerns for patient safety, (2) the EHR with eRx has affected efficiency in the clinic, and (3) EHR with eRx adoption has led to workarounds.

Conclusions

Concerns remain among providers and nurses regarding the use of EHR with eRx applications, although concerns differed between groups. Therefore, When EHR improvements are planned, it is important to consider the differing needs of the professionals who deliver care.

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