Implementation of an Electronic Medication Management System to Increase Medication Safety

Authors

Sierra R. Brown, University of Texas Health Science Center at HoustonFollow

Author Biographical Info

Sierra R. Brown, BSN, RN, PMH-BC is an accomplished registered nurse and doctoral candidate at The University of Texas Health Science Center at Houston, Cizik School of Nursing, where she is pursuing her Doctor of Nursing Practice (DNP) degree with a specialization as a Psychiatric-Mental Health Nurse Practitioner. With over a decade of experience in psychiatric care, Sierra began her career as a psychiatric technician before advancing into nursing, where she has worked in diverse and high-acuity environments, including Ben Taub Hospital, a Level 1 trauma center and the only hospital in Houston with a dedicated psychiatric emergency room.

Sierra is a transformational leader who values integrity, accountability, empathy, vision, and confidence. She has a proven record of implementing change through evidence-based practice and quality improvement (QI) initiatives. Her recent DNP project focused on the implementation of an Electronic Medication Management System (EMMS) to improve medication safety in a residential treatment center for women with substance use disorders, resulting in significant reductions in medication and documentation errors. This project reflects her passion for leveraging technology, education, and structured processes to enhance patient safety and operational efficiency.

In addition to her clinical expertise, Sierra is an educator, mentor, and advocate for healthcare equity. She is a proud member of Zeta Phi Beta Sorority, Incorporated, and actively participates in community outreach, particularly in mental health education and support. Sierra also shares her humor, experience, and insights as a nursing influencer on TikTok, where she blends relatable nursing moments with educational content to inspire and support both healthcare professionals and the public.

Date of Doctor of Nursing Practice Project Completion

2025

Faculty Advisor

Rebecca Tsusaki

Abstract

Abstract

Purpose: Medication errors compromise medication safety by increasing patient harm. This quality improvement project aimed to increase medication safety through the implementation of an electronic medication management system (EMMS) at a residential treatment center for women with substance use disorders.

Background: The facility previously relied on paper-based systems and was overseen by unlicensed personnel, which contributed to the frequent medication and documentation errors, delayed refills, inconsistent audits, and limited oversight. These challenges posed a significant risk to client safety and treatment outcomes.

Methodology: The Model for Improvement guided the intervention, which involved three Plan-Do-Study-Act cycles. Customized EMMS was developed to track inventory, automate documentation after administration submission, and issue refill alerts. All medication technicians received standardized training from a licensed nurse, with follow-up support provided throughout implementation.

Results: Data collected pre-, post- post-intervention, and analyzed using descriptive statistics to measure improvements in error rates, training compliance, and safe medication practices. By April 10, 2025, all medication technicians had completed training. Post- implementation data revealed a decrease in medication errors from 9 to 1 (88.9%) and documentation errors from 10 to 0 (100%). Safe medication practices increased from 52% to 94.7%, reflecting an 80.2 % improvement. Staff training completion increased from 20% to 100%.

Implications: Despite limited funding and initial leadership hesitation, the EMMS significantly improved medication safety, documentation accuracy, workflow efficiency, and increases medication education for medication technicians. The project demonstrated how an electronic system can lead to measurable improvements when paired with training. Broader implementation of EMMS is recommended to improve patient safety in similar environments.

Keywords

Electronic Medication Management System, Medication Safety, Medication Error Reduction, Documentation Errors, and Patient Safety.

Recommended Citation

Sierra R. Brown, "Implementation of an Electronic Medication Management System to Increase Medication Safety" (2025). Doctor of Nursing Practice Final Project Abstract. 104.
https://digitalcommons.library.tmc.edu/dnp_abstract/104