Electronic Health Record Competency and Medication Safety Among Critical Care Nurses: A Protocol for a Systematic Review

Abstract

Background: Electronic health records (EHRs) and integrated electronic medication systems are increasingly embedded in critical care practice, yet medication-related harm persists. The safety benefits of these technologies depend partly on nurses’ ability to use EHR functions accurately, interpret electronic information, and integrate digital safeguards with clinical judgment. Evidence directly linking EHR competency with medication safety among critical care nurses remains fragmented. Objective: This protocol describes a systematic review that will synthesize evidence on the relationship between EHR competency and medication safety among critical care nurses. Methods: The review will follow the Population–Exposure–Outcome framework. PubMed/MEDLINE, CINAHL, Scopus, Embase, Web of Science, and the Cochrane Library will be searched for English-language studies published from January 2015 to the final search date. Eligible designs will include randomized and quasi-experimental studies, cohort, case-control and analytical cross-sectional studies, qualitative studies, and mixed-methods studies that assess EHR-related competency and medication-safety outcomes in critical care nurses. Two reviewers will independently screen studies, extract data, and assess methodological quality using design-specific Joanna Briggs Institute critical appraisal tools; disagreements will be resolved by consensus or a third reviewer. This protocol has been registered in PROSPERO with a registration CRD420261473721. Findings will be synthesized narratively, with meta-analysis undertaken when methodological and clinical homogeneity permits. Where appropriate, certainty of evidence will be assessed using GRADE. Conclusion: The review is intended to clarify how EHR competency is defined and measured, identify medication-safety outcomes associated with competency, and determine individual, organizational, and technological factors that shape this relationship. The findings may inform nursing education, competency assessment, digital-health implementation, and medication-safety policy in critical care.