Research Priorities in the Field of Patient Safety in Iran: Results of a Delphi Study

Identification and Prioritization of Clinical Decision Support Functionalities Built Within A Computerized Provider Order Entry System

Background: Clinical decision support (CDS) functionalities in Computerized Provider Order Entry system (CPOE) need to be identified by the institutional healthcare providers in developing countries. In this regard, CDS functionalities should be a priority for the execution in CPOE. Objectives: Thus, our study was done to identify and prioritize the CDS functionalities in CPOE. Methods: A Two-round Modified Delphi process was used. Firstly, a systematic search was conducted in electronic databases from the date of database inception to February 2019 for identifying CDS functionalities integrated into CPOE. Studies were retrieved from databases, including PubMed, Embase, ProQuest, Scopus, Web of Science, Cochrane, Science Direct, ACM digital library, and IEEE Xplore Digital Library. Secondly, the Modified Delphi method was carried out in 2019 to provide contextual priorities regarding CDS functionalities in CPOE in two iterative rounds. A total of 12 experts working in the three Intensive Care Units (ICUs) with more than three years of experience with homegrown CPOE in Shiraz Nemazee Teaching Hospital, including two clinical pharmacists, two health information management faculty member, four cases with critical care fellowship, and four critical care experts participated in the study. The ≥ 66.6% agreement was considered as the consensus level. SPSS software version 24 was used for statistical analysis. Results: Totally, 327 studies, which met eligibility criteria were found. A number of 60 potential CDS functionalities in CPOE were identified from eligible studies. Also, 13 out of 60 CDS functionalities reached high priority consensus after 2 iterative Delphi rounds, including drug-allergy checking (83.3%), basic dosing guidance (75%), single dosing checking (66.7%), duplicate therapy checking (66.7%), drug-pregnancy alerts (75%), time-based alerts (66.7%), alert for deep vein thrombosis prophylaxis (66.7%), alerts for duplicate medication order checking (66.7%), drug-drug interaction checking (75%), intelligent dosing guidance based on the patients’ characteristics (66.7%), renal-drug problems checking (83.3%), drug-disease interaction checking (66.7%), and displaying medication/test cost (75%). Conclusions: Our study identified high-priority CDS functionalities to be considered in the CPOE system from the viewpoint of multidisciplinary experts, especially in Iran. Results of this study may be beneficial to plan, design, and implement CDS functionalities in CPOE in the ICU.

Front-line staff's perspective on patient safety culture in Iranian medical centers: A systematic review and meta-analysis

BACKGROUND

The prerequisite for promoting safety culture is to assess the existing safety culture level of institutes, because safety precautions without appropriate evaluation increase costs and unforeseen risks.

OBJECTIVE

This study aimed to systematically review the status of patient safety culture from the perspective of clinical personnel at Iranian hospitals through a meta-analysis of studies using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire.

METHODS

The present systematic review and meta-analysis was conducted in 2018. Data were gathered by searching Google Scholar, Scopus, PubMed, and Web of Science databases up to November 2018. Search keywords were "patient", "safety", "culture", "healthcare", "hospital", "medical center", "HSOPSC tool", and "Iran". The search protocol was limited to 10 years. To estimate the PSC score, computer software CMA:2 (Comprehensive Meta-Analysis) was used. The presence of heterogeneity across the studies was assessed with the I2 statistic. A forest plot was used to report the results. Publication bias was assessed through a funnel plot.

RESULTS

The meta-analysis of studies showed that the PSC score based on the random effect model was 52.7% (95% CI: 50.2%-55.2%), (Q = 522.3, df = 54, P < 0.05, I2 = 89.6). A mean of 12 dimensions of HSOPSC showed that the "Teamwork within units" dimension had the highest PSC score (67.2%) and "Non-punitive response to error" had the lowest score (40.4%).

CONCLUSIONS

Managers and policymakers should be directed towards non-punitive responses to errors and persuade staff to report errors and execute the approach to learn from mistakes. Also, a periodic government evaluation of the patient safety culture will help further its sustainable development.

The role of patients in the delivery of safe care in hospital: Study protocol

AIM

This paper outlines the protocol for a study aimed at exploring perspectives about the role of patients' in the delivery of safe care in hospital.

DESIGN

Qualitative exploratory study.

METHODS

Research Ethics Committee approval for this study was obtained in October 2018. The study will be conducted between February-April 2019 with data collected through focus group discussions and semi-structured interviews and will involve patients and healthcare professionals from hospitals in Tabriz. A descriptive qualitative approach will be adopted, and the data will be managed and analysed using MAXQDA 10 software.

DISCUSSION

The role of patients in furthering their own safety whilst in hospital cannot be underestimated and the results from this study can be used to support the development of practical strategies that address the delivery of safe hospital care and which involve patients and their caregivers.

Setting research priorities to achieve long-term health targets in Iran

Background

In 2015, it was estimated that the burden of disease in Iran comprised of 19 million disability-adjusted life years (DALYs), 74% of which were due to non-communicable diseases (NCDs). The observed leading causes of death were cardiovascular diseases (41.9%), neoplasms (14.9%), and road traffic injuries (7.4%). Even so, the health research investment in Iran continues to remain limited. This study aims to identify national health research priorities in Iran for the next five years to assist the efficient use of resources towards achieving the long-term health targets.

Methods

Adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 48 prominent Iranian academic leaders in the areas related to Iran’s long-term health targets, a group of research funders and policy makers, and 68 stakeholders from the wider society. 128 proposed research questions were scored independently using a set of five criteria: feasibility, impact on health, impact on economy, capacity building, and equity.

Findings

The top-10 priorities were focused on the research questions relating to: health insurance system reforms to improve equity; integration of NCDs prevention strategy into primary health care; cost-effective population-level interventions for NCDs and road traffic injury prevention; tailoring medical qualifications; epidemiological assessment of NCDs by geographic areas; equality in the distribution of health resources and services; current and future common health problems in Iran’s elderly and strategies to reduce their economic burden; the status of antibiotic resistance in Iran and strategies to promote rational use of antibiotics; the health impacts of water crisis; and research to replace the physician-centered health system with a team-based one.

Conclusions

These findings highlight consensus amongst various prominent Iranian researchers and stakeholders over the research priorities that require investment to generate information and knowledge relevant to the national health targets and policies. The exercise should assist in addressing the knowledge gaps to support both the National General Health Policies by 2025 and the health targets of the United Nations’ Sustainable Development Goals by 2030.