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Kato D, Lucas J, Sittig DF. Implementation of a health information technology safety classification system in the Veterans Health Administration's Informatics Patient Safety Office. J Am Med Inform Assoc 2024; 31:1588-1595. [PMID: 38758666 PMCID: PMC11187429 DOI: 10.1093/jamia/ocae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/04/2024] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE Implement the 5-type health information technology (HIT) patient safety concern classification system for HIT patient safety issues reported to the Veterans Health Administration's Informatics Patient Safety Office. MATERIALS AND METHODS A team of informatics safety analysts retrospectively classified 1 year of HIT patient safety issues by type of HIT patient safety concern using consensus discussions. The processes established during retrospective classification were then applied to incoming HIT safety issues moving forward. RESULTS Of 140 issues retrospectively reviewed, 124 met the classification criteria. The majority were HIT failures (eg, software defects) (33.1%) or configuration and implementation problems (29.8%). Unmet user needs and external system interactions accounted for 20.2% and 10.5%, respectively. Absence of HIT safety features accounted for 2.4% of issues, and 4% did not have enough information to classify. CONCLUSION The 5-type HIT safety concern classification framework generated actionable categories helping organizations effectively respond to HIT patient safety risks.
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Affiliation(s)
- Danielle Kato
- Pharmacy Benefits Management Clinical Informatics, Veterans Health Administration, Washington, DC 20420, United States
| | - Joe Lucas
- Certified Usability Analyst, Informatics Patient Safety, Veterans Health Administration, Washington, DC 20420, United States
| | - Dean F Sittig
- Department of Clinical and Health Informatics, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Pereira N, Duff JP, Hayward T, Kherani T, Moniz N, Champigny C, Carson-Stevens A, Bowie P, Egan R. Methods for studying medication safety following electronic health record implementation in acute care: a scoping review. J Am Med Inform Assoc 2024; 31:499-508. [PMID: 38037171 PMCID: PMC10797275 DOI: 10.1093/jamia/ocad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES The objective of this scoping review is to map methods used to study medication safety following electronic health record (EHR) implementation. Patterns and methodological gaps can provide insight for future research design. MATERIALS AND METHODS We used the Joanna Briggs Institute scoping review methodology and a custom data extraction table to summarize the following data: (1) study demographics (year, country, setting); (2) study design, study period, data sources, and measures; (3) analysis strategy; (4) identified limitations or recommendations; (5) quality appraisal; and (6) if a Safety-I or Safety-II perspective was employed. RESULTS We screened 5879 articles. One hundred and fifteen articles met our inclusion criteria and were assessed for eligibility by full-text review. Twenty-seven articles were eligible for extraction. DISCUSSION AND CONCLUSION We found little consistency in how medication safety following EHR implementation was studied. Three study designs, 7 study settings, and 10 data sources were used across 27 articles. None of the articles shared the same combination of design, data sources, study periods, and research settings. Outcome measures were neither defined nor measured consistently. It may be difficult for researchers to aggregate and synthesize medication safety findings following EHR implementation research. All studies but one used a Safety-I perspective to study medication safety. We offer a conceptual model to support a more consistent approach to studying medication safety following EHR implementation.
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Affiliation(s)
- Nichole Pereira
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
- Pediatric Intensive Care Unit, Alberta Health Services, Edmonton, AB T6G 2B7, Canada
| | - Jonathan P Duff
- Pediatric Intensive Care Unit, Alberta Health Services, Edmonton, AB T6G 2B7, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Tracy Hayward
- Department of Patient Safety, Covenant Health, Edmonton, AB T5R 4H5, Canada
| | - Tamizan Kherani
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Nadine Moniz
- Stroke Program, Alberta Health Services, Edmonton, AB T6G 2J3, Canada
| | | | - Andrew Carson-Stevens
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Paul Bowie
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
- Medical Directorate, NHS Education for Scotland, Glasgow EH4 2XU, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, United Kingdom
| | - Rylan Egan
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
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Afrash MR, Kianersi S, Bahadori M. Design, implementation, and evaluation of a CPOE system in a cancer care setting: A case study on the gastric cancer patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:58. [PMID: 37113421 PMCID: PMC10127491 DOI: 10.4103/jehp.jehp_263_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/09/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Chemotherapy is a complex, multi-disciplinary, and error-prone process. Information technology is being increasingly used in different health care settings with complex work procedures such as cancer care to enhance the quality and safety of care. In this study, we aimed to develop a computerized physician order entry (CPOE) for chemotherapy prescribing in patients with gastric cancer and to evaluate the impact of CPOE on medication errors and order problems. MATERIALS AND METHODS A multi-disciplinary team consisting of a chemotherapy council group and system design and implementation team was formed for chemotherapy process evaluation, requirement analysis, developing computer-based protocols, and implementation of CPOE. A before and after study was conducted to evaluate the impact of CPOE on the chemotherapy process and medication errors and problem orders. To evaluate the level of end-user satisfaction, an ISO Norm 9241/110 usability questionnaire was chosen for the evaluation. RESULTS Before the implementation of the CPOE system, 37 medication errors (46.25%) and 53 problem orders (66.25%) were recorded for 80 paper-based chemotherapy prescriptions. After implementation of the CPOE system, 7 (8.7%) medication errors and 6 (7.5%) problem orders were recorded for 80 CPOE prescriptions. The implementation of CPOE reduced the medication error by 37.55% and the problematic order by 58.75%. The results for usability evaluation indicate that the CPOE was within the first class of the ISONORM level rating; this shows that a CPOE is with very high satisfaction and a very high functionality rate. CONCLUSION Developing a CPOE system significantly improved safety and quality of the chemotherapy process in cancer care settings by reducing the medication error, deleting unnecessary steps, improving communication and coordination between providers, and use of updated evidence-based medicine in direct chemotherapy orders. However, the CPOE system does not prevent all medication errors and may cause new errors. These errors can be human-related factors or associated with the design and implementation of the systems.
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Affiliation(s)
- Mohammad Reza Afrash
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shirin Kianersi
- Department of Adult Hematology and Oncology, School of Medicine, Ayatollah Taleqhani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Baysari MT, Van Dort BA, Stanceski K, Hargreaves A, Zheng WY, Moran M, Day R, Li L, Westbrook J, Hilmer S. Is evidence of effectiveness a driver for clinical decision support selection? A qualitative descriptive study of senior hospital staff. Int J Qual Health Care 2023; 35:7008757. [PMID: 36715081 PMCID: PMC9940455 DOI: 10.1093/intqhc/mzad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/20/2022] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Limited research has focused on understanding if and how evidence of health information technology (HIT) effectiveness drives the selection and implementation of technologies in practice. This study aimed to explore the views of senior hospital staff on the role evidence plays in the selection and implementation of HIT, with a particular focus on clinical decision support (CDS) alerts in electronic medication management systems. A qualitative descriptive design was used. Twenty senior hospital staff from six Australian hospitals in New South Wales and Queensland took part in a semistructured interview. Interviews were audio-recorded and transcribed, and a general inductive content analysis approach was used to identify themes. Participants acknowledged the importance of an evidence base, but reported that selection of CDS alerts, and HIT more broadly, was rarely underpinned by evidence that technologies improve patient care. Instead, investments in technologies were guided by the expectation that benefits will be achieved, bolstered by vendor assurances, and a perception that implementation of HIT is unavoidable. Postponing implementation of a technology until an evidence base is available was not always feasible. Although some technologies were seen as not requiring an evidence base, stakeholders viewed evidence as extremely valuable for informing decisions about selection of CDS alerts. In the absence of evidence, evaluation or monitoring of technologies postimplementation is critical, particularly to identify new errors or risks associated with HIT implementation and use. Increased transparency from vendors, with technology evaluation outcomes made directly available to healthcare organizations, may result in less reliance on logic, intuition, and vendor assertions and more evidence-based selection of HIT.
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Affiliation(s)
- Melissa T Baysari
- *Corresponding author. Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Room 132 RC Mills Building, Camperdown, NSW 2006, Australia. E-mail:
| | - Bethany A Van Dort
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Kristian Stanceski
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Andrew Hargreaves
- Integrated Care, eHealth NSW, Level 15, Zenith Tower B, 821 Pacific Highway, Chatswood, NSW 2067, Australia
| | - Wu Yi Zheng
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia,Directorate of Strategy and Operations, Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Maria Moran
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Richard Day
- Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia,The Clinical School, St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney, NSW 2052, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road NSW 2109, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road NSW 2109, Australia
| | - Sarah Hilmer
- Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, NSW 2065, Australia,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, NSW 2065, Australia
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Kinlay M, Yi Zheng W, Burke R, Juraskova I, Ho LMR, Turton H, Trinh J, Baysari M. Stakeholder perspectives of system-related errors: Types, contributing factors, and consequences. Int J Med Inform 2022; 165:104821. [PMID: 35738163 DOI: 10.1016/j.ijmedinf.2022.104821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite growing evidence of the benefits of electronic medication management systems (EMMS), research has also identified a range of new safety risks linked with their use. There is limited qualitative research focusing on system-related errors that result from use of EMMS. The aim of this study was to explore in-depth stakeholders' perceptions and experiences of system-related errors. METHODS Semi-structured interviews were conducted with EMMS users and other relevant staff (e.g. supporting roles in EMMS) across a local health district in Sydney, Australia. Analysis was conducted iteratively using a general inductive approach, and then mapped to Reason's accident causation model, where codes were categorized as 1) unsafe acts (i.e. what error occurred), 2) latent conditions (i.e. what factors contributed to errors), and 3) consequences resulting from the error. RESULTS Twenty-five participants were interviewed between September 2020 and May 2021. Participants most frequently described omission errors (e.g. failure to check for duplicate orders) as unsafe acts, although commission errors and workarounds were also reported. Poor EMMS design was reported to be a significant workplace factor contributing to system-related errors, however participants also described user factors, such as an overreliance on the system, and organizational factors, such as system downtime, as contributing to errors. Reported consequences of system-related errors included medication errors, but also impacts to the EMMS and on workers. CONCLUSIONS EMMS design is a significant contributor to system-related errors, but this research showed that user and organizational factors are also at play. As these factors are not independent, minimizing system-related errors requires a multi-faceted approach, where mitigation strategies target not only the EMMS, but also the context in which the system has been implemented.
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Affiliation(s)
- Madaline Kinlay
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | | | - Rosemary Burke
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | | | - Hannah Turton
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Jason Trinh
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Implementing a New Electronic Health Record System in a University Hospital: The Effect on Reported Medication Errors. Healthcare (Basel) 2022; 10:healthcare10061020. [PMID: 35742071 PMCID: PMC9222436 DOI: 10.3390/healthcare10061020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
Closed-loop electronic medication management systems (EMMS) have been seen as a potential technology to prevent medication errors (MEs), although the research on them is still limited. The aim of this paper was to describe the changes in reported MEs in Helsinki University Hospital (HUS) during and after implementing an EPIC-based electronic health record system (APOTTI), with the first features of a closed-loop EMMS. MEs reported from January 2018 to May 2021 were analysed to identify changes in ME trends with quantitative analysis. Severe MEs were also analysed via qualitative content analysis. A total of 30% (n = 23,492/79,272) of all reported patient safety incidents were MEs. Implementation phases momentarily increased the ME reporting, which soon decreased back to the earlier level. Administration and dispensing errors decreased, but medication reconciliation, ordering, and prescribing errors increased. The ranking of the TOP 10 medications related to MEs remained relatively stable. There were 92 severe MEs related to APOTTI (43% of all severe MEs). The majority of these (55%, n = 53) were related to use and user skills, 24% (n = 23) were technical failures and flaws, and 21% (n = 21) were related to both. Using EMMS required major changes in the medication process and new technical systems and technology. Our medication-use process is approaching a closed-loop system, which seems to provide safer dispensing and administration of medications. However, medication reconciliation, ordering, and prescribing still need to be improved.
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Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-120300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were read repeatedly and related papers were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was, then, assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new errors. The rigorous analysis of the chemotherapy process and considering the designing principles could help develop the CPOE systems and minimize ME.
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8
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Karnehed S, Erlandsson LK, Norell Pejner M. Nurses' perspectives on an electronic medication administration record in home healthcare: Qualitative interview study (Preprint). JMIR Nurs 2021; 5:e35363. [PMID: 35452400 PMCID: PMC9077506 DOI: 10.2196/35363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. Objective The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. Methods This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. Results Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses’ superior position. The experience of the eMAR was regarded as transitioning the nurses’ professional role—away from the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants. Conclusions Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.
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Affiliation(s)
- Sara Karnehed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Kinlay M, Ho LMR, Zheng WY, Burke R, Juraskova I, Moles R, Baysari M. Electronic Medication Management Systems: Analysis of Enhancements to Reduce Errors and Improve Workflow. Appl Clin Inform 2021; 12:1049-1060. [PMID: 34758493 DOI: 10.1055/s-0041-1739196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Electronic medication management (eMM) has been shown to reduce medication errors; however, new safety risks have also been introduced that are associated with system use. No research has specifically examined the changes made to eMM systems to mitigate these risks. OBJECTIVES To (1) identify system-related medication errors or workflow blocks that were the target of eMM system updates, including the types of medications involved, and (2) describe and classify the system enhancements made to target these risks. METHODS In this retrospective qualitative study, documents detailing updates made from November 2014 to December 2019 to an eMM system were reviewed. Medication-related updates were classified according to "rationale for changes" and "changes made to the system." RESULTS One hundred and seventeen updates, totaling 147 individual changes, were made to the eMM system over the 4-year period. The most frequent reasons for changes being made to the eMM were to prevent medication errors (24% of reasons), optimize workflow (22%), and support "work as done" on paper (16%). The most frequent changes made to the eMM were options added to lists (14% of all changes), extra information made available on the screen (8%), and the wording or phrasing of text modified (8%). Approximately a third of the updates (37%) related to high-risk medications. The reasons for system changes appeared to vary over time, as eMM functionality and use expanded. CONCLUSION To our knowledge, this is the first study to systematically review and categorize system updates made to overcome new safety risks associated with eMM use. Optimization of eMM is an ongoing process, which changes over time as users become more familiar with the system and use is expanded to more sites. Continuous monitoring of the system is necessary to detect areas for improvement and capitalize on the benefits an electronic system can provide.
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Affiliation(s)
- Madaline Kinlay
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | | | - Rosemary Burke
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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10
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Gregory LR, Lim R, MacCullagh L, Riley T, Tuqiri K, Heiler J, Peters K. Intensive care nurses' experiences with the new electronic medication administration record. Nurs Open 2021; 9:1895-1901. [PMID: 33999517 PMCID: PMC8994949 DOI: 10.1002/nop2.939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022] Open
Abstract
Aim To explore the experiences of Registered Nurses who administered medications to patients using the electronic medication administration record (eMAR) in Electronic Record for Intensive Care (eRIC) at one adult intensive care unit (ICU) in NSW, Australia. Design The study research design used a qualitative descriptive exploratory approach that took place in two stages. Methods Five participants attended one focus group followed by the observation of each participant as medications were administered to their assigned patient using the eMAR in eRIC. Results From the data, three themes and one subtheme were identified. Themes included forcing nurses to work outside legal boundaries; patient safety; with a subtheme titled experiencing computer fatigue; and taking time away from the patient. To practise safely, nurses were required to implement workaround practices when using the new eMAR in ICU. Nurses also were concerned that the eMAR in eRIC took time away from the patient at the bedside and ‘added more screen time’ to their day.
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Affiliation(s)
- Linda R Gregory
- School of Nursing and Midwifery, Ingham Institute for Applied Medical Research, Western Sydney University, Penrith, NSW, Australia
| | - Rimen Lim
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, NSW, Australia
| | - Lois MacCullagh
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Therese Riley
- Sydney and Sydney Eye Hospital, South Eastern Sydney Local Health District, Randwick, NSW, Australia
| | - Karen Tuqiri
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, NSW, Australia
| | - Jan Heiler
- The Sutherland Hospital, South Eastern Sydney Local Health District, Caringbah, NSW, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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Dabliz R, Poon SK, Ritchie A, Burke R, Penm J. Usability evaluation of an integrated electronic medication management system implemented in an oncology setting using the unified theory of the acceptance and use of technology. BMC Med Inform Decis Mak 2021; 21:4. [PMID: 33407411 PMCID: PMC7789263 DOI: 10.1186/s12911-020-01348-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication management processes in an Oncology setting are complex and difficult to examine in isolation from interrelated processes and contextual factors. This qualitative study aims to evaluate the usability of an Electronic Medication Management System (EMMS) implemented in a specialised oncology unit using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS The study was conducted in a 12-bed outpatient Oncology unit of a major teaching hospital 6 months following implementation of a commercial EMMS. In-depth semi-structured interviews were conducted with doctors, nurses and pharmacists using the system to assess usability. The UTAUT framework was used to analyse the results, which facilitated evaluation of interrelated aspects and provided a structured summary of user experience and usability factors. RESULTS Direct cross-comparison between user groups illustrated that doctors and pharmacists were generally satisfied with the facilitating conditions (hardware and training), but had divergent perceptions of performance (automation, standardised protocols and communication and documented) and effort (mental and temporal demand) expectancy. In counterpoint, nurses were generally satisfied across all constructs. Prior experience using an alternative EMMS influenced performance and effort expectancy and was related to early dissatisfaction with the EMMS. Furthermore, whilst not originally designed for the healthcare setting, the flexibility of the UTAUT allowed for translation to the hospital environment. CONCLUSION Nurses demonstrated overall satisfaction with the EMMS, whilst doctors and pharmacists perceived usability problems, particularly related to restricted automaticity and system complexity, which hindered perceived EMMS success. The study demonstrates the feasibility and utility of the UTAUT framework to evaluate usability of an EMMS for multiple user groups in the Oncology setting.
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Affiliation(s)
- Racha Dabliz
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
| | - Simon K Poon
- School of Computer Science, University of Sydney, Sydney, NSW, Australia
| | - Angus Ritchie
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia.,Health Informatics Unit, Sydney Local Health District, Camperdown, NSW, Australia
| | - Rosemary Burke
- Pharmacy Services, Sydney Local Health District, Camperdown, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
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Lichtner V, Franklin BD, Dalla-Pozza L, Westbrook JI. Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy. BMC Med Inform Decis Mak 2020; 20:193. [PMID: 32795356 PMCID: PMC7427723 DOI: 10.1186/s12911-020-01212-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are serious safety risks associated with chemotherapy, often associated with interdependencies in regimens administered over months or years. Various strategies are used to manage these risks. Computerized provider order entry (CPOE) systems are also implemented to improve medication safety. Little is known regarding the effect of CPOE on how clinicians manage chemotherapy interdependencies and their associated safety strategies. METHODS We conducted a multi-method qualitative study in a paediatric hospital. We analysed 827 oncology incidents reported following CPOE implementation and carried out semi-structured interviews with doctors (n = 10), nurses (n = 6), a pharmacist, and oncology CPOE team members (n = 2). Results were interpreted according to safety models (ultra-safe, high-reliability organisations [HROs], or ultra-adaptive). RESULTS Incident reports highlighted two interrelated types of interdependencies: those within organisation of clinical activities and those inherent in chemotherapy regimens. Clinicians reported strategies to address chemotherapy risks and interdependencies. These included rigid rules and 'no go' contexts for treatment to proceed, typical of the ultra-safe model; use of time (e.g. planning only so far ahead) and sensitivity to operations, typical of HROs. We identified three different time horizons in CPOE use in relation to patients' treatments: life-long, the whole regimen, and the 'here and now'. CPOE supported ultra-safe strategies through automation and access to rules/standardisation, but also created difficulties and contributed to incidents. It supported the 'here and now' better than a life-long or whole regimen view of a patient treatment. Sensitivity to operations was essential to anticipate and resolve uncertainties, hazards, CPOE limitations, and mismatches between CPOE processes and workflow in practice. CONCLUSIONS Within oncology, CPOE appears to move the 'mix' of risk strategies towards ultra-safe models of safety and protocol-mandated care. However, in order to operate ultra-safe strategies embedded in CPOE and stay on protocol it is essential for clinicians to be thoughtful and show sensitivity to operations in CPOE use. CPOE design can be advanced by better consideration of mechanisms to support interdependencies.
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Affiliation(s)
- Valentina Lichtner
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. .,Department of Practice and Policy, UCL School of Pharmacy, University College London, BMA House, Entrance A, Tavistock Square, Bloomsbury, London, WC1H 9JP, UK.
| | - Bryony Dean Franklin
- Department of Practice and Policy, UCL School of Pharmacy, University College London, BMA House, Entrance A, Tavistock Square, Bloomsbury, London, WC1H 9JP, UK.,Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Elshayib M, Pawola L. Computerized provider order entry-related medication errors among hospitalized patients: An integrative review. Health Informatics J 2020; 26:2834-2859. [PMID: 32744148 DOI: 10.1177/1460458220941750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Institute of Medicine estimates that 7,000 lives are lost yearly as a result of medication errors. Computerized physician and/or provider order entry was one of the proposed solutions to overcome this tragic issue. Despite some promising data about its effectiveness, it has been found that computerized provider order entry may facilitate medication errors.The purpose of this review is to summarize current evidence of computerized provider order entry -related medication errors and address the sociotechnical factors impacting the safe use of computerized provider order entry. By using PubMed and Google Scholar databases, a systematic search was conducted for articles published in English between 2007 and 2019 regarding the unintended consequences of computerized provider order entry and its related medication errors. A total of 288 articles were screened and categorized based on their use within the review. One hundred six articles met our pre-defined inclusion criteria and were read in full, in addition to another 27 articles obtained from references. All included articles were classified into the following categories: rates and statistics on computerized provider order entry -related medication errors, types of computerized provider order entry -related unintended consequences, factors contributing to computerized provider order entry failure, and recommendations based on addressing sociotechnical factors. Identifying major types of computerized provider order entry -related unintended consequences and addressing their causes can help in developing appropriate strategies for safe and effective computerized provider order entry. The interplay between social and technical factors can largely affect its safe implementation and use. This review discusses several factors associated with the unintended consequences of this technology in healthcare settings and presents recommendations for enhancing its effectiveness and safety within the context of sociotechnical factors.
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Lichtner V, Baysari M, Gates P, Dalla-Pozza L, Westbrook JI. Medication safety incidents in paediatric oncology after electronic medication management system implementation. Eur J Cancer Care (Engl) 2019; 28:e13152. [PMID: 31436876 PMCID: PMC7161912 DOI: 10.1111/ecc.13152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
Objective To explore medication safety issues related to use of an electronic medication management system (EMM) in paediatric oncology practice, through the analysis of patient safety incident reports. Methods We analysed 827 voluntarily reported incidents relating to oncology patients that occurred over an 18‐month period immediately following implementation of an EMM in a paediatric hospital in Australia. We identified medication‐related and EMM‐related incidents and carried out a content analysis to identify patterns. Results We found ~79% (n = 651) of incidents were medication‐related and, of these, ~45% (n = 294) were EMM‐related. Medication‐related incidents included issues with: prescribing; dispensing; administration; patient transfers; missing chemotherapy protocols and information on current stage of patient treatment; coordination of chemotherapy administration; handling or storing medications; children or families handling medications. EMM‐related incidents were classified into four groups: technical issues, issues with the user experience, unanticipated problems in EMM workflow, and missing safety features. Conclusions Incidents reflected difficulties with managing therapies rich in interdependencies. EMM, and especially its ‘automaticity’, contributed to these incidents. As EMM impacts on safety in such high‐risk settings, it is essential that users are aware of and attend to EMM automatic behaviours and are equipped to troubleshoot them.
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Affiliation(s)
- Valentina Lichtner
- Department of Practice and Policy, School of Pharmacy, UCL, London, UK.,Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
| | - Melissa Baysari
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia.,Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Peter Gates
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children Hospital at Westmead, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
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