1
|
Daines L, Donaghy E, Canny A, Murray V, Campbell L, Stonham C, Bush A, McKinstry B, Milne H, Price D, Sheikh A, Pinnock H. Clinician views on how clinical decision support systems can help diagnose asthma in primary care: a qualitative study. J Asthma 2024; 61:377-385. [PMID: 37934476 DOI: 10.1080/02770903.2023.2280839] [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: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Asthma can be difficult to diagnose in primary care. Clinical decision support systems (CDSS) can assist clinicians when making diagnostic decisions, but the perspectives of intended users need to be incorporated into the software if the CDSS is to be clinically useful. Therefore, we aimed to understand health professional views on the value of an asthma diagnosis CDSS and the barriers and facilitators for use in UK primary care. METHODS We recruited doctors and nurses working in UK primary care who had experience of assessing respiratory symptoms and diagnosing asthma. Qualitative interviews were used to explore clinicians' experiences of making a diagnosis of asthma and understand views on a CDSS to support asthma diagnosis. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. RESULTS 16 clinicians (nine doctors, seven nurses) including 13 participants with over 10 years experience, contributed interviews. Participants saw the potential for a CDSS to support asthma diagnosis in primary care by structuring consultations, identifying relevant information from health records, and having visuals to communicate findings to patients. Being evidence based, regularly updated, integrated with software, quick and easy to use were considered important for a CDSS to be successfully implemented. Experienced clinicians were unsure a CDSS would help their routine practice, particularly in straightforward diagnostic scenarios, but thought a CDSS would be useful for trainees or less experienced colleagues. CONCLUSIONS To be adopted into clinical practice, clinicians were clear that a CDSS must be validated, integrated with existing software, and quick and easy to use.
Collapse
Affiliation(s)
- Luke Daines
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anne Canny
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Victoria Murray
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Leo Campbell
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carol Stonham
- NHS Gloucestershire Integrated Care Board, Gloucester, UK
- Primary Care Respiratory Society (PCRS), Knowle, UK
| | - Andrew Bush
- Imperial Centre for Paediatrics and Child Health and National Heart and Lung Institute, Imperial College, London, UK
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Brian McKinstry
- Centre for Population and Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Heather Milne
- South East GP Unit, NHS Education for Scotland, Edinburgh, UK
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Canny A, Donaghy E, Murray V, Campbell L, Stonham C, Bush A, McKinstry B, Milne H, Pinnock H, Daines L. Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study. Health Expect 2022; 26:307-317. [PMID: 36370457 PMCID: PMC9854294 DOI: 10.1111/hex.13657] [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: 07/06/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient-facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. METHODS Participants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In-depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. RESULTS Seventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self-management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision-making. CONCLUSION Undergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement. PATIENT AND PUBLIC CONTRIBUTION Prespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data.
Collapse
Affiliation(s)
- Anne Canny
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Eddie Donaghy
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Victoria Murray
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Leo Campbell
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning GroupGloucesterUK,Primary Care Respiratory Society (PCRS)KnowleUK
| | - Andrew Bush
- Imperial Centre for Paediatrics and Child Health and National Heart and Lung InstituteImperial CollegeLondonUK,Department of Paediatric Respiratory MedicineRoyal Brompton HospitalLondonUK
| | - Brian McKinstry
- Centre for Population and Health Sciences, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Heather Milne
- South East GP UnitNHS Education for ScotlandEdinburghUK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Luke Daines
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| |
Collapse
|
3
|
Asan O, Choudhury A, Somai MM, Crotty BH. Augmenting patient safety through participation by design - An assessment of dual monitors for patients in the outpatient clinic. Int J Med Inform 2020; 146:104345. [PMID: 33260089 DOI: 10.1016/j.ijmedinf.2020.104345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients and physicians engaging together in the electronic health record (EHR) during clinical visits may provide opportunities to both improve patient understanding and reduce medical errors. OBJECTIVE To assess the potential impact of a patient EHR display intervention on patient quality and safety. We hypothesized that if patients had a dedicated display with an explicit invitation to follow clinicians in the EHR that this would identify several opportunities to engage patients in their care quality and safety. MATERIAL AND METHODS Physician-patient outpatient encounters (24 patients and 8 physicians) were videotaped. Encounters took place in a hospital-based general internal medicine outpatient clinic where physicians and patients had their respective EHR monitors. Following the visits, each patient and physician was interviewed for 30 min to understand their perception of the mirrored-screen setting. RESULTS The following 7 themes were identified (a) curiosity, (b) opportunity to ask questions, (c) error identification, (d) control over medications, (e) awareness, (f) shared understanding & decision-making, (g) data privacy. These themes collectively comprised a conceptual model for how patient engagement in electronic health record use, through a dedicated second screen or an explicitly shared screen, relates to safety and quality opportunities. Therefore, the double EHR screen provides an explicit invitation for patients to join the process to influence safety. CONCLUSION Desired outcomes include real-time error identification and better-shared understanding and decision-making, leading to better downstream follow-through with care plans.
Collapse
Affiliation(s)
- Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, 07047, USA.
| | - Avishek Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, 07047, USA.
| | - Melek M Somai
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA.
| | - Bradley H Crotty
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA.
| |
Collapse
|
4
|
Completing asthma action plans by screen-sharing in video-consultations: practical insights from a feasibility assessment. NPJ Prim Care Respir Med 2020; 30:48. [PMID: 33087713 PMCID: PMC7578638 DOI: 10.1038/s41533-020-00206-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/25/2020] [Indexed: 11/08/2022] Open
Abstract
Supported self-management is a vital component of routine asthma care. Completion of an agreed personalised asthma action plan is integral to implementation of this care, and traditionally this requires a face-to-face consultation. We aimed to assess the practical feasibility and potential utility of using screen-sharing technologies to complete asthma action plans remotely. Assisted by people with diverse technological ability and using a range of devices, we tested the technological feasibility of completing action plans in remote consultations using two leading video-conference systems. We used a semi-structured topic guide to check functionality and lead feedback discussions. Themes were interpreted using the Model for ASsessment of Telemedicine applications (MAST). Discussions with ten participants (age 20–74 years) revealed that screen-sharing was practical on most devices. Joint editing of an action plan (as was possible with Zoom) was considered to encourage participation and improve communication. Attend Anywhere had less functionality than Zoom, but the NHS badging was reassuring. Most participants appreciated the screen-sharing and considered it enabled a meaningful discussion about their action plan. Online shared completion of action plans is feasible with only a few (potentially remediable) practical problems. These findings suggest this may be a fruitful approach for further study—made more urgent by the imperative to develop remote consultations in the face of a global pandemic.
Collapse
|
5
|
Daines L, Lewis S, Schneider A, Sheikh A, Pinnock H. Defining high probability when making a diagnosis of asthma in primary care: mixed-methods consensus workshop. BMJ Open 2020; 10:e034559. [PMID: 32317260 PMCID: PMC7204930 DOI: 10.1136/bmjopen-2019-034559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Making the diagnosis of asthma is challenging. Guidelines recommend that clinicians identify a group at 'high probability' of asthma. High probability, however, is not numerically defined giving rise to uncertainty. The aim of this work was to build consensus on what constitutes a high probability of asthma in primary care. High probability was defined as the probability threshold at which there is enough information to make a firm diagnosis of asthma, and a subsequent negative test would not alter that opinion (assumed to be a false negative). DESIGN Mixed-methods study. SETTING A consensus workshop using modified nominal group technique was held during an international respiratory conference. PARTICIPANTS International conference attendees eligible if they had knowledge/experience of working in primary care, respiratory medicine and spoke English. METHODS Participants took part in facilitated discussions and voted over three rounds on what constituted a high probability of asthma diagnosis. The workshop was audio-recorded, transcribed and qualitatively analysed. RESULTS Based on final votes, the mean value for a high probability of asthma in primary care was 75% (SD 7.6), representing a perceived trade-off between limiting the number of false positives (more likely if a lower threshold was used) and pragmatism on the basis that first-line preventive therapies (ie, low-dose inhaled corticosteroids) are relatively low risk. The need to review response to treatment was strongly emphasised for detecting non-responders and reviewing the diagnosis. CONCLUSION A consensus probability of 75% was the threshold at which the primary care participants in this workshop felt confident to establish the diagnosis of asthma, albeit with the caveat that a review of treatment response was essential. Contextual factors, including availability and timing of tests and the ease with which patients could be reviewed, influenced participants' decision making.
Collapse
Affiliation(s)
- Luke Daines
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steff Lewis
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Klein TM, Augustin M, Otten M. How should electronic health records be designed? A cross-sectional study in patients with psoriasis. BMC Med Inform Decis Mak 2019; 19:218. [PMID: 31718653 PMCID: PMC6849227 DOI: 10.1186/s12911-019-0926-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/14/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are promising tools for routine care. These applications might not only enhance the interaction between patient and physician but also support therapy management. This is crucial in complex and chronic conditions like psoriasis. However, EHRs can only unfold their full potential when being accepted by the users. Therefore, this study aims to analyse how EHRs should be designed for patients with psoriasis and to identify differences between patient subgroups. METHODS We developed a questionnaire on the acceptability of EHRs based on literature research and results from focus groups. Participants completed a paper-based or electronic version of the questionnaire. We recruited participants at an outpatient clinic as well as online via patient associations and a social media platform. We analysed data using descriptive statistics and bivariate analyses applying Chi-square and Fisher's exact test. RESULTS The sample encompassed 187 patients with psoriasis. Data reveals that 84.4% of the participants can think of entering data into an EHR. Participants prefer entering data at home (72.2%) instead of entering data in the waiting room (44.9%) and using an own internet-ready device (laptop/computer: 62.6%; smartphone/tablet: 61.5%) instead of a provided device (46.0%). Altogether, 55.6% of participants would accept entering data on a monthly basis when this lasts between one and 10 minutes and further 27.8% would accept even longer lasting data entry. Data privacy is of great concern (e.g. patient should decide who has access to data: 96.7%). Subgroup analyses reveal differences with regard to age, educational level, burden due to psoriasis, number of internet activities, use of electronic questionnaires and mode of administration. CONCLUSION The high acceptance of entering data is favourable for the implementation of EHRs. The results suggest technical and structural recommendations: Differences between subgroups support the development of flexible EHRs encompassing a basic module, which is expandable with further add-ons, and compatible to different devices. Furthermore, involving patients by entering data into an EHR requires that physicians communicate open-mindedly with the patient and consider data throughout decision-making. Patients should remain owner of their own health data and decide about its processing.
Collapse
Affiliation(s)
- Toni Maria Klein
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
7
|
Adane K, Gizachew M, Kendie S. The role of medical data in efficient patient care delivery: a review. Risk Manag Healthc Policy 2019; 12:67-73. [PMID: 31114410 PMCID: PMC6486797 DOI: 10.2147/rmhp.s179259] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Implementing accurate data management systems ensure safe and efficient transfer of confidential health care data. However, health care professionals overlooked their important tasks of medical data processing. Hence, using high-quality electronic health record (EHR) applications in health care is important to minimize medical errors. Therefore, this review tries to indicate the roles of EHR in advancing quality health care service provisions. Methods The keywords identified were EHR, EMR, medical data processing, medical data retention, medical data destruction, health care, and patient care, and a few related terms with different combinations. PubMed (National Library of Medicine), Google Scholar, and Google search engine were used to search for articles from those databases. Searching was done using boolean words “AND”, “OR”, and “NOT” using all [All fields] and [MeSH Terms] searching strategies. Results Articles were screened using the title, checked by their abstract, and the remaining related full-text materials were included or excluded by two individuals deciding its eligibility. Finally, 73 materials issued from 2013–2018 were used for qualitatively synthesizing and reconciling the idea to produce this review article. Conclusion Poor medical data processing systems are the key reasons for medical errors. Employing standardized data management systems reduce errors and associated sufferings. Therefore, using electronic tools in the health care institution ensures safe and efficient data management. Therefore, it is important to establish appropriate medical data management systems for efficient health care delivery.
Collapse
Affiliation(s)
- Kasaw Adane
- Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, University of Gondar, Ethiopia,
| | - Mucheye Gizachew
- School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Semalegne Kendie
- School of Sociology and Social Work, Department of Social Work, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
8
|
Zamani Z, Harper EC. Exploring the Effects of Clinical Exam Room Design on Communication, Technology Interaction, and Satisfaction. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:99-115. [PMID: 30719926 DOI: 10.1177/1937586719826055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article evaluates the effects of technology integration and design features in clinical exam rooms on examination experiences, communication, and satisfaction. BACKGROUND Exam room features can affect the delivery of patient-centered care and enhance the level of communication, which has been shown to directly impact clinical outcomes. Although there has been an increasing body of literature examining design and patient-centered care, little research has evaluated the extent to which information sharing and electronic health record (EHR) interaction are impacted. METHOD The research randomly allocated 22 patients, 28 caregivers, and 59 clinicians to simulated clinical encounters in four exam room mock-ups with semi-inclusive, exclusive, and inclusive layouts (128 sessions in 32 scenarios). Video recordings of the simulations were coded for clinician gazing, talking, and EHR-interaction behaviors. Participants also completed surveys and answered open-ended questions after experiencing each scenario (N = 362). RESULTS Semi-inclusive rooms with a triangular arrangement of consultation table, sharable screens, exam table, and caregiver chair were highly preferred as they supported conversation, gazing, and information sharing. The inclusive layout had higher durations of EHR interactions and enhanced viewing and sharing of EHR information. However, this layout was criticized for the lack of clinician-shared information. The exclusive layouts impeded information sharing, eye contact, and constrained simultaneous data entry and eye contact for clinicians. The distance and orientation between chair, exam table, curtain, and door were important for protecting patient and family comfort and privacy. CONCLUSION Characteristics and configurations of design qualities and strategies have a key role on examination experiences, communication, and satisfaction.
Collapse
|
9
|
Beedholm K, Frederiksen K. Patient involvement and institutional logics: A discussion paper. Nurs Philos 2018; 20:e12234. [PMID: 30592122 DOI: 10.1111/nup.12234] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
The research into patient involvement is seldom concerned with the significance of cultural and structural factors. In this discussion paper, we illustrate our considerations on some of the challenges in implementing the ideal of patient involvement by showing how such factors take part in shaping the ways in which the intentions to involve patients are converted to practical interventions. The aim was to contribute to the approach dealing with contextual and structural factors of significance for patient involvement. With the idea of "institutional logics," borrowed from the Danish scholar, Erik Riiskjaer, we first demonstrate, with examples from our own research, how patient involvement is interpreted differently within the different logics. Then, we show how the different interpretations of patient involvement meet and conflict in mutual competition as the ideals are sought to be converted to practical interventions. At last, we argue that an adequate theoretical model for the development in the future health care system should be expanded with a "patient logic."
Collapse
Affiliation(s)
- Kirsten Beedholm
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark
| | - Kirsten Frederiksen
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark
| |
Collapse
|
10
|
Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children. Br J Gen Pract 2017; 67:e437-e444. [PMID: 28137783 PMCID: PMC5442959 DOI: 10.3399/bjgp17x689353] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/19/2016] [Indexed: 11/24/2022] Open
Abstract
Background Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family. Aim To explore how and why general practice clinicians document DVA in families with children. Design and setting A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England. Method Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes. Results Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians. Conclusion Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access.
Collapse
|
11
|
The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study. PLoS One 2016; 11:e0153721. [PMID: 27093438 PMCID: PMC4836703 DOI: 10.1371/journal.pone.0153721] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/01/2016] [Indexed: 11/29/2022] Open
Abstract
Background Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients’ involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. Methods We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses’ medication administration rounds, pharmacists’ ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Results Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture. Conclusion Patients appear to have more access to paper-based records than electronic equivalents. However, to develop interventions to increase patient involvement with medication safety behaviours, a wider range of factors needs to be considered.
Collapse
|