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Rooplalsingh R, Edwards F, Affleck J, Young P, Tabah A, Carmichael S, Chappell B, Fung A, Jacobs K, Laupland K, Ramanan M. The Impact of Prescription Time Limits on Phosphate Administration in the Intensive Care Unit: A Before-After Quality Improvement Study. Healthcare (Basel) 2024; 12:1549. [PMID: 39120252 PMCID: PMC11311736 DOI: 10.3390/healthcare12151549] [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: 06/25/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
(1) Background: We aim to examine and improve phosphate prescribing as part of a quality assurance program by examining the change in the proportion of patients receiving phosphate with normal or high preceding serum phosphate concentrations before and after the introduction of the 24 h time limit to default phosphate prescription. (2) Methods: This was a quality assurance study conducted across three Australian adult intensive care units (ICUs). All adult patients with ICU lengths of stay greater than or equal to 48 h who had their serum phosphate concentrations measured were included. A 24 h time limit was introduced to the protocolised prescription in the electronic clinical information system for enteral and intravenous phosphate at participating ICUs. Patient characteristics, phosphate administration, and outcomes were compared before and after this time limit was introduced. The primary outcome was the proportion of patients to whom phosphate was prescribed after measurement of a normal or high serum phosphate level. Secondary outcomes were ICU length of stay, mortality, and discharge destination. (3) Results: A total of 1192 patients were included from three ICUs over the two periods. The proportion of patients with a normal or high measured phosphate level who then received phosphate supplementation was significantly lower in the second study period (30.3% vs. 9.9%; p < 0.001). This difference persisted when adjusted for potential confounders in a mixed-effects logistic regression model (an adjusted odds ratio for receiving phosphate with normal or high serum concentration 0.214, 95% confidence interval of 0.132-0.347; p < 0.001). No significant difference was seen in the typical ICU length of stay, in-hospital case-fatality rate, and hospital discharge destination between these groups. (4) Conclusions: This multicentre before-after study has demonstrated that the introduction of a 24 h limit on electronic phosphate prescriptions resulted in significantly fewer patients receiving phosphate when their serum phosphate concentration was normal or high, without any adverse impact on patient outcomes.
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Affiliation(s)
- Rajiv Rooplalsingh
- Department of Anaesthesia, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia;
| | - Felicity Edwards
- Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (F.E.); (A.T.); (K.L.)
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
| | - Julia Affleck
- Research Development Unit, Caboolture Hospital, Caboolture, QLD 4510, Australia;
| | - Patrick Young
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD 4020, Australia; (P.Y.); (K.J.)
- Intensive Care Unit, Caboolture Hospital, Caboolture, QLD 4510, Australia
| | - Alexis Tabah
- Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (F.E.); (A.T.); (K.L.)
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD 4020, Australia; (P.Y.); (K.J.)
- School of Medicine, The University of Queensland, Brisbane, QLD 4000, Australia
| | - Sinead Carmichael
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia;
| | - Belinda Chappell
- Pharmacy Department, Caboolture Hospital, Caboolture, QLD 4510, Australia;
| | - Andrea Fung
- Pharmacy Department, Redcliffe Hospital, Redcliffe, QLD 4020, Australia;
| | - Kylie Jacobs
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD 4020, Australia; (P.Y.); (K.J.)
| | - Kevin Laupland
- Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (F.E.); (A.T.); (K.L.)
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
| | - Mahesh Ramanan
- Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (F.E.); (A.T.); (K.L.)
- Intensive Care Unit, Caboolture Hospital, Caboolture, QLD 4510, Australia
- Intensive Care Unit, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
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Abell B, Naicker S, Rodwell D, Donovan T, Tariq A, Baysari M, Blythe R, Parsons R, McPhail SM. Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: a NASSS framework-informed scoping review. Implement Sci 2023; 18:32. [PMID: 37495997 PMCID: PMC10373265 DOI: 10.1186/s13012-023-01287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Successful implementation and utilization of Computerized Clinical Decision Support Systems (CDSS) in hospitals is complex and challenging. Implementation science, and in particular the Nonadoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, may offer a systematic approach for identifying and addressing these challenges. This review aimed to identify, categorize, and describe barriers and facilitators to CDSS implementation in hospital settings and map them to the NASSS framework. Exploring the applicability of the NASSS framework to CDSS implementation was a secondary aim. METHODS Electronic database searches were conducted (21 July 2020; updated 5 April 2022) in Ovid MEDLINE, Embase, Scopus, PyscInfo, and CINAHL. Original research studies reporting on measured or perceived barriers and/or facilitators to implementation and adoption of CDSS in hospital settings, or attitudes of healthcare professionals towards CDSS were included. Articles with a primary focus on CDSS development were excluded. No language or date restrictions were applied. We used qualitative content analysis to identify determinants and organize them into higher-order themes, which were then reflexively mapped to the NASSS framework. RESULTS Forty-four publications were included. These comprised a range of study designs, geographic locations, participants, technology types, CDSS functions, and clinical contexts of implementation. A total of 227 individual barriers and 130 individual facilitators were identified across the included studies. The most commonly reported influences on implementation were fit of CDSS with workflows (19 studies), the usefulness of the CDSS output in practice (17 studies), CDSS technical dependencies and design (16 studies), trust of users in the CDSS input data and evidence base (15 studies), and the contextual fit of the CDSS with the user's role or clinical setting (14 studies). Most determinants could be appropriately categorized into domains of the NASSS framework with barriers and facilitators in the "Technology," "Organization," and "Adopters" domains most frequently reported. No determinants were assigned to the "Embedding and Adaptation Over Time" domain. CONCLUSIONS This review identified the most common determinants which could be targeted for modification to either remove barriers or facilitate the adoption and use of CDSS within hospitals. Greater adoption of implementation theory should be encouraged to support CDSS implementation.
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Affiliation(s)
- Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - David Rodwell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Amina Tariq
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Robin Blythe
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rex Parsons
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Baysari MT, Dort BAV, Zheng WY, Li L, Hilmer S, Westbrook J, Day R. Prescribers’ reported acceptance and use of drug-drug interaction alerts: An Australian survey. Health Informatics J 2022; 28:14604582221100678. [DOI: 10.1177/14604582221100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drug-drug interaction (DDI) alerts are frequently included in electronic medical record (eMR) systems to provide users with relevant information and guidance at the point of care. In this study, we aimed to examine views of DDI alerts among prescribers, including junior doctors, registrars and senior doctors, across Australia. A validated survey for assessing prescribers’ reported acceptance and use of DDI alerts was distributed among researcher networks and in newsletters. Fifty useable responses were received, more than half ( n = 28) from senior doctors. Prescribers at all levels expected DDI alerts to improve performance but junior doctors reported that this was at a high cost, with respect to time and effort. Senior doctors and registrars reported rarely reading alerts and rarely changing prescribing decisions based on alerts. Respondents identified a number of problems with current alerts including limited relevance, repetition, and poor design, highlighting some clear areas for alert improvement.
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Affiliation(s)
- Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Bethany A Van Dort
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Wu Yi Zheng
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW, Australia
- Black Dog Institute, NSW Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hilmer
- Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Richard Day
- Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Clinical School, Faculty of Medicine, UNSW, Sydney, NSW, Australia
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Barriers and facilitators influencing medication-related CDSS acceptance according to clinicians: A systematic review. Int J Med Inform 2021; 152:104506. [PMID: 34091146 DOI: 10.1016/j.ijmedinf.2021.104506] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A medication-related Clinical Decision Support System (CDSS) is an application that analyzes patient data to provide assistance in medication-related care processes. Despite its potential to improve the clinical decision-making process, evidence shows that clinicians do not always use CDSSs in such a way that their potential can be fully realized. This systematic literature review provides an overview of frequently-reported barriers and facilitators for acceptance of medication-related CDSS. MATERIALS AND METHODS Search terms and MeSH headings were developed in collaboration with a librarian, and database searches were conducted in Medline, Scopus, Embase and Web of Science Conference Proceedings. After screening 5404 records and 140 full papers, 63 articles were included in this review. Quality assessment was performed for all 63 included articles. The identified barriers and facilitators are categorized within the Human, Organization, Technology fit (HOT-fit) model. RESULTS A total of 327 barriers and 291 facilitators were identified. Results show that factors most often reported were related to (a lack of) usefulness and relevance of information, and ease of use and efficiency of the system. DISCUSSION This review provides a valuable insight into a broad range of barriers and facilitators for using a medication-related CDSS as perceived by clinicians. The results can be used as a stepping stone in future studies developing medication-related CDSSs.
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Mogharbel A, Dowding D, Ainsworth J. Physicians' Use of the Computerized Physician Order Entry System for Medication Prescribing: Systematic Review. JMIR Med Inform 2021; 9:e22923. [PMID: 33661126 PMCID: PMC7974763 DOI: 10.2196/22923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computerized physician order entry (CPOE) systems in health care settings have many benefits for prescribing medication, such as improved quality of patient care and patient safety. However, to achieve their full potential, the factors influencing the usage of CPOE systems by physicians must be identified and understood. OBJECTIVE The aim of this study is to identify the factors influencing the usage of CPOE systems by physicians for medication prescribing in their clinical practice. METHODS We conducted a systematic search of the literature on this topic using four databases: PubMed, CINAHL, Ovid MEDLINE, and Embase. Searches were performed from September 2019 to December 2019. The retrieved papers were screened by examining the titles and abstracts of relevant studies; two reviewers screened the full text of potentially relevant papers for inclusion in the review. Qualitative, quantitative, and mixed methods studies with the aim of conducting assessments or investigations of factors influencing the use of CPOE for medication prescribing among physicians were included. The identified factors were grouped based on constructs from two models: the unified theory of acceptance and use of technology model and the Delone and McLean Information System Success Model. We used the Mixed Method Appraisal Tool to assess the quality of the included studies and narrative synthesis to report the results. RESULTS A total of 11 articles were included in the review, and 37 factors related to the usage of CPOE systems were identified as the factors influencing how physicians used CPOE for medication prescribing. These factors represented three main themes: individual, technological, and organizational. CONCLUSIONS This study identified the common factors that influenced the usage of CPOE systems by physicians for medication prescribing regardless of the type of setting or the duration of the use of a system by participants. Our findings can be used to inform implementation and support the usage of the CPOE system by physicians.
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Affiliation(s)
- Asra Mogharbel
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
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Sutherland K, Yeung W, Mak Y, Levesque JF. Envisioning the future of clinical analytics: a modified Delphi process in New South Wales, Australia. BMC Med Inform Decis Mak 2020; 20:210. [PMID: 32887609 PMCID: PMC7650225 DOI: 10.1186/s12911-020-01226-7] [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: 02/03/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Clinical analytics is a rapidly developing area of informatics and knowledge mobilisation which has huge potential to improve healthcare in the future. It is widely acknowledged to be a powerful mediator of clinical decision making, patient-centred care and organisational learning. As a result, healthcare systems require a strategic foundation for clinical analytics that is sufficiently directional to support meaningful change while flexible enough to allow for iteration and responsiveness to context as change occurs. Methods In New South Wales, the most populous state in Australia, the Clinical Analytics Working Group was charged with developing a five-year vision for the public health system. A modified Delphi process was undertaken to elicit expert views and to reach a consensus. The process included a combination of face-to-face workshops, traditional Delphi voting via email, and innovative, real-time iteration between text re-formulation and voting until consensus was reached. The six stage process engaged 35 experts — practising clinicians, patients and consumers, managers, policymakers, data scientists and academics. Results The process resulted in the production of 135 ideas that were subsequently synthesised into 23 agreed statements and encapsulated in a single page (456 word) narrative. Conclusion The visioning process highlighted three key perspectives (clinicians, patients and managers) and the need for synchronous (during the clinical encounter) and asynchronous (outside the clinical encounter) clinical decision support and reflective practice tools; the use of new and multiple data sources and communication formats; and the role of research and education.
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Affiliation(s)
- Kim Sutherland
- NSW Agency for Clinical Innovation, Chatswood, NSW, Australia.
| | | | - Yoke Mak
- eHealth NSW, Chatswood, NSW, Australia
| | - Jean-Frederic Levesque
- NSW Agency for Clinical Innovation, Chatswood, NSW, Australia.,Centre for Primary Health Care and Equity, UNSW, Randwick, New South Wales, Australia
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Cordier PY, Lyochon A, Boussen S, Cungi PJ, d'Aranda E, Bordes J, Martin E, Peytel E, Meaudre E, Goutorbe P. Rapid sequence induction traceability in an ICU dedicated patient data management system: a multicentric retrospective study. J Crit Care 2020; 54:292-297. [PMID: 31813460 DOI: 10.1016/j.jcrc.2019.08.021] [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: 06/14/2019] [Revised: 07/24/2019] [Accepted: 08/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Patient data management systems (PDMS) are widely used in intensive care units (ICUs) to improve care traceability. Verbal orders are still used for prescriptions requiring immediate execution but should be subsequently recorded in the system. We assessed the rapid sequence induction (RSI) traceability for endotracheal intubation in an ICU dedicated PDMS. MATERIALS AND METHODS A retrospective study was conducted on anonymous databases in 21 ICUs. Endotracheal tube insertions performed during one year were compared to the number of RSI registered in the PDMS. RESULTS We listed 5516 endotracheal tube insertions. A suxamethonium injection was registered in 829 cases and a rocuronium administration in 909 cases. The RSI traceability rate in the overall cohort was 31.5% and was greater in the units where nurses were allowed to record a drug administration before the computerized physician order entry. CONCLUSIONS PDMS are supposed to improve prescription completeness and traceability, but our study suggests an opposite result. A co-responsibility policy between physicians and nurses should be promoted to improve care traceability. PDMS ergonomic improvements and enhanced integration in clinical workflow might also result in better compliance with documentation requirements. In each centre, indicators of PDMS correct use should be defined and periodically monitored.
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Affiliation(s)
- Pierre-Yves Cordier
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France; LBA, UMRT 24, Aix Marseille Université-IFSTTAR, Boulevard Pierre Dramard, 13916, Marseille cedex 20, France.
| | - Arthur Lyochon
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Salah Boussen
- LBA, UMRT 24, Aix Marseille Université-IFSTTAR, Boulevard Pierre Dramard, 13916, Marseille cedex 20, France; Department of Anesthesiology and Intensive Care, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Pierre-Julien Cungi
- Intensive Care Unit, Sainte Anne Military Teaching Hospital, 2 Boulevard Sainte Anne, BP600, 83800 Toulon, France
| | - Erwan d'Aranda
- Intensive Care Unit, Sainte Anne Military Teaching Hospital, 2 Boulevard Sainte Anne, BP600, 83800 Toulon, France
| | - Julien Bordes
- Intensive Care Unit, Sainte Anne Military Teaching Hospital, 2 Boulevard Sainte Anne, BP600, 83800 Toulon, France
| | - Edouard Martin
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Eric Peytel
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Eric Meaudre
- Intensive Care Unit, Sainte Anne Military Teaching Hospital, 2 Boulevard Sainte Anne, BP600, 83800 Toulon, France
| | - Philippe Goutorbe
- Intensive Care Unit, Sainte Anne Military Teaching Hospital, 2 Boulevard Sainte Anne, BP600, 83800 Toulon, France
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Peute LW, Lichtner V, Baysari MT, Hägglund M, Homco J, Jansen-Kosterink S, Jauregui I, Kaipio J, Kuziemsky CE, Lehnbom EC, Leite F, Lesselroth B, Luna D, Otero C, Pedersen R, Pelayo S, Santos R, Silva NA, Tyllinen M, Van Velsen L, Zheng WY, Jaspers M, Marcilly R. Challenges and Best Practices in Ethical Review of Human and Organizational Factors Studies in Health Technology: a Synthesis of Testimonies. Yearb Med Inform 2020; 29:58-70. [PMID: 32303100 PMCID: PMC7442520 DOI: 10.1055/s-0040-1701979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Human and Organizational Factors (HOF) studies in health technology involve human beings and thus require Institutional Review Board (IRB) approval. Yet HOF studies have specific constraints and methods that may not fit standard regulations and IRB practices. Gaining IRB approval may pose difficulties for HOF researchers. This paper aims to provide a first overview of HOF study challenges to get IRB review by exploring differences and best practices across different countries. METHODS HOF researchers were contacted by email to provide a testimony about their experience with IRB review and approval. Testimonies were thematically analyzed and synthesized to identify and discuss shared themes. RESULTS Researchers from seven European countries, Argentina, Canada, Australia, and the United States answered the call. Four themes emerged that indicate shared challenges in legislation, IRB inefficiencies and inconsistencies, general regulation and costs, and lack of HOF study knowledge by IRB members. We propose a model for IRB review of HOF studies based on best practices. CONCLUSION International criteria are needed that define low and high-risk HOF studies, to allow identification of studies that can undergo an expedited (or exempted) process from those that need full IRB review. Enhancing IRB processes in such a way would be beneficial to the conduct of HOF studies. Greater knowledge and promotion of HOF methods and evidence-based HOF study designs may support the evolving discipline. Based on these insights, training and guidance to IRB members may be developed to support them in ensuring that appropriate ethical issues for HOF studies are considered.
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Affiliation(s)
- Linda W Peute
- Centre for Human Factor Engineering of Health Information technology - Amsterdam UMC, University of Amsterdam, department of Medical Informatics, Amsterdam, The Netherlands
| | - Valentina Lichtner
- Centre for Medication Safety and Service Quality, UCL School of Pharmacy, UK
| | - Melissa T Baysari
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Maria Hägglund
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Juell Homco
- Department of Medical Informatics, University of Oklahoma - Tulsa School of Community Medicine, USA
| | | | - Ignacio Jauregui
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
| | - Johanna Kaipio
- Department of Computer Science, Aalto University, Finland
| | | | - Elin Christina Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway; Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Sweden
| | | | - Blake Lesselroth
- Department of Medical Informatics, University of Oklahoma - Tulsa School of Community Medicine, USA
| | - Daniel Luna
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
| | - Carlos Otero
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
| | - Rune Pedersen
- Norwegian Centre for E-health Research, University Hospital of North Norway HF, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Sylvia Pelayo
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, INSERM-CIC-IT 1403/Evalab, Lille, France
| | | | | | - Mari Tyllinen
- Department of Computer Science, Aalto University, Finland
| | - Lex Van Velsen
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Wu Yi Zheng
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Monique Jaspers
- Centre for Human Factor Engineering of Health Information technology - Amsterdam UMC, University of Amsterdam, department of Medical Informatics, Amsterdam, The Netherlands
| | - Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, INSERM-CIC-IT 1403/Evalab, Lille, France
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Farre A, Heath G, Shaw K, Bem D, Cummins C. How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies. BMJ Qual Saf 2019; 28:1021-1031. [PMID: 31358686 PMCID: PMC6934241 DOI: 10.1136/bmjqs-2018-009082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Background Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research. Methods We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically. Results 79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact. Conclusions Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.
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Affiliation(s)
- Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Gemma Heath
- Life and Health Sciences, Aston University, Birmingham, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Danai Bem
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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