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Kinlay M, Zheng WY, Burke R, Juraskova I, Ho LMR, Turton H, Trinh J, Baysari MT. An Analysis of Incident Reports Related to Electronic Medication Management: How They Change Over Time. J Patient Saf 2024; 20:202-208. [PMID: 38525975 DOI: 10.1097/pts.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Electronic medication management (EMM) systems have been shown to introduce new patient safety risks that were not possible, or unlikely to occur, with the use of paper charts. Our aim was to examine the factors that contribute to EMM-related incidents and how these incidents change over time with ongoing EMM use. METHODS Incidents reported at 3 hospitals between January 1, 2010, and December 31, 2019, were extracted using a keyword search and then screened to identify EMM-related reports. Data contained in EMM-related incident reports were then classified as unsafe acts made by users and the latent conditions contributing to each incident. RESULTS In our sample, 444 incident reports were determined to be EMM related. Commission errors were the most frequent unsafe act reported by users (n = 298), whereas workarounds were reported in only 13 reports. User latent conditions (n = 207) were described in the highest number of incident reports, followed by conditions related to the organization (n = 200) and EMM design (n = 184). Over time, user unfamiliarity with the system remained a key contributor to reported incidents. Although fewer articles to electronic transfer errors were reported over time, incident reports related to the transfer of information between different computerized systems increased as hospitals adopted more clinical information systems. CONCLUSIONS Electronic medication management-related incidents continue to occur years after EMM implementation and are driven by design, user, and organizational conditions. Although factors contribute to reported incidents in varying degrees over time, some factors are persistent and highlight the importance of continuously improving the EMM system and its use.
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Affiliation(s)
- Madaline Kinlay
- From the Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney
| | | | | | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | | | | | - Jason Trinh
- Pharmacy Services, Sydney Local Health District
| | - Melissa T Baysari
- From the Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney
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Tranberg K, Due TD, Rozing M, Jønsson ABR, Kousgaard MB, Møller A. Challenges in reaching patients with severe mental illness for trials in general practice-a convergent mixed methods study based on the SOFIA pilot trial. Pilot Feasibility Stud 2023; 9:182. [PMID: 37908003 PMCID: PMC10617218 DOI: 10.1186/s40814-023-01395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) die prematurely due to undetected and inadequate treatment of somatic illnesses. The SOFIA pilot study was initiated to mend this gap in health inequity. However, reaching patients with SMI for intervention research has previously proven difficult. This study aimed to investigate the recruitment of patients with SMI for the SOFIA pilot study in 2021. METHODS We used a mixed-method convergent design. The qualitative material comprised 20 interviews with general practitioners (GPs) and staff, during patient recruitment. The quantitative data consisted of process data on baseline characteristics, GPs reported reasons for excluding a patient, reported reasons for patients declining participation, and registered data from a Danish population of patients with SMI. We used thematic analysis in the qualitative analysis and descriptive statistics for the quantitative analysis. Pillar integration was used for integrating the material. RESULTS Our findings show that selection bias occurred in the pilot study. We describe four main themes based on the integrated analysis that highlights selection issues: (1) poor data quality and inconsistency in defining severity definitions troubled identification and verification, (2) protecting the patient and maintaining practice efficiency, (3) being familiar with the patient was important for a successful recruitment, and (4) in hindsight, the GPs questioned whether the target population was reached. CONCLUSIONS In the light of theories of professions and street-level bureaucracy, we find that the main drivers of the patient selection bias occurring in the SOFIA pilot study were that 1) GPs and staff mended eligibility criteria to protect certain patients and/or to minimize workload and maintain efficiency in the practice 2) the data from the GP record systems and the digital assessment tool to assist recruitment was not optimal. Interventions targeting this patient group should carefully consider the recruitment strategy with a particular focus on professionals' discretionary practices and information technology pitfalls. TRIAL REGISTRATION The pilot trial protocol was registered on the 5th of November 2020. The registration number is NCT04618250 .
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Affiliation(s)
- Katrine Tranberg
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tina Drud Due
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Maarten Rozing
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Marius Brostrøm Kousgaard
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Duval Jensen J, Ledderer L, Kolbæk R, Beedholm K. Fragmented care trajectories in municipal healthcare: Local sensemaking of digital documentation. Digit Health 2023; 9:20552076231180521. [PMID: 37312959 PMCID: PMC10259120 DOI: 10.1177/20552076231180521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
Objective Since the 1990s, almost all healthcare organisations have had electronic health records (EHR) to organise and manage treatment, care and work routines. This article aims to understand how healthcare professionals (HCPs) make sense of digital documentation practice. Methods Based on a case study design, field observations and semi-structured interviews were conducted in a Danish municipality. A systematic analysis based on Karl Weick's sensemaking theory was applied to investigate what cues HCPs extract from timetables in the EHR and how institutional logics frame the enactment of documentation practice. Results The analysis uncovered three themes: making sense of planning, making sense of tasks and making sense of documentation. The themes illustrate that HCPs make sense of the digital documentation practice as a dominant managerial tool designed to control resources and work routines. This sensemaking leads to a task-oriented practice which centres on delivering fragmented tasks according to a timetable. Conclusion HCPs mitigate fragmentation by responding to a care professional logic, where they document to share information and carry out invisible work outside of timetables and scheduled tasks. However, HCPs are focused on solving specific tasks by the minute with the possible consequence that continuity and their overview of the service user's care and treatment disappear. In conclusion, the EHR system eliminates a holistic view of care trajectories, leaving it up to HCPs to collaborate in an effort to obtain continuity for the service user.
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Affiliation(s)
| | - Loni Ledderer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Raymond Kolbæk
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Zhai Y, Yu Z, Zhang Q, Qin W, Yang C, Zhang Y. Transition to a new nursing information system embedded with clinical decision support: a mixed-method study using the HOT-fit framework. BMC Med Inform Decis Mak 2022; 22:310. [PMID: 36443738 PMCID: PMC9703774 DOI: 10.1186/s12911-022-02041-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Nursing information systems embedded with standardized nursing language and clinical decision support have been increasingly introduced in health care settings. User experience is key to the adoption of health information technologies. Despite extensive research into the user experience with nursing information systems, few studies have focused on the interaction between user, technology and organizational attributes during its implementation. Guided by the human, organization and technology-fit framework, this study aimed to investigate nurses' perceptions and experiences with transition to a new nursing information system (Care Direct) 2 years after its first introduction. METHODS This is a mixed-method study using an embedded design. An online survey was launched to collect nurses' self-reported use of the new system, perceived system effectiveness and experience of participation in system optimization. Twenty-two semi structured interviews were conducted with twenty nurses with clinical or administrative roles. The quantitative and qualitative data were merged using the Pillar Integration Process. RESULTS The average score of system use behavior was 3.76 ± 0.79. Regarding perceived system effectiveness, the score of each dimension ranged 3.07-3.34 out of 5. Despite large variations in approaches to participating in system optimization, nurses had generally positive experiences with management and technical support. Eight main categories emerged from the integrated findings, which were further condensed into three themes: perceptions on system content, structure, and functionality; perceptions on interdisciplinary and cross-level cooperation; and embracing and accepting the change. CONCLUSIONS Effective collaboration between clinicians, administrators and technical staff is required during system promotion to enhance system usability and user experience. Clear communication of organizational missions to staff and support from top management is needed to smooth the system implementation process and achieve broader system adoption.
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Affiliation(s)
- Yue Zhai
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenghong Yu
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Qin
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- grid.8547.e0000 0001 0125 2443Department of Information, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
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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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