Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: a study protocol

被引：27

作者：

Westbrook, J. I. ^{[1
]}

Li, L. ^{[1
]}

Raban, M. Z. ^{[1
]}

Baysari, M. T. ^{[1
]}

Mumford, V. ^{[1
]}

Prgomet, M. ^{[1
]}

Georgiou, A. ^{[1
]}

Kim, T. ^{[1
]}

Lake, R. ^{[1
]}

McCullagh, C. ^{[2
]}

Dalla-Pozza, L. ^{[2
]}

Karnon, J. ^{[3
]}

O'Brien, T. A. ^{[2
]}

Ambler, G. ^{[2
,4
]}

Day, R. ^{[5
]}

Cowell, C. T. ^{[2
]}

Gazarian, M. ^{[5
]}

Worthington, R. ^{[2
]}

Lehmann, C. U. ^{[6
]}

White, L. ^{[7
]}

Barbaric, D. ^{[2
]}

Gardo, A. ^{[2
]}

Kelly, M. ^{[7
]}

Kennedy, P. ^{[8
]}

机构：

[1] Macquarie Univ, Australian Inst Hlth Innovat, Ctr Hlth Syst & Safety Res, Sydney, NSW, Australia

[2] Sydney Childrens Hosp Network, Sydney, NSW, Australia

[3] Univ Adelaide, Adelaide, SA, Australia

[4] Univ Sydney, Sydney, NSW, Australia

[5] Univ New South Wales, Sch Med Sci, Fac Med, Sydney, NSW, Australia

[6] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA

[7] Off Kids & Families NSW Hlth, Nashville, TN USA

[8] EHlth NSW Hlth Minist, Nashville, TN USA

来源：

BMJ OPEN | 2016年 / 6卷 / 10期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

PHYSICIAN ORDER ENTRY; CARE; INFORMATION; IMPLEMENTATION; TECHNOLOGY; MORTALITY; SAFETY; WORK; TIME;

D O I：

10.1136/bmjopen-2016-011811

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction: Medication errors are the most frequent cause of preventable harm in hospitals. Medication management in paediatric patients is particularly complex and consequently potential for harms are greater than in adults. Electronic medication management (eMM) systems are heralded as a highly effective intervention to reduce adverse drug events (ADEs), yet internationally evidence of their effectiveness in paediatric populations is limited. This study will assess the effectiveness of an eMM system to reduce medication errors, ADEs and length of stay (LOS). The study will also investigate system impact on clinical work processes. Methods and analysis: A stepped-wedge cluster randomised controlled trial (SWCRCT) will measure changes pre-eMM and post-eMM system implementation in prescribing and medication administration error (MAE) rates, potential and actual ADEs, and average LOS. In stage 1, 8 wards within the first paediatric hospital will be randomised to receive the eMM system 1 week apart. In stage 2, the second paediatric hospital will randomise implementation of a modified eMM and outcomes will be assessed. Prescribing errors will be identified through record reviews, and MAEs through direct observation of nurses and record reviews. Actual and potential severity will be assigned. Outcomes will be assessed at the patient-level using mixed models, taking into account correlation of admissions within wards and multiple admissions for the same patient, with adjustment for potential confounders. Interviews and direct observation of clinicians will investigate the effects of the system on workflow. Data from site 1 will be used to develop improvements in the eMM and implemented at site 2, where the SWCRCT design will be repeated (stage 2). Ethics and dissemination: The research has been approved by the Human Research Ethics Committee of the Sydney Children's Hospitals Network and Macquarie University. Results will be reported through academic journals and seminar and conference presentations.

引用

页数：11

共 35 条

[1] Australian Commission on Safety and Quality in Health Care, 2012, EL MED MAN EMM GUID
[2] Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study
Ballermann, Mark A.
Shaw, Nicola T.
Mayes, Damon C.
Gibney, R. T. Noel
Westbrook, Johanna I.
[J]. BMC MEDICAL INFORMATICS AND DECISION MAKING, 2011, 11
[3] Brigham and Women's Hospital, 2015, COMP PRESCR ORD ENTR
[4] Brown CA., 2006, BMC MED RES METHODOL, V6, P54, DOI DOI 10.1186/1471-2288-6-54
[5] Perceptions of the Effect of Information and Communication Technology on the Quality of Care Delivered in Emergency Departments: A Cross-Site Qualitative Study
Callen, Joanne
Paoloni, Richard
Li, Julie
Stewart, Michael
Gibson, Kathryn
Georgiou, Andrew
Braithwaite, Jeffrey
Westbrook, Johanna
[J]. ANNALS OF EMERGENCY MEDICINE, 2013, 61 (02) : 131 - 144
[6] Validity and reliability of observational methods for studying medication administration errors
Dean, B
Barber, N
[J]. AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2001, 58 (01) : 54 - 59
[7] Tenfold Medication Errors: 5 Years' Experience at a University-Affiliated Pediatric Hospital
Doherty, Catherine
Mc Donnell, Conor
[J]. PEDIATRICS, 2012, 129 (05) : 916 - 924
[8] Dufendach K R., 2015, Core Functionality in Pediatric Electronic Health Records Rockville, MD Agency for Healthcare Research and Quality (US)
[9] Gazarian M, 2014, AUST PRESCR, V37, P24
[10] Long-term Reduction in Adverse Drug Events: An Evidence-Based Improvement Model
Gazarian, Madlen
Graudins, Linda Velta
[J]. PEDIATRICS, 2012, 129 (05) : E1334 - E1342

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