Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study

被引:36
作者
Mozaffar, Hajar [1 ]
Cresswell, Kathrin M. [2 ]
Williams, Robin [3 ]
Bates, David W. [4 ]
Sheikh, Aziz [2 ]
机构
[1] Univ Edinburgh, Business Sch, 29 Buccleuch Pl, Edinburgh EH8 9JS, Midlothian, Scotland
[2] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Ctr Med Informat, Edinburgh, Midlothian, Scotland
[3] Univ Edinburgh, Inst Study Sci Technol & Innovat, Edinburgh, Midlothian, Scotland
[4] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
PHYSICIAN ORDER ENTRY; ELECTRONIC HEALTH RECORDS; PATIENT-SAFETY; MEDICATION ERRORS; INFORMATION-TECHNOLOGY; PRESCRIBING ERRORS; INTENSIVE-CARE; CONSEQUENCES; CPOE; IMPLEMENTATION;
D O I
10.1136/bmjqs-2016-005879
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective Hospital electronic prescribing (ePrescribing) systems offer a wide range of patient safety benefits. Like other hospital health information technology interventions, however, they may also introduce new areas of risk. Despite recent advances in identifying these risks, the development and use of ePrescribing systems is still leading to numerous unintended consequences, which may undermine improvement and threaten patient safety. These negative consequences need to be analysed in the design, implementation and use of these systems. We therefore aimed to understand the roots of these reported threats and identify candidate avoidance/mitigation strategies. Methods We analysed a longitudinal, qualitative study of the implementation and adoption of ePrescribing systems in six English hospitals, each being conceptualised as a case study. Data included semistructured interviews, observations of implementation meetings and system use, and a collection of relevant documents. We analysed data first within and then across the case studies. Results Our dataset included 214 interviews, 24 observations and 18 documents. We developed a taxonomy of factors underlying unintended safety threats in: (1) suboptimal system design, including lack of support for complex medication administration regimens, lack of effective integration between different systems, and lack of effective automated decision support tools; (2) inappropriate use of systems-in particular, too much reliance on the system and introduction of workarounds; and (3) suboptimal implementation strategies resulting from partial roll-outs/dual systems and lack of appropriate training. We have identified a number of system and organisational strategies that could potentially avoid or reduce these risks. Conclusions Imperfections in the design, implementation and use of ePrescribing systems can give rise to unintended consequences, including safety threats. Hospitals and suppliers need to implement short-and long-term strategies in terms of the technology and organisation to minimise the unintended safety risks.
引用
收藏
页码:722 / 733
页数:12
相关论文
共 60 条
[1]   Medication Errors Despite Using Electronic Health Records: The Value of a Clinical Pharmacist Service in Reducing Discharge-Related Medication Errors [J].
Alex, Sumana ;
Adenew, Ayne B. ;
Arundel, Cherinne ;
Maron, David D. ;
Kerns, Jennifer C. .
QUALITY MANAGEMENT IN HEALTH CARE, 2016, 25 (01) :32-37
[2]   Physicians' perception of CPOE implementation [J].
Allenet, Benoit ;
Bedouch, Pierrick ;
Bourget, Stephanie ;
Baudrant, Magalie ;
Foroni, Luc ;
Calop, Jean ;
Bosson, Jean-Luc .
INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 2011, 33 (04) :656-664
[3]  
[Anonymous], SOFTWARE ORG
[4]  
[Anonymous], I MED PREVENTING MED
[5]  
[Anonymous], HLTH SERV RES
[6]  
Ash J, UNINTENDED CONSEQUEN
[7]   The extent and importance of unintended consequences related to computerized provider order entry [J].
Ash, Joan S. ;
Sittig, Dean F. ;
Poon, Eric G. ;
Guappone, Kenneth ;
Campbell, Emily ;
Dykstra, Richard H. .
JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 2007, 14 (04) :415-423
[8]   Some unintended consequences of information technology in health care: The nature of patient care information system-related errors [J].
Ash, JS ;
Berg, M ;
Coiera, E .
JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 2004, 11 (02) :104-112
[9]  
Atkinson R., 2001, Social Research Update, V33, P1, DOI DOI 10.1111/J.1442-2018.2010.00541.X
[10]   Discontinuing medications: A novel approach for revising the prescribing stage of the medication-use process [J].
Bain, Kevin T. ;
Holmes, Holly M. ;
Beers, Mark H. ;
Maio, Vittorio ;
Handler, Steven M. ;
Pauker, Stephen G. .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2008, 56 (10) :1946-1952