Pharmacy interw rweaving safety within hospital health - - PowerPoint PPT Presentation

Pharmacy interw rweaving safety within hospital health information technology

Valentina Lichtner, Johanna Westbrook Bryony Dean Franklin

Funded by the European Union

Valentina.Lichtner@mq.edu.au @VLichtner

HIC 2018

Overview

• Background
• Aims and Methods
• Findings
• Conclusion

Medication safety with digital systems in hospital is achieved through ongoing work, building on good usability

Medication safety

11% of Europeans (*) experienced ‘a serious medical error from a medicine that was prescribed by a doctor’

European Commission (2016) Medical Errors. Special Eurobarometer 241/Wave 64.1 & 64.3

(*) respondents to Eurobarometer survey

One of the most serious concerns across all healthcare sectors worldwide

Medication safety

• Improvements by replacing

paper-based systems with digital systems

• Studies focused on electronic

prescribing and administration systems

electronic prescribing mobile apps as reminders for patients decision support for precise dosing decision support for pharmacogenomics electronic discharge summaries robotic dispensing barcode scanning for administration

• f medicines

stock management automated cabinets

Digitalisation

Delivering Digital Drugs @D3project

Aims

• Explore complexities
• f hospital medication

work and processes of digitalisation

Tracer approach : ‘follow the drugs’

• objects are followed through the organisation to investigate

processes across times and stakeholders and gather information about the whole organisation

• they are the starting point for expanding and connecting

The setting

• One of the largest NHS hospitals in

England

• Varied digital medicine systems in use
• Implementing an electronic prescribing

and administration system (EPMA) with decision support

EPR PAS EPMA Stock Mgt Dispensing

Methods

39 Interviews 22 pharmacy 11 nursing 4 medical 2 patients ~103 hours of

• bservations

Across 8 wards (4 with EPMA), 2 dispensaries, 2 stock management areas Documents Prescribing charts,

• nline drug formulary,

posters in clinical areas

Data analysis (1)

• Initial inductive coding
• immersion in the data
• identification of emerging themes
• qualitative analysis software

(NVivo)

• annotating process maps

Pharmacy medication steps with technology

Reconciliation at admission Inpatient Rx completed Medication review Ordering medications from Pharmacy Dispensing Pharmacist check Delivery Administration of medication Discharge EPMA EPR EPMA EPMA EPR EPMA Stock Mgt EPMA Supply/Stock Management Stock Mgt

Data analysis (2)

pharmacy key steps towards medication safety issues of non-integrated systems usability and cognitive work

• 1. Interweaving safety
• 2. Scaffolding people’s thinking
• 3. Linking-up unintegrated systems
• applying the theoretical lens of

medication safety as an ongoing achievement

Interweaving safety

• 1. Setting up medicines information in the system
• 2. Regularly checking its accuracy and appropriateness during ongoing

clinical care

• Interweaving work distributed across pharmacists, technicians,

support staff and delivery teams

• Embedded in multiple electronic medication systems

1

Cognitive scaffolding*

People organize and structure their work environment to facilitate cognitive work, improve efficiency and possibly reduce errors

* Andy Clark, 1997

Scaffolding people’s thinking

Pharmacy staff set up digital systems to scaffold others’ minds (doctors, nurses, other pharmacists, technicians and assistants) … we do all sorts of things like using […] tall man lettering, changing the order of the text, changing the way the [drug] strength is described perhaps, making it longer, making it shorter, whatever it might be…

(Pharmacy IT manager)

2

Linking-up systems

…we compensate for the lack of joined up technology by using people

(Pharmacy manager)

3

Linking-up systems

…That’s [strange]. See, I’ve typed in that number [7654321], it looks like that it’s her husband,

• possibly. Same surname. […]

But it’s [male name], and this one’s a [female name]. I think that might be a 2 instead of a 1.

• Yes. […] it might not have been spotted.

(Dispensing technician)

Usability issues

• speed : slow response

…10 minutes sitting there. Nothing [no response]. …the order you do thing in. And have you checked

• this. Have you checked that. […] You have it all in

your head and make a decision and then write it.

(Ward Pharmacist)

Usability issues

• long un-differentiated lists of medication

…it is quite hard […] to pick [high risk prescribing]

• ut from the clutter of routine...

(Ward Pharmacist)

Conclusions

A contribution to the ‘conceptual toolbox’ and language of safety in health IT

• Interweaving safety work
• Cognitive scaffolding

Take away messages

• Medication safety is an ongoing distributed achievement

based on people’s medication safety-oriented work with technology interweaved through ongoing patient care

• Cognitive scaffolding and usability change cognition and decision

making

• Poor usability risks undermining this safety work

References

• Braithwaite, J., R.L. Wears, and E. Hollnagel, Resilient health care: turning patient safety on its head.

International Journal for Quality in Health Care, 2015. 27(5): p. 418-20.

• Combey, P., A tracer approach to the study of organizations. Journal of Management Studies, 1980.

17(1): p. 96-126.

• Clark, A., Being there: putting brain, body, and world together again. 1997, Cambridge, Mass.; London:

MIT Press.

• Hutchins, E., How a cockpit remembers its speed. Cognitive Science, 1995. 19: p. 265-288.
• Lichtner, V., T. Cornford, and E. Klecun. ‘It’s people heavy’: A Sociotechnical view of hospital discharge.

in Proceedings of the 25th European Conference on Information Systems (ECIS). 2017. Portugal.

• Lintern, G. and A. Motavalli, Healthcare information systems: the cognitive challenge. BMC Medical

Informatics and Decision Making, 2018. 18(1): p. 3.

• Perrow, C., Normal accidents: living with high-risk technologies. 1984: Basic Books.

Delivering Digital Drugs @D3project