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Lau EY, Cragg A, Small SS, Butcher K, Hohl CM. Characterizing and Comparing Adverse Drug Events Documented in 2 Spontaneous Reporting Systems in the Lower Mainland of British Columbia, Canada: Retrospective Observational Study. JMIR Hum Factors 2024; 11:e52495. [PMID: 38236629 PMCID: PMC10835584 DOI: 10.2196/52495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Robust adverse drug event (ADE) reporting systems are crucial to monitor and identify drug safety signals, but the quantity and type of ADEs captured may vary by system characteristics. OBJECTIVE We compared ADEs reported in 2 different reporting systems in the same jurisdictions, the Patient Safety and Learning System-Adverse Drug Reaction (PSLS-ADR) and ActionADE, to understand report variation. METHODS This retrospective observational study analyzed reports entered into PSLS-ADR and ActionADE systems between December 1, 2019, and December 31, 2022. We conducted a comprehensive analysis including all events from both reporting systems to examine coverage and usage and understand the types of events captured in both systems. We calculated descriptive statistics for reporting facility type, patient demographics, serious events, and most reported drugs. We conducted a subanalysis focused on adverse drug reactions to enable direct comparisons between systems in terms of the volume and events reported. We stratified results by reporting system. RESULTS We performed the comprehensive analysis on 3248 ADE reports, of which 12.4% (375/3035) were reported in PSLS-ADR and 87.6% (2660/3035) were reported in ActionADE. Distribution of all events and serious events varied slightly between the 2 systems. Iohexol, gadobutrol, and empagliflozin were the most common culprit drugs (173/375, 46.2%) in PSLS-ADR, while hydrochlorothiazide, apixaban, and ramipril (308/2660, 11.6%) were common in ActionADE. We included 2728 reports in the subanalysis of adverse drug reactions, of which 12.9% (353/2728) were reported in PSLS-ADR and 86.4% (2357/2728) were reported in ActionADE. ActionADE captured 4- to 6-fold more comparable events than PSLS-ADR over this study's period. CONCLUSIONS User-friendly and robust reporting systems are vital for pharmacovigilance and patient safety. This study highlights substantial differences in ADE data that were generated by different reporting systems. Understanding system factors that lead to varying reporting patterns can enhance ADE monitoring and should be taken into account when evaluating drug safety signals.
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Affiliation(s)
- Erica Y Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Centre, Vancouver, BC, Canada
| | - Amber Cragg
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Centre, Vancouver, BC, Canada
| | - Serena S Small
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Centre, Vancouver, BC, Canada
| | - Katherine Butcher
- Pharmaceutical Science, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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Cragg A, Small SS, Lau E, Rowe A, Lau A, Butcher K, Hohl CM. Sharing Adverse Drug Event Reports Between Hospitals and Community Pharmacists to Inform Re-dispensing: An Analysis of Reports and Process Outcomes. Drug Saf 2023; 46:1161-1172. [PMID: 37783974 PMCID: PMC10632212 DOI: 10.1007/s40264-023-01348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Adverse drug events (ADEs) are a leading cause of unplanned hospital visits. We designed ActionADE, an online ADE reporting platform, and integrated it with PharmaNet, British Columbia's (BC's) provincial medication dispensing system, to overcome identified barriers in ADE reporting and communicate ADEs to community pharmacies. Our objectives were to characterise ADEs reported in ActionADE, explore associations between patients' age, sex and ADE characteristics, and estimate the re-dispensation rate of culprit medications in community pharmacies. METHODS We conducted a prospective observational study of ADE reporting in four BC hospitals between April 1, 2020 and October 31, 2022. We described the characteristics of ADEs reported into ActionADE, used logistic regression modelling to examine associations between age and sex and ADE characteristics, and calculated rates of avoided culprit drug re-dispensations using community pharmacists' responses to ActionADE alerts. RESULTS In total, 3591 ADE reports were initiated by hospital clinicians, 3174 of which were included in this analysis. Serious or life-threatening ADEs resulting in permanent disability, hospitalisation, extended hospitalisation, and/or death accounted for 28.5% (906/3174; 95% CI 27.0-30.1%) of reports. Males were more likely to have non-adherence reported compared to females and experienced life threatening ADEs at a younger age than females. Of 592 patients who had ≥ 1 adverse drug reaction or allergy report (a subset of ADEs) transmitted to community pharmacies, 200 subsequently attempted to re-fill the culprit or a same class drug. Community pharmacists responded to preventative alerts by avoiding re-dispensation in 33.0% (66/200; 95% CI 26.5-39.5%). INTERPRETATION ActionADE is the first interoperable system that communicates ADEs via a central medication database to community pharmacies. Every 10th ADE reported in ActionADE and shared to PharmaNet resulted in community pharmacists' avoiding one culprit or same class drug re-exposure. Further research is needed to understand ActionADE's impact on patient and health system outcomes.
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Affiliation(s)
- Amber Cragg
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Serena S Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erica Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adrianna Rowe
- Emergency Department, University Health Network, Toronto, ON, Canada
| | - Anthony Lau
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada
| | - Katherine Butcher
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.
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Fossouo Tagne J, Yakob RA, Mcdonald R, Wickramasinghe N. A Web-Based Tool to Report Adverse Drug Reactions by Community Pharmacists in Australia: Usability Testing Study. JMIR Form Res 2023; 7:e48976. [PMID: 37773620 PMCID: PMC10576234 DOI: 10.2196/48976] [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: 05/13/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are unintended and harmful events associated with medication use. Despite their significance in postmarketing surveillance, quality improvement, and drug safety research, ADRs are vastly underreported. Enhanced digital-based communication of ADR information to regulators and among care providers could significantly improve patient safety. OBJECTIVE This paper presents a usability evaluation of the commercially available GuildCare Adverse Event Recording system, a web-based ADR reporting system widely used by community pharmacists (CPs) in Australia. METHODS We developed a structured interview protocol encompassing remote observation, think-aloud moderating techniques, and retrospective questioning to gauge the overall user experience, complemented by the System Usability Scale (SUS) assessment. Thematic analysis was used to analyze field notes from the interviews. RESULTS A total of 7 CPs participated in the study, who perceived the system to have above-average usability (SUS score of 68.57). Nonetheless, the structured approach to usability testing unveiled specific functional and user interpretation issues, such as unnecessary information, lack of system clarity, and redundant data fields-critical insights not captured by the SUS results. Design elements like drop-down menus, free-text entry, checkboxes, and prefilled or auto-populated data fields were perceived as useful for enhancing system navigation and facilitating ADR reporting. CONCLUSIONS The user-centric design of technology solutions, like the one discussed herein, is crucial to meeting CPs' information needs and ensuring effective ADR reporting. Developers should adopt a structured approach to usability testing during the developmental phase to address identified issues comprehensively. Such a methodological approach may promote the adoption of ADR reporting systems by CPs and ultimately enhance patient safety.
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Affiliation(s)
- Joel Fossouo Tagne
- School of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, Australia
- Centre for Health Analytics, Murdoch Children's Research Institute, Health Informatics, Melbourne, Australia
| | | | - Rachael Mcdonald
- MedTechVic, Swinburne University of Technology, Melbourne, Australia
- Department of Nursing and Allied Health, Occupational Therapy, Swinburne University of Technology, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- School of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
- Epworth Healthcare, Melbourne, Australia
- School of Computing, Engineering & Mathematical Sciences, La Trobe University, Melbourne, Australia
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Fossouo Tagne J, Yakob RA, Mcdonald R, Wickramasinghe N. Linking Activity Theory Within User-Centered Design: Novel Framework to Inform Design and Evaluation of Adverse Drug Reaction Reporting Systems in Pharmacy. JMIR Hum Factors 2023; 10:e43529. [PMID: 36826985 PMCID: PMC10007010 DOI: 10.2196/43529] [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: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) may cause serious injuries including death. Timely reporting of ADRs may play a significant role in patient safety; however, underreporting exists. Enhancing the electronic communication of ADR information to regulators and between health care providers has the potential to reduce recurrent ADRs and improve patient safety. OBJECTIVE The main objectives were to explore the low rate of ADR reporting by community pharmacists (CPs) in Australia, evaluate the usability of an existing reporting system, and how this knowledge may influence the design of subsequent electronic ADR reporting systems. METHODS The study was carried out in 2 stages. Stage 1 involved qualitative semistructured interviews to identify CPs' perceived barriers and facilitators to ADR reporting. Data were analyzed by thematic analysis, and identified themes were subsequently aligned to the task-technology fit (TTF) framework. The second stage involved a usability evaluation of a commercial web-based ADR reporting system. A structured interview protocol that combined virtual observation, think-aloud moderating techniques, retrospective questioning of the overall user experience, and a System Usability Scale (SUS). The field notes from the interviews were subjected to thematic analysis. RESULTS In total, 12 CPs were interviewed in stage 1, and 7 CPs participated in stage 2. The interview findings show that CPs are willing to report ADRs but face barriers from environmental, organizational, and IT infrastructures. Increasing ADR awareness, improving workplace practices, and implementing user-focused electronic reporting systems were seen as facilitators of ADR reporting. User testing of an existing system resulted in above average usability (SUS 68.57); however, functional and user interpretation issues were identified. Design elements such as a drop-down menu, free-text entry, checkbox, and prefilled data fields were perceived to be extremely useful for navigating the system and facilitating ADR reporting. CONCLUSIONS Existing reporting systems are not suited to report ADRs, or adapted to workflow, and are rarely used by CPs. Our study uncovered important contextual information for the design of future ADR reporting interventions. Based on our study, a multifaceted, theory-guided, user-centered, and best practice approach to design, implementation, and evaluation may be critical for the successful adoption of ADR reporting electronic interventions and patient safety. Future studies are needed to evaluate the effectiveness of theory-driven frameworks used in the design and implementation of ADR reporting systems.
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Affiliation(s)
- Joel Fossouo Tagne
- School of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, Australia.,Centre for Health Analytics, Murdoch Children's Research Institute, Melbourne, Australia.,MedTechVic, Swinburne University of Technology, Melbourne, Australia
| | | | - Rachael Mcdonald
- MedTechVic, Swinburne University of Technology, Melbourne, Australia.,Department of Nursing and Allied Health, Occupational Therapy, Swinburne University of Technology, Melbourne, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- School of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia.,Epworth Healthcare, Melbourne, Australia
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Why hospital-based healthcare professionals do not report adverse drug reactions: a mixed methods study using the Theoretical Domains Framework. Eur J Clin Pharmacol 2022; 78:1165-1175. [PMID: 35476123 PMCID: PMC9043508 DOI: 10.1007/s00228-022-03326-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022]
Abstract
Purpose Adverse drug reaction (ADR) underreporting is highly prevalent across the world. This study aimed to identify factors associated with ADR reporting and map these to a behavioural change framework to help inform future interventions designed to improve ADR underreporting. Methods A mixed methods survey was distributed to healthcare professionals at a tertiary hospital in Sydney, Australia. Quantitative data was analysed using logistic regression to identify factors that predict ADR reporting. Qualitative data was evaluated using content analysis. These were then integrated and mapped to the 14 domains within the Theoretical Domains Framework (TDF) to identify target areas relevant for improving ADR reporting. Results One hundred thirty-three healthcare professionals completed the survey. Knowing how to report ADRs (OR 4.56, 95%CI 1.95–10.7), having been trained on ADR reporting (OR 2.72, 95%CI 1.29–5.77), and encountering ADRs as part of clinical practice (OR 10.3, 95%CI 3.59–29.4) were significant predictors of reporting an ADR. Content analysis identified three categories: modifying the ADR reporting process, enabling clinicians to report ADRs, and creating a positive ADR reporting culture. After data integration, the three target TDF domains were knowledge, environmental context/resources, and beliefs about consequences. Conclusion Future interventions designed to improve ADR reporting should address these target domains to instigate behaviour change in healthcare professionals’ reporting of ADRs. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03326-x.
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Skutezky T, Small SS, Peddie D, Balka E, Hohl CM. Beliefs and perceptions of patient safety event reporting in a Canadian Emergency Department: a qualitative study. CAN J EMERG MED 2022; 24:867-875. [PMID: 36344901 PMCID: PMC9763130 DOI: 10.1007/s43678-022-00400-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Patient safety events (PSEs) are unwanted or unexpected events that occur during medical care. High cognitive loads and frequent interruptions make emergency departments (EDs) uniquely error prone environments. Yet, frontline clinicians rarely report PSEs using incident reporting systems. The incidence, severity, and preventability of PSEs thus remain poorly understood, and contributing factors are understudied. We sought to understand ED staff beliefs and perceptions about their PSE reporting system and what features they believe are important in such a system. METHODS We conducted a qualitative study among healthcare providers working in the ED and departmental leadership. We recruited participants via email and held a series of interviews, focus groups, and participatory workshops. We iteratively analyzed the data using the constant comparative method and used thematic analysis to establish themes. RESULTS 50 participants attended at least one focus group, interview, or workshop. Participants perceived that PSE reporting through formal channels in the ED was challenging. Clinicians had an inherent desire to report PSEs and do so through numerous informal channels, yet underreported in formal reporting systems. The current PSE reporting system did not meet frontline staff needs and was viewed as ineffective in improving care quality and safety. We identified three key features for an improved PSE reporting system: (1) clear definitions; (2) transparency; and (3) simplicity. CONCLUSIONS In this study, we have identified ideal features for PSE reporting processes to meet the needs of both frontline staff and departmental leadership based on perceptions of current PSE reporting practices. Improved PSE reporting processes have the potential to increase PSE reporting in the ED overall, increasing the availability of information about PSEs to support quality improvement and improve patient safety.
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Affiliation(s)
- Trevor Skutezky
- grid.17091.3e0000 0001 2288 9830Department of Emergency Medicine, University of British Columbia, Vancouver, BC Canada
| | - Serena S. Small
- grid.17091.3e0000 0001 2288 9830Department of Emergency Medicine, University of British Columbia, Vancouver, BC Canada ,grid.417243.70000 0004 0384 4428Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC Canada
| | - David Peddie
- grid.417243.70000 0004 0384 4428Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC Canada ,grid.61971.380000 0004 1936 7494School of Communication, Simon Fraser University, Burnaby, BC Canada
| | - Ellen Balka
- grid.417243.70000 0004 0384 4428Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC Canada ,grid.61971.380000 0004 1936 7494School of Communication, Simon Fraser University, Burnaby, BC Canada
| | - Corinne M. Hohl
- grid.17091.3e0000 0001 2288 9830Department of Emergency Medicine, University of British Columbia, Vancouver, BC Canada ,grid.417243.70000 0004 0384 4428Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC Canada
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7
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Hau JP, Brasher PMA, Cragg A, Small S, Wickham M, Hohl CM. Using ActionADE to create information continuity to reduce re-exposures to harmful medications: study protocol for a randomized controlled trial. Trials 2021; 22:119. [PMID: 33546752 PMCID: PMC7866708 DOI: 10.1186/s13063-021-05061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Repeat exposures to culprit medications are a common cause of preventable adverse drug events. Health information technologies have the potential to reduce repeat adverse drug events by improving information continuity. However, they rarely interoperate to ensure providers can view adverse drug events documented in other systems. We designed ActionADE to enable rapid documentation of adverse drug events and communication of standardized information across health sectors by integrating with legacy systems. We will leverage ActionADE's implementation to conduct two parallel, randomized trials: patients with adverse drug reactions in the main trial and those diagnosed with non-adherence in a secondary trial. Primary objective of the main trial is to evaluate the effects of providing information continuity about adverse drug reactions on culprit medication re-dispensations over 12 months. Primary objective of the secondary trial is to evaluate the effect of providing information continuity on adherence over 12 months. METHODS We will conduct two parallel group, triple-blind randomized controlled trials in participating hospitals in British Columbia, Canada. We will enroll adults presenting to hospital with an adverse drug event to prescribed outpatient medication. Clinicians will document the adverse drug event in ActionADE. The software will use an algorithm to determine patient eligibility and allocate eligible patients to experimental or control. In the experimental arm, ActionADE will transmit information to PharmaNet, where adverse drug event information will be displayed in community pharmacies when re-dispensations are attempted. In the control arm, ActionADE will retain information in the local record. We will enroll 3600 adults with an adverse drug reaction into the main trial. The main trial's primary outcome is re-dispensation of a culprit or same-class medication within 12 months; the secondary trial's primary outcome will be adherence to culprit medication. Secondary outcomes include health services utilization and mortality. DISCUSSION These studies have the potential to guide policy decisions and investments needed to drive health information technology integrations to prevent repeat adverse drug events. We present an example of how a health information technology implementation can be leveraged to conduct pragmatic randomized controlled trials. TRIAL REGISTRATION ClinicalTrials.gov NCT04568668 , NCT04574648 . Registered on 1 October 2020.
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Affiliation(s)
- Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Amber Cragg
- Department of Emergency Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Serena Small
- Department of Emergency Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Maeve Wickham
- Department of Emergency Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.,School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z9, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada. .,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada. .,Vancouver General Hospital, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1M9, Canada.
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Baumgartner A, Kunkes T, Clark CM, Brady LA, Monte SV, Singh R, Wahler RG, Chen HYW. Opportunities and Recommendations for Improving Medication Safety: Understanding the Medication Management System in Primary Care Through an Abstraction Hierarchy. JMIR Hum Factors 2020; 7:e18103. [PMID: 32788157 PMCID: PMC7453327 DOI: 10.2196/18103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/12/2023] Open
Abstract
Background Despite making great strides in improving the treatment of diseases, the minimization of unintended harm by medication therapy continues to be a major hurdle facing the health care system. Medication error and prescription of potentially inappropriate medications (PIMs) represent a prevalent source of harm to patients and are associated with increased rates of adverse events, hospitalizations, and increased health care costs. Attempts to improve medication management systems in primary care have had mixed results. Implementation of new interventions is difficult because of complex contextual factors within the health care system. Abstraction hierarchy (AH), the first step in cognitive work analysis (CWA), is used by human factors practitioners to describe complex sociotechnical systems. Although initially intended for the nuclear power domain and interface design, AH has been used successfully to aid the redesign of numerous health care systems such as the design of decision support tools, mobile patient monitoring apps, and a telephone triage system. Objective This paper aims to refine our understanding of the primary care office in relation to a patient’s medication through the development of an AH. Emphasis was placed on the elements related to medication safety to provide guidance for the design of a safer medication management system in primary care. Methods The AH development was guided by the methodology used by seminal CWA literature. It was initially developed by 2 authors and later fine-tuned by an expert panel of clinicians, social scientists, and a human factors engineer. It was subsequently refined until an agreement was reached. A means-ends analysis was performed and described for the nodes of interest. The model represents the primary care office space through functional purposes, values and priorities, function-related purposes, object-related processes, and physical objects. Results This model depicts the medication management system at various levels of abstraction. The resulting components must be balanced and coordinated to provide medical treatment with limited health care resources. Understanding the physical and informational constraints on activities that occur in a primary care office depicted in the AH defines areas in which medication safety can be improved. Conclusions Numerous means-ends relationships were identified and analyzed. These can be further evaluated depending on the specific needs of the user. Recommendations for optimizing a medication management system in a primary care facility were made. Individual practices can use AH for clinical redesign to improve prescribing and deprescribing practices.
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Affiliation(s)
- Andrew Baumgartner
- Department of Family Medicine, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Taylor Kunkes
- Department of Industrial and Systems Engineering, School of Engineering and Applied Sciences, University at Buffalo, Buffalo, NY, United States
| | - Collin M Clark
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States
| | - Laura A Brady
- Department of Family Medicine, Primary Care Research Institute, State University of New York at Buffalo, Buffalo, NY, United States
| | - Scott V Monte
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States
| | - Ranjit Singh
- Department of Family Medicine, Primary Care Research Institute, State University of New York at Buffalo, Buffalo, NY, United States
| | - Robert G Wahler
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States
| | - Huei-Yen Winnie Chen
- Department of Industrial and Systems Engineering, School of Engineering and Applied Sciences, University at Buffalo, Buffalo, NY, United States
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Griffey RT, Schneider RM, Todorov AA, Yaeger L, Sharp BR, Vrablik MC, Aaronson EL, Sammer C, Nelson A, Manley H, Dalton P, Adler L. Critical Review, Development, and Testing of a Taxonomy for Adverse Events and Near Misses in the Emergency Department. Acad Emerg Med 2019; 26:670-679. [PMID: 30859666 DOI: 10.1111/acem.13724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES An adverse event (AE) is a physical harm experienced by a patient due to health care, requiring intervention. Describing and categorizing AEs is important for quality and safety assessment and identifying areas for improvement. Safety science suggests that improvement efforts should focus on preventing and mitigating harm rather than on error, which is commonplace but infrequently leads to AEs. Most taxonomies fail to describe harm experienced by patients (e.g., hypoxia, hemorrhage, anaphylaxis), focusing instead on errors, and use categorizations that are too broad to be useful (e.g., "communication error"). We set out to create a patient-centered, emergency department (ED)-specific framework for describing AEs and near misses to advance quality and safety in the acute care setting. METHODS We performed a critical review of existing taxonomies of harm, evaluating their applicability to the ED. We identified and adopted a classification framework and developed a taxonomy using an iterative process categorizing approximately 600 previously identified AEs and near misses. We reviewed this taxonomy with collaborators at four medical centers, receiving feedback and providing clarification. We then disseminated a set of representative scenarios for these safety experts to categorize independently using the taxonomy. We calculated interrater reliability and performance compared to our criterion standard. RESULTS Our search identified candidate taxonomies for detailed review. We selected the Adventist Health Systems AE taxonomy and modified this for use in the ED, adopting a framework of categories, subcategories, and up to three modifiers to further describe events. On testing, overall reviewer agreement with the criterion standard was 92% at the category level and 88% at the subcategory level. Three of the four raters concurred in 55 of 59 scenarios (93%) and all four concurred in 46 of 59 scenarios (78%). At the subcategory level, there was complete agreement in 40 of 59 (68%) scenarios and majority agreement in 55 of 59 instances (93%). Performance of individual raters ranged from very good (88%, 52/59) to near perfect (98%, 58/59) at the main category level. CONCLUSIONS We developed a taxonomy of AEs and near misses for the ED, modified from an existing framework. Testing of the tool with minimal training yielded high performance and good inter-rater reliability. This taxonomy can be adapted and modified by EDs seeking to enhance their quality and safety reviews and characterize harm occurring in their EDs for quality improvement purposes.
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Affiliation(s)
- Richard T. Griffey
- Division of Emergency Medicine Washington University School of Medicine St. Louis MO
| | - Ryan M. Schneider
- Division of Emergency Medicine Washington University School of Medicine St. Louis MO
| | | | - Lauren Yaeger
- Washington University School of Medicine St. Louis MO
| | - Brian R. Sharp
- Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health Madison WI
| | | | | | | | | | - Holly Manley
- Department of Clinical Patient Safety AdventHealth Altamonte FL
| | - Patricia Dalton
- Department of Clinical Patient Safety AdventHealth Altamonte FL
| | - Lee Adler
- Department of Clinical Patient Safety AdventHealth Altamonte FL
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10
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Small SS, Hohl CM, Balka E. Organizational implications of implementing a new adverse drug event reporting system for care providers and integrating it with provincial health information systems. Healthc Manage Forum 2019; 32:208-212. [PMID: 31091996 DOI: 10.1177/0840470419845384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cross-sector collaborations between academia, government, and private industry, known as Triple Helix configurations, are increasingly common. In the health Information Technology (IT) sector, such configurations often also include health delivery organizations where technology is implemented and used. The complexity of collaborating within and between multiple organizations can present hurdles for innovators that are seldom discussed in the literature. We outline challenges we encountered in cross-sector collaboration and offer some guiding principles for decision-makers, academics, industry partners, and health delivery organizations to successfully negotiate divergent approaches to innovation and implementation. We discuss an innovative project that aims to implement a researcher-designed adverse drug event reporting system into clinical care and integrate it with provincial and health authority IT systems. Based on our experience, implementing an interoperable health IT system must extend beyond technical integration to encompass meaningful stakeholder engagement to ensure utility for end-users and beneficial impact for participating organizations.
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Affiliation(s)
- Serena S Small
- 1 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,2 School of Communication, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Corinne M Hohl
- 1 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,3 Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,4 Emergency Department, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ellen Balka
- 1 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,2 School of Communication, Simon Fraser University, Burnaby, British Columbia, Canada
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Peddie D, Small SS, Badke K, Bailey C, Balka E, Hohl CM. Adverse Drug Event Reporting From Clinical Care: Mixed-Methods Analysis for a Minimum Required Dataset. JMIR Med Inform 2018; 6:e10248. [PMID: 29954724 PMCID: PMC6043729 DOI: 10.2196/10248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 12/02/2022] Open
Abstract
Background Patients commonly transition between health care settings, requiring care providers to transfer medication utilization information. Yet, information sharing about adverse drug events (ADEs) remains nonstandardized. Objective The objective of our study was to describe a minimum required dataset for clinicians to document and communicate ADEs to support clinical decision making and improve patient safety. Methods We used mixed-methods analysis to design a minimum required dataset for ADE documentation and communication. First, we completed a systematic review of the existing ADE reporting systems. After synthesizing reporting concepts and data fields, we conducted fieldwork to inform the design of a preliminary reporting form. We presented this information to clinician end-user groups to establish a recommended dataset. Finally, we pilot-tested and refined the dataset in a paper-based format. Results We evaluated a total of 1782 unique data fields identified in our systematic review that describe the reporter, patient, ADE, and suspect and concomitant drugs. Of these, clinicians requested that 26 data fields be integrated into the dataset. Avoiding the need to report information already available electronically, reliance on prospective rather than retrospective causality assessments, and omitting fields deemed irrelevant to clinical care were key considerations. Conclusions By attending to the information needs of clinicians, we developed a standardized dataset for adverse drug event reporting. This dataset can be used to support communication between care providers and integrated into electronic systems to improve patient safety. If anonymized, these standardized data may be used for enhanced pharmacovigilance and research activities.
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Affiliation(s)
- David Peddie
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Communication, Simon Fraser University, Burnaby, BC, Canada
| | - Serena S Small
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Communication, Simon Fraser University, Burnaby, BC, Canada
| | - Katherin Badke
- Vancouver General Hospital, Department of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Chantelle Bailey
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ellen Balka
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Communication, Simon Fraser University, Burnaby, BC, Canada
| | - Corinne M Hohl
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Vancouver General Hospital, Emergency Department, Vancouver, BC, Canada
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Hohl CM, Small SS, Peddie D, Badke K, Bailey C, Balka E. Why Clinicians Don't Report Adverse Drug Events: Qualitative Study. JMIR Public Health Surveill 2018; 4:e21. [PMID: 29487041 PMCID: PMC5849794 DOI: 10.2196/publichealth.9282] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/21/2017] [Accepted: 01/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adverse drug events are unintended and harmful events related to medications. Adverse drug events are important for patient care, quality improvement, drug safety research, and postmarketing surveillance, but they are vastly underreported. Objective Our objectives were to identify barriers to adverse drug event documentation and factors contributing to underreporting. Methods This qualitative study was conducted in 1 ambulatory center, and the emergency departments and inpatient wards of 3 acute care hospitals in British Columbia between March 2014 and December 2016. We completed workplace observations and focus groups with general practitioners, hospitalists, emergency physicians, and hospital and community pharmacists. We analyzed field notes by coding and iteratively analyzing our data to identify emerging concepts, generate thematic and event summaries, and create workflow diagrams. Clinicians validated emerging concepts by applying them to cases from their clinical practice. Results We completed 238 hours of observations during which clinicians investigated 65 suspect adverse drug events. The observed events were often complex and diagnosed over time, requiring the input of multiple providers. Providers documented adverse drug events in charts to support continuity of care but never reported them to external agencies. Providers faced time constraints, and reporting would have required duplication of documentation. Conclusions Existing reporting systems are not suited to capture the complex nature of adverse drug events or adapted to workflow and are simply not used by frontline clinicians. Systems that are integrated into electronic medical records, make use of existing data to avoid duplication of documentation, and generate alerts to improve safety may address the shortcomings of existing systems and generate robust adverse drug event data as a by-product of safer care.
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Affiliation(s)
- Corinne M Hohl
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Vancouver General Hospital Emergency Department, Vancouver, BC, Canada
| | - Serena S Small
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Communication, Simon Fraser University, Burnaby, BC, Canada
| | - David Peddie
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Communication, Simon Fraser University, Burnaby, BC, Canada
| | - Katherin Badke
- Department of Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, BC, Canada
| | - Chantelle Bailey
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ellen Balka
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Communication, Simon Fraser University, Burnaby, BC, Canada
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