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Milder TY, Stocker SL, Baysari MT, Day RO, Greenfield JR. 'We are somehow fixated on this being a diabetes drug': a qualitative study exploring the views of cardiologists and nephrologists about sodium-glucose cotransporter 2 inhibitor initiation. Intern Med J 2024; 54:559-567. [PMID: 37548317 DOI: 10.1111/imj.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are now indicated for heart failure and chronic kidney disease (CKD), irrespective of the presence of diabetes. Hence, cardiologists and nephrologists have an important role in initiating these drugs. AIMS To explore cardiologists' and nephrologists' perspectives regarding initiating SGLT2i and their safety monitoring practices when initiating SGLT2i. METHODS Purposive and snowball approaches were used to recruit participants working in diverse areas in New South Wales, Australia. Semi-structured interviews were conducted with 12 cardiologists and 12 nephrologists. Interviews were conducted until thematic saturation was reached. Emergent themes were identified from transcripts. An iterative general inductive approach was used for data analysis. RESULTS There was a reluctance amongst most non-heart-failure subspecialist cardiologists to initiate SGLT2i. Reasons included the perception of SGLT2i as diabetes drugs, concern about side effects, lack of experience and issues with follow-up. In contrast, nephrologists reported feeling confident to initiate SGLT2i. Nephrologists varied in their opinions about the severity of CKD at which SGLT2i initiation was reasonable and monitoring of renal function following initiation. Government subsidisation was an important factor in the decision to prescribe SGLT2i to people without diabetes. CONCLUSIONS Our findings highlight the complex transition from the perception of SGLT2i as diabetes drugs to cardiometabolic and reno-protective agents. Interdisciplinary collaboration may enable greater confidence amongst specialists to initiate SGLT2i, including in patients with CKD. Additionally, there is a need for clear and detailed guidance about SGLT2i prescription in patients with renal dysfunction and renal function monitoring following SGLT2i initiation.
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Affiliation(s)
- Tamara Y Milder
- Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Clinical Science Pillar, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sophie L Stocker
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jerry R Greenfield
- Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Clinical Science Pillar, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Baysari MT, Van Dort BA, Stanceski K, Hargreaves A, Zheng WY, Moran M, Day RO, Li L, Westbrook J, Hilmer SN. Qualitative study of challenges with recruitment of hospitals into a cluster controlled trial of clinical decision support in Australia. BMJ Open 2024; 14:e080610. [PMID: 38479736 PMCID: PMC10936458 DOI: 10.1136/bmjopen-2023-080610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To identify barriers to hospital participation in controlled cluster trials of clinical decision support (CDS) and potential strategies for addressing barriers. DESIGN Qualitative descriptive design comprising semistructured interviews. SETTING Five hospitals in New South Wales and one hospital in Queensland, Australia. PARTICIPANTS Senior hospital staff, including department directors, chief information officers and those working in health informatics teams. RESULTS 20 senior hospital staff took part. Barriers to hospital-level recruitment primarily related to perceptions of risk associated with not implementing CDS as a control site. Perceived risks included reductions in patient safety, reputational risk and increased likelihood that benefits would not be achieved following electronic medical record (EMR) implementation without CDS alerts in place. Senior staff recommended clear communication of trial information to all relevant stakeholders as a key strategy for boosting hospital-level participation in trials. CONCLUSION Hospital participation in controlled cluster trials of CDS is hindered by perceptions that adopting an EMR without CDS is risky for both patients and organisations. The improvements in safety expected to follow CDS implementation makes it challenging and counterintuitive for hospitals to implement EMR without incorporating CDS alerts for the purposes of a research trial. To counteract these barriers, clear communication regarding the evidence base and rationale for a controlled trial is needed.
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Affiliation(s)
- Melissa T Baysari
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bethany Annemarie Van Dort
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kristian Stanceski
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Wu Yi Zheng
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Maria Moran
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard O Day
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Sarah N Hilmer
- Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
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Judd BK, Whelehan DF, Baysari MT, Baillie AJ. The Impact of Personal Protective Equipment on Cognitive and Emotional Aspects of Health Care Work. J Occup Environ Med 2024; 66:174-178. [PMID: 38013405 DOI: 10.1097/jom.0000000000003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Personal protective equipment (PPE) is critical to the safety of health professionals and vital to clinical practice. However, there is little known about the cognitive and emotional impact of PPE on health professionals' performance, comfort, and well-being. METHODS A mixed-method, cross-sectional, observational study was adopted. An online survey consisting of 5-point Likert scale questions and free-text comments canvassed the opinions of patient-facing health professionals. RESULTS An overall negative impact of PPE on health professionals' ability to carry out work was found from 185 responses from medicine, nursing, and allied health disciplines, including increased fatigue, poor communication, and feeling uncomfortable. CONCLUSIONS There are significant negative impacts of PPE on health professionals' ability to carry out work, impairing communication, task efficiency, and comfort. Personal protective equipment is an essential infection control practice requiring further research, design, and testing to overcome challenges.
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Affiliation(s)
- Belinda K Judd
- From the Faculty of Medicine and Health, University of Sydney, Sydney, Australia (B.K.J., M.T.B., A.J.B.); and School of Medicine Trinity College Dublin, University of Dublin, Dublin, Ireland (D.F.W.)
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Van Dort BA, Ritchie A, Penm J, Gray TJ, Ronnachit A, Baysari MT. A tale of 2 digital hospitals: A qualitative study of antimicrobial stewardship teams. Br J Clin Pharmacol 2024. [PMID: 38294057 DOI: 10.1111/bcp.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
AIMS We aim to examine and understand the work processes of antimicrobial stewardship (AMS) teams across 2 hospitals that use the same digital intervention, and to identify the barriers and enablers to effective AMS in each setting. METHODS Employing a contextual inquiry approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model, observations and semistructured interviews were conducted with AMS team members (n = 15) in 2 Australian hospitals. Qualitative data analysis was conducted, mapping themes to the SEIPS framework. RESULTS Both hospitals utilized similar systems, however, they displayed variations in AMS processes, particularly in postprescription review, interdepartmental AMS meetings and the utilization of digital tools. An antimicrobial dashboard was available at both hospitals but was utilized more at the hospital where the AMS team members were involved in the dashboard's development, and there were user champions. At the hospital where the dashboard was utilized less, participants were unaware of key features, and interoperability issues were observed. Establishing strong relationships between the AMS team and prescribers emerged as key to effective AMS at both hospitals. However, organizational and cultural differences were found, with 1 hospital reporting insufficient support from executive leadership, increased prescriber autonomy and resource constraints. CONCLUSION Organizational and cultural elements, such as executive support, resource allocation and interdepartmental relationships, played a crucial role in achieving AMS goals. System interoperability and user champions further promoted the adoption of digital tools, potentially improving AMS outcomes through increased user engagement and acceptance.
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Affiliation(s)
- Bethany A Van Dort
- School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, Australia
- Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Timothy J Gray
- Department of Infectious Diseases and Microbiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Amrita Ronnachit
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Melissa T Baysari
- School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
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Newton N, Bamgboje-Ayodele A, Forsyth R, Tariq A, Baysari MT. How Are Clinicians' Acceptance and Use of Clinical Decision Support Systems Evaluated Over Time? A Systematic Review. Stud Health Technol Inform 2024; 310:259-263. [PMID: 38269805 DOI: 10.3233/shti230967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Clinical decision support systems (CDSS) can enhance the safety and quality of patient care, but their benefits are often hampered by low acceptance and use by clinicians in practice. Existing research has explored clinicians' experiences with CDSS in a static nature, with limited consideration of how user needs may change over time. This review aimed to identify the methods used to capture clinicians' acceptance and use of CDSS in hospital settings at different time points following implementation and highlight gaps to inform future work. Seventy-six studies met inclusion criteria. Qualitative methods were rarely used during the early implementation phases, particularly in the first 2 months following implementation. Further work is needed to understand clinicians' experiences immediately following implementation of CDSS and how these insights can be used to support use over time.
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Affiliation(s)
- Nicki Newton
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Adeola Bamgboje-Ayodele
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Rowena Forsyth
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Amina Tariq
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
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7
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Bamgboje-Ayodele A, Boscolo A, Hutchings O, Shaw M, Burger M, Taggart R, Simpson M, Shaw T, McPhail S, Baysari MT. Fighting the Same Battles on a New Battleground: Embedding Technologies in a Virtual Care Environment. Stud Health Technol Inform 2024; 310:1066-1070. [PMID: 38269978 DOI: 10.3233/shti231128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The pandemic necessitated the rapid design, development and implementation of technologies to allow remote monitoring of COVID-19 patients at home. This study aimed to explore the environmental barriers and facilitators to the successful development and implementation of virtual care technologies in this fast-paced context. We interviewed eight staff at a virtual hospital in Australia. We found key facilitators to be a learning organizational culture and strong leadership support. Barriers included interoperability issues, legislative constraints and unrealistic clinician expectations. Also, we found that a combination of hot-desking and the lack of single sign on in the virtual care environment, was reported to create additional work for staff. Overall, despite this unique context, our findings are consistent with prior work examining design and implementation of healthcare technologies. The fast pace and high-pressure environment appeared to magnify previously reported barriers, but also cultivate and foster a learning culture.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | | | | | | | | | | | | | - Tim Shaw
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
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8
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Bamgboje-Ayodele A, McPhail SM, Brain D, Taggart R, Burger M, Bruce L, Holtby C, Pradhan M, Simpson M, Shaw TJ, Baysari MT. How digital health translational research is prioritised: a qualitative stakeholder-driven approach to decision support evaluation. BMJ Open 2023; 13:e075009. [PMID: 37931965 PMCID: PMC10632864 DOI: 10.1136/bmjopen-2023-075009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES Digital health is now routinely being applied in clinical care, and with a variety of clinician-facing systems available, healthcare organisations are increasingly required to make decisions about technology implementation and evaluation. However, few studies have examined how digital health research is prioritised, particularly research focused on clinician-facing decision support systems. This study aimed to identify criteria for prioritising digital health research, examine how these differ from criteria for prioritising traditional health research and determine priority decision support use cases for a collaborative implementation research programme. METHODS Drawing on an interpretive listening model for priority setting and a stakeholder-driven approach, our prioritisation process involved stakeholder identification, eliciting decision support use case priorities from stakeholders, generating initial use case priorities and finalising preferred use cases based on consultations. In this qualitative study, online focus group session(s) were held with stakeholders, audiorecorded, transcribed and analysed thematically. RESULTS Fifteen participants attended the online priority setting sessions. Criteria for prioritising digital health research fell into three themes, namely: public health benefit, health system-level factors and research process and feasibility. We identified criteria unique to digital health research as the availability of suitable governance frameworks, candidate technology's alignment with other technologies in use,and the possibility of data-driven insights from health technology data. The final selected use cases were remote monitoring of patients with pulmonary conditions, sepsis detection and automated breast screening. CONCLUSION The criteria for determining digital health research priority areas are more nuanced than that of traditional health condition focused research and can neither be viewed solely through a clinical lens nor technological lens. As digital health research relies heavily on health technology implementation, digital health prioritisation criteria comprised enablers of successful technology implementation. Our prioritisation process could be applied to other settings and collaborative projects where research institutions partner with healthcare delivery organisations.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Steven M McPhail
- Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Brain
- Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Richard Taggart
- Sydney Local Health District, NSW Health, Camperdown, New South Wales, Australia
| | - Mitchell Burger
- Sydney Local Health District, NSW Health, Camperdown, New South Wales, Australia
| | - Lenert Bruce
- Murrumbidgee Local Health District, NSW Health, Wagga Wagga, New South Wales, Australia
| | - Caroline Holtby
- Murrumbidgee Local Health District, NSW Health, Wagga Wagga, New South Wales, Australia
| | | | - Mark Simpson
- eHealth NSW, Chatswood, New South Wales, Australia
| | - Tim J Shaw
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Ho EK, Ferreira ML, Hodges P, Halliday M, Maka K, Ceprnja D, Jennings M, Amorim AB, Baysari MT, Ferreira PH. Developing resilient clinical trials: Lessons learned from rolling out the Get Back to Healthy trial during a pandemic. Contemp Clin Trials 2023; 133:107330. [PMID: 37652357 DOI: 10.1016/j.cct.2023.107330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/21/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has caused wide-spread disruptions to the conduct of randomised controlled trials (RCTs), particularly those involving public health services. Using the Get Back to Healthy trial as an example, this study aimed to contextualise the challenges imposed by the COVID-19 pandemic on implementation of RCTs involving public health services in Australia, summarise the effect of common and novel contingency strategies employed to mitigate these challenges, and describe key lessons learned. METHODS The main challenges, the effect of contingency strategies employed, and key lessons learned were summarised descriptively. RESULTS The main COVID-19-related challenge has been slow recruitment due to the suspension of clinical services for the trial target population. This challenge has been addressed through carefully considered adjustments to trial design (i.e., expanding the trial eligibility criteria), which has markedly improved trial recruitment rates. Other challenges have included the rapid transition to remote consent and data collection methods, increased complexity of monitoring participant safety, and future statistical challenges with disentangling the impact of the COVID-19 pandemic from treatment effects. The key lessons learned are: (i) adaptations to trial design may be necessary during a pandemic; (ii) offering remote methods may encourage trial participation from all age groups during a pandemic; (iii) enhanced monitoring of safety is critical during a pandemic; (iv) statistical challenges are likely to occur and should be considered when interpreting trial results. CONCLUSION Key lessons learned may be useful for informing the conduct of resilient RCTs, particularly those involving public health services, in the present and future.
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Affiliation(s)
- Emma K Ho
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, Sydney, NSW, Australia; The University of Sydney, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Manuela L Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Paul Hodges
- University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Mark Halliday
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Katherine Maka
- Physiotherapy department, Westmead Hospital, Sydney, NSW, Australia
| | - Dragana Ceprnja
- Physiotherapy department, Westmead Hospital, Sydney, NSW, Australia
| | - Matthew Jennings
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anita B Amorim
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Paulo H Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, Sydney, NSW, Australia
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10
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Newton N, Bamgboje-Ayodele A, Forsyth R, Tariq A, Baysari MT. Does Involving Clinicians in Decision Support Development Facilitate System Use Over Time? A Systematic Review. Stud Health Technol Inform 2023; 304:11-15. [PMID: 37347561 DOI: 10.3233/shti230359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Involving clinician users in the design and development of Clinical Decision Support (CDS) systems is touted to improve the fit between system and user needs. However, the impact of clinician involvement on CDS acceptance and use in practice has not been systematically studied. This review aimed to identify the approaches taken to involve clinicians in CDS development and understand the impact of these approaches on barriers and facilitators to acceptance and use in hospital settings over time. Twenty-three studies met full inclusion criteria. Clinician involvement was rarely described in depth and no comparative studies were identified. Despite frequently reporting perceived ease of use, included studies still reported barriers to acceptance and use shortly after CDS implementation and years later. Future studies should report clinician involvement in adequate detail to enable understanding of its impact on CDS acceptance and use over time. Additional recommendations for future research, including conducting comparative studies and maintaining clinician involvement beyond implementation, are described.
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Affiliation(s)
- Nicki Newton
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Adeola Bamgboje-Ayodele
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Rowena Forsyth
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Amina Tariq
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Australia
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Roberts HI, Kinlay M, Debono D, Burke R, Jones A, Baysari MT. Nurses' Medication Administration Workarounds when Using Electronic Systems: An Analysis of Safety Incident Reports. Stud Health Technol Inform 2023; 304:57-61. [PMID: 37347569 DOI: 10.3233/shti230369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Electronic medication management systems (EMMS) have been implemented in most acute care settings in Australia to reduce medication error rates. One of the key challenges related to the introduction of EMMS in hospitals is the uptake of informal "workarounds" by clinicians, including nurses. In this study, we aimed to examine one workaround in depth, nurses not documenting medication administration in the EMMS at the time of administration. We conducted a review of incident reports to identify the factors that contribute to this workaround occurring and the consequences or potential consequences of this workaround on patients. We identified a range of contributing factors, with factors relating to the user (e.g. nurses being time poor) occurring most frequently in incident reports. The most frequently seen consequence of this workaround was the patient receiving an additional dose. This research revealed that strategies to reduce the uptake of this workaround should consider user and organisational factors rather than just EMMS design alone.
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Van Dort BA, Penm J, Ritchie A, Gray TJ, Ronnachit A, Baysari MT. Antimicrobial Stewardship (AMS) During COVID-19: Eyes and Ears on the AMS Team. Stud Health Technol Inform 2023; 304:62-66. [PMID: 37347570 DOI: 10.3233/shti230370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Antimicrobial stewardship (AMS) programs in hospitals comprise coordinated strategies to optimise antimicrobial use. The COVID-19 pandemic had a significant impact on the healthcare system, including AMS. This study aimed to understand the work processes of AMS teams during COVID-19 hospital restrictions and the role technology played in supporting AMS. Observations and interviews were conducted with AMS teams at two hospitals in Sydney, Australia. Participants reported an increase in antimicrobial use, a loss of resources for AMS activities, and reduced in-person interactions. Meetings were performed through videoconferencing, which resulted in greater access to information but led to poorer communication and impacted interdisciplinary relationships. As COVID-19 restrictions recede, AMS program changes should be evaluated to understand the most effective strategies to facilitate evidence-based AMS practices.
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Affiliation(s)
- Bethany A Van Dort
- The University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, NSW, Australia
- Prince of Wales Hospital, NSW, Australia
| | - Angus Ritchie
- The University of Sydney, Faculty of Medicine and Health, NSW, Australia
- Sydney Local Health District, NSW, Australia
| | - Timothy J Gray
- The University of Sydney, Faculty of Medicine and Health, NSW, Australia
- Sydney Local Health District, NSW, Australia
| | | | - Melissa T Baysari
- The University of Sydney, Faculty of Medicine and Health, NSW, Australia
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Lyon R, Jones A, Burke R, Baysari MT. What Goes Up, Must Come Down: A State-of-the-Art Electronic Health Record Downtime and Uptime Procedure in a Metropolitan Health Setting. Appl Clin Inform 2023; 14:513-520. [PMID: 37406674 PMCID: PMC10322225 DOI: 10.1055/s-0043-1768995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/19/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are used at most hospitals around the world, and downtime events are inevitable and common. Downtime represents a risky time for patients because patient information and critical EHR functionality are unavailable. Many institutions have used EHRs for years, with health professionals less likely to be familiar or comfortable with paper-based processes, resulting in an increased risk of errors during downtimes. There is currently limited guidance available on how to develop and operationalize downtime procedure at a local level. In this paper, we fill this gap by describing our state-of-the-art downtime and uptime procedure and its evaluation. METHOD A district-wide downtime and uptime procedure was revised and standardized based on lessons learned from other health care organizations. The procedure outlines downtime and uptime preparations including downtime drills, downtime viewer auditing, and downtime education; downtime response including activating downtime and tracking patient changes; and uptime recovery including medication reconciliation and uptime documentation. IMPLEMENTATION We implemented our new procedure across the district during an 8-hour planned downtime. A district downtime planning committee was formed, and a virtual command center was established to coordinate the downtime and uptime events. During downtime and uptime, onsite support was provided by the district's health informatics teams and clinicians. Data recovery was completed safely and efficiently with the revised uptime process. Following the event, we gathered staff feedback and reflections on implementing the procedure which highlighted its success but also revealed some areas for further improvement. CONCLUSION In this paper, we describe a state-of-the-art EHR downtime and uptime procedure and lessons learned from its implementation. The implementation was successful with staff well prepared and information reconciled efficiently ensuring safe continuity of care. It was only through extensive planning, significant commitment, and engagement of all stakeholders that this outcome was possible.
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Affiliation(s)
- Rachael Lyon
- Digital Health and Innovation, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
| | - Aaron Jones
- Digital Health and Innovation, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rosemary Burke
- Digital Health and Innovation, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
- Department of Pharmacy, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
| | - Melissa T. Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Awad S, Amon K, Baillie A, Loveday T, Baysari MT. Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: A systematic review. Int J Med Inform 2023; 172:105017. [PMID: 36809716 DOI: 10.1016/j.ijmedinf.2023.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Poorly designed electronic medication management systems (EMMS) or computerized physician order entry (CPOE) systems in hospital settings can result in usability issues and in turn, patient safety risks. As a safety science, human factors and safety analysis methods have potential to support the safe and usable design of EMMS. OBJECTIVE To identify and describe human factors and safety analysis methods that have been used in the design or redesign of EMMS used in hospital settings. MATERIALS AND METHODS A systematic review, following PRISMA guidelines, was conducted by searching online databases and relevant journals from January 2011 to May 2022. Studies were included if they described the practical application of human factors and safety analysis methods to support the design or redesign of a clinician-facing EMMS, or its components. Methods used were extracted and mapped to human centered design (HCD) activities: understanding context of use; specifying user requirements; producing design solutions; and evaluating the design. RESULTS Twenty-one papers met the inclusion criteria. Overall, 21 human factors and safety analysis methods were used in the design or redesign of EMMS with prototyping, usability testing, participant surveys/questionnaires and interviews the most frequent. Human factors and safety analysis methods were most frequently used to evaluate the design of a system (n = 67; 56.3%). Nineteen of 21 (90%) methods used aimed to identify usability issues and/or support iterative design; only one paper utilized a safety-oriented method and one, a mental workload assessment method. DISCUSSION AND CONCLUSION While the review identified 21 methods, EMMS design primarily utilized a subset of available methods, and rarely a method focused on safety. Given the high-risk nature of medication management in complex hospital environments, and the potential for harm due to poorly designed EMMS, there is significant potential to apply more safety-oriented human factors and safety analysis methods to support EMMS design.
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Affiliation(s)
- Selvana Awad
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; eHealth NSW, Australia.
| | - Krestina Amon
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Andrew Baillie
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Australia; Sydney Local Health District, Australia
| | | | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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15
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Baysari MT, Van Dort BA, Stanceski K, Hargreaves A, Zheng WY, Moran M, Day R, Li L, Westbrook J, Hilmer S. Is evidence of effectiveness a driver for clinical decision support selection? A qualitative descriptive study of senior hospital staff. Int J Qual Health Care 2023; 35:7008757. [PMID: 36715081 PMCID: PMC9940455 DOI: 10.1093/intqhc/mzad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/20/2022] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Limited research has focused on understanding if and how evidence of health information technology (HIT) effectiveness drives the selection and implementation of technologies in practice. This study aimed to explore the views of senior hospital staff on the role evidence plays in the selection and implementation of HIT, with a particular focus on clinical decision support (CDS) alerts in electronic medication management systems. A qualitative descriptive design was used. Twenty senior hospital staff from six Australian hospitals in New South Wales and Queensland took part in a semistructured interview. Interviews were audio-recorded and transcribed, and a general inductive content analysis approach was used to identify themes. Participants acknowledged the importance of an evidence base, but reported that selection of CDS alerts, and HIT more broadly, was rarely underpinned by evidence that technologies improve patient care. Instead, investments in technologies were guided by the expectation that benefits will be achieved, bolstered by vendor assurances, and a perception that implementation of HIT is unavoidable. Postponing implementation of a technology until an evidence base is available was not always feasible. Although some technologies were seen as not requiring an evidence base, stakeholders viewed evidence as extremely valuable for informing decisions about selection of CDS alerts. In the absence of evidence, evaluation or monitoring of technologies postimplementation is critical, particularly to identify new errors or risks associated with HIT implementation and use. Increased transparency from vendors, with technology evaluation outcomes made directly available to healthcare organizations, may result in less reliance on logic, intuition, and vendor assertions and more evidence-based selection of HIT.
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Affiliation(s)
- Melissa T Baysari
- *Corresponding author. Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Room 132 RC Mills Building, Camperdown, NSW 2006, Australia. E-mail:
| | - Bethany A Van Dort
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Kristian Stanceski
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Andrew Hargreaves
- Integrated Care, eHealth NSW, Level 15, Zenith Tower B, 821 Pacific Highway, Chatswood, NSW 2067, Australia
| | - Wu Yi Zheng
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia,Directorate of Strategy and Operations, Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Maria Moran
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Richard Day
- Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia,The Clinical School, St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney, NSW 2052, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road NSW 2109, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road NSW 2109, Australia
| | - Sarah Hilmer
- Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, NSW 2065, Australia,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, NSW 2065, Australia
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16
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Emadi F, Ghanbarzadegan A, Ghahramani S, Bastani P, Baysari MT. Factors affecting medication adherence among older adults using tele-pharmacy services: a scoping review. Arch Public Health 2022; 80:199. [PMID: 36042508 PMCID: PMC9429665 DOI: 10.1186/s13690-022-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Medication adherence among older adults (aged 60 and above), particularly those with chronic conditions who take several medications, is critical, and tele-pharmacy services are a way to improve medication adherence. This study sought to determine the factors influencing medication adherence (MA) in older adults using tele-pharmacy services. Method The Joana Briggs Institute scoping review methodology was implemented. Searches were conducted in databases PubMed, Scopus, ProQuest, Web of Science, and Embase from 2000 to the present day, to identify both qualitative and quantitative studies focusing on the use of tele-pharmacy by older people. Factors impacting MA were extracted and analyzed into themes using a qualitative approach. A concept map was also designed summarising these factors. Results Of 7495 articles obtained in the initial search, 52 articles met the inclusion criteria. The analysis resulted in 5 themes and 21 sub-themes representing factors that impacted MA with tele-pharmacy. These themes are divided broadly into technology and user related factors. Technology factors included design of the tele-pharmacy intervention, commercial aspects, and adherence measurement method. User factors included user-health constraints, behaviors and perceptions. Conclusion Industry, policymakers, and stakeholders should consider using tele-pharmacy services for improving medication adherence among older adults; however, ensuring interventions facilitate communication between patients and health care teams, and are accompanied by user training and support, is essential for technology uptake and effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00960-w.
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17
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Van Dort BA, Carland JE, Penm J, Ritchie A, Baysari MT. Digital interventions for antimicrobial prescribing and monitoring: a qualitative meta-synthesis of factors influencing user acceptance. J Am Med Inform Assoc 2022; 29:1786-1796. [PMID: 35897157 PMCID: PMC9471701 DOI: 10.1093/jamia/ocac125] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/16/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To understand and synthesize factors influencing user acceptance of digital interventions used for antimicrobial prescribing and monitoring in hospitals. MATERIALS AND METHODS A meta-synthesis was conducted to identify qualitative studies that explored user acceptance of digital interventions for antimicrobial prescribing and/or monitoring in hospitals. Databases were searched and qualitative data were extracted and systematically classified using the unified theory of acceptance and use of technology (UTAUT) model. RESULTS Fifteen qualitative studies met the inclusion criteria. Eleven papers used interviews and four used focus groups. Most digital interventions evaluated in studies were decision support for prescribing (n = 13). Majority of perceptions were classified in the UTAUT performance expectancy domain in perceived usefulness and relative advantage constructs. Key facilitators in this domain included systems being trusted and credible sources of information, improving performance of tasks and increasing efficiency. Reported barriers were that interventions were not considered useful for all settings or patient conditions. Facilitating conditions was the second largest domain, which highlights the importance of users having infrastructure to support system use. Digital interventions were viewed positively if they were compatible with values, needs, and experiences of users. CONCLUSIONS User perceptions that drive users to accept and utilize digital interventions for antimicrobial prescribing and monitoring were predominantly related to performance expectations and facilitating conditions. To ensure digital interventions for antimicrobial prescribing are accepted and used, we recommend organizations ensure systems are evaluated and benefits are conveyed to users, that utility meets expectations, and that appropriate infrastructure is in place to support use.
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Affiliation(s)
- Bethany A Van Dort
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane E Carland
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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18
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Baysari MT, Dort BAV, Zheng WY, Li L, Hilmer S, Westbrook J, Day R. Prescribers’ reported acceptance and use of drug-drug interaction alerts: An Australian survey. Health Informatics J 2022; 28:14604582221100678. [DOI: 10.1177/14604582221100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drug-drug interaction (DDI) alerts are frequently included in electronic medical record (eMR) systems to provide users with relevant information and guidance at the point of care. In this study, we aimed to examine views of DDI alerts among prescribers, including junior doctors, registrars and senior doctors, across Australia. A validated survey for assessing prescribers’ reported acceptance and use of DDI alerts was distributed among researcher networks and in newsletters. Fifty useable responses were received, more than half ( n = 28) from senior doctors. Prescribers at all levels expected DDI alerts to improve performance but junior doctors reported that this was at a high cost, with respect to time and effort. Senior doctors and registrars reported rarely reading alerts and rarely changing prescribing decisions based on alerts. Respondents identified a number of problems with current alerts including limited relevance, repetition, and poor design, highlighting some clear areas for alert improvement.
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Affiliation(s)
- Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Bethany A Van Dort
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Wu Yi Zheng
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW, Australia
- Black Dog Institute, NSW Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hilmer
- Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Richard Day
- Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Clinical School, Faculty of Medicine, UNSW, Sydney, NSW, Australia
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19
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Wise S, Coleshill MJ, Taylor N, Le M, Debono D, Day RO, Melocco T, Baysari MT, Laba T, Carland JE. Australian hospital outpatient pharmacies: service adaptations during the 2020 national coronavirus disease 2019 lockdown. Pharmacy Practice and Res 2022; 52:326-328. [PMID: 35942385 PMCID: PMC9348013 DOI: 10.1002/jppr.1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney Australia
- St Vincent’s Clinical Campus University of NSW Kensington Australia
| | - Matthew J. Coleshill
- St Vincent’s Clinical Campus University of NSW Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent’s Hospital Darlinghurst Australia
- Black Dog Institute Randwick Australia
| | - Natalie Taylor
- School of Population Health University of NSW Kensington Australia
| | - Michelle Le
- Department of Pharmacy St Vincent’s Hospital Sydney Australia
| | - Deborah Debono
- Faculty of Health University of Technology Sydney Sydney Australia
| | - Richard O. Day
- St Vincent’s Clinical Campus University of NSW Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent’s Hospital Darlinghurst Australia
| | - Terry Melocco
- Department of Pharmacy St Vincent’s Hospital Sydney Australia
| | - Melissa T. Baysari
- Biomedical Informatics and Digital Health School of Medical Sciences Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Tracey‐Lea Laba
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney Australia
- Pharmacy Program, Clinical and Health Services Unit University of South Australia Adelaide Australia
| | - Jane E. Carland
- St Vincent’s Clinical Campus University of NSW Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent’s Hospital Darlinghurst Australia
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20
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Abstract
Background Antimicrobial stewardship (AMS) programmes in hospitals support optimal antimicrobial use by utilizing strategies such as restriction policies and education. Several systematic reviews on digital interventions supporting AMS have been conducted but they have focused on specific interventions and outcomes. Objectives To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. Methods Multiple databases were searched from 2010 onwards. Review papers were eligible if they included studies that examined the effectiveness of AMS digital interventions in an inpatient hospital setting. Papers were excluded if they were not systematic reviews, were limited to a paediatric setting, or were not in English. Results Eight systematic reviews were included for data extraction. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. Due to the heterogeneity of the interventions and outcome measures, a meta-analysis could not be performed. The majority of reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. Conclusions Digital interventions reduce antimicrobial use and improve antimicrobial appropriateness in hospitals, but no firm conclusions can be drawn about the degree to which different types of digital interventions achieve these outcomes. Evaluation of sociotechnical aspects of digital intervention implementation is limited, despite the critical role that user acceptance, uptake and feasibility play in ensuring improvements in AMS are achieved with digital health.
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Affiliation(s)
| | - Jonathan Penm
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, Australia
- The University of Sydney, Faculty of Medicine and Health, Concord Clinical School, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- The University of Sydney, Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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21
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Counsell AB, Nguyen AD, Baysari MT, Kannangara DRW, Gamboa S, Day RO. Expanding the role of Australian community dietitians in gout management. Int J Rheum Dis 2021; 24:1402-1408. [PMID: 34658154 DOI: 10.1111/1756-185x.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
AIM Gout is a common form of inflammatory arthritis with suboptimal management. Management guidelines for gout highlight the importance of both pharmacological and non-pharmacological treatments. Dietitians can potentially assist in improving gout's associated dietary and lifestyle factors, and thereby play a role in improving its management. The aim of this study was to investigate perspectives of Australian community dietitians on whether their role in gout management could be expanded to improve management and treatment of gout. METHOD A snowballing recruitment strategy was used. Dietitians known to the research team were invited to participate and then they suggested further dietitians. Semi-structured interviews (one-on-one) were conducted with 16 dietitians. The focus was on their experiences of contributing to the management of gout, including any barriers and facilitators experienced. Interviews were transcribed verbatim and independently analyzed by 2 reviewers to identify themes. RESULTS The main reported role of dietitians in gout management was providing patient education. An identified facilitator was dietitians' understanding of gout and its dietary management. Barriers included the emphasis placed on medications for treatment by clinicians and patients, consultation costs, limitations in the evidence for the efficacy of dietary changes and lack of specific training in gout for dietitians. Dietitians predominantly managed the other metabolic conditions commonly associated with gout. CONCLUSION Currently, the role dietitians play in gout management is limited. However, dietitians have the potential to take on larger roles in gout education and can also indirectly contribute by way of management of commonly associated comorbidities in gout patients.
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Affiliation(s)
- Allyce B Counsell
- St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Amy D Nguyen
- St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Diluk R W Kannangara
- St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sarah Gamboa
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Richard O Day
- St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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22
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Ludlow K, Westbrook J, Jorgensen M, Lind KE, Baysari MT, Gray LC, Day RO, Ratcliffe J, Lord SR, Georgiou A, Braithwaite J, Raban MZ, Close J, Beattie E, Zheng WY, Debono D, Nguyen A, Siette J, Seaman K, Miao M, Root J, Roffe D, O'Toole L, Carrasco M, Thompson A, Shaikh J, Wong J, Stanton C, Haddock R. Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol. BMJ Open 2021; 11:e048657. [PMID: 34433599 PMCID: PMC8388274 DOI: 10.1136/bmjopen-2021-048657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. METHODS This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. ETHICS AND DISSEMINATION This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.
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Affiliation(s)
- Kristiana Ludlow
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mikaela Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kimberly E Lind
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Charles Perkins Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Leonard C Gray
- Centre for Research in Geriatric Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Richard O Day
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- The International Society for Quality in Health Care (ISQua), Dublin, Ireland
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Wu Yi Zheng
- Black Dog Institute, Sydney, New South Wales, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jo Root
- Consumers Health Forum of Australia, Deakin, Victoria, Australia
| | - David Roffe
- IT Consultant, Sydney, New South Wales, Australia
| | - Libby O'Toole
- Aged Care Quality and Safety Commission, Sydney, New South Wales, Australia
| | | | - Alex Thompson
- Anglicare Sydney, Sydney, New South Wales, Australia
| | - Javed Shaikh
- Anglicare Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Wong
- Anglicare Sydney, Sydney, New South Wales, Australia
| | - Cynthia Stanton
- Sydney North Health Network, Sydney, New South Wales, Australia
| | - Rebecca Haddock
- Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association, Canberra, Australian Capital Territory, Australia
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Marcilly R, Zheng WY, Beuscart R, Baysari MT. Comparison of the validity, perceived usefulness and usability of I-MeDeSA and TEMAS, two tools to evaluate alert system usability: a study protocol. BMJ Open 2021; 11:e050448. [PMID: 34353806 PMCID: PMC8344302 DOI: 10.1136/bmjopen-2021-050448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Research has shown that improvements to the usability of medication alert systems are needed. For designers and decisions-makers to assess usability of their alert systems, two paper-based tools are currently available: the instrument for evaluating human-factors principles in medication-related decision support alerts (I-MeDeSA) and the tool for evaluating medication alerting systems (TEMAS). This study aims to compare the validity, usability and usefulness of both tools to identify their strengths and limitations and assist designers and decision-makers in making an informed decision about which tool is most suitable for assessing their current or prospective system. METHODS AND ANALYSIS First, TEMAS and I-MeDeSA will be translated into French. This translation will be validated by three experts in human factors. Then, in 12 French hospitals with a medication alert system in place, staff with expertise in the system will evaluate their alert system using the two tools successively. After the use of each tool, participants will be asked to fill in the System Usability Scale (SUS) and complete a survey on the understandability and perceived usefulness of each tool. Following the completion of both assessments, participants will be asked to nominate their preferred tool and relay their opinions on the tools. The design philosophy of TEMAS and I-MeDeSA differs on the calculation of a score, impacting the way the comparison between the tools can be performed. Convergent validity will be evaluated by matching the items of the two tools with respect to the usability dimensions they assess. SUS scores and answers to the survey will be statistically compared for I-MeDeSA and TEMAS to identify differences. Free-text responses in surveys will be analysed using an inductive approach. ETHICS AND DISSEMINATION Ethical approval is not required in France for a study of this nature. The results will be published in a peer-reviewed journal.
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Affiliation(s)
- Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
- Inserm, CIC-IT 1403, F-59000 Lille, France
| | - Wu Yi Zheng
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Regis Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Melissa T Baysari
- The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, New South Wales, Australia
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24
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Baysari MT, van Dort BA, Prgomet M, Zheng WY, Raban MZ, Dalla-Pozza L, Mccullagh C, Westbrook J. The efficiency-thoroughness trade-off after implementation of electronic medication management: a qualitative study in paediatric oncology. Int J Qual Health Care 2021; 32:511-516. [PMID: 32761121 DOI: 10.1093/intqhc/mzaa086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The efficiency-thoroughness trade-off (ETTO) principle proposes that people and organizations are often required to make a trade-off between being efficient and being thorough, as it is difficult to be both efficient and thorough at the same time. This study aimed to compare pre- electronic medication management system (EMMS) expectation of how an EMMS is likely to impact on efficiency and thoroughness to post-EMM experiences of an EMMS and the ETTO. DESIGN Qualitative interview study. SETTING A paediatric oncology cancer centre in a large paediatric tertiary teaching hospital in Sydney, Australia. PARTICIPANTS Forty-four semi-structured interviews with doctors, nurses and pharmacists six months prior to and two years following implementation of an EMMS. RESULTS Prior to EMM implementation, staff identified a number of areas of work where both efficiency and thoroughness were expected to improve with EMM. These included ease of accessibility of the medication record, and organization and legibility of medication information. Following EMMS implementation, staff reported improvements in these areas. However, the EMMS was perceived to drive thoroughness (safety) benefits at the expense of efficiency (time). Measures to improve safety in the EMMS enforced processes that required time, such as medication double-checking procedures. CONCLUSIONS Overall, staff were aware of the competitive interplay between thoroughness and efficiency and reported that introduction of an EMMS had imposed processes that favoured improvements in thoroughness at the expense of efficiency.
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Affiliation(s)
- Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Bethany A van Dort
- Discipline of Biomedical Informatics and Digital Health, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mirela Prgomet
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Wu Yi Zheng
- Discipline of Biomedical Informatics and Digital Health, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Magdalena Z Raban
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children Hospital at Westmead, Sydney, Australia
| | | | - Johanna Westbrook
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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25
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Ho EK, Ferreira ML, Bauman A, Hodges PW, Maher CG, Simic M, Morton RL, Lonsdale C, Li Q, Baysari MT, Amorim AB, Ceprnja D, Clavisi O, Halliday M, Jennings M, Kongsted A, Maka K, Reid K, Reynolds T, Ferreira PH. Effectiveness of a coordinated support system linking public hospitals to a health coaching service compared with usual care at discharge for patients with chronic low back pain: protocol for a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:611. [PMID: 34243746 PMCID: PMC8272287 DOI: 10.1186/s12891-021-04479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. Methods Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. Discussion This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. Conclusion Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia. Trial Registration Prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/09/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04479-z.
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Affiliation(s)
- Emma K Ho
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Manuela L Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Milena Simic
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Chris Lonsdale
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anita B Amorim
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Dragana Ceprnja
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Ornella Clavisi
- Musculoskeletal Australia, Muscle Bone & Joint Health Ltd, Melbourne, VIC, Australia
| | - Mark Halliday
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Matthew Jennings
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Alice Kongsted
- Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Katherine Maka
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Kate Reid
- The Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Tahlia Reynolds
- The Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Paulo H Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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26
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Quinn E, Hsiao KH, Maitland-Scott I, Gomez M, Baysari MT, Najjar Z, Gupta L. Web-Based Apps for Responding to Acute Infectious Disease Outbreaks in the Community: Systematic Review. JMIR Public Health Surveill 2021; 7:e24330. [PMID: 33881406 PMCID: PMC8100883 DOI: 10.2196/24330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/08/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Web-based technology has dramatically improved our ability to detect communicable disease outbreaks, with the potential to reduce morbidity and mortality because of swift public health action. Apps accessible through the internet and on mobile devices create an opportunity to enhance our traditional indicator-based surveillance systems, which have high specificity but issues with timeliness. Objective The aim of this study is to describe the literature on web-based apps for indicator-based surveillance and response to acute communicable disease outbreaks in the community with regard to their design, implementation, and evaluation. Methods We conducted a systematic search of the published literature across four databases (MEDLINE via OVID, Web of Science Core Collection, ProQuest Science, and Google Scholar) for peer-reviewed journal papers from January 1998 to October 2019 using a keyword search. Papers with the full text available were extracted for review, and exclusion criteria were applied to identify eligible papers. Results Of the 6649 retrieved papers, 23 remained, describing 15 web-based apps. Apps were primarily designed to improve the early detection of disease outbreaks, targeted government settings, and comprised either complex algorithmic or statistical outbreak detection mechanisms or both. We identified a need for these apps to have more features to support secure information exchange and outbreak response actions, with a focus on outbreak verification processes and staff and resources to support app operations. Evaluation studies (6 out of 15 apps) were mostly cross-sectional, with some evidence of reduction in time to notification of outbreak; however, studies lacked user-based needs assessments and evaluation of implementation. Conclusions Public health officials designing new or improving existing disease outbreak web-based apps should ensure that outbreak detection is automatic and signals are verified by users, the app is easy to use, and staff and resources are available to support the operations of the app and conduct rigorous and holistic evaluations.
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Affiliation(s)
- Emma Quinn
- Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Camperdown, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Kai Hsun Hsiao
- Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Camperdown, Sydney, NSW, Australia
| | - Isis Maitland-Scott
- Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Camperdown, Sydney, NSW, Australia
| | - Maria Gomez
- Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Camperdown, Sydney, NSW, Australia
| | - Melissa T Baysari
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Zeina Najjar
- Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Camperdown, Sydney, NSW, Australia
| | - Leena Gupta
- Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Camperdown, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
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27
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Baysari MT, Duong MH, Hooper P, Stockey-Bridge M, Awad S, Zheng WY, Hilmer SN. Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool. BMC Med Inform Decis Mak 2021; 21:116. [PMID: 33820536 PMCID: PMC8022373 DOI: 10.1186/s12911-021-01484-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
Background Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice. Methods Our CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient’s DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists. Results Participants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback. Conclusion Usability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01484-z.
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Affiliation(s)
- Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, D17, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Mai H Duong
- Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, Australia
| | | | | | - Selvana Awad
- Clinical Engagement and Patient Safety, eHealth NSW, Sydney, Australia
| | - Wu Yi Zheng
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, D17, The University of Sydney, Sydney, NSW, 2006, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, Australia
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28
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Roydhouse SA, Carland JE, Debono DS, Baysari MT, Reuter SE, Staciwa AJ, Sandhu APK, Day RO, Stocker SL. Accuracy of documented administration times for intravenous antimicrobial drugs and impact on dosing decisions. Br J Clin Pharmacol 2021; 87:4273-4282. [PMID: 33792079 DOI: 10.1111/bcp.14844] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS Accurate documentation of medication administration time is imperative for many therapeutic decisions, including dosing of intravenous antimicrobials. The objectives were to determine (1) the discrepancy between actual and documented administration times for antimicrobial infusions and (2) whether day of the week, time of day, nurse-to-patient ratio and drug impacted accuracy of documented administration times. METHODS Patient and dosing data were collected (June-August 2019) for 55 in-patients receiving antimicrobial infusions. "Documented" and "actual" administration times (n = 660) extracted from electronic medication management systems and smart infusion pumps, respectively, were compared. Influence of the day (weekday/weekend), time of day (day/evening/night), nurse-to-patient ratio (high 1:1/low 1:5) and drug were examined. Monte Carlo simulation was used to predict the impact on dose adjustments for vancomycin using the observed administration time discrepancies compared to the actual administration time. RESULTS The median discrepancy between actual and documented administration times was 16 min (range, 2-293 min), with discrepancies greater than 60 minutes in 7.7% of administrations. Overall, discrepancies (median [range]) were similar on weekends (17 [2-293] min) and weekdays (16 [2-188] min), and for high (16 [2-157] min) and low nurse-to-patient ratio wards (16 [2-293] min). Discrepancies were smallest for night administrations (P < .05), and antimicrobials with shorter half-lives (P < .0001). The observed discrepancies in vancomycin administration time resulted in a different dose recommendation in 58% of cases (30% higher, 28% lower). CONCLUSIONS Overall, there were discrepancies between actual and documented antimicrobial infusion administration times. For vancomycin, these discrepancies in administration time were predicted to result in inappropriate dose recommendations.
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Affiliation(s)
- Stephanie A Roydhouse
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Jane E Carland
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Deborah S Debono
- Centre for Health Services Management, School of Public Health, The University of Technology Sydney, Sydney, Australia
| | - Melissa T Baysari
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Stephanie E Reuter
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Alice J Staciwa
- Pharmacy Department, St Vincent's Hospital Sydney, Sydney, Australia
| | - Anmol P K Sandhu
- Pharmacy Department, St Vincent's Hospital Sydney, Sydney, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Sophie L Stocker
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Sydney Pharmacy School, The University of Sydney, Sydney, Australia
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29
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Carland JE, Stocker SL, Baysari MT, Li C, Själin J, Moran MA, Tang S, Sandaradura I, Elhage T, Gilbey T, Williams KM, Marriott DJE, Day RO. Are vancomycin dosing guidelines followed? A mixed methods study of vancomycin prescribing practices. Br J Clin Pharmacol 2021; 87:4221-4229. [PMID: 33769612 DOI: 10.1111/bcp.14834] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Despite the availability of international consensus guidelines, vancomycin dosing and therapeutic drug monitoring (TDM) remain suboptimal. This study aimed to assess concordance of vancomycin dosing and TDM with institutional guidelines and to identify factors taken into consideration by clinicians when prescribing vancomycin. METHODS A retrospective audit of 163 patients receiving vancomycin therapy (≥48 hours) was undertaken. Data collected included patient characteristics, dosing history and plasma vancomycin and creatinine concentrations. Concordance of dosing and TDM with institutional guidelines was evaluated. Semi-structured interviews, including simulated prescribing scenarios, were undertaken with prescribers (n = 17) and transcripts analysed. RESULTS Plasma vancomycin concentrations (n = 1043) were collected during 179 courses of therapy. Only 24% of courses commenced with a loading dose with 72% lower than recommended. The initial maintenance dose was concordant in 42% of courses with 34% lower than recommended. Only 14% of TDM samples were trough vancomycin concentrations. Dose was not adjusted for 60% (21/35) of subtherapeutic and 43% (18/42) of supratherapeutic trough vancomycin concentrations, respectively. Interview participants reported that patient characteristics (including renal function), vancomycin concentrations, guidelines and expert advice influenced vancomycin prescribing decisions. Despite referring to guidelines when completing simulated prescribing scenarios, only 37% of prescribing decisions aligned with guideline recommendations. CONCLUSION Poor compliance with institutional vancomycin guidelines was observed, despite prescriber awareness of available guidelines. Multifaceted strategies to support prescriber decision-making are required to improve vancomycin dosing and monitoring.
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Affiliation(s)
- Jane E Carland
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Department of Pharmacology, School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Sophie L Stocker
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Melissa T Baysari
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Crystal Li
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Jacqueline Själin
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Maria A Moran
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Sarah Tang
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Pharmacy Department, Singapore General Hospital, Singapore, Singapore
| | - Indy Sandaradura
- Centre for Infectious Diseases and Clinical Microbiology, Westmead Hospital, Westmead, NSW, Australia.,Sydney School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Tania Elhage
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Timothy Gilbey
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Kenneth M Williams
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Deborah J E Marriott
- St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia
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30
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Nguyen AD, Baysari MT, Duong M, Zheng WY, Ng B, Lo S, Robinson F, Hilmer SN. Communicating deprescribing decisions made in hospital with general practitioners in the community. Intern Med J 2021; 51:1473-1478. [PMID: 33465266 DOI: 10.1111/imj.15208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Deprescribing, the supervised withdrawal of inappropriate medications, intends to manage polypharmacy, which is prevalent in older patients. AIMS To examine general practitioner (GP) perceptions of communication processes between clinicians in hospital and GP in the community about deprescribing decisions made in hospital. METHODS Focus groups and interviews were held with 15 GP, exploring deprescribing in hospitals, communication of deprescribing information and the format of communications. Sessions were audiotaped, transcribed and analysed using an inductive approach. RESULTS GP stated that they should be involved in deprescribing decisions, especially for older complex patients, because of their good knowledge of their patients. Barriers to effective communication included the acute nature of hospital stays and lack of time. Facilitators included long-term relationships of GP with their patients and engaged patients. GP preferred communication of deprescribing decisions to be over the telephone while the patient was still in hospital, and with a concise, electronic discharge summary at the time of discharge. GP indicated that rationale for medication changes and recommended follow-up actions were crucial in a discharge summary to enable care post-discharge. CONCLUSIONS GP welcome increased communication with hospital clinicians regarding deprescribing decisions made while patients are in hospital. Communication needs to be timely, transparent, succinct and accessible. Lack of time and difficulties contacting hospital clinicians challenge this process.
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Affiliation(s)
- Amy D Nguyen
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mai Duong
- Kolling Institute of Medical Research, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Wu Yi Zheng
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brendan Ng
- Kolling Institute of Medical Research, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Older Adult, Rehabilitation and Allied Health Services, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sarita Lo
- Kolling Institute of Medical Research, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Fiona Robinson
- Discipline of General Practice, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of General Practice, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Van Dort BA, Zheng WY, Sundar V, Baysari MT. Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals. J Am Med Inform Assoc 2021; 28:177-183. [PMID: 33186438 PMCID: PMC7810441 DOI: 10.1093/jamia/ocaa279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify and summarize the current internal governance processes adopted by hospitals, as reported in the literature, for selecting, optimizing, and evaluating clinical decision support (CDS) alerts in order to identify effective approaches. MATERIALS AND METHODS Databases (Medline, Embase, CINAHL, Scopus, Web of Science, IEEE Xplore Digital Library, CADTH, and WorldCat) were searched to identify relevant papers published from January 2010 to April 2020. All paper types published in English that reported governance processes for selecting and/or optimizing CDS alerts in hospitals were included. RESULTS Eight papers were included in the review. Seven papers focused specifically on medication-related CDS alerts. All papers described the use of a multidisciplinary committee to optimize alerts. Other strategies included the use of clinician feedback, alert data, literature and drug references, and a visual dashboard. Six of the 8 papers reported evaluations of their CDS alert modifications following the adoption of optimization strategies, and of these, 5 reported a reduction in alert rate. CONCLUSIONS A multidisciplinary committee, often in combination with other approaches, was the most frequent strategy reported by hospitals to optimize their CDS alerts. Due to the limited number of published processes, variation in system changes, and evaluation results, we were unable to compare the effectiveness of different strategies, although employing multiple strategies appears to be an effective approach for reducing CDS alert numbers. We recommend hospitals report on descriptions and evaluations of governance processes to enable identification of effective strategies for optimization of CDS alerts in hospitals.
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Affiliation(s)
- Bethany A Van Dort
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Wu Yi Zheng
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vivek Sundar
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Raban MZ, Baysari MT, Jorgensen ML, Tariq A, Georgiou A, Westbrook JI. Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities. Appl Clin Inform 2020; 11:812-820. [PMID: 33296919 DOI: 10.1055/s-0040-1721011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Transdermal medication patches have caused serious adverse events in residential aged care facilities (RACFs). Preliminary research suggests that facilities are using a workaround consisting of manually entered reminders in their electronic medication administration records (eMARs) to prompt staff to check and remove patches, because the eMAR does not support these tasks. However, the prevalence and factors associated with use of this workaround among facilities is unknown. OBJECTIVES The objectives of this study were to (1) examine the frequency and consistency with which manual reminders to check and remove transdermal patches were used in facility eMARs, and (2) identify resident and facility factors associated with reminder use, to inform eMAR redesign. METHODS This was a retrospective cross-sectional analysis of eMAR data from 66 Australian RACFs including 4,787 permanent residents, aged ≥65 years in January 2017. Prevalence of the use of reminders to check and remove patches, and consistency in their application within facilities were examined. Generalized estimating equations were used to determine factors associated with use of manual reminders. RESULTS One in five (n = 937) residents used a patch, and 83.6% of patches contained opioids, a high-risk medicine. 56.9% of facilities implemented manually entered check patch reminders in the eMAR, and 72.3% implemented remove reminders. The reminders were applied inconsistently, with only half of these facilities having reminders for all residents with patches. Residents in facilities in regional areas were more likely to have a check reminder compared with those in major cities (adjusted odds ratio = 4.72 [95% confidence interval: 1.69-13.20]). CONCLUSION Transdermal patches containing high-risk medicines are frequently used in RACFs, but their safe administration is not supported by a widely implemented eMAR. The frequent, but inconsistent use of a workaround to manually enter reminders indicates an unmet need for new eMAR functionality to improve safety.
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Affiliation(s)
- Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia.,Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mikaela L Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia
| | - Amina Tariq
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia
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Westbrook J, Sunderland N, Li L, Koyama A, McMullan R, Urwin R, Churruca K, Baysari MT, Jones C, Loh E, McInnes EC, Middleton S, Braithwaite J. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. Med J Aust 2020; 214:31-37. [PMID: 33174226 DOI: 10.5694/mja2.50849] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify individual and organisational factors associated with the prevalence, type and impact of unprofessional behaviours among hospital employees. DESIGN, SETTING, PARTICIPANTS Staff in seven metropolitan tertiary hospitals operated by one health care provider in three states were surveyed (Dec 2017 - Nov 2018) about their experience of unprofessional behaviours - 21 classified as incivility or bullying and five as extreme unprofessional behaviour (eg, sexual or physical assault) - and their perceived impact on personal wellbeing, teamwork and care quality, as well as about their speaking-up skills. MAIN OUTCOME MEASURES Frequency of experiencing 26 unprofessional behaviours during the preceding 12 months; factors associated with experiencing unprofessional behaviour and its impact, including self-reported speaking-up skills. RESULTS Valid surveys (more than 60% of questions answered) were submitted by 5178 of an estimated 15 213 staff members (response rate, 34.0%). 4846 respondents (93.6%; 95% CI, 92.9-94.2%) reported experiencing at least one unprofessional behaviour during the preceding year, including 2009 (38.8%; 95% CI, 37.5-40.1%) who reported weekly or more frequent incivility or bullying; 753 (14.5%; 95% CI, 13.6-15.5%) reported extreme unprofessional behaviour. Nurses and non-clinical staff members aged 25-34 years reported incivility/bullying and extreme behaviour more often than other staff and age groups respectively. Staff with self-reported speaking-up skills experienced less incivility/bullying (odds ratio [OR], 0.53; 95% CI, 0.46-0.61) and extreme behaviour (OR, 0.80; 95% CI, 0.67-0.97), and also less frequently an impact on their personal wellbeing (OR, 0.44; 95% CI, 0.38-0.51). CONCLUSIONS Unprofessional behaviour is common among hospital workers. Tolerance for low level poor behaviour may be an enabler for more serious misbehaviour that endangers staff wellbeing and patient safety. Training staff about speaking up is required, together with organisational processes for effectively eliminating unprofessional behaviour.
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Affiliation(s)
- Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Neroli Sunderland
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Alain Koyama
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Ryan McMullan
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | | | | | - Erwin Loh
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW.,Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, and Australian Catholic University, Sydney, NSW.,Australian Catholic University, Sydney, NSW
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
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Nathan N, Nguyen AD, Stocker S, Laba TL, Baysari MT, Day RO. Out-of-pocket spending among a cohort of Australians living with gout. Int J Rheum Dis 2020; 24:327-334. [PMID: 32975889 DOI: 10.1111/1756-185x.13979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To measure the direct and indirect out-of-pocket (OOP) costs borne by Australians with gout. METHODS A cross-sectional, Australia-wide, web-based survey was conducted over 12 months between May 2017 and April 2018. Participants were recruited via advertisements in doctors' clinics and healthcare organizations' websites, and social media platforms such as Facebook and Twitter. Survey questions collected information about participants' OOP spending on direct medical and non-medical gout-related healthcare costs. Participant demographics, gout status, healthcare sought, workdays lost to due gout and health-related quality of life were also collected. RESULTS Seventy-nine patients with gout completed the survey; 70 (89%) were male, and on average were 56 (SD 16) years of age and had gout for 14 (SD 12) years. For this cohort, the median total OOP direct medical cost was AU$200 per year (interquartile range [IQR]: AU$60-AU$570). Sixty (76%) people with gout reported being affected by gout during work; however, only 0.25 (IQR: 0-3) days of work (approximately $60) were lost due to gout in a year. Nine percent (n = 7) of participants experienced cost-related treatment attrition and 33% reported economic hardship (n = 26). Participants who experienced economic hardship or cost-related treatment attrition had higher median total gout-related direct costs than those who did not. CONCLUSION In Australia, gout has an OOP financial cost and reduces work productivity. The presence of cost-related treatment attrition among people with gout indicates that financial costs may be a significant barrier to seeking treatment for a subset of patients with gout.
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Affiliation(s)
- Nicholas Nathan
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Amy D Nguyen
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Sophie Stocker
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Richard O Day
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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35
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Zheng WY, Lichtner V, Van Dort BA, Baysari MT. The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Res Social Adm Pharm 2020; 17:832-841. [PMID: 32891535 DOI: 10.1016/j.sapharm.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Technology in the form of Automated Dispensing Cabinets (ADCs), Barcode Medication Administration (BCMA), and closed-loop Electronic Medication Management Systems (EMMS) are implemented in hospitals to assist with the supply, use and monitoring of medications. Although there is evidence to suggest that these technologies can reduce errors and improve monitoring of medications in general, little is known about their impact on controlled medications such as opioids. OBJECTIVES This review aimed to fill this knowledge gap by synthesising literature to determine the impact of ADCs, BCMA and closed-loop EMMS on clinical work processes, medication safety, and drug diversion associated with controlled medications in the inpatient setting. METHODS Eight databases (Medline, Pubmed, Embase, Scopus, Web of Science, PsycINFO, CINAHL, and ScienceDirect) were searched for relevant papers published between January 2000 and May 2019. Qualitative, quantitative, and mixed-methods empirical studies published in English that reported findings on the impact of ADCs, BCMA and/or closed-loop EMMS on controlled medications in the inpatient setting were included. RESULTS In total, 16 papers met the inclusion criteria. Eleven studies reported on ADCs, four on BCMA, and only one on closed-loop EMMS. Only four studies focused on controlled medications, with the remainder reporting only incidental findings. Studies reported the elimination of manual end-of-shift counts of controlled medications after ADC implementation but cases of drug diversion were reported despite introducing ADCs. Three quantitative studies reported reductions in medication errors after implementing BCMA, but medications labelled with wrong barcodes and unreadable barcodes led to confusion and administration errors. CONCLUSIONS More quality, targeted research is needed to provide evidence on the benefits and also risks of implementing technology to safeguard against inappropriate use of controlled medications in the inpatient setting. Processes need to be in place to supplement technological capabilities, and resources should be made available for post-implementation evaluations and interventions.
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Affiliation(s)
- Wu Yi Zheng
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, Sydney, New South Wales, Australia.
| | - Valentina Lichtner
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia; Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Bethany A Van Dort
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, Sydney, New South Wales, Australia
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Baysari MT, Moran M, Del Gigante J, Day RO. Indications-based prescribing: A challenge for hospital prescribers. Br J Clin Pharmacol 2020; 87:730-731. [PMID: 32875641 DOI: 10.1111/bcp.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Melissa T Baysari
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Moran
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Del Gigante
- Department of Pharmacy, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW, Sydney, New South Wales, Australia
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37
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Carland JE, Elhage T, Baysari MT, Stocker SL, Marriott DJE, Taylor N, Day RO. Would they trust it? An exploration of psychosocial and environmental factors affecting prescriber acceptance of computerised dose-recommendation software. Br J Clin Pharmacol 2020; 87:1215-1233. [PMID: 32691902 DOI: 10.1111/bcp.14496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/14/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Dose-prediction software can optimise vancomycin therapy, improving therapeutic drug monitoring processes and reducing drug toxicity. Success of software in hospitals may be dependent on prescriber uptake of software recommendations. This study aimed to identify the perceived psychosocial and environmental barriers and facilitators to prescriber acceptance of dose-prediction software. METHODS Semi-structured interviews, incorporating prescribing scenarios, were undertaken with 17 prescribers. Participants were asked to prescribe the next maintenance dose of vancomycin for a scenario(s) and then asked if they would accept a recommendation provided by a dose-prediction software. Interviews further explored opinions of dose-prediction software. Interview transcripts were analysed using an inductive approach to identify themes and the Theoretical Domains Framework was used to synthesise barriers and facilitators to software acceptance. RESULTS When presented with software recommendations, half of the participants were comfortable with accepting the recommendation. Key barriers to acceptance of software recommendations aligned with 2 Theoretical Domains Framework domains: Knowledge (uncertainty of software capability) and Beliefs about Consequences (perceived impact of software on clinical outcomes and workload). Key facilitators aligned with 2 domains: Beliefs about Consequences (improved efficiency) and Social Influences (influence of peers). A novel domain, Trust, was identified as influential. CONCLUSION Prescribers reported barriers to acceptance of dose-prediction software aligned with limited understanding of, and scepticism about, software capabilities, as well as concerns about clinical outcomes. Identification of key barriers and facilitators to acceptance provides essential information to design of implementation strategies to support the introduction of this intervention into the workplace.
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Affiliation(s)
- Jane E Carland
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia
| | - Tania Elhage
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Melissa T Baysari
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Sophie L Stocker
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia
| | - Deborah J E Marriott
- St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Natalie Taylor
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
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Gates PJ, Baysari MT, Gazarian M, Raban MZ, Meyerson S, Westbrook JI. Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis. Drug Saf 2020; 42:1329-1342. [PMID: 31290127 DOI: 10.1007/s40264-019-00850-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. RESULTS We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. CONCLUSIONS Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Madlen Gazarian
- School of Medical Sciences, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Sophie Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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Van Dort BA, Baysari MT, Carland JE, Stocker SL, Braithwaite HE, Fernon AR, Day RO. Education to improve vancomycin use: the perspectives of educators and education recipients. Intern Med J 2020; 50:565-572. [DOI: 10.1111/imj.14408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Bethany A. Van Dort
- The University of Sydney, Charles Perkins CentreFaculty of Health Sciences Sydney New South Wales Australia
- Australian Institute of Health InnovationMacquarie University Sydney New South Wales Australia
- Department of Clinical Pharmacology and ToxicologySt Vincent’s Hospital Sydney New South Wales Australia
- Faculty of MedicineUNSW Sydney Sydney New South Wales Australia
| | - Melissa T. Baysari
- The University of Sydney, Charles Perkins CentreFaculty of Health Sciences Sydney New South Wales Australia
- Australian Institute of Health InnovationMacquarie University Sydney New South Wales Australia
| | - Jane E. Carland
- Department of Clinical Pharmacology and ToxicologySt Vincent’s Hospital Sydney New South Wales Australia
- St Vincent’s Clinical SchoolUNSW Sydney Sydney New South Wales Australia
| | - Sophie L. Stocker
- Department of Clinical Pharmacology and ToxicologySt Vincent’s Hospital Sydney New South Wales Australia
- St Vincent’s Clinical SchoolUNSW Sydney Sydney New South Wales Australia
| | - Hannah E. Braithwaite
- St Vincent’s Clinical SchoolUNSW Sydney Sydney New South Wales Australia
- St Vincent’s Hospital Sydney Sydney New South Wales Australia
| | - Anna R. Fernon
- St Vincent’s Hospital Sydney Sydney New South Wales Australia
| | - Richard O. Day
- Department of Clinical Pharmacology and ToxicologySt Vincent’s Hospital Sydney New South Wales Australia
- Faculty of MedicineUNSW Sydney Sydney New South Wales Australia
- St Vincent’s Clinical SchoolUNSW Sydney Sydney New South Wales Australia
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Goh S, Baysari MT, Raban MZ. Errors in electronic prescribing systems. Aust Prescr 2020; 43:66. [PMID: 32346215 PMCID: PMC7186278 DOI: 10.18773/austprescr.2020.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Melissa T Baysari
- Digital Health, Faculty of Health Sciences, The University of Sydney.,Digital Health, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney
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Peute LW, Lichtner V, Baysari MT, Hägglund M, Homco J, Jansen-Kosterink S, Jauregui I, Kaipio J, Kuziemsky CE, Lehnbom EC, Leite F, Lesselroth B, Luna D, Otero C, Pedersen R, Pelayo S, Santos R, Silva NA, Tyllinen M, Van Velsen L, Zheng WY, Jaspers M, Marcilly R. Challenges and Best Practices in Ethical Review of Human and Organizational Factors Studies in Health Technology: a Synthesis of Testimonies. Yearb Med Inform 2020; 29:58-70. [PMID: 32303100 PMCID: PMC7442520 DOI: 10.1055/s-0040-1701979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Human and Organizational Factors (HOF) studies in health technology involve human beings and thus require Institutional Review Board (IRB) approval. Yet HOF studies have specific constraints and methods that may not fit standard regulations and IRB practices. Gaining IRB approval may pose difficulties for HOF researchers. This paper aims to provide a first overview of HOF study challenges to get IRB review by exploring differences and best practices across different countries. METHODS HOF researchers were contacted by email to provide a testimony about their experience with IRB review and approval. Testimonies were thematically analyzed and synthesized to identify and discuss shared themes. RESULTS Researchers from seven European countries, Argentina, Canada, Australia, and the United States answered the call. Four themes emerged that indicate shared challenges in legislation, IRB inefficiencies and inconsistencies, general regulation and costs, and lack of HOF study knowledge by IRB members. We propose a model for IRB review of HOF studies based on best practices. CONCLUSION International criteria are needed that define low and high-risk HOF studies, to allow identification of studies that can undergo an expedited (or exempted) process from those that need full IRB review. Enhancing IRB processes in such a way would be beneficial to the conduct of HOF studies. Greater knowledge and promotion of HOF methods and evidence-based HOF study designs may support the evolving discipline. Based on these insights, training and guidance to IRB members may be developed to support them in ensuring that appropriate ethical issues for HOF studies are considered.
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Affiliation(s)
- Linda W Peute
- Centre for Human Factor Engineering of Health Information technology - Amsterdam UMC, University of Amsterdam, department of Medical Informatics, Amsterdam, The Netherlands
| | - Valentina Lichtner
- Centre for Medication Safety and Service Quality, UCL School of Pharmacy, UK
| | - Melissa T Baysari
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Maria Hägglund
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Juell Homco
- Department of Medical Informatics, University of Oklahoma - Tulsa School of Community Medicine, USA
| | | | - Ignacio Jauregui
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
| | - Johanna Kaipio
- Department of Computer Science, Aalto University, Finland
| | | | - Elin Christina Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway; Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Sweden
| | | | - Blake Lesselroth
- Department of Medical Informatics, University of Oklahoma - Tulsa School of Community Medicine, USA
| | - Daniel Luna
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
| | - Carlos Otero
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
| | - Rune Pedersen
- Norwegian Centre for E-health Research, University Hospital of North Norway HF, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Sylvia Pelayo
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, INSERM-CIC-IT 1403/Evalab, Lille, France
| | | | | | - Mari Tyllinen
- Department of Computer Science, Aalto University, Finland
| | - Lex Van Velsen
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Wu Yi Zheng
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Monique Jaspers
- Centre for Human Factor Engineering of Health Information technology - Amsterdam UMC, University of Amsterdam, department of Medical Informatics, Amsterdam, The Netherlands
| | - Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, INSERM-CIC-IT 1403/Evalab, Lille, France
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Gates PJ, Baysari MT, Mumford V, Raban MZ, Westbrook JI. Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Saf 2020; 42:931-939. [PMID: 31016678 PMCID: PMC6647434 DOI: 10.1007/s40264-019-00823-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Classifying harm associated with a medication error can be time consuming and labour intensive and limited studies undertake this step. There is no standardised process, and few studies that report harm assessment provide adequate methods to allow for study replication. Studies typically mention that a clinical review panel classified patient harm and provide a reference to a classification tool. Moreover, in many studies it is unclear whether potential or actual harm was classified as studies refer only to ‘error severity’. The tools used to categorise the severity of patient harm vary widely across studies and few have been assessed for inter-rater reliability and criterion validity. In this paper, we describe the systematic process we undertook to synthesise the defining elements and strengths, while mitigating the limitations, of existing harm classification tools to derive the Harm Associated with Medication Error Classification (HAMEC). This new tool provides a harm classification for use across clinical and research settings. The provision of an explicit process for its application and guiding category descriptors are designed to reduce the risk of misclassification and produce results that are comparable across studies. As the World Health Organisation embarks on its international safety challenge of reducing medication-related harm by 50%, accompanying methodological advances are required to measure progress.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Abstract
OBJECTIVES There are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase and CINAHL from 1997 until November 2018. ELIGIBILITY CRITERIA Controlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations. DATA EXTRACTION AND SYNTHESIS Two reviewers independently applied the Cochrane Effective Practice and Organisation of Care group's resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results. RESULTS Of include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers. CONCLUSIONS There is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.
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Affiliation(s)
- Magdalena Z Raban
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claudia Gasparini
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Baysari MT, Zheng WY, Tariq A, Heywood M, Scott G, Li L, Van Dort BA, Rathnayake K, Day R, Westbrook JI. An experimental investigation of the impact of alert frequency and relevance on alert dwell time. Int J Med Inform 2019; 133:104027. [PMID: 31706231 DOI: 10.1016/j.ijmedinf.2019.104027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to determine the impact of alert frequency and relevance on alert dwell time. METHOD A 2 × 3 design was used where 127 university students completed 60 prescribing tasks and were presented with a variable frequency of computerized alerts (low, medium and high) with variable relevance (low and high). Participants were instructed to override an alert if it was not relevant to their prescription, and to cancel the order if the alert signalled an error in their order. RESULTS Participants presented with a small number of alerts spent more time attending to alert content than participants presented with a medium or high number of alerts (respectively median 15.6 s vs 10.8 vs 10.2 s). Alert relevance had no impact on alert dwell time. Alerts requiring an override response were 4.5 times more likely to be correctly actioned than alerts requiring the order to be cancelled. DISCUSSION Dwell time was influenced by alert frequency, with greater exposure to alerts associated with shorter dwell times. We hypothesize that this was because participants came to learn that spending time on alert information was unnecessary. We propose that when users experience no consequences or feedback from overriding alerts they quickly learn that this action is more efficient and so more rewarding than taking any other action.
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Affiliation(s)
- Melissa T Baysari
- The University of Sydney, Faculty of Health Sciences, Sydney Australia; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia.
| | - Wu Yi Zheng
- The University of Sydney, Faculty of Health Sciences, Sydney Australia; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Amina Tariq
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australia
| | - Maureen Heywood
- Department of Pharmacy, St Vincent's Hospital, Sydney Australia
| | - Grace Scott
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Ling Li
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Bethany A Van Dort
- The University of Sydney, Faculty of Health Sciences, Sydney Australia; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Kasun Rathnayake
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Richard Day
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney Australia; St Vincent's Clinical School, UNSW Medicine, UNSW, Sydney Australia
| | - Johanna I Westbrook
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
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Baysari MT, Duong M, Zheng WY, Nguyen A, Lo S, Ng B, Ritchie A, Le Couteur D, McLachlan A, Bennett A, Hilmer S. Delivering the right information to the right person at the right time to facilitate deprescribing in hospital: a mixed methods multisite study to inform decision support design in Australia. BMJ Open 2019; 9:e030950. [PMID: 31562155 PMCID: PMC6773288 DOI: 10.1136/bmjopen-2019-030950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To inform the design of electronic decision support (EDS) to facilitate deprescribing in hospitals we set out to (1) explore the current processes of in-hospital medicines review, deprescribing and communication of deprescribing decisions with the patient's general practitioner (GP), (2) identify barriers to undertaking these tasks and (3) determine user preferences for EDS. DESIGN Multimethod, multisite study comprising observations, semistructured interviews and focus groups. SETTING General medicine, geriatric medicine and rehabilitation wards at six hospitals in two local health districts in Sydney, Australia and primary care practices in one primary healthcare district in Sydney, Australia. PARTICIPANTS 149 participants took part in observations, interviews and focus groups, including 69 hospital doctors, 13 nurses, 55 pharmacists and 12 GPs. MAIN OUTCOME MEASURES Observational data on who was involved in medicines review and deprescribing, when medicines review took place, and what artefacts (eg, forms) were used. Participants reported perceptions of medicines review, polypharmacy and deprescribing and preferences for EDS. RESULTS Deprescribing, undertaken during medicines review, was typically performed by a junior doctor, following a decision to deprescribe by a senior doctor. Key barriers to deprescribing included a perception that deprescribing was not the responsibility of hospital doctors, a lack of confidence among junior doctors and pharmacists in broaching this topic with senior doctors and a lack of patient engagement in the deprescribing process. In designing EDS, the tools, likely to be used by junior doctors, pharmacists and nurses, should be available throughout the hospitalisation and should comprise non-interruptive evidence-based guidance on why and how to deprescribe. CONCLUSIONS Deprescribing decisions are complex and influenced by multiple factors. The implementation of EDS alone is unlikely to address all barriers identified. To achieve sustained improvements in monitoring of polypharmacy and subsequent deprescribing, a multifaceted intervention is needed.
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Affiliation(s)
- Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mai Duong
- Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
| | - Wu Yi Zheng
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy Nguyen
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarita Lo
- Department of Clinical Pharmacology and Aged Care, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
| | - Brendan Ng
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David Le Couteur
- University of Sydney Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - Andrew McLachlan
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sarah Hilmer
- Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Van Dort BA, Zheng WY, Baysari MT. Prescriber perceptions of medication-related computerized decision support systems in hospitals: A synthesis of qualitative research. Int J Med Inform 2019; 129:285-295. [DOI: 10.1016/j.ijmedinf.2019.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023]
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Baysari MT, Zheng WY, Li L, Westbrook J, Day RO, Hilmer S, Van Dort BA, Hargreaves A, Kennedy P, Monaghan C, Doherty P, Draheim M, Nair L, Samson R. Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts. BMJ Open 2019; 9:e026034. [PMID: 31427312 PMCID: PMC6701635 DOI: 10.1136/bmjopen-2018-026034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Drug-drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients' medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems. METHODS AND ANALYSIS A controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three as intervention sites with DDI alerts. The medical records of 280 patients admitted in the 6 months prior to and 6 months following implementation of the EMM system at each site (total 3360 patients) will be retrospectively reviewed by study pharmacists to identify potential DDIs, clinically relevant DDIs and associated patient harm. To identify barriers and facilitators to optimal use of alerts, 10-15 doctors working at each intervention hospital will take part in observations and interviews. Non-identifiable DDI alert data will be extracted from EMM systems 6-12 months after system implementation in order to quantify alert burden on prescribers. Finally, data collected from chart review and EMM systems will be linked with clinically relevant DDIs to inform the development of algorithms to trigger only clinically relevant DDI alerts in EMM systems. ETHICS AND DISSEMINATION This research was approved by the Hunter New England Human Research Ethics Committee (18/02/21/4.07). Study results will be published in peer-reviewed journals and presented at local and international conferences and workshops.
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Affiliation(s)
- Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Wu Yi Zheng
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Richard O Day
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sarah Hilmer
- Kolling Institute of Medical Research and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Bethany Annemarie Van Dort
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | | | - Corey Monaghan
- eHealth QLD, Queensland Department of Health, Brisbane, Queensland, Australia
| | - Paula Doherty
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Michael Draheim
- Metro South Health Service District, Brisbane, Queensland, Australia
| | - Lucy Nair
- Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
| | - Ruby Samson
- Nepean Hospital, Blue Mountains, New South Wales, Australia
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Baysari MT, Hardie R, Barclay P, Westbrook JI. Effects of an electronic medication management system on pharmacists’ work in a paediatric hospital. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Melissa T. Baysari
- Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University Sydney Australia
| | - Rae‐Anne Hardie
- Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University Sydney Australia
| | - Peter Barclay
- The Sydney Children's Hospital Westmead Sydney Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University Sydney Australia
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Abstract
The implementation of computerised prescribing can result in large reductions in prescribing error rates. The flow-on effects to patient outcomes are not well studied The reduction in errors is dependent on prescribers becoming proficient in using the electronic prescribing system. All potential safety benefits are therefore not expected to be achieved immediately Electronic prescribing systems introduce new types of errors, most frequently errors in selection. Some of these errors can be prevented if the system is well designed Computerised decision support embedded in electronic prescribing systems has enormous potential to improve medication safety. However, current support systems have a limited capacity to provide context-relevant advice to prescribers
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Affiliation(s)
- Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney
| | - Magdalena Z Raban
- Faculty of Health Sciences, The University of Sydney.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney
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Gates PJ, Meyerson SA, Baysari MT, Westbrook JI. The Prevalence of Dose Errors Among Paediatric Patients in Hospital Wards with and without Health Information Technology: A Systematic Review and Meta-Analysis. Drug Saf 2019; 42:13-25. [PMID: 30117051 DOI: 10.1007/s40264-018-0715-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. OBJECTIVE Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. RESULTS We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8-25% of patients experiencing a dose error, and approximately 2-6% of medication orders and approximately 3-8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1-6% of medication orders and approximately 3-8% of dose administrations contained a dose error. Few studies provided data for individual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. CONCLUSIONS Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre/post studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Sophie A Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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