Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

Objective: To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods: A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results: We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion: Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion: In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors

Melhoria de um conjunto de heurísticas de usabilidade para sistemas mHealth em smartphones

TCC(graduação) - Universidade Federal de Santa Catarina. Centro Tecnológico. Ciências da Computação.Smartphones têm se tornado parte significativa do cotidiano das pessoas, incluindo seu cuidado com a saúde. Entretanto, há uma série de problemas de usabilidade associados a aplicativos mHealth. O objetivo deste trabalho é a melhoria do conjunto de heurísticas e checklist MATcH-MED. Os itens do checklist foram revisados considerando análises anteriores e problemas de usabilidade do contexto. Assim, uma nova versão do MATcH-MED foi proposta. Foram coletados dados de 200 avaliações heurísticas e por meio de uma análise com a aplicação de Teoria de Resposta ao Item foi possível confirmar quais itens são capazes de medir a usabilidade de aplicativos mHealth para smartphones.Smartphones have become a significant aspect of peoples lives, including their healthcare. However, there are various usability problems associated with mHealth applications. The objective of this work is the improvement of the set of heuristics and checklist MATcH-MED. The itens of the checklist were reviewed considering previous analysis and usability problems of the context. Thus, a new version of the MATcH-MED was proposed. Data from 200 heuristic evaluations was collected and through the application of Item Response Theory was possible to identify which itens are acapable of measuring the usability of mHealth apps for smartphones

User-centered design and evaluation of RxMAGIC: A Prescription Management And General Inventory Control system for free clinic dispensaries

Medication management is a complex and expensive multistage process that covers the prescribing and ordering, order communication, dispensing, administering, and monitoring and use of prescription medications. While challenges in medication management are ubiquitous across all settings, they can be particularly exacerbated in a free clinic that serves a medically vulnerable population. These patients suffer from financial constraints, poor health literacy, multiple chronic conditions, and medication non-adherence. Clinical pharmacists play an integral role in the provision of healthcare services to these patients and could benefit from the use of medication management information technology (MMIT) to provide efficiencies in the tracking, provision, and use of medications. While MMITs exist, they are not designed to support the unique needs of pharmacists in these settings

Introducing User-Centred Design: a Longitudinal Study of a Healthcare Informatics Organisation

Information System designers report increasing difficulties applying User-Centred Design (UCD) techniques effectively due to the growing complexity of the domains in which they work and the techniques’ prescriptive nature. The rapid growth of “Big Data” and associated analytical tools thus demands closer investigation of UCD activities and processes within the complex and rapidly-changing work domains in which they are designed, developed and used. This thesis reports a longitudinal case study from inside a commercial organisation, through a six-year Action Research collaboration to introduce and embed UCD techniques in the design of health informatics tools in the UK. An assessment of the initial modus operandi is followed by the development of personas with data from interviews, user-generated screen captures and database server log files; these informed the redesign, evaluation and testing of the organisation’s flagship product. Finally, stakeholder interviews explore the wider impact of UCD techniques. In so doing, this thesis shows the value of auto-ethnographic documentation, based on being embedded in a design team and collaborative reflection, for practice-led research; it found the organisation’s culture around UCD was dynamic and design practices can change this culture through, for example, training opportunities and fostering customer relations. Individuals and extrinsic factors played strikingly key roles in reshaping the organisation’s culture; the commitment and resilience of individuals was important for sustaining UCD activities across several reorganisations and changes in business strategy. Finally, this thesis comprehensively presents and evaluates an innovative approach for grounding personas in database server and user-generated content. These findings concern both research and practice by informing the scope of the designer’s role, educational programmes and Action Research collaborations. They call for further attention on the compatibility of design and development processes and suggest that design practice can not only be tailored to organisations, but organisations can be fitted to design practice with the reassessment of the value of some UCD activities. Finally, this thesis can inform approaches to practice-led research, and more effective and efficient strategies for the introduction of UCD techniques to other organisations from the base of their hierarchy