Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study

In a before-and-after study, Johanna Westbrook and colleagues evaluate the change in prescribing error rates after the introduction of two commercial electronic prescribing systems in two Australian hospitals

Mobile applications for patient-centered care coordination : a review of human factors methods applied to their design, development, and evaluation

Objectives: To examine if human factors methods were applied in the design, development, and evaluation of mobile applications developed to facilitate aspects of patient-centered care coordination. Methods: We searched MEDLINE and EMBASE (2013-2014) for studies describing the design or the evaluation of a mobile health application that aimed to support patients' active involvement in the coordination of their care. Results: 34 papers met the inclusion criteria. Applications ranged from tools that supported self-management of specific conditions (e.g. asthma) to tools that provided coaching or education. Twelve of the 15 papers describing the design or development of an app reported the use of a human factors approach. The most frequently used methods were interviews and surveys, which often included an exploration of participants' current use of information technology. Sixteen papers described the evaluation of a patient application in practice. All of them adopted a human factors approach, typically an examination of the use of app features and/or surveys or interviews which enquired about patients' views of the effects of using the app on their behaviors (e.g. medication adherence), knowledge, and relationships with healthcare providers. No study in our review assessed the impact of mobile applications on health outcomes. Conclusion: The potential of mobile health applications to assist patients to more actively engage in the management of their care has resulted in a large number of applications being developed. Our review showed that human factors approaches are nearly always adopted to some extent in the design, development, and evaluation of mobile applications.8 page(s

Evaluation of hospital-wide computerised decision support in an intensive care unit : an observational study

We conducted an observational study with interviews in a 12-bed general/neurological intensive care unit (ICU) at a teaching hospital in Sydney, Australia, to determine whether hospital-wide computerised decision support (CDS) embedded in an electronic prescribing system is used and perceived as useful by doctors in an ICU setting. Twenty doctors were shadowed by the observer while on ward rounds (33.6 hours) and non-ward rounds (28 hours) in the ICU. These doctors were also interviewed to explore views of CDS. We found that computerised alerts were triggered frequently in the ICU (n=166, in 59% of orders), less than half of the alerts were read by doctors and only four alerts resulted in a medication order being changed. Pre-written orders were utilised frequently, however reference material was rarely accessed. Interviews with doctors revealed a willingness to use CDS features; however the primary barrier to use was lack of customisation for the ICU setting. Doctors working in the ICU triggered a high number of alerts when prescribing, 40% more alerts than doctors working on general wards of the same hospital. Certain procedures in place in the ICU (e.g. daily microbiology ward rounds) made many alerts redundant in this setting. Lack of customisation for the ICU led to dissatisfaction with CDS and infrequent use of some CDS features.6 page(s

TRACEr-RAV : modification of the 'Technique for retrospective analysis of cognitive errors' for Australian rail use

There is currently no widely accepted human error identification (HEI) tool used in Australia to identify and classify errors associated with rail accidents and incidents. The aim of this paper is to outline an attempt to develop a HEI tool for Australian use. The Technique for the Retrospective and Predictive Analysis of Cognitive Errors (TRACEr) is a HEI tool initially developed for air traffic control and subsequently revised and adopted in the UK as a rail-specific tool for train driving (TRACEr-Rail). In applying TRACEr-rail to an Australian sample of incidents and accidents, only moderate inter-rater reliability was demonstrated. The tool was also unable to classify adequately all the errors (and factors associated with errors) extracted from incident reports. In an attempt to improve the consistency with which the tool is applied and the tool's capacity to identify and categorise train driver errors in Australia, the tool was modified to become TRACEr-RAV (TRACEr-for Rail, Australian Version). Changes to TRACEr-Rail included the addition and omission of some error categories, revision of many of the category definitions, the provision of more appropriate examples, and the adoption of more Australian terminology. This paper outlines the difficulties encountered while using TRACEr-Rail and the changes made to the tool. It also describes the process of design for a study aimed to establish the reliability and usability of our new tool, TRACEr-RAV.9 page(s

The Impact of the ON-S1 standard on railway risk levels in Australia

The objective of this study was to compare risk levels, based on reported railway occurrences, across Australian states. A secondary aim was to use these numbers to assess the impact of a new reporting system, ON-S1, introduced in 2004, on the calculated risk levels. The Australian nationwide standard, ON-S1, defines how to categorize occurrences and their consequences, but it has not been consistently applied in all states. For example, New South Wales and Victoria use broader definitions of 'serious injury' than specified in ON-S1. This paper outlines challenges related to ON-S1's use and the appropriateness of calculating risks based on reported occurrences. Railway occurrence data from five Australian states/territories from 2001 to 2007 were reviewed. Data on fatalities, serious injuries and train kilometres were obtained from the Australian Transport Safety Bureau (ATSB) and The Independent Transport Safety and reliability Regulator's (ITSRR) safety reports. We used these data to calculate an index of Fatalities and Weighted Injuries (FWI), normalized for train kilometres. The results showed that the average annual risk per million train kilometres for the entire period (2001-2007) was highest in New South Wales (FWI 1.28), followed by Victoria (FWI 0.89), South Australia (FWI 0.77), Queensland (FWI 0.34) and Western Australia (FWI 0.26). Following the introduction of ON-S1, the FWI in New South Wales and Victoria doubled from 2004 to 2006. These trends continued into the first half of 2007. The other states showed a stable or decreasing trend. The highest risk appeared to be in the states with the largest populations containing Australia's largest cities. The use of train kilometres to normalize occurrence rates may be inappropriate because this measure does not take into account the number of people travelling on each train. The sharp increase in reported occurrences in New South Wales and Victoria may reflect the misuse of ON-S1, because a similar increase was not observed in the other states. The large difference in risk level between states highlights a need for consistent application of the national reporting regime in Australia to enable valid comparisons of occurrence rates between states.6 page(s

Clinical decision support systems for chronic obstructive pulmonary disease (COPD) in hospitals: A systematic review

Objectives: To synthesise the literature on clinical decision support (CDS) systems for chronic obstructive pulmonary disease (COPD). We aimed to (1) describe existing COPD CDS systems that have been designed, developed or are being used in practice, (2) describe the impact of COPD CDS systems on outcomes and (3) identify barriers and facilitators to implementation of COPD CDS systems. Methods: Five databases were searched to identify relevant studies. All studies in English that described clinician-facing COPD CDS systems designed for, or implemented in, hospitals and hospital-in-the-home settings were included. A qualitative narrative synthesis was undertaken, guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Results: Twelve studies reporting the use of CDS in hospital (n = 7) and hospital-in-the-home (n = 5) settings were included. Implementation efforts to reach target users were scantly reported, and low-to-medium adoption rates were observed. The reported effectiveness of the CDS systems was mixed. Only one study reported facilitators to the implementation of CDS systems, none reported on barriers to the implementation of CDS systems, and none reported any information on successful strategies to maintain implementation of CDS systems. Conclusion: The use of CDS systems in the management of patients with COPD in hospital-related settings is an important emerging field of research. Evidence suggests that the field has largely focused on systems targeted at physicians, often with incomplete descriptions and limited evaluations. Many opportunities to optimise and evaluate the implementation and use of COPD CDS systems in hospital settings remain, including robust evaluation of their impact on patient, clinician and health service outcomes.</p

iPad use at the bedside : a tool for engaging patients in care processes during ward rounds?

BACKGROUND: Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. AIMS: To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. METHODS: Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. RESULTS: Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. CONCLUSIONS: Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.5 page(s