Publications
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Cresswell K, Sheikh A, Franklin BD, et al., 2020, Theoretical and methodological considerations in evaluating large-scale health information technology change programmes, BMC HEALTH SERVICES RESEARCH, Vol: 20
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- Citations: 10
Garfield S, Franklin BD, 2020, The future is giving patients control over their ownmedication records, Pharmaceutical Journal, Vol: 304, ISSN: 0031-6873
Aufegger L, Serou N, Chen S, et al., 2020, Evaluating users' experiences of electronic prescribing systems in relation to patient safety: a mixed methods study, BMC Medical Informatics and Decision Making, Vol: 20, ISSN: 1472-6947
BackgroundUser interface (UI) design features such as screen layout, density of information, and use of colour may affect the usability of electronic prescribing (EP) systems, with usability problems previously associated with medication errors. To identify how to improve existing systems, our aim was to explore prescribers’ perspectives of UI features of a commercially available EP system, and how these may affect patient safety.MethodsTwo studies were conducted, each including ten participants prescribing a penicillin for a test patient with a penicillin allergy. In study 1, eye-gaze tracking was used as a means to explore visual attention and behaviour during prescribing, followed by a self-reported EP system usability scale. In study 2, a think-aloud method and semi-structured interview were applied to explore participants’ thoughts and views on prescribing, with a focus on UI design and patient safety.ResultsStudy 1 showed high visual attention toward information on allergies and patient information, allergy pop-up alerts, and medication order review and confirmation, with less visual attention on adding medication. The system’s usability was rated ‘below average’. In study 2, participants highlighted EP design features and workflow, including screen layout and information overload as being important for patient safety, benefits of EP systems such as keeping a record of relevant information, and suggestions for improvement in relation to system design (colour, fonts, customization) and patient interaction.ConclusionsSpecific UI design factors were identified that may improve the usability and/or safety of EP systems. It is suggested that eye-gaze tracking and think-aloud methods are used in future experimental research in this area. Limitations include the small sample size; further work should include similar studies on other EP systems.
Franklin BD, Abel G, Shojania KG, 2020, Medication non-adherence: an overlooked target for quality improvement interventions, BMJ QUALITY & SAFETY, Vol: 29, Pages: 271-273, ISSN: 2044-5415
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- Citations: 5
Furniss D, Dean Franklin B, Blandford A, 2020, The devil is in the detail: How a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety, HEALTH INFORMATICS JOURNAL, Vol: 26, Pages: 576-591, ISSN: 1460-4582
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- Citations: 9
Vos J, Franklin BD, Chumbley G, et al., 2020, Nurses as a source of system-level resilience: Secondary analysis of qualitative data from a study of intravenous infusion safety in English hospitals, INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 102, ISSN: 0020-7489
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- Citations: 10
Harkanen M, Vehvilainen-Julkunen K, Murrells T, et al., 2020, The Contribution of Staffing to Medication Administration Errors: A Text Mining Analysis of Incident Report Data, JOURNAL OF NURSING SCHOLARSHIP, Vol: 52, Pages: 113-123, ISSN: 1527-6546
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- Citations: 14
Geeson C, Wei L, Franklin BD, 2020, High-risk medicines associated with clinically relevant medication-related problems in UK hospitals: A prospective observational study, BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Vol: 86, Pages: 165-169, ISSN: 0306-5251
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- Citations: 6
Lichtner V, Prgomet M, Franklin BD, et al., 2020, The 'Back Office' of a Dispensing Cabinet: Technology and Work Contributing to Medication Safety, DIGITAL PERSONALIZED HEALTH AND MEDICINE, Vol: 270, Pages: 1405-1406, ISSN: 0926-9630
Feather C, Appelbaum N, Clarke J, et al., 2019, Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, BMJ Open, Vol: 9, Pages: 1-13, ISSN: 2044-6055
Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contribution of discrepancies in individual process steps to the occurrence of these errors.Methods: We conducted a prospective observational study of simulated resuscitations subjected to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude (>25% discrepant) or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.
Harkanen M, Paananen J, Murrells T, et al., 2019, Identifying risks areas related to medication administrations-text mining analysis using free-text descriptions of incident reports, BMC HEALTH SERVICES RESEARCH, Vol: 19
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- Citations: 14
Bell H, Garfield S, Khosla S, et al., 2019, Mixed methods study of medication-related decision support alerts experienced during electronic prescribing for inpatients at an English hospital, European Journal of Hospital Pharmacy: Science and Practice, Vol: 26, Pages: 318-322, ISSN: 2047-9956
Objectives Electronic prescribing and medication administration systems are being introduced in many hospitals worldwide, with varying degrees of clinical decision support including pop-up alerts. Previous research suggests that prescribers override a high proportion of alerts, but little research has been carried out in the UK. Our objective was to explore rates of alert overriding in different prescribing situations and prescribers’ perceptions around the use of decision support alerts in a UK hospital.Methods We conducted a mixed methods study on three cardiology wards, directly observing medical and non-medical prescribers’ alert override rates during both ward round and non-ward round prescribing; observations were followed by semi-structured interviews with prescribers, which were then transcribed and analysed thematically.Results Overall, 69% of 199 observed alerts were overridden. Alerts experienced during ward rounds were significantly more likely to be overridden than those outside of ward rounds (80% of 56 vs 51% of 63; p=0.001, Χ2 test). While respondents acknowledged that alerts could be useful, several also described negative unintended consequences. Many were of the view that usefulness of alerts was limited if the alert was reminding them to do something they would do anyway, or suggesting something they did not feel was relevant. Findings suggest that targeting, timing and additional features of alerts are critical factors in determining whether they are acted on or overridden.Conclusion The majority of alerts were overridden. Alerts may be less likely to be overridden if they are built into the prescribing workflow.
Mohsin-Shaikh S, Furniss D, Blandford A, et al., 2019, The impact of electronic prescribing systems on healthcare professionals' working practices in the hospital setting: a systematic review and narrative synthesis, BMC Health Services Research, Vol: 19, Pages: 1-8, ISSN: 1472-6963
BackgroundThe aim of this systematic review was to synthesise peer-reviewed literature assessing the impact of electronic prescribing (eP) systems on the working practices of healthcare professionals (HCPs) in the inpatient setting and identify implications for practice and research.MethodsWe searched PubMed, Medline, Embase, Cochrane and the Cumulative Index to Nursing Allied Health Literature databases for studies published from inception to November 2018. We included controlled, uncontrolled, observational and descriptive studies that explored the effect of eP on HCPs’ working practices in an inpatient setting. Data on setting, eP system and impact on working practices were extracted. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration CRD42017075804).ResultsSearches identified 1301 titles and abstracts after duplicate removal. 171 papers underwent full-text review. A total of 25 studies met the inclusion criteria, from nine different countries. Nineteen were of commercial eP systems. There were a range of study designs; most (n = 14) adopted quantitative methods such as cross-sectional surveys, ten adopted qualitative approaches and a further one used mixed methods. Fourteen of the 25 studies were deemed to be of high quality. Four key themes were identified: communication, time taken to complete tasks, clinical workflow, and workarounds. Within each theme, study findings differed as to whether the effects of eP on HCPs’ working practices were positive or negative.ConclusionThere is a lack of consensus within the literature on the impact of eP on HCPs’ working practices. Future research should explore the strategies resulting in a positive impact on HCPs’ working practices and learn from those that have not been successful.
Furniss D, Mayer A, Franklin BD, et al., 2019, Exploring structure, agency and performance variability in everyday safety: An ethnographic study of practices around infusion devices using distributed cognition, SAFETY SCIENCE, Vol: 118, Pages: 687-701, ISSN: 0925-7535
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- Citations: 10
Blandford A, Dykes PC, Franklin BD, et al., 2019, Intravenous Infusion Administration: A Comparative Study of Practices and Errors Between the United States and England and Their Implications for Patient Safety, DRUG SAFETY, Vol: 42, Pages: 1157-1165, ISSN: 0114-5916
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- Citations: 13
Cresswell K, Sheikh A, Krasuska M, et al., 2019, Reconceptualising the digital maturity of health systems., Lancet Digit Health, Vol: 1, Pages: e200-e201
Lichtner V, Franklin BD, Westbrook JI, 2019, Researching Collective Mindfulness and Health IT: A Framework and Translation to Context-Specific Questions., Stud Health Technol Inform, Vol: 265, Pages: 31-36
To improve patient safety, hospital organisations are encouraged to run their operations in line with high reliability organisations' collective mindfulness principles and practices. For the same safety goals, they also implement health information technology (IT). However, little is known about whether, or how, health IT can impact organisational mindfulness, and thereby safety. We propose that research in this area can be approached through a simple framework of overarching, umbrella questions, then carefully translated into nuanced context-specific questions and study designs. The framework and approach we propose provides a structure for comparing results from studies of collective mindfulness and health IT, across different clinical contexts and IT applications.
Geeson C, Wei L, Franklin BD, 2019, Development and performance evaluation of the Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to prevent medication-related problems, BMJ QUALITY & SAFETY, Vol: 28, Pages: 645-656, ISSN: 2044-5415
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- Citations: 18
Furniss D, Garfield S, Husson F, et al., 2019, Distributed Cognition: Understanding Complex Sociotechnical Informatics., Stud Health Technol Inform, Vol: 263, Pages: 75-86
Distributed cognition theory posits that our cognitive tasks are so tightly coupled to the environment that cognition extends into the environment, beyond the skin and the skull. It uses cognitive concepts to describe information processing across external representations, social networks and across different periods of time. Distributed cognition lends itself to exploring how people interact with technology in the workplace, issues to do with communication and coordination, how people's thinking extends into the environment and sociotechnical system architecture and performance more broadly. We provide an overview of early work that established distributed cognition theory, describe more recent work that facilitates its application, and outline how this theory has been used in health informatics. We present two use cases to show how distributed cognition can be used at the formative and summative stages of a project life cycle. In both cases, key determinants that influence performance of the sociotechnical system and/or the technology are identified. We argue that distributed cognition theory can have descriptive, rhetorical, inferential and application power. For evidence-based health informatics it can lead to design changes and hypotheses that can be tested.
Harkanen M, Vehvilainen-Julkunen K, Murrells T, et al., 2019, Medication administration errors and mortality: Incidents reported in England and Wales between 2007-2016, RESEARCH IN SOCIAL & ADMINISTRATIVE PHARMACY, Vol: 15, Pages: 858-863, ISSN: 1551-7411
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- Citations: 29
Appelbaum N, Clarke J, Feather C, et al., 2019, Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis
<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contributory role of individual process step discrepancies to these errors.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a prospective observational study of simulated resuscitations subject to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>At least one medication error was observed in every simulated case, and a large magnitude or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Medication errors were common with a conside
McLeod M, Karampatakis GD, Heyligen L, et al., 2019, The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study, BMC Health Services Research, Vol: 19, Pages: 1-15, ISSN: 1472-6963
BackgroundThe increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists’ activities, including interactions with patients and health professionals, and their perceptions of medication safety risks.MethodsA mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors.ResultsObservations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors.ConclusionThis study provides quantitative and qualitative
Phillips CJ, Gilchrist M, Cooke FJ, et al., 2019, Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts, BMJ Open, Vol: 9, ISSN: 2044-6055
OBJECTIVE: To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. SETTING: Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017. DESIGN: Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report. PARTICIPANTS: Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs. RESULTS: A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p<0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37) p<0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment. CONCLUSIONS: A relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP
Hemming K, Carroll K, Thompson J, et al., 2019, Quality of stepped-wedge trial reporting can be reliably assessed using an updated CONSORT: crowd-sourcing systematic review, Journal of Clinical Epidemiology, Vol: 107, Pages: 77-88, ISSN: 0895-4356
The Consolidated Standards Of Reporting Trials (CONSORT) extension for the stepped-wedge cluster randomised trial (SW-CRT) is a recently published reporting guideline for SW-CRTs. We assess the quality of reporting of a recent sample of SW-CRTs according to the 26 items in the new guideline using a novel crowd sourcing methodology conducted independently and in duplicate, with random assignment, by 50 reviewers. We assessed reliability of the quality assessments, proposing this as a novel way to assess robustness of items in reporting guidelines.Several items were well reported. Some items were very poorly reported, including several items that have unique requirements for the SW-CRT, such as the rationale for use of the design, description of the design, identification and recruitment of participants within clusters, and concealment of cluster allocation (not reported in more than 50% of the reports). Agreement across items was moderate (median percentage agreement was 76% [IQR 64 to 86]). Agreement was low for several items including the description of the trial design and why trial ended or stopped for example.When reporting SW-CRTs authors should pay particular attention to ensure clear reporting on the exact format of the design with justification, as well as how clusters and individuals were identified for inclusion in the study, and whether this was done before or after randomisation of the clusters, which are crucial for risk of bias assessments. Some items, including why the trial ended might either not be relevant to SW-CRTs, or might be unclearly described in the statement.
Ahmed Z, Jani Y, Franklin BD, 2018, Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations, BMC HEALTH SERVICES RESEARCH, Vol: 18, ISSN: 1472-6963
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- Citations: 3
Lyons I, Furniss D, Blandford A, et al., 2018, Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study, BMJ QUALITY & SAFETY, Vol: 27, Pages: 892-901, ISSN: 2044-5415
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- Citations: 44
Alsaidan J, Portlock J, Aljadhey HS, et al., 2018, Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries, SAUDI PHARMACEUTICAL JOURNAL, Vol: 26, Pages: 977-1011, ISSN: 1319-0164
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- Citations: 12
Al-Fageh B, Aljadhey H, Mahmoud MA, et al., 2018, Perceived causes of prescribing errors by physicians: A qualitative study, TROPICAL JOURNAL OF PHARMACEUTICAL RESEARCH, Vol: 17, Pages: 1415-1422, ISSN: 1596-5996
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- Citations: 3
Puaar SJ, Franklin BD, 2018, Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital, BMJ QUALITY & SAFETY, Vol: 27, Pages: 529-538, ISSN: 2044-5415
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- Citations: 13
Garfield S, Bell H, Nathan C, et al., 2018, A quality improvement project to increase self-administration of medicines in an acute hospital, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 30, Pages: 396-407, ISSN: 1353-4505
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- Citations: 4
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