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  • Journal article
    Harkanen M, Vehvilainen-Julkunen K, Murrells T, Paananen J, Franklin BD, Rafferty AMet al., 2019,

    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
  • Journal article
    Feather C, Appelbaum N, Clarke J, Franklin B, Sinha R, Pratt P, Maconochie I, Darzi Aet 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.

  • Journal article
    El-Khani U, Ashrafian H, Rasheed S, Veen H, Darwish A, Nott D, Darzi Aet al., 2019,

    The patient safety practices of emergency medical teams in disaster zones: a systematic analysis

    , BMJ Global Health, Vol: 4, Pages: 1-10, ISSN: 2059-7908

    Introduction: Disaster zone medical relief has been criticised for poor quality care, lack of standardisation and accountability. Traditional patient safety practices of Emergency Medical Teams (EMT) in disaster zones were not well understood. Improving the quality of healthcare in disaster zones has gained importance within global health policy. Ascertaining patient safety practices of EMTs in disaster zones may identify areas of practice that can be improved. Methods: A systematic search of OvidSP, Embase and Medline databases, key journals of interest, key grey-literature texts, the databases of the World Health Organisation (WHO), Médecins Sans Frontieres (MSF) and the International Committee of the Red Cross (ICRC), and Google Scholar were performed. Descriptive studies, case reports, case series, prospective trials and opinion pieces were included with no limitation on date or language of publication.Results: There were 9,685 records, evenly distributed between the peer-reviewed and grey literature. Of these, 30 studies and 9 grey literature texts met the inclusion criteria and underwent qualitative synthesis. From these articles, 302 patient safety statements were extracted. Thematic analysis categorised these statements into 84 themes (total frequency 632). The most frequent themes were limb injury (9%), medical records (5.4%), surgery decision making (4.6%), medicines safety (4.4%) and protocol (4.4%)Conclusion: Patient safety practices of EMTs in disaster zones are weighted towards acute clinical care, particularly surgery. The management of Non-Communicable Disease (NCD) is underrepresented. There is widespread recognition of the need to improve medical record keeping. High-quality data and institutional level patient safety practices are lacking. There is no consensus on disaster zone specific performance indicators. These deficiencies represent opportunities to improve patient safety in disaster zones.

  • Journal article
    Harkanen M, Paananen J, Murrells T, Rafferty AM, Franklin BDet 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
  • Journal article
    Arhi CS, Ziprin P, Bottle A, Burns EM, Aylin P, Darzi Aet al., 2019,

    Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study

    , Colorectal Disease, Vol: 21, Pages: 1270-1278, ISSN: 1462-8910

    AIM: The incidence of colorectal cancer in the under 50s is increasing. In this national population-based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. METHOD: We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary-care records. RESULTS: The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50-59, 2294 (31.4%) were aged 60-69 and 3345 (45.7%) were aged 70-79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60-69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red-flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. CONCLUSION: Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.

  • Journal article
    Bell H, Garfield S, Khosla S, Patel C, Franklin BDet 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.

  • Journal article
    Mohsin-Shaikh S, Furniss D, Blandford A, McLeod M, Ma T, Beykloo MY, Franklin BDet 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.

  • Journal article
    Ghafur S, Kristensen S, honeyford K, Martin G, Darzi A, Aylin Pet al., 2019,

    A retrospective impact analysis of the WannaCry cyber-attack on the NHS

    , npj Digital Medicine, Vol: 2, ISSN: 2398-6352

    A systematic analysis of Hospital Episodes Statistics (HES) data was done to determine the effects of the 2017 WannaCry attack on the National Health Service (NHS) by identifying the missed appointments, deaths, and fiscal costs attributable to the ransomware attack. The main outcomes measured were: outpatient appointments cancelled, elective and emergency admissions to hospitals, Accident & Emergency (A&E) attendances, and deaths in A&E. Compared with the baseline, there was no significant difference in the total activity across all trusts during the week of the WannaCry attack. Trusts had 1% more emergency admissions and 1% fewer A&E attendances per day during the WannaCry week compared with baseline. Hospitals directly infected with the ransomware, however, had significantly fewer emergency and elective admissions: a decrease of about 6% in total admissions per infected hospital per day was observed, with 4% fewer emergency admissions and 9% fewer elective admissions. No difference in mortality was noted. The total economic value of the lower activity at the infected trusts during this time was £5.9m including £4m in lost inpatient admissions, £0.6m from lost A&E activity, and £1.3m from cancelled outpatient appointments. Among hospitals infected with WannaCry ransomware, there was a significant decrease in the number of attendances and admissions, which corresponded to £5.9m in lost hospital activity. There was no increase in mortality reported, though this is a crude measure of patient harm. Further work is needed to appreciate the impact of a a cyber attack or IT failure on care delivery and patient safety.

  • Journal article
    Blandford A, Dykes PC, Franklin BD, Furniss D, Galal-Edeen GH, Schnock KO, Bates DWet 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
  • Journal article
    Furniss D, Mayer A, Franklin BD, Blandford Aet 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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