Publications
270 results found
Jones MD, Liu S, Powell F, et al., 2024, Exploring the Role of Guidelines in Contributing to Medication Errors: A Descriptive Analysis of National Patient Safety Incident Data., Drug Saf, Vol: 47, Pages: 389-400
INTRODUCTION: Clinical guidelines can contribute to medication errors but there is no overall understanding of how and where these occur. OBJECTIVES: We aimed to identify guideline-related medication errors reported via a national incident reporting system, and describe types of error, stages of medication use, guidelines, drugs, specialties and clinical locations most commonly associated with such errors. METHODS: Retrospective analysis of reports to the National Reporting and Learning System for England and Wales. A hierarchical task analysis (HTA) was developed, describing expected practice when using guidelines. A free-text search was conducted of medication incident reports (2016-2021) using search terms related to common guidelines. All identified reports linked to moderate-severe harm or death, and a random sample of 5100 no/low-harm reports were coded to describe deviations from the HTA. A random sample of 500 cases were independently double-coded. RESULTS: In total, 28,217 reports were identified, with 608 relating to moderate-severe harm or death. Fleiss' kappa for interrater reliability was 0.46. Of the 5708 reports coded, 642 described an HTA step discrepancy (including four linked to a death), suggesting over 3200 discrepancies in the entire dataset of 28,217 reports. Discrepancies related to finding guidelines (n = 300 reports), finding information within guidelines (n = 166) and using information (n = 176). Discrepancies were most frequently identified for guidelines produced by a local organisation (n = 405), and most occurred during prescribing (n = 277) or medication administration (n = 241). CONCLUSION: Difficulties finding and using information from clinical guidelines contribute to thousands of prescribing and medication administration incidents, some of which are associated with substantial patient harm.
Franklin BD, Bartel R, Howitt P, 2024, Avoiding harm through hearing our patients., BMJ, Vol: 384
Browne J, Franklin BD, Thomas EJ, et al., 2024, Our mission and how we hope to move the field forward: statement from the BMJ Quality & Safety senior editorial team 2023., BMJ Qual Saf, Vol: 33, Pages: 141-144
Garfield S, Etkind M, Franklin BD, 2024, Using patient and carer perspectives to improve medication safety at transitions of care., BMJ Qual Saf, Vol: 33, Pages: 149-151
Assunção-Costa L, Pinto CR, Machado JFF, et al., 2023, Validation of a method to assess the severity of medication administration errors in Brazil., BMJ Open Qual, Vol: 12
INTRODUCTION: Medication errors are frequent and have high economic and social impacts; however, some medication errors are more likely to result in harm than others. Therefore, it is critical to determine their severity. Various tools exist to measure and classify the harm associated with medication errors; although, few have been validated internationally. METHODS: We validated an existing method for assessing the potential severity of medication administration errors (MAEs) in Brazil. Thirty healthcare professionals (doctors, nurses and pharmacists) from Brazil were invited to score 50 cases of MAEs as in the original UK study, regarding their potential harm to the patient, on a scale from 0 to 10. Sixteen cases with known harmful outcomes were included to assess the validity of the scoring. To assess test-retest reliability, 10 cases (of the 50) were scored twice. Potential sources of variability in scoring were evaluated, including the occasion on which the scores were given, the scorers, their profession and the interactions among these variables. Data were analysed using generalisability theory. A G coefficient of 0.8 or more was considered reliable, and a Bland-Altman analysis was used to assess test-retest reliability. RESULTS: To obtain a generalisability coefficient of 0.8, a minimum of three judges would need to score each case with their mean score used as an indicator of severity. The method also appeared to be valid, as the judges' assessments were largely in line with the outcomes of the 16 cases with known outcomes. The Bland-Altman analysis showed that the distribution was homogeneous above and below the mean difference for doctors, pharmacists and nurses. CONCLUSION: The results of this study demonstrate the reliability and validity of an existing method of scoring the severity of MAEs for use in the Brazilian health system.
Grailey K, Franklin BD, Huf S, et al., 2023, Understanding the facilitators and barriers to barcode medication administration by nursing staff using behavioural science frameworks. A mixed methods study, BMC Nursing, Vol: 22, ISSN: 1472-6955
IntroductionBarcode medication administration (BCMA) technology helps ensure correct medications are administered by nursing staff through scanning of patient and medication barcodes. In many hospitals scanning rates are low, limiting the potential safety benefits. We aimed to explore the barriers and facilitators to BCMA use in a London hospital.MethodsIn this mixed methods study we used local quantitative data on BCMA scanning rates to identify clinically similar wards (in terms of patient acuity and workload) with different scanning rates for qualitative exploration. Interviews designed to elicit barriers to using BCMA technology were conducted with nursing staff, supported by observations of medication administration. Qualitative data were analysed inductively and a thematic framework constructed housing key themes, subsequently categorised into barriers and facilitators. To explore patient perspectives of BCMA scanning, a purposive sample of patients were also interviewed. These patient data were analysed deductively according to the thematic framework. Themes were mapped to behavioural science frameworks to further understand the behaviours involved. Results BCMA was operational on 15 wards, with only six having medication scan rates of more than 10% of scannable doses. Of three wards selected for qualitative investigation, the lowest scan rate was 6.7%. Twenty-seven nurses and 15 patients were interviewed. Eleven key themes were identified, encompassing both barriers and facilitators to BCMA use. Barriers included poor trolley ergonomics and perceived time inefficiency. Facilitators included a streamlined process and thorough training. All nurses described BCMA as positive for patient safety. Patients described BCMA as making them “feel safer”. Behavioural science frameworks highlighted the importance of professional role and an individual’s belief in their capability. ConclusionWe present a novel exploration of facilitators and barriers to
Feather C, Appelbaum N, Darzi A, et al., 2023, Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis, BMJ QUALITY & SAFETY, Vol: 32, Pages: 357-368, ISSN: 2044-5415
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Franklin BD, Thomas EJ, Soong C, 2023, Advancing equity, diversity and inclusion at <i>BMJ Quality</i> and <i>Safety</i>, BMJ QUALITY & SAFETY, Vol: 32, Pages: 301-304, ISSN: 2044-5415
Koldeweij C, Kleuskens M, Franklin BD, et al., 2023, PERCEIVED BARRIERS AND FACILITATORS FOR MODEL-INFORMED DOSING IN PREGNANCY AMONG HEALTHCARE PRACTITIONERS AND PREGNANT WOMEN: A QUALITATIVE STUDY, Annual Meeting of the American-Society-for-Clinical-Pharmacology-and-Therapeutics (ASCPT), Publisher: WILEY, Pages: S42-S42, ISSN: 0009-9236
Marang-van de Mheen PJ, Browne JP, Thomas EJ, et al., 2023, <i>Grand Rounds in Methodology</i>: a new series to contribute to continuous improvement of methodology and scientific rigour in quality and safety, BMJ QUALITY & SAFETY, Vol: 32, Pages: 13-16, ISSN: 2044-5415
Lichtner V, Prgomet M, Gates P, et al., 2023, Automatic dispensing cabinets and governance of controlled drugs: an exploratory study in an intensive care unit, EUROPEAN JOURNAL OF HOSPITAL PHARMACY, Vol: 30, Pages: 17-23, ISSN: 2047-9956
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- Citations: 2
Kelly D, Koay A, Mineva G, et al., 2023, A scoping review of non-professional medication practices and medication safety outcomes during public health emergencies, PUBLIC HEALTH, Vol: 214, Pages: 50-60, ISSN: 0033-3506
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Mohsin-Shaikh S, Blandford A, Franklin BD, 2023, Hospital pharmacists', doctors' and nurses' perceptions of intra- and inter- professional communication in the context of electronic prescribing and medication administration systems: A qualitative study., PLoS One, Vol: 18
BACKGROUND: Effective, integrated and coordinated communication is essential in providing high quality patient care. Little prior research has detailed the impact of electronic prescribing and medication administration (ePMA) systems on healthcare professionals' (HCPs') communication. We investigated hospital pharmacists', doctors' and nurses' perceptions of how ePMA systems have affected, or are expected to affect, the way they communicate with each other in an inpatient setting. METHODS: A qualitative study in three English NHS hospitals: two used different inpatient ePMA systems, and one used paper-based prescribing. We conducted focus groups with pharmacists, and semi-structured individual interviews with doctors and nurses. Transcribed data were analysed inductively using thematic analysis. RESULTS: Nine focus groups, three at each hospital, were conducted with pharmacists with different levels of seniority (58 pharmacists in total). Fourteen doctors and twelve nurses took part in individual interviews. Four themes were generated: modes of communication, reduced pharmacist visibility, system limitations, and future aspirations for ePMA. Whether working with ePMA or paper-based systems, all participants preferred to communicate face-to-face to facilitate collaborative discussions regarding patient care. Participants perceived that ePMA reduced contact time with patients. Pharmacists perceived that both their physical ward presence and their written communication on medication charts had reduced since introduction of ePMA. Doctors felt they were now less likely to ask pharmacists questions due to pharmacists' reduced physical presence on the ward. Hardware and software limitations were identified by all HCPs, with suggestions made for future developments to better support communication. CONCLUSION: ePMA does not necessarily support communication among HCPs. Pharmacists and doctors were also concerned that ePMA reduces communication between themselves and their pa
Chu A, Kumar A, Depoorter G, et al., 2022, Learning from electronic prescribing errors: a mixed methods study of junior doctors' perceptions of training and individualised feedback data, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Franklin BD, Thomas EJ, 2022, Replicating and publishing research in different countries and different settings: advice for authors, BMJ QUALITY & SAFETY, Vol: 31, Pages: 627-630, ISSN: 2044-5415
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- Citations: 1
Sutherland A, Jones MD, Howlett M, et al., 2022, Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety, DRUG SAFETY, Vol: 45, Pages: 881-889, ISSN: 0114-5916
Garfield S, Begum R, Wheeler C, et al., 2022, Pharmacy services for shielding patients should act as a blueprint for those who are housebound, Pharmaceutical Journal, Vol: 308, ISSN: 0031-6873
Alsaidan JA, Portlock J, Ata SI, et al., 2022, Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals., BMC Med Inform Decis Mak, Vol: 22
OBJECTIVES: To determine the frequency of clinical decision support system (CDSS) medication-related alerts generated, accepted, or overridden, to assess appropriateness of alert display and overrides, and to characterise the documentation of clinician justification for these overrides in an academic medical centre in Saudi Arabia. MATERIALS AND METHODS: System-generated CDSS reports for the period June 2015 to December 2017 were retrospectively reviewed and analysed. Alerts were classified into different types, and rates of alert overrides calculated as percentages of all generated alerts. A subset of 307 overridden alerts was assessed for appropriateness of display and override by two clinical pharmacists. Physician documentation of reasons for overriding alerts were categorised. RESULTS: A total of 4,446,730 medication-related alerts were generated from both inpatient and outpatient settings, and 4,231,743 (95.2%) were overridden. The most common alert type was 'duplicate drug', accounting for 3,549,736 (79.8%) of alerts. Of 307 alerts assessed for appropriateness, 246 (80%) were judged to be appropriately displayed and 244 (79%) were overridden appropriately. New drug allergy and drug allergy alerts had the highest percentage of being judged as inappropriately overridden. For 1,594,313 alerts (37.7%), 'no overridden reason selected' was chosen from the drop-down menu. CONCLUSIONS: The alert generation and override rate were higher than reported previously in the literature. The small sample size of 307 alerts assessed for appropriateness of alert display and override is a potential limitation. Revision of the CDSS rules for alerts (focusing on specificity and relevance for the local context) is now recommended. Future research should prospectively assess providers' perspectives, and determine patient harm associated with overridden alerts.
Yardley S, Francis S-A, Franklin BD, et al., 2022, Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesise scoping review and ethnographic methods in an activity theory analysis, BMJ OPEN, Vol: 12, ISSN: 2044-6055
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Black A, Gage H, Norton C, et al., 2022, Patient satisfaction with medication consultations and medicines information provided by nurses working autonomously in sexual health services: A questionnaire study, JOURNAL OF ADVANCED NURSING, Vol: 78, Pages: 523-531, ISSN: 0309-2402
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Garfield S, Begum A, Toh KL, et al., 2022, Do patients and family carers have different concerns about the use of medicines compared with healthcare professionals? A quantitative secondary analysis of healthcare concerns relating to adults with complex needs, PATIENT EDUCATION AND COUNSELING, Vol: 105, Pages: 447-451, ISSN: 0738-3991
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Cresswell K, Sheikh A, Franklin BD, et al., 2022, Benefits realization management in the context of a national digital transformation initiative in English provider organizations., J Am Med Inform Assoc, Vol: 29, Pages: 536-545
BACKGROUND: The Global Digital Exemplar (GDE) Programme is a national initiative to promote digitally enabled transformation in English provider organizations. The Programme applied benefits realization management techniques to promote and demonstrate transformative outcomes. This work was part of an independent national evaluation of the GDE Programme. AIMS: We explored how benefits realization management was approached and conceptualized in the GDE Programme. METHODS: We conducted a series of 36 longitudinal case studies of provider organizations participating in the GDE Programme, 12 of which were in depth. Data collection included a combination of 628 interviews (with implementation staff in provider organizations, national programme management staff, and suppliers), 499 documents (of national and local implementation plans and lessons learned), and 190 nonparticipant observations (of national and local programme management meetings to develop insights into the broader context of benefits realization activities, tensions arising, and how these were negotiated). Data were coded drawing on a sociotechnical framework developed in related work and thematically analyzed, initially within and then across cases, with the help of NVivo 11 software. RESULTS: Most stakeholders broadly agreed with the rationale of benefits realization in the GDE Programme to show due diligence that public money was appropriately spent, and to develop an evidence base supporting the value of digitally enabled transformation. Differing national and local reporting purposes, however, created tensions. Central requirements, for progress reporting and tracking high-level benefits, had limited perceived local value and were seen to impose an unnecessary burden on provider organizations. This was accentuated by the lack of harmonization of reporting requirements to different stakeholders (which differed in content and timing). There were tensions between the desire for early evidence of outcomes
Jones MD, Franklin BD, Watson MC, et al., 2022, User Testing to Improve Retrieval and Comprehension of Information in Guidelines to Improve Medicines Safety., J Patient Saf, Vol: 18, Pages: e172-e179
OBJECTIVE: The aim of the study was to investigate the effectiveness of user testing for improving healthcare professionals' retrieval and comprehension of information in medicines guidelines. METHODS: The United Kingdom's Injectable Medicines Guide was selected as a case study. This gives guidance to nurses on preparing and administering intravenous medicines on hospital wards, in line with standard UK practice. Three rounds of user testing were completed with 10 hospital nurses per round, using the Injectable Medicines Guide for voriconazole and aminophylline. Participants used the guidelines to answer 17 questions related to the administration of these medicines. Answers were scored for "finding" and "understanding" the required information. Semistructured interviews explored participants' opinions of guideline content, design, and wording, with responses analyzed thematically. The guidelines were revised between rounds. RESULTS: In round 1, 8 of 17 questions were answered correctly by all participants. Participants had difficulty with dose, dilution, administration rate, and adverse effects questions. Revisions included new subsections and increased calculation support. In round 2, 14 of 17 questions were answered correctly by all participants. Difficulty persisted with dose and administration rate questions and further revisions made. In round 3, 15 of 17 questions were answered correctly by all participants. Across all rounds, participants considered appropriate subheadings and information order as important for fast location of information. Specific, detailed, and practical instructions were perceived as important to improve understandability and usefulness. CONCLUSIONS: Key information in medicines guidelines may not be found and/or understood by healthcare professionals. User testing increased information retrieval and comprehension and could have an important role in improving the safety of medicines use.
Black A, Courtenay M, Norton C, et al., 2022, Independent nurse medication provision: A mixed method study assessing impact on patients' experience, processes, and costs in sexual health clinics, JOURNAL OF ADVANCED NURSING, Vol: 78, Pages: 239-251, ISSN: 0309-2402
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- Citations: 4
Jones MD, Franklin BD, Raynor DK, et al., 2022, Costs and Cost-Effectiveness of User-Testing of Health Professionals' Guidelines to Reduce the Frequency of Intravenous Medicines Administration Errors by Nurses in the United Kingdom: A Probabilistic Model Based on Voriconazole Administration, APPLIED HEALTH ECONOMICS AND HEALTH POLICY, Vol: 20, Pages: 91-104, ISSN: 1175-5652
Assuncao-Costa L, Pinto CR, Fernandes Machado JF, et al., 2022, Validation of a method to assess the severity of medication administration errors in Brazil: a study protocol, JOURNAL OF PUBLIC HEALTH RESEARCH, Vol: 11, ISSN: 2279-9028
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Lichtner V, Prgomet M, Gates P, et al., 2021, Challenges of Digital Commons: A Qualitative Study of an Automated Dispensing Cabinet in a Paediatric Intensive Care Unit., Stud Health Technol Inform, Vol: 284, Pages: 244-248
Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses' use of an ADC in a paediatric intensive care unit with 54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses' information needs, patients' medication needs, and ADC design. Running out of medications was a 'tragedy of the commons'. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign.
Lichtner V, Prgomet M, Gates P, et al., 2021, Evaluation of an Automated Dispensing Cabinet in Paediatric Intensive Care - Focus on Controlled Medications., Stud Health Technol Inform, Vol: 284, Pages: 323-325
Evidence is limited of automated dispensing cabinets (ADCs) impact on effectiveness and efficiency of controlled drugs' (CDs) governance processes. We carried out a mixed-methods study of an ADC in an intensive care unit. We found ADC improved effectiveness and efficiency of governance of CDs through secure storage, alerts and automated recording of transactions. Limitations were associated with ADC design and 'fit' between ADC and some types of CDs.
Wheeler C, Blencowe A, Jacklin A, et al., 2021, Combining research and design: A mixed methods approach aimed at understanding and optimising inpatient medication storage systems, PLOS ONE, Vol: 16, ISSN: 1932-6203
Jani YH, Chumbley GM, Furniss D, et al., 2021, The Potential Role of Smart Infusion Devices in Preventing or Contributing to Medication Administration Errors: A Descriptive Study of 2 Data Sets., J Patient Saf, Vol: 17, Pages: e1894-e1900
OBJECTIVES: Errors in medication administration are common, with many interventions suggested to reduce them. For intravenous infusion-related errors, "smart infusion devices" incorporating dose error reduction software are widely advocated. Our aim was to explore the role of smart infusion devices in preventing or contributing to medication administration errors using retrospective review of 2 complementary data sets that collectively included a wide range of errors with different levels of actual or potential harm. METHODS: We reviewed 216 medication administration errors identified from an observational study in clinical practice and 123 medication incidents involving infusion devices reported to a national reporting system. The impact of smart infusion devices in preventing or contributing to these errors was assessed by the research team and an expert panel. RESULTS: The data suggest that use of any infusion device rather than gravitational administration may have prevented 13% of observed errors and 8% of reported incidents; additional reductions may be possible with standalone smart infusion devices, and further potential reductions with smart infusion devices integrated with electronic prescribing and barcode administration systems. An estimated 52% to 73% of errors that occurred with traditional infusion pumps could be prevented with such integrated smart infusion devices. In the few cases where smart infusion devices were used, these contributed to errors in 2 of 58 observed errors and 7 of 8 reported incidents. CONCLUSIONS: Smart infusion devices not only prevent some medication administration errors but can also contribute to them. Further evaluation of such systems is required to make recommendations for policy and practice.
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