238 results found
Cresswell K, Sheikh A, Franklin BD, et al., 2021, Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England., J Med Internet Res, Vol: 23
BACKGROUND: The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service. OBJECTIVE: This study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge. METHODS: We conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding. RESULTS: We conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas. CONCLUSIONS: Knowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological settin
Jones MD, Franklin BD, Raynor DK, et al., 2021, 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, ISSN: 1175-5652
Ahmed M, Wheeler C, Franklin BD, et al., 2021, Resilience of Medication Adherence Practices in Response to Life Changes: Learning from Qualitative Data Obtained during the COVID-19 Pandemic., Healthcare (Basel), Vol: 9, ISSN: 2227-9032
Nonadherence to medicines is widespread and can adversely affect health outcomes. Previous research has identified that patients develop their own strategies to assist with adherence. However, such research has not focused on how the helpfulness of these strategies may change in response to changes in patients' circumstances. This study aimed to explore resilience of medication adherence to life changes. It involved secondary thematic analysis of the verbatim transcripts of 50 semi-structured interviews that were conducted with adults who were advised to shield or were over the age of 70 during the first wave of the COVID-19 pandemic in the UK. Interview data suggested that resilience of medication adherence varied between participants. Participants either reported that they had not used any specific strategies to remind them to take their medicines prior to the pandemic, that the strategies that they had employed prior to the pandemic remained effective during the pandemic, that they had needed to make some adjustments to the strategies used, or that the strategies they had used were no longer effective. In addition, beliefs about medicines and motivation to take them were altered for some participants. These findings suggest that challenges associated with medication adherence do not always remain stable over time and that healthcare professionals need to continue to monitor and support medication adherence long-term.
Jani YH, Franklin BD, 2021, Interruptive alerts: only one part of the solution for clinical decision support., BMJ Qual Saf
Garfield S, Wheeler C, Boucher C, et al., 2021, Medicines management at home during the COVID-19 pandemic: a qualitative study exploring the UK patient/carer perspective., Int J Pharm Pract
OBJECTIVES: To explore home medicine practices and safety for people shielding and/or over the age of 70 during the COVID-19 pandemic and to create guidance, from the patient/carer perspective, for enabling safe medicine practices for this population. METHODS: Semi-structured interviews were carried out with 50 UK participants who were shielding and/or over the age of 70 and who used medicines for a long-term condition, using telephone or video conferencing. Participants were recruited through personal/professional networks and through patient/carer organisations. Participants were asked about their experiences of managing medicines during the pandemic and how this differed from previous practices. Data were analysed using inductive thematic analysis. KEY FINDINGS: Patients' and their families' experiences of managing medicines safely during the pandemic varied greatly. Analysis suggests that this was based on the patient's own agency, the functioning of their medicines system pre-pandemic and their relationships with family, friends, community networks and pharmacy staff. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing healthcare services for medicine-related issues. Effects of the pandemic on medicines adherence were reported to be positive by some and negative by others. CONCLUSIONS: Pharmacy staff have a key role to play by establishing good relationships with patients and their families, working with prescribers to ensure medicines systems are as joined up as possible, and signposting to community networks that can help with medicines collection.
Charani E, McKee M, Ahmad R, et al., 2021, Optimising antimicrobial use in humans-review of current evidence and an interdisciplinary consensus on key priorities for research, LANCET REGIONAL HEALTH-EUROPE, Vol: 7, ISSN: 2666-7762
Williams R, Sheikh A, Franklin BD, et al., 2021, Using Blueprints to promote interorganizational knowledge transfer in digital health initiatives-a qualitative exploration of a national change program in English hospitals., J Am Med Inform Assoc, Vol: 28, Pages: 1431-1439
OBJECTIVE: The Global Digital Exemplar (GDE) Program is a national attempt to accelerate digital maturity in healthcare providers through promoting knowledge transfer across the English National Health Service (NHS). "Blueprints"-documents capturing implementation experience-were intended to facilitate this knowledge transfer. Here we explore how Blueprints have been conceptualized, produced, and used to promote interorganizational knowledge transfer across the NHS. MATERIALS AND METHODS: We undertook an independent national qualitative evaluation of the GDE Program. This involved collecting data using semistructured interviews with implementation staff and clinical leaders in provider organizations, nonparticipant observation of meetings, and key documents. We also attended a range of national meetings and conferences, interviewed national program managers, and analyzed a range of policy documents. Our analysis drew on sociotechnical principles, combining deductive and inductive methods. RESULTS: Data comprised 508 interviews, 163 observed meetings, and analysis of 325 documents. We found little evidence of Blueprints being adopted in the manner originally conceived by national program managers. However, they proved effective in different ways to those planned. As well as providing a helpful initial guide to a topic, we found that Blueprints served as a method of identifying relevant expertise that paved the way for subsequent discussions and richer knowledge transfers amongst provider organizations. The primary value of Blueprinting, therefore, seemed to be its role as a networking tool. Members of different organizations came together in developing, applying, and sustaining Blueprints through bilateral conversations-in some circumstances also fostering informal communities of practice. CONCLUSIONS: Blueprints may be effective in facilitating knowledge transfer among healthcare organizations, but need to be accompanied by other evolving methods, such as
Sheikh A, Anderson M, Albala S, et al., 2021, Health information technology and digital innovation for national learning health and care systems, LANCET DIGITAL HEALTH, Vol: 3, Pages: E383-E396
Anderson M, Pitchforth E, Asaria M, et al., 2021, LSE-Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19, The Lancet, Vol: 397, Pages: 1915-1978, ISSN: 0140-6736
Garfield S, Begum A, Toh KL, et al., 2021, 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 Educ Couns
OBJECTIVE: To identify concerns related to the use of medicines for adults with complex needs and explore whether these differed between healthcare professionals and patients/carers, in order to inform development of interventions to increase medication adherence. METHODS: A quantitative secondary analysis of a database of healthcare professionals' and patients'/carers' healthcare concerns, related to adults with complex needs. Categories of concerns related to medicines use were identified and concerns related to medication use coded against these. Data were analysed descriptively, and a Chi-square test conducted to test for differences in responses from healthcare professionals versus patients/carers. RESULTS: There was a significant difference in the types of medication concern raised by healthcare professionals versus those raised by patients/carers. Patients/carers expressed more concerns about side effects and interactions; healthcare professionals identified more concerns related to patient support and carers' knowledge/training. CONCLUSION: Healthcare professionals had significantly different concerns about medicines to patients; this may be a potential barrier to medication adherence. PRACTICE IMPLICATIONS: Healthcare professionals may need to adopt an approach to non-adherence that goes beyond education and counselling and adopts a wider patient perspective. Findings suggest that a greater focus on addressing side effects and interactions may be beneficial in increasing medication adherence.
Lichtner V, Prgomet M, Gates P, et al., 2021, Automatic dispensing cabinets and governance of controlled drugs: an exploratory study in an intensive care unit., Eur J Hosp Pharm, ISSN: 2047-9956
BACKGROUND: Governance of controlled drugs (CDs) in hospitals is resource intensive but important for patient safety and policy compliance. OBJECTIVES: To explore whether and how storing CDs in an automated dispensing cabinet (ADC) in a children's hospital intensive care unit (ICU) contributes to the effectiveness and efficiency of CD governance. METHODS: We conducted a mixed-methods exploratory study, comprising observations, interviews and audits, 3 months after ADC implementation. We observed 54 hours of medications activities in the ICU medication room (with 42 hours of timed data); interviewed nurses (n=19), management (n=1) and pharmacy staff (n=3); reviewed 6 months of ICU incident reports pertaining to CD governance; audited 6 months of CD register data and extracted logs of all ADC transactions for the 3 months following implementation. Data analysis focused on four main CD governance activities: safekeeping/controlling access, documenting use, monitoring, and reporting/investigating. RESULTS: Nurses and pharmacists perceived spending less time on CD governance tasks with the ADC. The ADC supported CD governance through automated documentation of CD transactions; 'blind counts'; automated count discrepancy checks; electronic alerts and reporting functionalities. It changed quality and distribution of governance tasks, such as removing the requirement for 'nurses with keys' to access CDs, and allowing pharmacists to generate reports remotely, rather than reviewing registers on the ward. For CDs in the ADC, auditing and monitoring appeared to be ongoing rather than periodic. Such changes appeared to create positive reinforcing loops. However, the ADC also created challenges for CD governance. Most importantly, it was not suitable for all CDs, leading to workarounds and parallel use of a safe plus paper registers. CONCLUSIONS: ADCs can significantly alter CDs governance in clinical areas. Effects of an ADC on efficiency and effectiv
Jones MD, Clarke J, Feather C, et al., 2021, Use of Pediatric Injectable Medicines Guidelines and Associated Medication Administration Errors: A Human Reliability Analysis, Annals of Pharmacotherapy, Pages: 106002802199964-106002802199964, ISSN: 1060-0280
<jats:sec><jats:title>Background:</jats:title><jats:p> In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs). </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice ( discrepancies) that contributed to large-magnitude and/or clinically significant MAEs. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Video recordings from the original study were reanalyzed to identify discrepancies in the steps required to find and extract information from the NHS Injectable Medicines Guide (IMG) website. These data were combined with MAE data from the same original study. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> In total, 44 discrepancies during use of the IMG were observed across 180 medication administrations. Of these discrepancies, 21 (48%) were associated with an MAE, 16 of which (36% of 44 discrepancies) made a major contribution to that error. There were more discrepancies (31 in total, 70%) during the steps required to access the correct drug webpage than there were in the steps required to read this information (13 in total, 30%). Discrepancies when using injectable medicines guidelines made a major contribution to 6 (27%) of 22 clinically significant and 4 (15%) of 27 large-magnitude MAEs. </jats:p></jats:sec><jats:sec><jats:title>Conclusion and Relevance:</jats:title><jats:p> Discrepancies during the use of an online injectable medici
Ocloo J, Garfield S, Franklin BD, et al., 2021, Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews, HEALTH RESEARCH POLICY AND SYSTEMS, Vol: 19, ISSN: 1478-4505
Hinder S, Cresswell K, Sheikh A, et al., 2021, Promoting inter-organisational knowledge sharing: A qualitative evaluation of England's Global Digital Exemplar and Fast Follower Programme, PLOS ONE, Vol: 16, ISSN: 1932-6203
Jones MD, McGrogan A, Raynor DK, et al., 2021, User-testing guidelines to improve the safety of intravenous medicines administration: a randomised in situ simulation study, BMJ QUALITY & SAFETY, Vol: 30, Pages: 17-26, ISSN: 2044-5415
Franklin BD, Puaar SJ, 2020, What is the impact of introducing inpatient electronic prescribing on prescribing errors? A naturalistic stepped wedge study in an English teaching hospital, HEALTH INFORMATICS JOURNAL, Vol: 26, Pages: 3152-3162, ISSN: 1460-4582
Grimes TC, Garfield S, Kelly D, et al., 2020, Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol, BMJ Open, Vol: 10, Pages: 1-6, ISSN: 2044-6055
Introduction Those who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences.Methods and analysis This is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to ‘cocoon’/‘shield’ and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient’s/carer’s perspective.Ethics and dissemination This study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.
Franklin BD, Thomas EJ, 2020, Introduction from the new editors-in-chief, BMJ QUALITY & SAFETY, Vol: 29, Pages: 873-874, ISSN: 2044-5415
Subakumar K, Franklin BD, Garfield S, 2020, Analysis of the third WHO Global Safety Challenge 'Medication Without Harm' patient-facing materials: exploratory descriptive study., Eur J Hosp Pharm, ISSN: 2047-9956
OBJECTIVES: To evaluate patients' views on the content and use of the 'Five Moments for Medication Safety' materials developed as part of the WHO's 'Medication Without Harm' Global Patient Safety Challenge. These comprise a booklet, flyer, infographic poster, pamphlet and mobile application. They include recommended questions for patients to ask healthcare professionals to gain a better understanding of their medication. METHODS: Structured interviews were conducted with members of the public who entered an outpatient pharmacy in a London teaching hospital, using a combination of open and closed questions. Qualitative data were analysed thematically. Quantitative data were analysed descriptively. χ2, Fisher's exact, Mann-Whitney U and Kruskal-Wallis tests were used to test for associations between responses and variables such as age. RESULTS: We approached 147 people; 100 (68%) agreed to take part. Of these, 83% thought that the materials would be 'quite' or 'very' useful. Potential barriers to their use were patients being of the view that they already ask healthcare professionals about their medicines or that there would be limited time available to answer their questions during consultations. Fifty-nine per cent of participants stated that they would prefer to be given the materials in waiting areas before seeing a healthcare professional; 61% thought they should be displayed on television screens in general practice surgeries. Age was significantly associated with preference for the mobile application (χ2 test, p<0.01), with younger people preferring this format. CONCLUSIONS: Patients' views of the Five Moments for Medication Safety materials were generally positive. Our findings suggest that they should be displayed on television screens in waiting areas and given to patients prior to appointments. More advice is needed for patients on how to incorporate the questions suggested in the resources into a brief healthcare consultation.
Harkanen M, Franklin BD, Murrells T, et al., 2020, Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis, JOURNAL OF ADVANCED NURSING, Vol: 76, Pages: 3573-3583, ISSN: 0309-2402
Garfield S, Furniss D, Husson F, et al., 2020, How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience, BMJ Quality & Safety, Vol: 29, Pages: 764-773, ISSN: 2044-5415
Background Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use.Methods We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts.Results We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals.Conclusion Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a ‘one size fits all’ approach.
Barakat S, Franklin BD, 2020, An Evaluation of the Impact of Barcode Patient and Medication Scanning on Nursing Workflow at a UK Teaching Hospital, PHARMACY, Vol: 8
Krasuska M, Williams R, Sheikh A, et al., 2020, Technological Capabilities to Assess Digital Excellence in Hospitals in High Performing Health Care Systems: International eDelphi Exercise, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 22, ISSN: 1438-8871
Lichtner V, Franklin BD, Dalla-Pozza L, et al., 2020, Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy, BMC MEDICAL INFORMATICS AND DECISION MAKING, Vol: 20
Garfield S, Teo V, Chan L, et al., 2020, To what extent is the World Health Organization's medication safety challenge being addressed in English hospital organizations? a descriptive study., Journal of Patient Safety, ISSN: 1549-8417
OBJECTIVES: Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)'s third Global Patient Safety Challenge were being addressed in a sample of hospital organizations. METHODS: A qualitative approach was taken using a combination of focus groups, semistructured interviews, and documentary analysis in 4 UK teaching hospital organizations. A purposive sampling strategy was adopted with the aim of recruiting health care professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organizations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organizations to identify interventions recently implemented, those currently being implemented, and plans for the future. A content analysis was undertaken using the WHO's third Global Patient Safety Challenge priority areas and domains as deductive themes. RESULTS: All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all 4 sites. However, a greater number of interventions focused on "health care professionals" and "systems and practices of medication management" than on "patients and the public." In terms of the priority areas, the main focus was on "high-risk situations," particularly high-risk medicines, with fewer interventions in the areas of "transitions of care" and "polypharmacy." CONCLUSIONS: More work may be needed to address patient and public involvement in medication safety and the priority areas of transitions of care and polypharmacy. Comparative global studies would help build an international picture and allow shared learning.
Black A, Gage H, Norton C, et al., 2020, A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: A mixed methods study, INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 107, ISSN: 0020-7489
Wheeler C, Furniss D, Galal-Edeen GH, et al., 2020, Patients' Perspectives on the Quality and Safety of Intravenous Infusions: A Qualitative Study, JOURNAL OF PATIENT EXPERIENCE, Vol: 7, Pages: 380-385, ISSN: 2374-3743
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
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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