260 results found
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, 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, ISSN: 2044-5415
Marang-van de Mheen PJ, Browne JP, Thomas EJ, et al., 2022, Grand Rounds in Methodology: 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
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
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
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
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
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
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
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.
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
Chaudhry NT, Franklin BD, Mohammed S, et al., 2021, The Secondary Use of Data to Support Medication Safety in the Hospital Setting: A Systematic Review and Narrative Synthesis, PHARMACY, Vol: 9
Harkanen M, Vehvilainen-Julkunen K, Franklin BD, et al., 2021, Factors Related to Medication Administration Incidents in England and Wales Between 2007 and 2016: A Retrospective Trend Analysis, JOURNAL OF PATIENT SAFETY, Vol: 17, Pages: E850-E857, ISSN: 1549-8417
Triantafyllou A, Garfield S, Shastri S, et al., 2021, To what extent are health care professionals in English hospitals aware of the World Health Organization's medication safety challenge?, Publisher: SPRINGER, Pages: 1767-1768, ISSN: 2210-7703
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.
Jani YH, Franklin BD, 2021, Interruptive alerts: only one part of the solution for clinical decision support, BMJ QUALITY & SAFETY, Vol: 30, Pages: 933-936, ISSN: 2044-5415
Krasuska M, Williams R, Sheikh A, et al., 2021, Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme., BMJ Health Care Inform, Vol: 28
BACKGROUND: There is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence. AIM: To qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme. METHODS: We conducted a series of in-depth case studies in 12 purposively selected provider organisations and a further 24 wider case studies of the remaining organisations participating in the GDE programme. Data collected included 628 interviews, non-participant observations of 190 meetings and workshops and analysis of 9 documents. We used thematic analysis aided by NVivo software and drew on sociotechnical theory to analyse the data. RESULTS: We found the GDE programme accelerated digital transformation within participating provider organisations. This acceleration was triggered by: (1) dedicated funding and the associated requirement for matched internal funding, which in turn helped to prioritise digital transformation locally; (2) governance requirements put in place by the programme that helped strengthen existing local governance and project management structures and supported the emergence of a cadre of clinical health informatics leaders locally; and (3) reputational benefits associated with being recognised as a centre of digital excellence, which facilitated organisational buy-in for digital transformation and increased negotiating power with vendors. CONCLUSION: The GDE programme has been successful in accelerating digital transformation in participating provider organisations. Large-scale digital transfor
Black A, Gage H, Norton C, et al., 2021, 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
Subakumar K, Franklin BD, Garfield S, 2021, Analysis of the third WHO Global Safety Challenge 'Medication Without Harm' patient-facing materials: exploratory descriptive study, EUROPEAN JOURNAL OF HOSPITAL PHARMACY, Vol: 28, Pages: E109-E114, ISSN: 2047-9956
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, Vol: 55, Pages: 1333-1340, ISSN: 1060-0280
Background: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).Objective: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.Methods: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.Results: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.Conclusion and Relevance:Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences. This highlights the need to test the usability of guidelines before clinical use.
Black A, Courtenay M, Norton C, et al., 2021, 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
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, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871
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, Vol: 20, Pages: 91-104, ISSN: 1175-5652
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, INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Vol: 29, Pages: 458-464, ISSN: 0961-7671
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, Vol: 9
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, The Lancet Regional Health - Europe, Vol: 7, Pages: 1-10, ISSN: 2666-7762
Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents.Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.
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