Comparative evaluation of different medication safety measures for the emergency department: physicians’ usage and acceptance of training, poster, checklist and computerized decision support

BMC Medical Informatics and Decision Making

Research Article

Hans-Ulrich Prokosch¹  Andrius Patapovas¹  Brita Sedlmayr¹  Melanie Kirchner¹  Thomas Bürkle¹  Manfred Criegee-Rieck¹  Fabian Müller²  Barbara Pfistermeister²  Renke Maas²  Renate Vogler²  Bettina Plank-Kiegele²  Harald Dormann³  Anja Sonst⁴ 

[1] Chair of Medical Informatics, University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany;Institute of Experimental and Clinical Pharmacology, University Erlangen-Nuremberg, Nuremberg, Germany;Klinikum Fuerth, Fuerth, Germany;Klinikum Fuerth, Fuerth, Germany;Institute of Experimental and Clinical Pharmacology, University Erlangen-Nuremberg, Nuremberg, Germany;

关键词: Evaluation;    Medication safety;    Emergency department;    Clinical decision support systems;    Technology acceptance;    TAM2;    Patient safety;   

DOI  :  10.1186/1472-6947-13-79

 received in 2012-10-21, accepted in 2013-07-19,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundAlthough usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome. Our objective was to comparatively investigate a set of traditional medication safety measures such as medication safety training for physicians, paper-based posters and checklists concerning potential medication problems versus the additional benefit of a computer-assisted medication check. We concentrated on usage, acceptance and suitability of such interventions in a busy emergency department (ED) of a 749 bed acute tertiary care hospital.MethodsA retrospective, qualitative evaluation study was conducted using a field observation and a questionnaire-based survey. Six physicians were observed while treating 20 patient cases; the questionnaire, based on the Technology Acceptance Model 2 (TAM2), has been answered by nine ED physicians.ResultsDuring field observations, we did not observe direct use of any of the implemented interventions for medication safety (paper-based and electronic). Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters. However, despite their positive attitude, physicians most often stated that they use the interventions in only up to ten percent for subjectively “critical” orders. Main reasons behind the low usage were deficits in ease-of-use and fit to the workflow. The intention to use the interventions was rather high after overcoming these barriers.ConclusionsMethodologically, the study contributes to Technology Acceptance Model (TAM) research in an ED setting and confirms TAM2 as a helpful diagnostic tool in identifying barriers for a successful implementation of medication safety interventions. In our case, identified barriers explaining the low utilization of the implemented medication safety interventions - despite their positive reception - include deficits in accessibility, briefing for the physicians about the interventions, ease-of-use and compatibility to the working environment.

【 授权许可】

CC BY   
© Sedlmayr et al.; licensee BioMed Central Ltd. 2013