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

Sedlmayr B, Patapovas A, Kirchner M, Sonst A, Müller F, Pfistermeister B, Plank-Kiegele B, Vogler R, Criegee-Rieck M, Prokosch HU, Dormann H, Maas R, Bürkle T - BMC Med Inform Decis Mak (2013)

Bottom Line: 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.Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters.Methodologically, 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Chair of Medical Informatics, University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany. brita.sedlmayr@uk-erlangen.de

ABSTRACT

Background: Although 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.

Methods: A 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.

Results: During 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.

Conclusions: Methodologically, 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.

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Adapted TAM2 model.
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Figure 1: Adapted TAM2 model.

Mentions: Although TAM2 is an established model, it needed extension with further constructs to capture the unique contextual features and to enhance its explanation capabilities for the ED medication safety field. Based on the previous field observation and suggestions from literature [39,40] TAM2 was extended with the variables “compatibility” (to workflow) defined as “the degree to which an innovation is perceived being consistent with the existing values, needs, and past experiences” [40] and “resistance to change”, described as “any conduct that serves to maintain the status quo in the face of pressure to alter the status quo” [39]. The extended TAM2 used here to explain the adoption or rejection of implemented medication safety interventions is presented in Figure 1.


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

Sedlmayr B, Patapovas A, Kirchner M, Sonst A, Müller F, Pfistermeister B, Plank-Kiegele B, Vogler R, Criegee-Rieck M, Prokosch HU, Dormann H, Maas R, Bürkle T - BMC Med Inform Decis Mak (2013)

Adapted TAM2 model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3733614&req=5

Figure 1: Adapted TAM2 model.
Mentions: Although TAM2 is an established model, it needed extension with further constructs to capture the unique contextual features and to enhance its explanation capabilities for the ED medication safety field. Based on the previous field observation and suggestions from literature [39,40] TAM2 was extended with the variables “compatibility” (to workflow) defined as “the degree to which an innovation is perceived being consistent with the existing values, needs, and past experiences” [40] and “resistance to change”, described as “any conduct that serves to maintain the status quo in the face of pressure to alter the status quo” [39]. The extended TAM2 used here to explain the adoption or rejection of implemented medication safety interventions is presented in Figure 1.

Bottom Line: 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.Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters.Methodologically, 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Chair of Medical Informatics, University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany. brita.sedlmayr@uk-erlangen.de

ABSTRACT

Background: Although 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.

Methods: A 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.

Results: During 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.

Conclusions: Methodologically, 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.

Show MeSH