Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in situ simulation testing.
Bottom Line: In situ simulation testing revealed significant improvements in prescribing on the IDEAS chart compared with the prescription chart currently in use in the study hospital.Medication orders on the IDEAS chart were significantly more likely to include correct dose entries (164/164 vs 166/174; p=0.0046) as well as prescriber's printed name (163/164 vs 0/174; p<0.0001) and contact number (137/164 vs 55/174; p<0.0001).In a simulated context, the IDEAS prescription chart significantly reduced a number of common prescribing errors including dosing errors and illegibility.
Affiliation: Imperial College London, St Mary's Hospital, London, UK.Show MeSH
Related in: MedlinePlus
Mentions: Findings from phase 1 led to some specific design specifications for the IDEAS chart that complemented recommendations from the AoMRC report. Given preferences across the professional groups derived from the focus groups, a booklet format was chosen and it was also decided that the IDEAS chart would be designed to be of sufficient length to avoid supplementary charts (eg, specific charts for medications such as warfarin or insulin, and repetitive transcriptions from one chart to another due to space running out). From observing behaviours on the ward and difficulties seen in using an existing chart documented from focus groups, an intuitive layout and ordering was chosen with separate sections for oxygen, anti-infectives and intravenous fluids. It was decided to try and incorporate some form of indexing so that people using the chart could quickly navigate to the relevant sections. Different settings and features suggested by the design team were tested with the wider project team that consisted of physicians, pharmacists and nursing staff. Behavioural scientists also suggested how a number of behavioural insights could also be incorporated into the design of the new IDEAS chart using a number of Mindspace effects (table 2, figures 1–4). The final IDEAS chart that was used for testing can be seen in online supplementary appendix 4.
Affiliation: Imperial College London, St Mary's Hospital, London, UK.