Background
Methods
Study design and setting
The interventions to improve medication safety
Repeated training
Paper posters and pocket checklists
Computerized decision support
The field observation
The TAM2 based questionnaire
-
Part A examined the use of the different medication safety interventions and included open ended questions to determine reasons for restricted use.
-
Part B was based on the TAM2 research model and comprised questions on physicians’ acceptance as well as the rated suitability of the measures used.
-
Part C concerned basic demographic data such as job status, working experience and computer skills.
Items | Measurement | Cronbach’s α after item deleted | Source |
---|---|---|---|
U1 | If you have questions on interactions and contraindications of drugs: How do you inform yourself at first? (look at the poster/look at the pocket- checklist/use the electronic medication check/ask colleagues/look at the “red list” (print version)/others -please specify) | -- | self- development |
U2 | Have you gotten a briefing regarding the usage of the measures? (yes/no) | ||
U3 | How often do you use the measures in your daily routine? (not at all/monthly/weekly/once a day/several times a day) | ||
U4 | In case of a critical drug order: To what percentage do you use the measures? (not at all/up to 10%/up to 25%/up to 50%/up to 100%) | ||
U5 | When have you used the measure for the last time? (never use/today/…days before) | ||
U6 | Which information sources do you usually use when checking medication electronically? (infobutton/checkbox “indication for drug known”/OntoDrug/PharmIndex/checkbox “ADE”/use no source) | ||
U7 | In which situations do you use the computer-assisted medication check? (open- ended) | ||
U8 | Previous field observations indicated that measures have not been used often. What can be the reasons for low usage in your opinion? (open-ended) | ||
U9 | What should be improved so that measures are used more frequently? (open-ended) | ||
PU
|
0.882
| PU1- self- development; [35] | |
PU1 | Medication safety measures basically make sense. | ||
PU2 | The measures could increase my productivity. | ||
PU3 | The measures could improve the quality of care. | ||
PU4 | The measures could enhance my effectiveness. | ||
PU5 | The measures could be useful in my job. | ||
PEOU
|
0.949
| [35] | |
PEOU1 | My interaction with measures is clear and understandable. | ||
PEOU2 | The measures are easy to use. | ||
PEOU3 | Interacting with measures will not require a lot of mental effort. | ||
PEOU4 | It will be easy to get measures to do what I want them to do. | ||
SN
|
--
| [35] | |
SN1 | Physicians who influence my behavior think I should use the measures. | ||
IM
|
0.881
| [35] | |
IM1 | Having the measures is a status symbol. | ||
IM2 | Physicians who use the measures have more prestige than those who do not. | ||
IM3 | Physicians who use the measures have a high profile. | ||
JR
|
0.869
| [35] | |
JR1 | Usage of the measures is relevant to the delivery of patient care. | ||
JR2 | Usage of the measures is important to the delivery of patient care. | ||
OQ
|
--
| [35] | |
OQ1 | The quality of drug information is high. | ||
RD
|
0.860
| [35] | |
RD1 | The measures could reduce the costs of my care delivery. | ||
RD2 | I believe I can communicate to others the consequences of using the measures. | ||
RD3 | The results of using the measures are apparent to me. | ||
RD4 | I have difficulty explaining why using the measures may or may not beneficial. | ||
COM
| -- | [40] | |
COM1 | Using the measures fits well with the way I work. | ||
RTC
|
0.860
| [39] | |
RTC1 | I don’t want the measures to change the way I order patient medication. | ||
RTC2 | Overall, I don’t want the measures to change the way I currently work. | ||
VO
| -- | [23] | |
VO | Use of the measures is voluntary. | ||
ITU
|
1.000
| [35] | |
ITU1 | Assuming that significant barriers to the use are overcome, I intend to use the measures. | ||
ITU2 | If significant barriers did not exist, I predict I would use the measures. | ||
General Suitability
| |||
GLO1 | How suitable do you judge the measures (training/poster/checklist/infobutton/checkbox “indication for drug known”/OntoDrug/PharmIndex/checkbox “ADE”) for emergency department? (5-point rating scale ranging from 1 = least suitable to 5 = above all suitable) | -- | self- development |
DG1 | What is your professional status? (senior physician/specialist in internal medicine/junior doctor) | -- | self- development |
EXP1 | How long have you been working as a physician? (for…years) | ||
EXP2 | How long have you been working with electronic patient records? (for…years) | ||
EXP3 | How do you rate your computer skills? (low/moderate/high) |
Results
Field observation results
Case | Status of the observed person | Type of case sheet | Medication according to… | Documented drugs | Drugs with infobutton | Used interventions |
---|---|---|---|---|---|---|
1 | specialist in internal medicine ED | digital | annex | 0 | . | none |
2 | specialist in internal medicine ED | digital | annex | 0 | . | none |
3 | specialist in internal medicine ED | digital | annex | 0 | . | none |
4 | specialist in internal medicine ED | digital | annex | 0 | . | none |
5 | specialist in internal medicine ED | digital | annex | 0 | . | none |
6 | junior doctor Med1/Med2 | digital | . | 6 | 2 | none |
7 | junior doctor Med1/Med2 | digital | annex | 0 | . | none |
8 | junior doctor Med1/Med2 | digital | medication plan of family physician | 8 | 3 | none |
9 | junior doctor Med1/Med2 | digital | medication plan of family physician | 8 | 5 | none |
10 | junior doctor Med1/Med2 | digital | annex | 0 | . | none |
11 | junior doctor Med1/Med2 | digital | . | . | . | none |
12 | specialist in internal medicine ED | digital | . | 2 | 0 | none |
13 | specialist in internal medicine ED | digital | annex | 0 | . | none |
14 | specialist in internal medicine ED | digital | annex | 0 | . | none |
15 | junior doctor ED | digital | annex | 0 | . | none |
16 | senior physician ED | digital | patients statements | 0 | . | none |
17 | medical specialist Med1/Med2 | paper | . | . | . | none |
18 | junior doctor ED | digital | patients statements | . | . | none |
19 | medical specialist Med1/Med2 | paper | patients statements | . | . | none |
20 | junior doctor ED | digital | . | . | . | none |
Questionnaire results
Subject characteristics (part C)
Self-reported use of the interventions (part A)
Response categories | |||||
---|---|---|---|---|---|
Interventions | No usage | Monthly | Weekly | Daily | No answer |
Paper poster
| 4 | 1 | 1 | 2 | 1 |
Paper checklist
| 2 | 3 | 0 | 3 | 1 |
Digital case sheet
| 1 | 0 | 3 | 5 | 0 |
Physician | Paper poster | Paper checklist | Digital case sheet | ||||||
---|---|---|---|---|---|---|---|---|---|
Got briefing | Frequency of use | Usage in …% of critical orders | Got briefing | Frequency of use | Usage in …% of critical orders | Got briefing | Frequency of use | Usage in …% of critical orders | |
1 | n.a. | n.a. | n.a. | n.a. | n.a. | n.a. | yes | weekly | up to 10% |
2 | yes | monthly | up to 10% | yes | monthly | up to 10% | yes | weekly | up to 10% |
3 | no | never | -- | no | never | -- | yes | weekly | up to 25% |
4 | yes | weekly | up to 25% | no | several times a day | up to 50% | no | several times a day | up to 50% |
5 | yes | once a day | up to 10% | yes | several times a day | up to 25% | yes | several times a day | up to 25% |
6 | yes | never | -- | yes | monthly | never | yes | once a day | up to 10% |
7 | yes | never | -- | yes | monthly | up to 10% | yes | once a day | up to 50% |
8 | yes | once a day | up to 50% | yes | several times a day | up to 100% | yes | several times a day | up to 100% |
9 | no | never | -- | no | never | -- | no | never | -- |
Acceptance of the interventions according to TAM2 (part B)
Physician | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Construct | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Mean | SD |
PUpaper
| 2.67 | 4.40 | -- | 2.80 | 4.40 | 1.60 | 4.60 | 4.80 |
3.61
| 1.240 |
PUIT
| 2.67 | 5.00 | 4.20 | 4.80 | 5.00 | 4.40 | 4.60 | 4.80 |
4.43
| 0.767 |
PEOUpaper
| 2.00 | 3.00 | -- | 4.50 | 3.75 | 2.00 | 4.75 | 3.50 |
3.36
| 1.098 |
PEOUIT
| 2.00 | 5.00 | 4.00 | 3.00 | 3.75 | 4.00 | 2.50 | 2.75 |
3.38
| 0.982 |
SNPaper
| . | 3.00 | -- | 5.00 | 5.00 | . | 4.00 | 1.00 |
3.60
| 1.673 |
SNIT
| . | 4.00 | 5.00 | 5.00 | 5.00 | . | 4.00 | 1.00 |
4.00
| 1.549 |
IMpaper
| . | 2.50 | -- | 3.00 | 2.50 | 3.00 | 3.00 | 3.00 |
2.83
| 0.258 |
IMIT
| . | 3.50 | 3.50 | 3.00 | 2.50 | 3.00 | 3.00 | 3.00 |
3.07
| 0.345 |
JRpaper
| 4.50 | 3.00 | -- | 4.00 | 4.00 | 5.00 | 5.00 | 5.00 |
4.36
| 0.748 |
JRIT
| 4.50 | 5.00 | 4.00 | 4.00 | 4.00 | 5.00 | 5.00 | 5.00 |
4.56
| 0.496 |
OQpaper
| . | 3.00 | -- | 3.00 | . | 5.00 | 3.00 | 5.00 |
3.80
| 1.095 |
OQIT
| . | 5.00 | 3.00 | 5.00 | . | 5.00 | 3.00 | 5.00 |
4.33
| 1.033 |
RDpaper
| 3.00 | 3.25 | -- | 3.00 | 4.00 | 3.00 | 4.00 | 5.00 |
3.61
| 0.762 |
RDIT
| 3.00 | 4.50 | 3.50 | 4.25 | 4.00 | 5.00 | 4.00 | 5.00 |
4.16
| 0.694 |
COMpaper
| 2.00 | 2.00 | -- | 2.00 | 4.00 | 1.00 | 4.00 | 3.00 |
2.57
| 1.134 |
COMIT
| 2.00 | 5.00 | 3.00 | 4.00 | 4.00 | 4.00 | 4.00 | 2.00 |
3.50
| 1.069 |
¬RTCpaper
| 4.00 | 4.50 | -- | . | 4.00 | 5.00 | 5.00 | 5.00 |
4.58
| 0.492 |
¬RTCIT
| 4.00 | 4.50 | 3.00 | . | 4.00 | 5.00 | 5.00 | 5.00 |
4.36
| 0.784 |
VOpaper
| 5.00 | 5.00 | -- | 5.00 | 3.00 | 5.00 | 5.00 | 4.00 |
4.57
| 0.787 |
VOIT
| 5.00 | 5.00 | 4.00 | 5.00 | 3.00 | 5.00 | 5.00 | 2.00 |
4.25
| 1.165 |
ITUpaper
| 2.50 | 4.00 | -- | 5.00 | . | 1.00 | 5.00 | . |
3.50
| 1.732 |
ITUIT
| 2.50 | 5.00 | 4.00 | 5.00 | . | 5.00 | 5.00 | . |
4.42
| 1.021 |
Relationship between TAM2 variables
Perceived suitability of interventions for the emergency department (Part B)
Discussion
Methods discussion
Results discussion
-
to emphasize the potential benefits of such interventions,
-
to establish an automated drug documentation as a prerequisite electronic medication safety interventions. This could be realized with a transfer of medication data from the future electronic health insurance card,
-
to signal feedback regarding the utilization of medication safety interventions, e.g. in meetings and training sessions and
-
to give physicians more time to adapt to new ways of working.