Considering Work Systems and Processes in Assessing the Impact of a CDSS Intervention: Preliminary Results.

The DetecIP project aims to implement multifactorial dynamic rules within a computerized decision support system (CDSS) for pharmaceutical analysis of orders to reduce the rate and severity of iatrogenic hyperkalemia and acute kidney injury. However, understanding the impact of this intervention (if any) requires that the way in which it influences the work systems and processes also be studied. This study presents the preliminary results of the analysis of the work contexts in which these rules will be implemented. A series of semi-structured interviews exploring the dimensions of the systems engineering initiative for patient safety (SEIPS) were conducted with healthcare professionals involved in the prevention and management of iatrogenic risks in five hospital units. Data were analyzed to identify current barriers and facilitators to the prevention and management of iatrogenic risks. Preliminary results from a geriatric unit and a cardiology unit reveal that, despite overall similarities in work processes, differences in the availability and location of physicians and clinical pharmacists influence how iatrogenic risks are managed. These contextual differences could influence the impact of the new CDSS rules once implemented.

Improving the usability and usefulness of computerized decision support systems for medication review by clinical pharmacists: A convergent, parallel evaluation.

BACKGROUND: Computerized decision support systems (CDSSs) help hospital-based clinical pharmacists to perform medication reviews and so are promising tools for improving medication safety. However, their poor usability can reduce effectiveness and acceptability. OBJECTIVES: To evaluate the usability and perceived usefulness of a CDSS for medication review by hospital-based pharmacists and to draw up guidelines on improving its usability. METHODS: We performed a convergent, parallel evaluation. Firstly, three researchers conducted a heuristic evaluation of the CDSS. Secondly, clinical pharmacists who use the CDSS filled out the Usefulness, Satisfaction and Ease of Use (USE) questionnaire. Lastly, semi-structured interviews with the pharmacists enabled us to understand their opinions and experiences. The results of the heuristic evaluation were used to identify potential improvements in the CDSS. We performed a statistical analysis of the USE questionnaire data. Interviews were analyzed based on the unified theory of acceptance and use of technology (UTAUT), together with a task-technology fit model. The results generated by these three approaches were compared in order to determine convergences and divergences, identify challenges related to the usability and usefulness of the CDSS, and draw up guidelines for its improvement. RESULTS: Forty-seven usability problems were discovered; they variously concerned the graphical user interface, the pharmacists' needs, and the medication review model implemented in the CDSS. Only the "usefulness" dimension of the USE was not scored positively. All the UTAUT dimensions and the task-technology fit dimension emerged in the interviews. Cross-comparisons of the results from the three approaches led to the identification of four challenges and the corresponding formulation of 23 guidelines. CONCLUSIONS: The guidelines developed here should help to improve the design and acceptability of CDSSs. Hence, CDSSs will be able to assist clinical pharmacists more fully with their medication reviews and help to further improve patient safety.

Context-Sensitive Implementation of Clinical Pharmacy Missions Within an Academic Hospital.

Clinical pharmacy activities contribute to improve patient safety. Yet, the work system's characteristics influence how clinical pharmacy activities are performed and conversely clinical pharmacy causes that work system to evolve. This exploratory study aims to identify the different ways in which clinical pharmacy activities are performed in different units of a large academic hospital. Interviews and observations have been performed to identify in each ward the clinical pharmacy activities implemented and how they are carried out.