Page 91 - HA Convention 2015

Special Topics

ST3.1 Technology Advancement 14:30 Theatre 1

Predicting and Preventing Technology Induced Medical Errors Monday, 18 May
Kushniruk A
School of Health Information Science, University of Victoria, Canada

Health information systems can improve the safety of healthcare but research findings have indicated that if they are not
designed and implemented properly they can also inadvertently introduce new types of errors (“technology-induced errors”).
This session will discuss technology-induced errors in medicine and will discuss approaches used to identify and mitigate
such errors. This presentation will also describe novel methods for assessing the usability of information systems and for
improving system safety by predicting technology-induced errors.

The discussion will draw on examples from the evaluation of a number of health applications, ranging from decision
support to web-based clinical guidelines and electronic health records. The approach described will be considered along
a continuum ranging from laboratory-based usability testing to in-situ clinical simulations (conducted in real healthcare
settings) and naturalistic study of system use. An integrated framework will be discussed for conducting evaluations of
information systems which borrows from advances a number of fields, including the cognitive, information and computer
sciences, as well as the emerging field of usability engineering. Low-cost rapid approaches to conducting usability testing
of health information systems will be described as a method for identifying potential technology-induced medical error.
Application of video analysis for assessing human-computer interaction in healthcare settings will be illustrated along with
extensions of the approach to what we term “clinical simulations” to assess system usability and safety in real settings.
Examples will be provided of how the approach has been used for improving both the usability and safety of electronic health
record systems, evidence-based guidelines and decision support systems.

ST3.2 Technology Advancement 14:30 Theatre 1

Inpatient Medication Order Entry (IPMOE) for Enhancing Safety and Efficacy of Medication Management HOSPITAL AUTHORITY CONVENTION 2015
Lau IT
Department of Medicine, Tseung Kwan O Hospital, Hong Kong

Medication errors are a major risk in healthcare. As early as 2001, the Institute of Medicine proposed that computerised
provider (automated) ‘order entry systems can reduce errors in drug prescribing and dosing.’ Medication order entry (MOE)
has been shown to reduce the problems of legibility, transcription and ambiguous abbreviations. Further, medication
safety and reduction of medication errors is enhanced when MOE is integrated with clinical decision support systems
to assist in checking for allergy, drug interactions, dose range, drug duplications and adjustments for renal impairment,
etc. and adherence to guidelines. In the inpatient setting, the value of inpatient MOE (IPMOE) is augmented if the loop of
prescription, dispensing and drug administration is closed, which, however, make the system much more complicated.
The advantages of IPMOE can only be realised when a system is well designed with due integration of workflow. Further,
successful implementation depends on vigorous staff engagement and change management. While IPMOE will reduce a lot
of medication errors, contingency plans have to be in place to address residual risks that depend on the system design and
emergent risks arising from the system features and new workflow.

The Hospital Authority (HA) embarked on the development of its in-house IPMOE system within its Clinical Management
System in 2010. It is a closed loop system wherein doctors make medication prescriptions, which are digitally signed and
transmitted to the pharmacy for vetting and dispensing. Nurses then administered medications with checking of patient and
drug identifications and confirmation of administration through barcode scanning. There are various features of intelligence,
including drug selection from previous prescriptions, common drug sets and dosages, allergy and drug interactions
checking, formulary management, electronic communication between pharmacists and doctors/nurses, scheduling of drug
administration, etc. All transactions in the system are updated instantaneously and medication administration forms can
be printed for contingency use in case of system breakdown. Continual enhancements such as pre-admission advance
prescriptions, ordering of complex drug regimens, etc. will be added. Future initiative in implementation of unit dose package
will further maximise efficacy and safety. Since 2013, the system has been successfully implemented in two HA hospitals
with the expected benefits realised.

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