The Library
Redesigning the ‘choice architecture’ of hospital prescription charts : a mixed methods study incorporating in situ simulation testing
Tools
Tools
Tools
King, Dominic, Jabbar, Ali, Charani, Esmita, Bicknell, Colin, Wu, Zhe, Miller, Gavin, Gilchrist, Mark, Vlaev, Ivo, Franklin, Bryony Dean and Darzi, Ara (2014) Redesigning the ‘choice architecture’ of hospital prescription charts : a mixed methods study incorporating in situ simulation testing. BMJ Open, 4 (12). e005473. doi:10.1136/bmjopen-2014-005473 ISSN 2044-6055.
Research output not available from this repository.
Request-a-Copy directly from author or use local Library Get it For Me service.
Official URL: http://dx.doi.org/10.1136/bmjopen-2014-005473
Abstract
Objectives: To incorporate behavioural insights into the user-centred design of an inpatient prescription chart (Imperial Drug Chart Evaluation and Adoption Study, IDEAS chart) and to determine whether changes in the content and design of prescription charts could influence prescribing behaviour and reduce prescribing errors.
Design: A mixed-methods approach was taken in the development phase of the project; in situ simulation was used to evaluate the effectiveness of the newly developed IDEAS prescription chart.
Setting: A London teaching hospital.
Interventions/methods: A multimodal approach comprising (1) an exploratory phase consisting of chart reviews, focus groups and user insight gathering (2) the iterative design of the IDEAS prescription chart and finally (3) testing of final chart with prescribers using in situ simulation.
Results: Substantial variation was seen between existing inpatient prescription charts used across 15 different UK hospitals. Review of 40 completed prescription charts from one hospital demonstrated a number of frequent prescribing errors including illegibility, and difficulty in identifying prescribers. Insights from focus groups and direct observations were translated into the design of IDEAS chart. 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). Antiinfective indication (28/28 vs 17/29; p<0.0001) and duration (26/28 vs 15/29; p<0.0001) were more likely to be completed using the IDEAS chart.
Conclusions: In a simulated context, the IDEAS prescription chart significantly reduced a number of common prescribing errors including dosing errors and illegibility. Positive behavioural change was seen without prior education or support, suggesting that some common prescription writing errors are potentially rectifiable simply through changes in the content and design of prescription charts.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Social Sciences > Warwick Business School > Behavioural Science Faculty of Social Sciences > Warwick Business School |
||||
| Journal or Publication Title: | BMJ Open | ||||
| Publisher: | BMJ | ||||
| ISSN: | 2044-6055 | ||||
| Official Date: | December 2014 | ||||
| Dates: |
|
||||
| Volume: | 4 | ||||
| Number: | 12 | ||||
| Article Number: | e005473 | ||||
| DOI: | 10.1136/bmjopen-2014-005473 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access (Creative Commons) |
Request changes or add full text files to a record
Repository staff actions (login required)
 |
View Item |
