PDF(Pubmed)
Abstract：
Direct oral anticoagulant (DOAC) medications are frequently associated with inappropriate prescribing and adverse events. To improve the safe use of DOACs, health systems are implementing population health tools within their electronic health record (EHR). While EHR informatics tools can help increase awareness of inappropriate prescribing of medications, a lack of empowerment (or insufficient empowerment) of nonphysicians to implement change is a key barrier.
This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing.
We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes.
A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant.
Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation.
RR2-10.1186/s13012-020-01044-5.
This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing.
We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes.
A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant.
Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation.
RR2-10.1186/s13012-020-01044-5.
摘要：
背景：直接口服抗凝药（DOAC）通常与不适当的处方和不良事件有关。为了提高DOAC的安全使用，卫生系统正在其电子健康记录（EHR）中实施人口健康工具。虽然EHR信息学工具可以帮助提高人们对药物处方不当的认识，非医师实施变革的授权不足(或授权不足)是一个关键障碍.
目的：本研究探讨了临床药师和抗凝护士的个人权威如何受到EHRDOACDashboard的安全DOAC处方的影响和改变其实施成功。
方法：在3个临床站点实施EHRDOAC仪表板后，我们对药剂师和护士进行了半结构化访谈。面试记录根据实施成功的关键决定因素进行编码。检查了各个临床医生权威与其他决定因素之间的交集，以确定主题。
结果：高水平的个人临床医生权威与高水平的关键促进者相关，以有效使用DOAC仪表板（沟通，人员配备和工作时间表，工作满意度,和EHR集成)。相反，缺乏个人权限通常与有效使用DOAC仪表板的关键障碍有关。积极的个人权威有时会出现另一个决定因素的负面例子，但是没有证据表明个人权威与另一个决定因素的积极实例同时发生。
结论：增加个人临床医生权威是有效实施EHRDOAC人群管理仪表板的必要前提，并对实施的其他方面产生积极影响。
■RR2-10.1186/s13012-020-01044-5。
目的：本研究探讨了临床药师和抗凝护士的个人权威如何受到EHRDOACDashboard的安全DOAC处方的影响和改变其实施成功。
方法：在3个临床站点实施EHRDOAC仪表板后，我们对药剂师和护士进行了半结构化访谈。面试记录根据实施成功的关键决定因素进行编码。检查了各个临床医生权威与其他决定因素之间的交集，以确定主题。
结果：高水平的个人临床医生权威与高水平的关键促进者相关，以有效使用DOAC仪表板（沟通，人员配备和工作时间表，工作满意度,和EHR集成)。相反，缺乏个人权限通常与有效使用DOAC仪表板的关键障碍有关。积极的个人权威有时会出现另一个决定因素的负面例子，但是没有证据表明个人权威与另一个决定因素的积极实例同时发生。
结论：增加个人临床医生权威是有效实施EHRDOAC人群管理仪表板的必要前提，并对实施的其他方面产生积极影响。
■RR2-10.1186/s13012-020-01044-5。
