背景:对患者造成伤害的药物事件(MIs)对患者产生深远的影响,药剂师,公共卫生,商业实践,和治理政策。已实施药物事件报告和学习系统(MIRLS)以减轻此类事件并促进加拿大社区药房的持续质量改进。他们旨在收集和分析MIs,以实施事件预防策略,以提高社区药房实践的安全性。然而,由于药房在使用这些系统时面临的持续障碍,这一目标仍然受到抑制.
目的:本研究旨在调查药物事件造成的危害和报告的技术障碍,并确定在MIRLS中纳入有说服力的设计策略以激励报告的机会。
方法:我们进行了2次范围审查,以提供关于用药错误与患者伤害之间关系的见解,以及基于信息系统的阻碍报告的障碍。在每次范围审查中搜索了七个数据库,包括PubMed,公共卫生数据库,ProQuest,Scopus,ACM图书馆,全球卫生,谷歌学者。接下来,我们使用说服系统设计(PSD)分类法分析了加拿大使用最广泛的MIRLS之一,这是一个分析框架,设计,评估说服系统。该框架将社会心理学的行为理论应用于基于技术的系统的设计,以激励行为改变。熟悉MIRLS的独立评估员报告了使用4类PSD策略构建到系统中的说服程度:主要任务,对话,社会,信誉支持。
结果:总体而言,第一次范围审查包括17篇文章,和一篇文章被纳入第二次范围审查。在第一次审查中,重大或严重伤害是最常见的伤害(11/17,65%),其次是死亡或致命伤害(7/17,41%)。在第二次审查中,作者发现迭代设计可以提高MIRLS的可用性;然而,数据安全和报告验证仍然是一个有待解决的问题。关于我们评估的MIRLS,参与者考虑了大部分的首要任务,对话,私营部门司分类法中的信誉支持战略是重要和有用的;然而,他们对合作等社会策略感到不舒服。我们发现,评估系统支持PSD分类法中的一些有说服力的策略;然而,我们确定了其他策略,如隧道,模拟,建议,赞美,奖励,提醒,权威,和可验证性,可以进一步增强系统的感知说服力和价值。
结论:MIRLS,具有说服力的特点,可以成为强大的激励工具,以促进社区药房更安全的用药实践。它们有可能突出MI报告的价值,并增加药剂师报告事件的准备程度。提出的有说服力的设计指南可以帮助系统开发人员和社区药房经理实现更有效的MIRLS。
Medication incidents (MIs) causing harm to patients have far-reaching consequences for patients, pharmacists, public health, business practice, and governance policy. Medication Incident Reporting and Learning Systems (MIRLS) have been implemented to mitigate such incidents and promote continuous quality improvement in community pharmacies in Canada. They aim to collect and analyze MIs for the implementation of incident preventive strategies to increase safety in community pharmacy practice. However, this goal remains inhibited owing to the persistent barriers that pharmacies face when using these systems.
This study aims to investigate the harms caused by medication incidents and technological barriers to reporting and identify opportunities to incorporate persuasive design strategies in MIRLS to motivate reporting.
We conducted 2 scoping reviews to provide insights on the relationship between medication errors and patient harm and the information system-based barriers militating against reporting. Seven databases were searched in each scoping review, including PubMed, Public Health Database, ProQuest, Scopus, ACM Library, Global Health, and Google Scholar. Next, we analyzed one of the most widely used MIRLS in Canada using the Persuasive System Design (PSD) taxonomy-a framework for analyzing, designing, and evaluating persuasive systems. This framework applies behavioral theories from social psychology in the design of technology-based systems to motivate behavior change. Independent assessors familiar with MIRLS reported the degree of persuasion built into the system using the 4 categories of PSD strategies: primary task, dialogue, social, and credibility support.
Overall, 17 articles were included in the first scoping review, and 1 article was included in the second scoping review. In the first review, significant or serious harm was the most frequent harm (11/17, 65%), followed by death or fatal harm (7/17, 41%). In the second review, the authors found that iterative design could improve the usability of an MIRLS; however, data security and validation of reports remained an issue to be addressed. Regarding the MIRLS that we assessed, participants considered most of the primary task, dialogue, and credibility support strategies in the PSD taxonomy as important and useful; however, they were not comfortable with some of the social strategies such as cooperation. We found that the assessed system supported a number of persuasive strategies from the PSD taxonomy; however, we identified additional strategies such as tunneling, simulation, suggestion, praise, reward, reminder, authority, and verifiability that could further enhance the perceived persuasiveness and value of the system.
MIRLS, equipped with persuasive features, can become powerful motivational tools to promote safer medication practices in community pharmacies. They have the potential to highlight the value of MI reporting and increase the readiness of pharmacists to report incidents. The proposed persuasive design guidelines can help system developers and community pharmacy managers realize more effective MIRLS.