The steps involved in the medication process for instance prescribing, dispensing and administering medicines (the "medication process") have always posed some risk to individual patient health. Such "medication errors" were sufficiently common indeveloped countries by the 1960s to warrant formal research. Moreover, the frequency of errors appears not to have declined with the introduction of electronic systems. Several technological approaches has been used to reduce medication errors such as Computerized Physician Order Entry (CPOE), Electronic Patient Record (EPR), drug record system in Denmark and PRESGUID project in France, based on models and theories of errors in healthcare and electronic systems that were drawn from different countries including the UK. Examples of the systems and their evaluation methodology are examined, some of them have already been implemented and others are still being assessed. Consequently, an addition of Clinical Decision Support Systems in current prescribing systems (CDSSs) is necessary. The research considers the development of a medication management model including all the steps of the medication process that involves a clinical decision support system starting from medication prescribing to administration. A necessary preliminary step is to understand the types and contexts of the risks involved. The design of the model was based on the systematic review and meta-analysis outcomes that analysed journal papers, addressing individual themes from definitions, the source of risks and the consequences of errors to comparisons of the medication errors rates between simple prescribing systems and electronic prescribing systems that include CDSSs. The English National Programme For IT is also given prominence as it is a test case for many developed countries and the context for much of my practical work. The new model demonstrates a notable reduction in the frequency of medication errors and the number of patients with Adverse Drug Events. A system dynamics methodology is used to design the model; the first step is the development of Causal Loop Diagrams (CLDs) which are used as an alternative summary of systematic review finding. They show connections between human and technological factors in the medication process and suggest points for support and intervention potentially addressed by the model that includes CDSSs. The second step is the development of system dynamic models of hospital medication flow in order to detect the effect of CDSSs in reducing the rate of patients with medication errors and application of the effect data of CDSSs to one large hospital to identify the consequence of the model with CDSSs on patient’s rate. An evaluation is performed based on focus groups and discussions with clinical pharmacists to demonstrate how the drug safety model can be used. Furthermore an exploitation of pharmacist’s opinions on CLDs and drugsafety model by using a short survey has been presented to improve the consequences of medication errors
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:508007 |
| Date | January 2009 |
| Creators | Henni, Sanaa |
| Publisher | City University London |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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