Medication errors, especially those that may be preventable, are among the most serious medication use concerns in older persons cared for in ambulatory care settings. The introduction of health IT into such complex settings can improve patient safety, but its adoption in outpatient offices is only just beginning, and increased use of IT alone will not be enough to deal with the many complex cognitive processes that are intricately interlinked with human factors. This proposal will implement an IT-based Crew Resource Management (CRM) tool. The selected IT system that will be adapted (with CRM elements embedded) for this study is the ACORN system, developed by the Dendress Corporation for facilitating quality improvement teams in hospital settings. The modified system, ACORNoffice, will be completed and alpha tested within 6 months. This study was formulated in consultation with Upstate New York Practice Based Research Network (UNYNET) clinicians who already using EMRs and interested in identifying affordable approaches that are useful and generalizable to their offices. The proposed study is an experimental design (single-blind randomized block cluster) of a site-level intervention. Outcome assessment will be focused on medication safety among geriatric patients and office staff use/application of the IT-based CRM tool.
The specific aims of the study are to: (1) Examine the impact of an IT-based CRM intervention on reducing selected adverse drug events (ADEs) among geriatric patients in primary care settings by evaluating changes in: (a) number of preventable ADEs;(b) severity of those ADEs;and (c) stage of the medication use process in which they occur (i.e. diagnosis, prescribing, transcribing, dispensing, administration, and monitoring). (2) Examine the impact of an IT-based CRM intervention on improving monitoring for geriatric patients on Persistent Medications in primary care settings by evaluating changes in monitoring rates for subjects (age 65+) on: (a) ACE Inhibitors or ARBs;(b) Digoxin;(c) Diuretics;and (d) Statins. (3) Evaluate office staff use and application of the IT-based CRM Tool for improving geriatric medication safety in primary care settings by examining utilization of the IT tool and changes in safety attitude constructs (safety climate, teamwork climate, stress recognition, working conditions, and perceptions of management and job satisfaction). Participatory research methods will be used to assess provider- and staff-identified barriers to implementation. The overall purpose of this proposed study is to conduct and publish the results of an IT demonstration project using a human factors approach to geriatric medication safety so as to provide pilot data for larger confirmatory studies and perhaps to develop and market test the IT-CRM software via Small Business Innovation Research (SBIR) mechanisms for eventual national release.
| Singh, Ranjit; Hickner, John; Mold, Jim et al. (2014) ""Chance favors only the prepared mind"": preparing minds to systematically reduce hazards in the testing process in primary care. J Patient Saf 10:20-8 |
