Abstract
BackgroundAlthough usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome. Our objective was to comparatively investigate a set of traditional medication safety measures such as medication safety training for physicians, paper-based posters and checklists concerning potential medication problems versus the additional benefit of a computer-assisted medication check. We concentrated on usage, acceptance and suitability of such interventions in a busy emergency department (ED) of a 749 bed acute tertiary care hospital.MethodsA retrospective, qualitative evaluation study was conducted using a field observation and a questionnaire-based survey. Six physicians were observed while treating 20 patient cases; the questionnaire, based on the Technology Acceptance Model 2 (TAM2), has been answered by nine ED physicians.ResultsDuring field observations, we did not observe direct use of any of the implemented interventions for medication safety (paper-based and electronic). Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters. However, despite their positive attitude, physicians most often stated that they use the interventions in only up to ten percent for subjectively “critical” orders. Main reasons behind the low usage were deficits in ease-of-use and fit to the workflow. The intention to use the interventions was rather high after overcoming these barriers.ConclusionsMethodologically, the study contributes to Technology Acceptance Model (TAM) research in an ED setting and confirms TAM2 as a helpful diagnostic tool in identifying barriers for a successful implementation of medication safety interventions. In our case, identified barriers explaining the low utilization of the implemented medication safety interventions - despite their positive reception - include deficits in accessibility, briefing for the physicians about the interventions, ease-of-use and compatibility to the working environment.
Highlights
Usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome
While Technology Acceptance Model (TAM) postulates that perceived usefulness and perceived ease-of-use are the key factors in the adoption, its further development Technology Acceptance Model 2 (TAM2) posits subjective norm, image, job relevance, output quality and result demonstrability as additional antecedents to the perceived usefulness variable
In 90% (18/20) of the observed cases the electronic case sheet was used for documenting, but only in 22% (4/18) of these cases detailed drug information for each drug was entered into the electronic case sheet
Summary
Usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome. Prevention strategies include medication safety guidelines, improved training and awareness of staff as well as computerized clinical decision support systems (CDSS). Such strategies promise to reduce medication errors and adverse drug events [6,7,8,9], but without guaranteeing success. Several studies demonstrated that computerized CDSS were not successful due to limited or no system use [10,11,12,13,14] The launch of such systems requires an adequate awareness and the determination to alter existing medication procedures, making user acceptance a key factor for successful implementation [15]. The UTAUT has integrated different technology acceptance models including TAM and contains performance expectancy (equivalent to perceived usefulness in TAM), effort expectancy (equivalent to perceived ease-of-use in TAM), social influence and facilitating conditions as core predictors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
