Christine Rose Ackerley

Designing an adverse drug event reporting system to prevent unintentional reexposures to harmful drugs: study protocol for a multiple methods design

Background Adverse drug events (ADEs) are unintended and harmful events related to medication use. Up to 30% of serious ADEs recur within six months because culprit drugs are unintentionally represcribed and redispensed. Improving the electronic communication of ADE information between care providers, and across care settings, has the potential to reduce recurrent ADEs. Objective We aim to describe the methods used to design Action ADE, a novel electronic ADE reporting system that can be leveraged to prevent unintentional reexposures to harmful drugs in British Columbia, Canada. Methods To develop the new system, our team will use action research and participatory design, approaches that employ social scientific research methods and practitioner participation to generate insights into work settings and problem resolution. We will develop a systematic search strategy to review existing ADE reporting systems identified in academic and grey literature, and analyze the content of these systems to identify core data fields used to communicate ADE information. We will observe care providers in the emergency departments and on the wards of two urban tertiary hospitals and one urban community hospital, in one rural ambulatory care center, and in three community pharmacies in British Columbia, Canada. We will also conduct participatory workshops with providers to understand their needs and priorities related to communicating ADEs and preventing erroneous represcribing or redispensing of culprit medications. These methods will inform the iterative development of a preliminary paper-based reporting form, which we will then pilot test with providers in a real-world setting. Results This is an ongoing project with results being published as analyses are completed. The systematic review has been completed; field observations, focus groups, and pilot testing of a preliminary paper-based design are ongoing. Results will inform the development of software that will enable clinically useful user-friendly documentation and communication of ADEs. Conclusions We take this approach with the recognition that information technology-based solutions in health care often fall short of expectations as a result of designers’ failure to account for organizational and work practice considerations, and the needs of end-users. We describe how integrating qualitative methods into an iterative participatory design process (planned in partnership with end-users) will allow us to address specific clinical needs, conceptualize linkages between systems, integrate the reporting system into clinicians’ workflow, and design the system to optimize its uptake into practice.

Patient experiences with informational discontinuity of care: Bridging the gaps

Abstract Informational continuity of care is a central component of effective health care delivery and patient management but is often not achieved, leaving patients to compensate for or suffer from the burden of informational discontinuity of care. Fragmentation and siloed care delivery and communication within and across care settings present significant challenges to informational continuity of care. This is especially the case in the context of adverse drug events (ADEs), the harmful and unanticipated outcomes of medication use. This paper introduces a project called ActionADE that is intended to bridge informational gaps related to ADEs by enabling the documentation and communication of patient-specific ADE information. It contributes to literature concerned with information sharing in healthcare through a focus on patient views about sharing medication information through the design of an ADE reporting system, and explores implications for system design within a sociotechnical framework.

Barriers to scaling up participatory design interventions in health IT: a case study

In this paper, we present an account of the challenges faced while implementing a participatory design intervention in healthcare. We use examples from the development of ActionADE, an electronic application for sharing patient-specific adverse drug event information between hospitals (where adverse drug events are documented) and community pharmacies (where harmful drugs can be unintentionally re- dispensed). While developing ActionADE entailed extensive qualitative work, its implementation is contingent on our research teams action in the health data infrastructure arena, including developing and maintaining stakeholder relationships and addressing policy and governance issues. Competencies and skills in this area are often overlooked, yet are required to achieve successful uptake of participatory design interventions in health information technology.

Action ADE: Enabling Cross-setting Communication to Prevent Adverse Drug Events

Adverse drug events (ADEs) are the harmful and unintended consequences of medication use. ADEs have become a leading cause of outpatient visits, emergency department visits, and unplanned admissions to hospital. Many of these events are not strictly pharmacological, but rather are related to practical challenges in the coordination of care,prescribing, dispensing, and medication use, and may be preventable with new modes of documentation and communication for medication management. Action ADE is a CSCW intervention that aims to enable communication of patient ADE information across healthcare settings in the province of British Columbia, Canada. Implementing Action ADE requires negotiations of political agendas and policy change, evolving medical information system infrastructures, and the needs and practices of clinicians and patients. As the initial design phase for Action ADE comes to a close and we enter into our first phase of piloting and implementation, this poster provides a snapshot of five domains in which our project intervenes and highlights findings from our extensive qualitative work.