A Systems Engineering Approach: Improving Medication Safety with Clinician Use of

State University Of New York At Buffalo, Buffalo NY

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Abstract

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