title: Comparative evaluation of different medication safety measures for the emergency department: physicians' usage and acceptance of training, poster, checklist and computerized decision support.
abstract: BACKGROUND
  Although 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  During 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.
  
  
  CONCLUSIONS
  Methodologically, 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.
authors.affiliation: Chair of Medical Informatics, University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany. brita.sedlmayr@uk-erlangen.de
authors.forename: Brita
authors.initials: B
authors.lastname: Sedlmayr
authors.forename: Andrius
authors.initials: A
authors.lastname: Patapovas
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirchner
authors.forename: Anja
authors.initials: A
authors.lastname: Sonst
authors.forename: Fabian
authors.initials: F
authors.lastname: Müller
authors.forename: Barbara
authors.initials: B
authors.lastname: Pfistermeister
authors.forename: Bettina
authors.initials: B
authors.lastname: Plank-Kiegele
authors.forename: Renate
authors.initials: R
authors.lastname: Vogler
authors.forename: Manfred
authors.initials: M
authors.lastname: Criegee-Rieck
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Prokosch
authors.forename: Harald
authors.initials: H
authors.lastname: Dormann
authors.forename: Renke
authors.initials: R
authors.lastname: Maas
authors.forename: Thomas
authors.initials: T
authors.lastname: Bürkle
mesh_terms: D057189:Checklist; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D004346:Drug Information Services / Q000592:standards*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004360:Drug Therapy, Computer-Assisted; D004363:Drug Utilization / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital; D005858:Germany; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000592:standards*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D000078329:Workforce
references.citation: AMIA Annu Symp Proc. 2003;:140-4
references.pmid: 14728150
references.citation: Comput Inform Nurs. 2010 Jan-Feb;28(1):49-56
references.pmid: 19940621
references.citation: Pediatrics. 2004 Jan;113(1 Pt 1):59-63
references.pmid: 14702449
references.citation: Int J Med Inform. 2007 Jan;76(1):66-77
references.pmid: 16901749
references.citation: J Am Med Inform Assoc. 2004 Jan-Feb;11(1):50-9
references.pmid: 14527974
references.citation: Med Care Res Rev. 2007 Dec;64(6):650-72
references.pmid: 17717378
references.citation: Internist (Berl). 2003 Jul;44(7):889-95
references.pmid: 14631585
references.citation: Br J Clin Pharmacol. 2008 Apr;65(4):573-9
references.pmid: 18070216
references.citation: Int J Evid Based Healthc. 2009 Mar;7(1):49-58
references.pmid: 21631846
references.citation: Qual Saf Health Care. 2007 Feb;16(1):28-33
references.pmid: 17301200
references.citation: J Am Med Inform Assoc. 2008 Mar-Apr;15(2):217-26
references.pmid: 18096915
references.citation: Br J Haematol. 2004 Apr;125(1):50-7
references.pmid: 15015968
references.citation: J Am Med Inform Assoc. 2011 Dec;18 Suppl 1:i51-61
references.pmid: 21486876
references.citation: J Biomed Inform. 2010 Feb;43(1):159-72
references.pmid: 19615467
references.citation: Int J Med Inform. 2009 Sep;78(9):588-604
references.pmid: 19482542
references.citation: BMJ. 1997 Sep 27;315(7111):791-5
references.pmid: 9345174
references.citation: Proc AMIA Symp. 2002;:155-9
references.pmid: 12463806
references.citation: Proc AMIA Annu Fall Symp. 1997;:677-81
references.pmid: 9357711
references.citation: Health Technol Assess. 1998;2(16):iii-ix, 1-274
references.pmid: 9919458
references.citation: Br J Clin Pharmacol. 2012 Jan;73(1):115-25
references.pmid: 21714807
references.citation: J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21
references.pmid: 10428004
references.citation: Stud Health Technol Inform. 2007;129(Pt 2):1093-7
references.pmid: 17911884
references.citation: J Am Med Inform Assoc. 2007 Nov-Dec;14(6):746-55
references.pmid: 17712083
references.citation: BMC Med Inform Decis Mak. 2007 Jul 06;7:20
references.pmid: 17617908
references.citation: Int J Med Inform. 2003 Jan;69(1):1-16
references.pmid: 12485700
references.citation: J Med Syst. 2012 Dec;36(6):3677-84
references.pmid: 22402980
references.citation: Inform Prim Care. 2009;17(4):231-40
references.pmid: 20359401
references.citation: BMC Health Serv Res. 2010 Aug 06;10:231
references.pmid: 20691097
references.citation: Int J Med Inform. 2009 Jul;78(7):482-93
references.pmid: 19328739
references.citation: Int J Med Inform. 2004 May;73(4):357-62
references.pmid: 15135754
references.citation: BMJ. 2002 Oct 26;325(7370):941
references.pmid: 12399345
references.citation: Br J Clin Pharmacol. 2013 Sep;76 Suppl 1:14-24
references.pmid: 24007449
references.citation: Eur J Clin Pharmacol. 2012 Aug;68(8):1209-19
references.pmid: 22374346
references.citation: JAMA. 1998 Apr 15;279(15):1200-5
references.pmid: 9555760
references.citation: Stud Health Technol Inform. 2000;77:852-6
references.pmid: 11187675
references.citation: J Pediatr Surg. 2005 Jan;40(1):57-9
references.pmid: 15868559
references.citation: Dtsch Arztebl Int. 2013 Mar;110(13):213-9
references.pmid: 23596501
references.citation: Stud Health Technol Inform. 2011;169:325-9
references.pmid: 21893766
references.citation: Int J Med Inform. 2009 Apr;78(4):219-29
references.pmid: 18768345
references.citation: Proc AMIA Symp. 2000;:853-7
references.pmid: 11080005
references.citation: Int J Med Inform. 2008 May;77(5):324-35
references.pmid: 17644029