Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study.
Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study.
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DOI：
10.2196/49025
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发表时间：
2023-10-24
影响因子：
2.7
通讯作者：
Barnes, Geoffrey D
中科院分区：
文献类型：
--
作者：
Ranusch, Allison;Lin, Ying-Jen;Dorsch, Michael P;Allen, Arthur L;Spoutz, Patrick;Seagull, F Jacob;Sussman, Jeremy B;Barnes, Geoffrey D
直接口服抗凝剂（DOAC）药物经常与不适当的处方和不良事件有关。为了改善DOAC的安全使用，卫生系统正在其电子健康记录（EHR）中实施人口健康工具。虽然EHR信息学工具可以帮助提高对不适当处方药物的认识，但非医生缺乏实施变革的权力（或权力不足）是一个关键障碍。本研究探讨了临床药师和抗凝护士的个人权威如何受到EHR DOAC仪表板安全DOAC药物处方的影响并改变其实施成功。我们进行了半结构化的采访，药剂师和护士后，在3个临床站点的EHR DOAC仪表板的实施。访谈记录根据实施成功的关键决定因素进行编码。个别临床医生的权威和其他决定因素之间的交叉点进行了检查，以确定主题。高水平的个人临床医生的权威与高水平的关键促进者有效地使用DOAC仪表板（沟通，人员配备和工作时间表，工作满意度，EHR集成）。相反，缺乏个人权威往往与有效使用DOAC仪表板的关键障碍有关。积极的个人权威有时会与另一个决定因素的负面例子一起出现，但没有证据表明个人权威与另一个决定因素的积极例子同时出现。增加个人临床医生的权力是一个必要的先决条件，有效实施EHR DOAC人口管理仪表板，并积极影响实施的其他方面。RR2-10.1186/s13012-020-01044-5
Direct oral anticoagulant (DOAC) medications are frequently associated with inappropriate prescribing and adverse events. To improve the safe use of DOACs, health systems are implementing population health tools within their electronic health record (EHR). While EHR informatics tools can help increase awareness of inappropriate prescribing of medications, a lack of empowerment (or insufficient empowerment) of nonphysicians to implement change is a key barrier. This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing. We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes. A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant. Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation. RR2-10.1186/s13012-020-01044-5