Christian NØHR a,1 , Sanne JENSEN b ,
Henrik Gliese PEDERSEN c , Anne Marie KANSTRUP a a Aalborg University, Denmark b Cooperate IT, Capital Region,, Denmark c IBM/ACURE, Copenhagen, Denmark
Keywords.
Patient safety, adverse drug events, participatory design, decision support.
Introduction
Medical care is intended to improve health, but often patients are harmed by the care they receive. As drug ordering and administration is the most common therapeutic treatment, adverse drug events (ADE’s) are the most common adverse event occurring during the care process [1].
Adverse drug events endanger the patients’ safety and instigate considerable extra hospital costs. Therefore, a significant reduction of preventable ADE is a challenging issue in Public Health [2]. The European project Patient Safety through Intelligent Procedures in medication (PSIP) aims at preventing medical errors. The objectives are: (1) to facilitate the systematic production of epidemiological knowledge on ADE’s and (2) to improve the entire medication cycle in a hospital environment.
The first sub-objective is to produce knowledge on ADE’s by data mining of structured hospital databases, and semantic mining of free-texts. This will provide a list of observed ADE, with frequencies and probabilities, thus giving a better understanding of potential risks. The second sub-objective is to deliver health provider and patients contextualized decision support by giving alerts and offering recommendations fitting the local risk parameters [3].
In the project human factors principles are considered a critical component of ADE characterization and prevention, and human factors methods have been applied with each step in the project [4]. This poster describes how the human factors principles have been applied in the design process of a clinical decision support module in the
Danish part of the PSIP project through participatory design methods.
Design through several iterations
The theoretical perspective was used as one of the core elements in a design game that was developed as the initial step in an iterative development process. The outcome
1
Corresponding Author: Christian Nøhr, Virtual Centre for Health Informatics, Department for Development and Planning, Aalborg University, Fibigerstræde 13, 9220 Aalborg, Denmark. E-mail: CN@v-chi.dk

from the design game was a number of design principles for computerized decision support systems, which was implemented in a paper mock-up [5]. A number of clinicians discussed and revised the mock-up, which in turn was further developed into a running prototype shell. This first prototype was tested in an authentic simulation environment to give the clinicians a hands-on experience with a possible realization of their original ideas. Their feedback from the simulation provided the final input for the design and implementation of a real prototype integrated with the commercial CPOE system used in the regional hospitals.
The final prototype provides decision support to the physician during the prescription process. This is accomplished by embedding ADE responses from a decision support module on the prescription screen based on the choices of drug to be prescribed and the conditions of the patient.
The design of the final prototype balances the requirement of an efficient and straightforward prescription process with the requirement to inform the prescribing physician about ADE responses regarding patient safety.
A primary goal for the prototype has been to place the response from the decision support module in focus of the healthcare professional during the prescription decision process. Placing the decision support in the central part of the application panel and placing other groups of information with a more immediate and natural interest of the physician around it accomplish this.
References
[1] Saur F, Patient and Medication Safety, EJHP-P 2005-4
[2] Institute Of Medicine, Preventing Medication Errors. The National Academic Press, Washington, DC,
2007.
[3] Beuscart R, McNair P, Brender J; PSIP consortium. Patient safety through intelligent procedures in medication: the PSIP project. Stud Health Technol Inform. 2009;148:6-13
[4] Beuscart-Zéphir MC, Nøhr C. Human factors engineering for computer-supported identification and prevention of adverse drug events. Stud Health Technol Inform. 2009;148:14-24
[5] Kanstrup AM, Nøhr C. Gaming against medical errors: methods and results from a design game on
CPOE. Stud Health Technol Inform. 2009;148:188-96