Medication safety and electronic decision support

Medication safety and electronic decision support

Medication errors and inappropriate medication therapy are two of the oldest, most costly and least tractable safety problems which health systems face. Digital systems (e.g. electronic medical and health records, clinical information systems) have the potential to make medication management safer and more effective. With that expectation, health systems worldwide are making vast investments in information technology.

Our research is investigating the ways in which information technology can reduce medication errors and support improved medication therapy decisions and outcomes in hospitals, the community and aged care. Our research also aims to understand and improve the fit between users and digital systems to optimise safety, quality, productivity, and efficiency through the development of electronic decision support tools.

We apply a broad range of methods, including randomised controlled trials, field observations, interviews and focus groups, simulation, and system logs to understand how information technology is used by clinicians, and identify optimal design features. Working closely with health system and industry partners, we ensure our findings are communicated and applied in the real-world.

Our world-leading research focuses on:

  • Design, development, configuration, implementation and evaluation of digital interventions, including clinical decision support
  • Consumer engagement in design and use of digital interventions to improve medication safety
  • Use of electronic health record data to identify and design interventions for medication safety and quality use of medicines
  • Providing evidence-based guidance on digital system configuration, including via the Health Innovation Series

Stream team members

Professor Johanna Westbrook
Professor and Director

Associate Professor Magda Raban
Associate Professor

Associate Professor Ling Li
Associate Professor

Dr Virginia Mumford
Senior Research Fellow

Dr Tim Badgery-Parker
Research Fellow

Dr Md Bayzidur Rahman
Senior Research Fellow

Dr Rachel Urwin
Research Fellow

Dr Lalit Yadav
Research Fellow

Dr Rajendra Gyawali
Postdoctoral Research Fellow

Dr Ryan McMullan
Postdoctoral Research Fellow

Dr Isabelle Meulenbroeks
Postdoctoral Research Fellow

Erin Fitzpatrick
Research Officer

Alison Merchant
Research Officer

Marea O'Donnell
Research Officer

Joanna Clive
Research Assistant

Rachel Jenkins
Research Assistant

Stream coordinator

Associate Professor Magda Raban
Ph: 02 9850 2433

News and media

Now recruiting GPs and nurse practitioners!

Are you a GP or Nurse Practitioner working in residential aged care?

Would you like to contribute to exciting research on clinical decision support?

Participants are needed for usability testing of a new clinical decision support tool from a collaborative project between the Australian Institute of Health Innovation AIHI and BESTMED.   

Register your interest here.

The Conversation highlights team’s work on IT flaws

An article published in The Conversation highlights findings from the recently published ‘Longitudinal study of the manifestations and mechanisms of technology-related prescribing errors in pediatrics’ which examined the occurrence and changes in technology-related prescribing errors (TREs) after the implementation of an electronic medication management module in the electronic medical record. Technology-related errors are errors that are facilitated by the design or configuration of the electronic medical record. After reviewing 35,000 medication orders at a pediatric hospital, study authors found as many as one in three medication errors were technology related. Click here to read the full article by The Conversation.

 
The Health Innovation Series turns 2!

The Health Innovation Series on e-Medication Safety publishes short form bulletins on tips for electronic system optimisation and use to improve medication safety. Click here to view all HIS issues.

Launched in September 2022, the series has now published 23 bulletins. As of August 2024, the issues have had 8915 downloads from 84 countries. Feedback from electronic system managers and clinicians has been positive, with many commenting on the practical format of the evidence-based recommendations, offering a useful resource for teaching.

An overview of the Health Innovation Series was presented at MedInfo 2023 - The 19th World Congress on Medical and Health Informatics. To read the conference proceeding, click here.

 
Article highlights consumer perspectives on antibiotic use in aged care

A recent study on consumer perspectives on antibiotic use in residential aged care, led by Dr Rajendra Gyawali, emphasised the need for effective provider-consumer communication and information sharing. Perspectives varied on consumer involvement in treatment decisions, with some residents actively seeking antibiotics and others relying on doctors. However, consumers were motivated by the desire for the best possible outcomes and care for those in residential aged care. The study also revealed consumers held positive attitudes towards antibiotics, did not associate antibiotics with the exclusive treatment of bacterial infections and lacked awareness of risks like antibiotic resistance.

 
World Congress on Medical Informatics proceedings published

The Medication Safety and Electronic Decision Support team’s papers presented at the 19th World Congress on Medical and Health Informatics were published:

Designing an informatics infrastructure for a National Aged Care Medication Roundtable. (Westbrook, JI, Seaman, K, Wabe, N, Raban, MZ, Urwin, R, Badgery-Parker, T, Mecardo, C, Mumford, V, Nguyen, AD, Root, J, Balmer, S, Waugh, K, Pinto, S, Burge, B, Aldeguer, E, Dunstan, T, Jorgensen, M, Gray, L, Bucknall, T, Etherton-Beer, C, Newell, B, Caughey, G, Beattie, E, Xenos, K & Cumming, A) https://doi.org/10.3233/SHTI230996

Stepped-wedge cluster RCT to assess the effects of an electronic medication system on medication administration errors. (Westbrook, JI, Li, L, Woods, A, Badgery-Parker, T, Mumford, V & Raban, MZ) https://doi.org/10.3233/shti230981

The Health Innovation Series: translating research evidence into practice. (Raban, MZ, Merchant, A, Clay, C, Fitzpatrick, E & Westbrook, JI) https://doi.org/10.3233/SHTI230983

The economics of medication safety: a cost-benefits analysis framework for evaluating an electronic medication system. (Mumford, V, Raban, MZ, Li, L, Merchant, A, Fitzpatrick, E, Badgery-Parker, T & Westbrook, JI) https://doi.org/10.3233/SHTI231209

 
More news

Selected publications

  1. Raban MZ, Fitzpatrick E, Merchant A, Rahman B, Badgery-Parker T, Li L, et al. Longitudinal study of the manifestations and mechanisms of technology-related prescribing errors in pediatrics. Journal of the American Medical Informatics Association [Internet]. 2024 Sep 11; Available from: https://doi.org/10.1093/jamia/ocae218
  2. Raban MZ, Merchant A, Fitzpatrick E, Baysari MT, Li L, Gates PJ, et al. Understanding technology-related prescribing errors for system optimisation: the Technology-Related Error Mechanism (TREM) classification. medRxiv [Internet]. 2024 Sep 3; Available from: https://doi.org/10.1101/2024.09.02.24312874
  3. Gyawali R, Gamboa S, Rolfe K, Westbrook JI, Raban MZ. Consumer perspectives on antibiotic use in residential aged care: a mixed-methods systematic review. American Journal of Infection Control [Internet]. 2024 Jul 1; Available from: https://doi.org/10.1016/j.ajic.2024.07.008
  4. Westbrook JI, Wabe N, Raban MZ. Using AI to improve medication safety. Nature Medicine [Internet]. 2024 May 8;30(6):1531–2. Available from: https://doi.org/10.1038/s41591-024-02980-1
  5. Mumford V, Raban MZ, Li L, Fitzpatrick E, Woods A, Merchant A, et al. Developing a process to measure actual harm from medication errors in paediatric inpatients: From design to implementation. British Journal of Clinical Pharmacology [Internet]. 2024 Mar 26;90(7):1615–26. Available from: https://doi.org/10.1111/bcp.16052
  6. Raban MZ, Merchant A, Clay C, Fitzpatrick E, Westbrook JI. The Health Innovation Series: translating research evidence into practice. In Bichel-Findlay J, Otero P, Scott P, Huesing E, editors, MEDINFO 2023 - The future is accessible: Proceedings of the 19th World Congress on Medical and Health Informatics. Amsterdam: IOS Press. 2024. p. 339-343. (Studies in Health Technology and Informatics). doi: 10.3233/SHTI230983
  7. Raban MZ, Gates PJ, Gamboa S, Gonzalez G, Westbrook JI. Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review. Journal of the American Medical Informatics Association [Internet]. 2023 May 15;30(7):1313–22. Available from: https://doi.org/10.1093/jamia/ocad083
  8. Raban MZ, Gonzalez G, Nguyen AD, Newell BR, Li L, Seaman KL, et al. Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review. BMJ Open [Internet]. 2023 Jan 1;13(1):e062688. Available from: https://doi.org/10.1136/bmjopen-2022-062688
  9. Westbrook JI, Li L, Raban MZ, Mumford V, Badgery-Parker T, Gates P, et al. Short- and long-term effects of an electronic medication management system on paediatric prescribing errors. Npj Digital Medicine [Internet]. 2022 Dec 13;5(1). Available from: https://doi.org/10.1038/s41746-022-00739-x
  10. Raban MZ, Gates PJ, Gasparini C, Westbrook JI. Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis. PLoS ONE [Internet]. 2021 Aug 23;16(8):e0256501. Available from: https://doi.org/10.1371/journal.pone.0256501
  11. Raban MZ, Baysari MT, Jorgensen ML, Tariq A, Georgiou A, Westbrook JI. Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities. Applied Clinical Informatics [Internet]. 2020 Oct 1;11(05):812–20. Available from: https://doi.org/10.1055/s-0040-1721011
  12. Raban MZ, Gasparini C, Li L, Baysari MT, Westbrook JI. Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis. BMJ Open [Internet]. 2020 Jan 1;10(1):e028494. Available from: https://doi.org/10.1136/bmjopen-2018-028494
  13. Westbrook JI, Lichtner V. Why is measuring the effects of information technology on medication errors so difficult? The Lancet Digital Health [Internet]. 2019 Nov 3;1(8):e378–9. Available from: https://doi.org/10.1016/s2589-7500(19)30157-8
  14. Koyama AK, Maddox CSS, Li L, Bucknall T, Westbrook JI. Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Quality & Safety [Internet]. 2019 Aug 7;29(7):595–603. Available from: https://doi.org/10.1136/bmjqs-2019-009552
  15. Lind KE, Raban MZ, Georgiou A, Westbrook JI. NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions. Pharmacoepidemiology and Drug Safety [Internet]. 2019 Aug 6;28(11):1480–8. Available from: https://doi.org/10.1002/pds.4866
  16. Lind KE, Raban MZ, Georgiou A, Westbrook JI. Duration of antipsychotic medication use by aged care facility residents with dementia. Alzheimer Disease & Associated Disorders [Internet]. 2019 Jul 19;33(4):331–8. Available from: https://doi.org/10.1097/wad.0000000000000336
  17. Westbrook JI, Li L, Shah S, Lehnbom EC, Prgomet M, Schofield B, et al. A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. International Journal of Medical Informatics [Internet]. 2019 Jun 18;129:253–9. Available from: https://doi.org/10.1016/j.ijmedinf.2019.06.011
  18. Gates PJ, Baysari MT, Mumford V, Raban MZ, Westbrook JI. Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Safety [Internet]. 2019 Apr 23;42(8):931–9. Available from: https://doi.org/10.1007/s40264-019-00823-4
  19. Raban MZ, Walter SR, Pont LG, Cheung L, Strumpman D, Westbrook JI. The potential impact of an electronic medication management system on safety‐critical prescribing errors in an emergency department. Journal of Pharmacy Practice and Research [Internet]. 2019 Apr 1;49(2):108–15. Available from: https://doi.org/10.1002/jppr.1455
  20. Westbrook JI, Baysari MT. Nudging hospitals towards evidence‐based decision support for medication management. The Medical Journal of Australia [Internet]. 2019 Mar 30;210(S6). Available from: https://doi.org/10.5694/mja2.50028
  21. Lind KE, Gray LC, Raban MZ, Georgiou A, Westbrook JI. Antidementia medication use by aged care facility residents with dementia. International Journal of Geriatric Psychiatry [Internet]. 2019 Mar 25;34(7):1029–40. Available from: https://doi.org/10.1002/gps.5105
  22. Pont LG, Raban MZ, Jorgensen ML, Georgiou A, Westbrook JI. Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use. International Journal for Quality in Health Care [Internet]. 2018 May 23;30(10):810–6. Available from: https://doi.org/10.1093/intqhc/mzy098
  23. Mumford V, Baysari MT, Kalinin D, Raban MZ, McCullagh C, Karnon J, et al. Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network. Journal of Paediatrics and Child Health [Internet]. 2018 Apr 19;54(9):987–96. Available from: https://doi.org/10.1111/jpc.13923
  24. Westbrook JI, Li L, Hooper TD, Raban MZ, Middleton S, Lehnbom EC. Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Quality & Safety [Internet]. 2017 Feb 23;26(9):734–42. Available from: https://doi.org/10.1136/bmjqs-2016-006123

Other publications

Centres related to this research

Centre for Health Systems and Safety Research

Content owner: Australian Institute of Health Innovation Last updated: 04 Nov 2024 12:12pm

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