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Theme 9: Improving patient safety: studying an evolving information technology system

Patient safety is a top agenda item in the organisational thinking of many healthcare systems. Avoidable harm has been a focus of attention, and key policy targets in the health service exist specifically aimed at: medication errors, healthcare associated infections, poor quality care, and other potentially harmful interventions. With the advances in medical technology over the past decades has come the potential for new therapies and therefore greater benefits to our patients. Information technology in healthcare specifically allows organisations to improve the safety and quality of medical care in new and exciting ways.

Up until now the NHS has been a late and slow adopter of technology compared to other industries and some healthcare institutions in other parts of the world (for example North America). With the implementation of more systems related to NHS Connecting for Health (CfH) – formerly the National Programme for Information Technology (NPfIT) – in England the widespread adoption of technology in the NHS is gaining pace. The rollout and adoption of the technology is slower than some clinicians and patients may have hoped, and although systems have been adopted in many organisations, their acceptance is not necessarily assured. Some organisations have also adopted other systems outside the current scope of CfH or developed their own systems that are not yet within scope. University Hospitals Birmingham NHS Foundation Trust is one such institution that has developed its own system particularly focused at electronic prescribing (ahead of the planned CfH system rollout), and it is this system that forms the central component of this research activity.

Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) Theme 9

Theme 9 was developed to study patient safety aspects of an evolving information technology system used in the University Hospitals Birmingham NHS Foundation Trust. The remit was to evaluate the effectiveness of certain specific enhancements, according to five pre-specified subthemes, to piece together various technological developments aimed at improving patient safety and quality in this healthcare organisation. There was also the awareness of the need to understand the organisational aspects and effects on the personnel who use these systems, so an overarching theme was planned to make observations to better understand the human machine interface during the rollout.

Our projects

The project concentrated on the health informatics solutions which have been implemented at the University Hospitals Birmingham NHS Foundation Trust. One of the main systems in use is the Prescribing, Information and Communication System (PICS). This system has been in use in some part of the Trust for over 10 years and as a ‘bespoke’ system with in-house programmers it has an evolving remit.

The rules-based prescribing system has proven that it can improve the safety of prescriptions and the administration of drugs. The system’s capabilities have been extended from electronic prescribing, alerts and alarms related to investigations, and simple on-screen communications to include order communications (radiology and other departments), electronic observation charting, and automated healthcare messaging (via text or pager). These extended capabilities gave us the opportunity to study the more targeted interventions that have been introduced with the information technology systems to improve safety and quality of care.

The five specific system attributes that were proposed to be studied as subthemes of our research were:

  1. Infection Control
    This remains a key priority for the Trust and we researched new warnings focused on reducing unnecessary antibiotic prescribing and prompts within the system aimed at controlling infections.
  2. Recognising and responding to the deteriorating patient
    This sub-theme aimed to evaluate the introduction of electronic observation charting that seeks to provide for the recording and alerting of any patients’ worsening condition before admission to intensive care (ITU) becomes necessary.
  3. Reducing prescription errors
    This was already at an advanced stage within PICS at the beginning of CLAHRC. Alerts and prompts to doctors and nurses during prescription and administration aim to eliminate common errors e.g. dosing mistakes. There was ongoing work in this sub-theme to study the error rates.
  4. Reducing inappropriate and promoting appropriate investigations
    We explored this area as PICS developed new test ordering procedures.
  5. Ensuring that investigations and prescriptions are given to the right patient
    This sub-theme’s remit was to explore the effects of patient bar-coding when ordering tests and administering drugs

Overarching sociological theme

Observational studies were planned throughout the implementation process in order to examine the way staff interacted with the IT system and the patients’ perspective on the use of such systems and the effect it had on clinician-patient interactions.

Author(s) Title Journal or Conference Publication Date
Cresswell, K; Coleman, J; Slee, A; Morrison, Z; Sheikh, A A toolkit to support the implementation of electronic prescribing systems into UK hospitals: preliminary recommendations Journal of Royal Society of Medicine
doi: 10.1177/0141076813502955
9 October 2013
Coleman, JJ; van der Sijs, H; Haefeli, WE; Slight, SP; McDowell, SE; Seidling, HM; Eiermann, B; Arts, J; Ammenwerth, E; Slee, A; Ferner, RE On the alert: future priorities for alerts in computerized decision support identified from a European workshop Medical Informatics and Decision Making
2013, 13:111.
DOI: 10.1186/10.1186/1472-6947-13-111
3 October 2013
Dixons-Wood, M; Redwood, S; Leslie, E; Minion, J; Martin, GP; Coleman, JJ Improving Quality and Safety of Care Using “Technovigilance”: An Ethnographic Case Study of Secondary Use of Data from an Electronic Prescribing and Decision Support System Millbank Quarterly. Volume 91, Issue 3, pages 424–454, September 2013
doi: 10.1111/1468-0009.12021
13 Sept 2013
Nirantharakumar, K; Hemming, K; Narendran, P; Marshall, T; Coleman, JJ A prediction model for adverse outcome in hospitalized patients with diabetes Diabetes Care. November 2013 36:3566-3572 11 September 2013
K Nirantharakumar, K; Saeed, M; I Wilson, I; Marshall, T; Coleman, JJ In-hospital mortality and length of stay in patients with diabetes having foot disease Journal of Diabetes and Its Complications

Volume 27, Issue 5, September–October 2013, Pages 454–458. doi: 10.1016/j.jdiacomp.2013.05.003.

15 June 2013

Theme lead

Dr Jamie Coleman

  • University Hospitals Birmingham NHS Trust