Additions to the book "Systems Design and Engineering" by Bonnema et.al. Subjects were chosen based on the Systems Engineering needs for Small and Medium Enterprises, as researched in the SESAME project. The
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The Junior Adverse Drug Event Manager (J-ADEM) team is a multifaceted intervention focusing on real-life education for medical students that has been shown to assist healthcare professionals in managing and reporting suspected adverse drug reactions (ADRs) to the Netherlands Pharmacovigilance Centre Lareb. The aim of this study was to quantify and describe the ADRs reported by the J-ADEM team and to determine the clinical potential of this approach. The J-ADEM team consisted of medical students tasked with managing and reporting ADRs in hospitalized patients. All ADRs screened and reported by J-ADEM team were recorded anonymously, and categorized and analysed descriptively. From August 2018 through January 2020, 209 patients on two wards in an academic hospital were screened for ADR events. The J-ADEM team reported 101 ADRs. Although most ADRs (67%) were first identified by healthcare professionals and then reported by the J-ADEM team, the team also reported an additional 33 not previously identified serious ADRs. In 10% of all reported ADRs, the J-ADEM team helped optimize ADR treatment. The ADR reports were largely well-documented (78%), and ADRs were classified as type A (66%), had a moderate or severe severity (85%) and were predominantly avoidable reactions (69%). This study shows that medical students are able to screen patients for ADRs, can identify previously undetected ADRs and can help optimize ADR management. They significantly increased (by 300%) the number of ADR reports submitted, showing that the J-ADEM team can make a valuable clinical contribution to hospital care.
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Purpose: The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Methods: Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram showing the relationship of computer technology, cognition, practitioner behavior, and system failure in the area of medical infusion devices. We subsequently conducted a systematic literature review on user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and noted the usability problems found with particular methods. Next, we assigned usability problems and related methods to the levels in the Impact Flow Diagram. Results: Most study methods used to find user interface issues with infusion pumps focused on observable behavior rather than on how artifacts shape cognition and collaboration. A concerted and theorydriven application of these methods when testing infusion pumps is lacking in the literature. Detailed analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well as how the scope of analysis may be broadened to include organizational and regulatory factors. Conclusion: Research methods to uncover use problems with technology may be used in many ways, with many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology.
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Clinical decision support systems (CDSSs) have gained prominence in health care, aiding professionals in decision-making and improving patient outcomes. While physicians often use CDSSs for diagnosis and treatment optimization, nurses rely on these systems for tasks such as patient monitoring, prioritization, and care planning. In nursing practice, CDSSs can assist with timely detection of clinical deterioration, support infection control, and streamline care documentation. Despite their potential, the adoption and use of CDSSs by nurses face diverse challenges. Barriers such as alarm fatigue, limited usability, lack of integration with workflows, and insufficient training continue to undermine effective implementation. In contrast to the relatively extensive body of research on CDSS use by physicians, studies focusing on nurses remain limited, leaving a gap in understanding the unique facilitators and barriers they encounter. This study aimed to explore the facilitators and barriers influencing the adoption and use of CDSSs by nurses in hospitals, using an extended Fit Between Individuals, Tasks, and Technology (FITT) framework.
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To evaluate the effect of the educational program "Guided Clinical Reasoning" (GCR) and the introduction of an intelligent electronic nursing documentation system (e-doc) on the quality of the nursing process.Evaluation was conducted at three measurement points and rated with the instrument "Quality of Nursing Diagnoses, Interventions and Outcomes" (Q-DIO).GCR showed the best Q-DIO-scores. No long-term effect was found after GCR cessation. The e-doc delivered the lowest scores, while showing adequate support in using nursing diagnoses.E-docs can support conducting the nursing process, but for meaningful e-doc use, clinical reasoning is essential.High-quality nursing documentation requires recognition of factors obstructing or supporting nurses in the use of e-docs while conducting the nursing process.
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Additions to the book "Systems Design and Engineering" by Bonnema et.al. Subjects were chosen based on the Systems Engineering needs for Small and Medium Enterprises, as researched in the SESAME project. The
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Aim: Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re-used widely across a variety of educational systems, they may be ideally suited for this purpose. Methods: With a cross-sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. Results: Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e-learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge-based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in-part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. Conclusion: Digital educational resources, ranging from e-learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real-life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials.
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Aims: Prescribing medication is a complex process that, when done inappropriately, can lead to adverse drug events, resulting in patient harm and hospital admissions. Worldwide cost is estimated at 42 billion USD each year. Despite several efforts in the past years, medication-related harm has not declined. The aim was to determine whether a prescriber-focussed participatory action intervention, initiated by a multidisciplinary pharmacotherapy team, is able to reduce the number of in-hospital prescriptions containing ≥1 prescribing error (PE), by identifying and reducing challenges in appropriate prescribing. Methods: A prospective single-centre before- and after study was conducted in an academic hospital in the Netherlands. Twelve clinical wards (medical, surgical, mixed and paediatric) were recruited. Results: Overall, 321 patients with a total of 2978 prescriptions at baseline were compared with 201 patients with 2438 prescriptions postintervention. Of these, m456 prescriptions contained ≥1 PE (15.3%) at baseline and 357 prescriptions contained ≥1 PEs (14.6%) postintervention. PEs were determined in multidisciplinary consensus. On some study wards, a trend toward a decreasing number of PEs was observed. The intervention was associated with a nonsignificant difference in PEs (incidence rate ratio 0.96, 95% confidence interval 0.83–1.10), which was unaltered after correction. The most important identified challenges were insufficient knowledge beyond own expertise, unawareness of guidelines and a heavy workload. Conclusion: The tailored interventions developed with and implemented by stakeholders led to a statistically nonsignificant reduction in inappropriate in-hospital prescribing after a 6-month intervention period. Our prescriber-focussed participatory action intervention identified challenges in appropriate in-hospital prescribing on prescriber- and organizational level.
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Description of a new hand/palm-held computerized 3D force measuring system. The system is built for interface (direct) measurement of 3D manual contact force with real-time data presentation. Static calibration was performed of the 3D force sensor with variable preloads to study their effect as well of the prototype system adapted for clinical manual examination and treatment. The new system enables, for the first time, recording and presenting of 3D manual contact forces at the patient-practitioner interface. 3D direct manual contact force measures have the potential to give a more complete and differentiated characterization of patient and practitioner forces than 1D forces. Clinical validity of the prototype system will have to be investigated, and for studying specific clinical manual handling techniques, obvious limitations require further development.
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Smart glasses were perceived to be potentially revolutionary for healthcare, however, there is only limited research on the acceptance and social implications of smart glasses in healthcare. This study aims to get a better insight into the theoretical foundations and the purpose was to identify themes regarding adoption, mediation, and the use of smart glasses from the perspective of healthcare professionals. A qualitative research design with focus groups was used to collect data. Three focus groups with 22 participants were conducted. Data were analyzed using content analysis. Our analysis revealed six overarching themes related to the anticipated adoption of smart glasses: knowledge, innovativeness, use cases, ethical issues, persuasion, and attitude. Nine themes were found related to anticipated mediation and use of smart glasses: attention, emotions, social influences, design, context, camera use, risks, comparisons to known products, and expected reaction and might influence the acceptance of smart glasses.
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