Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study.
DOAC
EHR
EHRs
anticoagulant
anticoagulants
clot
clots
clotting
dashboard
direct oral anticoagulant
electronic health record
health records
implementation
implementation science
individual clinician authority
interview
interviews
medical informatics
medication
pharmacist
pharmacology
pharmacy
population management
prescribe
prescribing
satisfaction
Journal
JMIR human factors
ISSN: 2292-9495
Titre abrégé: JMIR Hum Factors
Pays: Canada
ID NLM: 101666561
Informations de publication
Date de publication:
24 10 2023
24 10 2023
Historique:
received:
19
05
2023
accepted:
02
09
2023
revised:
16
08
2023
medline:
25
10
2023
pubmed:
24
10
2023
entrez:
24
10
2023
Statut:
epublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1186/s13012-020-01044-5.
Identifiants
pubmed: 37874636
pii: v10i1e49025
doi: 10.2196/49025
pmc: PMC10630856
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e49025Subventions
Organisme : AHRQ HHS
ID : R18 HS026874
Pays : United States
Informations de copyright
©Allison Ranusch, Ying-Jen Lin, Michael P Dorsch, Arthur L Allen, Patrick Spoutz, F Jacob Seagull, Jeremy B Sussman, Geoffrey D Barnes. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 24.10.2023.
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