Conducting an efficient proactive risk assessment prior to CPOE implementation in an intensive care unit

Abstract

Purpose To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU. Methods We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term). Results Sixteen unique relevant vulnerabilities were identified as a result of the PRA team’s efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing “issues list” of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n = 7) or shortly thereafter (n = 9). No other issues were identified beside those identified by the team. Conclusions Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints.

Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations

“…Our team developed and tested an efficient proactive risk assessment method that can be used before health IT implementation. [38] The error list can also be used by health IT vendors in their quality assurance process to assess their technology and its potential impact on patient safety.…”

Macroergonomics in Health Care Quality and Patient Safety

“…For instance, various methods such as FMEA have been developed to analyze vulnerabilities of high-risk processes. Macroergonomists have adapted these proactive risk assessment methods to analyze system vulnerabilities in IV medication administration (Wetterneck et al, 2006), medication management by ICU nurses (Faye et al, 2010) and patient transfer from operating room to ICU (Hundt et al, 2013). These adaptations are based on the SEIPS model (see Figure 1) (Carayon et al, 2006), rely on various data collection methods (e.g., observation, archival data analysis) to identify and characterize process vulnerabilities, and use a participatory process to ensure stakeholder representation in the analysis and redesign of the process (Carayon, Faye, Hundt, Karsh, & Wetterneck, 2011).…”

“…Since workflow assessment is one component in many common risk assessment methods, including Failure Mode and Effects Analysis (FMEA), it is logical to incorporate a technology’s design – and an evaluation of its usability – in the risk assessment (Wetterneck et al, 2006). Recommendations for changes that require modifications to workflows, technology design and training programs addressing the use of the technology can all occur as a result of a macroergonomic risk assessment (Hundt et al, 2013). …”

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

“…Proactive risk assessment to identify vulnerabilities associated with implementation of CPOE in intensive care units (ICUs) (Hundt et al 2013)…”