PubMed · 16106566
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Karen Denard Goldman, Kathleen Jahn Schmalz. 2005. E = MC2: effective multicultural competence.. https://doi.org/10.1177/1524839905275369
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OBJECTIVE: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. DESIGN: An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites. METHODS: Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences. RESULTS: Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences. CONCLUSION: Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.
BACKGROUND: Prescriptions must sometimes be changed or clarified before dispensing in order to provide a safe and professional service. The aims of this study were to gain insight into the types of prescription interventions performed by pharmacists, to explore the reason behind the interventions and to describe to which extent and how interventions are documented and communicated to the prescribers. MATERIAL AND METHODS: Prescription interventions (N = 1,084) performed at a community pharmacy in Norway from January 2002 to September 2004 were categorised. Two focus groups were used to validate the categories. The pharmacists in these groups were invited to discuss working procedures and professional judgements related to prescription interventions. RESULTS: The prescription interventions were grouped into seven categories. The two largest categories were "drugs not available" (37%) and "clarification of drug choice and dosage" (22%). Many interventions are not communicated to the prescribers. In principal, the pharmacists felt that interventions should be communicated to the prescriber even if this is often not the case. CONCLUSION: Pharmacists intervene on a range of prescription issues that are not communicated to the prescribers. Feedback requires time and resources for all involved. By ensuring that computer systems used by general practitioners comply with reimbursement legislation and technical requirements for prescriptions, the demand for many prescription interventions will be reduced. There is a need for a joint professional discussion on differentiation and standardisation of feedback on prescription interventions.
Learning disability nurse education, with a current emphasis on inclusive practice and a history of listening to the person with the disability, is well placed to take advantage of more 'experimental' forms of classroom teaching. In this article we argue for the use of forum theatre as a method of addressing topics from practice within an educational setting. Based on our emergent and exploratory work with students we detail at length the theoretical background that supports such an approach and contextualise the issues with reference to a short piece of drama we have used successfully with different student groups. We feel that the success of this method is due to the involvement of students in directing their own education as well as the inclusion of individuals labelled with learning disability as an integral part of the process.