'Technovigilance' improves hospital's record for delivering meds on time

A system monitoring when hospital staff missed or was late in administering medication brought significant improvement on that metric, according to a study published by Milbank Quarterly.

Data from an electronic prescribing and decision support system were used to generate reports on the performance of individuals, teams and clinical services as part of an English hospital's efforts to improve care. If staff missed a dose, the system sent an email to the ward nurse. If the ward nurse took no action, alerts moved up the organization, eventually reaching the CEO.

Researchers from the Universities of Leicester and Birmingham credit the effort with reducing the rate of missed doses from 12 percent to 5 percent.

"This is one element of what we call 'technovigilance'--turning data into intelligence, which can then be put into effective action. Other elements include using the electronic system to find examples of where care did not seem to meet the required standards, and holding high-level care omissions meetings with staff on clinical areas to find out what happened," Mary Dixon-Woods, professor of medical sociology at the University of Leicester Department of Health Sciences, said in an announcement.

The meetings addressed organizational problems, such as delivery of medications to the required locations, as well as emphasizing personal responsibility of individual staff.

The vigilance, however, brought unintended consequences, such as focusing staff on tasks being measured at the expense of less measurable, but important aspects, such as talking to patients, the researchers said.

And bringing the data down to the individual level made the meetings uncomfortable for some staff, though they were not meant to be punitive. Administrators said the monitoring bought a major "cultural shift" in attitudes toward administering medication on time.

Meanwhile, in looking at 24 research projects in the United States funded through its Improving Quality Through Clinician Use of Health IT (IQHIT) initiative, the Agency for Healthcare Research and Quality found that health IT can improve patients outcomes--but the technology alone doesn't do it.

In a survey by research firm KLAS, 48 percent of responding providers said clinical decision support tools were "significant" to the outcomes of patients, while 31 percent said CDS surveillance had a "moderate" impact on their patients. Five percent said the tools had no impact at all. The 140 providers were divided into three categories: pharmacy-focused surveillance; enterprise-wide surveillance and electronic medical record surveillance.

To learn more:
- read the study
- here's the announcement

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