A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

Transforming the English NHS using information technology: the story so far

The use of information and communication technologies (ICT) for transforming the way publicservices are delivered, has been an area of investment and focus in many countries in recentyears. The UK government envisioned moving from e-Government to transformationalgovernment by 2008, and initiatives such as the National Programme for IT (NPfIT) wereunderway towards this end. NPfIT was the largest civil IT programme worldwide at an initialestimated cost of £12.4bn over a ten-year period. It was launched in 2002 by the UKgovernment as part of its policy to transform the English NHS and to implement standardised ITsolutions at a national level. However, this top down, government led approach came underincreasing scrutiny, and is now being reconfigured towards a more decentralised mode of operations. This paper looks into the implementation of NPfIT and analyses the reasons behindits failure, and what effect the new NHS reforms are likely to have on the health sector. Wedraw from past studies (Weill and Ross, 2005) to highlight the key areas of concern in ITgovernance, using the NPfIT as an illustration

VERA: virtual environment for research in archaeology

The VERA (Virtual Environment for Research in Archaeology) project is based on a research excavation of part of the large Roman town at Silchester, which aims to trace the site's development from its origins before the Roman conquest to its abandonment in the fifth century A.D. [1]. The VERA project aims to investigate how archaeologists use Information Technology (IT) in the context of a field excavation, and also for post-excavation analysis. VERA is a two-year project funded by the JISC VRE 2 programme that involves researchers from the University of Reading, University College London, and York Archaeological Trust. The overall aim of the project is to assess and introduce new tools and technologies that can aid the archaeological processes of gathering, recording and later analysis of data on the finds and artefacts discovered. The researchers involved in the project have a mix of skills, ranging from those related to archaeology, and computer science, though to ones involving usability and user assessment. This paper reports on the status of the research and development work undertaken in the project so far; this includes addressing various programming hurdles, on-site experiments and experiences, and the outcomes of usability and assessment studies.

Team leadership across contexts: a qualitative study

Purpose – The purpose of this paper is to compare leadership functions from different team contexts considering context characteristics that contribute to team effectiveness. Design/methodology/approach – A qualitative study was conducted. Seven leaders of multidisciplinary child protection teams (MDTs) and nine managers of an information technology (IT) company took part in semi-structured interviews. The data were analyzed using content analysis with ATLAS.ti. Findings – Results showed that the two types of teams used different performance criteria, with teams from non-profit contexts lacking defined performance criteria. The results also showed that transition leadership functions are more frequently mentioned by IT than by MDT leaders. Moreover, interpersonal leadership functions emerged as independent functions that may occur in both the transition and action phases. Research limitations/implications – Context is paramount for performance criteria definition and for the relevance of certain team leadership functions over others. It also presents some suggestions for improvement to the model of Morgeson et al. (2010a). Practical implications – The results support the idea that there are differences in the leadership functions that are most valued by leaders, depending on the specific team’s context. Results also showed that some non-profit and less task-structured teams lack the specific performance criteria that could help them make more successful interventions. Originality/value – This paper reviews context literature, it shows that the emphasis on team leadership functions can vary across contexts and to the knowledge it is the first that compares the model of Morgeson et al. (2010a) in different contexts.

e-learning services provision and management

With the rapid development of information technology, learners demand effective personalised learning support, which imposes a new learning paradigm in learning content management. Standards as well as best practice in industry and research community have taken place to address the paradigm shift. With respect to this trend, it is recognised that finding learning content which meet personal learning requirements remains challenging. This paper describes a model of e-learning services provision which integrates the best practice in e-learning and Web services technology so that learning content management is capable of supporting applications of learning services.

A conceptual framework for aligning business and information systems from organisational learning perspective

The three decades of on-going executives’ concerns of how to achieve successful alignment between business and information technology shows the complexity of such a vital process. Most of the challenges of alignment are related to knowledge and organisational change and several researchers have introduced a number of mechanisms to address some of these challenges. However, these mechanisms pay less attention to multi-level effects, which results in a limited un-derstanding of alignment across levels. Therefore, we reviewed these challenges from a multi-level learning perspective and found that business and IT alignment is related to the balance of exploitation and exploration strategies with the intellec-tual content of individual, group and organisational levels.

Review of monitoring tools for e-learning platforms

The advancement of e-learning technologies has made it viable for developments in education and technology to be combined in order to fulfil educational needs worldwide. E-learning consists of informal learning approaches and emerging technologies to support the delivery of learning skills, materials, collaboration and knowledge sharing. E-learning is a holistic approach that covers a wide range of courses, technologies and infrastructures to provide an effective learning environment. The Learning Management System (LMS) is the core of the entire e-learning process along with technology, content, and services. This paper investigates the role of model-driven personalisation support modalities in providing enhanced levels of learning and trusted assimilation in an e-learning delivery context. We present an analysis of the impact of an integrated learning path that an e-learning system may employ to track activities and evaluate the performance of learners.

Interactive learning in UK construction practice: examining the role of BIM process standards

From a construction innovation systems perspective, firms acquire knowledge from suppliers, clients, universities and institutional environment. Building information modelling (BIM) involves these firms using new process standards. To understand the implications on interactive learning using BIM process standards, a case study is conducted with the UK operations of a multinational construction firm. Data is drawn from: a) two workshops involving the firm and a wider industry group, b) observations of practice in the BIM core team and in three ongoing projects, c) 12 semi-structured interviews; and d) secondary publications. The firm uses a set of BIM process standards (IFC, PAS 1192, Uniclass, COBie) in its construction activities. It is also involved in a pilot to implement the COBie standard, supported by technical and management standards for BIM, such as Uniclass and PAS1192. Analyses suggest that such BIM process standards unconsciously shapes the firm's internal and external interactive learning processes. Internally standards allow engineers to learn from each through visualising 3D information and talking around designs with operatives to address problems during construction. Externally, the firm participates in trial and pilot projects involving other construction firms, government agencies, universities and suppliers to learn about the standard and access knowledge to solve its specific design problems. Through its BIM manager, the firm provides feedback to standards developers and information technology suppliers. The research contributes by articulating how BIM process standards unconsciously change interactive learning processes in construction practice. Further research could investigate these findings in the wider UK construction innovation system.

A Design for Generating Personalised Feedback in Knowledge Construction

As the learning paradigm shifts to a more personalised learning process, users need dynamic feedback from their knowledge path. Learning Management Systems (LMS) offer customised feedback dependent on questions and the answers given. However these LMSs are not designed to generate personalised feedback for an individual learner, tutor and instructional designer. This paper presents an approach for generating constructive feedback for all stakeholders during a personalised learning process. The dynamic personalised feedback model generates feedback based on the learning objectives for the Learning Object. Feedback can be generated at Learning Object level and the Information Object level for both the individual learner and the group. The group feedback is meant for the tutors and instructional designer to improve the learning process.

Integrated clinical pathway management for medical quality improvement-based on a semiotically inspired systems architecture

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

The role of Investment Management Systems in regulatory compliance: a Post-Financial Crisis study of displacement mechanisms

The financial crisis of 2007–2009 and the resultant pressures exerted on policymakers to prevent future crises have precipitated coordinated regulatory responses globally. A key focus of the new wave of regulation is to ensure the removal of practices now deemed problematic with new controls for conducting transactions and maintaining holdings. There is increasing pressure on organizations to retire manual processes and adopt core systems, such as Investment Management Systems (IMS). These systems facilitate trading and ensure transactions are compliant by transcribing regulatory requirements into automated rules and applying them to trades. The motivation of this study is to explore the extent to which such systems may enable the alteration of previously embedded practices. We researched implementations of an IMS at eight global financial organizations and found that overall the IMS encourages responsible trading through surveillance, monitoring and the automation of regulatory rules and that such systems are likely to become further embedded within financial organizations. We found evidence that some older practices persisted. Our study suggests that the institutionalization of technology-induced compliant behaviour is still uncertain.