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.

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

The use of information technology by the quantity surveying professionals in Hong Kong

This paper introduces the findings of a recent study on the use of information technology (IT) among the quantity surveying (QS) organisations in Hong Kong. The study was conducted through a structured questionnaire survey among 18 QS organisations registered in Hong Kong, representing around 53% of the total number of organisations in the profession. The data set generated from this study provided rich information about what information technology the QS profession used, what the perceived benefits and barriers experienced by the users in the industry were. The survey concluded that although IT had been widely used in QS organisations in Hong Kong, it is mainly used to support various individual tasks of the QS services at a basic level, rather than to streamline the production of QS services as a whole through automation. Most of the respondents agreed that IT plays an important role in the QS profession but they had not fully taken advantage of IT to improve their competitive edge in the market. They usually adopted a more passive “wait and see” approach. In addition, very few QS organisations in Hong Kong have a comprehensive policy in promoting the use of IT within the organisations. It is recommended that the QS profession must recognise the importance of IT and take appropriate actions to meet the challenges of ever-changing and competitive market place.

Semantic-driven context-aware visual information indexing and retrieval: applied in the film post-production domain

A large volume of visual content is inaccessible until effective and efficient indexing and retrieval of such data is achieved. In this paper, we introduce the DREAM system, which is a knowledge-assisted semantic-driven context-aware visual information retrieval system applied in the film post production domain. We mainly focus on the automatic labelling and topic map related aspects of the framework. The use of the context- related collateral knowledge, represented by a novel probabilistic based visual keyword co-occurrence matrix, had been proven effective via the experiments conducted during system evaluation. The automatically generated semantic labels were fed into the Topic Map Engine which can automatically construct ontological networks using Topic Maps technology, which dramatically enhances the indexing and retrieval performance of the system towards an even higher semantic level.

iTrench: a study of user reactions to the use of information technology in field archaeology

This article describes work undertaken by the VERA project to investigate how archaeologists work with information technology (IT) on excavation sites. We used a diary study to research the usual patterns of behaviour of archaeologists digging the Silchester Roman town site during the summer of 2007. Although recording had previously been undertaken using pen and paper, during the 2007 season a part of the dig was dedicated to trials of IT and archaeologists used digital pens and paper and Nokia N800 handheld PDAs to record their work. The goal of the trial was to see whether it was possible to record data from the dig whilst still on site, rather than waiting until after the excavation to enter it into the Integrated Archaeological Database (IADB) and to determine whether the archaeologists found the new technology helpful. The digital pens were a success, however, the N800s were not successful given the extreme conditions on site. Our findings confirmed that it was important that technology should fit in well with the work being undertaken rather than being used for its own sake, and should respect established work flows. We also found that the quality of data being entered was a recurrent concern as was the reliability of the infrastructure and equipment.

Higher Education: Understanding the impact of distance learning mode on user information assimilation and satisfaction

There is increasing pressure to capture of video within Higher Education. Although much research has looked at how communication technologies enhance information transfer during playback of video, consideration of technical issues seems incongruous if we do not consider how presentation mode affects information assimilated by, and satisfaction of, learners with a range of individual differences, and from a range of different backgrounds. This paper considers whether a relationship exists between the media and presentation mode used in recorded content, and the level of information assimilation and satisfaction perceived by learners with a range of individual differences. Results aim to inform learning practitioners whether generic delivery is justified, or whether tailoring content delivery enhances the experience of specific learner groups.

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