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Title: Mixed methods evaluation of a computerised physician order entry system with clinical decision support alerts to enhance medication safety in two Saudi Arabian hospitals
Author: Alsaidan, Jamilah Ahmed
ISNI:       0000 0004 9359 4177
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2020
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Introduction: Computerised physician order entry (CPOE) linked with clinical decision support systems are part of health information technology (HIT) advocated to reduce medication errors, providing considerable opportunities into their evaluation in developed as well as developing countries. Evaluations on their use in Kingdom of Saudi Arabia have been limited, no evaluations to date have been carried out in King Saud university medical city (KSUMC) hospitals. Aims: The thesis aims were to conduct an updated systematic review of medication safety research from the Gulf Cooperation Council countries (GCC). Additional aims were to use a mixed methods approach to evaluate utilisation of CPOE and CDSS in KSUMC hospitals and to develop generalisable recommendations for improved medication-related alert designs and alert handling practises. Methods: The medication safety literature was searched systematically and one of the gaps identified was addressed. Thus, use of HIT in KSUMC was evaluated, combining quantitative and qualitative methods of data collection and analysis. System generated CDSS reports were retrospectively reviewed and analysed. Displayed alerts were characterised, rates of alert overrides calculated, and appropriateness of alert display and alert override were assessed. Semi-structured interviews were conducted with prescribing physicians. Results: During the study period a total of 4,446,730 medication related alerts were generated, 4,231,743 (95%) were overridden. The highest frequency alert type generated was 'drug duplicate', 3,549,736 (about 80% of all alerts). Of 307 alerts assessed 246 (80%) were judged to have been displayed appropriately and 244 (79%) were overridden appropriately. The main themes identified from interviews related to 'the system', 'human perspectives' and 'organisational context'. Conclusions: The override rate calculated at KSUMC was higher than rates reported in the international literature. Revision of the logarithmic rules for generated alerts (specificity and relevance for the KSUMC context) and determination of any patient harm from overridden alerts is now recommended.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available