Evaluating clinical decision support tools for medication administration safety in a simulated environment

• Simulation is an effective method for system design testing.
• Multiple CDS access points can help increase patient safety when workflow may need to change.
• Nurses were more likely to attend to alerts when they were color coded by level of potential danger.
• Nurses were more likely to allow interruptions to influence their process when the interruption was in person.

ObjectivesThe specific aims of this study were to develop a methodology and tools for the design of clinical decision support systems to decrease the incidence of medication administration errors.MethodsA mixed-methods design was utilized in this study. First, observations of medication administration practice were used to inform the design of a simulated information system with a variety of decision support tools. Then, nurses were observed administering medications in a simulated environment using the simulated system. Finally, the nurses participated in focus groups to provide input into system tools design. Observations of nurses’ use of the decision support tools as well as semi-structured focus groups were used to evaluate nurses’ use and perceptions of the utility of the system decision support tools.ResultsNurses’ evaluation of the medication administration decision support tools as well as their actual performance revealed a tendency to underestimate their need for support. Their preferences were for decision support that was short, color coded, and easily accessed. Observations of medication administration showed that nurses exhibit a variety of work processes to prepare and administer medications to patients and access system decision support tools at a variety of points in this process. System design should allow flexibility of multiple points and types of information delivery to accommodate variations in workflow to minimize the tendency for system workarounds.ConclusionsThis study was performed in one hospital and results may not generalize beyond this setting. However, this method used to design and test decision support could be transferred to other settings. Using simulation in this study provided a method for testing new information system design, related to a potentially dangerous procedure, in a manner that eliminated the hazards of potential unintended consequences for patients.