Data from: Redesigning the ‘choice architecture’ of hospital prescription charts: a mixed methods study incorporating in-situ simulation

Objectives: To incorporate behavioural insights into the user-centred design of an inpatient prescription chart (Imperial Drug Chart Evaluation and Adoption Study, IDEAS chart) and to determine whether changes in the content and design of prescription charts could influence prescribing behaviour and reduce prescribing errors. Design: A mixed-methods approach was taken in the development phase of the project; in situ simulation was used to evaluate the effectiveness of the newly developed IDEAS prescription chart. Setting: A London teaching hospital. Interventions/methods: A multimodal approach comprising (1) an exploratory phase consisting of chart reviews, focus groups and user insight gathering (2) the iterative design of the IDEAS prescription chart and finally (3) testing of final chart with prescribers using in situ simulation. Results: Substantial variation was seen between existing inpatient prescription charts used across 15 different UK hospitals. Review of 40 completed prescription charts from one hospital demonstrated a number of frequent prescribing errors including illegibility, and difficulty in identifying prescribers. Insights from focus groups and direct observations were translated into the design of IDEAS chart. In situ simulation testing revealed significant improvements in prescribing on the IDEAS chart compared with the prescription chart currently in use in the study hospital. Medication orders on the IDEAS chart were significantly more likely to include correct dose entries (164/164 vs 166/174; p=0.0046) as well as prescriber's printed name (163/164 vs 0/174; p<0.0001) and contact number (137/164 vs 55/174; p<0.0001). Antiinfective indication (28/28 vs 17/29; p<0.0001) and duration (26/28 vs 15/29; p<0.0001) were more likely to be completed using the IDEAS chart. Conclusions: In a simulated context, the IDEAS prescription chart significantly reduced a number of common prescribing errors including dosing errors and illegibility. Positive behavioural change was seen without prior education or support, suggesting that some common prescription writing errors are potentially rectifiable simply through changes in the content and design of prescription charts.

研究目标：将行为学洞察融入住院处方笺（帝国药物处方笺评估与采用研究，Imperial Drug Chart Evaluation and Adoption Study，IDEAS处方笺）的以用户为中心的设计中，并探究处方笺的内容与设计变更能否影响处方行为、减少处方差错。
研究设计：本项目开发阶段采用混合研究方法；并使用现场模拟（in situ simulation）评估新研发的IDEAS处方笺的有效性。
研究场景：伦敦某教学医院。
干预/研究方法：采用多模态研究路径，包含三个环节：（1）探索阶段：开展处方笺审查、焦点小组座谈与用户洞察收集；（2）IDEAS处方笺的迭代设计；（3）联合现场模拟（in situ simulation），由处方医师对最终版IDEAS处方笺开展测试。
研究结果：英国15家不同医院使用的现有住院处方笺存在显著差异。对某医院40份已完成的处方笺进行审查，发现多种常见处方差错，包括字迹模糊、难以识别处方医师。焦点小组座谈与直接观察得到的用户洞察被应用于IDEAS处方笺的设计优化中。现场模拟测试结果显示，相较于本研究医院当前使用的处方笺，IDEAS处方笺的处方开具表现存在显著提升。IDEAS处方笺上的用药医嘱更易包含正确的剂量录入项（164/164 vs 166/174；p=0.0046），以及处方医师的印刷体姓名（163/164 vs 0/174；p<0.0001）与联系电话（137/164 vs 55/174；p<0.0001）。使用IDEAS处方笺时，抗感染治疗的适应证（28/28 vs 17/29；p<0.0001）与疗程（26/28 vs 15/29；p<0.0001）的填写完成率也显著更高。
研究结论：在模拟场景中，IDEAS处方笺显著减少了多种常见处方差错，包括剂量差错与字迹模糊问题。无需预先开展教育培训或支持即可观察到积极的行为改变，这表明部分常见的处方书写差错可仅通过调整处方笺的内容与设计得到纠正。