Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals.

Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A. BMJ Qual Saf. 2016 Apr 29; [Epub ahead of print].

Computerized provider order entry systems are now widely deployed in hospitals, but their effectiveness at preventing adverse drug events has thus far been less impressive than hoped. Some of this lack of effect may be due to users engaging in workarounds that bypass safety features in order to preserve efficiency. This study used direct observation and interviews to characterize the types of workarounds used by clinical staff at five hospitals in the United Kingdom. Although some workarounds were endorsed by management (such as those to be used if the system was down), most were informal and related to difficulty using the software or to preserve professional roles (for example, senior doctors would delegate prescribing to trainees). Use of workarounds was associated with new potential safety risks, but the authors note that workarounds often represent a reasonable adaptation on the part of frontline staff—especially if the technology itself is not easy to use. They therefore advocate for more formal characterization of workarounds as a part of human factors engineering approaches to improving safety.

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