User testing to improve retrieval and comprehension of information in guidelines to improve medicines safety

Research output: Contribution to journalArticle

Abstract

Background: User-testing and subsequent modification of clinical guidelines increases health professionals’ information retrieval and comprehension. No study has investigated whether this results is safer care.
Objective: To compare the frequency of medication errors when administering as intravenous medicine using the current NHS Injectable Medicines Guide (IMG) versus and IMG version revised with user-testing.
Method: Single-blind, randomised parallel group in-situ simulation. Participants were on-duty nurses/midwives who regularly prepared intravenous medicines. Using a training manikin in their clinical area, participants administered a voriconazole infusion, a high-risk medicine requiring several steps to prepare. They were randomised to use current IMG guidelines or IMG guidelines revised with user-testing. Direct observation was used to time the simulation and identify errors. Participant confidence was measured using a validated instrument. The primary outcome was the percentage of simulations with at least one moderate-severe IMG-related error, with error severity classified by an expert panel.
Results: In total, 133 participants were randomised to current guidelines and 140 to user-tested guidelines. Fewer moderate-severe IMG-related errors occurred with the user tested guidelines (n=68, 49%) compared with the current guidelines (n=79, 59%), but this difference was not statistically significant (risk ratio: 0.82; 95% confidence interval: 0.66-1.02). Due to a reduction in minor errors, significantly more simulations were completed without any IMG-related errors with the user-tested guidelines (n=67, 48%) compared with current guidelines (n=26, 20%) (risk ratio: 2.46; 95% confidence interval: 1.68-3.60). Median simulation completion time was 1.6 minutes (95% confidence interval 0.2-3.0) less with the user-tested guidelines. Participants who used the user-tested guidelines reported greater confidence.
Conclusion: User-testing injectable medicines guidelines reduces the number of errors and the time taken to prepare and administer intravenous medicines, whilst increasing staff confidence.
Original languageEnglish
Number of pages52
JournalBMJ Quality and Safety
Early online date30 Jun 2020
DOIs
Publication statusE-pub ahead of print - 30 Jun 2020

Keywords

  • administration of drugs
  • drug information
  • intravenous drug administration
  • medication errors
  • nurses
  • patient safety
  • practice guidelines

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