NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK.
BMJ Open. 2023 Apr 27;13(4):e068798. doi: 10.1136/bmjopen-2022-068798.
The concept of safety work draws attention to the intentional work of ensuring safety within care systems. Clinical decision support (CDS) has been designed to enhance medication safety in primary care by providing decision-making support to prescribers. Sociotechnical theory understands that healthcare settings are complex and dynamically connected systems of fluid networks, human agents, changing relationships and social processes. This study aimed to understand the relationship between safety work and the use of CDS.
This qualitative study took place across nine different general practices in England. Stakeholders included general practitioners (GPs) and general practice-based pharmacists and nurse prescribers. Semi-structured interviews were conducted to illicit how the system was used by the participants in the context of medication safety work. Data analysis conducted alongside data collection was thematic and drew on socio-technical theory.
Twenty-three interviews were conducted with 14 GPs, three nurse prescribers and three practice pharmacists between February 2018 and June 2020.
Safety work was contextually situated in a complex network of relationships. Three interconnected themes were interpreted from the data: (1) the use of CDS within organisational and social practices and workflows; (2) safety work and the use of CDS within the interplay between prescribers, patients and populations; and (3) the affordances embedded in CDS systems.
The use of sociotechnical theory here extends current thinking in patient safety particularly in the ways that safety work was co-constituted with the use of CDS alerts. This has implications for implementation and use to ensure that the contexts into which such CDS systems are implemented are taken into account. Understanding how alerts can adapt safety culture will help improve the efficacy of CDS systems, enhance prescribing safety and help to further understand how safety work is achieved in primary care.
安全工作的概念引起了人们对护理系统内确保安全的有目的工作的关注。临床决策支持（CDS）旨在通过为决策者提供决策支持来增强初级保健中的药物安全性。社会技术理论认为，医疗保健环境是复杂的，是由流动网络、人类代理、不断变化的关系和社会过程动态连接的系统。本研究旨在了解安全工作与 CDS 使用之间的关系。
这项定性研究在英格兰的九个不同的全科医生诊所进行。利益相关者包括全科医生（GP）和基于全科医生的药剂师和护士处方者。进行半结构化访谈，以了解参与者在药物安全工作背景下如何使用该系统。数据分析与数据收集同时进行，采用社会技术理论。
2018 年 2 月至 2020 年 6 月期间，对 14 名全科医生、3 名护士处方者和 3 名执业药剂师进行了 23 次访谈。
安全工作是在复杂的关系网络中进行的。从数据中解释了三个相互关联的主题：（1）在组织和社会实践和工作流程中使用 CDS；（2）在处方者、患者和人群之间相互作用中使用 CDS 进行安全工作；（3）CDS 系统中嵌入的功能。
这里使用社会技术理论扩展了患者安全方面的现有思维，特别是在安全工作与 CDS 警报的使用共同构成的方式方面。这对实施和使用有影响，以确保考虑到实施此类 CDS 系统的背景。了解警报如何适应安全文化将有助于提高 CDS 系统的功效，增强处方安全性，并帮助进一步了解如何在初级保健中实现安全工作。
