Pharmacy, Imperial College Healthcare NHS Trust, London, UK
UCL School of Pharmacy, London, UK.
BMJ Open. 2024 Nov 27;14(11):e089026. doi: 10.1136/bmjopen-2024-089026.
To identify patient-safety-related unintended consequences of healthcare technologies experienced by their primary users: patients, carers and healthcare providers (HCPs).
Qualitative study based on data collected in online focus groups. Transcripts were analysed inductively after each focus group using reflexive thematic analysis, focusing on identifying unintended consequences of healthcare technologies with implications for patient safety. Patient safety was broadly conceptualised to include a more subjective concept of 'feeling safe' as well as risks of actual harm.
Patient/public and HCP participants from the UK with experience in healthcare technologies were recruited using a mixture of purposive, convenience and snowball sampling.
40 participants (29 patients/public, 11 HCPs) took part in 5 focus groups between November 2021 and February 2022.
We identified five main themes of unintended consequences with implications for patient safety: inequity of access, increased end-user burden, loss of the human element of healthcare, over-reliance on technology and unclear responsibilities. Both groups of participants identified unintended consequences directly affecting patients; HCPs also described those affecting themselves. Some unintended consequences are described in previous literature, including alert fatigue, the 'illusion of communication', reduced opportunities for face-to-face interactions and increased end-user burden. Others are potentially novel, including patients' psychological dependence on technologies, 'gaming' of data entry and incorrect interpretation of health data.
Drawing on the perspectives of patients/public as well as HCPs, we identified five areas of patient-safety-related unintended consequences associated with healthcare technologies. These should be considered when developing tools to identify and mitigate the patient-safety-related unintended consequences of healthcare technologies.
确定初级用户（患者、护理人员和医疗保健提供者）在使用医疗技术时所经历的与患者安全相关的意外后果。
基于在线焦点小组收集的数据进行的定性研究。在每次焦点小组之后，使用反思性主题分析对记录进行归纳分析，重点识别与患者安全相关的医疗技术的意外后果。患者安全被广泛概念化为包括“感到安全”的更主观概念以及实际伤害的风险。
使用有目的、便利和滚雪球抽样的混合方法，从英国有医疗技术经验的患者/公众和医疗保健提供者中招募参与者。
2021 年 11 月至 2022 年 2 月期间，共有 40 名参与者（29 名患者/公众，11 名医疗保健提供者）参加了 5 个焦点小组。
我们确定了五个与患者安全相关的意外后果主题，包括获取机会的不平等、终端用户负担的增加、医疗保健中人性的缺失、过度依赖技术和责任不明确。两组参与者都确定了直接影响患者的意外后果；医疗保健提供者还描述了那些影响自己的后果。一些意外后果在之前的文献中有描述，包括警报疲劳、“沟通的错觉”、面对面互动机会减少和终端用户负担增加。其他后果可能是新的，包括患者对技术的心理依赖、数据输入“作弊”和对健康数据的错误解释。
通过患者/公众和医疗保健提供者的观点，我们确定了与医疗技术相关的五个与患者安全相关的意外后果领域。在开发用于识别和减轻医疗技术与患者安全相关的意外后果的工具时，应考虑这些后果。
