Introduction

The most recent undertaking in the ongoing development of the CISQ family of tools is the research study – “Staff attitudes towards medication administration modules of clinical information systems: development and piloting of the CISQ-MedAdmin.”

This research is being done to adapt the existing CISQ for use in measuring staff attitudes and satisfaction with implementations of medication administration modules of clinical information systems.

The initial phase of this research was the development and piloting of the CISQ-MA tool. Piloting of the tool was be done at two Veteran’s Administration Health Delivery Networks, in Baltimore, MD, and Buffalo, NY, which had recently implemented Bar Code Medication Administration (BCMA), the medication administration module of the VA’s clinical information system.

Importance of the Research

Although computerized physician ordering of medications in acute care settings has been in existence for over 20 years in a few hospitals, it is just now beginning to be widely adopted. Even so, computerized physician ordering of medications is present in less than 20% of hospitals at the present time. Computerized medication administration, distinct yet related technology to computerized physician ordering of medications, in acute care most often takes the form of medication administration modules within broader and/or more comprehensive clinical information systems. Computerized medication administration is even less prevalent than computerized physician ordering of medications. The slow pace of the adoption of these technologies is changing due to the now widely publicized information about medical mistakes.

"To Err is Human”, the Institutes of Medicine (IOM) report released in December 1999, contends that iatrogeny accounts for between 44,000 and 98,000 deaths in the US annually. (Kohn, Corrigan, & Donaldson, 2000) The leading cause of medical mistakes is medication errors. Medication errors account for more than 7,000 deaths annually. Hospital costs of preventable adverse drug events are about $2 billion annually.

Legibility of orders, maintaining similarly named drugs on nursing units, and maintaining multidose vials on nursing units are the leading cause of medication errors. These problems are relatively easily fixed by Information Technology and procedural change solutions. The "second tier" of causes of inpatient medication errors are related to the five "R's" of medication administration: the Right patient, drug, dose, time, and route. The IOM has published a goal of reducing 50% of medication errors by 2003. The second goal in reducing preventable adverse drug events can be achieved via incremental improvements over the between 2003-2008. In order to meet this latter goal, the more complex causes of medication errors - medication administration - will have to be addressed.

Medication administration modules of CIS's are rapidly being developed, improved and implemented in large part as a solution to medication administration errors. For example, the VA Healthcare System has mandated the implementation the Bar Code Med Admin module of the VistA Hospital Information System at all 172 VA acute care facilities. Research has indicated that multiple factors impact on the success of systems similar to medication administration modules such as the design and functionality the module, the relative success of the implementation of the module, and staff satisfaction. During the phase of rapid development and implementation of medication administration modules, which will last approximately three years, an instrument that will allow for formative and summative evaluation of the modules and staff satisfaction with said will be extremely valuable.

It is thus the researchers’ objective to develop and pilot the CISQ-MA tool for use in evaluating staff attitudes which may improve processes of implementation, thereby increasing staff knowledge, use of, and satisfaction with the system.

Overview of the Research

Development & Piloting

The current study is composed of two phases: 1) tool development and 2) piloting the tool. The tool development phase of this study uses grounded theory methodology. Focus groups representing nurses will be convened at the Baltimore and Buffalo VAHDNs. The focus groups will be asked open-ended questions regarding medication administration module implementation.

The sub-dimensions of an existing Clinical Information System Questionnaire measurement instrument, the CISQ-36^©, will serve as a framework to pose questions to the focus groups regarding their experiences and satisfaction with the medication administration module implementation. The emergence of sub-dimensions not present in the CISQ-36 and/or the possible irrelevance of CISQ-36 sub-dimensions to the clinical domain of medication administration will be explored. Data from the focus groups will be evaluated and the research team will develop a draft of the Clinical Information System Questionnaire-Medication Administration (CISQ-MA) tool. The focus groups will again be convened to review and critically analyze the proposed CISQ-MA tool. Data from this meeting will be analyzed by the research team to prepare a final version of the CISQ-MA for piloting.

The piloting phase of the study utilizes an ex post facto, non-experimental research design. Staff members at the two sites will complete an on-line survey of past experiences with medication administration module implementation. The survey will be completed confidentially at the two sites, and the resultant data will be used to test the reliability and construct validity of the CISQ-MA.

Potential Uses/Benefits of the Tool

Our research team is excited about the potential for implementers such as yourself to use this new instrument as implementations are unfolding. It will allow implementers the opportunity to a) pinpoint strengths and weaknesses of a particular implantation; b) take corrective action if needed; c) repeat the administration of the CISQ-MA; and d) see the impact of the corrective action. It will allow evaluators to "speak with data" regarding the critical issue of staff satisfaction with medication administration module implementation.

A summative evaluation of implementation will assess whether the objectives for the experience were met. It will be beneficial to the institution to have a summative evaluation in order to improve upon the processes of implementation. Formative uses of the evaluation include improving implementation processes such as staff education, training on the new technology, and possibly the medication administration module itself. Recurrent themes found via evaluation of staff attitudes will alert the institution to areas of the system that may need technical improvement. The CISQ-MA tool can be of great benefit to healthcare institutions interested in learning from staff members, and improving from what they learn. Improvements will increase staff satisfaction; thereby improving use of the system. These improvements indirectly enhance patient care, and thus have the potential to improve patient outcomes.

The CISQ-MA tool may also be used as one part of a comprehensive evaluation of a clinical information system. A complete evaluation may include but is not limited to the effect of technology on patient outcomes, cost/benefit analyses, and staff satisfaction with the system.

Research Plan

The researchers developing the CISQ-MA tool hope to utilize the tool in a multi-site, multi-factorial analysis of the effect of medication administration modules on staff attitudes and patient outcomes. This research endeavor will begin after the tool is developed and reliability and validity of the tool is established through piloting.

If you would like to use this or one of the other CISQ Measurement Instruments, please go to the CISQ Measurement Instrument Request Form page.

Last updated: June 26, 2002