Considering Work Systems and Processes in Assessing the Impact of a CDSS Intervention: Preliminary Results

The DetecIP project aims to implement multifactorial dynamic rules within a computerized decision support system (CDSS) for pharmaceutical analysis of orders to reduce the rate and severity of iatrogenic hyperkalemia and acute kidney injury. However, understanding the impact of this intervention (if any) requires that the way in which it influences the work systems and processes also be studied. This study presents the preliminary results of the analysis of the work contexts in which these rules will be implemented. A series of semi-structured interviews exploring the dimensions of the systems engineering initiative for patient safety (SEIPS) were conducted with healthcare professionals involved in the prevention and management of iatrogenic risks in five hospital units. Data were analyzed to identify current barriers and facilitators to the prevention and management of iatrogenic risks. Preliminary results from a geriatric unit and a cardiology unit reveal that, despite overall similarities in work processes, differences in the availability and location of physicians and clinical pharmacists influence how iatrogenic risks are managed. These contextual differences could influence the impact of the new CDSS rules once implemented.