Mixed methods evaluation of a digital tool to support the transfer of medication information from ICU to ward

Transfer of medication information from intensive care units (ICUs) to general wards is error prone. Additional challenges emerge in hospitals where a different electronic medical record (eMR) is used in ICU and wards. Digital transfer systems, that support information transfer between different eMRs, could minimise errors, but limited research has evaluated these. We aimed to 1) determine the impact of eTOC, a medication transfer system, on medication errors and potential patient harms that occur during ICU-to-ward transfers, 2) to determine frequency of eTOC use post-implementation, and 3) explore how eTOC is used and viewed by clinicians.

A mixed methods approach was used at one metropolitan and one regional hospital in NSW, Australia. Part 1 comprised a pragmatic pre-post chart-review study (n = 200 patient transfers) and Part 2 used a qualitative approach, including usability testing (n = 4) and semi-structured interviews with clinicians (n = 11).

Implementation of the eTOC system did not significantly reduce the number of transfers containing an error (51 % vs 46 %, pre-post). Although the use of eTOC more than halved the odds of a medication error occurring (OR: 0.44, 95 %CI: 0.27-0.71), the system was inconsistently used. Interviews and usability testing revealed that barriers related both to system design/configuration and to the context of use and organisation (e.g., time pressure) impacted uptake of eTOC.

There is significant potential for technology to support transfer of medication information from ICU to the ward and improve safety if technology is designed well and aligns with how work is done in practice.