JMIR Publications

ABSTRACT

Background:

Medication incidents (MIs) causing patient harm hold far-reaching consequences for patients, pharmacists, public health, business practice and governance policy. Medication Incident Reporting and Learning Systems (MIRLS) have been implemented to mitigate such incidents and promote continuous quality improvement programs for Community Pharmacies in Canada. Such systems aim to collect and analyze MIs for the development and implementation of incident preventive strategies that will increase safety in community pharmacy practice. This goal remains inhibited due to persistent barriers pharmacies face when using these systems.

Objective:

The present research seeks to investigate the harms caused by medication errors, technological barriers to reporting, and identify opportunities to incorporate persuasive and motivational design strategies in MIRLS to motivate pharmacists and the pharmacy team to increase reporting.

Methods:

We conducted two scoping reviews to provide insights on the relationship between medication errors and patient harm, and the information-system-based barriers to medication error and incident reporting. Seven databases were searched in each scoping review. They include PubMed, Public Health Database, ProQuest, Scopus, ACM, Global Health and Google Scholar. Next, we analyzed one of the most widely used MIRLS in Canada using the Persuasive Systems Design (PSD) Model – a framework for analyzing, designing, implementing, and evaluating persuasive systems. The framework entails the application of behavioral theories from social psychology in the design of technology-based systems to motivate behavior change. Independent assessors familiar with the MIRLS reported the degree of persuasion built into the system using the four functional components of the model: primary task, dialogue, social, and credibility support strategies.

Results:

Seventeen (17) and one article were included in the first and second scoping reviews, respectively. In the first review, significant or serious harm was the most frequent harm (11/17, 64.71%), followed by death/fatal harm (7/17, 41.18%). In the second review, the authors found that iterative design could improve the usability of an MIRLS; however, data security and validation of reports remained an issue to be dealt with. Regarding the MIRLS that we assessed, participants considered most of the primary task, dialog, and credibility support strategies in the PSD model as important and useful; however, they were not comfortable with some of the social strategies such as cooperation. We found that the assessed system supported a number of persuasive design strategies from the PSD model; however, we identified additional motivational and persuasive design strategies such as tunneling, simulation, suggestion, praise, reward, reminder, authority, and verifiability that could further enhance the perceived persuasiveness and value of MIRLS. We discuss these strategies and implications for practice.

Conclusions:

MIRLS, equipped with persuasive design principles, can become powerful motivational tools to promote the culture of safety and safer medication practices in community pharmacies. They have the potential to highlight the value of medication incident reporting and increase the voluntary readiness of pharmacists to report incidents. The proposed persuasive design guidelines can help designers and developers of MIRLS as well as community pharmacy managers implement more effective quality improvement practices.