BMJ Open Quality最新文献

{"title":"Multidisciplinary Delphi study validated variables for calculating cost of medication errors in the Sri Lankan context.","authors":"Sakunika Ranasinghe, Dewmini Navodya, Abarna Nadeshkumar, Savini Senadheera, Nithushi Samaranayake","doi":"10.1136/bmjoq-2025-003538","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003538","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of medication errors needs to be costed but no standard method, nor a standard list of variables, has yet been identified. Hence, this study aimed to establish a standard list of cost variables (SLCV) for calculating the cost of medication errors in Sri Lanka from a provider perspective.</p><p><strong>Methods: </strong>The study had three discrete phases: a systematic review to identify cost variables used globally to calculate the cost of medication errors (published), followed by a Delphi study with 18 experts to assess appropriateness, accuracy, accessibility and measurability of identified cost variables. Finally, a hospital bill analysis was done to assess accessibility and measurability of cost variables.</p><p><strong>Results: </strong>In Delphi round 1, out of 13 cost variables, nine were retained as appropriate for calculating medication error costs. None were rated as accessible or measurable in the healthcare settings in Sri Lanka. Experts highlighted the need for a guideline to use the cost variables, which was then developed and shared among experts in Delphi round 2. The SLCV, including eight variables, was retained as appropriate for calculating medication error cost after Delphi round 2. Thirty-one bills confirmed the accessibility and measurability of most variables in SLCV.</p><p><strong>Conclusion: </strong>A standard list comprising eight appropriate cost variables to calculate the cost of medication errors, and a guideline was developed for Sri Lanka. The accessibility of these variables was affirmed through a bill audit.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving staff enjoyment at work in a community mental health team: a quality improvement project.","authors":"Emily Greenslade, Iona Gray, Jennifer Perry","doi":"10.1136/bmjoq-2024-003247","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003247","url":null,"abstract":"<p><strong>Background: </strong>Staffing has been a significant problem for our community rehabilitation team in the past with high vacancy rates, sickness and turnover, impacting negatively on patient care at times. Our project aim was to improve staff enjoyment at work, in the hope that this might also improve staff retention.</p><p><strong>Method: </strong>We measured enjoyment levels by distributing an anonymous questionnaire weekly at team meetings, scoring enjoyment levels on a scale 1-10 and collecting qualitative feedback. We also calculated monthly staffing levels. The team developed a driver diagram and interventions were introduced from this including reflective practice sessions, monthly teaching sessions, staff social events and a cross-cover/duty policy with guidance on flexible working.</p><p><strong>Results: </strong>After the interventions were implemented, the median staff enjoyment score increased slightly from 6.75/10 to 7/10 and the median staffing levels increased from 61% to 89% over a period of 18 months. We found that staffing levels and enjoyment levels correlated with each other. From analysis of the qualitative feedback over the duration of the project, the number of negative comments received did reduce. It should be noted that the number of comments around the intensity of workload remained the same when comparing the baseline period to the final weeks of the project.</p><p><strong>Conclusion: </strong>There was little change in staff enjoyment levels at work. This may be reflective of the general state of the National Health Service with poor levels of morale nationally but may also be linked to ongoing concerns in the qualitative feedback from the team about high workloads. Despite this, we made positive changes and the project helped bring the team together. The project further emphasises the link between staffing levels and enjoyment levels. Overall, our project helped to increase staffing levels and highlight the importance of well-being in the workplace.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysing the effect of multidisciplinary teams to address preventive healthcare gaps in a rural teaching clinic: a quality improvement project.","authors":"Veronica Hill, Brittany Woody, Fahad Irfan Abid, Meaghan Barros, Priya Pohani","doi":"10.1136/bmjoq-2025-003319","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003319","url":null,"abstract":"<p><p>Preventive care decreases the risk of illness, disease and death, yet patient adherence to preventive care is low, calculated to be around 5%, and rural residents are suspected to have even lower rates compared with urban patients. Despite continually updated guidelines and recommendations for screenings and preventive care, delivery of care to rural patients is difficult, and a deficit exists. This project aimed to use multidisciplinary teams at a teaching rural health clinic to close five preventive care gaps: lung cancer screening, colon cancer screening, Shingrix vaccination, osteoporosis screening and hepatitis C screening by 10% in the rural community.An electronic medical record (EMR) analysis was used to identify and prioritise preventive care gap deficiencies, and quality improvement methods integrating student physicians were used to integrate and optimise care gap closures into the daily routine of clinic staff.After three intervals of the project period, a 19% increase was achieved in lung cancer screening, a 49% increase in colon cancer screenings and 63% and 9% in osteoporosis and hepatitis C screenings. Additionally, medical providers had a change in practice management as a direct result of intentional attention to preventive care gaps. The Shingrix vaccination project needed to be stopped due to the availability of the vaccine.By using an EMR and a working relationship between staff, nursing, physicians and students, health disparities in a rural community were decreased.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of patient safety incident reporting practices in maternity care.","authors":"Emma Beecham, Gráinne Brady, Syka Iqbal, Qanita Fatima, Saeeda Arshad, Paulina Bondaronek, James O'Carroll, Stephanie Glaser, Dimitrios Siassakos, Katie Gilchrist, Jenny Dorey, Rebecca Knagg, Cecilia Vindrola","doi":"10.1136/bmjoq-2025-003432","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003432","url":null,"abstract":"<p><strong>Problem: </strong>Patient safety incident reporting in maternity care is central for improving safety, yet inconsistencies in reporting practices and limited understanding of system functionalities may reduce its effectiveness.</p><p><strong>Background: </strong>Reporting incidents allows healthcare providers to identify safety issues and implement improvements. However, variations in reporting practices, particularly in maternity care, have been found across different healthcare settings. Despite the growing use of electronic systems, challenges such as under-reporting, lack of feedback and insufficient organisational learning persist.</p><p><strong>Aim: </strong>This review explores how patient safety incidents are reported in maternity care, identifies the systems used globally, examines potential barriers and enablers to reporting, and highlights gaps in existing research and practice.</p><p><strong>Methods: </strong>A systematic review was conducted, analysing studies that focused on incident reporting practices in maternity care. An artificial intelligence text analysis tool (Caplena) was used to aid the synthesis of the study data. Methodologies included quantitative surveys, qualitative interviews and mixed methods approaches.</p><p><strong>Findings: </strong>A total of 15 studies from seven different countries were analysed. Reporting systems ranged from traditional paper-based methods to electronic platforms. Barriers included organisational culture, time pressures and inadequate reporting platforms. Enablers involved supportive leadership, training and user-friendly reporting systems. Substantial gaps included the under-reporting of near misses, lack of feedback mechanisms and insufficient attention to staff experiences.</p><p><strong>Discussion: </strong>The findings highlight the need for consistent, user-friendly reporting systems and fostering a supportive, non-punitive culture. Strengthening and improving feedback mechanisms is also critical to enhance reporting practices. Recommendations are provided for designing future reporting systems.</p><p><strong>Conclusion: </strong>Improving patient safety incident reporting in maternity care requires system improvements, cultural changes and further research to address identified gaps and optimise incident management systems.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altering physician referral practices is challenging, but not impossible: spine assessment clinic quality improvement study.","authors":"Aaron Varga, Florence Slomp, Vanessa Ritchie, Linda Slater-Maclean, Emily Thiessen, Aaron Hockley","doi":"10.1136/bmjoq-2024-002774","DOIUrl":"10.1136/bmjoq-2024-002774","url":null,"abstract":"<p><strong>Introduction: </strong>Access to medical specialists is a persistent challenge, with neurosurgical spine services reporting some of the longest waits across all fields. Inappropriate and incomplete referrals contribute to delayed access to these providers. Referral guidelines and physician education have been shown to decrease such inefficiencies. Therefore, the goal of this study was to address inappropriate referrals directed to the neurosurgical spine assessment clinic via implementation of a quality improvement initiative. We hypothesised that appropriate referrals, which included patients with potential surgical pathology and fulfilled referral criteria, would increase by 25% following referral guideline distribution.</p><p><strong>Methods: </strong>A three-phase study was implemented: (1) baseline data were collected from preintervention referrals by noting the reason for consultation and if certain information, deemed relevant for an appropriate referral, was included; (2) a referral guideline, outlining when and how to refer, was distributed to family physicians in the region; and (3) postintervention referrals were collected and analysed as in phase I.</p><p><strong>Results: </strong>A total of 404 referrals were collected (161 pre-intervention and 243 post-intervention). A 36% increase in patients who were deemed appropriate surgical candidates was reported post-intervention (p=0.044), with an escalation in the proportion of patients requiring neurosurgeon assessment observed over time. Limited improvements were appreciated in the presence of the criteria indicated for inclusion in a referral document.</p><p><strong>Conclusion: </strong>While challenges remain when attempting to modify the referring behaviours of primary care physicians, this research has demonstrated that guidelines aimed at enhancing specialist directed referrals can lead to improvements in their performance. Nonetheless, translating guidelines into practice is a recognised issue, often requiring time and multiple exposures. Active forms of medical education and multifaceted interventions have been demonstrated to be the most effective means of implementing guidelines into practice, an approach that could further address referral inadequacies in the future.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of WHO quality assessment/quality improvement tool for maternal and newborn care for gap analysis and POCQI methodology to improve preterm neonatal outcomes at a tertiary care centre: a quality improvement initiative.","authors":"Kiran Suthar, Sushma Nangia, Pratima Anand, Harish Pemde","doi":"10.1136/bmjoq-2025-003420","DOIUrl":"10.1136/bmjoq-2025-003420","url":null,"abstract":"<p><strong>Introduction: </strong>Preterm birth is a leading cause of neonatal mortality and morbidity globally. Evidence suggests that over three-quarters of premature deaths can be prevented through cost-effective interventions. However, compliance with evidence-based guidelines in neonatal care often falls <50%, even in well-resourced settings.</p><p><strong>Aims and objectives: </strong>The study evaluated system gaps using WHO Quality Assessment/Quality Improvement Tool for Maternal and Newborn Care (WHO QA/QI MN) and implemented Point of Care Quality Improvement (POCQI) methodology to improve and sustain the composite outcome of mortality and/or major morbidities, including bronchopulmonary dysplasia, necrotising enterocolitis stage 3, late-onset sepsis and intraventricular haemorrhage grade ≥3.</p><p><strong>Materials and methods: </strong>The study was conducted over 14 months. The adapted WHO QA/QI MN tool and POCQI methodology were used to focus on key clinical practices, namely, kangaroo mother care (KMC), use of mother's own milk (MoM) and antibiotic usage, utilising multiple plan-do-study-act cycles.</p><p><strong>Results: </strong>Among 961 preterm neonates enrolled, KMC rates increased from 70.25% to 85.58%, and exclusive MoM use by day 7 increased from 59.24% to 70.2%. Antibiotic use declined from 25.5% to 20.67%. While process improvements were noted, the composite outcome of mortality and major morbidities did not show statistically significant reduction; however, a decreasing trend was observed post-intervention.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility of using the WHO tool by trained personnel for gap analysis. POCQI is an important approach to enhance evidence-based care practices and sustain good outcomes for preterm neonates in resource-limited settings. A longer follow-up may be needed to observe significant improvements in clinical outcomes.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can benchmarking uncover the disparities in the perinatal dashboard and improve the quality of care that pregnant women of diverse ethnic backgrounds receive? A retrospective cross-sectional study.","authors":"Vedhapriya Sudhakar, Farah Siddiqui, Jennifer Nw Lim, Thillagavathie Pillay","doi":"10.1136/bmjoq-2025-003431","DOIUrl":"10.1136/bmjoq-2025-003431","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the impact of including ethnicity and English proficiency (EP) in the local perinatal dashboard to uncover outcome differences faced by pregnant women from diverse ethnic backgrounds.</p><p><strong>Design: </strong>A retrospective cross-sectional study was conducted at the University Hospitals of Leicester between September 2020 and December 2020, including 2862 singleton pregnancies at booking and 2407 deliveries. Data from the maternity server covered demographics and key performance indicators (KPIs), such as gestational age at booking, uptake of first trimester screening test (FTST), perinatal outcome, third- and fourth-degree perineal tears and post-partum haemorrhage (PPH). The NHS perinatal surveillance dashboard categorised these KPIs by ethnicity and EP.</p><p><strong>Results: </strong>The booking cohort comprised 62% White, 26% Asian, 3% Black, 2% mixed race and 2.5% any other ethnic group. Late antenatal booking was highest in the mixed-race cohort (15%). Women who do not speak English as their first language (NEPL) were the largest undecided group with the FTST uptake (10%). Among the delivery group, mixed-race women had a higher stillbirth rate (21.28 per 1000 live births) and preterm births (10%). Third- and fourth-degree tear rates were highest among ethnic minority-NEPL cohorts (4.36%), although they were not statistically significant. No significant differences were observed in PPH rates.</p><p><strong>Conclusions: </strong>This study highlights perinatal disparities among diverse ethnic groups and non-English-speaking women, necessitating targeted interventions to address these inequities for better perinatal outcomes for diverse populations. Including ethnicity and EP in perinatal dashboards reveals these disparities and aids in developing quality assurance systems to monitor and address them.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing surgical site infections in patients undergoing pancreatic resection: a quality improvement initiative.","authors":"Richard W Gilbert, Michelle Kwon, Muhammad Uzair Khalid, Michael Bleszynski, Stephen W Chung, Graziano Oldani, Maja Segedi, Mitchell Webb, Philemon Leung, Allison Mah, Megan O'Brien, Kristen M Kidson, Stephanie Chartier-Plante, Peter Kim","doi":"10.1136/bmjoq-2025-003484","DOIUrl":"10.1136/bmjoq-2025-003484","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) represent a significant source of morbidity during pancreaticoduodenectomy. The use of piperacillin-tazobactam (pip-tazo) has been shown to significantly reduce the incidence of SSI in this patient population. We thus elected to perform a quality improvement (QI) project to reduce superficial and deep SSI rates by ensuring all patients received pip-tazo as antibiotic prophylaxis.</p><p><strong>Methods: </strong>We collected baseline retrospective data on a historical cohort of patients undergoing pancreaticoduodenectomy or total pancreatectomy from 1 January 2022 to 31 December 2022. We then launched our QI project on 1 January 2023, consisting of a multidisciplinary team creation and numerous outreach activities. The project had two Plan, Do, Study, Act (PDSA) cycles and ran until April 2024. The Standards for Quality Improvement Reporting Excellence guidelines were used to report results.</p><p><strong>Results: </strong>Baseline cohort data included 64 patients, with 32% receiving pip-tazo and 39% developing an SSI. During phase one of our QI project (1 January 2023-31 August 2023), 54 patients underwent surgery, 90.7% received pip-tazo and 27.8% developed an SSI. Those who had undergone preoperative biliary stenting had a higher SSI rate (46.9% vs 4.4%). We thus added a second SSI reduction measure to patients with biliary stents: the ringed wound protector. During the second phase of our QI project (1 September 2023-1 April 2024), 51 patients underwent surgery, 98.0% received pip-tazo and 65.0% had a wound protector placed. SSI rates in this group were 9.8%.</p><p><strong>Conclusion: </strong>We describe a QI project whereby we increased the rates of correct antibiotic dosing in patients undergoing pancreatectomy to 98.0%. Although pip-tazo reduced SSI rates, the addition of a ringed wound protector in patients at high risk further reduced rates of SSI. We thus suggest the use of pip-tazo and ringed wound protectors as an effective strategy to reduce SSI rates in patients undergoing pancreatectomy.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the person-centredness of occupational therapy input into care planning in acute adult and older adults' inpatient services using Goal-Directed Care Plan guidelines.","authors":"Joshua Jesudunsin Ige, Erica Screaton, Emily Jepson, Deborah Morgan, Oladayo Bifarin","doi":"10.1136/bmjoq-2025-003543","DOIUrl":"10.1136/bmjoq-2025-003543","url":null,"abstract":"<p><strong>Background: </strong>Person-centred care planning is essential in mental health inpatient services, ensuring that patient goals align with clinical recovery plans. Despite its recognised importance, occupational therapists (OTs) in acute inpatient settings often face challenges in implementing structured, person-centred care plans within 10 days of admission based on the OT process within the acute inpatient services. The Goal-Directed Care Planning (GDCP) framework, previously successful in forensic and rehabilitation settings, was introduced to improve OT input into care plans in acute inpatient services.</p><p><strong>Objective: </strong>This study aimed to enhance the person-centredness of occupational therapy care plans by implementing the GDCP framework, with a target of improving OT contributions from 27.44% to 70% by October 2024.</p><p><strong>Methods: </strong>A quality improvement approach using multiple plan-do-study-act cycles was employed to embed the GDCP framework into three inpatient wards. Key interventions included standardising OT care-plan input, providing in-house training on care-plan audits, and ensuring timely documentation of patient goals and interventions. Monthly audits were conducted to assess progress and identify areas for further improvement.</p><p><strong>Results: </strong>Across the board, OT input into care plans significantly improved from 27.44% (June-October 2023) to 53.25% (November 2023-October 2024). Ward-specific improvements were observed, with Ward T increasing from 24.42% to 43.32%, Ward M from 37% to 67.03% and Ward P from 21.09% to 44.34%. Key areas of improvement included clearer goal-action links and increased involvement of patients in care planning.</p><p><strong>Conclusion: </strong>Implementing the GDCP framework enhanced the quality and consistency of OT contributions to care plans, fostering a more structured and outcome-driven approach. However, ongoing challenges such as workforce shortages and OTs being allocated to non-specialist roles in safer staffing need to be addressed to sustain improvements in person-centred care planning.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and governance of medication prescribing alerts among hospitals in Japan: a nationwide survey.","authors":"Noriyuki Nakayama, Makiko Takizawa, Yuko Ohishi, Yasuhiro Komatsu, Kazumi Tanaka","doi":"10.1136/bmjoq-2024-003253","DOIUrl":"10.1136/bmjoq-2024-003253","url":null,"abstract":"<p><strong>Background: </strong>Effective medication prescribing alerts are crucial for ensuring medication safety. However, the frequent occurrence of low-specificity alerts contributes to alert fatigue, where repeated non-critical alerts diminish clinicians' responsiveness to all alerts. Striking a balance between reducing alert fatigue and ensuring the effective functioning of critical alerts remains a key challenge in medication safety. Nevertheless, no nationwide surveys or reports from government bodies or academic societies have addressed alert management. Therefore, this study aimed to investigate the current landscape of alert management systems, clarify existing challenges in managing medication prescribing alerts and support the development of policies.</p><p><strong>Methods: </strong>We conducted a nationwide survey to examine how medication prescribing alert systems are managed in Japanese hospitals. Hospitals recognised for maintaining high standards in patient safety were selected to provide insights into current alert management practices. Survey invitation letters were sent to the healthcare information systems departments of the eligible hospitals. Participants were asked to complete the survey through a web-based form (Google Forms) or by mail. Data collection took place between December 2021 and January 2022.</p><p><strong>Results: </strong>Questionnaires were sent to 1055 hospitals, with responses received from 259 (response rate of 24.5%). A total of 110 (42.6%) hospitals reported being unaware of all types of medication prescribing alerts. Many hospitals reported an inability to measure alert data. Only 42 (16.3%) hospitals had established policies and procedures for adding new alerts.</p><p><strong>Conclusions: </strong>Only a few hospitals have a system for the quantitative evaluation and comprehensive control of medication prescribing alerts. Each hospital should implement a policy and procedure for alert management and develop an alert data measuring system.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}