Medication safety and electronic decision support

Medication error and inappropriate medication therapy are two of the oldest, most costly and least tractable safety problems which health systems face. Information technology has the potential to make medication management safer and more effective. With that expectation, health systems worldwide are making vast investments in information technology. Our research is investigating the ways in which information technology can reduce medication errors and support improved medication therapy decisions and outcomes in hospital and residential aged care facilities.

Our research also aims to understand and improve the fit between users and their work environment to optimise safety, productivity, and efficiency through the development of electronic decision support tools. We apply a broad range of methods, including field observations, interviews and focus groups, simulation, and system logs to understand how information technology is used by clinicians, and identify well-designed and poorly designed system features.

Stream team members

Professor Johanna Westbrook Professor and Director	Associate Professor Ling Li Associate Professor	Associate Professor Magdalena Raban Associate Professor
Dr Virginia Mumford Senior Research Fellow	Dr Tim Badgery-Parker Research Fellow	Dr Md Bayzidur Rahman Senior Research Fellow
Dr Rachel Urwin Research Fellow	Postdoctoral Research Fellow	Dr Ryan McMullan Postdoctoral Research Fellow
Ms Erin Fitzpatrick Research Officer	Ms Alison Merchant Research Officer
Ms Joanna Clive Research Assistant	Ms Sarah Gamboa Research Assistant	Ms Rachel Jenkins Research Assistant
Ms Kathleen Rolfe Research Assistant
Stream coordinator Associate Professor Magda Raban Ph: 02 9850 2433

News and media

Digital health systems are transforming care across healthcare sectors, but research shows they also create new hurdles for health professionals In June 2023, Professor Johanna Westbrook presented research evidence at the ‘PCHSS Showcase: Future proofing healthcare’ conference. Outcomes from a study regarding the implementation of an electronic management system, showed although medication prescribing errors declined within the first year, errors increased within the first few months of implementation. To combat the potential frustrations and errors that can arise when implementing digital clinical information systems, Professor Westbrook and colleagues at AIHI launched the Health Innovation Series to outline practical, evidence-based recommendations. This research was reported by the Health Services Daily, found here.
Review Finds EHR Nudge Interventions Drive Care Quality Improvements EHR Intelligence reports on the systematic review ‘Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals’. Led by Dr Magda Raban, the review evaluated five categories of nudge interventions: changing choice defaults; making information more visible; changing the range or composition of options; making information more or less salient; and changing option-related effort. Overall, 79.2 percent of EHR nudge interventions were successful in achieving improvements in care quality. Click here, to read the full article by EHR Intelligence.
eMM and medication administration errors under the spotlight An article on PULSE+IT, reports the findings of a study, on the effects of an electronic medication system (EMS) on medication administration errors. Led by Professor Johanna Westbrook, the study found that adding an electronic medication management module to the clinical information system of a paediatric hospital did not reduce medication administration errors, with no changes in rates of errors in the first 70 days after the introduction of an EMS. To read more about this study, click here.
New funding for digital solution to medication reviews in aged care Macquarie University has been awarded $1.5 million in the latest round of Medical Research Future Fund grants. Dr Karla Seaman and Dr Magda Raban are leading the team to improve the safe use of medicines in residential aged care by creating a digital one-stop platform for faster and easier medication reviews by pharmacists. The platform will allow all stakeholders, including pharmacists, GPs, residents and their carers, and aged care staff, to monitor the medication review process. Read about the project here.
New grant will transform medication safety in aged care using IT innovation Professor Johanna Westbrook has been awarded $992,386 from the National Health and Medical Research Council Medical Research Future Fund to lead a project to demonstrate how sophisticated and user-friendly IT systems can improve the management of medication and support staff and residents. Read about the project here.
More news

Selected publications

Raban MZ, Lind K. Nudging: can letters to GPs reduce antipsychotics in aged care? MJA Insight. 2020; 10 Feb.
Baysari MT, Raban MZ. The safety of computerised prescribing in hospitals. Australian Prescriber. 2019; 42(4):136-8.
Westbrook JI, Lichtner V. Why is measuring the effects of information technology on medication errors so difficult? The Lancet Digital Health; 2019;1(8):PE378-E379
Baysari MT, Zheng WY, Tariq Am, Heywood M, Scott G, Li L, Van Dort BA, Rathnayake K, Day RO, Westbrook JI. An experimental investigation of the impact of alert frequency and relevance on alert dwell time. International Journal of Medical Informatics; 2020;133:104027.
Raban MZ, Gasparini C, Li L, Baysari MT, Westbrook JI. Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis. BMJ Open. 2020; 10:e028494.
Gates P, Baysari MT, Gazarian M, Raban MZ, Meyerson S, Westbrook JI. Prevalence of medication errors among paediatric inpatients: systematic review and meta-analysis. Drug Safety. 2019; 42(11):1329-1342.
Gates P, Baysari MT, Mumford V, Raban MZ, Westbrook JI. Standardising the classification of harm associated with medication errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Safety. 2019; 42(8):931-939.
Lichtner V, Baysari MT, Gates P, Dalla-Pozza L, Westbrook JI. Medication safety incidents in paediatric oncology after electronic medication management system implementation. European Journal of Cancer Care. 2019; 28:e13152.
Westbrook JI, Li L, Shah S, Lehnbom E, Prgomet M, Schofield B, Cresswell K, Slee A, Coleman J, McCloughan L, Sheikh A. A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. International Journal of Medical Informatics. 2019; 129: 253-259.
Lind KE, Raban MZ, Georgiou A, Westbrook JI. NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high-risk conditions. Pharmacoepidemiology and Drug Safety. 2019; 28(11):1480-1488.
Lind KE, Raban MZ, Georgiou A, Westbrook JI. Duration of antipsychotic medication use by aged care facility residents with dementia. Alzheimer Disease and Associated Disorders. 2019; 33(4):331-338.
Lind KE, Gray LC, Raban MZ, Georgiou A, Westbrook JI. Antidementia medication use by aged care residents with dementia. International Journal of Geriatric Psychiatry. 2019; 34(7):1029-1040.
Raban MZ, Walter SR, Pont LG, Cheung L, Strumpman D, Westbrook JI. The potential impact of an electronic medication management system on safety critical prescribing errors in an emergency department. Journal of Pharmacy Practice and Research. 2019; 49:108-115.
Pont L, Raban MZ, Jorgensen ML, Georgiou A, Westbrook JI. Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use. International Journal for Quality in Health Care. 2018; 30(10):810-16.
Mumford V, Baysari MT, Kalinin D, Raban MZ, McCullagh C, Karnon J, Westbrook JI. Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network. Journal of Paediatrics and Child Health. 2018; 54(9):987-996.
Westbrook JI, Li L, Hooper TD, Raban MZ, Middleton S, Lehnbom EC. Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ quality & safety 2017; 26(9):734-42.
Koyama AK, Maddox CS, Li L, Bucknall T, Westbrook JI. Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Qual Saf. 2019.
Baysari MT, Zheng WY, Li L, Westbrook J, Day RO, Hilmer S, Van Dort BA, Hargreaves A, Kennedy P, Monaghan C, Doherty P, Draheim M, Nair L, Samson R. Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts. BMJ Open. 2019; 9(8):e026034.
Alexander GL, Georgiou A, Siette J, Madsen R, Livingstone A, Westbrook J, Deroche C. Exploring information technology (IT) sophistication in New South Wales residential aged care facilities. Aust Health Rev. 2019.
Page N, Baysari MT, Westbrook JI. Selection and use of decision support alerts in electronic medication management systems in Australian hospitals: a survey of implementers. Journal of Pharmacy Practice and Research. 2019; 49(2):142-9.
Westbrook JI, Baysari MT. Nudging hospitals towards evidence-based decision support for medication management. Med J Aust. 2019; 210 Suppl 6:S22-S4.
Baysari MT, Hardie RA, Lake R, Richardson L, McCullagh C, Gardo A, Westbrook J. Longitudinal study of user experiences of a CPOE system in a pediatric hospital. Int J Med Inform. 2018; 109:5-14.
Page N, Baysari MT, Westbrook JI. A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety. Int J Med Inform. 2017; 105:22-30.