Background

The prescribing process for children with cancer is complex, and errors can occur at any step. As a result, many interventions have been used to reduce errors. However, few of them have been designed based on an understanding of the prescriber behaviour that can lead to errors. In order to design effective behaviour change interventions, it is important first to understand the prescribing process and identify prescriber behaviours that could be targeted for change.

Objectives

To describe the prescribing process in a paediatric oncology ward and to identify prescriber behaviours during prescription writing that could be targeted to reduce errors.

Methods

This study employed two sequential phases. First, the prescribing process was observed and then described using the hierarchical task analysis (HTA) method. Second, prescriber tasks identified from the HTA were analysed using the behaviour change wheel (BCW) approach to identify promising behaviours for change. These identified behaviours were prioritised based on information collected from four focus groups with prescribers and chart review of errors made in the ward.

Results

The prescribing process was complex and involved multiple tasks performed in varying orders. Applying the BCW identified thirty-two candidate behaviours for potentially reducing prescribing errors. However, after prioritization, only two emerged as promising candidate behaviours for intervention: writing drug indications at the time of prescribing and using a pre-written order when ordering medications through electronic prescribing.

Conclusions

This research suggests that two behaviours could be promising in reducing errors. Having identified these behaviours, future work could explore what needs to change with respect to individuals and their work environments to achieve the desired change in these identified behaviours.

中文翻译：

---

可作为改变目标的处方者行为：对儿童处方书写过程中表现出的行为的分析

背景

癌症儿童的处方过程很复杂，任何步骤都可能发生错误。因此，许多干预措施已被用于减少错误。然而，其中很少有基于对可能导致错误的处方者行为的理解而设计的。为了设计有效的行为改变干预措施，重要的是首先要了解处方过程并确定可作为改变目标的处方者行为。

目标

描述儿科肿瘤病房的处方过程，并在处方过程中识别处方者行为，以减少错误。

方法

本研究采用了两个连续的阶段。首先，观察处方过程，然后使用分层任务分析 (HTA) 方法进行描述。其次，使用行为改变轮 (BCW) 方法分析从 HTA 确定的开处方者任务，以识别有希望的改变行为。根据从四个焦点小组收集的信息以及对病房中所犯错误的图表审查，对这些确定的行为进行了优先排序。

结果

处方过程很复杂，涉及以不同顺序执行的多项任务。应用 BCW 确定了 32 种可能减少处方错误的候选行为。然而，经过优先排序后，只有两种作为干预的有希望的候选行为出现：在开处方时写下药物适应症和在通过电子处方订购药物时使用预先写好的订单。

结论

这项研究表明，两种行为可能有助于减少错误。确定了这些行为后，未来的工作可以探索在个人及其工作环境方面需要改变什么，以实现这些确定行为的预期改变。