Skip to main content

Table 3 Example evidence contributing to development and implementation themes

From: Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions

Theme No. of studies contributing evidence to theme Informal evidence example Correspondence between themes and study outcomes
1. Customisation for use with children 14 The risk of failing to customize existing systems to assist with prescribing for pediatric patients is likely substantial. 2 of the 3 studies with negative findings were not customised for use with children. The evaluation in the 3rd study was not designed to test the impact of package type on prescribing.
(Holdsworth et al. 2007, p. 1064) [32]
2. Stakeholder engagement 9 Active involvement of our intensive care staff during the design, build, and implementation stages … are prerequisites for a successful implementation. None of the 3 studies with findings of harm described a stakeholder engagement process.
(Del Beccaro et al. 2006, p. 294) [30]
3. Fostering familiarity 13 Probably the most important and fundamental activity necessary for a smooth transition to CPOE is staff CPOE training … Poor training may lead to a lack of system understanding, which can result in frustration, poor acceptance, and a lack of full utilization. The training provided in the Han et al. study has been identified as inadequate, and no training was described in the other 2 studies with harmful outcomes. Studies measuring at multiple time points show greater benefits at later follow-up.
(Upperman et al. 2005a, p. e639) [44]
4. Adequate/appropriate infrastructure 6 Our finding [of an increase in mortality] may reflect a clinical applications program implementation and systems integration issue rather than a CPOE issue per se. The Han et al. study acknowledges that the harmful outcomes observed were likely due to infrastructure problems rather than EP itself.
(Han et al. 2005, p. 1511) [31]
5. Planning and iteration 14 It is important for hospitals to monitor, continually modify, and improve CPOE systems on the basis of data derived from their own institution. There was a relatively limited (3 months) preparatory phase in the Han et al. study in comparison to other studies.
(Walsh et al. 2008, p. e427) [46]