Mardya, Bella, et. al. (2023).

Informatics tools to promote patient safety: A scoping review: Jurnal

Keperawatan. Volume (Issue): Pages Number
http://ejournal-kertacendekia.id/index.php/nhjk/index

Review Article: Scoping Review

Informatics tools to promote patient safety: A scoping review

Bella Mardya1, Dana Prayoga Irawan2*, Ghofur Hariyono3, Izma Mega Ulita4, Muhammad
Nur5, Supriyanto6

2
Dana Prayoga Irawan Abstract

● Background: Several literature reviews discussing various informatic

*Correspondence: technological tools have been discussed. However, reviews of informatic
technology based on location have not been synthesized.
Dana Prayoga Irawan

Universitas Gadjah Mada ● Objective: This review focuses on the use of informatic technological tools in

Jl. Klaseman I No. 23, Ngabean Wetan, clinical and community settings to enhance patient safety and improve health
Sinduharjo, Kec. Ngaglik, Kabupaten worker communication, addressing predetermined clinical questions (PCC) based
Sleman, Daerah Istimewa Yogyakarta on population (P), concept (C), and context (C).
55581
● Design: This study is a scoping review with a comprehensive search from several
Email:
danaprayogairawan@mail.ugm.ac.id databases.

● Review Methods: The final selection of the articles was based on the following
Article Info: criteria: (1) nursing and health articles topic; (2) the articles were discussed about
patient safety; (3) clinical and community setting; (3) the research was free full
Received: text in English; and (4) articles were the original articles or research
papers/articles. Articles were excluded if they had a type of review study, such as
Revised:
systematic review, narrative study, or meta-analysis. An e-book or book results
Accepted: and articles from not reputable sources and also not suitable topic or purpose of
articles with ours was excluded.

DOI: ● Results: Seventeen journal articles explore the impact of digital technology on
patient safety, with ten focusing on the percentage of technology that can improve
https://doi.org/10.36720/nhjk.v%i%.p% patient safety, three articles emphasizing the importance of digital technology in
helping patient safety, and two articles focus on the application of digital
technology for patient safety, and other two articles focused on algorithmic scores
for use of digital technology on patient safety.

● Conclusion: Electronic health records and barcodes are common informatic

technological tools used in clinical and community settings worldwide to prevent
medication errors and other errors, making them valuable tools to improving
patient care and safety.

● Keywords: informatic tools, patient safety, technological system

© 2023 Bella Mardya, Dana Prayoga Irawan, Ghofur Haryono, Izma Mega Ulita, Muhammad Nur, Supriyanto. Nurse and E-ISSN
Health: Jurnal Keperawatan Published by Institute for Research and Community Service - Health Polytechnic of Kerta
Cendekia 2623-2448

NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL 12, ISSUE 2, JULY-DECEMBER 2023 1
 Mardya, Bella. (2023)

This is an Open Access Article distributed under the terms of the Creative Commons Attribution – NonCommercial 4.0 (CC P-ISSN
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NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023 2

 Mardya, Bella. (2023)
INTRODUCTION
The World Health Organization (WHO)
defines patient safety as the prevention of
errors and adverse effects in healthcare,
aiming to do no harm to patients. Millions of
patients globally who suffer disabilities,
injuries, or death annually due to unsafe
medical practices. This has led to the wider
recognition of the importance of patient safety,
the incorporation of patient safety approaches
into the strategic plans of health care
organizations and a growing body of research
in this field (Lawati et al., 2018). Patient safety
is crucial for healthcare quality and involves
avoiding injury or damage during services
(Mitchell et al., 2023). It involves safety
science methods, a trustworthy system,
guidance, leadership, communication,
information management, control, monitoring,
participation, decision-making, and
coordination. (Abdul et al. 2019; Bin, et. al.
2017). Patient safety also involves a culture of
safety, involving healthcare workers, patients,
and advocates.
WHAT DOES PATIENT SAFETY
INCLUDE?
The purpose of the National Patient
Safety Goals is to improve patient safety. The
goals focus on problems in health care safety
and how to solve them. According to National
Patient Safety Goals (2023), patients safety are
consist of 7 elements:
1. Goal One: Identify patients correctly
Use at least two ways to identify patients.
For example, use the patient’s name and
date of birth. This is done to make sure
that each patient gets the correct medicine
and treatment.
2. Goal Two: Improve staff communication
Get important test results to the right staff
person on time.
3. Goal Three: Use medicines safely
Before a procedure, labeling medicines
that are not labeled. For example,
medicines in syringes, cups and basins.
Do this in the area where medicines and
supplies are set up. Take extra care with
patients who take medicines to thin their
blood. Record and pass along correct
information about a patient’s medicines.
Find out what medicines the patient is
taking. Compare those medicines to new
medicines given to the patient. Give the
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
patient written information about the
medicines they need to take. Tell the
patient it is important to bring their up-to-
date list of medicines every time they
visit a doctor.
4. Goal Four: Use alarms safely
Make improvements to ensure that alarms
on medical equipment are heard and
responded to on time.
5. Goal Five: Prevent infection
Use the hand cleaning guidelines from the
Center for Disease Control and
Prevention or the World Health
Organization. Set goals for improving
hand cleaning. Use the goals to improve
hand cleaning.
6. Goal Six: Identify patient safety risks
Reduce the risk for suicide.
7. Goal Seven: Prevent mistakes in surgery
Make sure that the correct surgery is done
on the correct patient and at the correct
place on the patient’s body. Mark the
correct place on the patient’s body where
the surgery is to be done. Pause before the
surgery to make sure that a mistake is not
being made.
DEVELOPMENT
Using necessary sub-headings to divide and
discuss appropriately the topic. Narrative
review articles describe and discuss the state
of the science of a specific topic or theme from
a theoretical and contextual point of view. Do
not list the types of databases and
methodological approaches used to conduct
the review nor the evaluation criteria for
inclusion of retrieved articles during databases
search.
PREVALENCE OF EACH TYPE
Around 1 in every 10 patients is harmed in
health care and more than 3 million deaths
occur annually due to unsafe care. In low-to-
middle income countries, as many as 4 in 100
people die from unsafe care. Above 50% of
harm (1 in every 20 patients) is preventable;
half of this harm is attributed to medications.
Some estimates suggest that as many as 4 in
10 patients are harmed in primary and
ambulatory settings, while up to 80% (23.6–
85%) of this harm can be avoided. Common
adverse events that may result in avoidable
patient harm are medication errors, unsafe
surgical procedures, health care-associated
3
 Mardya, Bella. (2023)
infections, diagnostic errors, patient falls,
pressure ulcers, patient misidentification,
unsafe blood transfusion and venous
thromboembolism. Patient harm potentially
reduces global economic growth by 0.7% a
year. On a global scale, the indirect cost of
harm amounts to trillions of US dollars each
year. Investment in reducing patient harm can
lead to significant financial savings, and more
importantly better patient outcomes (5). An
example of a good return on investment is
patient engagement, which, if done well, can
reduce the burden of harm by up to 15%.
TECHNOLOGICAL INFORMATION
ROLE TO PROMOTE PATIENT SAFETY
Technological innovations play a
crucial role to enhance and promote patient
safety by automating tasks, introducing
medication alerts, clinical reminders,
improved diagnostic and consultation reports,
facilitating information sharing, improving
clinical decision-making, intercepting
potential errors, reducing variation in practice,
and managing workforce shortages as well as
making complete patient data available. The
increasing digitalization and use of E-Health
applications have the potential to contribute
significantly to improving patient safety
(Tobias, 2020). However, it is important to
note that these measures are often supported
by limited evidence and often come from
individual academic projects or start-up
companies (Alain, Astier et al., 2020). To
maximize benefits while minimizing risks, it is
essential to integrate these technologies into a
comprehensive framework that includes
organizational measures, adequate training,
and research (Michael, A. et al., 2016).
Healthcare organizations must align
information systems to collect real-time
clinical data and provide easy access to
meaningful process and outcomes data for
quality and patient safety teams (Hamid,
2019). Patient-generated reports can provide
valuable information that traditional healthcare
monitoring systems may miss, making patient
incident reporting tools essential for
understanding and addressing patient safety
issues (Uddin & Syed-Abdul, 2018).
A Health Information System can
improve patient safety by reducing adverse
events and improving care quality through the
use of quality indicators, which are screening
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
tools for the purpose of identifying potential
areas concerning clinical care quality (Lima &
Barbosa, 2015). This paper describes the
development of a computerized system of
Nursing Quality Indicators (SIQenf) for the
ICU, which supports the nursing care practice
and measure the quality of care and evaluate
patient safety through the detection of adverse
events and monitoring quality indicators in
nursing (Lima & Barbosa, 2015). The
subcategories include contact information,
medication safety, health status, optimizing
health, dental status, read information,
preparation two weeks before surgery, inform
the surgical ward, plan discharge, preparation
on admission and just before surgery. Both
healthcare workers and patients express the
need for a surgical patient safety checklist
(Harris et al., 2020). This study outlines a wide
range of risk elements that could be content of
a patient surgical safety checklist. Based on
these findings, a patient’s surgical checklists
can be developed (Harris et al., 2020).
Health information technology (IT) is
increasingly being used in Europe and the US
to improve health-care quality. However,
developing countries face challenges, such as a
lack of robust health IT infrastructure to
address privacy, confidentiality, and security
issues. Malaysia aims to advance health
information systems through IT with the focus
on correct nursing handover to ensure patient
safety. The increasing workload of nurses in
Intensive Care Units (ICUs) is affecting the
quality and safety of care. This study aims to
determine and compare the effect of the
Electronic Nursing Handover System (ENHS)
on patient safety in General ICU and COVID-
19 ICU (Tataei et al., 2023). Excessive
perioperative workloads can increase patient
safety risks, and mislabeled specimens can
negatively affected patients.
Previous strategies to improve safety
have focused on developing incident reporting
systems and changing systems of care and
professional behavior, with little involvement
of patients. WHO and European patient
organizations have emphasized the importance
of patient involvement in healthcare. The goal
is to develop technology that can identify
illness early, initiate action, and improve
patient care, outcomes, and healthcare
resources (Burns et al., 2022). These include
pharmacists preparing medication (i.e. ready to
4
 Mardya, Bella. (2023)

use and ready to administer), using printed research was free full text in English; and (4)
labels, and medication double checks. In the articles were the original articles or research
Netherlands, a protocol for safe injectable papers/articles.
medication administration has been
implemented in 2009, including the double Exclusion criteria
check proceeding (Hogerwaard et al., 2023). Articles were excluded if having type of
The need to engage with patients about the review study, such as systematic review,
quality and safety of their care has become narrative study, or meta-analysis. An e-book
increasingly evident, with recent high-profile or book results and articles from not reputable
reviews of poor hospital care emphasizing the sources and also not suitable topic or purpose
need for better systems for capturing and of articles with ours was excluded.
responding to patient perspectives. The Search outcome
research team has developed and refined the
The initial search retrieved 339,870 articles. A
PRASE (Patient Reporting and Action for a
further search limit and screening excluded
Safe Environment) intervention, which gains
264,553 articles under 2013 and were not
patient feedback about quality and safety on
including based on a qualitative study, case
hospital wards (Sheard et al., 2016). This
report, cross-sectional, cohort study, quasi-
study aims to identify the risk elements that
experimental, randomized controlled trial, case
patients and healthcare workers find to be
control, and mixed methods. Then,
included in a patient-driven surgical patient
60,021 articles were screened after reading the
safety checklist (Harris et al., 2020). The
titles and abstract (not suitable specific topic
realization that digital health systems can
and purpose with our study/inclusion criteria).
improve the quality and safety of patient care
We also excluded 15,279 articles which were
is growing.
not free access and full-text. Finally, which
resulted in the final selection of 17 articles.
MATERIAL AND METHODS
The 17 articles were synthesized based on the
Search strategy appraisal results using The Joanna Briggs
A comprehensive search performed within Institute (JBI) checklist for qualitative and
PubMed, EBSCO, Sage Journal, BMJ, quantitative study. While mixed methods
ScienceDirect and Proquest by using specific study, the synthesized and appraisal by using
keywords and phrases: ‘technological Mixed Methods Appraisal Tool (MMAT). The
information’, ‘tools’, ‘patient safety’, ‘EHR’, selection stage is explained in detail using the
and ‘informatic system’. The search process PRISMA flow diagram shown in Fig. 1.
was conducted in September 2023 by using a
combination of search terms, including the
terms Boolean (AND/OR). This review refers
to predetermined clinical questions, namely
PCC [population (P), concept (C), and context
(C)]. First, the population in this study were all
patients of all ages in hospital or community
health care. Second, the concept for this
review was technological and information
systems for increasing patient safety from
January 2023 to September 2023. Third, the
context is quantitative, qualitative, and mixed
methods study conducted in the hospital or
community setting.
Inclusion criteria
Figure 1 - Study selection process
The articles from January 2013 to September
2023 were included. The final selection of the
articles was based on the following criteria: (1)
Quality appraisal
nursing and health articles topic; (2) the
articles were discussed about patient safety; Six reviewers read 18 selected full texts and
(3) clinical and community setting; (3) the conducted critical appraisal using the JBI and

NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023 5

 Mardya, Bella. (2023)

MMAT checklist for analytical quantitative,

qualitative, and mixed-methods studies.

The considerations used to determine the Data extraction and analysis

quality of articles, therefore they fit into the Data extraction was done on 17 articles that
synthesis phase were research samples, had been obtained in the previous stage.
Studygrouping
Data found that
canthebe use of based
made a reliable barcode
on some
research subjects, purpose, validity, reliability
system significantly decreased
information suggested by Peters et al., specimen
of measuring instruments, confounding
management
(2015) namelyerrors and improved
(1) Author(s), specimen
(2) Year of
factors, and impact of technology and
information tools for patient safety and also to publication, (3) Source origin/country, (4) 17
labeling accuracy. Our review identified
research articles that
Aims/purpose(s), (5) evaluated interventions
Study population and to
determine the quality of analysis used in the
improve patient safety using
sample size, (6) How outcomes are information
study. The result of critical appraisal was 17
technology.and
measured, The(7)main
Keyfinding of that
findings this review
relate is
selected articles for data extraction and
that the most frequently
to the review question studies used digital
analysis.
technologies to improve patient safety are
software and barcode. These interventions
Table 1 - Characteristic of Study
No Author(s) Year of Country Continent
. Publication
1. Sheard et al. 2014 England U.K.
2. Lima & Barbosa 2015 Brazil America
3. Grant et al. 2015 Massachusetts America
4. McCoy & Das 2017 California & Missouri America
5. McFarlane et al. 2017 Utah America
6. Ericson et al. 2017 Sweden Europe
7. Svensk & Mclntyre 2019 Arizona America
8. Yu et al. 2019 Taiwan Asia
9. Salahuddin et al. 2019 Malaysia Asia
10. Harris et al. 2020 Norway Europe
11. Cho et al. 2021 Seoul Asia
12. Burns et al. 2022 Canada America
13. Laka et al. 2022 Australia Australia
14. Fischer et al. 2023 Sweden & Germany Europe
15. Hogerwaard et al. 2023 Netherlands Europe
16. Tataei et al. 2023 Iran Asia
17. Jabin et al. 2023 Sweden Europe
were applied across multiple areas of care in
RESULT both clinical and community settings.

From 17 synthesized journal articles,

seventeen journal articles explain the influence
of digital technology on patient safety. 10
articles focus on the percentage of digital
technology that can be influential in improving
patient safety. 3 articles focus on explaining
how important it is to use digital technology in
helping patient safety. 2 articles focus on the
application of digital technology for patient
safety. 2 articles focused on algorithmic scores
for use of digital technology on patient safety.

NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023 6


Author (s), Purpose
year of
publication
Lima & The purpose of the research was to develop a
Barbosa computerized system of nursing care quality
(2015) indicators for the Intensive Care Unit (ICU)
Svensk & The purpose of the research was to
McIntyre determine whether information embedded in
(2021) Quick Response (QR) codes could reduce
self-administered medication errors
compared to current medication labelling
among older and younger age groups.
Sheard et al. the purpose of the research is to evaluate the
(2016) efficacy of the PHRASE (Patient Reporting
and Action for a Safe Environment)
intervention in improving patient safety in
hospital wards.
Grant et al. the purpose of the research is to evaluate the
(2015) efficacy of the PHRASE (Patient Reporting
and Action for a Safe Environment)
intervention in improving patient safety in
hospital wards.
Harris et al. The purpose of the research was to identify
(2020) the risk elements that should be included in a
patient-driven surgical patient safety
checklist based on the experiences and
perspectives of both patients and healthcare
workers.
Mardya, Bella. (2023)
Sample
 N: No
 Location: No
 N: questionnaire
 Location: Hospital
 N: The sample in this article
consists of patients aged 16 years
or over
 Location: The study will be
undertaken within 32 hospital
wards
 N: consists of patients who were
prescribed one of the prespecified
study medications used to treat
hyperlipidemia, diabetes, or
hypertension.
 Location: Massachusetts General
Hospital in Boston
 N: The sample in this article
consists of surgical healthcare
workers and surgical patients
 Location: The study was conducted
at the Department of Health and
Caring Sciences, Western Norway
University of Applied Sciences,
and the Department of Anesthesia
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
Results
The computerized system, SIQenf, allows nurses to record quality indicators in
nursing, such as fall incidence, medication errors, and incidence of pressure
ulcers and it was developed for use in an ICU and aims to support healthcare
practice, measure the quality of patient care, and help in operation and
exploration.
The study found statistically significant main effects of more correct answers
when using QR code technology compared to current bottle labelling for
increasing patient safety in both older and younger age groups.
The PHRASE intervention collects feedback from patients about the safety of
their care using a 44-item questionnaire and a performance for reporting safety
incidents and positive experiences. The studies mentioned in the handed sources
are concentrated on assessing the PRASE (Case Reporting and Action for a Safe
terrain) intervention, which aims to ameliorate patient safety in sanitorium
wards. studies also include a qualitative process evaluation, which involves
examiner journals, ethnographic observation of action planning meetings,
structured interviews with action planning meeting leads, and collection of
crucial data about intervention wards.
The results of the study showed that the use of the Medication Metronome
system, compared to usual care, did not significantly improve the time from
prescription to subsequent LDL or HbA1c test results, time from prescription to
achieving LDL or HbA1c control, or the proportion of time patients spent at or
below LDL or HbA1c goal.
The findings of the study categorized safety risk factors into pre-operative
information, pre-operative preparations, post-operative information, post-
operative plans, and follow-up. The study found that patients needed repeated
information from healthcare workers and struggled with remembering and
understanding the importance of the information.
7

Hogerwaard the research was to assess the medication
et al. (2023) administration process and evaluate the
compliance with double check before and
after the implementation of barcode
medication administration (BCMA)
technology on infusion pumps in the
operating rooms.
McCoy & Das the research was to improve sepsis-related
(2017) patient outcomes at Cape Regional Medical
Center (CRMC) through the implementation
of a machine learning-based sepsis
prediction algorithm.
Burns et al. the research was to develop a technology
(2022) that could identify acute illness early in
medical patients, initiate appropriate action,
and improve patient care, outcomes, and
healthcare resource utilization.
Cho et al. The purpose of the study was to determine
(2021) the impact of an electronic analytic tool for
predicting fall risk on patient outcomes and
nurses' responses.
Yu et al. the research was to assess the use of barcode
(2019) technology in improving the accuracy of
pathology specimen labeling and patient
Mardya, Bella. (2023)
and Intensive Care, Haukeland
University Hospital, both located in
Bergen, Norway
 N: The sample in this article
consists of operating room
employees, including
anaesthesiologists residents and
student.
 Location: Hospital
 N: The sample in this article
consists of patients involved in a
quality improvement initiative at a
community hospital in southern
New Jersey.
 Location: The study was conducted
at Cape Regional Medical Center
(CRMC), a 242-bed acute care
hospital located in Cape May Court
House, New Jersey.
 N: article consists of patients
involved in a quality improvement
initiative at a community hospital
in southern New Jersey.
 Location: in the article was
conducted at Cape Regional
Medical Center (CRMC)
 N: patient-days in nursing units
across both the control and
intervention groups
 Location: No, there is no specific
research location stated in this
article.
 N: The sample in this article
consists of perioperative nurses
working at a teaching hospital in
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
The implementation of BCMA technology on infusion pumps resulted in a
significant reduction in MAEs for moments 2 and 3 (infusion pump start-up and
changing an empty syringe) in the operating rooms and ICU with anatomized
reported drug administration crimes (MAE) and conducted interviews and
compliances to understand the drug administration process ahead and after the
perpetration of barcode drug administration (BMCA) technology on infusion
pumps in the operating apartments.
The algorithm demonstrated a sensitivity of 0.83 and specificity of 0.96 in
retrospective analysis of CRMC patient data. Perpetration of the machine
learning algorithm redounded in advancements in sepsis- related in-sanitorium
mortality rate, sepsis- related sanitorium length of stay, and sepsis- related 30-
day readmission rate at CRMC.
The study found a significant decrease in patient transfers from the general
medical ward to the intensive care unit (ICU) with the use of the algorithm and
software program. The primary outgrowth measure was patient transfer from
the general medical ward to the ferocious care unit (ICU), and the secondary
outgrowth measures included the time demanded to order examinations, contact
elderly medical staff, and its intervention.
The mean fall rate increased in the control units and decreased in the
intervention units, but the injury rate did not differ significantly between the
two groups. The intervention group used a process metric for inpatient fall
pitfalls enforced using routinely attained data from the sanatorium’s EHR
system, while the control group used test
The study found that the use of a reliable barcode system significantly
decreased specimen management errors and improved specimen label accuracy.
8

safety
Tataei et al., was to determine and compare the effect of
(2023) the Electronic Nursing Handover System
(ENHS) on patient safety in the General ICU
and COVID-19 ICU
Rahman research was to assess healthcare quality
Jabin et al. issues affecting the reporting and
(2023) investigation levels of digital incident
reporting systems in Sweden.
McFarlane et was to investigate the potential value of the
al. (2017) HAIL (Human Alerting and Interruption
Logistics) technology in improving operator
performance in health surveillance
operations, particularly under high volumes
of data and frequent interruptions.
Salahuddin et research was to identify the factors
al. (2019) influencing the unsafe use of hospital
information systems in Malaysian
government hospitals.
Ericson et al. the research was to explore the purpose and
(2017) performance of clinical evaluation of
electronic health records (EHRs) among
stakeholders, including EHR vendors,
healthcare provider IT managers, users, and
representatives of national authorities.
Mardya, Bella. (2023)
the southern part of Taiwan
 Location: hospital
 N: 29 nurses
 Location: Imam Khomeini
University hospital in Urmia, Iran.
 N: The total sample size was 37
incidents.
 Location: No, there is no specific
research location stated in this
article.
 N: The sample in this article
consists of 16 licensed RNs
actively working at hospitals within
the Salt Lake City region of Utah,
USA.
 Location: Yes, the research
location stated in this article is the
Salt Lake City region of Utah,
USA.
 N: The sample in this article
consists of 31 medical doctors who
have a minimum of a year
experience in using the total
hospital information system (THIS)
 Location: The study was conducted
in three Malaysian government
hospitals, referred to as Hospitals
A, B, and C
 N: This includes representatives
from the five largest EHR vendors
in Sweden, IT managers from
healthcare providers, users
(physicians, nurses), and
representatives of national
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
The use of ENHS significantly improved the quality and efficiency of shift
handover, reduced the possibility of clinical error, saved handover time, and
increased patient safety compared to the paper-based method on patient safety
in the General ICU and COVID-19 ICU.
Only four incidents were identified as altering the consequences after the
investigation, highlighting the importance of thorough investigations to identify
potential harm or adverse events. The studies anatomized incident reports from
Sweden's public incident reporting depositories to assess healthcare quality
issues in digital incident reporting systems. incidents were classified into types
of issues and consequences using the Health Information Technology Bracket
System (megahit- CS).
The research collected comprehensive data logs, including vital values for
simulated patients, alarm event logs, deviation logs, and screen transition UI
events for the smartwatch. The primary focus of the research was to evaluate the
effects of the HAIL Clinical Alarm Triage (HAIL-CAT) prototype, which
provided context-enabled alarm notification services on a smartwatch to support
the mobile multitasking of hospital nurses.
The research used the Systems Engineering Initiative for Patient Safety (SEIPS)
model and the DeLone and McLean information system (DM IS) success model
to guide data collection and analysis. The study identified five themes that
influence the unsafe use of hospital information systems in Malaysian
government hospitals: knowledge, system quality, task stressor, organization
resources, and teamwork. The study emphasized the need for multiple
interventions, including technology systems and teamwork, to improve the safe
use of hospital information systems and reduce safety risks to patients.
The result of this article is that there is a lack of consensus among stakeholders
regarding the purpose and performance of clinical evaluation of electronic
health records (EHRs).
9

Laka et al. The purpose of the research was to identify
(2022) the challenges and opportunities in
implementing Clinical Decision Support
Systems (CDSS) at scale in Australia.
Fischer et al. the research was to analyse the key
(2023) challenges of the ATMP innovation
ecosystem in Sweden and Germany,
specifically focusing on R&D,
entrepreneurial activities, framework
conditions, and legitimacy.
Mardya, Bella. (2023)
authorities
 Location: There is no specific
research location stated in this
article.
 N: The sample in this article
consists of 9 males and 2 females
who participated in the study.
 Location: No, there is no specific
research location stated in this
article.
 N: The sample in this article
consists of experts from different
stakeholder groups in Germany and
Sweden, including industry,
academia, non-profit organizations,
drug regulators, and policy makers.
 Location: Yes, the article mentions
research locations in both Germany
and Sweden.
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
The findings emphasize the importance of stakeholder engagement in
developing a clear and shared vision for innovation, building clinicians' skills
and organizational capacity for change, and establishing a national consensus on
data standards for interoperable CDSS. The exploration used a qualitative
approach, specifically reflexive thematic analysis, to dissect the data attained
from interviews with policymakers. data analysis involved transcribing audio
recordings, rendering the reiterations, and relating patterns and themes
applicable to the exploration question. studies didn't admit specific backing and
were conducted in agreement with ethical guidelines
These measurement results were used to analyse the key challenges and barriers
to ATMP innovation and provide insights for other EU countries . The
exploration used an exploratory case studies approach and collected data
through desktop exploration and 17 expert interviews. experts canvassed were
from different stakeholder groups, including assiduity, academia, non-profit
associations, medicine controllers, and policy makers. study didn't bear ethical
blessing or patient concurrence.
10
 Mardya, Bella. (2023)
DISCUSSION
Our review identified 17 research articles
that evaluated interventions to improve patient
safety using information technology found that
software and barcode are the most frequently
used digital technologies to improve patient
safety. These interventions were applied
across multiple areas of care in both clinical
and community settings.
Software, such as Electronic Health Record
(EHR), Electronic Nursing Handover System
(EHNS), Novel Algorithm, Human Alerting
and Interruption Logistics (HAIL)
Application, Nursing Quality Indicator System
(SIQenf) are widely used to improve staff
communication, use alarms safely, prevent
infection, and identify patient safety risks.
This refers to the National Patient Safety
Goals (2023), namely the second goal to
improve staff communication, the fourth goal
to use alarms safely, the fifth goal to prevent
infection, and the sixth goal to identify patient
safety risks. Based on data, obtained the
results of 70% of public health practitioners
have used community health data taken from
EHRs (Wijaya & Rahman, 2020).
The second finding of this review is that
Quick Response (QR) Code and Barcode
scanning are commonly used in medicine
labelling to prevent medication errors. This
refers to the third goal of The National Patient
Safety Goals (2023) which is use medicines
safely. Barcode medication administration
(BCMA) technology is commonly used in
medicine labelling to prevent medication
errors, which is credited with minimizing
medication errors and enhancing patient
safety. Most studies report a significant
reduction in medication administration errors
of up to 80% using barcodes. (Leung AA,
2015).
Overall, results suggest there is evidence to
support the effectiveness of such interventions
in improving patient safety culture (e.g.,
general perceptions of safety culture can
significantly improve clinical care processes
(28, 48-49) and show potential to improve
aggregate measures of patient harm (29, 45).
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
However, these conclusions are limited by the
current evidence base, which includes studies
in acute care settings using established survey
measures, qualitative studies of safety culture,
some studies in outpatient settings, publication
bias, and selective reporting of positive
findings.
The review suggests that evidence to date
appears to include strategies comprised of
multiple components that incorporate team
training, mechanism to support team
communication and executive involvement in
frontline safety efforts. Organizations should
consider incorporating these elements into
efforts across a range of outcomes. Future
research should also consider a thorough
investigation of safety culture as a cross-
cutting contextual factor that may moderate
the effectiveness of other patient safety
practices, such as the implementation of rapid
response systems. To enhance the strength of
evidence on patient safety culture, theoretical
models should be meaningfully utilized in the
development of interventions for improvement
and such interventions should be robustly
evaluated. Additionally, efforts are needed to
better understand the contextual role of safety
culture in the implementation of other patient
safety practices and how efforts to improve
safety culture can best be applied to improve
the effectiveness of complementary or
additional interventions for safety and quality
of care.
CONCLUSION
In wordwide most frequently used
digital technologies to improve patient safety
are software and barcode. Electronic health
records and barcodes are common informatic
technological tools used in clinical and
community settings worldwide to prevent
medication errors and other errors, making
them valuable tools to improving patient care
and safety.
This review was limited on literatures
that explore about information technological
related to quality of health services and
clinical accreditation. Therefore, further
researcher is needed to find out which
literatures with explain about quality services
and clinical accreditation.
ACKNOWLEDGEMENT
11
 Mardya, Bella. (2023)

Thank you to the supervisor who has taken the advanced therapy medicinal products
time to direct in the preparation of the scoping (ATMP) innovation systems in Germany
review. and Sweden. Health Policy and
Technology, 12(2).
CONFLICT OF INTEREST https://doi.org/10.1016/j.hlpt.2023.10074
4
The author states that there is no conflict of
Grant, R. W., Ashburner, J. M., Jernigan, M.
interest in writing this paper. C., Chang, J., Borowsky, L. H., Chang,
Y., & Atlas, S. J. (2015). Randomized
FUNDING Trial of a Health IT Tool to Support
The study was supported by author teams. Between-Visit-Based Laboratory
Monitoring for Chronic Disease
ORCID Medication Prescriptions. Journal of
Bella Mardya General Internal Medicine, 30(5), 619–
ORCID ID Author 1 625. https://doi.org/10.1007/s11606-014-
https://orcid.org/000-0003-2742-1932 3152-y
Hamid, M. (2019). The role of World Health
REFERENCES Organization and Information
Technology in improving patient safety
Alain, Astier., Jean, Carlet., Torsten, Hoppe-
through reducing medical errors.
Tichy., Ann, Jacklin., Annette, Jeanes.,
Archives of Community Medicine and
Steve, McManus., Mathias, W., Pletz.,
Public Health, 5(2), 049–051.
Harald, Seifert., Ray, F. (2020). What is
https://doi.org/10.17352/2455-
the role of technology in improving
5479.000053
patient safety? A French, German and
Harris, K., Søfteland, E., Moi, A. L., Harthug,
UK healthcare professional perspective.
S., Storesund, A., Jesuthasan, S.,
https://doi.org/10.1177/25160435209756
Sevdalis, N., & Haugen, A. S. (2020).
61
Patients’ and healthcare workers’
Burns, J., Williams, D., Mlinaritsch, D.,
recommendations for a surgical patient
Koechlin, M., Canning, T., & Neitzel, A.
safety checklist - A qualitative study.
(2022). Early detection and treatment of
BMC Health Services Research, 20(1),
acute illness in medical patients with
1–10. https://doi.org/10.1186/s12913-
novel software: a prospective quality
020-4888-1
improvement initiative. BMJ Open
Hogerwaard, M., Stolk, M., Dijk, L. Van,
Quality, 11(3), 1–5.
Faasse, M., Kalden, N., Hoeks, S. E.,
https://doi.org/10.1136/bmjoq-2022-
Bal, R., & Horst, M. Ter. (2023).
001845
Implementation of barcode medication
Cho, I., Jin, I. sun, Park, H., & Dykes, P. C.
administration (BMCA) technology on
(2021). Clinical impact of an analytic
infusion pumps in the operating rooms.
tool for predicting the fall risk in
BMJ Open Quality, 12(2), 1–8.
inpatients: Controlled interrupted time
https://doi.org/10.1136/bmjoq-2022-
series. JMIR Medical Informatics, 9(11),
002023
1–13. https://doi.org/10.2196/26456
Laka, M., Carter, D., Milazzo, A., & Merlin,
Ericson, L., Hammar, T., Schönström, N., &
T. (2022). Challenges and opportunities
Petersson, G. (2017). Stakeholder
in implementing clinical decision support
consensus on the purpose of clinical
systems (CDSS) at scale: Interviews with
evaluation of electronic health records is
Australian policymakers. Health Policy
required. Health Policy and Technology,
and Technology, 11(3), 100652.
6(2), 152–160.
https://doi.org/10.1016/j.hlpt.2022.10065
https://doi.org/10.1016/j.hlpt.2017.02.00
2
5
Lawati, M. H. Al, Dennis, S., Short, S. D., &
Fischer, P., Reiss, T., Mahlich, J., Gicquel, E.,
Abdulhadi, N. N. (2018). Patient safety
Aichinger, H., Pullmann, L., & Bratan,
and safety culture in primary health care:
T. (2023). Unlocking the value of
A systematic review. BMC Family
innovative medicines: Insights from the

NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023 12

 Mardya, Bella. (2023)
Practice, 19(1), 1–12.
https://doi.org/10.1186/s12875-018-
0793-7
Lima, C. S. P., & Barbosa, S. F. F. (2015).
Patient Safety in Critical Care Unit:
Development of a Nursing Quality
Indicator System. Studies in Health
Technology and Informatics, 216, 251–
254. https://doi.org/10.3233/978-1-
61499-564-7-251
McCoy, A., & Das, R. (2017). Reducing
patient mortality, length of stay and
readmissions through machine learning-
based sepsis prediction in the emergency
department, intensive care unit and
hospital floor units. BMJ Open Quality,
6(2), e000158.
https://doi.org/10.1136/bmjoq-2017-
000158
McFarlane, D. C., Doig, A. K., Agutter, J. A.,
Mercurio, J. L., Mittu, R., Brewer, L. M.,
& Syroid, N. D. (2017). Defeating
information overload in health
surveillance using a metacognitive aid
innovation from military combat
systems. Journal of Defense Modeling
and Simulation, 14(4), 371–388.
https://doi.org/10.1177/15485129166672
46
Michael, A., Rosen., Michael, A., Rosen.,
Grace, Tran., Howard, Carolan., Mark,
Romig., Cynthia, Dwyer., Cynthia,
Dwyer., Aaron, S., Dietz., George, R.,
Kim., Alan, Ravitz., Adam, Sapirstein.,
Peter, J., Pronovost., Peter, J., P. (2016).
Data Driven Patient Safety and Clinical
Information Technology.
https://doi.org/10.1007/978-3-319-
20765-0_18
Mitchell, P., Cribb, A., & Entwistle, V.
(2023). Patient Safety and the Question
of Dignitary Harms. Journal of Medicine
and Philosophy (United Kingdom),
48(1), 33–49.
https://doi.org/10.1093/jmp/jhac035
National Patient Safety Goals. (2023).
Hospital: 2023 National Patient Safety
Goals.
Peters, M. D. J., Godfrey, C. M., Khalil, H.,
McInerney, P., Parker, D., & Soares, C.
B. (2015). Guidance for conducting
systematic scoping reviews.
International Journal of Evidence-Based
Healthcare, 13(3), 141–146.
NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023
https://doi.org/10.1097/XEB.000000000
0000050
Rahman Jabin, M. S., Steen, M., Wepa, D., &
Bergman, P. (2023). Assessing the
healthcare quality issues for digital
incident reporting in Sweden: Incident
reports analysis. Digital Health, 9.
https://doi.org/10.1177/20552076231174
307
Salahuddin, L., Ismail, Z., Hashim, U. R., Raja
Ikram, R. R., Ismail, N. H., & Naim @
Mohayat, M. H. (2019). Sociotechnical
factors influencing unsafe use of hospital
information systems: A qualitative study
in Malaysian government hospitals.
Health Informatics Journal, 25(4), 1358–
1372.
https://doi.org/10.1177/14604582187596
98
Sheard, L., O’Hara, J., Armitage, G., Wright,
J., Cocks, K., McEachan, R., Watt, I., &
Lawton, R. (2016). Erratum to:
Evaluating the PRASE patient safety
intervention - a multi-centre, cluster trial
with a qualitative process evaluation:
Study protocol for a randomised
controlled trial [Trials 15, (2014) (420)],
DOI: 10.1186/1745-6215-15-420. Trials,
17(1), 1–12.
https://doi.org/10.1186/s13063-016-
1655-z
Svensk, J., & McIntyre, S. E. (2021). Using
QR Code Technology to Reduce Self-
Administered Medication Errors.
Journal of Pharmacy Practice, 34(4),
587–591.
https://doi.org/10.1177/08971900198852
45
Tataei, A., Rahimi, B., Afshar, H. L., Alinejad,
V., Jafarizadeh, H., & Parizad, N. (2023).
The effects of electronic nursing
handover on patient safety in the general
(non-COVID-19) and COVID-19
intensive care units: a quasi-experimental
study. BMC Health Services Research,
23(1), 1–9.
https://doi.org/10.1186/s12913-023-
09502-8
Tobias, M. (2020). Information technology
and eHealth to improve patient safety.
Der Internist. https://doi.org/10.1007Der
Internist/S00108-020-00780-6
Uddin, M., & Syed-Abdul, S. (2018). Role of
electronic patient reported safety
13
 Mardya, Bella. (2023)

incidents in improving patient safety and https://doi.org/10.46815/jkanwvol8.v8i1.

care. International Journal for Quality in 39
Health Care, 30(10), 741–742. Yu, M. H., Lee, T. T., & Mills, M. E. (2019).
https://doi.org/10.1093/intqhc/mzy216 The effect of barcode technology use on
Wijaya, R. D., & Rahman, L. O. A. (2020). pathology specimen labeling errors.
Implementasi Electronic Health Records AORN Journal, 109(2), 183–191.
(Ehrs) Pada Pelayanan Kesehatan Di https://doi.org/10.1002/aorn.12585
Komunitas: Literature Review. Jurnal
Kesehatan, 8(1), 28.

Cite this article as: Mardya, Bella et al. (2023). Informatics tools to promote patient safety: A
scoping review. Nurse and Health: Jurnal Keperawatan, Volume (Issue), Pages Number.
https://doi.org/10.36720/nhjk.v%i%.p%

NURSE AND HEALTH: JURNAL KEPERAWATAN, VOL12, ISSUE 2, JULY-DECEMBER 2023 14