The Design of Artefacts in Support of Drugs Prescribing. an Analysis of the Discharge Process of Patients Based on Activity Theory

In this work we illustrate a case of fallability in the prescribing activity regarding discharged patients, conducted in the Cardiology Unit (CU) of the Hospital of S. Maria Annunziata, near Florence. The activity is analyzed using the theoretical framework of activity theory, an approach elaborated by the Soviet psychologists Leont’ev and Lurija, who developed the previous work done by Lev Vygotskij, known as cultural – historical psychology. Viewing the prescribing process through this theoretical framework is a way to go beyond the classic cognitive approach to the study of errors in such an activity. In fact the present work aims at understanding how artefacts can give real support to professionals and patients in order to fullfill their purposes; artefacts are tools of mediation between men and their objectives. We examine the case of discharged patients and the problems they encounter when reading the discharge document, written using ARGOS, a software used in the Cardiology Unit. Computer physician order entry systems (CPOE systems) are often considered the only solutions to errors in drug prescribing, mainly because mistakes in transcribing and the widespread poor quality of physician penmanship are seen as the most important problems in the medication prescribing process. Although quantitative researches are useful, we assert the need for more qualitative studies on medical activities.