Table 2

Mindspace elements incorporated in the IDEAS chart

Mindspace interventionDefinitionAction
DefaultsPeople tend to go with the preset option or default setting. This can be a problem with medication orders where once prescribed, they can often continue for days after the optimum duration of treatment as a consequence of prescribers not actively stopping themA separate section for antibiotic prescribing was incorporated into the IDEAS chart, with the default changed from one in which antibiotics continue to be given to one in which they will only be given if a clinician confirms that this is appropriate every 3 days (figure 1)
SalienceSalience refers to people's tendency to respond to what is novel and relevant. Increasing the salience of specific parts of the chart was attempted to improve completionThe allergy box in the IDEAS chart encourages people to enter both the allergy and reaction. In other areas, salient cues were used to reduce the potential for ambiguity (figure 2)
PrimingPeople’s behaviour and decision-making is strongly influenced by subconscious cues in a process called psychological primingIn the IDEAS prescription chart, traditional information based cues were replaced with an example of how a prescription entry should look at the start of the regular prescription section with the aim of priming subsequent prescribing behaviour (figure 3)
Checklist (commitment device)Checklists have a long history of use across many high-risk industries and a safe surgery checklist has been successfully implemented in hospital operating rooms.20 Checklists incorporate some of the key features of commitment devices and salience to provide checks and balances for safe prescribingA checklist was added to the front page of the IDEAS chart (figure 4). This focuses on three problem areas where there is often a failure to complete: (1) reaction type of any allergy (2) duration and indication for antibiotic courses (3) thromboembolism risk assessment (figure 4)