Clinical Patient Safety Framework
Patient safety is the primary design principle of the MOANA platform. Clinical safety is enforced through a combination of automated system controls, clinical workflow checks, and strict staff protocols.
1. The 10-Point Patient Safety Framework
| Safety Control | How the System Works | Healthcare Staff Responsibility |
|---|---|---|
| 1. Identity Verification | MPI assigns every patient a unique Moana ID. Probabilistic duplicate detection flags near-matches for review. | Search before creating a new record. Confirm two identifiers before acting on any patient record. |
| 2. Patient Banner Check | Patient banner appears at the top of every clinical screen showing Name, DOB, MRN, and active allergies. | Check the patient banner before every clinical action — prescribing, ordering, dispensing, vitals — every time. |
| 3. Two-Gate Medication Safety | Advisory at prescribing; enforced hard stop at dispensing if drug alert unacknowledged. Allergy added post-prescribing is caught at pharmacy. | Review allergy record before prescribing. Contact prescribing doctor when a dispensing block occurs. |
| 4. MEWS Deterioration Alert | MEWS ≥ 5 at ED triage fires an automatic HIGH-priority alert and creates a Clinical Decision Support (CDS) entry. | Respond immediately. Attend patient and escalate to the emergency medical officer. |
| 5. NEWS2 Deterioration Alert | Aggregate NEWS2 score ≥ 7 fires a STAT-priority alert to the assigned nurse and attending doctor simultaneously. | Attend the patient immediately. Call the doctor directly. Document every step with timestamps. |
| 6. Critical Lab Value — Dual Gate | Dual-gate: (1) Notify Clinician modal requires verbal contact documentation before submission; (2) 30-minute auto-escalation. | Make direct verbal contact before releasing a critical result. Document who was notified, time, and read-back. |
| 7. Critical Radiology Finding | Report release and doctor acknowledgment are separate, independently timestamped events in the audit trail. | Call the ordering clinician before releasing a critical report. Document verbal communication in report text. |
| 8. AI as Assistant Only | All AI outputs (handover summaries, OCR document extracts) are editable drafts — they do not auto-commit. | Review every AI draft carefully. Correct errors. Your professional sign-off makes it the official record. |
| 9. Immutable Audit Trail | Every action — records viewed, orders placed, results accessed, overrides entered — is permanently logged. | Every action is attributed. Correct errors through the approved clinical amendment process — never by overwriting. |
| 10. Patient Care Priority | Clinical care always takes precedence over software operation during technical delays. | If a system issue creates a clinical delay, activate paper downtime procedures immediately. Treat patient first. |
Patient Safety Checkpoint: Patient Care Always Takes Priority If a system issue creates a clinical delay, activate the approved paper downtime procedure immediately. Do not wait for technical resolution. Treat the patient first; document in the system retrospectively when connectivity is restored.
2. Clinical Decision Support (CDS) & Medication Safety Tiers
Moana's CDS system provides active drug-allergy and drug-drug interaction checking at every prescribing and dispensing step.
| Severity Tier | Clinical Meaning | At Prescribing (Doctor) | At Dispensing (Pharmacist) | Mandatory Override Process |
|---|---|---|---|---|
| Contraindicated | Combination is clinically contraindicated — significant risk of severe patient harm. | Advisory displayed; signing NOT blocked | HARD STOP (403) — dispensing blocked until alert acknowledged | Doctor documents written clinical justification; acknowledges alert; permanently logged. |
| Major | Clinically significant interaction — management change or dose adjustment likely required. | Advisory displayed; signing NOT blocked | HARD STOP (403) — dispensing blocked until alert acknowledged | Doctor documents clinical rationale; acknowledges before dispensing proceeds. |
| Moderate | Interaction of moderate clinical significance — close clinical monitoring indicated. | Inline advisory banner | Soft stop — acknowledgment required before dispensing | Pharmacist acknowledges and documents rationale. |
| Minor | Minimal clinical significance — interaction unlikely in most patients. | Informational tooltip | Advisory only — no block | No override required. |
CDS is a Tool, Not a Replacement for Clinical Judgement The CDS system provides alerts based on formulary data and documented allergy lists. It does not have access to the full clinical picture. Clinical judgement always takes precedence — review every alert, understand what it is communicating, and document your clinical reasoning when overriding.