McLeod, M;
Karampatakis, GD;
Heyligen, L;
McGinley, A;
Franklin, BD;
(2019)
The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study.
BMC Health Services Research
, 19
, Article 156. 10.1186/s12913-019-3986-4.
Preview |
Text
McLeod2019_Article_TheImpactOfImplementingAHospit.pdf - Published Version Download (1MB) | Preview |
Abstract
BACKGROUND: The increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists' activities, including interactions with patients and health professionals, and their perceptions of medication safety risks. METHODS: A mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors. RESULTS: Observations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors. CONCLUSION: This study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists' activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure 'business as usual' by enhancing and adapting their role.
| Type: | Article |
|---|---|
| Title: | The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1186/s12913-019-3986-4 |
| Publisher version: | http://doi.org/10.1186/s12913-019-3986-4 |
| Language: | English |
| Additional information: | Copyright © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
| Keywords: | Electronic prescribing, Electronic prescribing and medication administration system, Computerised physician order entry (CPOE), Pharmacist, Patient safety, Medication safety, Mixed methods, Work-sampling, Workflow, Interview |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10070634 |
Loading...
Loading...Loading...Loading...Archive Staff Only
 |
View Item |
