Jani, Yogini Hariprasad; (2008) Electronic Prescribing In Children (EPIC): an evaluation of implementation at a children’s hospital. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Medication errors are common and can cause significant mortality and morbidity. Electronic prescribing (EP), with or without clinical decision support systems (CDSS), is a complex intervention that has been proposed as a solution. US studies indicate that there may be a reduction in medication errors as well as adverse events, but equally new errors may be introduced. There is a paucity of studies assessing the use and impact of EP in the UK hospital setting, especially those involving paediatric patients. The aim of this thesis was to investigate and evaluate the implementation of an EP system at a children's hospital in the UK. The objectives were to assess the effect on prescribing errors, to explore the level of CDSS available and in use within the system, to identify any changes in practice and workflow patterns of healthcare professionals, and to determine the views of patients and users. Mixed qualitative and quantitative methods were used within an evaluation framework (the Cornford framework). The results show an overall reduction in prescribing errors directly as a result of more complete and legible prescriptions after EP. Outpatient errors decreased from 1219/1574 (77.4%) to 33/648 (5.1%), a 72.3% reduction [95% confidence interval (CI) -74.6% to -69.3%]. The number of outpatient visits that were error free increased from 185/883 (21%) to 225/250 (90%), 95% Cl of difference in proportions, 64% to 73.4%. Inpatient errors decreased from 85/1267 (6.7%) to 96/ 2079 (4.6%), 95% CI of difference in proportions, -3.4% to -0.5% There was an increase in discharge prescription errors from 839/1098 (76.4%>) to 1777/2057 (86.4%), 95% CI of difference in proportions, 7.88% to 12.94%. The dosing error rate in all types of prescriptions was lower after EP: 88/3939 (2.2%) vs. 57/4784 (1.2%), 95% CI of difference in proportions, -1.6% to -0.5%, but there was no statistically significant change in severity ratings of dosing errors. New types of errors, such as selection errors, were seen due to EP. Although principles of the medicines use process remained the same, the practical approach to tasks was altered. The system was accepted by users and patients, but there was a desire for further improvements, especially in the level of clinical decision support available to the end user. In conclusion, the EP system was implemented successfully. The benefits in medication safety appear to be the results of effective interaction between system functionality and usability, user acceptance and organisational infrastructure.

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