The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Aziz Sheikh - One of the best experts on this subject based on the ideXlab platform.
-
optimising Electronic Prescribing in hospitals a scoping review protocol
BMJ Health & Care Informatics, 2020Co-Authors: Jac Williams, David W Bates, Aziz SheikhAbstract:Introduction Electronic Prescribing (ePrescribing) systems can improve the quality of Prescribing decisions and substantially reduce the risk of serious medication errors in hospitals. However, realising these benefits depends on ensuring that relevant sociotechnical considerations are addressed. Optimising ePrescribing systems is essential to maximise the associated benefits and minimise the accompanying risks of these large-scale and expensive health informatics infrastructures. Methods We will undertake a systematic scoping review of the literature to identify strategies to achieve optimisation of ePrescribing systems. We will search Medline, Embase and CINAHL for the period 1 January 2010 to 1 June 2019 and the grey literature by using Google Scholar. Independent reviewers will screen the results using predefined inclusion and exclusion criteria and will extract data for narrative and thematic synthesis. Discussion This work will be published in a peer-reviewed journal and we will ensure that the findings are both accessible and interpretable to the public, academics, policymakers and National Health Service leaders.
-
safety risks associated with the lack of integration and interfacing of hospital health information technologies a qualitative study of hospital Electronic Prescribing systems in england
BMJ Quality & Safety, 2017Co-Authors: Kathrin Cresswell, Hajar Mozaffar, Lisa Lee, Robin Williams, Aziz SheikhAbstract:Background Substantial sums of money are being invested worldwide in health information technology. Realising benefits and mitigating safety risks is however highly dependent on effective integration of information within systems and/or interfacing to allow information exchange across systems. As part of an English programme of research, we explored the social and technical challenges relating to integration and interfacing experienced by early adopter hospitals of standalone and hospital-wide multimodular integrated Electronic Prescribing (ePrescribing) systems. Methods We collected longitudinal qualitative data from six hospitals, which we conceptualised as case studies. We conducted 173 interviews with users, implementers and software suppliers (at up to three different times), 24 observations of system use and strategic meetings, 17 documents relating to implementation plans, and 2 whole-day expert round-table discussions. Data were thematically analysed initially within and then across cases, drawing on perspectives surrounding information infrastructures. Results We observed that integration and interfacing problems obstructed effective information transfer in both standalone and multimodular systems, resulting in threats to patient safety emerging from the lack of availability of timely information and duplicate data entry. Interfacing problems were immediately evident in some standalone systems where users had to cope with multiple log-ins, and this did not attenuate over time. Multimodular systems appeared at first sight to obviate such problems. However, with these systems, there was a perceived lack of data coherence across modules resulting in challenges in presenting a comprehensive overview of the patient record, this possibly resulting from the piecemeal implementation of modules with different functionalities. Although it was possible to access data from some primary care systems, we found poor two-way transfer of data between hospitals and primary care necessitating workarounds, which in turn led to the opportunity for new errors associated with duplicate and manual information transfer. Extending ePrescribing to include modules with other clinically important information needed to support care was still an aspiration in most sites, although some advanced multimodular systems had begun implementing this functionality. Multimodular systems were, however, seen as being difficult to interface with external systems. Conclusions The decision to pursue a strategy of purchasing standalone systems and then interfacing these, or one of buying hospital-wide multimodular systems, is a pivotal one for hospitals in realising the vision of achieving a fully integrated digital record, and this should be predicated on a clear appreciation of the relative trade-offs between these choices. While multimodular systems offered somewhat better usability, standalone systems provided greater flexibility and opportunity for innovation, particularly in relation to interoperability with external systems and in relation to customisability to the needs of different user groups.
-
workarounds to hospital Electronic Prescribing systems a qualitative study in english hospitals
BMJ Quality & Safety, 2017Co-Authors: Kathrin Cresswell, Hajar Mozaffar, Lisa Lee, Robin Williams, Aziz SheikhAbstract:Background Concerns with the usability of Electronic Prescribing (ePrescribing) systems can lead to the development of workarounds by users. Objectives To investigate the types of workarounds users employed, the underlying reasons offered and implications for care provision and patient safety. Methods We collected a large qualitative data set, comprising interviews, observations and project documents, as part of an evaluation of ePrescribing systems in five English hospitals, which we conceptualised as case studies. Data were collected at up to three different time points throughout implementation and adoption. Thematic analysis involving deductive and inductive approaches was facilitated by NVivo 10. Results Our data set consisted of 173 interviews, 24 rounds of observation and 17 documents. Participating hospitals were at various stages of implementing a range of systems with differing functionalities. We identified two types of workarounds: informal and formal. The former were informal practices employed by users not approved by management, which were introduced because of perceived changes to professional roles, issues with system usability and performance and challenges relating to the inaccessibility of hardware. The latter were formalised practices that were promoted by management and occurred when systems posed threats to patient safety and organisational functioning. Both types of workarounds involved using paper and other software systems as intermediaries, which often created new risks relating to a lack of efficient transfer of real-time information between different users. Conclusions Assessing formal and informal workarounds employed by users should be part of routine organisational implementation strategies of major health information technology initiatives. Workarounds can create new risks and present new opportunities for improvement in system design and integration.
-
the challenges of implementing packaged hospital Electronic Prescribing and medicine administration systems in uk hospitals premature purchase of immature solutions
2017Co-Authors: Hajar Mozaffar, Kathrin Cresswell, Robin Williams, Zoe Morrison, Neil Pollock, Aziz SheikhAbstract:The UK National Health Service is making major efforts to implement Hospital Electronic Prescribing and Medicine Administration (HEPMA) to improve patient safety and quality of care. Substantial public investments have attracted a wide range of UK and overseas suppliers offering Commercial-Off –The-Shelf (COTS) solutions. A lack of (UK) implementation experience and weak supplier-user relationships are reflected in systems with limited configurability, poorly matched to the needs and practices of English hospitals. This situation echoes the history of comparable corporate information infrastructures - Enterprise Resource Planning systems - in the 1980s/1990s. UK government intervention prompted a similar swarming of immature, often unfinished, products into the market. This resulted, in both cases, in protracted and difficult implementation processes as vendors and adopters struggled to get the systems to work and match the circumstances of the adopting organisations. An analysis of the influence of the Installed Base on Information Infrastructures should explore how the evolution of COTS solutions is conditioned by the structure of adopter and vendor ‘communities’.
-
approaches to promoting the appropriate use of antibiotics through hospital Electronic Prescribing systems a scoping review
International Journal of Pharmacy Practice, 2017Co-Authors: Kathrin Cresswell, Hajar Mozaffar, Sonal Shah, Aziz SheikhAbstract:Objective To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. Methods A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews. Search terms related to different components of systems, hospital settings and antimicrobial stewardship. Two reviewers independently screened papers and mutually agreed papers for inclusion. We undertook an interpretive synthesis. Key findings We identified 143 papers. The majority of these were single-centre observational studies from North American settings with a wide range of system functionalities. Most evidence related to computerised decision support (CDS) and computerised physician order entry (CPOE) functionalities, of which many were extensively customised. We also found some limited work surrounding integration with laboratory results, pharmacy systems and organisational surveillance. Outcomes examined included healthcare professional performance, patient outcomes and health economic evaluations. We found at times conflicting conclusions surrounding effectiveness, which may be due to heterogeneity of populations, technologies and outcomes studied. Reports of unintended consequences were limited. Conclusions Interventions are centred on CPOE and CDS, but also include additional functionality aiming to support various facets of the medicines management process. Wider organisational dimensions appear important to supporting adoption. Evaluations should consider processes, clinical, economic and safety outcomes in order to generate generalisable insights into safety, effectiveness and cost-effectiveness.
Bryony Dean Franklin - One of the best experts on this subject based on the ideXlab platform.
-
mixed methods study of medication related decision support alerts experienced during Electronic Prescribing for inpatients at an english hospital
European Journal of Hospital Pharmacy, 2019Co-Authors: Helen Bell, Bryony Dean Franklin, Sara Garfield, Sonia Khosla, Chimnay PatelAbstract:Objectives Electronic Prescribing and medication administration systems are being introduced in many hospitals worldwide, with varying degrees of clinical decision support including pop-up alerts. Previous research suggests that prescribers override a high proportion of alerts, but little research has been carried out in the UK. Our objective was to explore rates of alert overriding in different Prescribing situations and prescribers’ perceptions around the use of decision support alerts in a UK hospital. Methods We conducted a mixed methods study on three cardiology wards, directly observing medical and non-medical prescribers’ alert override rates during both ward round and non-ward round Prescribing; observations were followed by semi-structured interviews with prescribers, which were then transcribed and analysed thematically. Results Overall, 69% of 199 observed alerts were overridden. Alerts experienced during ward rounds were significantly more likely to be overridden than those outside of ward rounds (80% of 56 vs 51% of 63; p=0.001, Χ 2 test). While respondents acknowledged that alerts could be useful, several also described negative unintended consequences. Many were of the view that usefulness of alerts was limited if the alert was reminding them to do something they would do anyway, or suggesting something they did not feel was relevant. Findings suggest that targeting, timing and additional features of alerts are critical factors in determining whether they are acted on or overridden. Conclusion The majority of alerts were overridden. Alerts may be less likely to be overridden if they are built into the Prescribing workflow.
-
the impact of Electronic Prescribing systems on healthcare professionals working practices in the hospital setting a systematic review and narrative synthesis
BMC Health Services Research, 2019Co-Authors: Soomal Mohsinshaikh, Monsey Mcleod, Bryony Dean Franklin, Dominic Furniss, Ann Blandford, Maedeh Y BeyklooAbstract:The aim of this systematic review was to synthesise peer-reviewed literature assessing the impact of Electronic Prescribing (eP) systems on the working practices of healthcare professionals (HCPs) in the inpatient setting and identify implications for practice and research. We searched PubMed, Medline, Embase, Cochrane and the Cumulative Index to Nursing Allied Health Literature databases for studies published from inception to November 2018. We included controlled, uncontrolled, observational and descriptive studies that explored the effect of eP on HCPs’ working practices in an inpatient setting. Data on setting, eP system and impact on working practices were extracted. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration CRD42017075804). Searches identified 1301 titles and abstracts after duplicate removal. 171 papers underwent full-text review. A total of 25 studies met the inclusion criteria, from nine different countries. Nineteen were of commercial eP systems. There were a range of study designs; most (n = 14) adopted quantitative methods such as cross-sectional surveys, ten adopted qualitative approaches and a further one used mixed methods. Fourteen of the 25 studies were deemed to be of high quality. Four key themes were identified: communication, time taken to complete tasks, clinical workflow, and workarounds. Within each theme, study findings differed as to whether the effects of eP on HCPs’ working practices were positive or negative. There is a lack of consensus within the literature on the impact of eP on HCPs’ working practices. Future research should explore the strategies resulting in a positive impact on HCPs’ working practices and learn from those that have not been successful.
-
the impact of implementing a hospital Electronic Prescribing and administration system on clinical pharmacists activities a mixed methods study
BMC Health Services Research, 2019Co-Authors: Monsey Mcleod, Georgios Dimitrios Karampatakis, Lore Heyligen, Ann Mcginley, Bryony Dean FranklinAbstract: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. 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. 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. 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.
-
the impact of a hospital Electronic Prescribing and medication administration system on medication administration safety an observational study
BMC Health Services Research, 2017Co-Authors: Seetal Jheeta, Bryony Dean FranklinAbstract:The aim of the study was to explore the impact of the implementation of an Electronic Prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices. The study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses’ medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend. Observations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3–6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9–5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1–2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8–4.7%; p = 0.04). The most common Electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications. Findings suggest no change in medication error rate, although ePA encourages certain types of errors and mitigates others. There was a statistically significant increase in documentation discrepancies which is likely to be due to adoption of new working practices with ePA.
-
secondary use of data from hospital Electronic Prescribing and pharmacy systems to support the quality and safety of antimicrobial use a systematic review
Journal of Antimicrobial Chemotherapy, 2017Co-Authors: Christianne Micallef, Navila T Chaudhry, Alison Holmes, Susan Hopkins, Jonathan Benn, Bryony Dean FranklinAbstract:BACKGROUND: Electronic Prescribing (EP) and Electronic hospital pharmacy (EHP) systems are increasingly common. A potential benefit is the extensive data in these systems that could be used to support antimicrobial stewardship, but there is little information on how such data are currently used to support the quality and safety of antimicrobial use. OBJECTIVES: To summarize the literature on secondary use of data (SuD) from EP and EHP systems to support quality and safety of antimicrobial use, to describe any barriers to secondary use and to make recommendations for future work in this field. METHODS: We conducted a systematic search within four databases; we included original research studies that were (1) based on SuD from hospital EP or EHP systems and (2) reported outcomes relating to quality and/or safety of antimicrobial use and/or qualitative findings relating to SuD in this context. RESULTS: Ninety-four full-text articles were obtained; 14 met our inclusion criteria. Only two described interventions based on SuD; seven described SuD to evaluate other antimicrobial stewardship interventions and five described descriptive or exploratory studies of potential applications of SuD. Types of data used were quantitative antibiotic usage data (n = 9 studies), dose administration data (n = 4) and user log data from an Electronic dashboard (n = 1). Barriers included data access, data accuracy and completeness, and complexity when using data from multiple systems or hospital sites. CONCLUSIONS: The literature suggests that SuD from EP and EHP systems is potentially useful to support or evaluate antimicrobial stewardship activities; greater system functionality would help to realize these benefits.
Ian C K Wong - One of the best experts on this subject based on the ideXlab platform.
-
characteristics of clinical decision support alert overrides in an Electronic Prescribing system at a tertiary care paediatric hospital
International Journal of Pharmacy Practice, 2011Co-Authors: Yogini Jani, Nick Barber, Ian C K WongAbstract:CONTEXT Electronic Prescribing (EP) systems are advocated as a solution to minimise medication errors. Benefits in patient safety are often as a result of some clinical decision support (CDS) within the system. OBJECTIVE To study the characteristics of the CDS alerts generated within a commercially available EP system in use at a tertiary care paediatric hospital in the UK. METHODS Retrospective review and characterisation of CDS alerts recorded in the EP system over 1 year. RESULTS A total of 16 182 conflict alerts were recorded when ordering 26 836 items, of which 3507 (13 alerts per 100 prescription orders (95% confidence interval, 12.8 to 13.6)) were visible to the user. Eighty nine percent (3119/3507) of all visible alerts were overridden by the user at point of Prescribing. Drug-allergy conflict alerts were the most accepted, and exact drug duplication alerts the least. CONCLUSION We found a high incidence of alert override, which is undesirable but consistent with that reported in the literature. The results suggest that the underlying algorithms for alert generation in many EP systems are not specific and need to be reviewed.
-
paediatric dosing errors before and after Electronic Prescribing
Quality & Safety in Health Care, 2010Co-Authors: Yogini Jani, Nick Barber, Ian C K WongAbstract:Objective To compare the incidence and severity rating of dose Prescribing errors before and after the implementation of a commercially available Electronic Prescribing system at a tertiary care children's hospital. Methods Dose errors were identified using prescription review to detect errors. Severity rating was determined by five judges using a validated, reliable scoring tool. The mean score for each error was used as an index of severity. Results Dose Prescribing errors occurred in 88 of the 3939 (2.2%) items prescribed for outpatients and inpatients, and on discharge prescriptions prior to the implementation of Electronic Prescribing (EP). After EP, there were 57 dose errors in 4784 (1.2%) items prescribed (1% absolute reduction (p<0.001 χ2 test; 95% CI of difference in proportions −1.6% to −0.5%)). A decrease in the severity rating of dose errors was also seen: dose errors with potentially minor outcomes 35/3939 (0.89%) pre vs 21/4784 (0.44%) post (95% CI of difference in proportions −0.8% to −0.11%, p=0.009 χ2 test); moderate outcome 46/3939 (1.17%) pre vs 33/4784 (0.69%) post (95% CI of difference in proportions −0.91% to −0.08, p=0.019, χ2 test); severe outcome: 7/3939 (0.18%) pre vs 3/4784 (0.06%) post (95% CI of difference in proportions −0.31% to +0.04, p=0.11, χ2 test). Conclusion Electronic Prescribing appears to reduce rates of dosing errors in paediatrics, but larger studies are required to assess the effect on the severity of these errors and in different settings.
-
Electronic Prescribing reduced Prescribing errors in a pediatric renal outpatient clinic
The Journal of Pediatrics, 2008Co-Authors: Yogini Jani, Maisoon Abdullah Ghaleb, Judith Cope, Nick Barber, Stephen D. Marks, Ian C K WongAbstract:Objective To assess the effect of an Electronic Prescribing (EP) system on the incidence and type of Prescribing errors and the number of error-free visits. Study design This was a before-and-after study conducted in a nephrology outpatient clinic at an acute tertiary care pediatric hospital. Results A total of 520 patients had 2242 items prescribed on 1141 prescriptions during the study period. The overall Prescribing error rate was 77.4% (95% confidence interval [CI] = 75.3% to 79.4%) for handwritten items and 4.8% (95% CI = 3.4% to 6.7%) with EP. Before EP, 1153 (73.3%; 95% CI = 71.1% to 75.4%) items were missing essential information, and 194 (12.3%; 95% CI = 10.8% to 14%) were judged illegible. After EP, only 9 (1.4%; 95% CI = 0.7% to 2.6%) items were missing essential information, and illegibility errors were eliminated. The number of patient visits that were error-free increased from 21% to 90% (69% difference; 95% CI = 64% to 73.4%) after the implementation of EP. Conclusions There was a high incidence of errors using handwritten prescriptions in the outpatient setting, with an overall error rate of 77.4%. EP significantly reduced errors related to completeness of prescriptions and eliminated legibility related errors.
Yogini Jani - One of the best experts on this subject based on the ideXlab platform.
-
economic impact of Electronic Prescribing in the hospital setting a systematic review
International Journal of Medical Informatics, 2016Co-Authors: Yogini Jani, Nick Barber, Zamzam Ahmed, Sara Garfield, Bryony Dean FranklinAbstract:Objective To examine evidence on the economic impact of Electronic Prescribing (EP) systems in the hospital setting. Method We conducted a systematic search of MEDLINE, EMBASE, PsycINFO, International Pharmaceutical Abstracts, the NHS Economic Evaluation Database, the European Network of Health Economic Evaluation Database and Web of Science from inception to October 2013. Full and partial economic evaluations of EP or computerized provider order entry were included. We excluded studies assessing Prescribing packages for specific drugs, and monetary outcomes that were not related to medicines. A checklist was used to evaluate risk of bias and evidence quality. Results The search yielded 1160 articles of which three met the inclusion criteria. Two were full economic evaluations and one a partial economic evaluation. A meta-analysis was not appropriate as studies were heterogeneous in design, economic evaluation method, interventions and outcome measures. Two studies investigated the financial impact of reducing preventable adverse drug events. The third measured savings related to various aspects of the system including those related to medication. Two studies reported positive financial effects. However the overall quality of the economic evidence was low and key details often not reported. Discussion There seems to be some evidence of financial benefits of EP in the hospital setting. However, it is not clear if evidence is transferable to other settings. Research is scarce and limited in quality, and reported methods are not always transparent. Further robust, high quality research is required to establish if hospital EP is cost effective and thus inform policy makers’ decisions.
-
characteristics of clinical decision support alert overrides in an Electronic Prescribing system at a tertiary care paediatric hospital
International Journal of Pharmacy Practice, 2011Co-Authors: Yogini Jani, Nick Barber, Ian C K WongAbstract:CONTEXT Electronic Prescribing (EP) systems are advocated as a solution to minimise medication errors. Benefits in patient safety are often as a result of some clinical decision support (CDS) within the system. OBJECTIVE To study the characteristics of the CDS alerts generated within a commercially available EP system in use at a tertiary care paediatric hospital in the UK. METHODS Retrospective review and characterisation of CDS alerts recorded in the EP system over 1 year. RESULTS A total of 16 182 conflict alerts were recorded when ordering 26 836 items, of which 3507 (13 alerts per 100 prescription orders (95% confidence interval, 12.8 to 13.6)) were visible to the user. Eighty nine percent (3119/3507) of all visible alerts were overridden by the user at point of Prescribing. Drug-allergy conflict alerts were the most accepted, and exact drug duplication alerts the least. CONCLUSION We found a high incidence of alert override, which is undesirable but consistent with that reported in the literature. The results suggest that the underlying algorithms for alert generation in many EP systems are not specific and need to be reviewed.
-
paediatric dosing errors before and after Electronic Prescribing
Quality & Safety in Health Care, 2010Co-Authors: Yogini Jani, Nick Barber, Ian C K WongAbstract:Objective To compare the incidence and severity rating of dose Prescribing errors before and after the implementation of a commercially available Electronic Prescribing system at a tertiary care children's hospital. Methods Dose errors were identified using prescription review to detect errors. Severity rating was determined by five judges using a validated, reliable scoring tool. The mean score for each error was used as an index of severity. Results Dose Prescribing errors occurred in 88 of the 3939 (2.2%) items prescribed for outpatients and inpatients, and on discharge prescriptions prior to the implementation of Electronic Prescribing (EP). After EP, there were 57 dose errors in 4784 (1.2%) items prescribed (1% absolute reduction (p<0.001 χ2 test; 95% CI of difference in proportions −1.6% to −0.5%)). A decrease in the severity rating of dose errors was also seen: dose errors with potentially minor outcomes 35/3939 (0.89%) pre vs 21/4784 (0.44%) post (95% CI of difference in proportions −0.8% to −0.11%, p=0.009 χ2 test); moderate outcome 46/3939 (1.17%) pre vs 33/4784 (0.69%) post (95% CI of difference in proportions −0.91% to −0.08, p=0.019, χ2 test); severe outcome: 7/3939 (0.18%) pre vs 3/4784 (0.06%) post (95% CI of difference in proportions −0.31% to +0.04, p=0.11, χ2 test). Conclusion Electronic Prescribing appears to reduce rates of dosing errors in paediatrics, but larger studies are required to assess the effect on the severity of these errors and in different settings.
-
Electronic Prescribing reduced Prescribing errors in a pediatric renal outpatient clinic
The Journal of Pediatrics, 2008Co-Authors: Yogini Jani, Maisoon Abdullah Ghaleb, Judith Cope, Nick Barber, Stephen D. Marks, Ian C K WongAbstract:Objective To assess the effect of an Electronic Prescribing (EP) system on the incidence and type of Prescribing errors and the number of error-free visits. Study design This was a before-and-after study conducted in a nephrology outpatient clinic at an acute tertiary care pediatric hospital. Results A total of 520 patients had 2242 items prescribed on 1141 prescriptions during the study period. The overall Prescribing error rate was 77.4% (95% confidence interval [CI] = 75.3% to 79.4%) for handwritten items and 4.8% (95% CI = 3.4% to 6.7%) with EP. Before EP, 1153 (73.3%; 95% CI = 71.1% to 75.4%) items were missing essential information, and 194 (12.3%; 95% CI = 10.8% to 14%) were judged illegible. After EP, only 9 (1.4%; 95% CI = 0.7% to 2.6%) items were missing essential information, and illegibility errors were eliminated. The number of patient visits that were error-free increased from 21% to 90% (69% difference; 95% CI = 64% to 73.4%) after the implementation of EP. Conclusions There was a high incidence of errors using handwritten prescriptions in the outpatient setting, with an overall error rate of 77.4%. EP significantly reduced errors related to completeness of prescriptions and eliminated legibility related errors.
Kathrin Cresswell - One of the best experts on this subject based on the ideXlab platform.
-
safety risks associated with the lack of integration and interfacing of hospital health information technologies a qualitative study of hospital Electronic Prescribing systems in england
BMJ Quality & Safety, 2017Co-Authors: Kathrin Cresswell, Hajar Mozaffar, Lisa Lee, Robin Williams, Aziz SheikhAbstract:Background Substantial sums of money are being invested worldwide in health information technology. Realising benefits and mitigating safety risks is however highly dependent on effective integration of information within systems and/or interfacing to allow information exchange across systems. As part of an English programme of research, we explored the social and technical challenges relating to integration and interfacing experienced by early adopter hospitals of standalone and hospital-wide multimodular integrated Electronic Prescribing (ePrescribing) systems. Methods We collected longitudinal qualitative data from six hospitals, which we conceptualised as case studies. We conducted 173 interviews with users, implementers and software suppliers (at up to three different times), 24 observations of system use and strategic meetings, 17 documents relating to implementation plans, and 2 whole-day expert round-table discussions. Data were thematically analysed initially within and then across cases, drawing on perspectives surrounding information infrastructures. Results We observed that integration and interfacing problems obstructed effective information transfer in both standalone and multimodular systems, resulting in threats to patient safety emerging from the lack of availability of timely information and duplicate data entry. Interfacing problems were immediately evident in some standalone systems where users had to cope with multiple log-ins, and this did not attenuate over time. Multimodular systems appeared at first sight to obviate such problems. However, with these systems, there was a perceived lack of data coherence across modules resulting in challenges in presenting a comprehensive overview of the patient record, this possibly resulting from the piecemeal implementation of modules with different functionalities. Although it was possible to access data from some primary care systems, we found poor two-way transfer of data between hospitals and primary care necessitating workarounds, which in turn led to the opportunity for new errors associated with duplicate and manual information transfer. Extending ePrescribing to include modules with other clinically important information needed to support care was still an aspiration in most sites, although some advanced multimodular systems had begun implementing this functionality. Multimodular systems were, however, seen as being difficult to interface with external systems. Conclusions The decision to pursue a strategy of purchasing standalone systems and then interfacing these, or one of buying hospital-wide multimodular systems, is a pivotal one for hospitals in realising the vision of achieving a fully integrated digital record, and this should be predicated on a clear appreciation of the relative trade-offs between these choices. While multimodular systems offered somewhat better usability, standalone systems provided greater flexibility and opportunity for innovation, particularly in relation to interoperability with external systems and in relation to customisability to the needs of different user groups.
-
workarounds to hospital Electronic Prescribing systems a qualitative study in english hospitals
BMJ Quality & Safety, 2017Co-Authors: Kathrin Cresswell, Hajar Mozaffar, Lisa Lee, Robin Williams, Aziz SheikhAbstract:Background Concerns with the usability of Electronic Prescribing (ePrescribing) systems can lead to the development of workarounds by users. Objectives To investigate the types of workarounds users employed, the underlying reasons offered and implications for care provision and patient safety. Methods We collected a large qualitative data set, comprising interviews, observations and project documents, as part of an evaluation of ePrescribing systems in five English hospitals, which we conceptualised as case studies. Data were collected at up to three different time points throughout implementation and adoption. Thematic analysis involving deductive and inductive approaches was facilitated by NVivo 10. Results Our data set consisted of 173 interviews, 24 rounds of observation and 17 documents. Participating hospitals were at various stages of implementing a range of systems with differing functionalities. We identified two types of workarounds: informal and formal. The former were informal practices employed by users not approved by management, which were introduced because of perceived changes to professional roles, issues with system usability and performance and challenges relating to the inaccessibility of hardware. The latter were formalised practices that were promoted by management and occurred when systems posed threats to patient safety and organisational functioning. Both types of workarounds involved using paper and other software systems as intermediaries, which often created new risks relating to a lack of efficient transfer of real-time information between different users. Conclusions Assessing formal and informal workarounds employed by users should be part of routine organisational implementation strategies of major health information technology initiatives. Workarounds can create new risks and present new opportunities for improvement in system design and integration.
-
the challenges of implementing packaged hospital Electronic Prescribing and medicine administration systems in uk hospitals premature purchase of immature solutions
2017Co-Authors: Hajar Mozaffar, Kathrin Cresswell, Robin Williams, Zoe Morrison, Neil Pollock, Aziz SheikhAbstract:The UK National Health Service is making major efforts to implement Hospital Electronic Prescribing and Medicine Administration (HEPMA) to improve patient safety and quality of care. Substantial public investments have attracted a wide range of UK and overseas suppliers offering Commercial-Off –The-Shelf (COTS) solutions. A lack of (UK) implementation experience and weak supplier-user relationships are reflected in systems with limited configurability, poorly matched to the needs and practices of English hospitals. This situation echoes the history of comparable corporate information infrastructures - Enterprise Resource Planning systems - in the 1980s/1990s. UK government intervention prompted a similar swarming of immature, often unfinished, products into the market. This resulted, in both cases, in protracted and difficult implementation processes as vendors and adopters struggled to get the systems to work and match the circumstances of the adopting organisations. An analysis of the influence of the Installed Base on Information Infrastructures should explore how the evolution of COTS solutions is conditioned by the structure of adopter and vendor ‘communities’.
-
approaches to promoting the appropriate use of antibiotics through hospital Electronic Prescribing systems a scoping review
International Journal of Pharmacy Practice, 2017Co-Authors: Kathrin Cresswell, Hajar Mozaffar, Sonal Shah, Aziz SheikhAbstract:Objective To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. Methods A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews. Search terms related to different components of systems, hospital settings and antimicrobial stewardship. Two reviewers independently screened papers and mutually agreed papers for inclusion. We undertook an interpretive synthesis. Key findings We identified 143 papers. The majority of these were single-centre observational studies from North American settings with a wide range of system functionalities. Most evidence related to computerised decision support (CDS) and computerised physician order entry (CPOE) functionalities, of which many were extensively customised. We also found some limited work surrounding integration with laboratory results, pharmacy systems and organisational surveillance. Outcomes examined included healthcare professional performance, patient outcomes and health economic evaluations. We found at times conflicting conclusions surrounding effectiveness, which may be due to heterogeneity of populations, technologies and outcomes studied. Reports of unintended consequences were limited. Conclusions Interventions are centred on CPOE and CDS, but also include additional functionality aiming to support various facets of the medicines management process. Wider organisational dimensions appear important to supporting adoption. Evaluations should consider processes, clinical, economic and safety outcomes in order to generate generalisable insights into safety, effectiveness and cost-effectiveness.
-
five key recommendations for the implementation of hospital Electronic Prescribing and medicines administration systems in scotland
Journal of innovation in health informatics, 2017Co-Authors: Kathrin Cresswell, Ann Slee, Aziz SheikhAbstract:NHS Scotland is about to embark on the implementation of Hospital Electronic Prescribing and Medicines Administration (HEPMA) systems. There are a number of risks associated with such ventures, thus drawing on existing experiences from other settings is crucial in informing deployment.Drawing on our previous and ongoing work in English settings as well as the international literature, we reflect on key lessons that NHS Scotland may wish to consider in going forward. These deliberations include recommendations surrounding key aspects of deployment strategy surrounding: 1) the way central coordination should be conceptualised, 2) how flexibility in can be ensured, 3) paying attention to optimising systems from the outset, 4) how expertise should be developed and centrally shared, and 5) ways in which learning from experience can be maximised.Our five recommendations will, we hope, provide a starting point for the strategic deliberations of policy makers. Throughout this journey, it is important to view the deployment of HEPMA as part of a wider strategic goal of creating integrated digital infrastructures across Scotland.