Abstract
Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.
Highlights
Hospital discharge information communication to patients’ general practitioners (GPs) in the United Kingdom (UK) has been provided by handwritten methods
Improved patient safety and GP communication are cited as core benefits of hospital electronic prescribing and medicines administration (HEPMA) implementation [6]
The study design used semi-structured face-to-face qualitative interviews to describe fully the perspectives of health professionals involved in discharge communication
Summary
Hospital discharge information communication to patients’ general practitioners (GPs) in the United Kingdom (UK) has been provided by handwritten methods. This consisted of inpatient prescription review and manual transcription, with possible amendments, to another paper document, with addition of salient clinical information. A 2009 NHS England report states that “e-prescribing systems will change how people work” and predicts HEPMA implementation will permit simple and direct discharge prescription production. It suggests hospital staff will develop “work-arounds” which may be helpful but may compromise safety [7]. There is a paucity of information about hospital staff perspectives before and after system implementation
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