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Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek


Pamela Ruth Mills

Anita Elaine Weidmann

Derek Stewart


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.


MILLS, P.R., WEIDMANN, A.E. and STEWART, D. 2017. Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation. International journal of clinical pharmacy [online], 39(6), pages 1320-1330. Available from:

Journal Article Type Article
Acceptance Date Sep 26, 2017
Online Publication Date Oct 26, 2017
Publication Date Dec 31, 2017
Deposit Date Nov 3, 2017
Publicly Available Date Nov 3, 2017
Journal International journal of clinical pharmacy
Print ISSN 2210-7703
Electronic ISSN 2210-7711
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 39
Issue 6
Pages 1320-1330
Keywords Behavioural determinants; Discharge communication; Hospital electronic prescribing and medicines administration; Patient safety; Qualitative research; Theoretical domains framework; United Kingdom
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