Hospital electronic prescribing and medicines administration system implementation into a district general hospital: a mixed method evaluation of discharge communication.

Mills, Pamela Ruth

Abstract

Hospital electronic prescribing and medicines administration (HEPMA) system implementation is advocated by national e-health strategies to produce patient safety benefits. No previous study has evaluated the impact of HEPMA implementation on either discharge information communication or occurence of discharge prescribing errors. The aims of this thesis were to assess the impact of HEPMA system implementation on medicines-related discharge communication and prescribing errors, and to understand the perspective of hospital staff involved in the communication process. Following a narrative literature review, a convergent parallel mixed methods approach was selected, consisting of interpretative phenomenology, and experimental before-and-after study design. Face-to-face semi-structured interviews were undertaken with a purposive sample of hospital staff involved in discharge information communication, using the Theoretical Domains Framework (TDF) as a theoretical lens. In addition, a quasi-experimental retrospective case notes review was completed both before and after implementation. Pre-implementation, staff described patient safety concerns with traditional discharge communication processes. They cited frequent prescribing errors, and associated adverse events and hospital readmissions. HEPMA implementation was anticipated to improve patient safety and create more efficient discharge communication. Post-implementation staff articulated improved information quality highlighting fewer omitted medicines and improved patient safety. TDF findings of behaviour change highlighted behavioural alteration including adoption of processes to improve discharge quality. Quantitative data collection (n = 159 before and after) confirmed qualitative findings, showing increased compliance with discharge documentation. For example: staff grade recorded increased from 40% to 100% (p < 0.001); prescribing error quantity and severity were reduced, with errors reduced from 99% to 23% of patients (p < 0.001) and only 22% of identified errors likely to cause harm; and omitted medicines decreased from 42% to 11% of patients (p < 0.001). The findings contribute original knowledge concerning the impact of HEPMA implementation on discharge information communication and prescribing errors. The study demonstrated reduced prescribing errors and improved patient safety, which potentially impacted health and wellbeing. Qualitative findings and quantitative results are transferable, and applicable to other NHS organisations or similar healthcare settings.

Citation

MILLS, P.R. 2016. Hospital electronic prescribing and medicines administration system implementation into a district general hospital: a mixed method evaluation of discharge communication. Robert Gordon University, DPP thesis.

• Thesis Type: Thesis
• Deposit Date: Aug 17, 2016
• Publicly Available Date: Aug 17, 2016
• Keywords: HEPMA; Discharge communication; Prescribing errors; Patient safety; Theoretical domains framework; Behavioural change
• Public URL: http://hdl.handle.net/10059/1581
• Contract Date: Aug 17, 2016
• Award Date: Jan 31, 2016