Exploring the facilitators and barriers towards implementation of electronic prescribing, dispensing, and administration of medicines in hospitals in Ireland.

Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. The aim of this doctoral research was to explore this under-researched area in three phases. Phase one: - Phase one focused on critically appraising and synthesising the available evidence on healthcare professionals perceptions, attitudes, and views of the facilitators and barriers to implementing electronic prescribing, electronic dispensing, and/or electronic administration of medicines in the hospital setting. The review protocol was registered with the Centre for Reviews and Dissemination and conducted according to best practice. Key facilitators included systems improved patient safety and provided better access to patients drug records and that team leadership and hardware/software availability and reliability were essential for successful implementation. Key barriers consisted of hardware and network problems, altered work practices, and weakened interpersonal communication between healthcare professionals and with patients. Phase two: - This phase employed a qualitative phenomenological design to gain original insight into the perceptions of local key stakeholders towards the facilitators and barriers to implementing prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospitals in Ireland using Normalization Process Theory as a theoretical framework. Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two hospital Information Technology managers. Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multidisciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Phase three: - A similar qualitative methodology was employed in phase three of this research in order to explore the perceptions of national key stakeholders and eHealth leads towards the facilitators and barriers to system implementation. Sixteen consenting invitees participated: eight hospital leads, four government leads, two regulatory leads, and two academics. Key facilitators included enhanced patient safety, workflow efficiencies, improvements in governance, and financial gains. Perceived barriers included the introduction of new drug errors, loss of patient contact, initial time inefficiencies, and issues with the complexity of integration and standardisation of work processes. Overall, adequate technology, stakeholder involvement, and organisational leadership and support are required at a national and local level to drive the eHealth agenda forward. Testing at scale, contingency plans, and ongoing evaluations will assist in determining success or otherwise of system implementation. This research has generated novel findings with many potentially transferable themes identified which extend the evidence base. This will assist organisations to better plan for implementation of medication-related eHealth systems

Reflections on Post-bailout Policy Analysis in Ireland

This short article reflects on observations from the forthcoming volume Policy Analysis in Ireland, edited by Hogan & Murphy. The volume forms part of the International Library of Policy Analysis series, which covers more than twenty countries, published by Policy Press and edited by Michael Howlett and Iris Geva-May. While various themes emerge from the Irish volume, this article focuses on only one core question: whether and how the 2008 economic crisis contracted and expanded the capacity for policy analysis in Ireland. The troika of the International Monetary Fund, European Central Bank and the European Commission are associated with policy capacity innovation, but also with significant austerity. Both had a major and long-term impact on public services. While the article documents a range of successful post-bailout attempts to improve policy analysis capacity, it also points to often less conscious, but sometimes deliberate, decisions that diminished some forms of policy analysis capacity. We find economic policymaking capacity enhanced while changes to resources and policy opportunity structures depleted both space and the capacity for social policy analysis. This was particularly so within the equality and social justice sectors. Given ongoing social risks, the Covid-19 pandemic and the climate crisis, Ireland needs to adjust for a future of permanent uncertainty, or perpetual crises, and should seek to rebalance investment in social policy capacity and to develop systems for integrated policy analysi

Transmission of fast solitons for the NLS with an external potential

We consider the dynamics of a boosted soliton evolving under the cubic NLS with an external potential. We show that for sufficiently large velocities, the soliton is effectively transmitted through the potential. This result extends work of Holmer, Marzuola, and Zworski, who considered the case of a delta potential with no bound states, and work of Datchev and Holmer, who considered the case of a delta potential with a linear bound state.Comment: 13 page

Walking in Sunshine, or Away From It? Creating a Unified Transparency Index

Abstract: Despite the strengths of the two bodies of literature on Freedom of Information (FOI) and Lobbying Regulation, a main inadequacy is that they fail to meet each other. The reason why both the FOI and lobbying regulation literatures need to be synthesized is that both should be seen as the two sides of the deliberative democracy coin: FOI legislation aims to regulate the actions of state officials, while lobbying laws seek to regulate the actions of private interests attempting to influence such officials. The novelty of this paper is that we thus extend and link the ideas raised in these two bodies of literature, by performing a comparative analysis across 16 jurisdictions in North America, Europe and Asia. Our first main goal is to identify a measure for the effectiveness of FOI legislation throughout the world that can be compared on a normalized scale. Secondly, we combine these scores with those from the extant literature on lobbying regulations, producing what we refer to as an overall ‘sunshine score.’ This score will represent one of the first encompassing transparency measures in the literature, which helps us better conceptualize a unified understanding the relationship between FOI and lobbying rules, as well as the openness of democratic systems throughout the world

Equitability revisited: why the “equitable threat score” is not equitable

In the forecasting of binary events, verification measures that are “equitable” were defined by Gandin and Murphy to satisfy two requirements: 1) they award all random forecasting systems, including those that always issue the same forecast, the same expected score (typically zero), and 2) they are expressible as the linear weighted sum of the elements of the contingency table, where the weights are independent of the entries in the table, apart from the base rate. The authors demonstrate that the widely used “equitable threat score” (ETS), as well as numerous others, satisfies neither of these requirements and only satisfies the first requirement in the limit of an infinite sample size. Such measures are referred to as “asymptotically equitable.” In the case of ETS, the expected score of a random forecasting system is always positive and only falls below 0.01 when the number of samples is greater than around 30. Two other asymptotically equitable measures are the odds ratio skill score and the symmetric extreme dependency score, which are more strongly inequitable than ETS, particularly for rare events; for example, when the base rate is 2% and the sample size is 1000, random but unbiased forecasting systems yield an expected score of around −0.5, reducing in magnitude to −0.01 or smaller only for sample sizes exceeding 25 000. This presents a problem since these nonlinear measures have other desirable properties, in particular being reliable indicators of skill for rare events (provided that the sample size is large enough). A potential way to reconcile these properties with equitability is to recognize that Gandin and Murphy’s two requirements are independent, and the second can be safely discarded without losing the key advantages of equitability that are embodied in the first. This enables inequitable and asymptotically equitable measures to be scaled to make them equitable, while retaining their nonlinearity and other properties such as being reliable indicators of skill for rare events. It also opens up the possibility of designing new equitable verification measures

Re-thinking the coronavirus pandemic as a policy punctuation: COVID-19 as a path-clearing policy accelerator

This article joins with others in this special issue to examine the evolution of our understanding of how the coronavirus disease (COVID)-19 pandemic impacted policy ideas and routines across a wide variety of sectors of government activity. Did policy ideas and routines transform as a result of the pandemic or were they merely a continuation of the status quo ante? If they did transform, are the transformations temporary in nature or likely to lead to significant, deep and permanent reform to existing policy paths and trajectories? As this article sets out, the literature on policy punctuations has evolved and helps us understand the impact of COVID-19 on policy-making but tends to conflate several distinct aspects of path trajectories and deviations under the general concept of “critical junctures” which muddy reflections and findings. Once the different possible types of punctuations have been clarified, however, the result is a set of concepts related to path creation and disruption—especially that of “path clearing”—which are better able to provide an explanation of the kinds of policy change to be expected to result from the impact of events such as the 2019 coronavirus pandemi

Healthcare professionals' perceptions of the facilitators and barriers to implementing electronic systems for the prescribing, dispensing and administration of medicines in hospitals: a systematic review.

Abstract Objective To identify, critically appraise, synthesise and present the available evidence on healthcare professionals' perceptions of the facilitators and barriers to implementing electronic prescribing, dispensing and/or administration of medicines in the hospital setting. Methods A systematic search of studies focusing on healthcare professionals' perceptions of technologies for prescribing, dispensing and administering medicines in the hospital setting was performed using MEDLINE, Cumulative Index to Nursing and Allied Health, International Pharmaceutical Abstracts, PsycARTICLES, PsycINFO, Cochrane Database of Systematic Reviews and Centre for Reviews and Dissemination. Grey literature inclusive of manual searching of core journals, relevant conference abstracts and online theses were also searched. Independent duplicate screening of titles, abstracts and full texts was performed by the authors. Data extraction and quality assessment were undertaken using standardised tools, followed by narrative synthesis. Key findings Five papers were included in the systematic review after screening 2566 titles. Reasons for exclusion were duplicate publication; non-hospital setting; a lack of investigation of healthcare professionals' perceptions and a lack of focus on implementation processes or systems specific to electronic prescribing, dispensing or administration of medicines. Studies were conducted in the USA, Sweden and Australia. All studies used qualitative interview methods. Healthcare professionals perceived systems improved patient safety and provided better access to patients' drug histories and that team leadership and equipment availability and reliability were essential for successful implementation. Key barriers included hardware and network problems; altered work practices such as time pressure on using the system and remote ordering as a potential risk for errors; and weakened interpersonal communication between healthcare professionals and with patients. Conclusions Few studies were identified on healthcare professionals' perceptions of the facilitators and barriers to system implementation in hospitals. Key facilitators included a perception of increased patient safety and better access to patients' drug history while key barriers involved technical problems, changes to routine work practices and weakened interpersonal communication. Investigating this area further will assist in improving patient safety and reducing medication costs by informing and strengthening implementation strategies

Use of normalization process theory to explore key stakeholders’ perceptions of the facilitators and barriers to implementing electronic systems for medicines management in hospital settings.

Background: Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. Objective: To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing systems, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings using Normalization Process Theory as a theoretical framework. Methods: Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two Information Technology managers. Results: Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multi-disciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Conclusions: Many themes that are potentially transferable to other national settings have been identified and extend the evidence base. This will assist organisations around the world to better plan for implementation of medication-related eHealth systems

Re-thinking the Coronavirus Pandemic as a Policy Punctuation: Covid-19 as a Path-clearing Policy Accelerator

This article joins with others in this special issue to examine the evolution of our understanding of how the coronavirus disease (COVID)-19 pandemic impacted policy ideas and routines across a wide variety of sectors of government activity. Did policy ideas and routines transform as a result of the pandemic or were they merely a continuation of the status quo ante? If they did transform, are the transformations temporary in nature or likely to lead to significant, deep and permanent reform to existing policy paths and trajectories? As this article sets out, the literature on policy punctuations has evolved and helps us understand the impact of COVID-19 on policy-making but tends to conflate several distinct aspects of path trajectories and deviations under the general concept of “critical junctures” which muddy reflections and findings. Once the different possible types of punctuations have been clarified, however, the result is a set of concepts related to path creation and disruption—especially that of “path clearing”—which are better able to provide an explanation of the kinds of policy change to be expected to result from the impact of events such as the 2019 coronavirus pandemic