The impact of electronic prescribing on pharmacists’ communication in UK inpatient settings: a mixed methods study

Background: Electronic prescribing and medication administration (ePMA) systems are becoming widely adopted across the UK. System users, researchers and patients are now questioning the profound nature through which these systems affect the ways in which healthcare professionals (HCPs) communicate with each other. Aim: The overall aim of this PhD was to explore the impact of ePMA systems on pharmacists’ communication with other HCPs and identify areas of improvement. Method: A systematic review explored the impact of electronic prescribing systems on HCPs’ working practices. Focus groups and semi-structured interviews were conducted with hospital pharmacists, doctors and nurses to explore their perceptions of how ePMA systems have affected, or are expected to affect, the way they communicate with each other. Observations, collecting both quantitative and qualitative data, were carried out to study how pharmacists communicated with other HCPs at two sites with established ePMA systems and one with paper-based prescribing. Results: The systematic review identified four areas of working practices affected by ePMA. The focus group and interview study suggested that ePMA systems were not being used to facilitate communication among HCPs. Doctors felt that the written and physical presence of the pharmacist had reduced since ePMA systems were introduced. Participants suggested ways their current ePMA systems could improve and streamline communication. The observational study revealed differences in pharmacists’ working practices; factors included differences in pharmacy services, organisational cultures and prescribing systems. More medication charts were reviewed by the pharmacists at the ePMA sites, but a lower percentage of patients were reviewed face-to-face. This may be indicative of a potentially negative impact of ePMA on pharmacist-patient relationships. Conclusion: Practical challenges faced by HCPs working with ePMA systems were identified. Recommendations were made for clinical practice, ePMA providers and future researchers. A recommendation made to the hospitals was to consider updating their pharmacy clinical guidelines to incorporate ePMA into their working practice

Hospital pharmacists', doctors' and nurses' perceptions of intra- and inter- professional communication in the context of electronic prescribing and medication administration systems: A qualitative study.

BackgroundEffective, integrated and coordinated communication is essential in providing high quality patient care. Little prior research has detailed the impact of electronic prescribing and medication administration (ePMA) systems on healthcare professionals' (HCPs') communication. We investigated hospital pharmacists', doctors' and nurses' perceptions of how ePMA systems have affected, or are expected to affect, the way they communicate with each other in an inpatient setting.MethodsA qualitative study in three English NHS hospitals: two used different inpatient ePMA systems, and one used paper-based prescribing. We conducted focus groups with pharmacists, and semi-structured individual interviews with doctors and nurses. Transcribed data were analysed inductively using thematic analysis.ResultsNine focus groups, three at each hospital, were conducted with pharmacists with different levels of seniority (58 pharmacists in total). Fourteen doctors and twelve nurses took part in individual interviews. Four themes were generated: modes of communication, reduced pharmacist visibility, system limitations, and future aspirations for ePMA. Whether working with ePMA or paper-based systems, all participants preferred to communicate face-to-face to facilitate collaborative discussions regarding patient care. Participants perceived that ePMA reduced contact time with patients. Pharmacists perceived that both their physical ward presence and their written communication on medication charts had reduced since introduction of ePMA. Doctors felt they were now less likely to ask pharmacists questions due to pharmacists' reduced physical presence on the ward. Hardware and software limitations were identified by all HCPs, with suggestions made for future developments to better support communication.ConclusionePMA does not necessarily support communication among HCPs. Pharmacists and doctors were also concerned that ePMA reduces communication between themselves and their patients. Hospital managers should ensure sufficient hardware for HCPs, including pharmacists, to conduct their work in clinical areas, and work with ePMA system suppliers to develop ways of enhancing, rather than inhibiting, communication