A survey exploring National Health Service ePrescribing Toolkit use and perceived usefulness amongst English hospitals

Background: There is currently limited guidance for hospitals to implement ePrescribing systems. We have developed an ePrescribing Toolkit designed to support ongoing implementation, adoption and optimisation of efforts. Aim: To investigate the perceived usefulness, reported use and areas for further development of the Toolkit by ePrescribing implementers in English hospitals. Methods: Questionnaire-based survey of hospitals that have or are interested in implementing ePrescribing systems. Results: We received responses from a total of 78 individuals representing 49 English NHS Trusts (out of 82 different Trusts who were emailed the survey, 60% response rate). The overwhelming majority of respondents (92%) were familiar with the ePrescribing Toolkit and 66% reported using it to guide their ongoing implementation efforts. The majority of ePrescribing Toolkit users (85%) viewed it as a helpful resource. Implementers particularly valued the case studies describing lessons learnt from hospitals that had already implemented ePrescribing systems. Suggestions for improvement included more information in relation to the progress of hospitals implementing systems, the names of key contacts in these sites, a list of available systems and the contact details of ePrescribing vendors. Respondents also highlighted the need for more information on optimisation and specialist prescribing. Conclusions: Interactive elements and learning lessons from early adopter sites that had accumulated experiences of implementing systems was viewed as the most helpful aspect of the ePrescribing Toolkit. The Toolkit now needs to be further developed to facilitate the continuing implementation/optimisation of ePrescribing and other health information technology across the NHS

Study of the Relationship Between Years of Teaching Experience and a Developmental Progression of Teachers' Concerns

Occupational and Adult Educatio

A toolkit to support the implementation of electronic prescribing systems into UK hospitals: preliminary recommendations.

Hospital electronic prescribing (or ePrescribing) systems have the potential to reduce drug-related morbidity and mortality. However, their implementation and adoption has been slow to date, despite the considerable service interest in implementing systems and the long-standing policy drive towards computerization. The underlying reasons may include the demise of the National Programme for Information Technology; a lack of change management expertise and capacity in the National Health Service (NHS); the relatively immature and fragmented market; limited standards guiding procurement, functional specifications and expected benefits; and lack of resources

Triggering change: Towards a conceptualisation of major change processes in farm decision-making

In this paper, we present a broad conceptualisation of major change in farm level trajectories. We argue that as a result of path dependency, major changes in farming practice primarily occur in response to 'trigger events', after which farm managers intensify their consideration of the options open to them, and may set a new course of action. In undertaking new actions, the farm system enters a period of instability, while new practices become established. Over time these new practices, if successfully achieving anticipated aims, lead to a further period of path dependency. Recognising and capitalising upon this pattern of events is important for the development of policies oriented towards incentivising major change in farming practices, and may explain why similar projects and/or policies influence some 'types' of farmers differently, and at different times. To illustrate our arguments, examples of this process are described in relation to empirical examples of major on-farm change processes, drawn from qualitative interviews with organic and conventional farmers in two English case study area

Triggering change: Towards a conceptualisation of major change processes in farm decision-making

In this paper, we present a broad conceptualisation of major change in farm level trajectories. We argue that as a result of path dependency, major changes in farming practice primarily occur in response to 'trigger events', after which farm managers intensify their consideration of the options open to them, and may set a new course of action. In undertaking new actions, the farm system enters a period of instability, while new practices become established. Over time these new practices, if successfully achieving anticipated aims, lead to a further period of path dependency. Recognising and capitalising upon this pattern of events is important for the development of policies oriented towards incentivising major change in farming practices, and may explain why similar projects and/or policies influence some 'types' of farmers differently, and at different times. To illustrate our arguments, examples of this process are described in relation to empirical examples of major on-farm change processes, drawn from qualitative interviews with organic and conventional farmers in two English case study area

On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop

Background: Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. Methods: A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. Results: We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. Conclusions: We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems

Qualitative analysis of multi-disciplinary round-table discussions on the acceleration of benefits and data analytics through hospital electronic prescribing (ePrescribing) systems

Background: Electronic systems that facilitate prescribing, administration and dispensing of medicines (ePrescribing systems) are at the heart of international efforts to improve the safety, quality and efficiency of medicine management. Considering the initial costs of procuring and maintaining ePrescribing systems, there is a need to better understand how to accelerate and maximise the financial benefits associated with these systems.Objectives: We sought to investigate how different sectors are approaching the realisation of returns on investment from ePrescribing systems in U.K. hospitals and what lessons can be learned for future developments and implementation strategies within healthcare settings.Methods: We conducted international, multi-disciplinary, round-table discussions with 21 participants from different backgrounds including policy makers, healthcare organisations, academic researchers, vendors and patient representatives. The discussions were audio-recorded, transcribed and then thematically analysed with the qualitative analysis software NVivo10.Results: There was an over-riding concern that realising financial returns from ePrescribing systems was challenging. The underlying reasons included substantial fixed costs of care provision, the difficulties in radically changing the medicines management process and the lack of capacity within NHS hospitals to analyse and exploit the digital data being generated. Any future data strategy should take into account the need to collect and analyse local and national data (i.e. within and across hospitals), setting comparators to measure progress (i.e. baseline measurements) and clear standards guiding data management so that data are comparable across settings.Conclusions: A more coherent national approach to realising financial benefits from ePrescribing systems is needed as implementations progress and the range of tools to collect information will lead to exponential data growth. The move towards more sophisticated closed-loop systems that integrate prescribing, administration and dispensing, as well as increasingly empowered patients accessing their data through portals and portable devices, will accelerate these developments. Meaningful analysis of data will be the key to realise benefits associated with systems

Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme.

Electronic prescribing (ePrescribing) systems allow health-care professionals to enter prescriptions and manage medicines using a computer. We set out to find out how these ePrescribing systems are chosen, set up and used in English hospitals. Given that these systems are designed to improve medication safety, we looked at whether or not these systems affected the number of prescribing errors made (mistakes such as ordering the wrong dose of medication). We also tried to see whether or not the systems were good value for money (or more cost-effective). Finally, we made recommendations to help hospitals choose, set up and use ePrescribing systems. We found that setting up ePrescribing systems was very difficult because there is a need to take into consideration how different pharmacists, nurses and doctors work, and the different work that needs to be carried out for different diseases and medical conditions. We recorded a link between the implementation of ePrescribing systems and a reduction in some high-risk prescribing errors in two out of three study sites. Given that the error reductions corresponded to the warnings triggered by the system, we concluded that the system is likely to have caused the error reduction. Prescribing errors may lead to adverse events that lead to death, impaired quality of life and longer hospital stays. The cost of an ePrescribing system increased in proportion to reduced errors, reaching £4.31 per patient per year for the site that experienced the greatest reduction in prescribing errors (i.e. site S). This estimate is based on assumptions in the model and how much a health service is willing to pay for a unit of health benefit. To help professionals choose, set up and use ePrescribing systems in the future, we produced an online ePrescribing Toolkit (www.eprescribingtoolkit.com/; accessed 21 December 2019) that, with support from NHS England, is becoming widely used internationally