Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings: protocol for a systematic review of qualitative studies

Perception of Healthcare Professionals towards Electronic-Prescribing at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Cross-Sectional Study

Background

Electronic-prescribing (e-prescribing) is the most recent technological advancement in the medication use process. Its adoption and consequent realization of its potential benefits, however, mainly depend on the healthcare professionals' perception, willingness to accept, and engagement with the technology.

Objectives

This study is aimed at assessing the perception of healthcare professionals towards e-prescribing at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, from June 1 to August 30, 2021.

Method

A cross-sectional study was conducted using a simple random sampling technique. A self-administered questionnaire was used for data collection. Data were entered into and analyzed by using the Statistical Package for the Social Sciences (SPSS® (IBM Corporation)) version 24. Both descriptive and inferential statistics like the Kruskal-Wallis and Mann-Whitney tests were used for data analysis. A statistical significance was declared at a p value < 0.05.

Result

From 401 participants, the majority of study participants had a neutral perception of e-prescribing. More than two-thirds (68.8%) of them had a neutral perception towards the perceived usefulness of e-prescribing with a median (interquartile range (IQR)) perceived usefulness of 43.0 (7.0) (maximum score = 60). The perceived ease of use of e-prescribing was also neutral in the case of more than three-fourths (79.8%) of participants with a median (IQR) perceived ease of use of 49.0 (6) (maximum score = 75). Similarly, more than half (56.6%) of the participants had a neutral perception towards the perceived fitness of e-prescribing with a median (IQR) perceived fitness of 15.0 (2.5) (maximum score = 15). The perception of the participants showed a significant difference based on their qualifications and work and computer use experience. Participants who heard about e-prescribing and e-prescribing software had a significantly higher mean rank score of perceived usefulness, perceived ease of use, and perceived fitness of e-prescribing. Participants who previously used e-prescribing had also a significantly higher mean rank score of perceived usefulness. Conclusion and Recommendation. The majority of healthcare professionals had a neutral perception of e-prescribing. The perception of healthcare professionals differs based on their qualifications, work and computer use experience, and their exposure to e-prescribing. The hospital should take all expectations and concerns of all HCPs into consideration and provide experience-sharing opportunities for all healthcare professionals who may potentially be involved in e-prescribing.

How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies

Background

Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research.

Methods

We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically.

Results

79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact.

Conclusions

Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.

Electronic prescribing: introducing a stat optional dose to improve time to antibiotic on the acute medical unit

Darlington Memorial Hospital is a district general hospital in the North East of England. The acute medical unit (AMU) takes referrals from the emergency department and also direct from general practitioners (GPs) in the region. Research shows that early recognition and management of sepsis is key to improving outcomes and significantly decreases mortality. Having observed several cases of delayed sepsis management in patients referred from their GP, we aimed to improve time to antibiotic therapy in patients identified as having sepsis as per the National Institute for Health and Care Excellence 2016 NG51 sepsis guidelines. We analysed the time from admission to antibiotic administrations for patients referred to AMU via their GP with suspected sepsis. We found there was a significant delay between antibiotic prescribing and administration. Baseline data showed that only 36% of patients received a stat dose of antibiotic on admission. Results showed that those patients with a stat dose prescribed had a median time of 36 min from prescription to antibiotic compared with 98 min for those without. We introduced a stat antibiotic option with all antibiotic prescriptions on the electronic prescribing system, encouraging prescribers to administer a stat dose. Through focusing on antibiotic prescribing systems and practices over two PDSA cycles, we were able to improve the time from prescription to administration of antibiotics for patients with sepsis. We reduced the delay in antibiotic administration in patients with sepsis from 49 to 34 min, an improvement of 31% (15/49). The percentage of patients receiving a stat dose of antibiotics increased from 36% to 63%. While we acknowledge that there remains room for improvement with regards to antibiotic prescribing and sepsis management, we have made sustainable interventions with important improvements. E-prescribing systems must be evaluated and modified accordingly on a regular basis to ensure that they positively contribute to quality patient care and clinical practice.