Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p,0.001; x 2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses preintervention and 4.3% of 1139 afterwards (p = 0.005; x 2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p,0.001; x 2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; x 2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Electronic prescribing has been shown to reduce prescribing errors in US hospitals.• However we know little about its effect on prescribing quality, or its effectiveness in UK hospitals where systems for medication prescribing and supply are very different.• Hospital pharmacists already review prescriptions to both detect errors and improve prescription quality. WHAT THIS STUDY ADDS• Electronic prescribing significantly increased prescribing quality in a UK hospital, as shown by fewer pharmacists' interventions and fewer prescribing errors. • However, some new types of error were introduced.• There was relatively little overlap between prescribing errors and pharmacists' interventions, signifying their different contributions to prescribing quality.• Electronic prescribing and pharmacists' interventions should be viewed as an integrated system. AIMSTo investigate the effects of electronic prescribing (EP) on prescribing quality, as indicated by prescribing errors and pharmacists' clinical interventions, in a UK hospital. METHODSPrescribing errors and pharmacists' interventions were recorded by the ward pharmacist during a 4 week period both pre-and post-EP, with a second check by the principal investigator. The percentage of new medication orders with a prescribing error and/or pharmacist's intervention was calculated for each study period. RESULTSFollowing the introduction of EP, there was a significant reduction in both pharmacists' interventions and prescribing errors. Interventions reduced from 73 (3.0% of all medication orders) to 45 (1.9%) (95% confidence interval (CI) for the absolute reduction 0.2, 2.0%), and errors from 94 (3.8%) to 48 (2.0%) (95% CI 0.9, 2.7%). Ten EP-specific prescribing errors were identified. Only 52% of pharmacists' interventions related to a prescribing error pre-EP, and 60% post-EP; only 40% and 56% of prescribing errors resulted in an intervention preand post-EP, respectively. CONCLUSIONSEP improved the quality of prescribing by reducing both prescribing errors and pharmacists' clinical interventions. Prescribers and pharmacists need to be aware of new types of error with EP, so that they can best target their activities to reduce clinical risk. Pharmacists may need to change the way they work to complement, rather than duplicate, the benefits of EP.Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

Purpose Numerous studies have examined non-adherence to adjuvant endocrine therapy in women recovering from breast cancer, but none provides a comprehensive theory to explain the challenges of long-term medication taking and resilience needed to continue. The aim of this study was to source, appraise, and synthesize data from existing qualitative studies to develop an in-depth explanatory model of non-adherence and discontinuation of hormonal medication among breast cancer survivors. Methods A comprehensive search of databases and the literature identified 24 eligible qualitative studies published 2010–2019. Quotations (n = 801) listed within these papers and the original author interpretations were synthesized using NVivo, and grounded theory methodology. Results At the beginning, knowledge about adjuvant endocrine therapy, trust in doctors, and worries and expectations, mean agreeing to medication is the only viable option, akin to a Hobson’s choice. Thereafter, women’s ability to deal with medication side-effects, knowledge and support received affect their decision to continue, akin to a horned dilemma where giving up the medication risks cancer recurrence and continuing means reduced contentment. Women stopping medication altogether question treatment necessity, search for normalcy and prioritize quality of life. Conclusion Shared experiences and understandings were uncovered by examining commonalities in existing publications. The core category explained the difficulties women face with the initial decision to accept long-term endocrine therapy and then the everyday challenges of continuing or deciding to stop treatment early. An educational tool to inform survivors and health professionals about these challenges could potentially improve women’s experience on treatment and in turn their adherence.

OBJECTIVES  Continuing professional development (CPD) has potential to be useful in pharmacy revalidation but past uptake and attitudes to CPD in Great Britain (GB) need to be mapped. This review examines published literature to chart the participation and beliefs of pharmacy professionals towards CPD in GB in a decade that had seen a formal transition from continuing education to CPD. METHODS  A comprehensive review of the published literature was conducted to identify studies of the uptake of, or attitudes towards, CPD cross different sectors of pharmacy in GB from 2000 to 2010. KEY FINDINGS  Twenty-two studies were included and analysed, including 13 research papers, six conference papers, two news items reporting survey outcomes and one commissioned study. Eight barriers to CPD were identified as: time, financial costs and resource issues, understanding of CPD, facilitation and support for CPD, motivation and interest in CPD, attitudes towards compulsory CPD, system constraints, and technical problems. Pharmacy professionals on the whole agreed with the principle of engaging with CPD but there was little evidence to suggest widespread and wholehearted acceptance and uptake of CPD, essential for revalidation. CONCLUSIONS  If CPD is to succeed, people's beliefs and attitudes must be addressed by recognising and modifying perceived barriers through a combination of regulatory, professional, work-related and personal channels. A number of recommendations are made. Direct experience of effective CPD in the absence of perceived barriers could impact on personal development, career development and patient benefit thus strengthening personal beliefs in the value of CPD in an iterative manner.

ObjectivesTo capture people's beliefs about medicines reuse and to map the determinants of intentions to reuse medicines in the future.MethodsParticipants were recruited through an advert placed in the university's community newsletter reaching 15 000 households. Adults wishing to participate were interviewed using convenience sampling, with recruitment continuing until data saturation. Participants were interviewed face‐to‐face by two researchers using a semi‐structured interview schedule based on the theory of planned behaviour (TPB). Interview transcripts were analysed by thematic analysis, with the themes classified according to the TPB. The University's research ethics committee approval was obtained.Key findingsNineteen participants were interviewed. The potential economic and environmental benefits of medicines reuse were juxtaposed with stability and safety worries. Participants trusted pharmacists to quality‐assure returned medicines, but wondered if they had the time and storage space to dedicate to medicines reuse. Environmentalists were seen as the main proponents of medicines reuse with drug manufacturers, some taxpayers and parents seen as the main opponents. The physical characteristics of reused medicines, and quality assurance and logistics of reuse processes were seen to enable/obstruct engagement in medicines reuse. A working definition of medicines reuse as a behaviour was developed.ConclusionsPeople could potentially agree to reuse medicines if their concerns are addressed and the process is well defined and managed. This is a qualitative study with a small number of participants meaning the results may not be generalisable. The themes generated will enable a structured questionnaire to be developed for quantifying broader views.