Five key recommendations for the implementation of Hospital Electronic Prescribing and Medicines Administration systems in Scotland

Cresswell, Kathrin; Slee, Ann; Sheikh, Aziz

doi:10.14236/jhi.v23i4.904

Cited by 6 publications

(8 citation statements)

References 22 publications

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“…ITP-directed therapy prescribed by general practitioners in the community to patients with post-vaccination ITP was uncommon (≤10%). The overwhelming majority of ITP-directed therapy (for example, pulsed dexamathasone, prednisolone with or without intravenous immunoglobulin, rituximab and immunosuppressants) is, however, is likely to have been initiated in the hospital setting by hematologists, but these data were not accessible to us, as hospital prescribing in Scotland remains predominantly paper based 29 . These patients with community prescribing of oral corticosteroids are likely to have had persistent ITP that was managed in primary care.…”

Section: Discussionmentioning

confidence: 99%

First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

Simpson

Shi

Vasileiou

et al. 2021

Nat Med

235

251

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Reports of ChAdOx1 vaccine–associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0–27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41–13.83), with an estimated incidence of 1.13 (0.62–1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29–3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12–1.34) 0–27 d after vaccination, with an SCCS RR of 0.97 (0.93–1.02). For hemorrhagic events 0–27 d after vaccination, the aRR was 1.48 (1.12–1.96), with an SCCS RR of 0.95 (0.82–1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.

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Section: Discussionmentioning

confidence: 99%

First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

Simpson

Shi

Vasileiou

et al. 2021

Nat Med

235

251

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“…Recommendations for implementation of CPOE have been published [ 55 , 56 ] and it is clear that socio-technical changes to interprofessional and patient communications caused by CPOE are also an outcome of CPOE implementation. Many issues are common to both CPOE and paper-based prescribing systems.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system

2020

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Background Computerised Physician Order Entry (CPOE) is considered to enhance the safety of prescribing. However, it can have unintended consequences and new forms of prescribing error have been reported. Objective The aim of this study was to explore the causes and contributing factors associated with prescribing errors reported by multidisciplinary prescribers working within a CPOE system. Main Outcome Measure Multidisciplinary prescribers experience of prescribing errors in an CPOE system. Method This qualitative study was conducted in a hospital with a well-established CPOE system. Semi-structured qualitative interviews were conducted with prescribers from the professions of pharmacy, nursing, and medicine. Interviews analysed using a mixed inductive and deductive approach to develop a framework for the causes of error. Results Twenty-three prescribers were interviewed. Six main themes influencing prescribing were found: the system, the prescriber, the patient, the team, the task of prescribing and the work environment. Prominent issues related to CPOE included, incorrect drug name picking, default auto-population of dosages, alert fatigue and remote prescribing. These interacted within a complex prescribing environment. No substantial differences in the experience of CPOE were found between the professions. Conclusion Medical and non-medical prescribers have similar experiences of prescribing errors when using CPOE, aligned with existing published literature about medical prescribing. Causes of electronic prescribing errors are multifactorial in nature and prescribers describe how factors interact to create the conditions errors. While interventions should focus on direct CPOE issues, such as training and design, socio-technical, and environmental aspects of practice remain important.

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“…79 Our study also echoes with findings that essential local needs need to be prioritised and the key activity during implementation of both standalone and multi-modular systems should be information integration whilst maximising clinical benefit. 67,74…”

Section: Discussionmentioning

confidence: 99%

Identifying strategies to overcome roadblocks to utilising near real-time healthcare and administrative data to create a Scotland-wide learning health system

Mukherjee

Cresswell²,

Sheikh

2021

Health Informatics J

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Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients’ data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts.

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Five key recommendations for the implementation of Hospital Electronic Prescribing and Medicines Administration systems in Scotland

Cited by 6 publications

References 22 publications

First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system

Identifying strategies to overcome roadblocks to utilising near real-time healthcare and administrative data to create a Scotland-wide learning health system

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