The impact of computerised physician order entry and clinical decision support on pharmacist-physician communication in the hospital setting: A qualitative study

Abstract

BackgroundThe implementation of Computerised Physician Order Entry (CPOE) and Clinical Decision Support (CDS) has been found to have some unintended consequences. The aim of this study is to explore pharmacists and physicians perceptions of their interprofessional communication in the context of the technology and whether electronic messaging and CDS has an impact on this.MethodThis qualitative study was conducted in two acute hospitals: the University Hospitals Birmingham NHS Foundation Trust (UHBFT) and Guy’s and St Thomas’ NHS Foundation Trust (GSTH). UHBFT use an established locally developed CPOE system that can facilitate pharmacist-physician communication with the ability to assign a message directly to an electronic prescription. In contrast, GSTH use a more recently implemented commercial system where such communication is not possible. Focus groups were conducted with pharmacists and physicians of varying grades at both hospitals. Focus group data were transcribed and analysed thematically using deductive and inductive approaches, facilitated by NVivo 10.ResultsThree prominent themes emerged during the study: increased communication load; impaired decision-making; and improved workflow. CPOE and CDS were found to increase the communication load for the pharmacist owing to a reduced ability to amend electronic prescriptions, new types of prescribing errors, and the provision of technical advice relating to the use of the system. Decision-making was found to be affected, owing to the difficulties faced by pharmacists and physicians when trying to determine the context of prescribing decisions and knowledge of the patient. The capability to communicate electronically facilitated a non-interruptive workflow, which was found to be beneficial for staff time, coordination of work and for limiting distractions.ConclusionThe increased communication load for the pharmacist, and consequent workload for the physician, has the potential to impact on the quality and coordination of care in the hospital setting. The ability to communicate electronically has some benefits, but functions need to be designed to facilitate collaborative working, and for this to be optimised through interprofessional training.

The Use of a Decision Support System in Swedish Pharmacies to Identify Potential Drug-Related Problems—Effects of a National Intervention Focused on Reviewing Elderly Patients’ Prescriptions

“…Some unintended consequences of the implementation of CDSSs have been described, for example, increased pharmacist–physician communication load [ 53 ]. Research has also shown the need for improvement of many aspects of CDSSs such as usability [ 40 ].…”

Electronic prescribing in paediatric secondary care: are harmful errors prevented?

“…For each order, sites were asked to state whether or not the order could be placed or if it was not applicable, for example when the order related to a drug that was prescribed on paper at their site. In addition sites were asked to record the levels of CDS provided for each order using one of five descriptors in Table 1 20. No specific instructions were provided as to how to simulate the orders.…”

The impact of electronic prescribing systems on healthcare professionals’ working practices in the hospital setting: a systematic review and narrative synthesis

“…Of the 25 studies, seven were from the UK [10–16], four from the US [17–20], four from the Netherlands [21–24], three from France [25–27], two from Australia [28, 29], two from Saudi Arabia [30, 31] and one each from Denmark [32], Spain [33] and Iran [34]. Nineteen studied commercial systems, one a home-grown system [25], one both a commercial and a home grown [15] system and for four studies it was not possible to establish the system type [11, 30, 31, 34]. Nineteen studies referred to their electronic systems as CPOE, and among these, three specified that the system was for prescribing medication only [22–24].…”

“…Twelve papers highlighted the impact of eP systems on HCPs’ communication among professions. Two reported a positive impact on HCPs [17, 20], two reported no significant difference [27, 29], three reported a negative impact [22, 23, 26] and five reported a preference for verbal communication over electronic [11, 15, 21, 25, 31]. Two specifically reported a positive impact on doctor-nurse communication since introduction of eP [17, 20].…”

“…Two studies revealed that both medical and nursing staff preferred verbal communication rather than communication through an eP system [21, 31]; this view was further supported in interviews conducted with doctors and pharmacists [15]. Nurses reported that they always supplemented eP communication with a phone call to confirm medication orders, which they perceived to add to their workload [21, 31].…”