Publications
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Garfield S, Furniss D, Husson F, et al., 2018, Use of patient-held information about medication (PHIMed) to support medicines optimisation: protocol for a mixed-methods descriptive study, BMJ OPEN, Vol: 8, ISSN: 2044-6055
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- Citations: 1
Furniss D, Lyons I, Franklin BD, et al., 2018, Procedural and documentation variations in intravenous infusion administration: a mixed methods study of policy and practice across 16 hospital trusts in England, BMC Health Services Research, Vol: 18, ISSN: 1472-6963
Background:Procedural and documentation deviations relating to intravenous (IV) infusion administration can have important safety consequences. However, research on such deviations is limited. To address this we investigated the prevalence of procedural and documentation deviations in IV infusion administration and explored variability in policy and practice across different hospital trusts.Methods:We conducted a mixed methods study. This involved observations of deviations from local policy including quantitative and qualitative data, and focus groups with clinical staff to explore the causes and contexts of deviations. The observations were conducted across five clinical areas (general medicine, general surgery, critical care, paediatrics and oncology day care) in 16 National Health Service (NHS) trusts in England. All infusions being administered at the time of data collection were included. Deviation rates for procedural and documentation requirements were compared between trusts. Local data collectors and other relevant stakeholders attended focus groups at each trust. Policy details and reasons for deviations were discussed.Results:At least one procedural or documentation deviation was observed in 961 of 2008 IV infusions (deviation rate 47.9%; 95% confidence interval 45.5–49.8%). Deviation rates at individual trusts ranged from 9.9 to 100% of infusions, with considerable variation in the prevalence of different types of deviation. Focus groups revealed lack of policy awareness, ambiguous policies, safety and practicality concerns, different organisational priorities, and wide variation in policies and practice relating to prescribing and administration of IV flushes and double-checking.Conclusions:Deviation rates and procedural and documentation requirements varied considerably between hospital trusts. Our findings reveal areas where local policy and practice do not align. Some policies may be impractical and lack utility. We suggest clearer evidence-ba
Faiella G, Parand A, Franklin BD, et al., 2018, Expanding healthcare failure mode and effect analysis: A composite proactive risk analysis approach, RELIABILITY ENGINEERING & SYSTEM SAFETY, Vol: 169, Pages: 117-126, ISSN: 0951-8320
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- Citations: 51
Parand A, Faiella G, Franklin BD, et al., 2018, A prospective risk assessment of informal carers' medication administration errors within the domiciliary setting, ERGONOMICS, Vol: 61, Pages: 104-121, ISSN: 0014-0139
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- Citations: 16
Lichtner V, Westbrook J, Franklin BD, 2018, Pharmacy Interweaving Safety Within Hospital Health Information Technology, CONNECTING THE SYSTEM TO ENHANCE THE PRACTITIONER AND CONSUMER EXPERIENCE IN HEALTHCARE, Vol: 252, Pages: 105-111, ISSN: 0926-9630
Ocloo J, Garfield S, Dawson S, et al., 2017, Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a protocol for a systematic review of reviews, BMJ Open, Vol: 7, Pages: 1-6, ISSN: 2044-6055
Introduction The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients and their relatives have emerged as a result of clinical failings in the NHS, challenging paternalistic healthcare, which have led to a new focus on PPI in quality and safety, nationally and internationally. Evidence suggests that PPI within patient safety is often atheoretical and located within a biomedical discourse. This review will explore the literature on PPI across patient safety, healthcare and social care to identify theory, barriers and enablers that can be used to develop PPI in patient safety.Methods and analysis Systematic searches of three electronic bibliographic databases will be conducted, using both MeSH and free-text terms to identify empirical literature published from database inception to May 2017. The screening process will involve input from at least two researchers and any disagreement will be resolved through discussion with a third reviewer. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Data extraction from included articles will be conducted by at least two researchers using a data extraction form. Extracted information will be analysed using a narrative review approach, which synthesises data using a descriptive method.Ethics and Dissemination No ethical approval is required for this review as no empirical data were collected. We believe that the findings and recommendations from this review will be particularly relevant for an audience of academics and policymakers. The findings will, therefore, be written up and disseminated in international peer-reviewed journals and academic conferences with a health focus. They will also be disseminated to leading health policy organisations in the NHS, such as NHS England and NHS Improvement and national policy bodies such as the Health Foundation.
Rafferty AM, Franklin BD, 2017, Interruptions in medication administration: are we asking the right questions?, BMJ Quality and Safety, Vol: 26, Pages: 701-703, ISSN: 2044-5415
Jheeta S, Franklin BD, 2017, The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study, BMC Health Services Research, Vol: 17, ISSN: 1472-6963
BackgroundThe aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices.MethodsThe study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses’ medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend.ResultsObservations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3–6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9–5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1–2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8–4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications.ConclusionsFindings suggest no change in medication error rate, alth
Geeson C, Wei L, Franklin BD, 2017, Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to improve patient outcomes. Protocol for an observational study, BMJ Open, Vol: 7, ISSN: 2044-6055
Introduction Medicines optimisation is a key role for hospital pharmacists, but with ever-increasing demands on services there is a need to increase efficiency while maintaining patient safety. The aim of this study is to develop a prognostic model, the Medicines Optimisation Assessment Tool (MOAT), which can be used to target patients most in need of pharmacists' input while in hospital.Methods and analysis The MOAT will be developed following recommendations of the Prognosis Research Strategy partnership. Using a cohort study we will prospectively include 1500 adult patients from the medical wards of two UK hospitals. Data on medication-related problems (MRPs) experienced by study patients will be collected by pharmacists at the study sites as part of their routine daily clinical assessment of patients. Data on potential risk factors such as polypharmacy, renal impairment and the use of 'high risk' medicines will be collected retrospectively from the information departments at the study sites, laboratory reporting systems and patient medical records. Multivariable logistic regression models will then be used to determine the relationship between potential risk factors and the study outcome of preventable MRPs that are at least moderate in severity. Bootstrapping will be used to adjust the MOAT for optimism, and predictive performance will be assessed using calibration and discrimination. A simplified scoring system will also be developed, which will be assessed for sensitivity and specificity.Ethics and dissemination This study has been approved by the Proportionate Review Service Sub-Committee of the National Health Service Research Ethics Committee Wales REC 7 (16/WA/0016) and the Health Research Authority (project ID 197298). We plan to disseminate the results via presentations at relevant patient/public, professional, academic and scientific meetings and conferences, and will submit findings for publication in peer-reviewed journals.
Black A, Courtenay M, Gage H, et al., 2017, A COMPARISON OF THE CLINICAL SAFETY OF INDEPENDENT NURSE PRESCRIBING (INP) AND USE OF PATIENT GROUP DIRECTIONS (PGDS) BY NURSES IN UK SEXUAL HEALTH CLINICS, Publisher: BMJ PUBLISHING GROUP, Pages: A56-A56, ISSN: 1368-4973
Black A, Courtenay M, Gage H, et al., 2017, A COMPARISON OF DEMOGRAPHIC CHARACTERISTICS AND WORKLOADS OF INDEPENDENT NURSE PRESCRIBERS (INP) AND NURSES USING PATIENT GROUP DIRECTIONS (PGDS) IN SEXUAL HEALTH CLINICS, Publisher: BMJ PUBLISHING GROUP, Pages: A60-A60, ISSN: 1368-4973
Black A, Courtenay M, Gage H, et al., 2017, PATIENTS' SATISFACTION WITH MEDICATION INFORMATION PROVIDED BY NURSES USING INDEPENDENT NURSE PRESCRIBING (INP) OR PATIENT GROUP DIRECTIONS (PGDS) IN UK SEXUAL HEALTH SERVICES, Publisher: BMJ PUBLISHING GROUP, Pages: A56-A56, ISSN: 1368-4973
Car J, Tan WS, Huang Z, et al., 2017, eHealth in the future of medications management: personalisation, monitoring and adherence, BMC Medicine, Vol: 15, ISSN: 1741-7015
Background: Globally, healthcare systems face major challenges with medicines management and medicationadherence. Medication adherence determines medication effectiveness and can be the single most effectiveintervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, weexplore the role of eHealth in the patients’ medicines management journey in primary care, focusing on personalisationand intelligent monitoring for greater adherence.Discussion: eHealth offers opportunities to transform every step of the patient’s medicines management journey.From booking appointments, consultation with a healthcare professional, decision-making, medication dispensing,carer support, information acquisition and monitoring, to learning about medicines and their management in daily life.It has the potential to support personalisation and monitoring and thus lead to better adherence. For some of thesedimensions, such as supporting decision-making and providing reminders and prompts, evidence is stronger, but formany others more rigorous research is urgently needed.Conclusions: Given the potential benefits and barriers to eHealth in medicines management, a fine balance needs tobe established between evidence-based integration of technologies and constructive experimentation that could leadto a game-changing breakthrough. A concerted, transdisciplinary approach adapted to different contexts, includinglow- and middle-income contries is required to realise the benefits of eHealth at scale.
Micallef C, Chaudhry NT, Holmes AH, et al., 2017, Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 1880-1885, ISSN: 1460-2091
Background: Electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems are increasingly common. A potential benefit is the extensive data in these systems that could be used to support antimicrobial stewardship, but there is little information on how such data are currently used to support the quality and safety of antimicrobial use.Objectives: To summarize the literature on secondary use of data (SuD) from EP and EHP systems to support quality and safety of antimicrobial use, to describe any barriers to secondary use and to make recommendations for future work in this field.Methods: We conducted a systematic search within four databases; we included original research studies that were (1) based on SuD from hospital EP or EHP systems and (2) reported outcomes relating to quality and/or safety of antimicrobial use and/or qualitative findings relating to SuD in this context.Results: Ninety-four full-text articles were obtained; 14 met our inclusion criteria. Only two described interventions based on SuD; seven described SuD to evaluate other antimicrobial stewardship interventions and five described descriptive or exploratory studies of potential applications of SuD. Types of data used were quantitative antibiotic usage data (n = 9 studies), dose administration data (n = 4) and user log data from an electronic dashboard (n = 1). Barriers included data access, data accuracy and completeness, and complexity when using data from multiple systems or hospital sites.Conclusions: The literature suggests that SuD from EP and EHP systems is potentially useful to support or evaluate antimicrobial stewardship activities; greater system functionality would help to realize these benefits.
Holmes AH, Boyd SE, Moore LSP, et al., 2017, Obtaining antibiotics online from within the UK: a cross-sectional study, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091
Cornford T, Lichtner V, Dickson J, et al., 2017, Delivering Digital Drugs: An Exploratory Study of the Digitalisation of Supply and Use of Medicines.
Medicines' supply and use is incresingly reliant on digital means and information. This poster presents exploratory research over five episodes of digitalisation of medicines across the supply network. We 'follow the drug' through this emerging field, providing an initial map of this new territory.
Parand A, Garfield S, Vincent C, et al., 2016, Carers’ medication administration errors in the domiciliary setting: a systematic review, PLOS One, Vol: 11, ISSN: 1932-6203
PURPOSE Medications are mostly taken in patients’ own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs) within the patient’s home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them. METHODS A narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment.RESULTS Thirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age), environmental factors (e.g. storage), medication factors (e.g. number of medicines), prescription communication factors (e.g. comprehensibility of instructions), psychosocial factors (e.g. carer-to-carer communication), and care-recipient factors (e.g. recipient age). The few interventions effective in preventing MAEs involved carer training and tailored equipment. CONCLUSION This review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors w
Tudor Car L, Papachristou N, Gallagher J, et al., 2016, Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study, BMC Family Practice, Vol: 17, ISSN: 1471-2296
Background: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care.Methods: We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of ¬48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014.Results: The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score.Conclusions: Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIO
Garfield S, Franklin BD, 2016, Understanding models of error in clinical practice, Pharmaceutical Journal, Vol: 296, Pages: 361-364, ISSN: 0031-6873
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Furniss D, Iacovides I, Lyons I, et al., 2016, Patient and public involvement in patient safety research: a workshop to review patient information, minimise psychological risk and inform research., Research Involvement and Engagement, Vol: 2, ISSN: 2056-7529
PLAIN ENGLISH SUMMARY: Patient safety is a growing research area. However, although patients and the public are increasingly involved in clinical research, there is little guidance on how best to involve patients in patient safety research. Here we focus on how patients can contribute to the design of patient safety research. We conducted a workshop with patients as part of a project exploring errors and safety in the delivery of intravenous medication (medication given via a vein). The workshop was designed to explore how best to engage with hospital inpatients about these issues, to generate research topics, and to inform researchers about patients' experiences. Nine patients participated, each of whom had previously received intravenous medication. Participants advised against using terms such as 'error'; they also advocated caution when using terms such as 'safety' when describing the study to patients as this may worry some who had not thought about these issues before. We received thorough and useful feedback on our patient information sheets to ensure they were clear and understandable to patients. Patients also shared rich experiences with us about their treatment, which emphasised the need to extend our research focus to include a wider range of factors affecting quality and safety. ABSTRACT: Background Patient safety has attracted increasing attention in recent years. This paper explores patients' contributions to informing patient safety research at an early stage, within a project on intravenous infusion errors. Currently, there is little or no guidance on how best to involve patients and the wider public in shaping patient safety research, and indeed, whether such efforts are worthwhile. Method We ran a 3-hour workshop involving nine patients with experience of intravenous therapy in the hospital setting. The first part explored patients' experiences of intravenous therapy. We derived research questions from the resulting discussion through qualitative
Ahmed Z, Garfield S, Jani Y, et al., 2016, Impact of electronic prescribing on patient safety in hospitals: Implications for the UK, Clinical Pharmacist, Vol: 8, ISSN: 1758-9061
NHS hospitals in England are expected to be paperless by 2020 as set out in a comprehensive framework published by the National Information Board. The use of hospital electronic prescribing (EP) systems is therefore likely to increase rapidly in the near future. The aim of this review is to summarise the available evidence of the impact of inpatient EP on patient safety, with a focus on implications for the UK. MEDLINE and EMBASE were searched to identify systematic and narrative reviews published between 2000 and 2015 that examined the effects of EP on safety-related outcome measures. A total of ten reviews were identified. The evidence for the effects of EP on medication errors, adverse drug events, workflow, and healthcare professional communication are discussed, as are the potential unintended consequences and how they can be identified and mitigated. The review concludes with considerations of the evolution of EP in healthcare, especially in relation to advances in health information technology, inpatient involvement with their medication in the context of EP, and how EP may be used by policymakers and end users to further benefit patient safety.
Garfield S, Jheeta S, Husson F, et al., 2016, The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study, PLOS ONE, Vol: 11, ISSN: 1932-6203
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Franklin BD, 2016, 'Smart' intravenous pumps: how smart are they?, BMJ Quality & Safety, Vol: 26, Pages: 93-94, ISSN: 2044-5423
Reynolds M, Jheeta S, Benn J, et al., 2016, Improving feedback on junior doctors’ prescribing errors: mixed methods evaluation of a quality improvement project, BMJ Quality & Safety, Vol: 26, Pages: 240-247, ISSN: 2044-5423
Background Prescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation. Aim To reduce prescribing errors in a UK hospital by improving feedback on prescribing errors. Interventions We developed three linked interventions using plan*do*study*act cycles: (1) name*stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to feed back to doctors on individual prescribing errors; (3) fortnightly prescribing advice emails that addressed a common and/or serious error. Implementation and evaluation Interventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctor s stated their name. Outcome measures were junior doctors’ and pharmacists’ perceptions of current feedback provision (evaluated using quantitative pre*post questionnaires and qualitative focus groups), and the prevalence of erroneous medication orders written by junior doctors between August and December 2013.
Blandford A, Furniss D, Lyons I, et al., 2016, Exploring the current landscape of intravenous infusion practices and errors (ECLIPSE): protocol for a mixedmethods observational study, BMJ Open, Vol: 6, ISSN: 2044-6055
Introduction: Intravenous medication is essential for many hospital inpatients. However, providing intravenous therapy is complex and errors are common. 'Smart pumps' incorporating dose error reduction software have been widely advocated to reduce error. However, little is known about their effect on patient safety, how they are used or their likely impact. This study will explore the landscape of intravenous medication infusion practices and errors in English hospitals and how smart pumps may relate to the prevalence of medication administration errors. Methods and analysis: This is a mixed-methods study involving an observational quantitative point prevalence study to determine the frequency and types of errors that occur in the infusion of intravenous medication, and qualitative interviews with hospital staff to better understand infusion practices and the contexts in which errors occur. The study will involve 5 clinical areas (critical care, general medicine, general surgery, paediatrics and oncology), across 14 purposively sampled acute hospitals and 2 paediatric hospitals to cover a range of intravenous infusion practices. Data collectors will compare each infusion running at the time of data collection against the patient's medication orders to identify any discrepancies. The potential clinical importance of errors will be assessed. Quantitative data will be analysed descriptively; interviews will be analysed using thematic analysis. Ethics and dissemination: Ethical approval has been obtained from an NHS Research Ethics Committee (14/SC/0290); local approvals will be sought from each participating organisation. Findings will be published in peer-reviewed journals and presented at conferences for academic and health professional audiences. Results will also be fed back to participating organisations to inform local policy, training and procurement. Aggregated findings will inform the debate on costs and benefits of the NHS investing in smart pump technology
Garfield S, Jheeta S, Husson F, et al., 2016, Lay involvement in the analysis of qualitative data in health services research: a descriptive study., Res Involv Engagem, Vol: 2
PLAIN ENGLISH SUMMARY: There is a consensus that patients and the public should be involved in research in a meaningful way. However, to date, lay people have been mostly involved in developing research ideas and commenting on patient information.We previously published a paper describing our experience with lay partners conducting observations in a study of how patients in hospital are involved with their medicines. In a later part of the same study, lay partners were also involved in analysing interviews that a researcher had conducted with patients, carers and healthcare professionals about patient and carer involvement with medicines in hospital. We therefore wanted to build on our previous paper and report on our experiences with lay partners helping to conduct data analysis. We therefore interviewed the lay members and researchers involved in the analysis to find out their views.Both lay members and researchers reported that lay partners added value to the study by bringing their own perspectives and identifying further areas for the researcher to look for in the interviews. In this way researchers and lay partners were able to work together to produce a richer analysis than would have been possible from either alone. ABSTRACT: Background It is recognised that involving lay people in research in a meaningful rather than tokenistic way is both important and challenging. In this paper, we contribute to this debate by describing our experiences of lay involvement in data analysis.Methods We conducted semi-structured interviews with the lay partners and researchers involved in qualitative data analysis in a wider study of inpatient involvement in medication safety. The interviews were transcribed verbatim and coded using open thematic analysis.Results We interviewed three lay partners and the three researchers involved. These interviews demonstrated that the lay members added value to the analysis by bringing their own perspectives; these were systematically integ
Ahmed Z, Barber N, Jani Y, et al., 2015, Economic impact of electronic prescribing in the hospital setting: A systematic review, International Journal of Medical Informatics, Vol: 88, Pages: 1-7, ISSN: 1872-8243
ObjectiveTo examine evidence on the economic impact of electronic prescribing (EP) systems in the hospital setting.MethodWe conducted a systematic search of MEDLINE, EMBASE, PsycINFO, International Pharmaceutical Abstracts, the NHS Economic Evaluation Database, the European Network of Health Economic Evaluation Database and Web of Science from inception to October 2013. Full and partial economic evaluations of EP or computerized provider order entry were included. We excluded studies assessing prescribing packages for specific drugs, and monetary outcomes that were not related to medicines. A checklist was used to evaluate risk of bias and evidence quality.ResultsThe search yielded 1160 articles of which three met the inclusion criteria. Two were full economic evaluations and one a partial economic evaluation. A meta-analysis was not appropriate as studies were heterogeneous in design, economic evaluation method, interventions and outcome measures. Two studies investigated the financial impact of reducing preventable adverse drug events. The third measured savings related to various aspects of the system including those related to medication. Two studies reported positive financial effects. However the overall quality of the economic evidence was low and key details often not reported.DiscussionThere seems to be some evidence of financial benefits of EP in the hospital setting. However, it is not clear if evidence is transferable to other settings. Research is scarce and limited in quality, and reported methods are not always transparent. Further robust, high quality research is required to establish if hospital EP is cost effective and thus inform policy makers’ decisions.
Launders H, Jacklin A, Franklin BD, 2015, Allergy transcription before and after the implementation of an inpatient electronic prescribing system in a tertiary referral hospital: a case study in two oncology wards, Safety in Health, Vol: 1, ISSN: 2056-5917
Background Patients with allergies can be protected from potentially life threatening harm by recording their allergen and reaction correctly. Electronic prescribing is being widely implemented with a view to improving patient safety; decision support functions can alert prescribers to the risk of prescribing an allergen. However the allergen must be correctly recorded to utilize this functionality. This study aimed to explore whether the introduction of an inpatient electronic prescribing system, in place of paper-based prescribing, has affected the accuracy of transfer of allergen data between hospital documentation systems.Methods Retrospective case note review of a random sample of 100 patients admitted to two oncology wards in a UK hospital before implementation of electronic prescribing, and 100 admitted afterwards. We compared accuracy of allergy information transcribed from admission documentation to the inpatient prescribing system and then to the separate electronic discharge summary for paper-based versus electronic inpatient prescribing. We analyzed data separately for patients with no known drug allergy and those with a recorded allergen.Results There was no difference between prescribing systems in the transfer of ‘no known drug allergy’ status from the admission documentation to the inpatient prescribing record. However transfer of ‘no known drug allergy’ status was better on electronic discharge summaries prepared from the separate electronic inpatient system (transferred correctly for 58 of 72 discharges, 81%) when compared with paper inpatient prescriptions (26 of 68 patient discharges, 38%) p<0.001.For patients with an allergy the correct transfer of allergens from admission documentation to the inpatient prescribing record was lower for the electronic prescribing system (10 of 28 patient admissions, 36%) when compared with paper prescribing (21 of 32 patient admissions, 66%) p=0.02. However correct transfer of aller
Powell N, Franklin BD, Jacklin A, et al., 2015, Omitted doses as an unintended consequence of a hospital restricted antibacterial system: a retrospective observational study, Journal of Antimicrobial Chemotherapy, Vol: 70, Pages: 3379-3383, ISSN: 1460-2091
Objective: To determine the frequency of omitted doses of antibacterial agents and explore a number of risk factors, including the effect of a restricted antibacterial system. Methods: Antibacterial data were extracted from a hospital electronic prescribing and medication administration system for the period 1 January to 30 April 2014. Percentage dose omission rates were calculated. Omission rates for the first dose of antibacterial courses were analysed using logistic regression to identify any correlation between first dose omission rates and potential risk factors including the antibacterials’ restriction status and whether or not they were ward stock. Results: 90,761 antibacterial doses were included. Of these, 6,535 (7.2%) were documented as having been omitted; 847 (0.9% of 90,761) due to medication being unavailable. Non-restricted, ward stock antibacterials had the lowest frequency of omission with 6.2% (271 of 4,391) first doses omitted. The prevalence was 10.4% (27 of 260) for restricted, ward stock antibacterials (OR = 1.6, 95% CI: 1.0 – 2.4, p = 0.027), and 15.5% (53 of 341) for non-restricted, non-ward stock antibacterials (OR = 2.7, 95% CI: 2.0 – 3.7, p = <0.001). Restricted, non-ward stock antibacterials had the highest frequency of 30.7% (71 of 231; OR = 6.2, 95% CI: 4.5 to 8.4, p = <0.001). Conclusions: Antibacterials not stocked in clinical areas were significantly more likely to be omitted. The prevalence of omitted doses increased further if the antibiotic was also restricted. To achieve safe effective antimicrobial use, a balance is needed between promoting antimicrobial stewardship and preventing unintended omitted doses.
McLeod M, Barber N, Franklin BD, 2015, Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses' Medication Administration Processes and Systems (the MAPS Study)., PLOS One, Vol: 10, Pages: e0128958-e0128958, ISSN: 1932-6203
CONTEXT: Research has documented the problem of medication administration errors and their causes. However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety. AIM: To identify system factors that facilitate and/or hinder successful medication administration focused on three inter-related areas: nurse practices and workarounds, workflow, and interruptions and distractions. METHODS: We used a mixed-methods ethnographic approach involving observational fieldwork, field notes, participant narratives, photographs, and spaghetti diagrams to identify system factors that facilitate and/or hinder successful medication administration in three inpatient wards, each from a different English NHS trust. We supplemented this with quantitative data on interruptions and distractions among other established medication safety measures. FINDINGS: Overall, 43 nurses on 56 drug rounds were observed. We identified a median of 5.5 interruptions and 9.6 distractions per hour. We identified three interlinked themes that facilitated successful medication administration in some situations but which also acted as barriers in others: (1) system configurations and features, (2) behaviour types among nurses, and (3) patient interactions. Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'. The former contributed to a more streamlined workflow with fewer interruptions while the latter seemed to empower patients to act as a defence barrier against medication errors by being: (1) an active resource of information, (2) a passive information resource, and/or (3) a 'double-checker'. CONCLUS
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