Mills Pamela Ruth, Weidmann Anita Elaine, Stewart Derek
Pharmacy Department, University Hospital Crosshouse, Kilmarnock, Ayrshire, Scotland, KA2 0BE, UK.
School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, AB10 7GJ, UK.
Int J Clin Pharm. 2017 Dec;39(6):1320-1330. doi: 10.1007/s11096-017-0543-2. Epub 2017 Oct 26.
Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.
建议实施电子处方系统以提高患者安全和全科医生出院信息沟通。关于系统实施前后医院工作人员观点的信息匮乏。目的：探讨医院工作人员对医院电子处方与药品管理（HEPMA）系统实施前后处方和出院沟通系统的看法。地点：一家拥有560张床位的英国地区综合医院。方法：对参与处方和出院沟通流程的医院工作人员进行有目的抽样的半结构化面对面定性访谈。访谈逐字记录并使用框架法进行编码。行为方面映射到理论领域框架（TDF）以突出相关的行为改变决定因素。主要结局指标：实施前后工作人员的看法。结果：19名医院工作人员（顾问医生、初级医生、药剂师和高级护士从业者）在实施前后参与。实施前的主要主题是住院病历和出院信件设计以及出院沟通流程，存在信息难以辨认和不准确的问题。预计实施后安全性会提高。实施后的主题是住院病历清晰度和出院信件质量得到改善。实施前与工作人员行为决定因素相关的TDF领域是知识（任务或环境）；技能（能力）；社会/专业角色和身份；对能力的信念；环境背景和资源（包括事件）。实施后另外两个领域相关：社会影响和行为调节（包括自我监督）。参与者描述了实施前的挑战和患者安全问题，这些问题在实施后大多得到解决。结论：HEPMA的实施使人们认识到患者安全得到了改善。使用TDF能够对实施导致的行为改变进行分析，例如，工作人员采取行为以确保全科医生收到高质量的出院信息。
