How safe are electronic prescribing systems? Evaluating a simulation tool to assess the use of medication-related decision support in electronic prescribing systems in the UK

Abstract

Electronic prescribing (EP) is widely adopted in healthcare to enhance medication safety and efficiency. Evidence suggests that EP reduces medication errors and adverse drug events, though the extent of benefits can be influenced by several factors, including how the EP system was designed, implemented, customised, and adopted. The researcher considered these different challenges in Chapter 1 and highlighted the importance of optimising EP systems to maximise their benefits. A systematic review of the literature was conducted to explore tools that have been previously used to evaluate the safety of EP systems. Thirteen papers were identified that described tools that were implemented in USA, Canada, Austria, Denmark, France and Korea. (Chapter 2). No equivalent UK tool was found. To address this knowledge gap, the researcher described the development of the e-Prescribing Risk and Safety Evaluation (ePRaSE) tool in the UK and its different component parts (Chapter 3). The researcher then conducted an eDelphi study to obtain expert consensus on the level of risk associated with preventable EP events (Chapter 4). The usability and acceptability of the ePRaSE assessment was then explored using different qualitative methods (Chapter 5). Thirty-two healthcare professionals across 22 different NHS hospitals participated in semi-structured interviews (n=25) and thirteen think-aloud observations (n=20) involving 11 different EP systems. The tool was found to be useful and acceptable, with some areas for further improvement identified (Chapters 6-8). The researcher also presented quantitative results obtained from the national rollout of ePRaSE in 45 hospitals (Chapter 9). Variation in scores was observed, independent of EP system vendor and scope for improvement in EP system configuration was apparent. An overarching discussion and conclusion drawing on both qualitative and quantitative findings was presented in Chapter 10, and key recommendations made to further refine the ePRaSE assessment and help inform future research in this area.