A mixed method service evaluation of Electronic Prescribing and Medicines Administration (EPMA) within 10 community hospitals in England
Authors: Altman I L , Holkham C , Gosrani R 
Published: November 2024

Abstract

Introduction
Electronic Prescribing and Medicines Administration (EPMA) was implemented in 13 adult inpatient wards across 10 community hospitals within one NHS community trust in England, March 2023, replacing paper drug-charts. EPMA, integrates with patients’ electronic health records, includes prescribing, administration, closed-loop supply, discharge prescribing, electronic-tasking between clinicians and provides a medicines audit trail. Laptops enable remote access.

Aim
To evaluate EPMA against expected safety, quality and efficiencies benefits, assess clinicians’ acceptance of EPMA and impact on pharmacy practice compared to paper-drug charts.

Methods
Mixed methods1 evaluation conducted in November and December 2023. This evaluation included assessing twenty-six expected multi-dimensional benefits as being achieved, partially achieved or not achieved post-EPMA implementation based on quantitative and qualitative data.
Online anonymous surveys were emailed to all eligible clinicians: prescribers, nurses and pharmacy staff working on 13 inpatient wards, containing closed and open questions, adapted according to clinical group for different aspects of EPMA including questions to assess clinicians’ acceptance of EPMA2. These data were analysed using descriptive statistics in Excel.
Pharmacy staff working on the inpatient wards and the dispensary were invited to attend separate virtual focus groups for pharmacists, pharmacy technicians and dispensary staff, respectively. These were recorded and transcribed via Microsoft Teams. Eight pharmacists, six pharmacy technicians and five dispensary staff agreed to participate. A semi-structured interview guide was used covering EPMA’s impact on practice, communication, patient safety, benefits and challenges. Thematic-analysis3 of the focus group interviews were undertaken by IA. Themes were validated with pharmacists and pharmacy technicians, respectively. The NHS Health Research Authority decision tool confirmed this evaluation was not NHS Research therefore did not require NHS ethics review or approval. Sussex Community NHS Foundation Trust approved this service evaluation.

Results
Of 26 expected multi-dimensional benefits post EPMA, 77% were achieved or partially achieved with 13% not achieved.
Thirty-seven inpatient ward clinicians responded to the survey: eight prescribers, fifteen nurses, six pharmacists and eight pharmacy technicians. This showed clinicians underutilised some functionalities, although 100% felt confident using EPMA. Overall, 81% of clinicians stated medication safety had improved with EPMA, 16% felt it was the same and 3% felt it was worse, with 92% not wanting to return to paper drug-charts. Clinicians requested further prescribing developments.
Thematic analysis identified four themes for pharmacists: maintaining visibility with prescribers, moving towards targeted interactions with prescribers but reducing opportunistic interactions, being increasingly available due to remotely accessing EPMA and improving patient safety through increased prescription checking; and three themes for pharmacy technicians: expanding role, improving workflow and enhancing communication with clinicians. The dispensary staff focus group emphasised that EPMA adversely impacted dispensary workflow.

Discussion/Conclusion
EPMA achieved some expected benefits. Clinicians have accepted EPMA, perceiving improved medication safety compared to paper-drug charts. Pharmacists are exploring ways of adapting their practice. Pharmacy technicians are enhancing their roles. Recommendations include EPMA system improvements, additional EPMA training, reviewing dispensary and pharmacists’ workflow.
EPMA needs time to embed in practice. Limitations of the evaluation included no focus groups for prescribers and nurses, and limited baseline data pre-EPMA.

References
1. Hadi MA, Alldred DP, Closs SJ, Briggs M. Mixed-methods research in pharmacy practice: recommendations for quality reporting (part 2), Int J Pharm Pract, 2014, 22 (1): 96–100
2. Yi MY, Jackson JD, Park JS, Probst JC. Understanding information technology acceptance by individual professionals: Towards an integrative view. Inf Manag J, 2006, 43: 350-363
3. Braun V, Clarke, V. Using thematic analysis in psychology. Qualitative Research in Psychology, 2006, 3 (2): 77–101