A Service Evaluation of the Implementation of E-sign for Homecare Prescriptions in Secondary Care
Authors: Pothecary A , Griffiths S , Bastian L , Hill A 
Published: November 2023

Abstract

Introduction
Homecare Medicine Services allow patients with chronic conditions, reliant on specialist medicines prescribed by secondary care, to manage their symptoms at home rather than requiring regular attendance to a hospital for treatment1.
The Royal Cornwall Hospital NHS Trust (RCHT) manages over 3000 patients on homecare services across a range of specialties. Traditional homecare processes required prescriptions to be printed on paper at the hospital, signed by hand by a prescriber and then securely couriered to the homecare provider for processing. The secondary care Electronic Prescription Service (EPS) is coming but in the interim a solution was commissioned by the National Homecare Medicines Committee to improve processes, reduce administrative burden, and improve the timeliness of prescriptions for direct patient benefit. The product selected was E-sign (E-Sign (UK) Ltd) which allows prescriptions, as PDF files, to be signed with an advanced electronic signature and tracked through a managed workflow compliant with applicable legislation2.
Working collaboratively with Sciensus we introduced E-sign in March 2022. In the last year we have processed approximately 3500 prescriptions via this process. We sought to evaluate E-sign prior to wider adoption within the Trust.

Aim
To evaluate the acceptability, benefits or drawbacks of the new E-sign process for prescribers and patients.

Methods
In January 2022 (pre- implementation) we audited 100 homecare prescriptions recording the time between prescribing on our electronic prescribing system (ePMA) and collection by the Sciensus courier. Post-implementation data was gathered by comparing the time of prescribing on ePMA and time of release to Sciensus on the E-sign workflow for 142 prescriptions in May 2023. Data was analysed in Microsoft Excel and a T-test was used to test significance.
A short survey was sent to all prescriber and pharmacist users of the E-sign system (12) to evaluate the speed, flexibility and ease of use of the system.
As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required, it was registered with the Trust’s clinical audit database.

Results
There was a statistically significant (p &lt; 0.05) decrease in the average time taken for prescription transmission, from 200 hours pre-implementation to 25 hours post-implementation.
All respondents to the survey (N=8) agreed it was easier to use than the manual system and would recommend it to colleagues. Most (75%) felt the system was faster and more flexible than the paper system. 50% believed it improved the service to patients. All respondents would recommend the system to their colleagues.

Discussion/Conclusion
The E-sign system has brought benefits to prescribers and ultimately patients. Prescriptions are now transferred significantly more quickly to homecare providers, and the risk of lost prescriptions is removed. E-sign has allowed for service transformation; we now have prescribers who work entirely remotely using E-sign. Future developments will include collaborating with additional homecare providers, including a new patient workflow, and migrating to EPS when available. Study limitations were due to the sample size of prescribers available for survey.

References
1. Royal Pharmaceutical Society of Great Britain, Professional Standards for Homecare Services in England. 2013.
2. Human Medicines Regulations 2012 No 1916, Part 12, Chapter 2, Regulation 219