Thesis
Electronic prescribing impact on hospital pharmacy inpatient medication review prioritisation
- Creator
- Rights statement
- Awarding institution
- University of Strathclyde
- Date of award
- 2025
- Thesis identifier
- T17534
- Person Identifier (Local)
- 202058467
- Qualification Level
- Qualification Name
- Department, School or Faculty
- Abstract
- Hospital pharmacy services are engaging with methods to prioritise inpatients for pharmaceutical review in response to the increased pressure on healthcare services and workforce challenges. Hospital Electronic Prescribing and Medicines Administration (HEPMA) systems continue to be implemented in developed countries across the world as a means to reduce medication errors. Use of HEPMA data within pharmacy service patient prioritisation tools is emerging in the literature but there is limited published research around the prioritisation methods used specifically with HEPMA data, or of any ethical implications in using automated patient prioritisation tools. The aim of this thesis was to identify and describe the methods used to prioritise hospital inpatients for medication review by hospital pharmacists after HEPMA system implementation, and to identify any ethical considerations from automated patient prioritisation tool use within this process. Methods: Stage 1 - A systematic literature review was conducted in the first stage of this thesis. The review sought to identify methods of patient prioritisation by healthcare professionals (HCPs) using a HEPMA system in Medline, Embase, CINAHL and The Cochrane Library between 2012 and 2022. An evidence gap with respect to the professional ethics of using patient prioritisation methods in the hospital pharmacy service was identified in the literature review, which consequently led to the second stage of this thesis. Stage 2 - Two focus groups were conducted with 12 hospital pharmacists from a Scottish Health Board prior to the use of automated patient prioritisation (APP) to explore any ethical concerns using an ethical decision-making framework. Results: Stage 1 - Thirteen studies were identified in the systematic literature review and hospital pharmacists were confirmed as the HCP most often engaging with methods to prioritise patients. Antimicrobial teams and nurses were the other HCPs identified in the studies. Use of machine learning models (MLMs) was noted as a new and innovative way of prioritising patients by hospital pharmacists and three categories of prioritisation method were identified: HCP prioritisation using HEPMA system functionality, HEPMA data presented for HCP prioritisation and HEPMA data automatically prioritised by software. Most studies either presented HEPMA data for HCP prioritisation or used software to automatically prioritise patients for the HCP. Pharmacists were the only HCP to use automated methods of prioritisation. Stage 2 – Focus group participants agreed that APP use is a fair and pragmatic approach to managing daily workload by directing pharmacy staff to the patients most at risk of harm from prescribed medications but also highlighted ethical concerns that organisations should consider prior to adoption. Pharmacy staff must continue to use their professional judgement when using APP, avoiding an overreliance on automation to ensure that patient clinical information not included within an APP tool is included within professional prioritisation. A governance need was also identified to ensure review and update of the underpinning clinical rules of APP so it is reflective of current practice to support robust risk prioritisation. Complete visibility of high-risk patients was thought to have the potential to cause issue if a workforce does not have the capacity to meet the demand, which could have an impact on staff wellbeing. Any identification of workforce capacity limitations through APP use was considered a lever for business case development to secure further staff resource and/or service transformation. Conclusion: HEPMA systems can influence methods of patient prioritisation if they contain functionality specific for this purpose or by creating large scale electronic data sets for HCPs to engage with, which would not have been readily available prior to implementation. Ethical issues with APP can arise if pharmacy staff resource does not have capacity to review all identified high risk patients within working hours; if pharmacists use APP to prioritise patients without professional judgement there is risk that not all patient clinical information will be reviewed, and staff may lose autonomy; if APP tools are not updated to reflect current practice then there is risk of patient harm. Despite ethical concerns, use of APP brings opportunity for service evaluation and transformation.
- Advisor / supervisor
- Wall, Alexa
- Bennie, Marion
- Kurdi, Amanj
- Resource Type
- DOI
Relations
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PDF of thesis T17534 | 2025-11-18 | Public | Download |