Combining research and design: A mixed methods approach aimed at understanding and optimising inpatient medication storage systems.

Background: Almost every patient admitted to hospital will receive medication during their stay. Medication errors are an important cause of patient morbidity and mortality, as well as an economic burden for healthcare institutions. Research suggests that current methods of storing medication on hospital wards are not fit for purpose, contributing to inefficiency and error.

The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.

Background: Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting.

Improving feedback on junior doctors' prescribing errors: mixed-methods evaluation of a quality improvement project.

Background: Prescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation.

Omitted doses as an unintended consequence of a hospital restricted antibacterial system: a retrospective observational study.

Objectives: The objective of this study was to determine the frequency of omitted doses of antibacterial agents and explore a number of risk factors, including the effect of a restricted antibacterial system.

Methods: Antibacterial data were extracted from a hospital electronic prescribing and medication administration system for the period 1 January to 30 April 2014. Percentage dose omission rates were calculated.

Patient and public involvement in data collection for health services research: a descriptive study.

Plain English Summary: There is a consensus that patients and the public should be involved in research in a meaningful way. To date, lay people have been mostly involved in developing research ideas and commenting on patient information but not as much in actual data collection. We have had firsthand experience with lay people helping to conduct a study on how patients in hospital are involved with their medicines.

A descriptive exploratory study of how admissions caused by medication-related harm are documented within inpatients' medical records.

Background: Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions.

The use and functionality of electronic prescribing systems in english acute NHS trusts: a cross-sectional survey.

Objectives: To describe current use of electronic prescribing (EP) in English acute NHS hospital trusts, and the use of multiple EP systems within the same hospital.

Design: Descriptive cross-sectional postal survey.

Setting: Acute NHS hospital trusts in England.

Feedback on prescribing errors to junior doctors: exploring views, problems and preferred methods.

Background: Prescribing errors are common in hospital inpatients. However, the literature suggests that doctors are often unaware of their errors as they are not always informed of them. It has been suggested that providing more feedback to prescribers may reduce subsequent error rates.

The evaluation of a novel model of providing ward pharmacy services.

Background: In UK hospitals, traditional ward pharmacy services involve pharmacists visiting their wards once or twice a day each weekday. However, to provide a more patient orientated ward pharmacy service, we developed the Imperial Model of Ward Pharmacy. This is based on pharmacists seeing every drug chart every other day, allowing increased focus towards patients' needs on other days.

The use of a consultant-led ward round checklist to improve paediatric prescribing: an interrupted time series study.

Unlabelled: A Check and Correct checklist has previously been developed to increase feedback on prescribing quality and enhance physicians' focus on patients' drug charts during ward rounds. Our objective was to assess the impact of introducing such a prescribing checklist on the quality and safety of inpatient prescribing in two paediatric wards in a London teaching hospital. Between 15 March 2011 and 15 May 2011 (pre-intervention) and between 23 May 2011 and 23 July 2011 (post-intervention), we recorded rates of both technical prescription writing errors and clinical prescribing errors twice a week.

Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in "early adopter" hospitals.

Objectives: To evaluate the implementation and adoption of the NHS detailed care records service in "early adopter" hospitals in England.

Design: Theoretically informed, longitudinal qualitative evaluation based on case studies.

Setting: 12 "early adopter" NHS acute hospitals and specialist care settings studied over two and a half years.

Including pharmacists on consultant-led ward rounds: a prospective non-randomised controlled trial.

This study aimed to compare interventions made by pharmacists attending consultant-led ward rounds in addition to providing a ward pharmacy service, with those made by pharmacists providing a word pharmacy service alone. A prospective non-randomised controlled study on five inpatient medical wards was carried out at two teaching hospitals. A mean of 1.

Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes.

Aim: To compare the prevalence and causes of prescribing errors in newly written medication orders and how quickly they were rectified, in three NHS organisations.

Methods: Errors in newly written inpatient and discharge medication orders were recorded in Spring/Summer 2009 by ward pharmacists on medical admissions and surgical wards, as well as the number of erroneous doses administered (or omitted) before errors were corrected. Logistic regression analysis was used to explore the effects of ward (nested within organisation) and clinical specialty, and whether the pharmacist had checked the patient's medication history during data collection.

A quality improvement programme to increase compliance with an anti-infective prescribing policy.

Objectives: The UK Department of Health has made recommendations on safe and appropriate prescribing of anti-infectives. In response, we reviewed our anti-infective policies to ensure they were in line with best practice. As a result, a new adult anti-infective policy was launched.

Using discrete event simulation to design a more efficient hospital pharmacy for outpatients.

We present the findings of a discrete event simulation study of the hospital pharmacy outpatient dispensing systems at two London hospitals. Having created a model and established its face validity, we tested scenarios to estimate the likely impact of changes in prescription workload, staffing levels and skill-mix, and utilisation of the dispensaries' automatic dispensing robots. The scenarios were compared in terms of mean prescription turnaround times and percentage of prescriptions completed within 45 min.

Learning lessons from electronic prescribing implementations in secondary care.

This paper reports a study undertaken in the UK to gather lessons learned from hospital sites that have implemented electronic prescribing systems. The work was commissioned by NHS Connecting for Health, the UK Department of Health agency responsible for the implementation of the National Programme for Information Technology. The aim was to capture front-line experience of the project and systems implementation, and to share it with staff who will in the future participate in other implementations.

Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation.

Objectives: To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service.

Design: A mixed methods, longitudinal, multisite, socio-technical case study.

Setting: Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete.

Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions.

Purpose: To compare four methods of detecting prescribing errors (PE) in the same patient cohorts before and after an intervention (computerised physician order entry; CPOE) and to determine whether the impact of CPOE is identified consistently by all methods.

Methods: PEs were identified using (1) prospective detection by ward pharmacist; (2) retrospective health record review; (3) retrospective use of a trigger tool and (4) spontaneous reporting over two separate 4-week periods on one surgical ward in a UK teaching hospital.

Results: We reviewed 93 patients pre- and 114 post-CPOE.

The contribution of a pharmacy admissions service to patient care.

The aim of this study was to determine the impact of two specialised admissions pharmacists on an acute medical admissions ward. For a one-week period, contributions made to the medical post-take ward round (PTWR), the number of drug histories taken and interventions made as a result, and the availability of medication needed on discharge were documented. An average of 1.

Improving practice--working together to improve the use of antimicrobials.

The Hospital Pharmacy Initiative was a Department of Health funded programme in England between 2003 and 2006. It has produced a number of benefits that are organizational, educational, professional, clinical and economic. The opportunity to share experiences, identify what works well and collaborate across national boundaries to address a problem that is taxing all governments and NHS acute trusts and causes considerable concern to patients and their families should be a common goal for the UK.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time.

Design, Setting And Participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward.

Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system.

The effects of electronic prescribing on the quality of prescribing.

What Is Already Known About This Subject: Electronic prescribing has been shown to reduce prescribing errors in US hospitals. However we know little about its effect on prescribing quality, or its effectiveness in UK hospitals where systems for medication prescribing and supply are very different. Hospital pharmacists already review prescriptions to both detect errors and improve prescription quality.

Providing feedback to hospital doctors about prescribing errors; a pilot study.

Objective: To assess the feasibility and acceptability of obtaining data on prescribing error rates in routine practice, and presenting feedback on such errors to medical staff.

Setting: One clinical directorate of a London teaching trust.

Methods: Ward pharmacists recorded all prescribing errors identified in newly written medication orders on one day each fortnight between February and May 2005.