The impact of hospital electronic prescribing systems on medication conversations: a realist review...Royal Pharmaceutical Society Annual Conference, November 7, 2025, London, United Kingdom
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All Authors
Burgin,A.
Gardner,P.
Easthall,C.
Randell,R.
LTHT Author
Burgin, Angela
LTHT Department
Medicines Management & Pharmacy Services
Clinical Pharmacy
Clinical Pharmacy
Non Medic
Advanced Clinical Pharmacist
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
Introduction: Digital systems in healthcare have well established benefits, but there can be unintended consequences and disruptions to patient care. For instance, Electronic Prescribing (EP) systems can lead to a reduction in conversations with patients about their medicines 1]. This is at odds with the medicines optimisation approach which aims to support improved and safer medicines use by understanding the patient抯 perspective 1,2]. Aim: To determine the consequences of replacing end-ofbed medication charts on hospital wards with EP systems, on communication between patients and clinicians? Why, for whom and in what contexts do these consequences occur? Methodology: A realist review was employed because it seeks to understand causation of how the subject of study works, for whom, and in what circumstances 3]. Phase 1: Theory Generation - A scoping review informed initial theory development. This was reviewed by an Expert Advisory Panel (EAP) who shared reflections, augmented and refined the theory. Phase 2: Theory Testing - Medline, Embase, CINAHL, Scopus, Web of Science were searched. Article titles and abstracts screened for relevance using inclusion and exclusion criteria. Full text screening assessed for data richness and rigour 3]. Additional reviewers screened 10% of articles at each stage, with disagreements resolved through discussion. Data was extracted and synthesised using the SEIPS 2.0 model 4] to organise contextual factors and outcomes, and Behaviour Change Theory 5] to identify behavioural responses to technology. This informed initial recommendations to improve patient involvement in medication conversations. These findings will be further refined using observation and interview data from two UK hospital case-studies � this has Health Research Authority and NHS Research Ethics Committee approval. Results: Phase 1: Theory Generation - Twenty-seven reviews were included and five themes identified; 1) practice-related impact, 2) information source, 3) environment, 4) culture and 5) staff role/task with medicines and EP. The EAP validated, added further insight, and the theme 憄atient-characteristics�. Phase 2: Theory Testing - After duplicate removal, 5,635 studies were screened for relevance, 106 underwent full-text screening, resulting in 37 studies for inclusion in the review. Theory testing identified 3 key unintended outcomes of EP use, 1) reduced patient communication and involvement in medication conversations, 2) reduced staff presence on the ward, 3) changes to day-to-day work and role. Contexts thought to trigger these outcomes included technology design and availability, organisational factors, and person factors, e.g., years� service. Behavioural mechanisms included culture, staff capability to deliver shared decision making, and patient concern questioning staff about care. Discussion: This review describes contextual factors faced by staff and patients at ward, organisation, and wider healthcare system level that influence how ward staff respond to hospital EP use, and why. The findings suggest the need to: i) redesign work processes, ii) redefine patient-centred care and behaviours in technology-rich environments and support staff to develop this skill set, iii) identify opportunities for face-toface collaboration of staff and patients for medication conversations. Strengths and limitations included researcher background as a pharmacist and clinical informatician. Insider knowledge was considered a strength but may result in data extraction and interpretation bias.
Journal
International Journal of Pharmacy Practice