Developing an intervention to enhance inpatient participation in medication safety in the context of electronic prescribing

Known as IMPRESS (Inpatient Medication, Patient Relationships and Electronic SystemS), this study focussed on understanding inpatient engagement with their medication and the effect of paper-based vs electronic medication records on this, before going on to identify potential interventions to improve safety in this area.

Further information about the project

Inpatient medication errors are a significant concern. An approach not widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing (EP) is becoming increasingly prevalent in the hospital setting. The IMPRESS study aimed to explore how hospital inpatients engaged with medication safety-related behaviours in two UK hospital trusts, the facilitators and barriers to this engagement, the impact of EP, and potential interventions to increase inpatient engagement with medication safety. 

The researchers conducted ethnographic observations and interviews in the two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during the course of the study. Researchers and lay volunteers observed nurses’ medication administration rounds, pharmacists’ ward rounds, doctor-led ward rounds and drug history taking. Researchers also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Following this, the researchers presented their findings to a public panel plus a series of stakeholder groups to identify potential interventions to facilitate patient involvement in their medication safety.

Throughout the project, a patient and clinician engagement group were closely involved. Lay members play a critical role within the project team and were involved in data collection, analysis and dissemination of findings.

The researchers and their lay partners found that neither paper-based nor electronic medication records were routinely shown to inpatients by healthcare professionals. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside.  However, both patients and healthcare professionals were of the view that either patients should be involved in these discussions, or they should be held away from patients. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggested that there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professionals’ beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture.

Patients and carers seemed unaware of many of the initiatives that are already in place to help inpatients be involved with their medication, such as discussion with ward pharmacists and self-administration of medication. This suggests that these interventions are not widely implemented in practice and/or patients are not made aware of these options. Research and quality improvement programmes are needed to focus on implementing these interventions more widely and building on them further.

More detailed findings can be found here.

Contact details

For more information about this project, please contact either Bryony Dean Franklin, Executive Lead Pharmacist Research & Director, Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, Sara Garfield, Research pharmacist and research lead for IMPRESS, Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust or Hannah O'Malley, Research Manager at the Health Foundation.