A qualitative exploration of the impact of a Hospital Electronic Prescribing and Medicines Administration (HEPMA) protocol on junior doctor confidence and competence to prescribe end of life care medicines

Abstract Background With Hospital Electronic Prescribing and Medicines Administration (HEPMA) systems now in widespread use across hospital inpatient clinical services, work is underway to measure the benefits of HEPMA on healthcare systems and patient care. HEPMA functionality enables users to prescribe medicines by ‘bundle’ or ‘protocol’; it is suggested that this is a significant system benefit, though there are few qualitative data to support this. Aim This study aimed to explore the impact of an electronic anticipatory care medicines protocol on junior doctor perceptions of their confidence and competence to prescribe opioids and midazolam for patients at the end of life. Methods Between May and August 2022, one-to-one semi-structured interviews were conducted at a 570-bed District General Hospital (DGH) with junior doctors who had experience of prescribing on both HEPMA and paper-based systems. Audio recordings of the interviews were transcribed verbatim and underwent thematic analysis. Results 10 junior doctors participated (median age 23 years). Analysis generated five main themes that described perceptions and attitudes towards confidence and competence. These were prescribing safety benefits; IT infrastructure, interoperability and system design concerns; clinical knowledge and training needs; cultural and social factors and risks of automation in prescribing. Conclusion This study suggests that junior doctors experienced an overall increase in their confidence and competence to prescribe anticipatory medicines post-implementation of a HEPMA/CPOE protocol. Further studies are required to detail the impact of HEPMA/CPOE protocols on end-user clinical practice.