Background Medication errors are common in hospital inpatients. While many interventions have been proposed to address these problems, few have been shown to have significant benefits. A complementary approach is to facilitate greater involvement of patients with their inpatient medication. However, there is relatively little research in this area and it is not known which interventions lead to improved healthcare outcomes. Work is therefore needed to investigate the roles that healthcare professionals and patients believe are appropriate for hospital inpatients to take relating to safety. Objective To explore the extent to which hospital inpatients reported that they engaged with medication safety-related behaviours, the extent to which they would like to, and the extent to which healthcare professionals reported that they would support such engagement. Setting An NHS hospital Trust in West London. Methods 100 Patients and healthcare professionals were recruited on ten wards within the Trust and invited to complete quantitative questionnaires. Data were analysed descriptively and exploratory comparisons made between different groups of respondents. Main outcome measures inpatient medication safety involvement scale and control preference scale for patient involvement in decision making. Results 100 patients (98 % response rate) and 104 healthcare professionals (59 % response rate) were recruited. The majority of patients and healthcare professionals were supportive of hospital inpatients being involved with their medication. However there was a significant gap between desire for patient involvement and what patients reported having experienced. Female patients and those under 65 wanted a significantly higher level of involvement than males and over 65s. Few associations were found between healthcare professionals' reported support for involvement and their profession or gender. However, pharmacists and nurses were significantly more likely to report supporting patients asking questions about their medicines and self administering their own medicines than doctors. Conclusion Healthcare professionals and patients desire a higher level of patient involvement with their medication while in hospital than patients currently report. Interventions need to be developed to bridge the gap between desired and actual patient involvement.

BackgroundThe aim of this systematic review was to synthesise peer-reviewed literature assessing the impact of electronic prescribing (eP) systems on the working practices of healthcare professionals (HCPs) in the inpatient setting and identify implications for practice and research.MethodsWe searched PubMed, Medline, Embase, Cochrane and the Cumulative Index to Nursing Allied Health Literature databases for studies published from inception to November 2018. We included controlled, uncontrolled, observational and descriptive studies that explored the effect of eP on HCPs’ working practices in an inpatient setting. Data on setting, eP system and impact on working practices were extracted. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration CRD42017075804).ResultsSearches identified 1301 titles and abstracts after duplicate removal. 171 papers underwent full-text review. A total of 25 studies met the inclusion criteria, from nine different countries. Nineteen were of commercial eP systems. There were a range of study designs; most (n = 14) adopted quantitative methods such as cross-sectional surveys, ten adopted qualitative approaches and a further one used mixed methods. Fourteen of the 25 studies were deemed to be of high quality. Four key themes were identified: communication, time taken to complete tasks, clinical workflow, and workarounds. Within each theme, study findings differed as to whether the effects of eP on HCPs’ working practices were positive or negative.ConclusionThere is a lack of consensus within the literature on the impact of eP on HCPs’ working practices. Future research should explore the strategies resulting in a positive impact on HCPs’ working practices and learn from those that have not been successful.

This audit has shown that the guidelines are being followed but the paediatric dosing of vancomycin requires modification to achieve therapeutic levels. Limitations of the audit included low patient numbers, standard 1 and 3 could not be assessed and an assumption was made that all the levels documented were taken at the correct time, unless stated. Not enough data were collected to make suggestions based on different ages. An option would be to follow recommendation that frequency of dosing is changed from three to four times a day.1 A continuous infusion of vancomycin could also be considered.