Pharmacist-Physician Communications in a Highly Computerised Hospital: Sign-Off and Action of Electronic Review Messages

BackgroundSome hospital Computerized Physician Order Entry (CPOE) systems support interprofessional communication. The aim of this study was to investigate the effectiveness of pharmacist-physician messages sent via a CPOE system.MethodData from the year 2012 were captured from a large university teaching hospital CPOE database on: 1) review messages assigned by pharmacists; 2) details of the prescription on which the messages were assigned; and 3) details of any changes made to the prescription following a review message being assigned. Data were coded for temporal, message and prescription factors. Messages were analysed to investigate: 1) whether they were signed-off; and 2) the time taken. Messages that requested a measurable action were further analysed to investigate: 1) whether they were actioned as requested; and 2) the time taken. We conducted a multivariable analysis using Generalised Estimating Equations (GEE) to account for the effects of multiple factors simultaneously, and to adjust for any potential correlation between outcomes for repeated review messages on the same prescription. All analyses were performed using SPSS 22 (IBM SPSS Inc., Chicago, IL, USA), with pResultsPharmacists assigned 36,245 review messages to prescriptions over the 12 months, 34,506 of which were coded for analysis after exclusions. Nearly half of messages (46.6%) were signed-off and 65.5% of these were signed-off in ≤ 48 hours. Of the 9,991 further analysed for action, 35.8% led to an action as requested by the pharmacist and just over half of these (57.0%) were actioned in ≤ 24 hours. Factors predictive of an action were the time since the prescription was generated (pConclusionIn this study we observed a lower rate of sign-off and action than we might have expected, suggesting uni-directional communication via the CPOE system may not be optimal. An established pharmacist-physician collaborative working relationship is likely to influence the prioritisation and response to messages, since a more desirable outcome was observed in settings and with grades of pharmacists where this was more likely. Designing systems that can facilitate collaborative communication may be more effective in practice.研究背景：部分医院的计算机化医师医嘱录入（Computerized Physician Order Entry，CPOE）系统支持跨专业沟通。本研究旨在探究通过CPOE系统发送的药师与医师间沟通讯息的有效性。 研究方法：本研究采集了某大型大学教学医院2012年的CPOE数据库数据，涵盖以下三类内容：1）药师指派的审核讯息；2）被指派该讯息的处方详情；3）审核讯息指派后对处方作出的所有变更详情。研究对与时效性、讯息及处方相关的各类因素进行编码。针对所有审核讯息开展两项分析：1）讯息是否已签署确认；2）讯息处理耗时。对于要求执行可量化操作的讯息，进一步开展两项分析：1）是否按药师要求完成了对应操作；2）操作完成耗时。本研究采用广义估计方程（Generalised Estimating Equations，GEE）开展多变量分析，以同时考量多因素的影响，并校正同一张处方重复发送审核讯息时，其结局间可能存在的相关性。所有分析均使用SPSS 22（IBM SPSS公司，美国伊利诺伊州芝加哥市）完成，设定统计学显著性阈值为p < 0.05。 研究结果：12个月研究周期内，药师共为处方指派了36245条审核讯息，经排除不符合分析要求的数据后，共计34506条讯息被纳入分析。近半数讯息（46.6%）完成签署确认，其中65.5%的讯息在48小时内完成签署确认。在进一步开展操作分析的9991条讯息中，35.8%的讯息按药师要求完成了对应操作，其中仅过半数（57.0%）的操作在24小时内完成。可预测操作执行情况的因素包括处方生成后的时长（p < 0.05）。 研究结论：本研究发现，讯息签署确认率与操作执行率均低于预期，提示通过CPOE系统开展的单向沟通或并非最优方案。成熟的药师与医师协作工作关系或可影响讯息的优先级排序与响应速度，因为在存在此类协作关系的场景及对应职称的药师群体中，可观察到更理想的结局。设计可促进协作沟通的系统，在实际临床应用中或可更为有效。