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Introducing an Electronic Prescription to an Outpatient Multispecialty Clinic

Chapter 3: The Change Model (Methodology)
In this chapter we’ll go into the details of full implementation of using E-prescription to a multi-speciality clinic using the HSE change Model
Kindly use the following headings:
3.1 Introduction
3.2 Culture
3.3 Leadership
3.4 Change Models
Two change models were provided (briefly write about both of them & rationale why HSE model was chosen or preferred for this project.
1. HSE Change model
2. Senior & Swailes Change Model
3.5 The Change Process (Using HSE Mode)
3.5.1 Initiation
1.1 Identify what is driving the need for change and the degree of urgency, example: Field force analysis
1.2 Clarify leadership roles and identify the key influencers and stakeholders, example: Stakeholder analysis
1.3 Assess readiness and capacity for change
1.4 Attend to organisational politics
1.5 Identify the leverage points and opportunities for change
1.6 Perform an initial assessment of the impact of the change:
Medication Error Incident Reports Years 2011 -2014
Number of Incidents
Number of Incidents
1.7 Outline the initial objectives and outcomes for the change: The information gained from the impact assessment assisted in clarifying and outlining the change aim and objectives, presented in chapter 1.
1.8 Agree initial resource requirements
1.9 Outline the initial business case for change
3.5.2 Planning
2.1 Build a shared vision
2.2 Communicate the vision and the business case for change
2.3 Increase readiness and capacity for change
2.4 Demonstrate that change is underway
3.5.3 Implementation
5.1 Implement the change
5.2 Sustain momentum
3.5.4 Mainstreaming
1. Acknowledge success and achievement
2. Support integration of the change
3. Ensure decision-making processes support the change
4. Build a system to refine and continuously improve
5. Learn from the change process and establish best practice for change
6. Review the temporary change support structures, systems and roles
Main body should include the following details of the change process:
At the beginning and as we discussed earlier in the rationale for this study in chapter one , pre study data was collected and we felt that going for this change is very important to improve patient care and to avoid more incidents due poor hand written prescriptions.
We met all people involved including physicians, pharmacist & nursing staff to get their current concerns and expectations of the upcoming implementation.
1st meeting
 Concerns: Time consumed for the process
 Expectations: if the current system will be linked to pharmacy stock to know if the medication prescribed is out of stock and what the best alternatives available are.
 Many physicians (especially old school) believed that the implementation won’t make a big difference, still they were informed it’s a must change that the clinic should go through to meet the requirements of healthcare authorities.
 Concerns: physicians won’t comply with the new system.
 Expectations: less time consumed calling doctors for double check & less dispensing errors due poor hand written prescription.
 Concerns: main concerns that some doctors may shift this responsibility to their nurses.
 Expectation: if went well, less time spent between pharmacist and physicians to clarify drugs prescribed and at other times alternatives in pharmacy
Meeting with IT (Information technology) team:
• Main points were to design required e-prescription format (after few days of discussion with the physicians), it was decided to use a readymade format designed for our main branch in Dubai where e-prescription was implemented four years back.
In addition to old format (attached copy in appendix), our physicians requested additional options where they’ll get a reminder for a re-fill prescriptions, we worked for about 3 weeks to finalize the desired design with the IT Team.
The e-prescription was uploaded to our Healthcare Information system (HMIS) – PulseMedPlus℠ (Infdim.com, 2003)
Infdim.com, (2003). Hospital Information System –HMIS– PulseMedPlus (SM). [online] Available at: https://www.infdim.com/pulse.asp [Accessed 25 Feb. 2016].
• Training started 2nd week of November for the 1st floor physicians (18 doctors), training was done for each doctor in their clinics, people attend each training were (physician, IT, doctor’s assistant nurse & me), and Training session was booked on each physician schedule after 1st appointment with patients to ensure the presence of each doctor.
• Training of the physicians (13 physicians) on the 2nd floor done on the 3rd week of November.
• By the last week of November all physicians start ordering electronic prescriptions to their patients.
• All manual prescription books were removed from clinics & one book was kept on each floor nurse station.
• The Clinic revised its Ordering and prescribing of medicine policy to add the following:
“Using the available electronic prescription module of the PULSE clinic information system can reduce illegibility of prescriptions. The prescribing doctors are encouraged to use the electronic prescription system and the IT department of clinic X is tasked with providing an easy-to-use system and system improvements in order to increase the number of electronic prescriptions in Clinic X.”
• The change was implemented, in the following chapter (Evaluation Chapter) we’ll collect the data after the change & evaluate the process for future reference.

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