Exploring hospital pharmacist perspectives on ethical considerations from automated patient prioritisation: a qualitative study

INTRODUCTION: The use of Hospital Electronic Prescribing and Medicines Administration (HEPMA) data in automated patient prioritisation (APP) tools is an emerging area of interest within pharmacy practice and research. As the Scottish Government continues to invest in digital transformation across health and social care, pharmacy professionals are increasingly required to adapt to new technologies whilst maintaining high standards of patient care. APP tools offer the potential to enhance operational efficiency and support clinical decision making. However, despite growing implementation internationally, there is a scarcity of published research exploring the ethical considerations associated with use. AIM: To explore hospital pharmacists' perspectives of ethical considerations from APP tool use prior to adoption in the hospital pharmacy setting. METHOD: Two focus groups were conducted with a total of 12 hospital pharmacists (Pharmacist Team Manager n = 2, Advanced Pharmacist n = 5, Specialist Pharmacist n = 3, Pharmacist n = 2) from a Scottish Health Board prior to the implementation of APP using the 'CoRE-Values' ethical decision-making framework, with the aid of a clinical vignette for context. Focus group transcripts were analysed thematically with the four domains of the framework as mapped themes. RESULTS: Participants considered the use of APP to be a fair and pragmatic approach to managing daily workload, enabling pharmacy teams to focus on patients most at risk of medication related harm. However, professional judgement remains essential when interpreting APP outputs, and caution must be exercised to avoid an overreliance on automation. The clinical rules underpinning APP must be regularly reviewed to ensure alignment with current practice and emerging evidence. While complete visibility of high-risk patients offers significant clinical value, it may also expose limitations in workforce capacity. Participants noted that this visibility could be leveraged to support business case development to secure further staff resource and/or service transformation. CONCLUSION: APP use can support clinical decision making by directing pharmacy staff to patients at risk of medication related harm in hospitals, but ethical concerns can arise if organisations do not give due consideration to these issues prior to adoption.