Case Study Site A

Background and Methods

Data at this site were collected between December 2011 and August 2012. Overall, we conducted 23 interviews with users (pharmacists, nurses, and doctors of varying levels of seniority) and implementers; and eight observations (12.5 hours) of strategic meetings and system use. We also took notes during the recruitment meeting and collected eight Trust documents relating to anticipated changes in processes with the introduction of the new system (including work process maps, implementation plans, business case).

The Trust provides acute care for an urban population of approximately 330,000 patients. At the time of data collection, the Trust had a separate Patient Administration System (PAS), which was used for clinical information and did not integrate with ePrescribing.

They began the implementation of a standalone ePrescribing system in 2010, and already had a pharmacy stock control system by the same developer. The system had limited decision support for interactions/allergies and also included order sets, but it was not used for certain types of medications (including infusions and warfarins). As the system did not have reporting functionality, the Trust had developed a local reporting system in house, which allowed drawing on ePrescribing data and searching for medications of interest (e.g. high risk).

The implementation of the ePrescribing system took place over a period of 12 months (four wards per month), and the Trust was live in all 36 inpatient wards at the time of data collection. They had not implemented in outpatients and critical care.

Key Challenges / Findings

Overall, users were positive about the performance of the system, but all professions felt that it may in some instances have increased workloads. This was perceived to be due to additional hardware and software components introduced within established working environments. The use of HEPMA was hampered by concerns relating to limited access to computer terminals and the sub-optimal performance of software, as well as challenges of having to gather and integrate information from multiple sources (including the new system and paper). These changes resulted in users employing informal coping mechanisms including having to wait until a computer was available, or the delaying of inputting of data into electronic systems to avoid the repeated need for perceived lengthy log-in procedures.

Lessons Learnt / Key Messages

Overall, the system was liked by users. However, clinical staff were faced with changes to physical and virtual environments as a result of implementation, which resulted in them devising strategies to cope with these challenges. Implementation teams may not necessarily be aware of the coping strategies as they are informal, but they need to be tracked over time to avoid potential adverse consequences for patient care.

NIHR Programme Grant for Applied Research, Principal Investigator: Professor Aziz Sheikh
Collaborators' logos The University of Edinburgh Harvard University The University of Nottingham University of Birmingham University Hospitals Birmingham
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