Reduction in the time taken to prescribe/wider staff time benefits
Network members sought benefits in the time taken to prescribe, either through medicines administration, through discharge processes or other areas.
The shared experience in these areas was particularly stark. Some network members reported disbenefits in terms of time saved from the beginning, finding that the increase in the time things were taking was challenging and, in some cases, this led to regression to paper processes.
Although benefits were being realised, the key takeaway is to manage expectations. At least initially, things will take longer, and time may be saved in later processes, for example less querying as prescriptions are complete and legible. Plan for this and be totally upfront about it. You could suggest measuring at different time points. Prior to implementation (if measuring), immediately after deployment then 6 and 12 months after deployment. Be mindful of when junior doctor intakes are, as time to use may go up/down depending on how experienced the majority of the prescribing body are in using the system.
What peers in the network found
Don’t promise to release time specifically
Be honest about what you expect. Focus on enabling other, potentially new, activities due to a reduction in time spent on manual processes. Involve end-users at an early stage in documenting current workflow and design. This will increase understanding and adoption and, if done thoughtfully and with adequate time, lower workarounds
Involve end users at an early stage
in documenting current workflow and design. This will increase understanding and adoption and, if done thoughtfully and with adequate time, lower workarounds
Take time documenting workflows
For discharge, take the time to gain a full understanding of what data can be pulled into discharge summaries and where it is kept
Understand that measurement is not easy.
Quantify what time was being spent on before and what it’s being spent on now. A proper, resourced time-in-motion study (before and after) is one of the best ways
Create feedback loops
Make sure staff know where who and how to raise problems with their experience o workarounds and drop off will creep in
Get your supplier on site
Immerse your supplier in your environment so they really understand your workflows and how they operate/are experienced in reality
Tailor your product.
Ensure the solution meets the needs of YOUR organisation and how you work rather than settle for an out-of-the-box solution
What to watch out for
- Time to login – how long does it take and will this change?
- Regression to paper processes when the benefits of the system aren’t immediately seen
- Workaround – usually indicate that something is not right.
- Mandatory defined fields not being completed properly e.g symbol in place of comments/information. Can you use structured data drop-downs/radio buttons to combat this, or will this increase time taken to prescribe without any real benefit to safety and cost? Weigh these up in every scenario.
- Wifi coverage and bandwith – don’t rely on perceived Wifi coverage and bandwidth, audit it properly and upgrade areas. Think about power points for charging mobile workstations. In some hospitals there could be a lead time of several months
- Consider workflow and ward mapping in depth. Physical space is easy to forget when thinking of a virtual system, but it’s crucial.
What to read
The Five Rights of Clinical Decision Support: CDS Tools Helpful for Meeting Meaningful Use
Who to contact
Katy McLachlan – Principal Pharmacist, Electronic Prescribing, King’s College Hospital