ERROR MANAGEMENT Qualitative evaluation of an electronic prescribing and administration system

Objective: To provide a formative socio-technical evaluation of a pilot implementation of an integrated electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on one ward. Design: A qualitative observational approach using discourse analysis within a socio-technical evaluation framework addressing systems functions, human perspectives and organisational context. Setting: Surgical ward in a teaching hospital. Participants: Staff on study ward and in pharmacy. Intervention: Implementation over time of an integrated electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Assessment of technical performance, developed attitudes to the new system, changes to delivery of care and work practices. Results: The system was successfully implemented on the ward, and remained in operation for over 2 years. Many of the technical components of the system initially showed problems, but the system evolved, with increased functionality and improved performance. Attitudes to the system in the early stages were mixed. Over time, and with experience of making the system work for them, staff attitudes changed to become more balanced and the potential benefits of the system became clearer to most. The system structured the work of staff, sometimes unexpectedly. Conclusions: Electronic prescribing systems need to be seen as occasions for change and learning rather than as black-boxed technical solutions to identified problems. The evaluation framework allows understanding as well as hypothesis testing, and is recommended for future evaluations of electronic prescribing systems.