Table 2

 Principal findings

System functionHuman perspectivesOrganisational context
Structure ServeRx is a standalone technical system that integrates support for electronic prescribing, scheduling, automated dispensing and electronic administration, as well as elements of stock control Includes computerised drug trolley and automated cabinets for storage Installed on one ward and with no substantial connection (other than basic data) to the hospital’s other information systems Exhibited initial technical problems and needed tailoring to local requirements and UK practice Many problems rectified with subsequent versions but some hardware and software shortcomings remainInitial training provided to doctors, nurses and pharmacists but ongoing support (including the physical presence of a trainer on the ward) was necessary Doctors had little involvement in shaping of the system and some considered this as not appropriate Nurses hesitant about the system at the outset System driven forward by pharmacists; other professionals felt that it reflected most strongly pharmacists’ interests Pharmacists clearer at the outset what the system was for and what they wanted from itOne of a number of ICT-based projects in pharmacy A pilot project, envisaged as an opportunity to learn from this system and inform future initiatives Initiated and managed by pharmacy Enjoyed extra resources Substantial commitment from many staff members
Process The system reached stability and became well integrated into the work of the ward Once stable, the data processing functioned well Inbuilt structuring of core work processes of prescribing, dispensing and administration of drugs performed satisfactorily for most but not all drugs Limited decision support for prescribingThe system influences how, when and where prescribing is done and checked, shaping the work processes of doctors, nurses and pharmacists Experience of using the system over time and over its versions has meant that the attitudes towards it have evolved and shifted Nurses administering drugs were bound by a sequence of procedures embedded in the system The way different professionals communicated with each other changedExperience emphasised the challenge that comes when the working practices of professional groups and interdisciplinary teams are reshaped by introducing a powerful and structuring technology Technology can be explicitly used to enforce a “good” process, but some aspects of practice do not neatly fit, or are incompatible with, the system This is apparent on one ward, but across a hospital the effect could be magnified as different specialities are considered
Outcome A usable technology (hardware and software) that was over time shaped and integrated into ward practice Facilitates safe or safer prescribing and administration processes Provides data which are of an appropriate quality and available for all participants in the care process Continuing mismatch between system characteristics and the use of certain drugsA system which pharmacists, and perhaps more reluctantly, nurses came to accept and many would miss Doctors’ opinions more varied; they identified shortcomings but believed in benefits an ideal system might bring Restructuring effects on the way different professional groups work,varying opportunity to exercise a degree of autonomy Generally perceived as safer or at least potentially safer, reducing some errors, but also acknowledged as introducing new risksThe pilot has led to valuable lessons: benefits and drawbacks of electronic prescribing; scope of impact; the processes involved in “hosting” such a system; project management and implementation strategies The system was not moved with the ward when it was relocated The system is now planned to be used on a care of the elderly ward