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Implementation of distributed automated medication dispensing units in a new hospital: Nursing and pharmacy experience
Author(s) -
Craswell Alison,
Bennett Kate,
Hanson Julie,
Dalgliesh Brett,
Wallis Marianne
Publication year - 2021
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.15793
Subject(s) - workaround , checklist , nursing , patient safety , thematic analysis , pharmacy , sociotechnical system , medicine , hospital pharmacy , patient satisfaction , health care , qualitative research , knowledge management , psychology , computer science , social science , sociology , economics , cognitive psychology , programming language , economic growth
Aims and objectives To explore the structures, processes and outcomes involved in an Automated Medication Dispensing system implementation and its impact on patient safety. Background Increasing digitalisation of medication prescribing, dispensing, administration and stock management has occurred over the past two decades. While automated medication dispensing units aim to provide safe, high‐quality, patient‐centred care, the implementation may result in unintended consequences leading to suboptimal outcomes. Design This study uses a qualitative approach guided by Donabedian's structure, process and outcome framework. Methods Twenty‐six registered nurses and pharmacy assistant staff, from clinical areas equipped with automated medication dispensing cabinets, participated in semi‐structured interviews. In‐depth, thematic analysis explored the structures and processes. Together with interview data, content analysis of text data generated by internal risk management and critical incident reporting systems was undertaken to evaluate outcomes. Findings were considered in light of the Interactive Sociotechnical Analysis approach to health information technology. The COREQ checklist was used in preparation of this article. Results Pharmacy assistants reported better satisfaction with the system at implementation than nurses. Training provided for nurses and their involvement in system implementation was reported as insufficient; however, nurses’ use of and satisfaction with the system improved over time. A recursive relationship between the changes imposed by the system and nurses’ creative problem solving (workarounds) used to manage these changes, impacted work productivity for nurses and safety for patients. Conclusions The individualised nature of “workarounds” employed offered both risks and opportunities which require further identification, investigation and management. Relevance to clinical practice Nurses are the majority of the health workforce. Digitalisation of traditionally paper‐based activities in health care, impacting nursing work, requires similar strategies to any practice change.