| 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 controlIncludes computerised drug trolley and automated cabinets for storageInstalled on one ward and with no substantial connection (other than basic data) to the hospital's other information systemsExhibited initial technical problems and needed tailoring to local requirements and UK practiceMany problems rectified with subsequent versions but some hardware and software shortcomings remain |
Initial training provided to doctors, nurses and pharmacists but ongoing support (including the physical presence of a trainer on the ward) was necessaryDoctors had little involvement in shaping of the system and some considered this as not appropriateNurses hesitant about the system at the outsetSystem driven forward by pharmacists; other professionals felt that it reflected most strongly pharmacists' interestsPharmacists clearer at the outset what the system was for and what they wanted from it |
One of a number of ICT‐based projects in pharmacyA pilot project, envisaged as an opportunity to learn from this system and inform future initiativesInitiated and managed by pharmacyEnjoyed extra resourcesSubstantial commitment from many staff members |
| Process |
The system reached stability and became well integrated into the work of the wardOnce stable, the data processing functioned wellInbuilt structuring of core work processes of prescribing, dispensing and administration of drugs performed satisfactorily for most but not all drugsLimited decision support for prescribing |
The system influences how, when and where prescribing is done and checked, shaping the work processes of doctors, nurses and pharmacistsExperience of using the system over time and over its versions has meant that the attitudes towards it have evolved and shiftedNurses administering drugs were bound by a sequence of procedures embedded in the systemThe way different professionals communicated with each other changed |
Experience emphasised the challenge that comes when the working practices of professional groups and interdisciplinary teams are reshaped by introducing a powerful and structuring technologyTechnology can be explicitly used to enforce a “good” process, but some aspects of practice do not neatly fit, or are incompatible with, the systemThis 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 practiceFacilitates safe or safer prescribing and administration processesProvides data which are of an appropriate quality and available for all participants in the care processContinuing mismatch between system characteristics and the use of certain drugs |
A system which pharmacists, and perhaps more reluctantly, nurses came to accept and many would missDoctors' opinions more varied; they identified shortcomings but believed in benefits an ideal system might bringRestructuring effects on the way different professional groups work,
varying opportunity to exercise a degree of autonomyGenerally perceived as safer or at least potentially safer, reducing
some errors, but also acknowledged as introducing new risks |
The 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 strategiesThe system was not moved with the ward when it was relocatedThe system is now planned to be used on a care of the elderly ward |
