Use of Normalization Process Theory to explore key stakeholders' perceptions of the facilitators and barriers to implementing electronic systems for medicines management in hospital settings.

BACKGROUND: Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. OBJECTIVE: To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing systems, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings using Normalization Process Theory as a theoretical framework. METHODS: Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two Information Technology managers. RESULTS: Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multi-disciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. CONCLUSIONS: Many themes that are potentially transferable to other national settings have been identified and extend the evidence base. This will assist organisations around the world to better plan for implementation of medication-related eHealth systems.

What Stops Doctors Switching from Intravenous to Oral Antibiotics?

Aims To explore doctors' perceptions of the motivators and barriers to complying with intravenous to oral switch antibiotic guidelines in a Model 4 Irish hospital. Methods A cross-sectional study was carried out amongst doctors attending hospital-wide educational sessions in November 2018 via a validated paper-based survey post ethical approval. Data were independently analysed using SPSS. Results One hundred and seventy four doctors of all grades and a variety of specialties participated. Respondents felt they were aware of the local intravenous to oral switch criteria but expressed they required prompts to consider switching to oral agents when appropriate, inclusive of alert stickers in the Kardex and medical notes as well as reminders from nursing and pharmacy staff. Other interventions to assist with improved decision-making included further education to junior doctors on the benefits of an intravenous to oral switch, electronic prescribing, and better accessibility to laboratory results. Conclusion Results will assist in implementing quality improvement initiatives to increase the rate of guideline compliance.