Facilitators and barriers to system implementation
| Facilitators | Barriers |
|---|---|
| Increased patient safety: decreasing medication errors by reducing transcription errors29 | Technical problems: logged out and information not saved; malfunctions and cumbersome access procedures; poorly functioning proximity badges; fear of a slow system, poor functionality and integration with pharmacy systems; cumbersome process for cosigning medications; miscoded medications, items not scanned, empty unit-dose packages delivered to wards, batteries not holding charges or recharged regularly; mobile carts large and difficult to move; network trouble and problems with patient wristbands29–33 |
| Better access to a patient’s drug history: comprehensive patient overview and easier to alter patients drug list29 32 | Altered work practices: effect on ward rounds and remote ordering potential for errors; total patient care at risk, task allocation practice; computer illiteracy making training difficult; time pressure on using system and less time on wards; time pressure with no allocation of extra staff 30 32 |
| Organisational stability and implementation team leadership: teamwork and involvement of end users33 | Weakened interpersonal communication: less face-to-face interaction between healthcare professionals and patients; loss of an unofficial means of communication; potential for exposing knowledge deficits and increasing conflicts29 31 |
| Equipment availability and reliability: adequate access to and reliability of hardware and computer network; need to be intuitive and user-friendly32 33 | Practice-related medication errors: administer medications at the incorrect time30 |
| Adequate staff training: classroom training; one-on-one training; 24 h support; availability of super users31 32 | Poor access to computers: long wait times; priority issues29 30 |
| Flexible implementation timelines: time to gain experience; adapt to new ways of working30 31 32 | Logistics of education and training: training staff prior to and during system implementation problematic due to shift work; resistance or busy schedules; healthcare professionals spending time to train others30 32 |
| Improved pharmacological knowledge: via automatically generated interaction alerts and producer-independent drug information33 | Unsupportive management teams: more challenging both during and after implementation32 |
| Time efficiency: reduce duplication of administrative work; ease of locating chart information31 33 | Implementation roll-out: time for potential stress and errors; short implementation timelines increased pressure30 32 |
| Improved interdepartmental communication: information exchange between departments coupled with the ability to quickly and easily communicate with pharmacy31 | Cost: cost of the system; cutting cost resulting in an inferior system30 |
| Circumvention of the system: misuse or non-use of key elements due to poor implementation management; lack of training; lack of input into the design and deficiencies in quality of technology29 | |
| Security: online patient medication details more accessible and visible than paper charts30 | |
| De-skilling: becoming dependent on the system31 |