Table 4

Facilitators and barriers to system implementation

Increased patient safety: decreasing medication errors by reducing transcription errors29Technical 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 32Altered 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 users33Weakened 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 33Practice-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 32Poor access to computers: long wait times; priority issues29 30
Flexible implementation timelines: time to gain experience; adapt to new ways of working30 31 32Logistics 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 information33Unsupportive management teams: more challenging both during and after implementation32
Time efficiency: reduce duplication of administrative work; ease of locating chart information31 33Implementation 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 pharmacy31Cost: 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