Table 2

Description of studies included in systematic review

Author, year, countryParticipantsType of systemContextAimsResearch methods usedMain findings
Bastholm Rahmner et al, 2004, Sweden2921 emergency department physiciansElectronic prescribing with decision support and electronic transfer of prescriptions to pharmacies.This pre implementation study was conducted in the largest accident & emergency department in the Nordic countries with approximately 90 000 visitors per year. Physicians hand write prescriptions and use a dictaphone for medical record documentation.To identify physicians’ perceptions of the various facilitators and barriers prior to implementing a computerised drug prescribing support system.Semistructured individual interviewsFacilitators identified included easy access to a patient’s drug history (which was not met by the new system); enhanced pharmacological knowledge from medication alerts; readily accessible information; and time efficiencies.
Barriers identified included technical problems due to current problems encountered with the electronic medical record and alerts signalled too frequently; shortage of computers in the emergency department; an alteration to routine and habits resulting in diminished patient contact.
Technical prerequisites formed the base for successful implementation where time was perceived as a necessary requirement to adapt to new ways of working.
Malato and Kim, 2004, USA3012 nursesElectronic medication administration record system where nurses input prescriptions into a computer that allows pharmacists review orders for appropriateness related to age, weight, diagnosis and drug compatibility. Pharmacists then enter these orders, as a patient profile, into the system and nurses directly access medications using fingerprint ID.This initial and post implementation study was conducted in two acute care nursing units in a large 600-bed public acute hospital. Nursing staff administer approximately 300 medications per hour. A paper-based medication system had been replaced by the implementation of this system.To examine nurses’ perceptions towards implementation of a computerised medication system.Open-ended individual interviews. ObservationBarriers identified included end user perceptions of inadequate training; negative experiences of implementation; perceived deficiencies in quality of technology; perceptions of lack of participatory design; and an ensuing circumvention of the new system.
Georgiou et al, 2009, Australia3150 management, medical, nursing and pharmacy staffElectronic prescribing and direct drug administration functionalities using an electronic medication chart.This pre-implementation study was conducted in a large teaching hospital. Initial planning for the new system had been underway for >2 years at the beginning of the study's data collection. Training had not yet begun for a large majority of hospital staff. The hospital already had a CPOE system in place for the ordering of pathology and radiology tests, and diet and allied health requests. Existing medication management was performed using paper charts.To identify the main barriers of a broad range of hospital staff to system implementation.20 semistructured individual interviews. 6 focus groups involving a total of 30 participantsBarriers identified included alteration to work practices; software/hardware concerns; alteration to relationships/communication; requirements for education and training; inexperienced staff ability; and de-skilling. Four interrelated constructs highlighted what participants were concerned about: if it would help; if it would work; if they could cope; and if it would impair existing interactions.
Culler et al, 2011, USA3214 nursesElectronic medication administration record system with decision support. It displays alerts based on laboratory results; documents the dose route, and site of administration; and automatically records discretion-based variances and missed or refused administrations.This post-implementation study was conducted in two large paediatric hospitals. Initial planning for the new system had been underway for >2 years at the beginning of the study's data collection. Training had not yet begun for the large majority of hospital staff. The hospital already had a CPOE system in place for the ordering of pathology and radiology tests, and diet and allied health requests. Existing medication management was performed using paper charts.To describe the various facilitators and barriers by nurses to the implementation of an electronic medication administration record system at two paediatric hospitals.Semistructured individual interviewsFacilitators included the system’s ability to improve patient safety and accessibility of patient information.
The most significant barrier to adoption was excessive time for logging into the system.
Spetz et al, 2012, USA33118 nurses, pharmacists, physicians, IT staff and managersBar-coded electronic medication administration record system.This post-implementation study was conducted in seven of the 162 Veteran Affairs hospitals. Site selection was based on staff satisfaction survey data, staff turnover, geography and the level of care provided. A computerised patient record system was implemented over a decade from the early 1990s. The barcode medication administration system was implemented over 1 year.To identify factors and strategies associated with successful system implementation in Veteran Affairs hospitals and how these might apply to other hospitals.Semistructured individual interviewsFive broad themes arose as factors that affected the process and success of implementation: organisational stability and implementation team leadership; implementation timelines; equipment availability and reliability; staff training; and changes in workflow.
  • CPOE, computerised provider order entry.