A Qualitative Study Exploring the Barriers and Facilitators Associated with the Implementation of a Closed Loop Medication System in a UK Hospital Trust
Authors: Tolley C L , Sami R A , Slight S P 
Published: March 2021

Abstract

Introduction
Implementation of novel digital technologies into complex hospital systems, particularly within the United Kingdom’s (UKs) National Health Service, is challenging and can result in delays to the use and evaluation of innovative systems. MedEye is a bedside tool for preventing medication administration errors used as part of a closed-loop medication administration system.

Aim
The aim of this study was to understand the barriers and facilitators associated with implementing MedEye for the first time in a large UK Teaching Hospital Trust.

Methods
We used a case study approach and conducted semi-structured interviews (n=9) with key members of the project implementation team from Pharmacy (n=3), Nursing (n=2), commercial system provider(n=2), IT (n=1) and academia (n=1) and 20 hours of field observations. We explored stakeholder’s experiences about the implementation process, barriers and facilitators and any key lessons learnt according to constructs from Sittig and Singh’s Eight Dimension Sociotechnical Model.1 We analysed the data from interviews and observations using the framework approach.2 We firstly familiarised ourselves with the data, coded interviews, guided by our analytical framework, charted and then interpreted the data. All necessary ethical and organisational approvals were obtained.

Results
We identified themes relating to eight sociotechnical domains. Clinical Content: the format of the medication library and process for ordering medications were different to other European sites that had implemented MedEye, posing challenges for developers. Hardware and Software Computing Infrastructure: the integration of MedEye with the electronic prescribing system was one of the “biggest challenges”(P2) and contributed to delays. Human Computer Interface: the MedEye system’s user interface was described as “clean, simple and easy to use”(P2).People: nurses and senior management “absolutely wanted this [project] to work”(P1).Communication and Workflow: it was sometimes difficult to communicate effectively because the IT team had their own “set of jargon which is very technical” and the clinical team used “lots of medical jargon”(P2), resulting in misunderstandings. Internal Organisational Policies, Procedures and Culture: the hospital recognised the potential safety benefits of MedEye. However, its implementation was different to other IT products, which would “have actually gone through the development cycle”(P7).External Rules, Regulations and Pressures: the IT and informatics team’s resources were stretched with multiple projects been implemented simultaneously. System Measurement and Monitoring: the project team conducted “a lot of testing”(P3), to refine the technology.

Conclusions
This study sought to understand the sociotechnical challenges when implementing a novel digital technology in a UK hospital and identified themes related to eight domains. We acknowledge that our study had a few limitations: we interviewed a small number of participants who were directly involved in the implementation process, and the study was conducted in one hospital Trust, limiting the generalisability of the findings. However, use of the eight-domain sociotechnical framework strengthened our study, allowing us to derive the specific facilitators and barriers to the implementation and deployment process. This study also emphasises the importance of working closely with IT managers who can coordinate work within an organisation to anticipate delays and mitigate against project risks.

References
1. Sittig, D.F. and H. Singh, A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality & safety in health care, 2010. 19 Suppl 3(Suppl 3): p. i68-i74.
2. Pope, C., S. Ziebland, and N. Mays, Qualitative research in health care. Analysing qualitative data. BMJ (Clinical research ed.), 2000. 320(7227): p. 114–116.