Introduction
"A Spoonful of Sugar"¹ suggested that hospital pharmacy staff could add most value to patient care through working near patients. This would be supported through increased and more widespread usage of information technology (IT), including Electronic Patient Record (EPR) systems. Implementation of EPR systems has been slow and fragmented²; however a few NHS trusts have successfully used them for a number of years³. Despite this, the way in which hospital pharmacy staff interact with EPR systems to provide near patient services has yet to be explored. The aim of this study was to investigate how pharmacy staff in an acute NHS hospital trust make use of an EPR system in the provision of ward based clinical pharmacy services to inpatients.

Method
The study was carried out within the pharmacy department of one acute NHS hospital trust. Six semi-structured one-to-one interviews, one focus group, and observation in the role of "participant as observer" were carried out with pharmacists and technicians. The study purposively selected staff members with ward-based responsibilities. The interviews and focus group were audio-taped and transcribed verbatim. Handwritten notes were made during observation, which were later transcribed. A thematic framework was iteratively developed, based on both a priori issues and themes arising from the data. This process was assisted using the qualitative data analysis package NVIVOâ.

Findings
Study participants used the EPR system to access a broad range of current and archive clinical and non-clinical information held about their patients. This helped them contribute to patient care, and prioritise and plan workloads. Information drawn from the EPR was used in conjunction with other sources: patients’ paper medical records, their primary healthcare team, the patients themselves and other members of trust staff. Similarly, participants documented and communicated their contributions to patient care in several places, directly in the EPR, though more often in the paper medical record or on the inpatient prescription chart. A number of participants annotated printed patient lists derived from the EPR, either to communicate patient information to pharmacy colleagues, or as a personal aide memoire.

The EPR system supported production of an electronic ‘Immediate Discharge Summary’ (IDS). Pharmacists could directly input their own additions and amendments to both the discharge medication list and the information to be communicated to the GP. Printed versions of the IDS were used in medication supply, and distributed to GPs.

Discussion
This study has described how hospital pharmacy staff have incorporated an EPR system into their work to contribute to inpatient care in one trust. The EPR system in this trust formed only part of the patient medical record. The participants’ modes of working mirrored this, using other information sources, methods of communication and documentation, which involved people, paper and electronic systems. These findings support the assertions of Berg⁴, that in adopting healthcare IT systems, the aim should be to integrate with, rather than entirely replace, existing systems.

References

1. The Audit Commission for Local Authorities and the National Health Service in England and Wales. A Spoonful of Sugar. Medicines Management in NHS hospitals. 2001. London.

2. Burke K. NHS misses target for introducing electronic records. BMJ 2002;324:870.

3. Protti D, Peel V. Critical Success Factors for Evolving a Hospital Toward an Electronic Patient Record System: A Case Study of Two Different Sites. J. Healthc. Inf. Manag. 1998;12:29-38.

4. Berg M. Patient care information systems and health care work: a sociotechnical approach. Int.J.Med.Inf. 1999;55:87-101