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ELECTRONIC PRESCRIBING – HOW DOES IT AFFECT THE WARD PHARMACIST?
Franklin BD, O’Grady K, Donyai P, Jacklin A and Barber N
Academic Pharmacy Unit, Hammersmith Hospitals NHS Trust/School of Pharmacy, University of London, London, WC1N
bdean@hhnt.nhs.uk

Background
It is likely that electronic prescribing will be a common feature in tomorrow’s hospitals. However, we do not yet know how its introduction will affect the practice of hospital pharmacists. We are evaluating a closed-loop electronic prescribing, automated dispensing, bar-coded administration system (ServeRx) on one surgical ward. As part of this evaluation, we wanted to explore its impact on the ward pharmacist. Our objectives were to assess the impact of ServeRx on the time spent providing a ward pharmacy service, and on the activities undertaken.

Methods
Data were collected both before, and about one year after, the introduction of ServeRx. The same ward pharmacist remained responsible for the study ward. In each period, data collection took place in two phases. First, the ward pharmacist was asked to self-report the time taken to provide a ward pharmacy service each day for four weeks. Second, a more detailed study was carried out for two weeks. During this second phase, the ward pharmacist was observed and her activities recorded using two-dimensional work sampling based on methods described previously1. The two dimensions were "activity" (11 categories) and "contact" (5 categories).

Results
The overall time taken to provide a weekday ward pharmacy service to the study ward rose from a mean of 1 hour 8 minutes each day, to 1 hour 38 minutes (p = 0.001; unpaired t-test). However, pre-ServeRx, an average of only 78% of patients
drug charts could be seen each day, as charts were unavailable. Post-ServeRx, all medication records could be seen. Before ServeRx, the average time per chart screened was 3 minutes 7 seconds; following ServeRx it was 3 minutes 30 seconds.

The percentage of time spent on the following activities increased following ServeRx: changing therapy/monitoring (increase from 4% to 7% of total time), giving advice (9% to 19%), prescription monitoring (16% to 23%) and non-productive time (6% to 11%). Time spent on the following decreased: looking for charts (3% to 0%), checking patients’ own drugs (5% to 0%), supply (23% to 14%), and travel (7% to 4%). Time spent on information gathering and prescription annotation remained about the same. In terms of contact, there was an increase in the percentage of time spent with doctors and a decrease with nurses. Percentages of time spent with patients, pharmacy staff, self and others remained similar, although since the total time providing a ward pharmacy service was greater following ServeRx, each of these increased in real terms.

Conclusions
The introduction of ServeRx increased the time required to provide a ward pharmacy service; however, more medication records were seen and there was little difference in the time taken per record screened. There were some changes in the types of activity undertaken. Reassuringly, there was no decrease in the time spent with patients.

References

  1. Beech EF and Barber ND (1993). The development of a self-reporting multi-dimensional work sampling measure to study ward pharmacy services in the United Kingdom. Journal of Social and Administrative Pharmacy. 10: 157-162


Presented at the HSRPP Conference 2005, Reading