Ms Heidi Wong1, Miss Stefanie Ford2, Miss Nadine Lezar2, Miss Kathrine Kho2, Miss Marley Davis2
1Children’s Health Queensland, Brisbane, Australia, 2Queensland University of Technology, Brisbane, Australia
Electronic medication management systems (eMMS) have built-in decision support for electronic prescribing, dispensing and administration; with the aim to improve patient safety. However, they can cause significant impact on health care workflows. This study aims to identify changes in pharmacists’ work patterns pre- and post- implementation of eMMS at a tertiary paediatric hospital.
Observational time and motion studies were conducted in paediatric medical and surgical wards in September-October 2017 (6 months pre-eMMS implementation) and May-June 2018 (1 month post-eMMS implementation). Pharmacists’ activities, locations and computer usage for each minute were manually recorded on a paper observation tool and subsequently collated into a spreadsheet for analysis. Total time spent on various tasks were expressed as percentages of total work time; and subsequently compared between the two observation periods.
7 pharmacists were observed over 4502 minutes in 2017 while 10 pharmacists were observed over 6651 minutes in 2018. Apart from clinical review, pharmacists spent less time on direct patient care tasks such as medication chart review, dispensing/checking prescriptions and pathology results review (68% vs 52%) after eMMS implementation. In particular, their face-to-face contact time with patients and families was reduced from 15.9% to 10.9%. Instead, they spent more time communicating with other staff (17% vs 29%) such as clarifying issues with doctors (3.31% vs 7.5%) and nurses (1.78% vs 5.64%), and discussing with colleagues on eMMS technical issues (7.2% vs 12.45%). They experienced more interruptions but there were less drug information queries.
Electronic medication management system consolidates all of patient information into one single location. However pharmacists can be overwhelmed with the volume of information and this may explain why they triplicated time spent on clinical review. Health professionals have previously expressed concerns that we would spend more time on computers than patients; which was reflected in our study. In contrast to literature, our pharmacists spent less time on direct patient care tasks while familiarising with eMMS during the transition period. We will repeat this study at 12 months post-eMMS to see if the changes sustain as we move into “business as usual” phase.
Heidi currently works as the pharmacist medical lead at the Queensland Children’s Hospital. She has over 15 years of clinical experience in paediatrics and is a recognised advocate for paediatrics at statewide and national levels. Her research interests include general paediatrics, paediatric medicines information, clinical education and system improvements.