Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

The implementation of electronic paediatric prescribing in paediatric hospital

ward settings (IePP)

Albert Farre1 2 and Carole Cummins1

1 School of Health and Population Sciences, University of Birmingham2 Research and Development, Birmingham Children’s Hospital NHS Foundation Trust

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Background

• Need for greater use of ‘soft intelligence’ on quality and safety.

• Key lessons learned from previous national research on eP.

• Broader field of HIT implementation studies, growing evidence on the importance of ‘sociotechnical’ process evaluations.

• Focus on quality and safety of care provision and everyday practice from clinicians’ perspective.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Objectives

1. To understand the complex organisational reality in which ePP will be introduced, and the nature of ePP-related change processes.

2. To explore staff perspectives in relation to currently established practices and processes involved in the prescribing and administration of medicines in the ward setting.

3. To assess the impact of implementing ePP on care provision and hospital work in the ward setting from the perspective of nurses, doctors and managers.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Methods

• Process and impact evaluation.

• Qualitatively-driven mixed-method study.

• 3 interrelated sub-studies.

• Embedded design - including a primary qualitative study and two embedded supplementary sub studies, qualitative and quantitative respectively.

• Data collection before, during and after the intervention.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Methods

Interviews + Focus Groups

Questionnaire (1)

Questionnaire (2)

Observation (1)

Observation (3)

Observation (2)

PREimplementation

stage

POSTimplementation

stage

PILOT stage

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Methods (Sub-study 1)

Interviews + Focus Groups

Questionnaire (1)

Questionnaire (2)

Observation (1)

Observation (3)

Observation (2)

PREimplementation

stage

POSTimplementation

stage

PILOT stage

Understanding change in the ward setting

• Ethnographic research, including non-participant observation and informal conversational interviews

• Approximately 350 hours of observation (150h phase 1, and 200h across phases 2 and 3)

• 2-3 wards and 30 informal interviews

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Methods (Sub-study 2)

Interviews + Focus Groups

Questionnaire (1)

Questionnaire (2)

Observation (1)

Observation (3)

Observation (2)

PREimplementation

stage

POSTimplementation

stage

PILOT stage

Exploring staff perspectives on currently established practices

• Qualitative in-depth interviews and, where possible, focus groups.

• Staff directly involved in the prescribing and administration of medicines in the ward (i.e. doctors, nurses and pharmacists) in addition to any relevant managerial roles.

• 6-12 interviews and 3-6 focus groups.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Methods (Sub-study 3)

Interviews + Focus Groups

Questionnaire (1)

Questionnaire (2)

Observation (1)

Observation (3)

Observation (2)

PREimplementation

stage

POSTimplementation

stage

PILOT stage

Measuring impact

• Online self-completion questionnaire.

• Before-and-after design.

• To be developed based on qualitative data emerging from sub-study 2.

• Face and content validity assessment through panel of experts. Reliability assessment through interviews after completion.

• Addressed to any members of staff involved in the ward setting.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Data analysis and integration

• Qualitatively-driven design – overall data analysis will draw on qualitative reasoning.

• Theoretically informed by Normalization Process Theory.

• Qualitative and quantitative data will be connected and integrated at various stages – 3 at PRE stage (QUAL-qual; qual-

quant; quant-QUAL) and 1 at POST stage (quant-QUAL).

• Data collection and data analysis will take place concurrentlyso that issues raised in earlier rounds of fieldwork can be explored in subsequent ones.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Participation

• To combine engagement with (i) key ward stakeholders in the hospital, and interested members from (ii) the CLAHRC-WM PPI advisory group; (iii) the Trust’s young people advisory group; and (iv) the Trust’s special interest group on eP.

• The views of those involved may help to…

a) enhance and challenge our coding framework and interpretation of the data.

b) increase the meaningfulness and encourage ownershipof the findings.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Where we are at?

• Study protocol was written and peer reviewedthrough the CLAHRC WM.

• REC application was submitted and favourable opinion from REC has been obtained.

• R&D form has been validated.

• SSI form under review at BCH.

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands

Thank you!